Monitoring equity and research policy

When ethics and politics collide in donor-funded global health research
Storeng K; Palmer J: The Lancet, doi:, 2019

In this paper, the authors share their experience of censorship in evaluation research for global health. Their experience shows a broader trend of external funders and implementing partners who deliberately use ethical and methodological arguments to undermine essential research. In a context of chronic underfunding of universities and their growing dependence on externally-driven research grants, the authors propose several structural and cultural changes to prevent manipulation of research governance systems and to safeguard the independence of research. While they acknowledge censorship to be a strong word, they justify its use in situations found where researchers in commissioned research-based evaluations are asked by funders to omit important results from their final report. The authors note that universities' provide methodological and subject area expertise and strong systems of research ethics and governance, but also observe that current systems are ill equipped to deal with these challenges.

Evidence map of knowledge translation strategies, outcomes, facilitators and barriers in African health systems
Edwards A; Zweigenthal V; Olivier J: Health Research Policy and Systems 17(16) 1-14, 2019

This paper provides a systematic overview of the literature on knowledge translation strategies employed by health system researchers and policy-makers in African countries. An evidence mapping methodology was adapted from the social and health sciences literature and used to generate a schema of knowledge translation strategies, outcomes, facilitators and barriers.The knowledge translation literature in African countries is found to be widely distributed, problematically diverse and growing. Significant disparities exist between reports on knowledge translation in different countries, and there are many settings without published evidence of local knowledge translation characteristics. Commonly reported knowledge translation strategies include policy briefs, capacity-building workshops and policy dialogues. Barriers affecting researchers and policy-makers include insufficient skills and capacity to conduct knowledge translation activities, time constraints and a lack of resources. Availability of quality locally relevant research was the most reported facilitator. Limited knowledge translation outcomes reflect persisting difficulties in outcome identification and reporting.

Repositioning Africa in global knowledge production
Fonn S; Ayiro L; Cotton P; Habib et al: The Lancet 392(10153), 1163-1166, 2018

Sub-Saharan Africa accounts for 13·5% of the global population but less than 1% of global research output. In 2008, Africa produced 27 000 published papers—the same number as The Netherlands. Informed by a nuanced understanding of the causes of the current scenario, the authors propose action that should be taken by African universities, governments, and development partners to foster the development of research-active universities on the continent. Since the 1990s, African universities have sought to regain their role as agents of transformation. On a per capita basis, African universities remain severely underfunded in view of increasing enrolment, the establishment of new universities, and the declining purchasing power of African currencies. Part of the explanation is that Africa contributes less than 1% of the global expenditure on research and development. By comparison, Latin America and the Caribbean account for 3%; Europe for 27%; Asia for 31%, and North America for 37%. Sub-Saharan Africa depends greatly on international collaboration and visiting academics for its research output. In 2012, southern Africa, east Africa, and west and central Africa produced 79%, 70%, and 45% of all their research output, respectively, through international collaborations. African Education ministers have met several times recently to address challenges in higher education. The authors argue that research-intensive universities across sub-Saharan Africa need to be identified, recognised, strengthened, and invested in through new sources of funding. Creating and maintaining research-intensive universities will require consistent investment in human capital, research equipment, and relevant administrative support, at far higher levels than is available under current conditions. To ensure that designated research-intensive universities do not become complacent and to allow for the entry of upcoming high-achieving universities, the authors propose on-going peer review every 3–5 years. At a minimum, the authors propose that research-intensive universities commit their own resources to research and that African governments increase their support for research in general and provide targeted funding for research-intensive universities—in addition to the usual operational funds and tuition income currently available to these institutions.

The future of African Studies: what we can do to keep Africa at the heart of our research
Nolte I: Journal of African Cultural Studies (Forthcoming Special Issue: Ethical Collaboration), doi:, 2019

Over the past two decades, Africa has returned to academic agendas outside of the continent. At the same time, the field of African Studies has come under increasing criticism for its marginalisation of African voices, interests, and agendas. This article explores how the complex transformations of the academy have contributed to a growing division of labour. Increasingly, African scholarship is associated with the production of empirical fact and socio-economic impact rather than theory, with ostensibly local rather than international publication, and with other forms of disadvantage that undermine respectful exchange and engagement. This article suggests ways of understanding and engaging with these inequalities.

More talk than action: gender and ethnic diversity in leading public health universities
Khan M; Lakha F; Tan M; Singh S; et al: The Lancet 393 (1071), 594-600, 2019

Improving the career progression of women and ethnic minorities in public health universities has been a longstanding challenge. The authors believe it might be addressed by including staff diversity data in university rankings. In this study, findings from a mixed methods investigation of gender-related and ethnicity-related differences in career progression at the 15 highest ranked social sciences and public health universities in the world are presented. The study revealed that clear gender and ethnic disparities remain at the most senior academic positions, despite numerous diversity policies and action plans reported. In all universities, representation of women declined between middle and senior academic levels, despite women outnumbering men at the junior level. Ethnic-minority women might have a magnified disadvantage because ethnic-minority academics constitute a small proportion of junior-level positions and the proportion of ethnic-minority women declines along the seniority pathway.

Success of a South-South collaboration on Human Resources Information Systems (HRIS) in health: a case of Kenya and Zambia HRIS collaboration
Were V; Jere E; Lanyo K; et al: Human Resources for Health 17(6), doi:, 2019

This paper is a road map of using a South-South collaboration to develop a Human Resources Information System (HRIS) to inform scale-up of the health workforce. In the last decade, Kenya implemented one of the most comprehensive HRIS in Africa. It was funded by the US President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) and implemented by Emory University. The Kenyan team collaborated with the Zambian team to establish a similar HRIS in Zambia. This case study describes the collaboration activities between Zambia and Kenya which included needs assessment, establishment of project office, stakeholders’ sensitization, technical assistance and knowledge transfer, software reuse, documents and guidelines reuse, project structure and management, and project formative evaluation. Furthermore, it highlights the need for adopting effective communication strategies, collaborative planning, teamwork, willingness to learn and having minimum technical skills from the recipient country as lessons learned from the collaboration. As a result of the collaboration, while Kenya took 5 years, Zambia was able to implement the project within 2 years which is less than half the time it took Kenya. This case presents a unique experience in the use of South-South collaboration in establishing a HRIS. It illustrates the steps and resources needed while identifying the successes and challenges in undertaking such collaboration.

A health policy analysis reader: The politics of policy change in low- and middle-income countries
Gilson L; Orgill M; Shroff Z: Alliance for Health Policy and Systems Research, 2018

This reader aims to encourage and deepen health policy analysis work in low- and middle-income countries (LMICs). It presents the range of health policy analysis studies that have been conducted in LMICs, highlights relevant theory, and points to new directions for such work. It also includes methodological and analytical pointers, and considers how to use health policy analysis prospectively to support health policy change. The Reader’s primary audience includes all those with an interest in understanding and influencing health policy change, including researchers and educators, as well as policy advocates, managers, and policy-makers. The Reader will also be of interest to those who have specialist policy studies or public administration backgrounds, and also to those with limited prior engagement with relevant social science perspectives.

New research chairs program will expand research and innovation in Africa
International Development Research Centre, South Africa’s National Research Foundation (NRF): IRDC, December 2018

IDRC and South Africa’s National Research Foundation (NRF) have announced a new research chairs initiative. The OR Tambo Africa Research Chairs Initiative, named after Oliver Reginald Tambo, the pre-eminent South African leader and advocate of science and technology, will support up to 10 top researchers from across Africa over the next five years. Through international and regional strategic partnerships, the Chairs will contribute to the development of long-term mutually beneficial research collaborations on the continent. They will focus on world-class research in diverse fields and on training graduate students at leading universities in the 15 sub-Saharan African countries that make up the Science Granting Councils Initiative (SGCI), a collaboration between IDRC, NRF, the Swedish International Development Cooperation Agency, and the UK’s Department for International Development. The application and selection process will be conducted using a two-phase approach coordinated by NRF, which will also manage the Chairs once awarded. The call for institutional expressions of interest was launched in December 2018 and the call for detailed chair-holder applications will be launched in May/June 2019. Councils participating in SGCI are expected to play a key role in the research and grants management, implementation, and sustainability of the Chairs.

Evaluating health research priority-setting in low-income countries: a case study of health research priority-setting in Zambia
Kapiriri L; Schuster-Wallace C and Chanda-Kapata P: Health Research Policy and Systems 16(105) 1-12, 2018

This paper describes and evaluates health research priority-setting in Zambia from the perspectives of key stakeholders using an internationally validated evaluation framework. This was a qualitative study based on 28 in-depth interviews with stakeholders who had participated in the priority-setting exercises. An interview guide was employed. Emerging themes were, in turn, compared to the framework parameters. Although there is apparent commitment to health research in Zambia, health research priority-setting is limited by lack of funding, and consistently used explicit and fair processes. The designated national research organisation and the availability of tools that have been validated and pilot tested within Zambia provide an opportunity for focused capacity strengthening for systematic prioritisation, monitoring and evaluation. The authors observe that the utility of the evaluation framework in Zambia could indicate potential usefulness in similar low-income countries.

Establishing Standards to Evaluate the Impact of Integrating Digital Health into Health Systems
Labrique A; Vasudevan L; Weiss W; et al: Global Health: Science and Practice 6(Supplement 1) S5-S17, 2018

In this commentary, the authors summarize the key milestones in the rise of digital health, illustrating efforts to bridge gaps in the evidence base, a shifting focus to scale-up and sustainability, growing attention to the precise costing of these strategies, and an emergent implementation science agenda to better characterize the necessary ecosystem of scale—the social, political, economic, legal, and ethical context that supports digital health implementation. In 2016, WHO established a guidelines development group to assess current evidence and recommendations for digital strategies. The guidelines development process recommends strategies that are adequately supported by sufficient evidence but also highlights promising strategies that currently have a low threshold of evidence that require future research, with a particular eye toward health system integration of these strategies. The evidence base of digital health approaches that have been successfully scaled up is growing, and new technology and shared standards provide a framework that can decrease the risk and amplify the promises of digital health investments. The authors argue that digital health innovations are increasing accessibility, promoting transparency, and have the capacity to increase accountability—all necessary facets of lasting health systems strengthening.