The main pattern of research funding is driven by the interests of research funders, who are often external rather than domestic actors. When priority-setting processes do occur, they are typically disease-driven and without a broader, more integrated systems-level perspective (for example, determining how research might address one or more health-system building blocks). As a result, there is rarely consensus on national evidence needs, few national research priorities are set, and research in low- to middle-income countries (LMICs) continues to follow the fleeting and shifting priorities of global funders. This brief discusses the fundamental concepts of priority setting exercises; explores the priority-setting dynamic between the national and global levels; describes priority setting exercises specific to health policy and systems research; and details the work of the in driving global priorities based on the evidence needs of LMIC policy-makers through a three-step approach. It concludes with recommendations for how researchers, LMIC policy-makers and the global community might increasingly promote, fund and convene priority-setting exercises in health policy and systems research.
Monitoring equity and research policy
In this conceptual article, the authors compare and contrast the evolution of climate change and AIDS research. They demonstrate how scholarship and response in these two seemingly disparate areas share certain important similarities, such as the "globalisation" of discourses and associated masking of uneven vulnerabilities, the tendency toward techno-fixes, and the polarisation of debates within these fields. They also examine key divergences, noting in particular that climate change research has tended to be more forward-looking and longer-term in focus than AIDS scholarship. Suggesting that AIDS scholars can learn from these key parallels and divergences, the paper offers four directions for advancing AIDS research: focusing more on the differentiation of risk and responsibility within and among AIDS epidemics; taking (back) on board social justice approaches; moving beyond polarised debates; and shifting focus from reactive to forward-looking and proactive approaches.
International comparisons show that the average South African will not live longer than 50 years. South Africa was one of only six out of a group of 37 developed and developing countries that had a decreasing life expectancy between 1990 and 2007. South Africa’s life expectancy decreased from 62 years in 1990, to 50 years in 2007. Only Zimbabwe had a worse trend for life expectancy. The statistics in this report show that, in 2009, the average life expectancy at birth for South Africans was 51 years. Between 2001 and 2006 the life expectancy at birth was 51 years for males, and 55 years for females. This is expected to decrease between 2006 and 2011 to 48 years for males, and 51 years for females. KwaZulu-Natal had the lowest life expectancy at birth in 2009 at 43 years, followed by the Free State and Mpumalanga at 47 years each. These three provinces also had some of the highest HIV prevalence rates at 16%, 14%, and 14% respectively. International comparisons also show that in 2007, some 27% of males and 33% of females in South Africa would survive to age 65. Out of a comparison group of 37 developing and developed countries, only Mozambique and Zimbabwe had lower survival rates.
Researchers and innovators in developed countries seeking authoritative information on how to solve a particular technical problem or develop a new product generally turn either to scientific journals or patent information. However, patent information enjoys certain advantages over scientific journals, according to William Meredith, head of the World Intellectual Property Organization Patent Information and IP Statistics Section. Despite the stated benefits of patent disclosure, Gakuru Muchemi, a senior lecturer at the Department of Electrical and Information Engineering of the University of Nairobi, noted in an interview that ‘the use of patent disclosure information either as a research tool or teaching aid in our institutions of learning and research still remains unused or underutilised.’ On the other hand, Meredith added that, ‘even where the innovators in developing countries may not be able to reproduce the latest cutting edge technology contained in patent documents, they may be still be able to use information contained in the specifications about the technology to adapt to local situations.’
Policy-makers and health system managers routinely face difficult decisions around improving health and promoting equity. They must consider complex, core questions about particular programmes to implement and effective strategies for organising the overall health system. For instance, does contracting out services to the private sector improve access to health care? How could the health system best retain trained health care providers in underserved areas? Do conditional cash transfers improve the uptake of health interventions? This brief provides essential background information to systematic reviews: how they are conducted, what they entail and their theoretical roots. It discusses tools like GRADE (Grading of Recommendations, Assessment, Development and Evaluation) and organisations like the Cochrane Collaboration. The brief calls for increased funding to support systematic reviews, improved methodological development in the reviewing process, increased networking and the need to promote training of end-users. The use of knowledge translation is highlighted.
This prevalence survey – based on blood samples from 34,000 pregnant women who attended antenatal clinics in 52 health districts in South Africa – measured HIV prevalence at 29.3%, compared to 29.4% in 2007 and 29% in 2006. Prevalence among women aged 15 to 40 declined slightly from 22.1% in 2007 to 21.7% in 2008, but the infection rate among women in the 30 to 34 age group rose from 39.6% in 2007 to 40.4% in 2008. Age was found to be the most important risk factor, with women of 22 years or older significantly more likely to be HIV-infected. In this age group, race was the next most important factor, with 37.6% of African women infected, compared to 6.8% of white, Asian and coloured (mixed race) women. The figures revealed wide variations between the country's nine provinces: as in previous years, KwaZulu-Natal Province recorded the highest prevalence (38.7%) and Western Cape the lowest (16.1%); at district level the disparities were even greater - in some the infection rate was as high as 45%, in others as low as 5%. The survey authors strongly recommended that the health department conduct more in-depth epidemiological surveys to investigate the causes of these wide disparities.
Since 1986, Uganda has made substantial progress in promoting good governance at the political and economic fronts. It recorded sustained economic growth averaging 6% over the last two decades, moving from recovery and reconstruction toward sustainable growth and poverty reduction. Macroeconomic stability remains a cornerstone of the country’s reform efforts. According to Uganda Official Statistics, the proportion of people living in absolute poverty, declined from 56% to 35% between 1992 and 2005/06, although per capita income gains have been modest because of the country’s high population. Nonetheless, significant challenges persist, and these include the fight against poverty and corruption, the resolution of the conflict in the North and other forces that hamper Uganda’s democratisation and economic development process. They call for a concerted effort from all interested parties across the country. The major challenge ahead consists in sustaining the momentum of the peer review process through the successful implementation of the National Programme of Action (NPOA) emanating from the exercise. The Forum will receive Annual Progress Reports in this regard and maintain sustained interest in the implementation process.
Several South African organisations have recently joined together to form the Budget and Expenditure Monitoring Forum (BEMF). The forum advocates for reasonable and sufficient funds to be allocated to health care based on the best evidence available, particularly for HIV programmes, and for those funds to be spent in a reasonable and constitutionally valid manner. It will work to ensure that there are no further treatment interruptions and moratoriums, that there is proper monitoring and evaluation of the highly active antiretroviral treatment (HAART) and prevention of mother-to-child transmission (PMTCT) programmes, and that the national departments of health and finance intervene in provinces not delivering these programmes adequately. In the last financial year several budgeting decisions were made which the member organisations of the BEMF believe violated the legal rights of individuals. The most visible was the moratorium on the initiation of patients onto HAART in the Free State from November 2008 through March 2009. The Southern African HIV Clinicians Society estimated that at least 30 lives a day were lost as a result this decision.
The overarching aim of this study is to develop a GIS-based planning approach that contributes to equitable and efficient provision of urban health services in cities in sub-Saharan Africa. The broader context of the study is the 'urban health crisis', namely the disparity between the increasing need for medical care in urban areas and declining carrying capacity of existing public health systems. The analysis proposes a 'what if' type of planning approach designed to evaluate and improve the spatial performance of the Dar es Salaam governmental health care system. It illustrates how more sophisticated GIS-based analytical techniques can be usefully applied to strategic spatial planning of urban health services delivery. Its evaluation framework appraises the performance of the existing Dar es Salaam governmental health delivery system on the basis of generic quantitative accessibility indicators, while its intervention framework explores how existing health needs can better be served by proposing alternative spatial arrangements of provision using scarce health resources. Health planners will be able to detect spatial deficiencies of a given delivery system, propose priority spatial planning interventions and estimate the expected impact of potential interventions on spatial performance.
Recent attempts to integrate geographic information systems (GIS) and participatory techniques have given rise to terminologies such as participatory GIS and community-integrated GIS. Although GIS was initially developed for physical geographic application, it can be used for the management and analysis of health and health care data. Geographic information systems, combined with participatory methodology, have facilitated the analysis of access to health facilities and disease risk in different populations. Little has been published about the usefulness of combining participatory methodologies and GIS technology in an effort to understand and inform community-based intervention studies, especially in the context of HIV. This paper attempts to address this perceived gap in the literature. The authors describe the application of participatory research methods with GIS in the formative phase of a multisite community-based social mobilisation trial, using voluntary counselling and testing and post-test support as the intervention.