Perceptions in health research are a product of the circumstances within the society, where the research activities are situated. In East Africa there has been a change in conceptualisation over a period of time from an elitist de-linked status to the present, which has evolved to embrace the local community. In this paper, researchers trace the changes and highlight some occurrences that exerted the greatest influence in shaping the notions that currently dominate in research. They conclude that the paradigm shift is a positive development and that the present conception is suitable for heath research at this point in time.
Monitoring equity and research policy
The changing conceptions and focus of health research in East Africa
Langat SK, Onyatta JP: African Journal of Health Sciences 13(1-2): 1-6, 2008
Access to information as a tool for socio-economic justice
Dimba M: Pambazuka News, 8 April 2008
In countries plagued by socio-economic imbalances inherited from undemocratic systems of government, it is crucial that the products of democratic transition, such as freedom of information legislation, must be used to address imbalances. In the field of socio-economic rights, freedom of information creates a basis for contestation and justification of government decisions on resource allocation. It creates a basis for a fair and reasonable manner of decision-making.
Evidence of non-use of health management information systems data in Inbufumbira East Health Sub-district, Kisoro District, Uganda
Paschal N: Health Policy and Development 5(1): 1-10
A goal of the health management information system (HMIS) is to provide reliable, comprehensive information about the health system to health managers, to enable them take decisions that will improve the services provided to the consumers. Whereas HMIS quality concerns like the accuracy, completeness and timeliness of reports have been more commonly assessed and reported about in a number of studies, relatively less documentation is found on the actual utilisation of the information generated from HMIS reports. Yet, the HMIS is not an end in itself but just a tool to inform managers and enable them take informed and timely decisions. This study assessed the utilisation of HMIS data for decision making at the grassroots level in Bufumbira East Health Sub-District (HSD) of Kisoro District. It was found that HMIS data were not used for decision making at the point of collection and that the HMIS was dogged by many problems like few dedicated staff. The staff lacked sensitization on the HMIS and were not trained in completing the reports and data analysis. Lower level units submitted their data directly to the district bypassing the HSD. The HMIS was not planned for and lacked funding and stationery. HMIS functioning was not a subject for support supervision and there was only verbal feedback from the district level. It was recommended that the normal flow of HMIS data through the HSD level be re-established and that support supervision on the HMIS be instituted. Planning for the improvement of the system would ultimately lead to its utilisation.
Health research ethics review and needs of institutional ethics committees in Tanzania
Ikingura JKB, Kruger M and Zeleke W: Tanzania Journal of Health Research 9(3):154-158
This study was undertaken to describe the performance of health research ethics review procedures of six research centres in Tanzania. Data collection was done through a self-administered questionnaire and personal interviews. The results showed that there were on average 11 members (range= 8-14) in each Research Ethic Committee. However, female representation in the committees was low (15.2%). The largest proportion of the committee members was biomedical scientists (51.5%). Others included medical doctors (19.7%), social scientists (7.6%), laboratory technologists (10.6%), religious leaders (4.5%), statisticians (3.0%), teachers (1.5%) and lawyers (1.5). Committee members had different capacities to carry out review of research proposals. with the majority having moderate and good capacity. Only half of the respondents had prior ethics review training. Although the majority deemed that ethical guidelines were very important, there were challenges in the use of ethical guidelines which included lack of awareness on the national accreditation mechanisms for ethics committee. Adherence to ethical principles and regulations was influenced by being a scientist, being an employee of a professional organisation and having an interest in the use of ethical guidelines. These findings indicate the need for capacity strengthening (through training and resource support), inclusion of more female representation and other mandatory professions to the research ethics committees.
Monitoring effectiveness of programmes to prevent mother-to-child HIV transmission in lower-income countries
Stringer EM, Chi BH, Chintu N, Creek TL, Ekouevi DK, Coetzee D, Tih P, Boulle A, Dabis F, Shaffer N, Wilfert CM, Stringer JSA: Bulletin of the World Health Orgaization 86(1), January 2008
This article proposes a new method for evaluating prevention of mother-to-child transmission of HIV (PMTCT) programmes. The authors suggest that HIV-free survival is the gold standard (or ideal measure) for settings with limited resources. It captures not only HIV infections, as well as deaths prevented, but also the benefits of survival for all children exposed to HIV including those that do not become infected. The authors also propose modifying regular country-wide Demographic and Health Surveys (DHS) by including more detailed questions regarding maternal HIV history, PMTCT programme enrolment and interventions received, infant feeding practices and household child mortality. In sampled households, they advocate the addition of a ‘heel stick’ for dried blood spot collection among children less than two years of age. The authors conclude that modifying the DHS as they propose could provide a reliable method for assessing PMTCT effectiveness which could be used Africa-wide. It would also have the added advantage of including women who have not accessed institutional obstetric care and would otherwise have been excluded from most assessments.
Performance indicators for quality in surgical and laboratory services at Muhimbili National Hospital in Tanzania
Mbembati NA, Mwangu M, Muhondwa EP and Leshabari MM: East African Journal of Public Health 5(1), 2008
Muhimbili National Hospital (MNH), a teaching and national referral hospital, is undergoing major reforms to improve the quality of health care. Researchers performed a retrospective descriptive study using a set of performance indicators for the surgical and laboratory services of MNH in years 2001 and 2002, to help monitor and evaluate the impact of reforms on the quality of health care during and after the reform process. In 2001, 23.5% of non-emergency operations were planned, while in 2002, 29% were postponed. The most common reasons for operation postponement were 'time-barred', interference by emergency operations, no show of patients and inoperable anaesthetic machines. Equipment problems and supply and staff shortages together accounted for one quarter of postponements. In the laboratory, a lack of equipment prevented some tests, but quality assurance was performed for most tests. Current surgical services at MNH were reported to be inadequate; operating theatres require modern, functioning equipment and adequate supplies of consumables to provide satisfactory care.
Sound choices: Enhancing Capacity for Evidence-Informed Health Policy
Green A and Bennet S (eds): Alliance for Health Policy and Systems Research, World Health Organization
This Review addresses a mismatch between what is known about how to respond to particular health problems in poor economies and what is actually done about them. It focuses on one cause of the problems that ensue from the mismatch – capacity constraints. Weak capacity at a number of levels in the institutions and interfaces between knowledge generation and use in policy-making has been identified by the Alliance for Health Policy and Systems Research (HPSR) as a key strategic issue in addressing health care in low-income countries.
WHO strategy aims for leadership in health research
Real Health News, 28 April 2008
The WHO research strategy team has just finished its global consultations towards setting a new focus and role for WHO in health research: leadership and convening power to help other bodies set agendas, and an internal focus on ‘making a difference’ – getting care to where it’s most needed. The strategy is reported to demand impact both internally, within WHO, and externally, to give WHO a global leadership role.
WHO urged to back radical changes in drug research and development
Universities Allied for Essential Medicines
An international group of prominent academics — including several Nobel prize winners — has urged WHO member states to support radically new ways to address the lack of research into diseases that affect the poor. In particular, they are seeking a sizeable increase in government support for research into these diseases through an international research and development fund, and alternatives to the financial incentives of patents.
Further details: /newsletter/id/33138
Birth of the subject: the ethics of monitoring development programmes
George SK: Journal of Global Ethics 4(1):19-36, April 2008
NGO-based and rigorously monitored development programmes are bringing about important and positive socio-economic changes in the developing world. However, there are numerous instances of the employment of aggressive and grueling monitoring techniques which objectify the subject of development, the primary stakeholder, claiming development results as the successful achievement of goals of the donor or implementing organization. It is in this context that one can speak of an ethic of monitoring development programmes. The paper argues that such an ethic can be positively based on principles like empowering people through development work without hurting their sense of self-worth, the principle of trust and partnership and, negatively, never striving to objectify any person or people for the achievement of some objective, even if this objective is in itself honourable and desirable. The paper contends that if development is freeing the subject, the central player, to exercise their capability to live their life to the fullest, then development monitoring and development work in general has to enhance freedom, autonomy and openness.