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.
Monitoring equity and research policy
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.
This World Bank Independent Evaluation Group (IEG) report on almost $18 billion worth of health, nutrition and population work covered projects from 1997 to 2008 by the World Bank. It rated 220 projects according to how well they met stated objectives, regardless of how good those objectives were. Highly satisfactory outcomes were almost unheard of, and only about two-thirds of projects had moderately satisfactory outcomes or better. Projects in Africa were ‘particularly weak’, with only 27% achieving satisfactory outcomes. Overall only 29% of freestanding HIV projects had satisfactory outcomes, falling to 18% in Africa. Repeating a consistent criticism of past reports, the IEG found that monitoring and evaluation (M&E) ‘remains weak’, while ‘evaluation is almost nonexistent’. Only 27% of projects had ‘substantial or high’ M&E structures. This has led to ‘irrelevant objectives, inappropriate project designs, unrealistic targets, inability to measure the effectiveness of interventions.’ Even those projects that meet their objectives ‘may be performing at substantially lower levels than their outcomes would suggest’.
Have disease-specific global health initiatives (GHIs) burdened health systems that are already fragile in poor countries or have they been undermined by weak health systems? This study reviews and analyses existing data and 15 new studies that were submitted to the World Health Organization for the purpose of writing this report. It makes some general recommendations and identifies a series of action points for international partners, governments, and other stakeholders that will help ensure that investments in GHIs and country health systems can fulfil their potential to produce comprehensive and lasting results in disease-specific work, and advance the general public health agenda. If adjustments to the interactions between GHIs and country health systems will improve efficiency, equity, value for money and outcomes in global public health, then these opportunities should not be missed.
The use of attitude questions is very common in comparative surveys as it allows researchers to gauge the perspectives of respondents toward social issues and explain cross-country differentials in attitudes. Comparative studies implicitly assume that equivalently worded items are measuring the same construct in different settings. However, the results of these studies might be questionable if the measurement invariant assumption is violated and different groups of respondents do not have a shared understanding of the attitude items. This paper uses item response theory to compare the measurement of items and to test whether equivalently worded attitude questions about family dissolution are understood in the same way across various communities in India, Malaysia, Pakistan and the Philippines. The paper also examines the interaction between the respondent's gender, the sex of the spouse leaving the marriage and the responses to the attitude questions about acceptability of family dissolution.
Does research influence public policy and decision-making and, if so, how? This book is the most recent to address this question, investigating the effects of research in the field of international development. It starts from a sophisticated understanding about how research influences public policy and decision-making. It shows how research can contribute to better governance in at least three ways: by encouraging open inquiry and debate, by empowering people with the knowledge to hold governments accountable, and by enlarging the array of policy options and solutions available to the policy process. Knowledge to Policy examines the consequences of 23 research projects funded by Canada’s International Development Research Centre. Key findings and case studies from Asia, Africa, and Latin America are presented in a reader-friendly, journalistic style, giving the reader a deeper grasp and understanding of approaches, contexts, relationships and events.
This project explored the feasibility of using the Buxton and Hanney Payback Framework to determine the impact of a stratified random sample of competitively funded, primary health care research projects. The project conducted telephone interviews based on the Payback Framework with leaders of the research teams and nominated users of their research, used bibliometric methods for assessing impact through publication outputs and obtained documentary evidence of impact where possible. The framework provided rich information about the pathways to impact, better understanding of which may enhance impact. It is feasible to use the Buxton and Hanney Payback framework and logic model to determine the proximal impacts of primary health care research.
Three years ago, the Society of General Internal Medicine's Evidence-based Medicine Task Force began an inquiry to integrate evidence-based medicine (EBM) and the learning organization (LO), an approach to training from a systems-based perspective, into one model to address the knowing-doing gap problem. The authors of this study searched several databases for relevant LO frameworks and their related concepts by using a broad search strategy. They found seven LO frameworks particularly relevant to evidence-based practice innovations in organisations. These were integrated to form the new Evidence in the Learning Organization (ELO) model, which can be used by health organisations to identify their capacities to learn and share knowledge about evidence-based practice innovations.
A disparate series of contemporary lists of health service providers were used to update a public health facility database in Kenya, last compiled in 2003. These new lists were derived primarily through the national distribution of antimalarial and antiretroviral commodities since 2006. A combination of methods were used to map service providers and analyse disparity in geographic access to public health care. The update shows that, with concerted effort, a relatively complete inventory of mapped health services is possible, with enormous potential for improving planning. Expansion in public health care in Kenya has resulted in significant increases in geographic access, although several areas of the country need further improvements. This information will be key to future planning for Kenya’s public health sector.
Current systematic reviews have a utilitarian bias – they tend to be concerned more with the effects on populations and average effects than with distributional effects and impacts in disadvantaged sub¬groups. the author poses that systematic reviews should routinely consider the effects of interventions on health inequities. The Cochrane Health Equity Field was set up explicitly to further this agenda, to encourage systematic review authors to explicitly assess the effects of interventions not only on the whole population, but on the disadvantaged. Evidence on interventions to improve public health is in short supply, partic¬ularly evidence on social determinants. Public health systematic reviewers need to continue to develop new methods and better frameworks to inform decision-making.