Monitoring equity and research policy

"Learning by doing" is key to achieving universal access to HIV/AIDS prevention and treatment, says WHO

To achieve universal access to HIV prevention and treatment, the scientific and public health community must respond quickly to developments on the ground to narrow the gap between discovery and intervention. Dr Charlie Gilks, head of treatment, prevention and scale up at the World Health Organization's (WHO) HIV/AIDS Department, stressed the need to "learn by doing" at the 3rd International AIDS Society Conference on HIV Pathogenesis and Treatment, a biennial scientific meeting, in Rio de Jeneiro, Brazil. Gilks emphasized the importance of research on HIV prevention in addition to more effective ways to deliver treatment. "While we work to keep people alive and healthy with the tools we have now, we also need to ensure that future generations will have access to better prevention technologies," said Gilks, referring to the importance of vaccine and microbicide research.

2008 National Antenatal HIV and Syphilis Prevalence Survey
South African Department of Health: 5 October 2009

This prevalence survey – based on blood samples from 34,000 pregnant women who attended antenatal clinics in 52 health districts in South Africa – measured HIV prevalence at 29.3%, compared to 29.4% in 2007 and 29% in 2006. Prevalence among women aged 15 to 40 declined slightly from 22.1% in 2007 to 21.7% in 2008, but the infection rate among women in the 30 to 34 age group rose from 39.6% in 2007 to 40.4% in 2008. Age was found to be the most important risk factor, with women of 22 years or older significantly more likely to be HIV-infected. In this age group, race was the next most important factor, with 37.6% of African women infected, compared to 6.8% of white, Asian and coloured (mixed race) women. The figures revealed wide variations between the country's nine provinces: as in previous years, KwaZulu-Natal Province recorded the highest prevalence (38.7%) and Western Cape the lowest (16.1%); at district level the disparities were even greater - in some the infection rate was as high as 45%, in others as low as 5%. The survey authors strongly recommended that the health department conduct more in-depth epidemiological surveys to investigate the causes of these wide disparities.

2009 Mine Safety Audit Report
Department of Minerals and Energy: 3 February 2009

A mine safety audit report detailing the high number of injuries and fatalities in South Africa’s mines each year has been released by the Department of Minerals and Energy, revealing serious gaps in the safety standards in the mining industry. In the past three years, unsafe working conditions have led to the death of 200 mine workers annually, in addition to the almost 5,000 people who are injured annually. Many of these injuries are so severe that limbs need to be amputated which leads to a significant reduction in standards of living and ability to earn an income. In terms of Occupational Health and Safety, the mining industry scored a dismal 59% compliance, while also scoring only 56% for health risk management, while public health and safety in mines received 65% compliance. Singling out particular mining sectors, the diamond sector scored a low 47% compliance with health risk management regulations. The gold industry also scored a dismal 53% compliance when it came to health risk management.

5th Annual East African Health and Scientific Conference and Exhibition Concludes in Kampala, Uganda
East African Community Headquarters, Kampala, Uganda, March 2015

The EAC Sectoral Council of Health Ministers Regional Health Sector Strategic Plan (2015-2020) is a roadmap for improving and strengthening of the regional health sector through implementation of the various approaches, interventions and innovation in the region. The 5th EAC Health and Scientific Conference contributes to and is a catalyst for strengthening regional cooperation in the health sector especially with regard to the improvement of health care service delivery and patient care outcomes. It is a platform for synthesizing, sharing and dissemination of research findings to inform policy makers, scientists and programmers on evidence-based decision-making and mobilization of political will and resources for the Health Sector.

A checklist for health research priority setting: Nine common themes of good practice
Viergever RF, Olifson S, Ghaffar A, Terry RF: Health Research Policy and Systems 8(36), 15 December 2010

Following a literature review and an analysis of health research priority-setting exercises that have been organised or coordinated by the World Health Organization since 2005, this article proposes a checklist for health research priority-setting that allows for informed choices on different approaches and ensures good practice. The list is intended to provide generic assistance for planning health research prioritisation processes. The nine themes in the checklist are: identifying contextual factors; using a comprehensive approach; ensuring inclusiveness in decision-making processes; identifying and gathering relevant information; planning for implementation; selecting criteria for setting priorities; choosing methods for selecting priorities; evaluating priorities; and writing a report that will make the process that was followed transparent.

A civil society perspective on health research

Complex global public health challenges such as the rapidly widening health inequalities, and unprecedented emergencies such as the pandemic of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) demand a reappraisal of existing priorities in health policies, expenditure and research. Research can assist in mounting an effective response, but will require increased emphasis on health determinants at both the national and global levels, as well as health systems research and broad-based and effective public health initiatives. Civil society organizations (CSOs) are already at the forefront of such research.

A common evaluation framework for the African Health Initiative
Bryce J, Requejo J, Moulton LH, Ram M, Black RE and Population Health Implementation and Training – Africa Health Initiative Data Collaborative: BMC Health Services Research 13(Suppl 2):S10, 31 May 2013

In this paper, the authors describe the components of the African Health Initiative framework; this includes the conceptual model, core metrics to be measured in all sites, and standard guidelines for reporting on the implementation of partnership activities and contextual factors that may affect implementation, or the results it produces. They also describe the systems that have been put in place for data management, data quality assessments, and cross-site analysis of results. The conceptual model for the Initiative highlights points in the causal chain between health system strengthening activities and health impact where evidence produced by the partnerships can contribute to learning. This model represents an important advance over its predecessors by including contextual factors and implementation strength as potential determinants, and explicitly including equity as a component of both outcomes and impact. Specific measurement challenges include the prospective documentation of programme implementation and contextual factors. Methodological issues addressed in the development of the framework include the aggregation of data collected using different methods and the challenge of evaluating a complex set of interventions being improved over time based on continuous monitoring and intermediate results.

A comparable yardstick: adjusting for education bias in South African health system responsiveness ratings
Rossouw L; Smith A: Health Policy and Planning 32(Suppl3) iii67–iii74, 2017

Health-system responsiveness (HSR) measures the experience of health-system users in terms of the non-clinical aspects of the health system. The authors explore the association between education levels and reporting behaviour in terms of HSR in South Africa using data from the World Health Organization Study on Global Ageing and Adult Health for South Africa (WHO SAGE) conducted in 2007 and 2008. The authors consider the reporting behaviour of 1499 adults aged 50 and older in terms of the reported HSR for their most recent outpatient provider visit during the preceding 12 months. More specifically, they explore whether there are systematic biases in reporting behaviour by education levels and other socio-economic covariates through the use of data from anchoring vignettes. Large differences were found in HSR ratings between the lowest and highest education groups after adjusting for reporting bias using the anchoring vignettes. This finding holds across all seven HSR domains captured in the WHO SAGE dataset. In the most extreme case, individuals with no education are likely to underreport poor HSR by between 2.6 and 9.4% percentage points compared with individuals with secondary schooling or higher. It is proposed that policy-makers take cognizance of potential reporting biases in HSR ratings and make the necessary adjustments to obtain data that are as true and accurate as possible. The need for this is seen to be especially acute in a country such as South Africa with large socio-economic inequalities and disparities in access to healthcare.

A Decade of Biomedical Research in West Africa (2005–14): A Bibliometric Analysis of the Ten Most Productive Countries in Medline
Nwagwu W: Council for the Development of Social Science Research in Africa, July 2016

This research determined the quantity and quality of publications in biomedical research in top-producing countries in West Africa during 2005–14 as well as characteristics of journals and collaborative evidence in the area. Data was drawn from MEDLINE/PubMed and Google Scholar while the impact factors of the journals were retrieved from the SCImago Journal and Country Rank portal. Quantity of publications was measured by counting the number of publications attributable to a country while h-index was extracted to measure quality. Productivity was analysed by sorting the data according to their first named authors, journals and publication dates, and analysed using MS Excel and LOTKA®. Nigeria, Ghana, Senegal, Burkina Faso and Mali had the highest number of publications. In respect of productivity, apart from Côte d’Ivoire that had an α value less than 2 indicating a higher level of productivity, all other countries had an α value greater than 2. West African Journal of Medicine is the only journal of West African origin in the list of top ten journals where the authors from the sub-region published their papers, and it ranked tenth. Nigeria and Ghana published more of their research in local journals in comparison with other countries, but these journals have very low mean impact factors. This study reinforces the need for improved research production and collaboration between the big and small countries.

A framework for entry: PAR values and engagement strategies in community research
Ochocka J, Moorlag E and Janzen R: Gateways: International Journal of Community Research and Engagement (3), 2010

The purpose of this article is twofold: to explore the entry process in community-based research when researching sensitive topics; and to suggest a framework for entry that utilises the values of participatory action research (PAR). The article draws on a collaborative community-university research study that took place in the Waterloo and Toronto regions of Ontario, Canada, from 2005–2010. The article emphasises that community entry is not only about recruitment strategies for research participants or research access to community but it is also concerned with the ongoing engagement with communities during various stages of the research study. The indicator of success is a well established and trusted community-researcher relationship. This article first examines this broader understanding of entry, then looks at how community research entry can be shaped by an illustrative framework, or guide, that uses a combination of participatory action research (PAR) values and engagement strategies.