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.
Monitoring equity and research policy
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.
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.
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.
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.
In recent decades there has been increasing evidence of a relationship between self-reported racism and health. Although a plethora of instruments to measure racism have been developed, very few have been described conceptually or psychometrically. Furthermore, this research field has been limited by a dearth of instruments that examine reactions/responses to racism and by a restricted focus on African American populations. In response to these limitations, the 31-item Measure of Indigenous Racism Experiences (MIRE) was developed to assess self-reported racism for Indigenous Australians. This paper describes the development of the MIRE together with an opportunistic examination of its content, construct and convergent validity in a population health study involving 312 Indigenous Australians. The MIRE has considerable utility as an instrument that can assess multiple facets of racism together with responses/reactions to racism among indigenous populations and, potentially, among other ethnic/racial groups.
In light of increased access to policy dialogue about the reform of the international aid architecture, this paper explores ways in which southern researchers can maximise their input in to the debate. The authors argue that the current aid system is changing significantly, not only in terms of the increasing amounts of money which are likely to flow through the system, but also because of the range of new donors and funding vehicles which are joining it. This change is making the system more complex, and could potentially reduce the effectiveness of the aid that flows through it, but it also offers significant opportunities for reform. Specifically a number of decision-making fora have recently opened up which offer the chance for greater participation by southern organisations, particularly research institutes and think-tanks. To aid southern researchers’ affect on the debate the authors propose that they: target the content of the research; ensure it is in an appropriate medium and tailor it to the policy-makers; identify which international aid policy fora are most likely to take up their research; and increase focus on effective communication – researchers need to prepare a communications strategy to help to target their limited resources and capacity more effectively.
The new South African National Health Act has clarified that children may take part in ‘non-therapeutic' research (NTR) and the age at which they may provide independent consent to such research, viz. at legal majority. However, the Act will require consent from the Minister of Health for all research classed as NTR and involving minors regardless of the level of risk. This requirement is overly broad. It will require that low-risk research without direct benefits, which might be adequately reviewed by an accredited research ethics committee (REC), must also be reviewed by the Minister. As it currently stands this requirement is argued to serve no plausible ethical purpose, to cause delays and discourage essential research on the needs of children, and may inspire researchers and RECs alike to ‘foil the system'. The authors argue that in the long term there should be comprehensive law reform for child research. However, in the short term, amendments should be made to the Act to narrow the scope of this provision.
The complex evidence-policy interface in low and middle income country settings is receiving increasing attention. Future Health Systems (FHS): Innovations for Equity, is a research consortium conducting health systems explorations in six Asian and African countries: Bangladesh, India, China, Afghanistan, Uganda, and Nigeria. Three key activities were undertaken during the initial phase of this five-year project: key considerations in strengthening evidence-policy linkages in health system research were developed through workshops and electronic communications; four considerations were applied to research proposals in each of the six countries to highlight features in the research plans that potentially strengthen the research-policy interface and opportunities for improvement; and utility of the approach for setting research priorities in health policy and systems research was reflected upon. Developmental consideration with four dimensions a poverty, vulnerabilities, capabilities, and health shocks a provides an entry point in examining research-policy interfaces in the six settings. Research plans focused upon on the ground realities in specific countries strengthens the interface. Focusing on research prioritised by decision-makers, within a politicised health arena, enhances chances of research influencing action. Early and continued engagement of multiple stakeholders, from local to national levels, is conducive to enhanced communication at the interface.
This paper presents the methodology and findings from a proof-of-concept study undertaken to explore the viability of conducting a systematic, largely qualitative synthesis of evaluation reports emanating from Community Based Rehabilitation (CBR) projects in developing countries. Computer assisted thematic qualitative analysis was conducted on recommendation sections from 37 evaluation reports, arising from 36 disability and development projects in 22 countries. Quantitative overviews and qualitative summaries of the data were developed. The application of the synthesis methodology utilised in this proof-of-concept study was found to be potentially very beneficial for future research in CBR, and indeed in any area within health services or international development in which evaluation reports rather than formal research evidence is the primary source material. The proof-of-concept study identified a number of limitations which are outlined. Based on the conclusions of 37 evaluation reports, future policy frameworks and implementation strategies in CBR should include a stronger emphasis on technical, organisational, administrative and personnel aspects of management and strategic leadership.