While there have been increased calls for strengthening community health systems (CHSs), key priorities for this field have not been fully articulated. This paper seeks to fill this gap, presenting a collaboratively defined research agenda, accompanied by a ‘manifesto’ on strengthening research and practice in the CHS. Eight domains of research priorities for CHSs were identified: clarifying the purpose and values of the CHS, ensure inclusivity; design, implementation and monitoring of strategies to strengthen the CHS; social, political and historical contexts of CHS; community health workers (CHWs); social accountability; the interface between the CHS and the broader health system; governance and stewardship; and finally, the ethical methodologies for researching the CHS.
Monitoring equity and research policy
The authors explored how health research knowledge is translated into policy in Zambia, and what facilitates or hinders this, from document review and key informant interview. While the document review suggested policy efforts to promote knowledge translation, the interviews raised challenges in coordination and linkages between knowledge and policy-making processes, attributed to lack of research knowledge translation capacity, limited resources and lack of knowledge hubs. However, the authors suggest that emerging local research leadership and a stock of underused local health are an opportunity to enhance knowledge to policy links, if supported.
The Global Health Security Index predicted that the world in general was not well prepared for the pandemic but did not predict individual country preparedness. Ten factors seem to have contributed to the index failing to predict country responses, including limited consideration of globalisation, geography, and global governance, bias to high income countries, failure to assess health system capacity, overlooking the role of political leadership and ideology, overlooking the importance of context, the limits of national wealth as a predictive factor, no examination of inequalities within countries, the importance of social security and the provisions to protect people from losing their jobs and homes. The authors note that civil society capacity was not assessed, and the gap between capacity and its application was also not assessed. The authors argue that future assessments of pandemic preparedness need to take these 10 factors into account by adopting a systems approach which enables a focus on critical system components
To ask why COVID-19 hasn’t been deadlier in Africa is to suggest that more Africans should be dying. We need better questions. Almost every major international news outlet has asked a variation of the question. Some speculate that something structural or physiological has dampened the impact of COVID-19 on Africa’s population; otherwise, Africa would be faring worse. Others argue that African governments are simply doing a better job of managing the disease than other regions, despite evidence to the contrary. Neither analysis reflects the complex realities of COVID-19 in Africa. The question itself, in its crudest form, has provoked considerable, justifiable anger on social media in various African countries. Yet as the deaths mount in Brazil, India, the United States, and the UK, and as Europe prepares for its second wave, the official death toll in African countries remains low. Even in South Africa, the most severely affected African country, confirmed deaths are far fewer than predicted. Experts are left wondering why their predictions were wrong. To ask why more Africans aren’t dying of COVID-19 exposes the expectation that when the world suffers, Africa must suffer more. We can learn collectively from the questions we ask. Knowledge-making is about grappling with useful questions—those that move humanity toward a greater understanding of shared circumstances. But questions that distract from meaningful comparisons dominate the current moment. “Why aren’t more Africans dying of COVID-19,” like so many questions about Africa, fails to illuminate.
In the context of COVID-19, this paper outlines how health policy and systems research (HPSR) can both address current short-term challenges, and support the system transformations needed to strengthen people-centred and equitable health systems over the long term. Due to the acute nature of the pandemic, few papers have yet focused on how health systems are coping with or adapting to the pandemic, or how health policy-making and decision-making has (or has not) changed in this time of crisis. This paper makes proposals for a structured research agenda to inform health policy and system responses to COVID-19 that can move us beyond the current crisis, and into the future, with a focus on low- and middle-income countries.
In this article the authors argue that many African governments have so far responded more proactively and effectively to Covid-19 than some governments in high income countries (HICs). Much of this capacity to respond effectively can be explained by an existing culture of using evidence to inform policy decision-making. African researchers are producing evidence on how to protect and prioritise already existing health interventions which can increase health system resilience and preparedness for Covid-19. The authors argue that African nations have generated and used evidence for decision- making on solutions to tackle the pandemic. Data-poverty and technology deficits are a challenge. The authors note that partnerships to assist with production, collation, and use of evidence are appearing nationally, regionally, and globally to support quick but measured evidence-informed decisions.
In the light of the COVID-19 pandemic a collective of organisations have taken urgent action to collate useful guidance and resources related to research ethics. The resources are organized under the following categories: general guidance, social justice, health systems strengthening, preparedness, care and resource rationing, emergency powers, health care worker wellbeing, gender, quarantine and other mandatory measures, clinical trails, guidance for funders and other resource collections.
To understand better both impact of and responses to COVID-19, UN Women is recommending stand-alone surveys or integration of questions on violence against women in socio-economic and gender surveys to assess the prevalence and responses to gender based violence during COVID-19. This data is argued to be critical to support evidence-based interventions and to make available lifesaving services. UN Women in East and Southern Africa is working closely with the partner agencies and providing technical support to develop model surveys and guidelines to support quality assessments. This briefing also provides case study analyses of gendered effects of COVID-19 in Uganda, Kenya, South Africa, Ethiopia, Burundi, Zimbabwe, Mozambique and Malawi.
This paper presents an evaluation of the current capacity of the national health information systems in Mozambique, and the available indicators to monitor health inequalities, in line with Sustainable Development Goals 3. A data source mapping of the health information system in Mozambique was conducted. Eight data sources contain health information to measure and monitor progress towards health equity in line with the 27 Sustainable Development Goal 3 indicators. Seven indicators bear information with nationally funded data sources, ten with data sources externally funded, and ten indicators either lack information or it does not applicable for the matter of the study. None of the 27 indicators associated with Sustainable Development Goal 3 can be fully disaggregated by equity stratifiers; they either lack some information or do not have information at all. The indicators that contain more information are related to maternal and child health. The authors report that there are important information gaps in Mozambique’s current national health information system which prevents it from being able to comprehensively measure and monitor health equity.
Health facility data are a critical source of local and continuous health statistics. Countries have introduced web-based information systems that facilitate data management, analysis, use and visualisation of health facility data. Working with teams of Ministry of Health and country public health institutions analysts from 14 countries in Eastern and Southern Africa, the authors explored data quality using national-level and subnational-level (mostly district) data for the period 2013–2017. The focus was on endline analysis where reported health facility and other data are compiled, assessed and adjusted for data quality, primarily to inform planning and assessments of progress and performance. The analyses showed that although completeness of reporting was generally high, there were persistent data quality issues that were common across the 14 countries, especially at the subnational level. These included the presence of extreme outliers, lack of consistency of the reported data over time and between indicators (such as vaccination and antenatal care), and challenges related to projected target populations, which are used as denominators in the computation of coverage statistics. The authors propose continuous efforts to improve recording and reporting of events by health facilities, systematic examination and reporting of data quality issues, feedback and communication mechanisms between programme managers, care providers and data officers, and transparent corrections and adjustments will be critical. to improve the quality of health statistics generated from health facility data.