Public health today enjoys commitment, resources, and powerful interventions but the power of these interventions is not matched by the power of health systems to deliver them to those in greatest need, on an adequate scale and in time. According to this document, this arises, in part, from the fact that research on health systems has been so badly neglected and underfunded. In the absence of sound evidence, we will have no good way to compel efficient investments in health systems. Outlined in this document are a number of options for action by stakeholders to facilitate evidence-informed decision-making and the strengthening of health systems. These complementary options are intended to support the embedding of research within decision-making processes and promote a steady programme of national and global investment in HPSR. Member States of WHO may opt to pursue some or all of these actions, based on their individual context . 1. Embed research within decision-making processes. 2. Support demand-driven research. 3. Strengthen capacity for research and use of evidence. 4. Establish repositories of knowledge. 5. Improve the efficiency of investments in research. 6. Increase accountability for actions.
Monitoring equity and research policy
The Mozambique Population Health Implementation and Training (PHIT) Partnership focuses on improving the quality of routine data and its use through appropriate tools to facilitate decision making by health system managers; strengthening management and planning capacity and funding district health plans; and building capacity for operations research to guide system-strengthening efforts. This seven-year effort covers all 13 districts and 146 health facilities in Sofala Province. The Mozambique PHIT Partnership expects to provide evidence on the effect of efforts to improve data quality coupled with the introduction of tools, training, and supervision to improve evidence-based decision making. This contribution to the knowledge base on what works to enhance health systems is highly replicable for rapid scale-up to other provinces in Mozambique, as well as other sub-Saharan African countries with limited resources and a commitment to comprehensive primary health care.
The challenge of improving healthcare information in countries with meagre resources will require more than just highlighting insufficiencies, according to this editorial. The right to access health information is a key component of a strong health system, but to be effective it requires evaluation and synthesis of evidence, translation of evidence into educational materials, and implementation and dissemination. Health information is key to improving weak health systems. If governments are legally obliged to support the right to access reliable health information, what can be done to ensure that they do so? It is suggested that a legal approach may not work, but that locating access to reliable health information within the broader human rights framework may generate benefit from the momentum of human rights advocacy.
In this study, the authors aim to provide a comprehensive description of available data sources, propose a set of indicators for monitoring the global landscape of health research and development (R&D), and present a sample of country indicators on research inputs (investments), processes (clinical trials), and outputs (publications), based on data from international databases. Total global investments in health R&D (both public and private sector) in 2009 reached US$240 billion. Only about 1% of all health R&D investments were allocated to neglected diseases in 2010. Diseases of relevance to high-income countries were investigated in clinical trials seven-to-eight-times more often than were diseases whose burden lies mainly in low-income and middle-income countries. This report confirms that substantial gaps in the global landscape of health R&D remain, especially for and in low-income and middle-income countries. Too few investments are targeted towards the health needs of these countries. Better data are needed to improve priority setting and coordination for health R&D, the authors argue, ultimately to ensure that resources are allocated to diseases and regions where they are needed the most. The establishment of a global observatory on health R&D, which is being discussed at WHO, could address the absence of a comprehensive and sustainable mechanism for regular global monitoring of health R&D.
Tackling health inequalities must be a central plank of public policy for any Government, and this report is intended to help to shape the policy direction, and influence the targeting and delivery of services, in tackling inequalities. The evidence base about “what works” is still fairly weak, but there is now a commitment to address this. Resources are going into research and development to advance our knowledge and understanding of what works. This report works in parallel to that research, in terms of measuring inequalities in order to plan, set targets, monitor and evaluate. The authors recommend establishing mechanisms to monitor inequalities in health and to evaluate the effectiveness of measures taken to reduce them. This report is relevant to anyone involved in addressing health inequalities, as it presents the complicated science of the measurement of inequalities in a rigorous but accessible way.
In 2007, the 60th World Health Assembly endorsed a Global Plan of Action on Workers’ Health for 2008-2017 and urged WHO member states to devise national policies and plans for its implementation. To establish a baseline for measuring progress, information was collected in 2008-2009 from Member States – this report presents the findings of that survey. While most countries have introduced ways of addressing risks at the workplace such as integrated management of chemicals and tobacco smoking bans, enforcement of regulations for workplace health protection remains insufficient. Less than half of countries surveyed have endorsed or drafted a national plan of action on workers’ health. Only one third of countries cover more than 30% of their workers with occupational health services. Although half the countries have national workers’ health profiles with data on occupational diseases, injuries, and legislation, information about communicable and non-communicable diseases among workers and about lifestyle risks are the least-covered topics. Workers’ health issues feature in policies concerning management of chemicals, emergency preparedness and response, employment strategies, and vocational training. However, workers’ health is seldom considered in policies regarding climate change, trade, economic development, poverty reduction, and general education.
For the first time since 1996, the United Nations Food and Agriculture Organisation (FAO) has significantly revised how estimates the number of hungry people in the world. When the new methodology is used to generate estimates for the past 20 years, the figures show a steady decline, running counter to previous estimates, which showed a continual increase in the number of undernourished people from the mid-1990s up to the late 2000s. What lies behind the FAO’s revised prevalence of undernourishment estimates are changes in the methodology used to arrive at the estimate and newer, more complete data used for the building blocks of the FAO model. The methodological innovations may be found in the assumed distribution of dietary energy consumption, and the way in which variations in habitual food consumption are estimated. The most important data change is that estimates of food losses at the retail distribution level, not only at the production and storage levels, are taken into account. The FAO is in the process of developing a range of additional food security indicators, intended to reflect changes in ‘determinants of (or inputs to) food security’ and to capture how food prices evolve in relation to consumer prices in general in developing countries.
In this study, researchers conducted a quasi-formative evaluation between October and December 2011 on four regional-led African research networks: Central Africa Network on Tuberculosis, HIV/AIDS and Malaria (CANTAM); East African Consortium for Clinical Research (EACCR); West African Network of Excellence for TB, AIDS and Malaria (WANETAM), and the Trials of Excellence for Southern Africa (TESA) launched between 2009 and 2010. They shared a participatory appraisal of field reports, progress reports and presentations from each network to jointly outline the initial experiences of the merits, outputs and lessons learnt. Results showed that the self-regulating democratic networks, with 64 institutions in 21 African countries, have trained over 1, 000 African scientists, upgraded 36 sites for clinical trials, leveraged additional € 24 million and generated 38 peer-reviewed publications through networking and partnerships. The shared initial merits and lessons learnt portray in part the strengthened capacity of these networks for improved research coordination and conduct of planned multi-centre clinical trials in Africa. Increased funding by African agencies, governments and international health partners will ensure sustainability of these networks for research capacity development and demonstrate their commitment to achieving the Millennium Development Goals in Africa.
For many years, economic indicators were considered the ultimate measure of a country’s well-being. But the general happiness of a country doesn’t always correlate with its wealth. In fact, economic indicators don’t match up with a number of important indicators about well-being. Hence the Social Progress Index, an initiative from the Social Progress Imperative and Harvard Business School Professor Michael Porter that examines how 50 countries perform on 52 indicators related to basic human needs, the foundations of well-being, and opportunity. The index looks at social and environmental outcomes directly rather than proxies of economic indicators. These social and environmental components include personal safety, ecosystem sustainability, health and wellness, shelter, sanitation, equity and inclusion, and personal freedom and choice. Each component is calculated based on specific outcomes: health and wellness, for example, is determined by life expectancy, obesity, cancer death rate, and other factors. The author argues that the index will allow businesses to better articulate the purpose they serve, and how business can collectively shape, influence and be a co-collaborator in some of the bigger social progress issues.
During the March 2013 Council on Health Research for Development (COHRED) Colloquium, participants highlighted the value of research and development in supporting public health in developing countries and the importance of building self-reliance for countries through government investment. Although the meeting was not aiming at consensus, a few key themes emerged. Participants widely agreed that countries should increase their own investments in research for health to attract external funding and ensure fairer collaboration. And in the context of the global economic crisis, participants also took note of an emerging trend among external funders toward implementation research, which looks at how to effectively translate findings into practice, and suggested that governments should do the same. With less funding available, governments increasingly have to justify additional spending on health research, show the value of investment and increase efficiency. Participants called on countries to look at the knowledge and technology interventions they already have, invest in research to examine why they are or not working, and focus on optimising them.