Adherence to therapies is an indicator of inequities as well as access to drugs. In average, 50% of patients in developed countries do not take their prescribed medicines after one year, despite having full access to medicines. In developing countries it is even worse, due to poor access to health services, medicines, lack of education and unhealthy lifestyles, which especially affects the poorest populations. Intended for policy-makers, health managers, and clinical practitioners, this report provides a concise summary of the consequences of poor adherence for health and economics. It also discusses the options available for improving adherence, and demonstrates the potential impact on desired health outcomes and health care budgets. It is hoped that this report will lead to new thinking on policy development and action on adherence to long-term therapies.
Monitoring equity and research policy
Health policy and systems research (HPSR) is increasing in prominence in low and middle income countries, stimulated by social and political pressure towards health system equity and efficiency. Yet the institutional capacity to fund and produce quality research and to have a positive impact on health system development has been little examined and touches mainly on specific areas such as malaria research or the impact of research on health reforms. This paper seeks to develop an empirical basis for assisting decisions on what are likely to be good investments to increase capacity in health policy and systems research (HPSR) in developing countries.
Health policy and systems research (HPSR) is increasing in prominence in low and middle income countries, stimulated by social and political pressure towards health system equity and efficiency. Yet the institutional capacity to fund and produce quality research and to have a positive impact on health system development has been little examined and touches mainly on specific areas such as malaria research or the impact of research on health reforms. In general, however, there is increasing pressure to direct research investments on the basis of evidence of policy relevance and impact. Indeed, in this decade of efforts to link development, health and research world-wide, there is little enquiry into the role of scientific capacity in general. This paper seeks to develop an empirical basis for assisting decisions on what are likely to be good investments to increase capacity in health policy and systems research (HPSR) in developing countries. It presents the results of a survey undertaken by the Alliance for Health Policy and Systems Research (Alliance-HPSR) in 2000 and 2001 to analyse institutional structure and characteristics, engagement with stakeholders, institutional capacity, level of attainment of critical mass and the process of knowledge production by institutions in low and middle income countries.
The social and environmental contexts that determine disease are no longer simply domestic but increasingly global. The box in this article lists what we consider the main inherently global health issues, a term describing health determining phenomena that transcend national borders and political jurisdictions. Considerable research exists on each of these issues, although not always with health as a principal outcome. Greater attention in research is required to the linkages between these issues and to their economic and political drivers that are, like the issues, increasingly global in scope. Such drivers include macroeconomic policies associated with international finance institutions, liberalisation of trade and investment, global trade agreements, and technological innovations, all of which are creating greater interdependence between people and places. Assessing how these inherently global health issues affect health is a complex task. Recent work on locating these inherently global health issues in comprehensive health frameworks, however, will prove useful in identifying specific research questions that are useful to policy makers and civil society.
This study aims to assess id21's success in increasing the influence of UK-funded research within international development policy. It begins by examining the ways in which policy-makers access and employ research. The study then uses these findings to assess the validity and performance of the dissemination methods id21 currently uses.
Increasing global attention is focusing on ways to improve health systems and the contribution that research-informed policies can make to this. It has long been recognised that a range of factors is involved in the interactions between health research and policy-makers. The emerging focus on Health Research Systems (HRS) has identified additional mechanisms through which greater utilisation of research could be achieved. Assessment of the role of health research in policy-making is best undertaken as part of a wider study that also includes utilisation of health research by industry, medical practitioners, and the public. The utilisation of health research in policy-making should eventually lead to desired outcomes, including health gains, says an article in Health Research Policy and Systems.
Good public policy decisions require reliable information about the causal relationships among variables. Policymakers must understand the way the world works and the likely effects of manipulating the variables that are under their control. The purpose of this paper from The Robert Wood Johnson Foundation's Changes in Health Care Financing and Organisation (HCFO) is to assist policymakers by providing an introduction to some of the problems associated with causal inference from empirical data. The paper also will be helpful to researchers who are attempting to draw causal inferences from data, or explain their results to policymakers.
There has been a marked lack of dialogue on policymaking between the areas of reproductive health and reform of the health sector. Policies in each area have been developed by different actors, pursuing different objectives. Consequently, disjointed policy-making has tended to predominate. A framework is proposed for enhancing such dialogue and collaboration between the two fields, with reference to links between actors, an understanding of policy contexts, the development of compatible aims and the need for institutional strengthening.
This article describes the Life Course Health Development (LCHD) framework, which was created to explain how health trajectories develop over an individual’s lifetime and how this knowledge can guide new approaches to policy and research. The Life Course Health Development (LCHD) framework offers a new approach to health measurement, health system design, and long-term investment in health development and also suggests new directions for research.
Research on international development investigates new policies and strategies that can help in the fight against global poverty and for a better standard of living for all. But there is little point to this research if it is not communicated effectively to the people who have the ability to act on its recommendations and implement the necessary changes. Who are these people, what types of research are they interested in, and what are the best ways to communicate this research to them? In early 2002, id21, the Institute of Development Studies at the University of Sussex, set about addressing these questions by surveying, interviewing and collecting comments from over 1900 NGO and aid agency staff, politicians, policy-makers, students and researchers. The results of these surveys have now been analysed to produce a comprehensive set of insights into how development research and its effective communication can influence policy and help bring about social change. A summary of reports is available from http://www.id21.org/id21-info/impact/summary.pdf, while the full report is available from the URL provided below.