This study assessed the completeness and accuracy of routine prevention of mother-to-child transmission of HIV (PMTCT) data submitted to the district health information system (DHIS) in three districts of Kwazulu-Natal province, South Africa, covering 316 clinics and hospitals. Data elements were reported only 50.3% of the time and were ‘accurate’ (within 10% of reconstructed values) 12.8% of the time. The data element ‘Antenatal Clients Tested for HIV’ was the most accurate element (consistent with the reconstructed value) 19.8% of the time, while ‘HIV PCR testing of baby born to HIV positive mother’ was the least accurate, with only 5.3% of clinics meeting the definition of accuracy. Data collected and reported in the public health system across three large, high HIV-prevalence districts was neither complete nor accurate enough to track process performance or outcomes for PMTCT care. Systematic data evaluation can determine the magnitude of the data reporting failure and guide site-specific improvements in data management. Solutions are currently being developed and tested to improve data quality.
Monitoring equity and research policy
The quality of health care, including access to HIV prevention and testing services, depends to a large extent on which of South Africa's 52 districts you happen to live in. Major inequities were noted between urban and rural areas, as rural areas were usually underserved. Some of the inequities highlighted by the District Health Barometer (DHB) can be traced to differences in health spending, with different districts spending different amounts. The uneven distribution of HIV infection in South Africa also influenced ratings: higher rates of Caesareans were linked to higher HIV rates in pregnant women. Writing in the DHB, Dr Tanya Doherty attributed a lack of improvement in child and maternal mortality rates to the HIV epidemic – under-five mortality barely shifted from 60 per 1,000 births in 1990, to 59 in 2007, while maternal mortality actually increased. Prevention of mother-to-child HIV transmission (PMTCT) is vital to reducing maternal and child mortality and combating HIV, but health authorities have failed to properly monitor PMTCT interventions. ‘This is indicative of management neglect of the programme from national to facility level,’ she wrote.
What is the current status of occupational health and safety (OHS) in southern African? Of an estimated 14 million injuries per year, a mere 93,000 injuries are reported. This brief notes that more data is needed, which should be analysed and reported regularly. In existing compensation systems, there is too much focus on financial governance and not on the production of information to prevent accidents and disease. It recommends that social security/compensation and reporting systems need to be introduced where these do not exist. Active surveillance methods need to be introduced through surveys already carried out by national statistical offices, or by adding occupational health components to future labour force or health and demographic surveys. In addition, targeted research needs to be funded and supported. It will take many years and a lot of resources for southern African countries to develop information systems as sophisticated as those in Western countries.
Impaired access to research information in health-related fields is not solely the preserve of developing countries but it is hugely exacerbated in poorer regions of the world. Why are such influential bodies as the Australian National Health and Medical Research Council, the Canadian Institutes of Health Research, the Centre for Disease Control and the National Institute of Health in the USA, the United Kingdom Medical Research Council and the Wellcome Trust promoting open access? Because it brings such benefits to health research including: increased visibility for research outputs; a concomitant increased usage and impact; an increase in the speed at which scientific research progresses; the facilitation of interdisciplinary research; and the enabling of new semantic computing tools to create new knowledge from existing knowledge. Open access is a key piece of the jigsaw for improving world health. All stakeholders in that vision should commit themselves to its implementation.
Access to health research publications is an essential requirement in securing the chain of communication from the researcher to the front-line health worker. As the diagram of the knowledge cycle from the Canadian Institutes of Health Research shows, health knowledge generated in the world’s laboratories is passed down the information chain through publications, through its impact and application, its subsequent “translation” into appropriate contexts for different user communities, arriving finally with health workers and the general public. This article focuses on the first link in the chain, from research author to reader, and the free online access to peer-reviewed published articles that are the building blocks for future health innovation developments.
New drugs, vaccines and diagnostics for the diseases of the developing world could save millions of lives and prevent enormous suffering and economic loss. Despite substantial new funding from the Gates Foundation and other donors, financing for the research and development (R&D) of these new health technologies remains inadequate. New approaches are needed to generate more resources, make funding more stable and flexible, and further engage the expertise of the pharmaceutical industry. Several new financing mechanisms have been launched recently, and others are being proposed. This paper summarises some of the most promising new ideas and offers a framework for evaluating them.
As long as standards and norms governing international research partnerships remain undefined in the legal environment, contractual matters will consume excessive energy, detract from the real work of health research professionals and set up collaborating institutions as potential adversaries rather than partners with a common research agenda. Agreed standards and norms for research contracting provide a framework for guidelines for equitable partnerships that can be put into practice in low- and middle-income countries to address the needs of local populations. The recently established International Collaboration on Equitable Research Contracts is conducting a global assessment of research contracting by developing and disseminating model contracts in which the rights, responsibilities and requirements of all partners are recognised. This evidence will inform the development of practical tools to achieve more equitable results in international research partnerships.
The quality of health care, including access to HIV prevention and testing services, depends to a large extent on which of South Africa's 52 districts you happen to live in. Some of the inequities highlighted by the District Health Barometer can be traced to differences in health spending, with districts in Western Cape Province spending the most on primary health care and districts in Free State Province spending the least. In the report, Dr Tanya Doherty of South Africa's Medical Research Council attributed a lack of improvement in child and maternal mortality rates to the HIV epidemic – under-five mortality barely shifted from 60 per 1,000 births in 1990 to 59 in 2007, while maternal mortality actually increased. Prevention of mother-to-child HIV transmission (PMTCT) is vital to reducing maternal and child mortality and combating HIV, but health authorities have failed to properly monitor PMTCT interventions. ‘This is indicative of management neglect of the programme from national to facility level,’ Doherty wrote.
South Africa's management of tuberculosis (TB) has significantly improved compared to what it was in 2005, according to this joint review of the TB programme by the World Health Organisation (WHO), development partners and non-governmental organisations (NGOs). Specifically, the TB defaulter rate has declined and cure rate has increased. The review included observations of provision of care in clinics and hospitals, and interviews with TB services managers and health workers. It found major improvements on quality and access to TB services (TB diagnosis and treatment available in all health facilities) resulting in increased case detection and treatment success. However, staffing levels were found to be sufficient in some provinces but insufficient in others and staff were very often not adequately trained in TB control, while drugs were generally available and in sufficient quantities. The Review recommended that infection control measures should be improved, as these was found to be weak.
The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) annually review data on immunisation coverage to estimate national coverage with routine service delivery of commonly used vaccines. The estimates are based on government reports submitted to WHO and UNICEF and are supplemented by survey results from the published and grey literature. Local experts are consulted for additional information on the performance of specific immunisation systems. Estimates are derived through a country-by-country review of available data informed and constrained by a set of heuristics – no statistical or mathematical models are used. Draft estimates are made, sent to national authorities for review and comment and modified in light of their feedback. While the final estimates may not differ from reported data, they constitute an independent technical assessment by WHO and UNICEF of the performance of national immunisation systems. These country-specific estimates, available from 1980 onward, are updated annually.