Monitoring equity and research policy

The problem of ‘trickle-down science’ from the Global North to the Global South
Reidpath D; Allotey P: BMJ Global Health 4(4), doi:, 2019

Countries in the Global South continue to struggle to train and retain good researchers and practitioners to address local, regional and global health challenges. As a result, there is an ongoing reliance on the Global North for solutions to local problems and an inability to develop alternative approaches to problem solving that take local (non-northern) contexts into account. Current paradigms of scientific advancement provide no long-term models to challenge the status quo or privilege knowledge that is generated primarily in the Global South. This has major impacts on access to funding which perpetuates the problem. The authors argue that there needs to be a concerted and demonstrable shift to value and promote the development of research and scientific traditions that are borne out of the reality of local contexts that complement knowledge and evidence generated in the Global North.

Regional Research–Policy Partnerships for Health Equity and Inclusive Development: Reflections on Opportunities and Challenges from a Southern African Perspective
Yeates N; Moeti T; Luwabelwa M: Institute for Development Studies Bulletin 50(1) 121-142, 2019

This article critically reflects on the experience and lessons from a health-focused social policy research project involving a partnership spanning multiple countries across southern Africa and Europe. It asks what factors condition the efficacy of the partnership–policy nexus. The policy research project Southern African Development Community partnership case study used participatory action research to create a regional indicators-based monitoring toolkit of pro poor health policy and change for the region. The article addresses the partnership drivers, features, methodological context, and process of the project, and the wider implications for constructing partnerships for social change impact. Lessons drawn from this case study underscore the importance of participatory action research -inspired partnership structures and working methods while querying assumptions that the relationship between participatory action research and policy change is seamless. The authors argue that greater focus is needed on the wider institutional context conditioning the work of partnerships when considering the efficacy of a nexus between partnerships and policy.

Strengthening ethical community engagement in contemporary Malawi
Nyirenda D; Gooding K; Sambakunsi R; et al: Wellcome Open Research, Lilongwe, 2019

Although community engagement is increasingly promoted in global health research to improve ethical research practice, the authors observe that there is sometimes a disconnect between the broader moral ambitions for community engagement in the literature and guidelines on the one hand and its rather narrower practical application in health research on the other. In practice, less attention is said to be paid to engaging communities for the ‘intrinsic’ value of showing respect and ensuring inclusive participation of community partners in research design. Rather, more attention is paid to the use of community engagement for ‘instrumental’ purposes to improve community understanding of research and ensure successful study implementation. Against this backdrop, the authors reviewed the literature and engaged various research stakeholders at a workshop to discuss ways of strengthening ethical engagement of communities and to develop context-relevant guidelines for community engagement in health research in Malawi. They concluded by proposing a model with three elements that would increase participatory community engagement in health research namely: collaboration, consultation and communication from the onset of research.

The problem of ‘trickle-down science’ from the Global North to the Global South
Reidpath D; Allotey P: BMJ Global Health 4(4), doi:, 2019

Ten years ago, Nigel Crisp observed, with respect to the healthcare workforce that ‘the global health system is characterised by an import–export business in which rich countries export the ideology of Western scientific medicine and aid predicated on this ideology to poor countries. In return, the poor countries export a portion of their preciously limited pool of trained health workers back to the rich countries’. The authors of the paper suggest that a similar situation holds in scientific research. Many of the very brightest minds from the Global South go to institutions of higher learning in the Global North, either as graduate students or as fully fledged researchers. They are attracted by better pay, resources, engagement and prestige. There are then three broad outcomes: If the move is a permanent one (which is the case 70% of the time) many turn their focus away from the concerns of the south towards the research priorities in the north, where the funding is. Others remain in the north but keep their focus on the issues of the south, albeit often with limited impact, and sometimes compromising their career progression in the north. The third outcome is the return of the researcher to the south, and frustration over the lack of an enabling environment to apply their skills. Trickle-down science as a strategy for advancing knowledge for current and future challenges has enabled an inequity in the distribution of scientific capacities. However the authors observe that there are ways to engage more effectively with the growing, if disempowered, talent in the south to build of enabling environments, leadership and a quality and volume of home grown, contextually driven knowledge.

Facilitators, best practices and barriers to integrating family planning data in Uganda’s health management information system
Wandera S; Kwagala B; Nankinga O; Ndugga P; et al: BMC Health Services Research 19(327) 1-13, 2019

This study sought to investigate the facilitators, best practices and barriers of integrating family planning data into the district and national Health management information systems in Uganda. The authors conducted a qualitative study in Kampala, Jinja, and Hoima Districts of Uganda, based on 16 key informant interviews and a multi-stakeholder dialogue workshop with 11 participants. The technical facilitators of integrating family planning data from public and private facilities in the national and district Health management information systems were user-friendly software; web-based and integrated reporting; and availability of resources, including computers. Organizational facilitators included prioritizing family planning data; training staff; supportive supervision; and quarterly performance review meetings. Key behavioural facilitators were motivation and competence of staff. Collaborative networks with implementing partners were also found to be essential for improving performance and sustainability. Significant technical barriers included limited supply of computers in lower level health facilities, complex forms, double and therefore tedious entry of data, and web-reporting challenges. Organizational barriers included limited human resources; high levels of staff attrition in private facilities; inadequate training in data collection and use; poor culture of information use; and frequent stock outs of paper-based forms. Behavioural barriers were low use of family planning data for planning purposes by district and health facility staff. Family planning data collection and reporting are integrated in Uganda’s district and national health management information systems. Best practices included integrated reporting and performance review, among others. Limited priority and attention is given to family planning data collection at the facility and national levels. Data are not used by the health facilities that collect them. The authors recommend reviewing and tailoring data collection forms and ensuring their availability at health facilities. All staff involved in data reporting should be trained and regularly supervised.

Setting the global research agenda for community health systems: literature and consultative review
Agarwal S; Kirk K; Sripad P; Bellows B; et al: Human Resources for Health 17(22), doi:, 2019

Globally, there is renewed interest in and momentum for strengthening community health systems. Recent reviews have identified factors critical to successful community health worker (CHW) programs but pointed to significant evidence gaps. This systematic review identifies areas for a global research agenda to strengthen CHW programs. Research gap areas that were identified in the literature and validated through expert consultation include selection and training of CHWs and community embeddedness, institutionalisation of CHW programs (referrals, supervision, and supply chain), CHW needs including incentives and remuneration, governance and sustainability of CHW programs, performance and quality of care, and cost-effectiveness of CHW programs. Priority research questions included queries on effective policy, financing, governance, supervision and monitoring systems for CHWs and community health systems, implementation questions around the role of digital technologies, CHW preferences, and drivers of CHW motivation and retention over time. As international interest and investment in CHW programs and community health systems continue to grow, the authors propose that it becomes critical not only to analyse the evidence that exists, but also to clearly define research questions and collect additional evidence to ensure that CHW programs are effective, efficient, equity promoting, and evidence based.

When ethics and politics collide in donor-funded global health research
Storeng K; Palmer J: The Lancet, doi:, 2019

In this paper, the authors share their experience of censorship in evaluation research for global health. Their experience shows a broader trend of external funders and implementing partners who deliberately use ethical and methodological arguments to undermine essential research. In a context of chronic underfunding of universities and their growing dependence on externally-driven research grants, the authors propose several structural and cultural changes to prevent manipulation of research governance systems and to safeguard the independence of research. While they acknowledge censorship to be a strong word, they justify its use in situations found where researchers in commissioned research-based evaluations are asked by funders to omit important results from their final report. The authors note that universities' provide methodological and subject area expertise and strong systems of research ethics and governance, but also observe that current systems are ill equipped to deal with these challenges.

Evidence map of knowledge translation strategies, outcomes, facilitators and barriers in African health systems
Edwards A; Zweigenthal V; Olivier J: Health Research Policy and Systems 17(16) 1-14, 2019

This paper provides a systematic overview of the literature on knowledge translation strategies employed by health system researchers and policy-makers in African countries. An evidence mapping methodology was adapted from the social and health sciences literature and used to generate a schema of knowledge translation strategies, outcomes, facilitators and barriers.The knowledge translation literature in African countries is found to be widely distributed, problematically diverse and growing. Significant disparities exist between reports on knowledge translation in different countries, and there are many settings without published evidence of local knowledge translation characteristics. Commonly reported knowledge translation strategies include policy briefs, capacity-building workshops and policy dialogues. Barriers affecting researchers and policy-makers include insufficient skills and capacity to conduct knowledge translation activities, time constraints and a lack of resources. Availability of quality locally relevant research was the most reported facilitator. Limited knowledge translation outcomes reflect persisting difficulties in outcome identification and reporting.

Repositioning Africa in global knowledge production
Fonn S; Ayiro L; Cotton P; Habib et al: The Lancet 392(10153), 1163-1166, 2018

Sub-Saharan Africa accounts for 13·5% of the global population but less than 1% of global research output. In 2008, Africa produced 27 000 published papers—the same number as The Netherlands. Informed by a nuanced understanding of the causes of the current scenario, the authors propose action that should be taken by African universities, governments, and development partners to foster the development of research-active universities on the continent. Since the 1990s, African universities have sought to regain their role as agents of transformation. On a per capita basis, African universities remain severely underfunded in view of increasing enrolment, the establishment of new universities, and the declining purchasing power of African currencies. Part of the explanation is that Africa contributes less than 1% of the global expenditure on research and development. By comparison, Latin America and the Caribbean account for 3%; Europe for 27%; Asia for 31%, and North America for 37%. Sub-Saharan Africa depends greatly on international collaboration and visiting academics for its research output. In 2012, southern Africa, east Africa, and west and central Africa produced 79%, 70%, and 45% of all their research output, respectively, through international collaborations. African Education ministers have met several times recently to address challenges in higher education. The authors argue that research-intensive universities across sub-Saharan Africa need to be identified, recognised, strengthened, and invested in through new sources of funding. Creating and maintaining research-intensive universities will require consistent investment in human capital, research equipment, and relevant administrative support, at far higher levels than is available under current conditions. To ensure that designated research-intensive universities do not become complacent and to allow for the entry of upcoming high-achieving universities, the authors propose on-going peer review every 3–5 years. At a minimum, the authors propose that research-intensive universities commit their own resources to research and that African governments increase their support for research in general and provide targeted funding for research-intensive universities—in addition to the usual operational funds and tuition income currently available to these institutions.

The future of African Studies: what we can do to keep Africa at the heart of our research
Nolte I: Journal of African Cultural Studies (Forthcoming Special Issue: Ethical Collaboration), doi:, 2019

Over the past two decades, Africa has returned to academic agendas outside of the continent. At the same time, the field of African Studies has come under increasing criticism for its marginalisation of African voices, interests, and agendas. This article explores how the complex transformations of the academy have contributed to a growing division of labour. Increasingly, African scholarship is associated with the production of empirical fact and socio-economic impact rather than theory, with ostensibly local rather than international publication, and with other forms of disadvantage that undermine respectful exchange and engagement. This article suggests ways of understanding and engaging with these inequalities.