In this study, the authors analysed the spending of the Bill and Melinda Gates Foundation, a major independent international funder, on neglected tropical diseases (NTDs). They included 67 projects funded between October 1998 and November 2008, 55% of which were from Africa. Projects were categorised as social science or non-social science research. The authors found that 26 projects (39%) were social science related while 41 projects (61%) were basic science or other translational research, including drug development. A total of US$697 million was spent to fund the projects, of which 35% (US$241 million) went to social science research. Although the level of funding for social science research has generally been lower than that for non-social science research over the past ten years, social science research attracted more funding in 2004 and 2008. The authors argue that, due to the high demand for improved delivery and utilisation of current NTD drugs/technologies, which are informed by social science-based research, funding priorities need to reflect greater investment in this type of research into NTDs.
Monitoring equity and research policy
In this study, researchers developed a simple, generalisable method for measuring research output to support attempts to build research capacity, and in other contexts. They developed an indicator of individual research output, based on grant income, publications and numbers of PhD students supervised. They then used the indicator to measure research output from two similarly-sized research groups in different countries. Research output scores of 41 staff in Research Department A had a wide range, from zero to 8; the distribution of these scores was highly skewed. Only about 20% of the researchers had well-balanced research outputs, with approximately equal contributions from grants, papers and supervision. Over a five-year period, Department A's total research output rose, while the number of research staff decreased slightly, in other words research productivity (output per head) rose. Total research output from Research Department B, of approximately the same size as A, was similar, but slightly higher than Department A. The authors conclude that their proposed indicator can be used for comparisons within and between countries. Modelling can be used to explore the effect on research output of changing the size and composition of a research department.
The primary objective of this study was a comprehensive re-estimation of disability weights that quantify health losses for all non-fatal consequences of disease and injury for the Global Burden of Disease Study 2010. A total of 13,902 respondents were interviewed in Bangladesh, Indonesia, Peru and Tanzania, and 16,328 in a web survey. Analysis of paired comparison responses indicated a high degree of consistency across surveys: correlations between individual survey results and results from analysis of the pooled dataset were 0.9 or higher in all surveys except in Bangladesh (0.75). Most of the 220 disability weights were located on the mild end of the severity scale, with 58 (26%) having weights below 0.05. Five (11%) health states had weights below 0.01, such as mild anaemia, mild hearing or vision loss, and secondary infertility. The health states with the highest disability weights were acute schizophrenia (0.76) and severe multiple sclerosis (0.71). The researchers identified a broad pattern of agreement between the old and new weights (0.70), particularly in the moderate-to-severe range. However, in the mild range below 0.2, many states had significantly lower weights in this study than previously. In contrast with the popular hypothesis that disability assessments vary widely across samples with different cultural environments, the results of this study suggest highly consistent results.
In this study, researchers examined current rates for healthy life expectancy (HALE) and changes over the past two decades in 187 countries, using data from the Global Burden Disease Study 2010. They calculated HALE estimates for each population defined by sex, country and year, and estimated the contributions of changes in child mortality, adult mortality, and disability to overall change in population health between 1990 and 2010. Findings showed that, in 2010, global male HALE at birth was 58.3 years and global female HALE at birth was 61.8 years. HALE increased more slowly than did life expectancy over the past 20 years, with each one-year increase in life expectancy at birth associated with a 0.8-year increase in HALE. Between countries and over time, life expectancy was strongly and positively related to number of years lost to disability. HALE also differs substantially between countries. As life expectancy has increased, the number of healthy years lost to disability has also increased in most countries, consistent with the expansion of morbidity hypothesis, which has implications for health planning and health-care expenditure, the authors argue. Compared with substantial progress in reduction of mortality over the past two decades, relatively little progress has been made in reduction of the overall effect of non-fatal disease and injury on population health. The authors propose that HALE may be a useful indicator for monitoring health post-2015.
The 46 African member states of the World Health Organisation (WHO) have commended WHO for operating the African Health Observatory (AHO) and requested that individual countries be assisted to establish their own national health observatories (NHOs). The need for NHOs was highlighted by the concerns raised by a number of countries at a regional committee meeting on the unavailability of timely information as hampering progress in providing quality health services in their countries. Zambia called for the inclusion of ‘community information systems’ to complement conventional data gathering. A number of countries raised the issue of integrating the NHOs into national health information systems (NHIS) as crucial to avoid burdening the NHIS. They noted that the NHOs should be simple and work towards harmonising data collection and coordination. Most countries saw the establishment of NHOs through technical support from the WHO as an opportunity to deal with the challenges of data fragmentation and the attendant problems of policy incoherencies.
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.
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.