Many countries in the African region do not have functional national health research systems (NHRS) that generate, disseminate, uses, and archives health-related knowledge/ideas in published form (hard, electronic or audio forms). In such countries, death of each modern or traditional health practitioner constitutes a permanent loss of a library of knowledge, ideas, innovations and inventions. The WHO African Advisory Committee on Health Research and Development (AACHRD) has attributed the fragility of NHRS in the Region to poor environment for research, inadequate manpower, inadequate infrastructures and facilities, inaccessibility to modern technology, and lack of funds. The weak and uncoordinated NHRS partly explain the poor overall performance of majority of national health systems in the Region. Continued fragility of NHRS can be attributed to lack of implementation of the WHO Regional Committee for Africa and the World Health Assembly resolutions on health research. This paper urges African countries, to fully implement the contents of those resolutions, for substantive health research outputs to share with the rest of the world at the next Ministerial Summit on Research for Health, which will take place in the African Region in 2008.
Monitoring equity and research policy
Public health programmes operate without uniform, empirical measures, a fact often forgotten amidst recent enthusiasm for modelling public health on the private sector, where the dollar dictates strategic and operational priorities. As a result, it is surprisingly difficult to determine whether or not public health interventions work and whether their benefits are equitably distributed. Certainly, the medical bases for most interventions are sound. There can be little doubt that standardised treatment regimens cure tuberculosis or that oral rehydration resuscitates children with diarrhoeal illnesses. History, however, shows that medical science is neither necessary nor sufficient for effectiveness. Public health interventions succeeded in controlling problems from scurvy to smallpox to cholera to puerperal fever decades before medical science identified causative agents or specific therapies. Proof that medical interventions work is generated in carefully controlled, highly resourced environments. The validity of this evidence must be re-evaluated after translation into policy, especially in the poor, chaotic conditions of the developing world. The same interventions are seldom evaluated in low-resource comparison groups and, indeed, the same measures of effectiveness – like CD4 count or ejection fraction – would be impractical. Such conditions pose enormous challenges to research and implementation alike. Resources are limited, data are scarce, bias is abundant and few validated techniques exist for analysis on a scale larger than the individual case study.
The annual meetings of the Global Forum are premier international events for stakeholders in health research for development. This Forum 11 report provides an overview and synthesis of the key issues discussed and conclusions reached. These include: the need for additional research; better systems of organizing and funding research, for ensuring participation in the process by all the stakeholders and for facilitating research to ensure impact on the health of those in need. Other central themes include: expanding the use of evidence in policy- and decision-making; equity and human rights (access and inclusion); encouraging innovation in research; research priority setting; research capacity strengthening; possibilities with inter-sectoral collaboration; advocacy for more research and resources; and communication of research results.
In preparation for the forthcoming Ministerial Forum on Health Research, to be held in Bamako, Mali in November 2008, more than 40 researchers from 28 countries, both in the South and the North, who have a particular interest in health policy and systems research (HPSR) and the application of evidence to health policy, gathered in Nyon, Switzerland on 25-27th May to: critically assess developments in HPSR in low and middle income countries and its application to policy since the Mexico Summit, 2004; highlight current gaps, priorities and challenges in the HPSR field that need to be addressed; and discuss and agree how best to move forward the HPSR field. Meeting participants reviewed evidence about the evolution of the HPSR field and debated emerging needs, with a view to informing discussions at Bamako, and further action by the institutions sponsoring and participating in the meeting, as well as by other key stakeholders including national governments, researchers, research and development funders.
Inadequate reporting is problematic for several reasons. If authors do not provide sufficient details concerning the conduct of their study, readers are left with an incomplete picture of what was done. As such, they are not able to judge the merits of the results and interpret them. The EQUATOR Network is a new initiative aimed at improving the clarity and transparency of reporting health research.
Perceptions in health research are a product of the circumstances within the society, where the research activities are situated. In East Africa there has been a change in conceptualisation over a period of time from an elitist de-linked status to the present, which has evolved to embrace the local community. In this paper, researchers trace the changes and highlight some occurrences that exerted the greatest influence in shaping the notions that currently dominate in research. They conclude that the paradigm shift is a positive development and that the present conception is suitable for heath research at this point in time.
In countries plagued by socio-economic imbalances inherited from undemocratic systems of government, it is crucial that the products of democratic transition, such as freedom of information legislation, must be used to address imbalances. In the field of socio-economic rights, freedom of information creates a basis for contestation and justification of government decisions on resource allocation. It creates a basis for a fair and reasonable manner of decision-making.
A goal of the health management information system (HMIS) is to provide reliable, comprehensive information about the health system to health managers, to enable them take decisions that will improve the services provided to the consumers. Whereas HMIS quality concerns like the accuracy, completeness and timeliness of reports have been more commonly assessed and reported about in a number of studies, relatively less documentation is found on the actual utilisation of the information generated from HMIS reports. Yet, the HMIS is not an end in itself but just a tool to inform managers and enable them take informed and timely decisions. This study assessed the utilisation of HMIS data for decision making at the grassroots level in Bufumbira East Health Sub-District (HSD) of Kisoro District. It was found that HMIS data were not used for decision making at the point of collection and that the HMIS was dogged by many problems like few dedicated staff. The staff lacked sensitization on the HMIS and were not trained in completing the reports and data analysis. Lower level units submitted their data directly to the district bypassing the HSD. The HMIS was not planned for and lacked funding and stationery. HMIS functioning was not a subject for support supervision and there was only verbal feedback from the district level. It was recommended that the normal flow of HMIS data through the HSD level be re-established and that support supervision on the HMIS be instituted. Planning for the improvement of the system would ultimately lead to its utilisation.
This study was undertaken to describe the performance of health research ethics review procedures of six research centres in Tanzania. Data collection was done through a self-administered questionnaire and personal interviews. The results showed that there were on average 11 members (range= 8-14) in each Research Ethic Committee. However, female representation in the committees was low (15.2%). The largest proportion of the committee members was biomedical scientists (51.5%). Others included medical doctors (19.7%), social scientists (7.6%), laboratory technologists (10.6%), religious leaders (4.5%), statisticians (3.0%), teachers (1.5%) and lawyers (1.5). Committee members had different capacities to carry out review of research proposals. with the majority having moderate and good capacity. Only half of the respondents had prior ethics review training. Although the majority deemed that ethical guidelines were very important, there were challenges in the use of ethical guidelines which included lack of awareness on the national accreditation mechanisms for ethics committee. Adherence to ethical principles and regulations was influenced by being a scientist, being an employee of a professional organisation and having an interest in the use of ethical guidelines. These findings indicate the need for capacity strengthening (through training and resource support), inclusion of more female representation and other mandatory professions to the research ethics committees.
This article proposes a new method for evaluating prevention of mother-to-child transmission of HIV (PMTCT) programmes. The authors suggest that HIV-free survival is the gold standard (or ideal measure) for settings with limited resources. It captures not only HIV infections, as well as deaths prevented, but also the benefits of survival for all children exposed to HIV including those that do not become infected. The authors also propose modifying regular country-wide Demographic and Health Surveys (DHS) by including more detailed questions regarding maternal HIV history, PMTCT programme enrolment and interventions received, infant feeding practices and household child mortality. In sampled households, they advocate the addition of a ‘heel stick’ for dried blood spot collection among children less than two years of age. The authors conclude that modifying the DHS as they propose could provide a reliable method for assessing PMTCT effectiveness which could be used Africa-wide. It would also have the added advantage of including women who have not accessed institutional obstetric care and would otherwise have been excluded from most assessments.