Although most countries in sub-Saharan Africa lack an effective and comprehensive national civil registration and vital statistics system (CRVS), in the past decades the number of Health and Demographic Surveillance Systems (HDSSs) has increased throughout the region. The authors of this paper argue that, in the absence of an adequate national CRVS, HDSSs should be more effectively utilised to generate relevant public health data, and also to create local capacity for longitudinal data collection and management systems. If HDSSs get strategically located to cover different geographical regions in a country, data from these sites could be used to provide a more complete national picture of the health of the population. Strategic planning is needed at national levels to geographically locate HDSS sites and to support these through national funding mechanisms. The authors emphasise that HDSSs should not be seen as a replacement for civil registration systems. Rather, they should serve as a short- to medium-term measure to provide data for health and population planning at regional levels with possible extrapolation to national levels. HDSSs can also provide useful lessons for countries that intend to set up nationally representative sample vital registration systems in the long term.
Monitoring equity and research policy
Health decision-makers need to rely more on data to inform their decision making, according to this paper. The failure to consider empirical evidence regularly before making programme and policy decisions is due primarily to the complex causal pathway between data collection, its use, and improvement in health outcomes, she argues. Further, specific and comprehensive guidance to improve data demand and use is lacking. This paper fills this gap by providing specific recommendations for how to improve data-informed decision making by suggesting domains of interventions, activities, actors, tools, and resources to involve in the process in each step. The eight activity areas listed in the conceptual framework and the further detail provided in the logic model provide a comprehensive roadmap for how to design, monitor, and evaluate interventions to improve the demand for and use of data in decision making. More experience is needed applying the comprehensive framework in different contexts, the authors warn. The factors influencing demand for and use of data are dependent on the local context and specific needs. It is probable that all of the activity areas discussed in this paper may not need to be implemented as part of an intervention to improve the demand for and use of data; and that other activity areas not listed here, will be relevant instead. Moreover, the relative importance of each activity area is unknown, as is the level of intensity of each activity area. Nonetheless, this conceptual framework and logic model should contribute to the literature on comprehensive approaches to improving the use of data in decision making.
Exploring some of the assumptions underlying ‘evidence based’ approaches to poverty reduction, this paper argues that the discourse of Evidence-Based Policy (EBP) offers poor guidance to those who seek to ensure that social policy making is informed by the findings of social science. EBP discourse relies on a technocratic, linear understanding of the policy making process and on a naïve empiricist understanding of the role of evidence. This renders it unable to engage with the role of the underlying discursive frameworks and paradigms that render evidence meaningful and invest it with consequence: EBP discourse does not help us understand either how policy changes, or what is at stake in dialogue across the ‘research-policy divide’. Rather than simply focusing on evidence, approaches to policy change need to focus on how evidence is used in the politically loaded and ideologically compelling ‘policy narratives’ that contest rival policy frameworks. The paper considers an example from the South African context – the shift to the ‘two economies’ framework and the policy interventions associated with the Accelerated and Shared Growth Initiative for South Africa (ASGISA)– and explores the implications for approaches to research more attuned to the realities of the policymaking process. It concludes with a discussion of the implications for social researchers and policy makers.
As there is little published evidence about processes in research-policy partnerships in different contexts, this paper aims to help fill this research gap by analysing experiences of research-policy partnerships between Ministries of Health and research organisations for the implementation of the Mental Health and Poverty Project in Ghana, South Africa, Uganda and Zambia. The authors developed a conceptual framework for understanding and assessing research-policy partnerships to guide the study and collected data via semi-structured interviews with Ministry of Health Partners (MOHPs) and Research Partners (RPs) in each country. The principles of trust, openness, equality and mutual respect were identified by respondents as constituting the core of partnerships. The MOHPs and RPs had clearly defined roles, with the MOHPs largely providing political support and RPs leading the research agenda. The authors also found that taking account of influences on the partnership at individual, organisation and contextual/system levels can increase its effectiveness. A common understanding of mutually-agreed goals and objectives of the partnership is essential. Although partnerships are often established for a specific purpose, such as carrying out a particular project, the effects of partnership go beyond a particular initiative.
Greater health systems research and development is needed to support the global malaria eradication agenda, argues the malERA Consultative Group on Health Systems and Operational Research. In this paper, the Group focuses on the health systems needs of the elimination phase of malaria eradication and analyses groupings of countries at different stages along the pathway to elimination. It examines the difference between the last attempt at eradication of malaria and more recent initiatives, and considers the changing health system challenges as countries make progress towards elimination. The paper contains a review of recent technological and theoretical developments related to health systems and the renewed commitment to strengthening health systems for universal access and greater equity. The Group identifies a number of needs for research and development, including tools for analysing and improving effective coverage and strengthening decision making and discuss the relevance of these needs at all levels of the health system from the community to the international level.
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.
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.