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 equity and research policy
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.
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.
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.