The Consortium for Health Policy and Systems Analysis in Africa (CHEPSAA) project (2011-2014) is a four-year collaboration between seven African and four European universities aimed at strengthening the capacity of universities in Ghana, Kenya, Nigeria, Tanzania and South Africa to: produce high quality health policy and systems research (HPSR); provide HPSR training; engage with networks; and communicate research into policy and practice. In this presentation given at the Second Global Symposium on Health Systems Research in November 2012, the authors present the results of their study to evaluate the performance of CHEPSAA and to evaluate HPSR capacity in the seven universities. The university-based institutes were found to share a vision for HPSR that relates to wider institutional purpose. While structures and processes to support HPSR exist, and HPSR ‘champions’ were identified in the study, the authors found these were undermined by succession challenges. Staff shortages were problematic, especially among especially senior staff. The institutes also exhibited different income patterns including unpredictable external funding. The authors conclude that local universities are central to strengthening HPSR capacity in Africa and CHEPSAA African partners already have sufficient capacity to build upon; however, HSPR in Africa is still an emerging field that needs support.
Monitoring equity and research policy
According to this evaluation, South Africa has improved most of its health indicators since 2009, significantly expanded its programme of antiretroviral therapy and launched an ambitious government policy to address lifestyle risks, as well as an integrated strategic framework for prevention of injury and violence, which remains to be implemented. A radical system of national health insurance and re-engineering of primary health care will be phased in over 14 years to enable universal, equitable and affordable health-care coverage. National consensus has been reached about seven priorities for health research with a commitment to increase the health research budget to 2% of national health spending. However, large racial differentials still exist in the social determinants of health, Integration of services for HIV, tuberculosis and non-communicable diseases needs to improve, as do surveillance and information systems. Additionally, successful interventions need to be delivered more widely. The authors conclude that transformation of the health system into a national institution that is based on equity and merit and is built on an effective human-resources system could still place South Africa on track to achieve the health-related Millennium Development Goals 4, 5 and 6.
The South African Government is to allocate more funds to health research over the next decade and add clinical research centres to hospitals earmarked for revitalisation so that it can build relevant evidence-based knowledge into the public health system. Deputy Minister of Health, Dr Gwen Ramokgopa, said that her department was currently spending 0.6% of its budget on health research, less than the 2% minimum it committed to in its 2001 health research policy.
In this article, the author argues that, in order to promote development of new products and their access to populations, especially in developing countries, it is necessary to change the current pharmaceutical research and development (R&D) model. The cost of research should be delinked from the prices of the products generated. The challenge is not only about increasing investment in research or improving the rate of innovation. This will not suffice if the new products are not effectively accessible for those who need them. It is a responsibility of States to provide effective solutions to the health problems of the majority of the planet’s population, he argues, calling for the establishment of a binding convention on R&D for new medicines, vaccines and other pharmaceutical products and technologies. A global binding agreement, negotiated in the World Health Organisation, could be an important part of the solution. Naturally, reaching consensus for its adoption will not be a simple task, neither can it be expected to be instantaneous. It would probably require some years of intense negotiation. However, it will be worth the effort if it can avoid the early death or improve the quality of life of millions of people by creating, on a solid foundation, a new paradigm for research and access to health products, the author concludes.
The aim of this study was to review and assess the factors that facilitate the development of sustainable health policy analysis institutes in low and middle income countries and the nature of external support for capacity development provided to such institutes. Comparative case studies of six health policy analysis institutes (three from Asia and three from Africa) were conducted. The findings are organised around four key themes. (i) Financial resources: Three of the institutes had received substantial external grants at start-up, however two of these institutes subsequently collapsed. At all but one institute, reliance upon short term, donor funding, created high administrative costs and unpredictability. (ii) Human resources: The retention of skilled human resources was perceived to be key to institute success but was problematic at all but one institute. (iii) Governance and management: Boards made important contributions to organisational capacity through promoting continuity, independence and fund raising. (iv) Networks: Links to policy makers helped promote policy influences, while external networks with other research organisations helped promote capacity. Overall, health policy analysis institutes remain very fragile. A combination of more strategic planning, active recruitment and retention strategies, and longer term, flexible funding, for example through endowments, needs to be promoted.
This report summarises the outcomes of the conference Forum 2012, which was held in April 2012 in Cape Town, South Africa. It identifies that countries need to collect evidence and use it to identify priorities for their people and that external funders should not set agendas. Assessment should be made of where research is needed before embarking on projects, as is constant monitoring and evaluation. Research ethics frameworks need to be improved and integrated into health research systems. Partnerships are seen to be crucial, particularly local partnerships and scientists need mentoring, stable jobs and good salaries, and to know they are valued. People need to be engaged at a young age about research and innovation for development. Investing in research for health requires a long-term view. Promoting equity in health means addressing the social and economic conditions that cause inequality. Research and innovation can help identify and develop solutions to expand the availability of good quality healthcare and people's access to it, thereby reducing disparities in health.
In this review, the authors discuss nine key lessons documenting the experience of the Zambia Forum for Health Research, primarily to inform and exchange experience with the growing community of African KTPs. This Knowledge Translation Platform (KTP) provided cohesion and leadership for national-level knowledge translation efforts. They found that ZAMFOHR’s success was linked to selecting a multi-stakeholder and multi-sectoral Board of Directors, performing comprehensive situation analyses to understand not only the prevailing research-and-policy dynamics but a precise operational niche, and selecting a leader who bridges the worlds of research and policy. ZAMFOHR also helped build the capacity of both policy-makers and researchers, as well as a database of local evidence and national-level actors, while catalysing work in particular issue areas by identifying leaders from the research community, creating policy-maker demand for research evidence and fostering the next generation by mentoring up-and-coming researchers and policy-makers. Ultimately, ZAMFOHR’s experience shows that an African KTP must pay significant attention to its organisational details and invest in the skill base of the wider community and, more importantly, of its own staff. At the same time, the role of networking cannot be underestimated.
In this blog from the Second Global Symposium on Health Systems Research, held in Beijing in October 2012, the author discusses the Emerging Voices programme for the Conference. The first part involved an introduction to new methods of presenting scientific research findings to a diverse audience in an effective way: Pecha Kucha and the Prezi. The author considered these picture-based alternatives better the traditional text-based PowerPoint presentation. Secondly, participants went on cultural and field visits to local Chinese traditional sites and were introduced to the Chinese health system. The author visited a district health office and two health centres in a rural area and was particularly impressed by the integration of Chinese traditional medicine with the Western medicine within the mainstream health system. This means that the Chinese give both disciplines and approaches adequate resources and attention in terms of developing them further. The conference offered a great opportunity to meet senior health systems researchers who could share their participatory action research methodologies.
This paper presents a pragmatic framework for developing and prioritising policy interventions tailored to local epidemiological, political and social conditions. The “policy effectiveness–feasibility loop” (PEFL) framework was developed as part of a multinational project aiming to inform policy for the prevention and control of cardiovascular diseases and diabetes in four middle-income territories. Central to the proposed approach is the involvement of policy-makers in the collection of evidence and its appraisal. The PEFL framework resembles a “equity effectiveness loop”, which is intended to estimate the impact of interventions to reduce socioeconomic inequalities. The major difference is that the PEFL approach includes assessing the local context and the feasibility of potential interventions. Furthermore, its focus is on policy-level interventions, and hence the situation analysis involves local policy-makers. The situation analysis and option appraisal stages of the framework are analogous to policy dialogue, as they facilitate discussion between stakeholders and researchers on policies and how to implement them. The outputs resulting from application of the framework can be used to prepare policy briefs for informing stakeholder discussions on policy options.
The Foundation for Professional Development (FPD) collects information annually on HIV and AIDS service provision and estimates service needs in the City of Tshwane Metropolitan Municipality (CTMM). In this study, researchers used antiretroviral therapy (ART) data from the Department of Health and Statistics South Africa (SSA) mid-year population estimates to approximate the ART need among adults in the CTMM. According to SSA data, ART need decreased dramatically from 2010 to 2011 and was lower than the number of adults receiving ART. Although the noted difference was probably due to changes in the calculations by SSA, no detailed or confirmed explanation could be offered. The authors hope that their paper may provide a constructive contribution to the discussion about the use of model-derived estimates of ART need. They argue that it is critical that those providing estimates (in this case, SSA) clearly indicate whether any significant changes exist compared with earlier reports and, if so, the cause and implications of these changes.