In November 2016, the global health systems research community gathered in Vancouver, Canada, for the Fourth Global Symposium on Health Systems Research. The current movement for health systems research developed out of a need to strengthen health systems in low-income and middle-income countries. More than 25 years ago, the Commission on Health Research for Development published a report that represented a pivotal change in thinking about health research for development. The main argument of the report was that research contributed little to health in low-income and middle-income countries, because it matched poorly with needs in the global South, was dominated by researchers from the North, and had a narrow biomedical focus. While health systems research has taken off in some high-income countries, progress in low-income and middle-income countries has not kept up. The 2008 Global Ministerial Forum on Research for Health in Bamako, Mali, concluded with the recommendation to increase investments in health systems research and organise a global symposium specifically focused on improving health systems in low-income and middle-income countries. Since then, the field has expanded rapidly. To contribute to the debate concerning the status and future of the health systems research field, the authors assessed the research presented at the previous global symposia. They systematically analysed the 1816 abstracts that were presented at the global symposia in Beijing (2012) and Cape Town (2014) and the participant lists of the Cape Town, Beijing, and Montreux (2010) symposia. The findings present several promising developments but also highlight that research inequities persist. While the authors observe a gender balance (51% of first authors are female) and substantial contributions from countries such as India, China, and South Africa, the North-South imbalance that was described 26 years ago remains.
Monitoring equity and research policy
The San of South Africa are one of the most researched communities in the world. Their indigenous knowledge and genetic makeup have been of great interest to researchers as they are ancestors of the first hunter-gatherers in Africa. While the media and researchers have continued to want to engage with the community, TRUST, a global initiative which seeks to reduce exploitation in North-South research collaborations, alongside the San Council created a contract to protect the community from exploitation, and to ensure that the San also benefit from any research. This paper outlines a locally driven Code of Ethics for involving San people in research that has been initiated by a range of organisations in Southern Africa. Referencing the original research and media contract, this is now being finalised into the first indigenous-developed ethics code in Africa.
Building Capacity to Use Research Evidence (BCURE) is a programme of work funded by the UK Department for International Development (DFID) which aims to build the skills, knowledge and systems that will allow policy makers and practitioners in low income countries to access, appraise and use rigorous evidence. BCURE works through a consortium of organisations, focusing on building capacity to make evidence informed decisions. Examples of some of the different interventions are incorporating processes to improve evidence use by Cabinet Ministers, using innovative online training methods to improve the skills of individuals to make evidence informed decisions, establishing open policy dialogues between government officials, civil society and the research sector to promote the use of evidence in decision making and developing the African Evidence Network – where policy makers and practitioners can discuss and share lessons on evidence use. Each project has a primary provider, who oversees the management of that work. BCURE is being delivered with a specific focus on building the capacity of locally based partner organisations in the countries where projects are operating, as essential for the sustainability of the programme.
The International Panel on Social Progress (IPSP) is a global initiative that brings together a large group of scholars brought together to compile evidence across disciplines to rethink ideas of a just society. They recognised the interconnected forces of: weakening traditional nation states; technological change; profound and unequal transformations in health and education outcomes; and contestations between the religious and secular. IPSP have produced this report aimed at social actors, movements, organisations, politicians and decision-makers, to provide them with the best evidence on questions that bear on social change. The report has 22 chapters covering a comprehensive range of areas that have an important bearing on society now and into the future. It is the first comprehensive synthesis of social sciences knowledge about key issues facing humankind today. This first draft is available for public consultation and comment and IPSP invite comments from all concerned citizens and organisations. There is a web based platform for comments and inputs.
Public health has multicultural origins. By the close of the nineteenth century, Schools of Public Health (SPHs) began to emerge in western countries in response to major contemporary public health challenges. The Flexner Report (1910) emphasised the centrality of preventive medicine, sanitation, and public health measures in health professional education. The Alma Ata Declaration on Primary Health Care (PHC) in 1978 was a critical milestone, especially for low and middle-income countries (LMICs), conceptualising a close working relationship between PHC and public health measures. The Commission on Social Determinants of Health (2005–2008) strengthened the case for SPHs in LMICs as key stakeholders in efforts to reduce global health inequities. This scoping review groups text into public health challenges faced by LMICs and the role of SPHs in addressing these challenges. The challenges faced by LMICs include rapid urbanisation, environmental degradation, unfair terms of global trade, limited capacity for equitable growth, mass displacements associated with conflicts and natural disasters, and universal health coverage. Poor governance and externally imposed donor policies and agendas, further strain the fragile health systems of LMICs faced with epidemiological transition. Moreover barriers to education and research imposed by limited resources, political and economic instability, and unbalanced partnerships additionally aggravate the crisis. To address these contextual challenges effectively, SPHs are offering broad based health professional education, conducting multidisciplinary population based research and fostering collaborative partnerships. SPHs are also looked upon as the key drivers to achieve sustainable development goals (SDGs).
The African Institute for Development Policy AFIDEP conducted a training workshop for more than 15 parliament staff from 10 African countries on evidence-informed decision-making (EIDM) on June 27-28, 2016 in Munyonyo, Uganda. The parliamentary staff included researchers and clerks who support parliamentary health committees. These staff provide committees with briefings on issues to inform their debates and decisions, and therefore play a crucial role in the ecosystem of evidence use in parliament. The workshop equipped the parliamentary researchers and clerks with knowledge and skills in: the critical place of evidence in the legislature; knowledge of where and how to effectively search for evidence, assess its quality, and synthesise and package it appropriately for use by MPs.
The Global Forum 2015 panel session dialogue entitled “From evidence to policy – thinking outside the box” was held on 26 August 2015 in the Philippines to debate why evidence was not fully translated into policy and practice and what could be done to increase its uptake. This paper reports the reasons and possible actions for increasing the uptake of evidence, and highlights the actions partners could take to increase the use of evidence in the African Region. The Global Forum 2015 debate attributed African Region’s low uptake of evidence to the big gap in incentives and interests between research for health researchers and public health policy-makers; limited appreciation on the side of researchers that public health decisions are based on multiple and complex considerations; perception among users that research evidence is not relevant to local contexts; absence of knowledge translation platforms; sub-optimal collaboration and engagement between industry and research institutions; lack of involvement of civil society organisations; lack of engagement of communities in the research process; failure to engage the media; limited awareness and debate in national and local parliaments on the importance of investing in research and innovation; and dearth of research and innovation parks in the African Region. The actions needed in the Region to increase the uptake of evidence in policy and practice include strengthening national health research governance; bridging the motivation gap between researchers and health policy-makers; restoring trust between researchers and decision-makers; ensuring close and continuous intellectual intercourse among researchers, ministry of health policy-makers and technocrats during the life course of research projects or programmes; proactive collaboration between academia and industry; regular briefings of civil society, media, relevant parliamentary committees and development partners; development of vibrant knowledge translation platforms; development of action plans for implementing research recommendations, preferably in the context of the Sustainable Development Goals; and encouragement of competition on health research strengthening and research output and uptake among the countries using a barometer or scorecard to review their performance at various regional ministerial forums and taking into account the lessons learned from the MDG period.
The need for legislative information and research, especially in developing and transition countries, is growing as policy-making processes become more complex, particularly in the context of globalisation, regional integration and decentralisation. Since the executive branch of governments generally has access to a larger pool of knowledge and expertise than the national legislature, there is a need to address the imbalance in access to knowledge between the executive, legislature and judiciary in order to promote better quality policy-making. Better access to information and research can help empower legislatures to formulate and pass effective legislation and perform effective scrutiny of government. Using the Research and Policy in Development (RAPID) framework, this study maps the links between researchers and legislators in a number of transition and developing countries; explores the role of politics in influencing researcher–legislator linkages; and comments on the type of research produced as well as the credibility of the research/researchers. Civil society organisations (CSO) particularly in Sub-Saharan Africa, perhaps because of weak political parties, play a key role in representing grassroots constituencies in legislative processes. Legislative committee hearings across all legislatures tend to be a key mechanism through which researchers’ voices can be heard in the processes of law-making and oversight. Some legislatures, particularly those in East Asia, have substantial in-house technocratic capacity, including library and research services and the capacity to commission research. In Sub-Saharan Africa, a number of (donor-funded) organisations have been set up to provide the legislature with input and capacity, particularly on management of public finances. Researcher–legislator linkages, particularly in Sub-Saharan Africa, tend to be stronger or more visible in areas that are perceived to require hard data, such as quantitative analyses. These include public financial management, particularly budgeting and budget control. In Sub-Saharan Africa, these formal mechanisms were found in the study to be externally funded and/or -inspired. Where hard data is concerned, research tends to be demand-oriented; in the softer sectors, CSOs have tended to take the initiative to engage legislators. The relationship between political context factors and researcher–legislator links was found to be complex. Legislators’ personal motivations, such as the desire for political advancement, to influence policy, for power in a legislative body and for private gain, can affect the way they view or use evidence in the policy process. The capacity provided by a legislature’s procedures, structures and support mechanisms also influences the role of research in law-making and oversight processes. They propose that researchers work harder to ensure evidence is accessible by legislators and related to legislative decisions, that fits tightly with legislative processes. Legislators emphasised the need for researchers to go beyond stating research findings to actually narrate a compelling story with practical policy recommendations. Moreover, evidence is more likely to be taken up if messages resonate with broader national policy agendas, such as economic growth. Given the pressures on their time and relatively low research literacy levels, research intended for legislators needs to be presented in short summaries, where possible illustrated by pictures and/or charts. Nevertheless, Legislators’ staff prefer formats that present more detail.
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 functional national health research system (NHRS) is crucial in strengthening a country’s health system to promote, restore and maintain the health status of its population. Progress towards the goal of universal health coverage in the post-2015 sustainable development agenda will be difficult for African countries without strengthening of their NHRS to yield the required evidence for decision-making. This study developed a barometer to facilitate monitoring of the development and performance of NHRSs in WHOs African Region. The African national health research systems barometer algorithm was developed in response to a recommendation of the African Advisory Committee for Health Research and Development of WHO. Survey data collected from all the 47 Member States in the WHO African Region using a questionnaire were entered into an Excel spreadsheet and analysed. The barometer scores for each country were calculated and the performance interpreted according to a set of values ranging from 0% to 100%. The overall NHRS barometer score for the African Region was 42%, which is below the average of 50%. Among the 47 countries, the average NHRS performance was less than 20% in 10 countries, 20–40% in 11 countries, 41–60% in 16 countries, 61–80% in nine countries, and over 80% in one country. The performance of NHRSs in 30 (64%) countries was below 50%. An African NHRS barometer with four functions and 17 sub-functions was developed to identify the gaps in and facilitate monitoring of NHRS development and performance. The NHRS scores for the individual sub-functions can guide policymakers to locate sources of poor performance and to design interventions to address them.