This is the first of a series of three papers addressing the current challenges and opportunities for the development of Health Policy and Systems Research (HPSR). HPSR is a multidisciplinary and interdisciplinary field identified by the topics and scope of questions asked rather than by methodology. The focus of discussion is HPSR in low- and middle-income countries. Topics of research in HPSR include international, national, and local health systems and their interconnectivities, and policies made and implemented at all levels of the health system. Research questions in HPSR vary by the level of analysis (macro, meso, and micro) and intent of the question (normative/evaluative or exploratory/explanatory). Current heightened attention on HPSR contains significant opportunities, but also threats in the form of certain focus areas and questions being privileged over others; “disciplinary capture” of the field by the dominant health research traditions; and premature and inappropriately narrow definitions. The authors call for greater attention to fundamental, exploratory, and explanatory types of HPSR; to the significance of the field for societal and national development, necessitating HPSR capacity building in low- and middle-income countries; and for greater literacy and application of a wide spectrum of methodologies.
Monitoring equity and research policy
This is the second of a series of three papers addressing the current challenges and opportunities for the development of Health Policy and Systems Research (HPSR). According to this paper, all researchers hold a knowledge paradigm that frames their understanding of reality and of the functions and nature of research. Some disciplines are dominated by a particular paradigm and some are spread across paradigms. The criticisms that Health Policy and Systems Research (HPSR) is too context specific, does not offer clear lessons for policy makers, and is not rigorous are partly a reflection of differences in knowledge paradigms between those with predominantly clinical, biomedical, and epidemiological backgrounds, underpinned by a positivist paradigm, and those with social science backgrounds underpinned by a relativist paradigm. Health policies and systems are complex social and political phenomena, constructed by human action rather than naturally occurring. Therefore, the authors argue, relativist social science perspectives are of particular relevance to HPSR as they recognise that all phenomena are in essence constructed through human behaviour and interpretation. Social science insights that can advance the science of HPSR include: approaches to generalising from rich understanding of context; supporting policy learning; and enhancing research rigour and quality.
In South Africa, the number of papers produced in health and rehabilitation sciences is insignificant compared with other health-related disciplines, according to the authors of this paper. To identify strategies to increase the number of these papers, the authors reviewed published papers that examined the effectiveness of interventions designed to promote research publications among academics and clinicians in health and rehabilitation sciences programmes. Seven of the papers reported on interventions for academics, and six reported on the interventions for academics in the nursing profession. The most common interventions were ‘writing support groups’, ‘writing retreats’, and ‘writing courses’ that lasted from three days to five years. The interventions were designed to meet the needs of the participants for structured time, motivation, improved writing skills and peer support. All the interventions produced significant research output relating to submission or publication of academic papers. The implementation of these interventions by South African tertiary institutions where health and rehabilitation sciences are offered may improve the number of papers published by the health research community, the authors conclude.
In this article, the author argues that international agreements and planning instruments such as the World Bank’s Poverty Reduction Strategy Papers (PRSPs) often fail to question the parameters within which national plans are prepared. Home grown solutions can only be produced from knowledge and policies that are locally generated and context specific. Southern knowledge centres (or think tanks) – which are estimated to number about 2,000 – then have a crucial role to play in promoting economic and social development in the global South, particularly in the poorer economies. In an increasingly interconnected world, Northern and Southern think tanks are joining forces in partnerships and networks to generate and use knowledge more systematically to address national, regional, and global challenges. A number of examples of North-South collaborations are discussed in the article, including the Chronic Poverty Research Centre and the Climate and Development Knowledge Network. Networks of think tanks can provide an extremely effective mechanism for learning and innovation, the author notes, and they can enable collaboration beyond the usual institutional, cultural, and functional boundaries of an organisation.
Despite the benefits to collaborative approaches and sharing of best practices, none of this can take place in the absence of adequate funding, the authors of this article argue. They call for re-examination of funding initiatives that bypass academic institutions because of a reluctance to fund ‘Ivory Tower’ initiatives. Recent initiatives will invest approximately US$130 million over the next five years to strengthen Africa’s educational institutions to produce the quantity and quality of scientists and health care workers needed to address the healthcare problems in the region. Whereas this represents a step in the right direction, substantially more funding will be required, including funding from the African governments themselves, to address national health priorities. The authors challenge conventional notions that academia is hesitant to come down from their ivory towers. Universities can and must be socially relevant. Funding and investments are needed now to make these collaborations sustainable, they conclude.
Complementary medicine research, including naturopathic medicine research, is plagued with many methodological challenges, the authors of this paper argue. Many of these challenges have also been experienced in public health research. Public health research has met these challenges with a long history of multidisciplinary, multimethod, and whole systems approaches to research that may better resonate with the “real world” clinical settings of naturopathic medicine. Additionally, many of the underlying principles of naturopathic medicine are analogous to the underlying principles and activities of public health, specifically in such areas as health promotion, prevention, patient education, and proactive rather than reactive approaches to disease management and treatment. Future research in the field of naturopathic medicine may benefit from adopting public health research models rather than focusing exclusively on biomedical models, the authors argue. A complementary and collaborative relationship between these fields may provide an opportunity to deliver research that more accurately reflects naturopathic medicine practice, as well as providing the opportunity to improve health outcomes more generally.
At the Berlin 9 conference, held in Washington DC, United States from 9-10 November 2011, it was announced that 33 research institutions, associations and foundations in North America have added their signatures to the Berlin Declaration on Open Access to Knowledge in the Sciences and Humanities, committing to support open access research in the future. The signing brings the total signatories to nearly 300, including many of the top research institutions in the world. The Berlin Declaration aims to ‘make scientific and scholarly research more accessible to the broader public by taking full advantage of the possibilities offered by digital electronic communication.’
In this study, researchers investigated the alignment of health research capacity at Makerere College of Health Sciences (MakCHS) with the health needs and priorities of Uganda, as outlined in the country’s Health Sector Strategic Plan (HSSP). They assessed MakCHS’s research grants and publication portfolio, as well as all the university’s publications, between January 2005 and December 2009. A total of 58 active grants were identified, of which 18 had been initiated prior to 2005 and there were an average of about eight new grants per year. Most grants funded basic and applied research, with major focus areas being HIV and AIDS (44%), malaria (19%), maternal and child health (14%) and tuberculosis (11%). A total of 837 publications were identified, with an average of 167 publications per year, 66% of which addressed the country’s priority health areas, and 58% had MakCHS faculty members or students as first authors. Findings indicate that the research grants and publications at MakCHS are generally well-aligned with Ugandan Health Ministry priorities. Greater efforts to establish centralised and efficient grants management procedures are needed, the researchers argue. In addition, efforts are needed to expand capacity for MakCHS faculty leadership of grants, as well as to continue to expand the contribution of MakCHS faculty to lead research publications.
In this study, reproductive-age women were recruited from the Butajira Demographic Surveillance System (DSS) database to analyse the determinants of fertility in rural Ethiopia. A district health survey maternity history questionnaire was administered to 9,996 participants. Results showed that delayed marriage, a higher level of education, a smaller family, absence of child death experience and living in food-secured households were associated with a smaller number of children. Fertility was significantly higher among women with no child-sex preference. However, migration status of women was not statistically significant. The researchers argue that policy makers should focus on increasing women’s secondary school enrollment and age at first marriage. The community should also be made aware on the negative impact of fertility on household economy, the environment and the country's socio-economic development at large.
The World Intellectual Property Organisation (WIPO), in conjunction with the World Health Organisation, private sector and foundation partners, is preparing to launch a new voluntary database for the sharing of intellectual property for research and development (R&D) on medicines, vaccines and diagnostics for neglected diseases. The project will target least-developed countries and is likely to include a database and a space for creating partnerships. But budget, oversight and the role of member states are still unclear. The aim of the initiative is to boost discovery and development of medicines, vaccines and diagnostics for neglected tropical diseases plus malaria and tuberculosis through greater availability of intellectual property to researchers.