Monitoring equity and research policy

More talk than action: gender and ethnic diversity in leading public health universities
Khan M; Lakha F; Tan M; Singh S; et al: The Lancet 393 (1071), 594-600, 2019

Improving the career progression of women and ethnic minorities in public health universities has been a longstanding challenge. The authors believe it might be addressed by including staff diversity data in university rankings. In this study, findings from a mixed methods investigation of gender-related and ethnicity-related differences in career progression at the 15 highest ranked social sciences and public health universities in the world are presented. The study revealed that clear gender and ethnic disparities remain at the most senior academic positions, despite numerous diversity policies and action plans reported. In all universities, representation of women declined between middle and senior academic levels, despite women outnumbering men at the junior level. Ethnic-minority women might have a magnified disadvantage because ethnic-minority academics constitute a small proportion of junior-level positions and the proportion of ethnic-minority women declines along the seniority pathway.

Success of a South-South collaboration on Human Resources Information Systems (HRIS) in health: a case of Kenya and Zambia HRIS collaboration
Were V; Jere E; Lanyo K; et al: Human Resources for Health 17(6), doi:, 2019

This paper is a road map of using a South-South collaboration to develop a Human Resources Information System (HRIS) to inform scale-up of the health workforce. In the last decade, Kenya implemented one of the most comprehensive HRIS in Africa. It was funded by the US President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) and implemented by Emory University. The Kenyan team collaborated with the Zambian team to establish a similar HRIS in Zambia. This case study describes the collaboration activities between Zambia and Kenya which included needs assessment, establishment of project office, stakeholders’ sensitization, technical assistance and knowledge transfer, software reuse, documents and guidelines reuse, project structure and management, and project formative evaluation. Furthermore, it highlights the need for adopting effective communication strategies, collaborative planning, teamwork, willingness to learn and having minimum technical skills from the recipient country as lessons learned from the collaboration. As a result of the collaboration, while Kenya took 5 years, Zambia was able to implement the project within 2 years which is less than half the time it took Kenya. This case presents a unique experience in the use of South-South collaboration in establishing a HRIS. It illustrates the steps and resources needed while identifying the successes and challenges in undertaking such collaboration.

A health policy analysis reader: The politics of policy change in low- and middle-income countries
Gilson L; Orgill M; Shroff Z: Alliance for Health Policy and Systems Research, 2018

This reader aims to encourage and deepen health policy analysis work in low- and middle-income countries (LMICs). It presents the range of health policy analysis studies that have been conducted in LMICs, highlights relevant theory, and points to new directions for such work. It also includes methodological and analytical pointers, and considers how to use health policy analysis prospectively to support health policy change. The Reader’s primary audience includes all those with an interest in understanding and influencing health policy change, including researchers and educators, as well as policy advocates, managers, and policy-makers. The Reader will also be of interest to those who have specialist policy studies or public administration backgrounds, and also to those with limited prior engagement with relevant social science perspectives.

New research chairs program will expand research and innovation in Africa
International Development Research Centre, South Africa’s National Research Foundation (NRF): IRDC, December 2018

IDRC and South Africa’s National Research Foundation (NRF) have announced a new research chairs initiative. The OR Tambo Africa Research Chairs Initiative, named after Oliver Reginald Tambo, the pre-eminent South African leader and advocate of science and technology, will support up to 10 top researchers from across Africa over the next five years. Through international and regional strategic partnerships, the Chairs will contribute to the development of long-term mutually beneficial research collaborations on the continent. They will focus on world-class research in diverse fields and on training graduate students at leading universities in the 15 sub-Saharan African countries that make up the Science Granting Councils Initiative (SGCI), a collaboration between IDRC, NRF, the Swedish International Development Cooperation Agency, and the UK’s Department for International Development. The application and selection process will be conducted using a two-phase approach coordinated by NRF, which will also manage the Chairs once awarded. The call for institutional expressions of interest was launched in December 2018 and the call for detailed chair-holder applications will be launched in May/June 2019. Councils participating in SGCI are expected to play a key role in the research and grants management, implementation, and sustainability of the Chairs.

Evaluating health research priority-setting in low-income countries: a case study of health research priority-setting in Zambia
Kapiriri L; Schuster-Wallace C and Chanda-Kapata P: Health Research Policy and Systems 16(105) 1-12, 2018

This paper describes and evaluates health research priority-setting in Zambia from the perspectives of key stakeholders using an internationally validated evaluation framework. This was a qualitative study based on 28 in-depth interviews with stakeholders who had participated in the priority-setting exercises. An interview guide was employed. Emerging themes were, in turn, compared to the framework parameters. Although there is apparent commitment to health research in Zambia, health research priority-setting is limited by lack of funding, and consistently used explicit and fair processes. The designated national research organisation and the availability of tools that have been validated and pilot tested within Zambia provide an opportunity for focused capacity strengthening for systematic prioritisation, monitoring and evaluation. The authors observe that the utility of the evaluation framework in Zambia could indicate potential usefulness in similar low-income countries.

Establishing Standards to Evaluate the Impact of Integrating Digital Health into Health Systems
Labrique A; Vasudevan L; Weiss W; et al: Global Health: Science and Practice 6(Supplement 1) S5-S17, 2018

In this commentary, the authors summarize the key milestones in the rise of digital health, illustrating efforts to bridge gaps in the evidence base, a shifting focus to scale-up and sustainability, growing attention to the precise costing of these strategies, and an emergent implementation science agenda to better characterize the necessary ecosystem of scale—the social, political, economic, legal, and ethical context that supports digital health implementation. In 2016, WHO established a guidelines development group to assess current evidence and recommendations for digital strategies. The guidelines development process recommends strategies that are adequately supported by sufficient evidence but also highlights promising strategies that currently have a low threshold of evidence that require future research, with a particular eye toward health system integration of these strategies. The evidence base of digital health approaches that have been successfully scaled up is growing, and new technology and shared standards provide a framework that can decrease the risk and amplify the promises of digital health investments. The authors argue that digital health innovations are increasing accessibility, promoting transparency, and have the capacity to increase accountability—all necessary facets of lasting health systems strengthening.

Identifying health policy and systems research priorities for the sustainable development goals: social protection for health
Mary Qiu M; Jessani N; Bennett S: International Journal for Equity in Health 17(155) 1-14, 2018

This paper sought to identify potential research priorities concerning social protection and health in low and middle-income countries, from multiple perspectives. Priority research questions were identified through research reviews on social protection interventions and health, interviews with 54 policy makers from Ministries of Health, multi-lateral or bilateral organizations, and NGOs. Data was collated and summarized using a framework analysis approach. The final refining and ranking of the questions were completed by researchers from around the globe through an online platform. The overview of reviews identified 5 main categories of social protection interventions: cash transfers; financial incentives and other demand side financing interventions; food aid and nutritional interventions; parental leave; and livelihood/social welfare interventions. Policy-makers focused on the implementation and practice of social protection and health, how social protection programs could be integrated with other sectors, and how they should be monitored/evaluated. A collated list resulted in 31 priority research questions. Scale and sustainability of social protection programs ranked highest. The top 10 research questions focused heavily on design, implementation, and context, with a range of interventions that included cash transfers, social insurance, and labour market interventions. The authors observe that there is potentially a rich field of enquiry into the linkages between health systems and social protection programs, but research within this field has focused on a few relatively narrowly defined areas. The SDGs provide an impetus to the expansion of research of this nature, with priority setting exercises such as this helping to align funder investment with researcher effort and policy-maker evidence needs.

Towards a global monitoring system for implementing the Rio Political Declaration on Social Determinants of Health: developing a core set of indicators for government action on the social determinants of health to improve health equity
Working Group for Monitoring Action on the Social Determinants of Health: International Journal for Equity in Health 17(136) 1-27, 2018

In the 2011 Rio Political Declaration on Social Determinants of Health, World Health Organization Member States pledged action in five areas crucial for addressing health inequities. Their pledges referred to better governance for health and development, greater participation in policymaking and implementation, further reorientation of the health sector towards reducing health inequities, strengthening of global governance and collaboration, and monitoring progress and increasing accountability. The authors describe the selection of indicators proposed to be part of the initial World Health Organization global system for monitoring action on the social determinants of health. The authors describe the processes and criteria used for selecting social determinants of health action indicators that were of high quality and the described the challenges encountered in creating a set of metrics for capturing government action on addressing the Rio Political Declaration’s five Action Areas. The authors developed 19 measurement concepts, identified and screened 20 indicator databases and systems, including the 223 Sustainable Development Goals indicators, and applied strong criteria for selecting indicators for the core indicator set. They identified 36 suitable existing indicators, which were often Sustainable Development Goals indicators.

Towards an interdisciplinary approach to wellbeing: Life histories and Self-Determination Theory in rural Zambia
White S; Jha S: Social Science & Medicine (212)153-160, 2018

This paper implemented a qualitative analysis of wellbeing in life history interviews in Chiawa, rural Zambia. The enquiry goes beyond simply reading across methods, disciplines and contexts, to consider fundamental differences in constructions of the human subject, and how these relate to understandings of wellbeing. Field research took place in two periods, August–November, 2010 and 2012. Analysis drew on 46 individual case studies, conducted through open-ended interviews. These were identified through a survey with an average of 390 male and female household heads in each round, including 25% female headed households. As social determinants theory predicts, the interviews confirm elements of autonomy, competence and relatedness as vital to wellbeing. However, these are expressed in ways that highlight material and relational, rather than psychological, factors. The authors endorsed social determinants theory’s utility in interdisciplinary approaches to wellbeing, but only if it admits its own cultural grounding in the construction of socially and culturally distinctive questions on basic psychological needs.

Q&A: ‘Research in the global South is of higher quality’
Chongwang J: Sci Dev Net, August 2018

An article published in the journal Nature on July 5 puts forward a new technique for the evaluation of research on development. It marks a departure from conventional approaches that, according to the author, have significant weaknesses. This new method for the evaluation of development research — known as RQ+ or Research Quality Plus — emphasises the crucial importance of context, local knowledge and the views of the populations whose lives the research aims to improve. Conventional approaches to evaluating scientific endeavours are argued by the author to have a number of inbuilt constraints. For example, they focus primarily on peer assessment or bibliometrics but don’t explicitly pass judgement on the originality or usefulness of the research, nor do they look at the degree of respect for local knowledge. The RQ+ approach goes beyond an evaluation focused solely on the scientific merit of research outputs and includes other dimensions that are essential to measuring the value and quality of research. RQ+ takes account of what evaluators have to say, but their views should be evidence-based, rather than a simple opinion. Those carrying out the evaluation should take into consideration external points of view — for example those of users targeted by the research or of the communities it is supposed to benefit — as well as the perspectives of other researchers working in the same field.