The South African Child Gauge monitors the realisation of children’s rights and is published annually. Key features include: legislative developments affecting children; child-centred data tracking children’s access to social assistance, education, housing, health and other services; and a series of essays to inform, focus and sometimes direct national dialogue and debate. While South Africa is making progress towards meeting the Millennium Development Goal (MDG) target on sustainable access to safe drinking water, this has not trickled down to children – only 64% of children have access to safe drinking water on site. Progress has been slow for access to basic sanitation, education and gender equality. On the MDG targets for reducing child hunger, HIV, tuberculosis and child mortality, South Africa is not making any progress, according to the Gauge. South Africa has also failed to submit its reports on progress in relation to implementing the UN Convention of the Rights of the Child – the key accountability mechanism aimed at monitoring South Africa’s progress in promoting the maximum survival and development of children. The report further notes that South Africa is one of only twelve countries worldwide that has failed to reduce child mortality since 1990.
Monitoring equity and research policy
Health information systems (HIS) are increasingly being recognised as the ‘central nervous system’ of the health sector, with the information they generate being used for decision making to improve health system performance, accountability and health outcomes. To guide countries in developing and strengthening their HIS, Health Metrics Network (HMN) has developed a standard reference for health information systems development, the HMN Framework. This brief report demonstrates the widespread application of the Framework and the growing body of evidence that better health information improves health outcomes and contributes to saving lives. By 2010, HMN tracked a cumulative total of US$ 514 million from a limited number of domestic and donor sources that was invested in HIS strengthening globally. Although estimates show an upward trend in investment, the brief argues that further resources are needed to meet the increasing demand from countries for HIS investment. It argues that a strengthened HIS produces better quality information for use in decision making, and that information-driven decisions lead to cost savings, more efficient use of resources, better quality essential health services, improved coverage and more lives saved.
Africa's progress depends on her capacity to generate, adapt, and use scientific knowledge to meet regional health and development needs. Yet, according to this paper, Africa's higher education institutions that are mandated to foster this capacity lack adequate resources to generate and apply knowledge, raising the need for innovative approaches to enhance research capacity. The paper describes a newly developed programme to support PhD research in health and population sciences at African universities: the African Doctoral Dissertation Research Fellowship (ADDRF) Programme. It documents the authors’ experiences implementing the programme. As health research capacity-strengthening in Africa continues to attract attention and as the need for such programmes to be African-led is emphasised, the authors propose that their experiences in developing and implementing the ADDRF may offer invaluable lessons to other institutions undertaking similar initiatives.
According to this study, the availability, quality and use of health information, research evidence and knowledge is not adequate in the African Region. This has resulted in two major types of knowledge gaps: gaps in health knowledge, and the so-called ‘know-do gap’. Health knowledge gaps are where essential answers on how to improve the health of the people in the Region are missing. This is an issue related to the acquisition or generation of health information and research evidence. The ‘know-do gap’ is the failure to apply all existing knowledge to improve people’s health. This is related to the issue of sharing and translation of health information, research evidence, or knowledge. Although there are major structural constraints, the study argues that the key to narrowing the knowledge gap and sustaining health and development gains is a long-term commitment to strengthen national capability to ensure the availability of relevant and high quality health information and evidence and its use for policy and decision making. Close links and the co-ordination of fragmented disciplines such as information, health research and knowledge management are argued to be an essential step in this process.
Health impact assessment (HIA) has been proposed as one mechanism that can inform decision-making by public policy-makers, yet it has been criticised for a lack of rigour in its use of evidence. The aim of this study was to formulate, develop and test a practical guide to reviewing publicly available evidence for use in HIA. The formulation and development of the guide involved substantial background research, qualitative research with the target audience, substantial consultations with potential users and other stakeholders, a pilot study to explore content, format and usability, and peer review. Finally, the guide was tested in practice by invited volunteers who used it to appraise existing HIA evidence reviews. During development, a wealth of data was generated on how the guide might be applied in practice, on terminology, on ensuring clarity of the text and on additional resources needed. The final guide provides advice on reviewing quantitative and qualitative research in plain language and is suitable for those working in public health but who may not have experience in reviewing evidence. During testing, it enabled users to discriminate between satisfactory and unsatisfactory evidence reviews. By late 2009, 1,700 printed and 2,500 downloaded copies of the guide had been distributed. In conclusion, substantive and iterative consultation, though time-consuming, was pivotal to producing a simple, systematic and accessible guide to reviewing publicly available research evidence for use in HIA.
This report is part of initial findings from an ongoing review of development progress to generate comparative analysis that illustrates relative and absolute progress at national, sub-national and regional levels. The analysis is based on the Millennium Development Goal (MDG) database, household demographic and health surveys and multiple indicator cluster surveys. Two measures are used to evaluate progress: absolute and relative. Both measures are needed to tell the full story of progress, particularly in low-income countries. The report found that most countries are making progress on most of the key MDG indicators. For example, the number of people living in extreme poverty fell from an estimated 1.8 billion in 1990 to 1.4 billion in 2005. The share of children in primary school in low- and middle-income countries has risen from just over 70% to well over 80%. Ninety-five per cent of countries are making progress in reducing child mortality, which overall fell from 101 to 69 per 1000 live births between 1990 and 20071. And, despite wide variation in progress on maternal mortality, access to maternal health services has increased in about 80% of countries. The key message from many years of working towards the MDGs is that progress is possible. In every aspect of development – even in the least successful of the MDGs reviewed here, on maternal health (Goal 5) – a significant number of countries have made real achievements. Although these statistics are encouraging, the challenge for the remaining five years and beyond is to learn from, and build upon, progress made.
Field trials require extensive data preparation and complex logistics. The use of personal digital assistants (PDAs) can bypass many of the traditional steps that are necessary in a paper-based data entry system. In this study, the authors programmed, designed and supervised the use of PDAs for a large survey enumeration and mass vaccination campaign. The project was implemented in Zanzibar, Tanzania. Zanzibar is composed of two main islands, Unguja and Pemba, where outbreaks of cholera have been reported since the 1970s. PDAs allowed the researchers to digitise information at the initial point of contact with the respondents. Immediate response by the system in case of error helped ensure the quality and reliability of the data. PDAs provided quick data summaries that allowed subsequent research activities to be implemented in a timely fashion. Portability, immediate recording and linking of information was found to enhance structured data collection in the study. The study recommends PDAs as more useful than paper-based systems for data collection in the field, especially in impoverished settings in developing countries.
The 2009 General Household Survey entailed face-to-face interviews with a total of 25,361 households (including multiple households) across all nine provinces. It confirms a number of positive trends related to service delivery as established by previous surveys. However, although access to basic services continues to improve, there is some discontent with the quality of those services. In the case of housing, for example, 16.1% of those occupying state-subsidised housing said that the walls were weak or very weak and 14.9% regard their roofs as weak or very weak. Similarly, although 58% of users of water services said that the quality of such services was good, there has been a steady decline in levels of satisfaction since 2005. The survey also reveals that the number of people living in informal dwellings has dropped. In spite of the resolution to eradicate the use of bucket toilets, it has been found that as soon as bucket toilets were eliminated in a community, other newly formed communities started using the system for a lack of alternatives. Nationwide the percentage of households with no toilets or bucket toilets decreased from 12.6% in 2002 to 6.6% in 2009.
Open collaboration and sharing of information among scientists at scientific meetings can foster innovation and discovery. However, such sharing can be at odds with potential patenting and commercialisation objectives. This tension may be mitigated if certain procedures are followed in the context of scientific meetings. The article first discusses what makes a scientific finding patentable and then sets out four specific patent issues for scientists to consider before attending a scientific meeting and sharing their research. Finally, it provides recommendations on how scientists can best protect their intellectual property rights while sharing information at scientific meetings.
According to this article, epidemiologists and public health researchers are moving very slowly in the data-sharing revolution, and agencies that maintain global health databases are reluctant to share data too. Funders of public health research are beginning to call for change and developing data-sharing policies that are in the public interest. However they are not yet adequately addressing the obstacles that underpin the failure to share data, which include professional structures that reward publication of analysis but not of data, and funding streams and career paths that continue to undervalue critical data management work. Practical issues need to be sorted out too: how and where should data be stored for the long term, who will control access and who will pay for those services? The article offers goals for data sharing and a work plan for reaching them, and challenges respondents to move beyond well-intentioned, but largely aspirational, data-sharing plans.