Recent estimates of malaria-attributable under-five deaths prevented using the Lives Saved Tool (LiST) confirm the substantial impact and good cost-effectiveness that insecticide-treated nets (ITNs) and indoor residual spraying have achieved in high-endemic sub-Saharan Africa. ITNs, the author argues, have an additional indirect mortality impact by preventing deaths from other common child illnesses, to which malaria contributes as a risk factor. As conventional ITNs are being replaced by long-lasting insecticidal nets and scale-up is expanded, additional lives may be saved, and these figures may be calculated using LiST. LiSt combines key indicators for time trend analysis with dynamic transmission models, fitted to long-term trend data on vector, parasite and human populations over successive phases of malaria control and elimination. The author argues that policy makers and programme planners should use LiST as a planning tool, but notes that this will require enhanced monitoring and evaluation of the national programme and its impact.
Monitoring equity and research policy
Because of increased global trade and travel, micro-organisms now travel globally faster than before. To track these microorganisms, whole genome sequence analysis is the ideal instrument, but to make effective use of the results a global genomic database for microorganisms is needed. In this editorial, the author argues that the introduction of genomic testing represents a giant step forward for developing countries in the fight against infectious diseases. He compares the introduction of this new technology to the spread of cellphones, which made expensive and exclusive landlines unnecessary and made communication possible for everybody. Similarly, identification and typing of microorganisms will suddenly become technically and economically feasible, enabling control and prevention efforts previously missing in many regions. At the same time, developing countries moving to use this technology will not need to develop expensive, specialised lab systems, since microbiological lab work will basically be the same for TB, enterobacteria, viruses, etc. The author calls on developing countries to participate in this process from the start.
The main aim of this study was to determine how data on water source quality affect assessments of progress towards the 2015 Millennium Development Goal (MDG) target on access to safe drinking-water. Data was collected from five countries on whether drinking-water sources complied with World Health Organisation water quality guidelines on contamination with thermotolerant coliform bacteria, arsenic, fluoride and nitrates in 2004 and 2005. Taking account of data on water source quality resulted in substantially lower estimates of the percentage of the population with access to safe drinking-water in 2008 in four of the five study countries: the absolute reduction was 11% in Ethiopia, 16% in Nicaragua, 15% in Nigeria and 7% in Tajikistan. There was only a slight reduction in Jordan. Microbial contamination was more common than chemical contamination. The authors warn that the WHO criteria used to determine whether a water source is safe can lead to substantial overestimates of the population with access to safe drinking-water and, consequently, also overestimates the progress made towards the 2015 MDG target. Monitoring drinking-water supplies by recording both access to water sources and their safety would be a substantial improvement.
The authors of this study assessed the feasibility of using birth attendants instead of bereaved mothers as perinatal verbal autopsy respondents in low- and middle-income countries. Verbal autopsy interviews for early neonatal deaths and stillbirths were conducted separately among mothers (reference standard) and birth attendants in 38 communities in four developing countries, including the Democratic Republic of Congo and Zambia. For early neonatal deaths, concordance between maternal and attendant responses across all questions was 94%. Concordance was at least 95% for more than half the questions on maternal medical history, birth attendance and neonate characteristics. Concordance on any given question was never less than 80%. For stillbirths, concordance across all questions was 93%. Concordance was 95% or greater more than half the time for questions on birth attendance, site of delivery and stillborn characteristics. Overall, the causes of death established through verbal autopsy were similar, regardless of respondent. In conclusion, birth attendants can substitute for bereaved mothers as verbal autopsy respondents.
Incidence is a better measure than prevalence for monitoring AIDS, but it is not often used because longitudinal HIV data from which incidence can be computed is scarce. The objective of this study was to estimate the force of infection and incidence of HIV in Malawi using crosssectional HIV sero-prevalence data from the Malawi Demographic and Health Survey conducted in 2004. The researchers estimated population incidence from the force of infection by accounting for the prevalence, as the force of infection applies only to the HIV-negative part of the population. The estimated HIV population incidence per 100,000 person-years among men is 610 for the 15–24 year age range, 2,700 for the 25–34 group and 1,320 for 35–49 year olds. For females, the estimates are 2,030 for 15–24 year olds, 1,710 for 25–34 year olds and 1,730 for 35–49 year olds. In conclusion, the researchers assert that their method provides a simple way of simultaneously estimating the incidence rate of HIV and the age-specific population prevalence for single ages using population-based crosssectional sero-prevalence data. The estimated incidence rates depend on the HIV and natural mortalities used in the estimation process.
In this study, researchers evaluated the effect of an intervention to improve the quality of data used to monitor the prevention of mother-to-child transmission (PMTCT) of HIV in South Africa. The study involved 58 antenatal clinics and 20 delivery wards (37 urban, 21 rural and 20 semi-urban) in KwaZulu-Natal province that provided PMTCT services and reported data to the District Health Information System. The data improvement intervention, which was implemented between May 2008 and March 2009, involved training on data collection and feedback for health information personnel and programme managers, monthly data reviews and data audits at health-care facilities. Data on six data elements used to monitor PMTCT services and recorded in the information system were compared with source data from health facility registers before, during and after the intervention. Findings suggested that the level of data completeness increased from 26% before to 64% after the intervention. Similarly, the proportion of data in the information system considered accurate increased from 37% to 65%. Moreover, the correlation between data in the information system and those from facility registers rose from 0.54 to 0.92.
RESYST is a new international research consortium funded by the United Kingdom’s Department for International Development. It aims to enhance the resilience and responsiveness of health systems globally to promote health and health equity and reduce poverty. RESYST conducts research in a variety of countries in Africa and Asia, including low- and middle-income countries, seeking to identify lessons that are transferable across contexts. Research is conducted in three areas: financing (focusing on how best to finance universal health coverage in low and middle-income countries); health workforce (identifying effective, practical interventions to address human resource constraints); and governance (studying the relationships among frontline actors and mid-level management, and leadership in health policy implementation processes).
This study describes implementation of South Africa’s HIV monitoring and evaluation (M&E) system, determines the extent to which it is integrated with the district health information system (DHIS), and evaluates factors influencing the extent of HIV M&E integration. The study was conducted in one health district in South Africa. Data were collected through key informant interviews with programme and health facility managers and review of M&E records at health facilities providing HIV services. Results indicated that the HIV M&E system is top-down, over-sized, and captures a significant amount of energy and resources to primarily generate antiretroviral treatment (ART) indicators. Processes for producing HIV prevention indicators are integrated with the district health information system. However, processes for the production of HIV treatment indicators by-pass the DHIS and ART indicators are not disseminated to district health managers. Specific reporting requirements linked to ear-marked funding, politically-driven imperatives, and mistrust of DHIS capacity are key drivers of this silo approach. In conclusion, parallel systems that bypass the DHIS represent a missed opportunity to strengthen system-wide M&E capacity. Integrating HIV M&E (staff, systems and process) into the health system M&E function would mobilise ear-marked HIV funding towards improving DHIS capacity to produce quality and timely HIV indicators that would benefit both programme and health system M&E functions.
According to this reader, health policy and systems research (HPSR) is often criticised for lacking rigour, providing a weak basis for generalisation of its findings and, therefore, offering limited value for policy-makers. This reader aims to address these concerns through supporting action to strengthen the quality of HPSR. It is primarily intended for researchers and research users, teachers and students, particularly those working in low- and middle-income countries. It provides guidance on the defining features of HPSR and the critical steps in conducting research in this field. It showcases the diverse range of research strategies and methods encompassed by HPSR, and it provides examples of good quality and innovative HPSR papers.
The World Health Organisation’s (WHO) Consultative Expert Working Group on Research and Development (CEWG) has proposed the adoption of a convention which would incorporate a mechanism for resource distribution, pooling of funds and global coordination to help developing countries with the research and development for their public health systems. In its draft report to WHO, it argued that intellectual property rights and other incentives, such as financial mechanisms and coordination among stakeholders, are needed to ensure research and development lead to relevant and affordable medical innovations for poor patients. Responses to the report have been typically polarised among WHO Member States, with developing countries expressing strong support and industrial nations taking a more cautious approach. Before the formal negotiations of a convention can start, though, a number of variables are still to be considered, such as the need to table a procedural resolution to take note of the report and to request time before engaging in further negotiations.