The research community has shown increasing interest in developing and using metrics to determine the relationships between urban living and health. In particular, the authors have seen a recent exponential increase in efforts aiming to investigate and apply metrics for urban health, especially the health impacts of the social and built environments as well as air pollution. A greater recognition of the need to investigate the impacts and trends of health inequities is also evident through more recent literature. Data availability and accuracy have improved through new affordable technologies for mapping, geographic information systems and remote sensing. However, less research has been conducted in low- and middle-income countries where quality data are not always available, and capacity for analysing available data may be limited. For this increased interest in research and development of metrics to be meaningful, the best available evidence must be accessible to decision makers to improve health impacts through urban policies.
Monitoring equity and research policy
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.
The authors outline a comprehensive approach for developing a cross-sectoral, multi-dimensional and dynamic understanding of resilience. This underpins the message of the Sustainable Development Goals (SDGs) that development is multi-faceted and the achievement of many of the individual development goals is dependent on the accomplishment of other goals. It also acknowledges that shocks and stresses can reverse years of development gains and efforts to eradicate poverty by 2030. The authors argue that this approach to understanding resilience draws on data that countries will collect for the SDGs anyway and entails only a small additional burden.
This report explores evidence of success in environmental justice (EJ) activism on socio-environmental mining conflicts by applying a collaborative statistical approach, combining qualitative and quantitative methods. The empirical evidence covers 346 mining cases from around the world in the EJOLT Atlas of Environmental Justice, and is enriched by an interactive discussion of results with activists and experts. The authors used a social network analysis to study the nature of the relationships both among corporations involved in the mining activity, on the one hand, and among EJ organisations, on the other. Multivariate analysis methods were used to examine the defining factors in achieving EJ success and qualitative analysis, based on descriptive statistics, was conducted to investigate factors that configure the perception of success for EJ and incorporate activist knowledge into the theory of EJ. The authors argue that overall, such analytical exercises, coproduced with activists, should be seen as a source of engaged knowledge creation, which is increasingly being recognised as a pertinent method to inform scientific debate with policy implications, and that it can also be insightful and relevant for activism.
In his book Damned Lies and Statistics (2001), Best points out that ‘people who bring statistics to our attention have reasons for doing so’. Some statistics are manufactured and manipulated as ammunition for political struggles, although their purpose is hidden behind assertions of objectivity and accuracy. The author argues that numbers often get amplified in the echo chamber of mainstream media and that one should never accept on face value that statistics always reveal truths. He argues that they are often used to manage perceptions more than to help analysis and understanding of complex realities. He thus urges people to be involved in reviewing and commenting on the work of and proposals from the UN Statistical Commission as they develop indicators for the SDGs.
The West African Health Organization (WAHO) implemented a research development program in West Africa during 2009–2013 with components of stewardship, financing, sustainable resourcing and research utilization. This paper describes how programme and lessons learnt, triangulating activity reports, an independent evaluation and the authors’ experiences with stakeholders. WAHO and major stakeholders validated these findings during a regional meeting. All 15 ECOWAS countries benefited from this regional research development programme. WAHO provided technical and financial support to eight countries to develop their policies, priorities and plans for research development to improve their research governance and organised capacity-strengthening training in health systems research methodology, resource mobilization, ethical oversight and on HRWeb, a research information management platform. WAHO helped launch a regional network of health research institutions to improve collaboration between regional participating institutions and mobilised funding for the programme. It supported 24 health research projects. High staff turnover, weak institutional capacities and ineffective collaboration were some of the challenges encountered during implementation. The regional collaborative approach to health research was found to be effective given the challenges in the region, and with research partnerships and funding helped strengthen local health research environments.
Universal provision of antiretroviral therapy (ART), while feasible, is expensive. In light of this limitation, the World Health Organisation (WHO) has launched the 3 × 5 initiative, to provide ART to 3 million people by the end of the year 2005. In Southern Africa, large-scale provision of ART will likely be achieved through fragile public health systems. ART programmes should therefore be developed and expanded in ways that will not aggravate inequities or result in the inappropriate withdrawal of resources from other health interventions or from other parts of the health system. This paper, proposes a framework for monitoring equity in access and health systems issues in ART programmes in Southern Africa. It proposes that an equity monitoring system should comprise seven thematic areas. These thematic areas encompass a national monitoring system which extends beyond one agency or single data collection method. Together with monitoring of targets in terms of numbers treated, there should also be monitoring of health systems impacts and issues in ART expansion, with reporting both nationally and to a regional body.
Developed collaboratively with actors in the region, this toolkit is a guide to the implementation of an indicator system to measure regional policy change and pro-poor regional health policy successes targeted at the pilot areas of HIV/AIDS, TB and malaria in the SADC context. The toolkit also aims to capture the limitations the health sectors in many countries may have in addressing structural issues that make the poor more vulnerable or at risk.
Integrated Community Case Management of Childhood Illness (iCCM) is a policy for providing treatment for malaria, diarrhoea and pneumonia for children below 5 years at the community level, which is generating increasing evidence and support at the global level. This article explores whether, how and why evidence influenced policy formulation for iCCM in Niger, Kenya and Mozambique, and explains the use of evidence in these contexts. Findings indicate that all three countries used national monitoring data to identify the issue of children dying in the community prior to reaching health facilities, whereas international research evidence was used to identify policy options. Nevertheless, policymakers greatly valued local evidence and pilot projects proved critical in advancing iCCM. World Health Organisation and United Nations Children's Fund (UNICEF) functioned as knowledge brokers, bringing research evidence and experiences from other countries to the attention of local policymakers as well as sponsoring site visits and meetings. Both Mozambique and Kenya exhibit Problem-Solving research utilisation with different outcomes.
The annually published District Health Barometer (DHB) in South Africa is designed and compiled to assist South Africa’s National Department of Health in making health and related information available for monitoring progress in health service delivery at district level. The Barometer provides current information on functioning and associated fluctuations in all the country’s health districts, describing performance over time in relation to previous years as well as between districts. Each edition highlights problem areas, data quality issues, sustained and notable progress, and aspects requiring deeper research into underlying factors contributing to the indicator values and trends. This 10th edition of the DHB presents data on 44 indicators, with trend illustrations and health profiles for South Africa as a whole, the nine provinces and the 52 districts, as well as a chapter on the country’s burden of disease. As in previous years, a varied picture emerges in terms of the national profile. Significant gains are noted in the rates of stillbirth; early mother-to-child transmission of HIV; cure among new pulmonary smear-positive TB patients; couple year protection; women under age 18 delivering babies in hospital; case fatality among children under five years of age from diarrhoea with dehydration and from pneumonia; and antenatal clients initiated on ART. However, persistent challenges prevail with regard to the Caesarean section rate in district hospitals, the school Grade 1 screening coverage, the measles 2nd dose coverage, and the case fatality rate for severe acute malnutrition in children under five years of age.