Health offers a universal indicator of progress in attaining the United Nations Secretary General's goals for sustainable energy for all, argues the World Health Organisation (WHO) in this report. Citing estimates of close to 1.3 million deaths annually due to urban air pollution and 2 million death to household air pollution, WHO notes that this health burden could be avoided with more efficient, better used and better distributed energy technologies. WHO puts forward some key health-relevant indicators of progress on sustainable energy, including: household access to modern, low-emission heating/cooking technologies; energy access at community health facilities, particularly for reliable electricity; health burden from air pollution-related diseases and injuries; health equity impacts of energy policies including access by poor and vulnerable populations; clean electricity generation across the energy supply chain in terms of reduced pollution; and greater efficiencies and reliance on renewable energy sources.
Monitoring equity and research policy
CEWG, the expert working group advising the World Health Organisation (WHO) on research and development, has recommended that the May 2012 World Health Assembly adopt an international convention on research and development (R&D) that will bind member states to action and catalyse new knowledge for diseases that primarily affect the global poor but for which patents provide insufficient market incentives. In this editorial, the chairpersons of the expert group summarise the recommendations and report of CEWG, which they say constitute a transformative change for achieving access to medicines. They argue that financial contributions should be determined based on the concept that both the costs and benefits of R&D should be shared. They recommend a role for WHO in the stronger coordination of R&D and suggest pooling of financial investments to secure efficient allocations to where demands and opportunities are identified through active participation of developing countries. An international convention, the authors argue, is a way to secure a systemic and sustainable solution since it creates a formalised platform for the future where countries can be held accountable.
This presentation, delivered at Forum 2012 in April 2012, describes a partnership between the Dutch Council on Health Research for Development (COHRED), the African Union (AU) and the NEPAD Agency (a technical arm of the AU) to help African countries develop their national health research agendas. The partnership aims to support Africans’ ownership and optimal utilisation of research for health to achieve health and health equity, reduce poverty, and contribute to the socio-economic development of countries, regions and the continent. It is also intended to strengthen the existing capacity of African institutions and networks to support the process of capacity building at the governance and policy levels of national research systems. At the initial phase, three countries have been identified and selected to participate in the programme: Mozambique, Senegal and Tanzania. In Mozambique, a national priority setting process is being carried out, while in Tanzania, national research priorities and agenda have been set and the partnership has developed a ‘research ethics ‘management’ platform, as well as a national research for health management information system.
Participants at Forum 2012, held in Cape Town in April 2012, have argued that it is a misconception that developing countries rely purely on international aid, as they remain the major funders of research in their countries, despite finding it difficult to meet recommended targets for research and development spending. They called for greater collaboration with neighbouring countries, such as pooling resources and knowledge, as well as better cooperation between different sectors within countries to drive improved health outcomes. Innovation was also identified as a key factor in compensating for the lack of infrastructure and resources, especially in the form of new information and communication technologies (ICTs), with virtual collaboration, sharing of data and mobile health technology to reach rural areas, being some of the exciting possibilities. At the Forum, participants had the opportunity to share experiences on how to set their own priorities for research, build capacities and provide incentives for innovation, with the need to always ensure the involvement of communities in setting the priorities for health research being a strong and recurring theme. Also high on the Forum 2012 agenda was the issue of women’s health, although it was stressed that the focus should be on sexual and reproductive health and not simply on maternal health.
In Tanzania, as in many developing countries, the national Health Management Information System (HMIS) is stuck in a vicious cycle: national health data are used little because they are of poor quality, and their relative lack of use, in turn, makes their quality remain poor. In this study, an action research approach was applied to strengthen the use of information and improve data quality in Zanzibar. The underlying premise was that encouraging use in small incremental steps could help to break the vicious cycle and improve the HMIS. To test the hypothesis at the national and district levels a project to strengthen the HMIS was established in Zanzibar. The project included quarterly data-use workshops during which district staff assessed their own routine data and critiqued their colleagues’ data. The data-use workshops generated inputs that were used by District Health Information Software developers to improve the tool. The HMIS, which initially covered only primary care outpatients and antenatal care, eventually grew to encompass all major health programmes and district and referral hospitals. The workshops directly contributed to improvements in data coverage, data set quality and rationalisation, and local use of target indicators. The authors conclude that data-use workshops with active engagement of data users themselves can improve health information systems overall and enhance staff capacity for information use, presentation and analysis for decision-making.
At Forum 2012, held in Cape Town in April 2012, a session was convened to explore the current roles and future potential of international partnerships in advancing African development through health research. Attendees sought to identify the elements of partnerships that would bring the greatest benefits to research and capacity development in Africa and, at the same time strengthen health and development systems on the continent. COHRED said that funders and research programmes must consciously build systems and capacity in their areas that can extend beyond silos and support other campaigns. Participants developed a number of specific and general recommendations. Most crucially, perhaps, research for health programmes must design capacity building for development and health systems into their programmes from the earliest stages, i.e., this must be a goal and not merely an incidental, even unexpected collateral benefit. Partnering organisations should be selected with attention to their commitment to ensuring that the infrastructure and human expertise which will be developed for the programme is sustainable and transferable. Country ownership will benefit from locally anchored partners, such as national universities, who will still be there when a particular research programme is concluded.
In this global review, researchers aimed to determine which countries are experiencing gaps in health research, identifying Chad, Angola, DRC, Sudan, Lesotho, Rwanda, Madagascar, Algeria, and the Central African Republic as African countries with the lowest levels of health research. Efforts to strengthen capacity in health research have, so far, concentrated on countries where there is existing capacity rather than those where it is almost completely lacking. Judged by absolute numbers of scientific papers, those with the fewest are mainly small islands and a few countries that are politically isolated. Judged by papers per capita, the lowest include countries in the former Soviet Union and Africa, both regions experiencing declines in life expectancy in recent years, and states experiencing conflict. Although there is a positive association between economic development and research output, some relatively wealthy countries seriously underperform. There are many examples of good practice, including regional networks and international partnerships. The authors present a strong argument for external funders to look to the long term and consider how best to build health research capacity where it is virtually absent.
In this study, the Lives Saved Tool (LiST) model was used to quantify the likely impact that malaria prevention intervention scale-up has had on malaria mortality over the past decade (2001-2010) across 43 malaria endemic countries in sub-Saharan African. The likely impact of insecticide-treated nets (ITNs) and malaria prevention interventions in pregnancy (intermittent preventive treatment [IPTp] and ITNs used during pregnancy) over this period was assessed. Results indicated that malaria prevention intervention scale-up over the past decade has prevented 842,800 child deaths due to malaria in the 43 countries, compared to a baseline of the year 2000. Over the entire decade, this represents an 8.2% decrease in the number of malaria-caused child deaths that would have occurred over this period had malaria prevention coverage remained unchanged since 2000. The biggest impact occurred in 2010 with a 24.4% decrease in malaria-caused child deaths compared to what would have happened had malaria prevention interventions not been scaled-up beyond 2000 coverage levels. ITNs accounted for 99% of the lives saved. The results suggest that funding for malaria prevention in Africa over the past decade has had a substantial impact on decreasing child deaths due to malaria. Rapidly achieving and then maintaining universal coverage of these interventions should be an urgent priority for malaria control programmes in the future, the authors argue. Successful scale-up in many African countries will likely contribute substantially to meeting Millennium Development Goal (MDG) 4 to reduce child mortality, as well as succeed in meeting MDG 6 (Target 1) to halt and reverse malaria incidence by 2015.
Little is known about the burden of influenza in sub-Saharan Africa. Routine influenza surveillance is key to getting a better understanding of the impact of acute respiratory infections on sub-Saharan African populations. To address this gap, a project called Strengthening Influenza Sentinel Surveillance in Africa (SISA) was launched in Angola, Cameroon, Ghana, Nigeria, Rwanda, Senegal, Sierra Leone and Zambia. It aimed to help improve influenza sentinel surveillance, including both epidemiological and virological data collection, and to develop routine national, regional and international reporting mechanisms. These countries received technical support through remote supervision and onsite visits. Consultants worked closely with health ministries, the World Health Organization, national influenza laboratories and other stakeholders involved in influenza surveillance. Working documents such as national surveillance protocols and procedures were developed or updated and training for sentinel site staff and data managers was organised. The main lesson emerging from SISA is that targeted support to countries can help them strengthen national influenza surveillance, but long-term sustainability can only be achieved with external funding and strong national government leadership.
In this paper, the authors outline the process of developing country-specific spreadsheet-based models to explore the financial resource requirements of health system reform options in South Africa and Tanzania. Their intention is to provide guidance for analysts who wish to develop their own models, and to illustrate, with reference to the South African and Tanzanian modelling experience, how one has to adapt to data constraints and context-specific modelling requirements. They found that using modelling to assess the financial feasibility and implications of alternative health system reform paths can be of great value in supporting evidence-informed policy-making. Developing one's own spreadsheet model has a number of advantages, including allowing greater flexibility to reflect specific country circumstances and requiring the analyst to carefully evaluate the assumptions built into the model. A pragmatic approach should be adopted in data scarce contexts, but all assumptions should be made explicit and justified. A major advantage of the modelling process is that it can highlight priority areas for improved data collection.