Monitoring equity and research policy

Health Equity Tourism: Ravaging the Justice Landscape
Lett E; Adekunle D; McMurray P; et al: Journal of Medical Systems 46 (17), 2022

“Health equity tourism” is described as the process of previously unengaged investigators pivoting into health equity research without developing the necessary expertise for high-quality work. In this essay, the authors define the phenomenon and provide an explanation of the antecedent conditions that facilitated its development. They outline its consequences as recapitulating systems of inequity within the academy and diluting a landscape carefully curated by scholars who have demonstrated sustained commitments to equity research as a primary scientific discipline and praxis. The authors provide a set of principles to guide equity researchers.

Female adolescents living with HIV telling their story through ‘my story’ book in Malawi: A visual methodology innovation
Mwalabu G;, Mbendera I; Petrucka P; Manjanja V: PLoS ONE 16(10), e0257126, 2021

Female adolescents living with Human Immunodeficiency Virus (HIV) face lifelong challenges in reproductive and sexual health ranging from relational, social and legal-ethical considerations. A visual method and storybook research innovation was used with young female adolescents in Malawi that initiate sex as early as 15 years, mostly with adult partners, given their reluctance to discuss sexual matters through more direct questions during interviews. The researchers thus used invoke youth-friendly research approaches to address these issues and enable these vulnerable individuals to articulate their experience and advocate their preferred changes.

Intervention – “Impermanence: On Frantz Fanon’s Geographies”
Aguiar J; Chowdhury A; Falk M; et al: Antipode Online, August 2021

This 'cartographic' and political economy analysis of Frantz Fanon’s ‘geographies’ points to a series of narrative maps that draw attention to the differential geographies of racism and colonialism, using geography, landscape, cartography, architecture, space, place, and borders, to make sense of blackness and oppression and liberation. Fanon’s envisions anti-colonial geographies as always in flux, nested in, yet cannot be fully defined by, the colonial imperative. Stasis – even the street or the walls of the clinic – is impossible. Colonial geographies are thus identified as unsustainable because, even in their heaviness, they are impermanent, in flux, and alterable.

Mapping Algorithms Are Failing to Address Urban Inequalities in the Global South
Costa-Lima M; Freitas C; Farias S: Failed Architecture, 2021

Algorithms act according to what they are trained for, and human beings are the ones training them. Therefore, when algorithms are clearly reinforcing existing inequalities, it is crucial to question who writes these algorithms, and in whose interests they are writing them. More importantly, these people should be held accountable for the socio-spatial effects of their products. As local governments have failed to build a good spatial data infrastructure for informal settlements, other stakeholders are stepping in and the authors raise the threat posed by algorithms moderated by big tech corporations deciding the boundaries ad features of neighbourhoods.

Strengthening Research and Practice in Community Health Systems: A Research Agenda and Manifesto
Tetui M; Hurtig A-K; Jonsson F; et al: International Journal of Health Policy and Management, doi: 10.34172/IJHPM.2021.71, 2021

While there have been increased calls for strengthening community health systems (CHSs), key priorities for this field have not been fully articulated. This paper seeks to fill this gap, presenting a collaboratively defined research agenda, accompanied by a ‘manifesto’ on strengthening research and practice in the CHS. Eight domains of research priorities for CHSs were identified: clarifying the purpose and values of the CHS, ensure inclusivity; design, implementation and monitoring of strategies to strengthen the CHS; social, political and historical contexts of CHS; community health workers (CHWs); social accountability; the interface between the CHS and the broader health system; governance and stewardship; and finally, the ethical methodologies for researching the CHS.

Health research knowledge translation into policy in Zambia: policy-maker and researcher perspectives
Malama A; Zulu J; Nzala S; et al: Health Research Policy and Systems 19(42), 1-11, 2021

The authors explored how health research knowledge is translated into policy in Zambia, and what facilitates or hinders this, from document review and key informant interview. While the document review suggested policy efforts to promote knowledge translation, the interviews raised challenges in coordination and linkages between knowledge and policy-making processes, attributed to lack of research knowledge translation capacity, limited resources and lack of knowledge hubs. However, the authors suggest that emerging local research leadership and a stock of underused local health are an opportunity to enhance knowledge to policy links, if supported.

Explaining covid-19 performance: what factors might predict national responses?
Baum F; Freedom T; Musolino C; Abramovitz M; et al: BMJ 372(91), 2021

The Global Health Security Index predicted that the world in general was not well prepared for the pandemic but did not predict individual country preparedness. Ten factors seem to have contributed to the index failing to predict country responses, including limited consideration of globalisation, geography, and global governance, bias to high income countries, failure to assess health system capacity, overlooking the role of political leadership and ideology, overlooking the importance of context, the limits of national wealth as a predictive factor, no examination of inequalities within countries, the importance of social security and the provisions to protect people from losing their jobs and homes. The authors note that civil society capacity was not assessed, and the gap between capacity and its application was also not assessed. The authors argue that future assessments of pandemic preparedness need to take these 10 factors into account by adopting a systems approach which enables a focus on critical system components

How to talk about COVID-19 in Africa
Nyabola N: The Boston Review, USA, October 2020

To ask why COVID-19 hasn’t been deadlier in Africa is to suggest that more Africans should be dying. We need better questions. Almost every major international news outlet has asked a variation of the question. Some speculate that something structural or physiological has dampened the impact of COVID-19 on Africa’s population; otherwise, Africa would be faring worse. Others argue that African governments are simply doing a better job of managing the disease than other regions, despite evidence to the contrary. Neither analysis reflects the complex realities of COVID-19 in Africa. The question itself, in its crudest form, has provoked considerable, justifiable anger on social media in various African countries. Yet as the deaths mount in Brazil, India, the United States, and the UK, and as Europe prepares for its second wave, the official death toll in African countries remains low. Even in South Africa, the most severely affected African country, confirmed deaths are far fewer than predicted. Experts are left wondering why their predictions were wrong. To ask why more Africans aren’t dying of COVID-19 exposes the expectation that when the world suffers, Africa must suffer more. We can learn collectively from the questions we ask. Knowledge-making is about grappling with useful questions—those that move humanity toward a greater understanding of shared circumstances. But questions that distract from meaningful comparisons dominate the current moment. “Why aren’t more Africans dying of COVID-19,” like so many questions about Africa, fails to illuminate.

What role can health policy and systems research play in supporting responses to COVID-19 that strengthen socially just health systems?
Gilson L; Marchal B; Ayepong I; Barasa E; et al: Health Policy and Planning (czaa112), doi: https://doi.org/10.1093/heapol/czaa112, 2020

In the context of COVID-19, this paper outlines how health policy and systems research (HPSR) can both address current short-term challenges, and support the system transformations needed to strengthen people-centred and equitable health systems over the long term. Due to the acute nature of the pandemic, few papers have yet focused on how health systems are coping with or adapting to the pandemic, or how health policy-making and decision-making has (or has not) changed in this time of crisis. This paper makes proposals for a structured research agenda to inform health policy and system responses to COVID-19 that can move us beyond the current crisis, and into the future, with a focus on low- and middle-income countries.

Evidence for decisions in the time of COVID-19: Eyes on Africa
Jessani N; Langer L; van Rooyen C; Stewart R: The Thinker, Vol 84, 2020

In this article the authors argue that many African governments have so far responded more proactively and effectively to Covid-19 than some governments in high income countries (HICs). Much of this capacity to respond effectively can be explained by an existing culture of using evidence to inform policy decision-making. African researchers are producing evidence on how to protect and prioritise already existing health interventions which can increase health system resilience and preparedness for Covid-19. The authors argue that African nations have generated and used evidence for decision- making on solutions to tackle the pandemic. Data-poverty and technology deficits are a challenge. The authors note that partnerships to assist with production, collation, and use of evidence are appearing nationally, regionally, and globally to support quick but measured evidence-informed decisions.

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