A pool of 38 pan-African Centers of Excellence (CoEs) in health innovation has been selected and recognised by the African Network for Drugs and Diagnostics Innovation (ANDI), through a competitive criteria based process. The process identified a number of opportunities and challenges for health research and development (R&D) and innovation in the continent. The CoEs are envisioned as an innovative network of public and private institutions with a critical mass of expertise and resources to support projects and a variety of activities for capacity building and scientific exchange, including hosting fellows, trainees, scientists on sabbaticals and exchange with other African and non-African institutions. The authors argue that a credible and sustainable solution to the health challenges in Africa must leverage existing R&D, manufacturing and commercialisation capacity across the continent to support integrated capacity utilisation and economic development. They call for greater and better integrated funding for health R&D. As a pan-African initiative focusing on health R&D, promoting local manufacturing and access to medicines, the ANDI initiative is in a good position to contribute in the actualisation of an integrated and coordinated product R&D platform in the African continent, the authors conclude.
Monitoring equity and research policy
In this study, researchers evaluated the effectiveness of South Africa’s national prevention programme for mother-to-child transmission (PMTCT) of HIV. They included a total of 10,820 eligible infants from 572 facilities in their survey, conducted 10,735 interviews and drew 10,178 dried blot spot specimens. Findings indicated a 3.5% national MTCT rate in pregnancy and intrapartum with varying distribution across the nine provinces (1.4% to 5.9%). Maternal HIV acquisition since the last HIV test was potentially high at 4.1% and therefore repeat HIV testing at 32 weeks pregnancy and couple testing is critical, the authors argue. While uptake of PMTCT services is over 90%, CD4 testing and early infant diagnosis (EID) uptake are considerably lower and represent on-going missed opportunities in the PMTCT programme. The authors call for a review of EID strategies that routinely offer infant HIV testing only to known HIV-exposed infants, as virtual elimination of paediatric HIV infection is possible with intensified effort. Only 20% of HIV-positive women were exclusively breastfeeding, 62% were formula feeding and 18% were practicing high-risk mixed feeding, suggesting a need for increased attention to infant feeding.
Increased urbanisation means there are an estimated 800 million slum-dwellers globally, according to World Health Organisation (WHO), who face increased health hazards and risks. Health is an important benchmark of sustainability of urban policies, WHO argues. It proposes health indicators that reflect progress on the social equity, environment and development dimensions of sustainable cities. WHO calls for slum housing improvements that benefit health, as assessed by well-defined measures for safe, resilient, and climate-adapted structures that also have access to clean energy and basic utilities. Urban air quality must be monitored in terms of particulate pollution with respect to WHO air quality guidelines. Healthy, efficient transport in urban areas must be promoted and violence reduced in terms of intentional homicides. Governance indicators can assess how cities account for health in urban planning and building codes, and in monitoring air/water quality and sanitation risks. WHO argues that indicators should include access to urban services, which is essential to public health and sustainable cities, and suggests indicators for health care services, green spaces, fresh food markets and waste management.
In this brief prepared for Rio+20 in June 2012, the world Health Organisation (WHO) argues that a healthy workforce is a prerequisite for social and economic development, and fair terms of employment and decent working conditions are critical to the health of the working-age population. Yet global occupational health statistics from 2011 reveal that an estimated 2.3 million people died from work related injuries, illnesses, and accidents. WHO calls for more systematic measurement and reporting of workers' health to help reduce work-related injuries, illnesses and deaths. Compliance with basic national occupational safety and health standards, at country level and by sector, can support improved workers' health, including in the transition to a green economy. Monitoring progress on the ratification and implementation of core international labour conventions covering occupational safety and health policies and occupational health services is a third measure supporting improved workers' health and safety.
Measurement of access to safe and climate resilient drinking-water resources, as well as sanitation, is increasingly critical in an era of continued population growth and climate change. Therefore ensuring access to safe, resilient and sustainable water and sanitation will accelerate attainment of multiple environment and health-related goals for sustainable development, according to this brief by the world Health Organisation. Indicators of access to safe drinking water require greater refinement to reflect the large, continuing gaps in access to safe drinking water among the world's poorest populations, and measure progress towards attainment of the universal right to water. Monitoring access to adequate climate-resilient water and sanitation systems is particularly critical in light of the increasing impacts of temperature change and extreme weather on water sources, sanitation systems and human health. WHO calls on public health agencies to embrace Integrated Water Resource Management, an approach that provides a comprehensive and multisectoral approach for the identification and management of water-related health risks.
A major obstacle to the progress of the Millennium Development Goals has been the inability of health systems in many low- and middle-income countries to effectively implement evidence-informed interventions. This paper looks at the relationships between implementation research and knowledge translation and identifies the role of implementation research in the design and execution of evidence-informed policy. After a discussion of the benefits and synergies needed to translate implementation research into action, the authors consider how implementation research can be used along the entire continuum of the use of evidence to inform policy. The paper provides specific examples of the use of implementation research in national level programmes by looking at the scale up of zinc for the treatment of childhood diarrhoea in Bangladesh and the scaling up of malaria treatment in Burkina Faso. A number of tested strategies to support the transfer of implementation research results into policy-making are provided to help meet the standards that are increasingly expected from evidence-informed policy-making practices.
Online, open access (OA) medical publishing has provided new opportunities for increased transparency and innovation in clinical trial reporting, which if widely adopted can ultimately help enhance the quality and reliability of evidence, argue the authors of this article. They discuss the OA movement’s role in medical research and provide an up-to-date analysis of recent initiatives and trends. Access to original research remains the driving force behind OA, recently exemplified in the United States by a Whitehouse petition for open access publication of tax-funded research as well as the negative reaction to the controversial Research Works Act, which would restrict sharing data between researchers. Meanwhile the British government has also announced its support for OA. Improving availability of data, increasing access to research in developing countries and creating new services for easier location and reuse of clinical information are all priorities for the future and can contribute to the advancement of clinical medicine, according to the article.
In the past few years there has been an ongoing debate as to whether the proliferation of open access (OA) publishing would damage the peer review system and put the quality of scientific journal publishing at risk. The aim of this study was to inform this debate by comparing the scientific impact of OA journals with subscription journals, controlling for journal age, the country of the publisher, discipline and (for OA publishers) their business model. A total of 610 OA journals were compared with 7,609 subscription journals using Web of Science citation data, while an overlapping set of 1,327 OA journals were compared with 11,124 subscription journals using Scopus data. Results showed that average citation rates were about 30% higher for subscription journals. However, after controlling for discipline (medicine and health versus other), age of the journal and the location of the publisher (four largest publishing countries versus other countries) the differences largely disappeared in most subcategories except for journals that had been launched prior to 1996. In medicine and health, OA journals founded in the last 10 years are receiving about as many citations as subscription journals launched during the same period.
The 20th anniversary of the report of the Commission on Health Research for Development inspired a Symposium to assess progress made in strengthening essential national health research capacity in developing countries and in global research partnerships. Significant aspects of the health gains achieved in the 20th century are attributed to the advancement and translation of knowledge, and knowledge continues to occupy center stage amidst growing complexity that characterizes the global health field. The way forward is argued to entail a reinvigoration of research-generated knowledge as a crucial ingredient for global cooperation and global health advances. The authors argue that this needs to overcome in the divides between domestic and global health, among the disciplines of research (biomedical, clinical, epidemiological, health systems), between clinical and public health approaches, public and private investments, and between knowledge gained and action implemented.
As the urban population of the planet increases, putting new stress on infrastructure and institutions and exacerbating economic and social inequalities, public health and other disciplines are being forced to find new ways to address urban health equity. The authors propose that urban indicator processes focused on health equity can promote new modes of healthy urban governance, where the formal functions of government combine with science and social movements to define a healthy community and direct policy action. An inter-related set of urban health equity indicators that capture the social determinants of health, including community assets, and to track policy decisions, can help inform efforts to promote greater urban health equity. Adaptive management, a strategy used globally by scientists, policy makers, and civil society groups to manage complex ecological resources, is a potential model for developing and implementing urban health equity indicators. While urban health equity indicators are lacking and needed within cities of both the global north and south, the authors warn that universal sets of indicators may be less useful than context-specific measures accountable to local needs.