A mine safety audit report detailing the high number of injuries and fatalities in South Africa’s mines each year has been released by the Department of Minerals and Energy, revealing serious gaps in the safety standards in the mining industry. In the past three years, unsafe working conditions have led to the death of 200 mine workers annually, in addition to the almost 5,000 people who are injured annually. Many of these injuries are so severe that limbs need to be amputated which leads to a significant reduction in standards of living and ability to earn an income. In terms of Occupational Health and Safety, the mining industry scored a dismal 59% compliance, while also scoring only 56% for health risk management, while public health and safety in mines received 65% compliance. Singling out particular mining sectors, the diamond sector scored a low 47% compliance with health risk management regulations. The gold industry also scored a dismal 53% compliance when it came to health risk management.
Monitoring equity and research policy
So will open access build a bridge to reduce health inequity? The potential is certainly great but the digital divide remains large, with estimates that only 13% of the developing world uses the internet, often on slow and expensive connections. Therefore, the inequity in accessing information and communication technology infrastructure will need to improve to allow people to get a foot onto the information bridge. But even once they are there, they will still only be able to access information that has been paid for – even when that information was created using taxpayers’ money. There is a role for more research funders and donors to support open access as an integral cost of undertaking the research itself to ensure public access. While the United Nations might be seen as having a ‘slow bandwidth’ approach to this issue, things are moving ahead with the work of the International Telecommunications Union on promoting greater access to information and communication technology worldwide and the newly developed World Health Organization strategy on research for health.
This study assessed the completeness and accuracy of routine prevention of mother-to-child transmission of HIV (PMTCT) data submitted to the district health information system (DHIS) in three districts of Kwazulu-Natal province, South Africa, covering 316 clinics and hospitals. Data elements were reported only 50.3% of the time and were ‘accurate’ (within 10% of reconstructed values) 12.8% of the time. The data element ‘Antenatal Clients Tested for HIV’ was the most accurate element (consistent with the reconstructed value) 19.8% of the time, while ‘HIV PCR testing of baby born to HIV positive mother’ was the least accurate, with only 5.3% of clinics meeting the definition of accuracy. Data collected and reported in the public health system across three large, high HIV-prevalence districts was neither complete nor accurate enough to track process performance or outcomes for PMTCT care. Systematic data evaluation can determine the magnitude of the data reporting failure and guide site-specific improvements in data management. Solutions are currently being developed and tested to improve data quality.
The quality of health care, including access to HIV prevention and testing services, depends to a large extent on which of South Africa's 52 districts you happen to live in. Major inequities were noted between urban and rural areas, as rural areas were usually underserved. Some of the inequities highlighted by the District Health Barometer (DHB) can be traced to differences in health spending, with different districts spending different amounts. The uneven distribution of HIV infection in South Africa also influenced ratings: higher rates of Caesareans were linked to higher HIV rates in pregnant women. Writing in the DHB, Dr Tanya Doherty attributed a lack of improvement in child and maternal mortality rates to the HIV epidemic – under-five mortality barely shifted from 60 per 1,000 births in 1990, to 59 in 2007, while maternal mortality actually increased. Prevention of mother-to-child HIV transmission (PMTCT) is vital to reducing maternal and child mortality and combating HIV, but health authorities have failed to properly monitor PMTCT interventions. ‘This is indicative of management neglect of the programme from national to facility level,’ she wrote.
What is the current status of occupational health and safety (OHS) in southern African? Of an estimated 14 million injuries per year, a mere 93,000 injuries are reported. This brief notes that more data is needed, which should be analysed and reported regularly. In existing compensation systems, there is too much focus on financial governance and not on the production of information to prevent accidents and disease. It recommends that social security/compensation and reporting systems need to be introduced where these do not exist. Active surveillance methods need to be introduced through surveys already carried out by national statistical offices, or by adding occupational health components to future labour force or health and demographic surveys. In addition, targeted research needs to be funded and supported. It will take many years and a lot of resources for southern African countries to develop information systems as sophisticated as those in Western countries.
Impaired access to research information in health-related fields is not solely the preserve of developing countries but it is hugely exacerbated in poorer regions of the world. Why are such influential bodies as the Australian National Health and Medical Research Council, the Canadian Institutes of Health Research, the Centre for Disease Control and the National Institute of Health in the USA, the United Kingdom Medical Research Council and the Wellcome Trust promoting open access? Because it brings such benefits to health research including: increased visibility for research outputs; a concomitant increased usage and impact; an increase in the speed at which scientific research progresses; the facilitation of interdisciplinary research; and the enabling of new semantic computing tools to create new knowledge from existing knowledge. Open access is a key piece of the jigsaw for improving world health. All stakeholders in that vision should commit themselves to its implementation.
Access to health research publications is an essential requirement in securing the chain of communication from the researcher to the front-line health worker. As the diagram of the knowledge cycle from the Canadian Institutes of Health Research shows, health knowledge generated in the world’s laboratories is passed down the information chain through publications, through its impact and application, its subsequent “translation” into appropriate contexts for different user communities, arriving finally with health workers and the general public. This article focuses on the first link in the chain, from research author to reader, and the free online access to peer-reviewed published articles that are the building blocks for future health innovation developments.
New drugs, vaccines and diagnostics for the diseases of the developing world could save millions of lives and prevent enormous suffering and economic loss. Despite substantial new funding from the Gates Foundation and other donors, financing for the research and development (R&D) of these new health technologies remains inadequate. New approaches are needed to generate more resources, make funding more stable and flexible, and further engage the expertise of the pharmaceutical industry. Several new financing mechanisms have been launched recently, and others are being proposed. This paper summarises some of the most promising new ideas and offers a framework for evaluating them.
As long as standards and norms governing international research partnerships remain undefined in the legal environment, contractual matters will consume excessive energy, detract from the real work of health research professionals and set up collaborating institutions as potential adversaries rather than partners with a common research agenda. Agreed standards and norms for research contracting provide a framework for guidelines for equitable partnerships that can be put into practice in low- and middle-income countries to address the needs of local populations. The recently established International Collaboration on Equitable Research Contracts is conducting a global assessment of research contracting by developing and disseminating model contracts in which the rights, responsibilities and requirements of all partners are recognised. This evidence will inform the development of practical tools to achieve more equitable results in international research partnerships.
The quality of health care, including access to HIV prevention and testing services, depends to a large extent on which of South Africa's 52 districts you happen to live in. Some of the inequities highlighted by the District Health Barometer can be traced to differences in health spending, with districts in Western Cape Province spending the most on primary health care and districts in Free State Province spending the least. In the report, Dr Tanya Doherty of South Africa's Medical Research Council attributed a lack of improvement in child and maternal mortality rates to the HIV epidemic – under-five mortality barely shifted from 60 per 1,000 births in 1990 to 59 in 2007, while maternal mortality actually increased. Prevention of mother-to-child HIV transmission (PMTCT) is vital to reducing maternal and child mortality and combating HIV, but health authorities have failed to properly monitor PMTCT interventions. ‘This is indicative of management neglect of the programme from national to facility level,’ Doherty wrote.