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.
Monitoring equity and research policy
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.
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.
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.
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.
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.
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.
Strengthening health systems for improved policy making in low- and middle-income (LMIC) countries requires sustained efforts from many people, working collaboratively across multiple levels. Accordingly, the authors of this paper argue that the complexity of health systems necessitates approaches that are grounded in systems thinking at the global, national and subnational levels, and that recognise the need for ways of working that promote integration rather than fragmentation. Network structures represent a broad set of collaborative approaches that are useful for bringing stakeholders together. The authors propose that health systems in LMIC countries will be strengthened if policy researchers, policy makers and other stakeholders are able to explicitly and purposefully apply systems thinking concepts to the design, implementation, monitoring and evaluation of networks.
Malaria vector studies are a very important aspect of malaria research as they assist researchers to learn more about the malaria vector. Research programmes in various African countries include studies that assess various methods of preventing malaria transmission including controlling the malaria vector. Various institutions have also established mosquito colonies that are maintained by staff from the institutions. Malaria vector research presents several dilemmas relating to the various ways in which humans are used in the malaria vector research enterprise. A review of the past and present practices reveals much about the prevailing attitudes and assumptions with regard to the ethical conduct of research involving humans. The focus on the science of malaria vector research has led some researchers in African institutions to engage in questionable practices which reveal the ethical tensions inherent in the choice between science and the principles of justice, nonmaleficence and respect for individuals. The analysis of past and present choices in malaria vector research has relevance to broader questions of human dignity and are in line with the current emphasis on ethical research worldwide.
This paper examines the challenges and opportunities in establishing and sustaining north– south research partnerships in Africa through a case study of the UK-Africa Academic Partnership on Chronic Disease, which brought together multidisciplinary chronic disease researchers based in the UK and Africa to collaborate on research, inform policymaking, train and support postgraduates and create a platform for research dissemination. During the funded period researchers created a platform for research dissemination through international meetings and publications, but other goals, such as engaging in collaborative research and training postgraduates, were not as successfully realised. Enabling factors included trust and respect between core working group members, a shared commitment to achieving partnership goals, and the collective ability to develop creative strategies to overcome funding challenges. Barriers included limited funding, administrative support, and framework for monitoring and evaluating some goals. As chronic disease research partnerships in low-income regions operate within health systems that prioritise infectious diseases, their long-term sustainability will therefore depend on integrated funding systems that help build capacity, the authors argue. They identify social capital, measurable goals, administrative support, creativity and innovation and funding as five key ingredients that are essential for sustaining research partnerships.