Decision-makers in countries around the world face a series of common problems as they aim to make appropriate choices to improve the performance of their health systems. With eight per cent of the world's economic output invested in health systems, the way these systems are organized to collect resources and transform them into services for people in need can profoundly influence health outcomes for populations. Yet the scientific evidence-base to inform critical health system decisions is much weaker than the evidence-base to inform individual clinical decisions. This volume reports on a large body of work led by the World Health Organisation that is intended to strengthen the foundations for evidence-based policies aimed at health systems development.
Monitoring equity and research policy
This article explores how health research can be improved to ensure that its results are translated into action. It is based on the author's experience of health research on HIV/AIDS in South Africa. The article pays particular attention to dissemination, and it argues that the most common approach to information dissemination adopted by research organisations, passive dissemination of information in the form of research reports and policy recommendations, is largely ineffective.
The purpose of this report was to assess the application of clinical predictors for the diagnosis of the HIV infections, including AIDS, among TB-positive subjects enrolled within an urban heterosexual sero-discordant couple (one partner HIV-positive and the other HIV-negative) cohort study at an HIV prevention and research centre in Lusaka, Zambia. The report documents the relative effectiveness of the World Health Organisation clinical case definition for HIV/AIDS (WHOCCDA) in predicting HIV/AIDS cases and discusses the health and policy implications.
To improve communication of research to policy-makers it will be necessary to strengthen researchers' communication skills; aim for close collaboration between researchers and policy-makers; construct an appropriate platform from which to communicate and strengthen institutional policy capacity for uptake. To improve communication of research to other researchers the strengthening of Southern research capacity is needed in order to enable Southern researchers to access Northern-produced research. Lastly, in order to improve communication of research to the poor and organisations working with the poor it will be necessary to incorporate communication activities into project design. This is according to a working paper from the Overseas Development Institute in the United Kingdom.
Health research generates knowledge that can be utilized to improve health system performance and, ultimately, health and health equity. The authors of this article propose a conceptual framework for health research systems (HRSs) that defines their boundaries, components, goals, and functions. The framework adopts a systems perspective towards HRSs and serves as a foundation for constructing a practical approach to describe and analyse HRSs. The analysis of HRSs should, in turn, provide a better understanding of how research contributes to gains in health and health equity.
Translating the discoveries of clinical research into practice is vital, as the UK’s Academy of Medical Sciences says in a recent report. But what do doctors in developing countries face in trying to keep up with the task? In this article, the authors say the challenges are legion. Medical academics in the developing world tend to work far from clinics. They often teach huge classes and bear heavy workloads, and struggle with poor salaries and little access to new findings in biomedicine. The research they conduct is all too often underfunded and irrelevant to national needs.
Uganda is widely regarded as an HIV/AIDS success story, but the reality of this claim has rarely been critically investigated. Although evidence-based medicine is increasingly important, analysis of the Ugandan epidemiological situation shows that the so-called proof accepted for policy recommendations can be subject to creative interpretation. There are several policy lessons that can be learned from the response to HIV/AIDS in Uganda, where declining prevalence rates of HIV-1 have been reported in a number of surveillance sites around the country since 1992. (This article requires registration.)
A gap often exists between research findings and the desired outcome of putting them into use to improve health service delivery, policies, and practices. But this issue of Network highlights several factors that can facilitate the speed and ease of moving research to practice. How various factors can coincide to produce rapid utilization of research findings is illustrated by acceptance of the antiretroviral nevirapine to prevent mother-to-child transmission of HIV in the developing world.
The growing global burden of non-communicable diseases in poor countries and poor populations has been neglected by policy makers, major multilateral and bilateral aid donors, and academics. Despite strong evidence for the magnitude of this burden, the preventability of its causes, and the threat it poses to already strained health care systems, national and global actions have been inadequate. A full range of policy responses is required from government and non-governmental agencies, but unfortunately the capacity and resources for this response are insufficient, and governments need to respond appropriately.
Uganda is widely regarded as an HIV/AIDS success story, but the reality of this claim has rarely been critically investigated. Although evidence-based medicine is increasingly important, analysis of the Ugandan epidemiological situation shows that the so-called proof accepted for policy recommendations can be subject to creative interpretation. There are several policy lessons that can be learned from the response to HIV/AIDS in Uganda. (registration needed)