This paper explores parasite movements as a source of valuable information for planning control strategies for malaria. Mobile parasite carrying individuals can instigate transmission in receptive areas, spread drug resistant strains and reduce the effectiveness of control strategies. The identification of mobile groups, their routes of travel and how these movements connect differing transmission zones, potentially enables limited resources for interventions to be efficiently targeted over space, time and populations. National data on population and migration were linked to migration, travel, and other data to understand malaria movement patterns. Together with existing spatially referenced malaria data and mathematical models, network analysis techniques were used to quantify the demographics of human and malaria movement patterns in Kenya, Uganda and Tanzania. Patterns of human and malaria movements varied between demographic groups, within country regions and between countries. Migration rates were highest in 20–30 year olds in all three countries, but when accounting for malaria prevalence, movements in the 10–20 year age group became more important.
Monitoring equity and research policy
Communities of Practice (CoPs) are groups of people that interact regularly to deepen their knowledge on a specific topic. Thanks to information and communication technologies, CoPs can involve experts distributed across countries and adopt a ‘transnational’ membership. This has allowed the strategy to be applied to domains of knowledge such as health policy with a global perspective. CoPs represent a potentially valuable tool for producing and sharing explicit knowledge, as well as tacit knowledge and implementation practices. They may also be effective in creating links among the different ‘knowledge holders’ contributing to health policy (e.g., researchers, policymakers, technical assistants, practitioners, etc.). CoPs in global health are growing in number and activities. As a result, there is an increasing need to document their progress and evaluate their effectiveness. This paper represents a first step towards such empirical research as it aims to provide a conceptual framework for the analysis and assessment of transnational CoPs in health policy. The framework is developed based on the findings of a literature review as well as on the authors' experience, and reflects the specific features and challenges of transnational CoPs in health policy. It organizes the key elements of CoPs into a logical flow that links available resources and the capacity to mobilize them, with knowledge management activities and the expansion of knowledge, with changes in policy and practice and, ultimately, with an improvement in health outcomes. Additionally, the paper addresses the challenges in the operationalization and empirical application of the framework
In this study researchers aimed to identify priority policy issues in access to medicines (ATM) relevant for low- and middle-income countries, to identify research questions that would help address these policy issues, and to prioritise these research questions in a health policy and systems research (HPSR) agenda. The study involved i) country- and regional-level priority-setting exercises performed in 17 countries across five regions, with a desk review of relevant grey and published literature combined with mapping and interviews of stakeholders. A list of 18 research questions was formulated according to four ranking criteria (innovation, impact on health and health systems, equity, and lack of research). The top three research questions were: i) In risk protection schemes, which innovations and policies improve equitable access to and appropriate use of medicines, sustainability of the insurance system, and financial impact on the insured? ii) How can stakeholders use the information available in the system, e.g., price, availability, quality, utilisation, registration, procurement, in a transparent way towards improving access and use of medicines? and iii) How do policies and other interventions into private markets, such as information, subsidies, price controls, donation, regulatory mechanisms, promotion practices, etc., impact on access to and appropriate use of medicines? The HPSR agenda discussed here adopts a health systems perspective and will guide relevant, innovative research, likely to bear an impact on health, health systems and equity.
Billions are spent on health innovations, but very little on how best to apply them in real-world settings. Despite the importance of implementation research, it continues to be a neglected field of study, partly because of a lack of understanding regarding what it is and what it offers. Intended for newcomers to the field, those already conducting implementation research, and those with responsibility for implementing programmes, this guide provides an introduction to basic implementation research concepts and briefly outlines what it involves, and describes the many exciting opportunities that it presents.
The Western Cape Province has a local-level mortality surveillance system that has been upgraded to do automated cause of death coding using IRIS software, in concordance with the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) codes. This paper reviews the achievements in providing district-level and subdistrict-level mortality data, and describes the lessons learnt and the challenges for sustaining such a system. Cause of death coding was upgraded from a shortlist to full ICD-10 coding for natural causes of death in a customised data capture system. A total of 33 564 deaths from natural causes were coded for 2009, with 9.4% due to ill-defined causes. Completeness was estimated at 83.7% and mortality profiles were provided for all health districts for the first time, highlighting district variations in age-standardised mortality rates, although HIV and tuberculosis were the leading causes of premature mortality across all districts. It is necessary to train data capturers in medical terminology and doctors in death certification, as well as building quality assurance measures into the system. Local cause of death coding enables quality issues to be identified and addressed directly at source. IRIS makes it possible to standardise coding across districts for routine cases. Dissemination of local mortality information creates a demand for updated results, which are sometimes difficult to meet. Challenges include securing the appropriate resource allocation, integrating into a fragmented health system, and ensuring co-operation between government departments. Utilisation of information technology opportunities (eg, electronic registration of death) remains a challenge.
INTREC (INDEPTH Training and Research Centres of Excellence) was established to provide training for researchers from the INDEPTH network on associations between health inequities, the social determinants of health (SDH), and health outcomes, and on presenting their findings in a usable form to policy makers. The authors of this paper assessed the current status of SDH training in three of the African INTREC countries – Ghana, Tanzania, and South Africa – as well as the gaps, barriers, and opportunities for training. Results indicated that SDH-relevant training is available, but the number of places available for students is limited, the training tends to be public-health-oriented rather than inclusive of the broader, multi-sectoral issues associated with SDH, and insufficient funding places limitations on both students and on the training institutions themselves, thereby affecting participation and quality. The authors argue that there is a clear role for INTREC to contribute to the training of a critical mass of African researchers on the topic. This work will be accomplished most effectively by building on pre-existing networks, institutions, and methods.
According to this letter, the Global Fund indicators that have been used in the past do not reflect a commitment to strengthening the response for women and girls. Many key indicators of progress do not address the differing realities for women and girls versus men and boys. For example, the indicator for new HIV infections is not disaggregated by sex. Similarly, the Global Fund has administered many grants with a focus on orphans and vulnerable children (OVC), but few of the programmes use indicators that reflect that the experiences of orphans and vulnerable children who are girls will differ from those of boys, both in the opportunities and obstacles they will encounter. The author argues that failure to measure progress in preventing new infections among women, or to measure the effects of OVC programmes on girls, means there is no incentive for countries that receive Global Fund grants to ensure that their efforts are addressing the specific challenges faced by women and girls. Other necessary indicators must be developed about the specific effects of HIV and AIDS on women, such as access to testing, counseling, and treatment among women who are not pregnant. Integration of HIV services and contraception provision, as well as violence experienced by all women - not just those who are married or cohabiting – need to be addressed, especially as research has repeatedly shown that sexual violence puts women and girls at elevated risk of contracting HIV.
Despite spending huge sums of money on health every year the African regions burden of disease is persistently high. Weaknesses are identified in factors as health leadership and governance, service delivery, health workforce, medicines, vaccines, and health technologies; health information; and health system financing that have undermined the capacity of health systems of countries in the region to improve population health without wastage of resources. In this book, the author applies a data envelopment analysis technique, interlacing lecture notes with research articles and case studies to equip students and practitioners of economics, operations research, management science, and public health with knowledge and skills for undertaking technical efficiency, allocative efficiency, cost efficiency, and total factor productivity analyses.
This literature review was conducted to identify examples of embedded health policy and systems research (HPSR) used to inform decision-making in low- and middle-income countries (LMICs). The authors found that multiple forces converge to create context-specific pathways through which evidence enters into decision-making. Depending on the decision under consideration, the literature indicates that decision-makers may call upon an intricate combination of actors for sourcing HPSR. While proximity to decision-making does have advantages, it is not the position of the organisation within the network, but rather the qualities the organisation possesses, that enable it to be embedded. These findings suggest that four qualities influence embeddedness: reputation, capacity, quality of connections to decision-makers, and quantity of connections to decision-makers and others. In addition to this, the policy environment (e.g. the presence of legislation governing the use of HPSR, presence of strong civil society, etc.) strongly influences uptake. The authors’ conceptual model highlights several important considerations for decision-makers and researchers about the arrangement and interaction of evidence-generating organisations in health systems.
In Uganda, a team of researchers, policy makers, civil society and the media has been formed to build a collaboration that would help in discussing appropriate strategies to mitigate the high disease burden in Uganda. A preparatory secretariat identified researchers and key resource persons to guide four workshops, which were held between 2006 and 2009. A total of 322 participants attended of whom mid-level policy makers, researchers and the media were consistently high. The workshops generated a lot of interest that lead to presentation and discussion of nationally relevant health research results. The workshops had an impact on the participants’ skills in writing policy briefs, participating in the policy review process and entering into dialogue with policy makers. A number of lessons were learned: getting health research into policy is feasible but requires few self-motivated individuals to act as catalysts; and adequate funding and a stable internet are necessary to support the process. Mid-level policy makers and programme managers had interest in this initiative and are likely sustain it as they move to senior positions in policy making, the authors report.