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.
Monitoring equity and research policy
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.
This research aimed to elaborate a theory of knowledge translation (KT) in Uganda that could also serve as a reference for other low- and middle income countries. The researchers employed qualitative approaches to examine the principal barriers and facilitating factors to KT. A review of the literature revealed that the most common factors facilitating knowledge uptake included institutional strengthening, research characteristics, dissemination processes, partnerships and political context. The analysis of interviews conducted by the researchers, however, showed that policymakers and researchers ranked institutional strengthening for KT, research characteristics and partnerships as the most important. Respondents rasied the importance of mainstreamed structures within the Ministry of Health to coordinate and disseminate research, the separation of roles between researchers and policymakers, and the role of communities and civil society in KT. The study tests a framework that can be more widely used in empirical research on the process of KT on specific policy issues.
In September 2011, it was announced that Dutch, Japanese and American scientists had independently genetically altered the H5N1 avian influenza virus, transforming it into a highly lethal, airborne strain that could conceivably spread easily between humans. The studies were funded by the United States (US) and the US National Science Advisory Board for Biosecurity (NSABB) then prevented the researchers from releasing their findings on the grounds that the experiment could be replicated by terrorists. The scientists involved in the H5N1 research have questioned the need for redacting the studies’ findings, arguing that “there is already enough information publicly available” to reproduce their experiments and that withholding the information only serves to disadvantage legitimate scientific research. The incident has sparked intense international public debate, clearly dividing much of the scientific and policy-making community. Some commentators have argued that an international consensus on appropriate approaches is needed, as national governments can only control matters in their own jurisdiction and this is an international question. The World Health Organisation, which has maintained a relatively low profile regarding the controversial H5N1 studies so far, agreed to host a technical meeting on 16-17 February 2012 to discuss the issues.
In this analysis of participatory civil society assessments, the authors make a number of important points. A new generation of country-led civil society assessments is now required, which will address important fundamental issues of philosophy, principle and methods and should be tailored to national and historical contexts. New approaches to civil society assessment need to shift from mapping and reporting to forecasting and foresight to be more relevant to civil society and policymakers. Diminishing returns of international comparative civil society assessments means that the time has come to expand and disaggregate assessment tools to make them progressively more meaningful and valid locally. The range of tools should be versatile to satisfy different stakeholders and stakeholders should question the applicability of “Western‟ theories and approaches to non-western societies. When conducting assessments in restrictive and culturally sensitive environments, certain factors, such as collective work, mutual trust and self-criticism, are needed to achieve positive results. A multi-stakeholder approach should be taken that represents government, business and the organised citizenry. It is also time to go beyond NGOs and public formal organisations to include informal organisations, which often have greater importance for the health of society. Final recommendations include going beyond a sectoral approach, using a domain approach to civil society assessments, adopting a clearer multi-centred theory of governance and recognising norm-free assessment as a fallacy.
The non-profit Universities Allied for Essential Medicines (UAEM) is a student-driven movement to promote equitable global access and innovation in publicly funded medical research. Through UAEM’s advocacy, universities that license medical research to industry have now begun to include requirements for generic production or “at cost” provisions for low- and middle-income countries. These “global access” provisions lower the price of the final products for poor patients, and have been adopted by leading institutions including Harvard, Yale, the University of British Columbia, and the US National Institutes for Health (NIH). While over 30 research institutions worldwide have endorsed a “Statement of Principles and Strategies” supporting global access to their medical discoveries, the students of UAEM want to ensure that this translates into real-world impact. They argue that the statement itself should be strengthened, and individual universities can adopt more robust policies. Most importantly, however, universities must demonstrate that they are regularly including global access provisions in their licensing negotiations with pharmaceutical companies. Improving the transparency of universities and their licensing practices is critical. Not only do universities need to ensure affordable access to their medical breakthroughs, but they also need to show that they are committing resources, both human and financial, to research on neglected diseases.
Canadian occupational health and infection control researchers have found that training is key to a positive safety culture, leading them to develop information and communication technology (ICT) tools to promote occupational health and infection control. The South African government invited the Canadian team to work with local colleagues, resulting in an improved web-based health information system to track incidents, exposures, and occupational injury and diseases, just in time for the H1N1 pandemic. Research from these experiences led to strengthened focus on building capacity of health and safety committees, and new modules are thus being created, informed by that work. The international collaboration between occupational health and infection control researchers in Canada, Ecuador and South Africa led to the improvement of the research framework and development of tools, guidelines and information systems. Furthermore, the research and knowledge-transfer experience highlighted the value of partnership amongst Northern and Southern researchers in terms of sharing resources, experiences and knowledge.