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.
Monitoring equity and research policy
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.
Primary health care (PHC) in South Africa forms an integral part of both the country's health policies and health system and has been prioritised as a major strategy in achieving health for all. On the eve of the 30th anniversary of the Alma Ata Declaration, PHC is once again in the spotlight. How far have we come in the last 30 years? How far in the last three? The third edition of the District Health Barometer, the 2006/07 report sheds some light by monitoring the trend of key health and financial indicators in PHC over the last three years by district and province.
Primary health care (PHC) in South Africa forms an integral part of both the country's health policies and health system and has been prioritised as a major strategy in achieving health for all. On the eve of the 30th anniversary of the Alma Ata Declaration, PHC is once again in the spotlight. How far have we come in the last 30 years? How far in the last three? The third edition of the District Health Barometer, the 2006/07 report sheds some light by monitoring the trend of key health and financial indicators in PHC over the last three years by district and province.
Research plays a crucial role in developing solutions to the health problems suffered by the populations of low and middle income countries. Most health research for and in low and middle income countries is funded from external sources. And most of this externally funded research takes the form of 'vertical' - condition-specific - programmes. This paper begins by highlighting four important problems that result from reliance on this type of funding; including an unduly narrow focus of research on conditions for which international funding is available (mostly HIV and AIDS, tuberculosis, and malaria); lack of interest in leaving behind sustainable capacity in research after the research projects have ended; and loss of interest in the local programme at the time when research findings should be translated into action.
While the importance of promoting equity to achieve health is now recognised, the health gap continues to increase globally between and within countries. The description in this study looks at how the Cape Town Equity Gauge initiative, part of the Global Equity Gauge Alliance (GEGA) is endeavouring to tackle this problem. In two very different, but connected projects, the authors demonstrate the value of adopting the GEGA approach, and the importance of involvement of all stakeholders at all stages. The studies also illustrate the potential of a research institution as informed 'outsiders', in influencing policy and practice.
This report and summary deals with the findings of the survey that deal with the District Health Barometer (DHB) publication. The DHB aims at improving the quality of and access to primary health care through monitoring important aspects of the health system at a district level by analysing and comparing a carefully selected range of health indicators.
Health equity has become an increasingly popular research topic during the course of the past 25 years. Many factors explain this trend, including a growing demand from policymakers, better and more plentiful household data, and increased computer power. But progress in quantifying and understanding health equities would not have been possible without appropriate analytic techniques. These techniques can provide researchers and analysts with a step-by-step practical guide to the measurement of a variety of aspects of health equity, with worked examples and computer code, mostly for the computer program Stata.
This article seeks to identify the role of databases in health policy. Access to information and communication technologies has changed traditional relationships between the state and professionals, creating new systems of surveillance and control. As a result, databases may have a profound effect on controlling clinical practice. Three case studies were undertaken to reconstruct the development and use of databases as policy instruments. Our results demonstrate that policy makers hardly used the databases, neither for cost control nor for quality assurance. Further analysis revealed that these databases facilitated self-regulation and quality assurance by (national) bodies of professionals, resulting in restrictive prescription behavior amongst physicians. The databases fulfill control functions that were formerly located within the policy realm. The databases facilitate collaboration between policy makers and physicians, since they enable quality assurance by professionals. Delegating regulatory authority downwards into a network of physicians who control the use of pharmaceuticals seems to be a good alternative for centralized control on the basis of monitoring data.