The South African Government is to allocate more funds to health research over the next decade and add clinical research centres to hospitals earmarked for revitalisation so that it can build relevant evidence-based knowledge into the public health system. Deputy Minister of Health, Dr Gwen Ramokgopa, said that her department was currently spending 0.6% of its budget on health research, less than the 2% minimum it committed to in its 2001 health research policy.
Monitoring equity and research policy
South African government to allocate more funds for health research
Bateman C: South African Medical Journal 102(6): 345-346, June 2012
A resolution by the World Health Assembly: Will there finally be a cure for diseases that affect the poor?
Correa C: South Views 42, South Centre, 12 November 2012
In this article, the author argues that, in order to promote development of new products and their access to populations, especially in developing countries, it is necessary to change the current pharmaceutical research and development (R&D) model. The cost of research should be delinked from the prices of the products generated. The challenge is not only about increasing investment in research or improving the rate of innovation. This will not suffice if the new products are not effectively accessible for those who need them. It is a responsibility of States to provide effective solutions to the health problems of the majority of the planet’s population, he argues, calling for the establishment of a binding convention on R&D for new medicines, vaccines and other pharmaceutical products and technologies. A global binding agreement, negotiated in the World Health Organisation, could be an important part of the solution. Naturally, reaching consensus for its adoption will not be a simple task, neither can it be expected to be instantaneous. It would probably require some years of intense negotiation. However, it will be worth the effort if it can avoid the early death or improve the quality of life of millions of people by creating, on a solid foundation, a new paradigm for research and access to health products, the author concludes.
Further details: /newsletter/id/37406
Approaches to developing the capacity of health policy analysis institutes: A comparative case study
Bennett S, Corluka A, Doherty J and Tangcharoensathien V: Health Research Policy and Systems 10(7): 1-9, 5 March 2012
The aim of this study was to review and assess the factors that facilitate the development of sustainable health policy analysis institutes in low and middle income countries and the nature of external support for capacity development provided to such institutes. Comparative case studies of six health policy analysis institutes (three from Asia and three from Africa) were conducted. The findings are organised around four key themes. (i) Financial resources: Three of the institutes had received substantial external grants at start-up, however two of these institutes subsequently collapsed. At all but one institute, reliance upon short term, donor funding, created high administrative costs and unpredictability. (ii) Human resources: The retention of skilled human resources was perceived to be key to institute success but was problematic at all but one institute. (iii) Governance and management: Boards made important contributions to organisational capacity through promoting continuity, independence and fund raising. (iv) Networks: Links to policy makers helped promote policy influences, while external networks with other research organisations helped promote capacity. Overall, health policy analysis institutes remain very fragile. A combination of more strategic planning, active recruitment and retention strategies, and longer term, flexible funding, for example through endowments, needs to be promoted.
Beyond Aid: Research and Innovation as key drivers for Health, Equity and Development
Council on Health Research for Development Group (COHRED): 2012
This report summarises the outcomes of the conference Forum 2012, which was held in April 2012 in Cape Town, South Africa. It identifies that countries need to collect evidence and use it to identify priorities for their people and that external funders should not set agendas. Assessment should be made of where research is needed before embarking on projects, as is constant monitoring and evaluation. Research ethics frameworks need to be improved and integrated into health research systems. Partnerships are seen to be crucial, particularly local partnerships and scientists need mentoring, stable jobs and good salaries, and to know they are valued. People need to be engaged at a young age about research and innovation for development. Investing in research for health requires a long-term view. Promoting equity in health means addressing the social and economic conditions that cause inequality. Research and innovation can help identify and develop solutions to expand the availability of good quality healthcare and people's access to it, thereby reducing disparities in health.
Creating a Knowledge Translation Platform: Nine Lessons from the Zambia Forum for Health Research
Kasonde JM and Campbell S: Health Research Policy and Systems 10(31), 3 October 2012
In this review, the authors discuss nine key lessons documenting the experience of the Zambia Forum for Health Research, primarily to inform and exchange experience with the growing community of African KTPs. This Knowledge Translation Platform (KTP) provided cohesion and leadership for national-level knowledge translation efforts. They found that ZAMFOHR’s success was linked to selecting a multi-stakeholder and multi-sectoral Board of Directors, performing comprehensive situation analyses to understand not only the prevailing research-and-policy dynamics but a precise operational niche, and selecting a leader who bridges the worlds of research and policy. ZAMFOHR also helped build the capacity of both policy-makers and researchers, as well as a database of local evidence and national-level actors, while catalysing work in particular issue areas by identifying leaders from the research community, creating policy-maker demand for research evidence and fostering the next generation by mentoring up-and-coming researchers and policy-makers. Ultimately, ZAMFOHR’s experience shows that an African KTP must pay significant attention to its organisational details and invest in the skill base of the wider community and, more importantly, of its own staff. At the same time, the role of networking cannot be underestimated.
Emerging Voices 2012: Moses’ experiences
Tetui M: Makerere University School of Public Health, Uganda, 30 October 2012
In this blog from the Second Global Symposium on Health Systems Research, held in Beijing in October 2012, the author discusses the Emerging Voices programme for the Conference. The first part involved an introduction to new methods of presenting scientific research findings to a diverse audience in an effective way: Pecha Kucha and the Prezi. The author considered these picture-based alternatives better the traditional text-based PowerPoint presentation. Secondly, participants went on cultural and field visits to local Chinese traditional sites and were introduced to the Chinese health system. The author visited a district health office and two health centres in a rural area and was particularly impressed by the integration of Chinese traditional medicine with the Western medicine within the mainstream health system. This means that the Chinese give both disciplines and approaches adequate resources and attention in terms of developing them further. The conference offered a great opportunity to meet senior health systems researchers who could share their participatory action research methodologies.
Use of evidence to support healthy public policy: a policy effectiveness–feasibility loop
Bowman S, Unwin N, Critchley J, Capewell S, Husseini A, Maziak W et al: Bulletin of the World Health Organization 90(11): 847-853, November 2012
This paper presents a pragmatic framework for developing and prioritising policy interventions tailored to local epidemiological, political and social conditions. The “policy effectiveness–feasibility loop” (PEFL) framework was developed as part of a multinational project aiming to inform policy for the prevention and control of cardiovascular diseases and diabetes in four middle-income territories. Central to the proposed approach is the involvement of policy-makers in the collection of evidence and its appraisal. The PEFL framework resembles a “equity effectiveness loop”, which is intended to estimate the impact of interventions to reduce socioeconomic inequalities. The major difference is that the PEFL approach includes assessing the local context and the feasibility of potential interventions. Furthermore, its focus is on policy-level interventions, and hence the situation analysis involves local policy-makers. The situation analysis and option appraisal stages of the framework are analogous to policy dialogue, as they facilitate discussion between stakeholders and researchers on policies and how to implement them. The outputs resulting from application of the framework can be used to prepare policy briefs for informing stakeholder discussions on policy options.
Challenges with using estimates when calculating ART need among adults in South Africa
Gerritsen AAM, Mitchell JS, Johnson SM, Delva W: South African Medical Journal 102(10): 798-799, October 2012
The Foundation for Professional Development (FPD) collects information annually on HIV and AIDS service provision and estimates service needs in the City of Tshwane Metropolitan Municipality (CTMM). In this study, researchers used antiretroviral therapy (ART) data from the Department of Health and Statistics South Africa (SSA) mid-year population estimates to approximate the ART need among adults in the CTMM. According to SSA data, ART need decreased dramatically from 2010 to 2011 and was lower than the number of adults receiving ART. Although the noted difference was probably due to changes in the calculations by SSA, no detailed or confirmed explanation could be offered. The authors hope that their paper may provide a constructive contribution to the discussion about the use of model-derived estimates of ART need. They argue that it is critical that those providing estimates (in this case, SSA) clearly indicate whether any significant changes exist compared with earlier reports and, if so, the cause and implications of these changes.
Evaluating health systems strengthening interventions in low-income and middle-income countries: are we asking the right questions?
Adam T, Hsu J, de Savigny D, Lavis JN, Røttingen J and Bennett S: Health Policy and Planning 27 (suppl): iv9–iv19, 27 September 2012
The authors of this paper assessed recent evaluations of health systems (HS) strengthening interventions in low- and middle-income countries from 2009–10. Out of 106 evaluations, less than half (43%) asked broad research questions to allow for a comprehensive assessment of the intervention’s effects across multiple HS building blocks. Only half of the evaluations referred to a conceptual framework to guide their impact assessment. Overall, 24% and 9% conducted process and context evaluations, respectively, to answer the question of whether the intervention worked as intended, and if so, for whom, and under what circumstances. None incorporated evaluation designs that took into account the characteristics of complex adaptive systems such as non-linearity of effects or interactions between the HS building blocks. The authors call for more comprehensive evaluations of the range of effects of an intervention, when appropriate. They identify some barriers to more comprehensive evaluations as limited capacity, lack of funding, inadequate time frames, lack of demand from both researchers and research funders, or difficulties in undertaking this type of evaluation.
Outcome mapping and social frameworks: Tools for designing, delivering and monitoring policy via distributed partnerships
Shaxson L and Clench B: Delta Partnership, Working Paper 1, February 2011
The current trend towards the devolution of government responsibility is usually accompanied by severe cuts in public sector budgets, forcing government departments to develop different ways of working via partnerships of various types (government and non-government) and at various levels (national, regional and local). The challenge, the authors of this paper argue, will be finding ways for these partnerships to engage all partners fully in delivering public policy whilst recognising that each partner has a different mandate and different objectives that will align to different degrees with the policy’s stated goals. They argue that devolution of government responsibility has negatively affected policymaking as Ministers tend to focus on a small number of core activities, or outputs, rather than being accountable for delivering the final outcomes that solve or ameliorate societal problems. And any further devolution of responsibility is likely to give rise to ‘messy’ partnerships as well. The authors propose that current policy-making tools based on logic and prediction will fail to deal with the complexity of partnership working, and instead they recommend techniques like outcome mapping and social frameworks, which are covered in detail in the paper.