Monitoring equity and research policy

Challenges for routine health system data management in a large public programme to prevent mother-to-child HIV transmission in South Africa
Mate KS, Bennett B, Mphatswe W, Barker P and Rollins N: PLoS ONE 4(5), 12 May 2009

This study assessed the completeness and accuracy of routine prevention of mother-to-child transmission of HIV (PMTCT) data submitted to the district health information system (DHIS) in three districts of Kwazulu-Natal province, South Africa, covering 316 clinics and hospitals. Data elements were reported only 50.3% of the time and were ‘accurate’ (within 10% of reconstructed values) 12.8% of the time. The data element ‘Antenatal Clients Tested for HIV’ was the most accurate element (consistent with the reconstructed value) 19.8% of the time, while ‘HIV PCR testing of baby born to HIV positive mother’ was the least accurate, with only 5.3% of clinics meeting the definition of accuracy. Data collected and reported in the public health system across three large, high HIV-prevalence districts was neither complete nor accurate enough to track process performance or outcomes for PMTCT care. Systematic data evaluation can determine the magnitude of the data reporting failure and guide site-specific improvements in data management. Solutions are currently being developed and tested to improve data quality.

Challenges in linking health research to policy: a commentary on developing a multi-stakeholder response to orphans and vulnerable children in Ghana
Gyapong J, Selby R and Anakwah K: Health Research Policy and Systems 9(Suppl 1): S14, 16 June 2011

The Ghanaian government’s strategy on orphans and vulnerable children (OVCs) recommends they should be encouraged to live in their home communities rather than in institutions. The paper presents lessons here on efforts to use research to build a response across different agencies to address the problems that communities and families face in caring for these children in their communities. This approach to building consensus on research priorities points to the value of collaboration and dialogue with multiple stakeholders as a means of fostering ownership of a research process and supporting the relevance of research to different groups. The authors argue that if the context within which researchers, policy makers and stakeholders work were better understood, the links between them were improved and research were communicated more effectively, then better policy making which links across different sectors may follow. At the same time, collaboration among these different stakeholders to ensure that research meets social needs, must also satisfy the requirements of scientific rigour.

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.

Challenging Inequities in Health: from ethics to action

Edited by Timothy Evans, Margaret Whitehead, Finn Diderichsen, Abbas Bhuiya and Meg Wirth.
Challenging Inequities in Health: From Ethics to Action provides new perspectives on the idea of health equity, the scale of the inequalities and the ways in which gender, social context and globalization impact the health of populations in thirteen countries. The studies seek to expose health disparities within countries, revealing stark social inequalities in life expectancy and health status.

Changing Mindsets - Strategy on Health Policy and Systems Research
World Health Organisation: 2012

As the first-ever global-level strategy on Health Policy and Systems Research (HPSR), this document represents a unique milestone in the evolution of health policy and systems research. It has three broad aims. First, it seeks to unify the worlds of research and decision-making and connect the various disciplines of research that generate knowledge to inform and strengthen health systems. It is targeted at decision-makers at all levels of the health system - from national policy-makers to front line providers of health services - and seeks support to make HPSR increasingly demand-driven and responsive to the needs of 21st century health systems. Second, this strategy contributes to a broader understanding of the field of HPSR by clarifying the scope and role of HPSR. It provides insight into the dynamic processes through which HPSR evidence is generated and used in decision-making. Finally, it is hoped that this strategy will serve as an agent for change. It advocates for a paradigm that emphasises the need for close collaboration between researchers and decision-makers rather than work along parallel pathways. The strategy speaks to decision-makers and researchers as part of one community and proposes actions that both can take in order to strengthen the performance of health systems. It calls for a more prominent role for HPSR at a time when the health systems mandate is evolving towards broader goals of universal health coverage and equity.

Child Gauge 2017: Investing in children for sustainable development - Survive. Thrive. Transform
Jamieson L; Berry L; Lake L: The Children's Institute, South Africa, 2017

The South African Child Gauge® is published annually by the Children’s Institute, University of Cape Town, to monitor progress towards realising children’s rights. This issue focuses on children and the Sustainable Development Goals (SDGs). Part one summarises and comments on policy and legislative developments that affect children. These include developments in international and South African law. Part two motivates for greater investment to ensure South Africa’s children not only survive but thrive and reach their full potential, by focusing on the SDGs, ensuring that the 2030 Global Agenda promotes children’s survival and development, identifying local priorities, promoting nurturing care, creating safe environments, improving child nutrition, getting reading right, creating inclusive and enabling environments and reflecting on progress and calling for action. Part three presents child-centred data 2002-2015 to monitor progress and track the realisation of children’s socio-economic rights in South Africa. A set of key indicators tracks progress in demography, income poverty, unemployment and social grants, child health and access to education, housing and basic services.

Climate for evidence informed health system policymaking in Cameroon and Uganda before and after the introduction of knowledge translation platforms: a structured review of governmental policy documents
Ongolo-Zogo P; Lavis JN; Tomson G; Sewankambo NK: Health Research Policy and Systems 13(2), 1 January 2015

There is a scarcity of empirical data on African country climates for evidence-informed health system policymaking (EIHSP) to backup the longstanding reputation that research evidence is not valued enough by health policymakers as an information input. In this paper, the authors assess whether and how changes have occurred in the climate for EIHSP before and after the establishment of two Knowledge Translation Platforms housed in government institutions in Cameroon and Uganda since 2006. The authors merged content analysis techniques and policy sciences analytical frameworks to guide this structured review of governmental policy documents geared at achieving health Millennium Development Goals. They combined i) a quantitative exploration of the usage statistics of research-related words and constructs, citations of types of evidence, and budgets allocated to research-related activities; and (ii) an interpretive exploration using a deductive thematic analysis approach to uncover changes in the institutions, interests, ideas, and external factors displaying the country climate for EIHSP. Descriptive statistics compared quantitative data across countries during the periods 2001–2006 and 2007–2012. The use of evidence syntheses to frame poverty and health problems, select strategies, or forecast the expected outcomes has remained sparse over time and across countries. The budgets for research increased over time from 28.496 to 95.467 million Euros (335%) in Cameroon and 38.064 to 58.884 million US dollars (155%) in Uganda, with most resources allocated to health sector performance monitoring and evaluation. The consistent naming of elements pertaining to the climate for EIHSP features the greater influence of external donors through policy transfer. The authors indicate that the review illustrated a conducive climate for EIHSP in Cameroon and Uganda but a persistent undervalue of evidence syntheses and recommend that global and national health stakeholders raise the profile of evidence syntheses (e.g., systematic reviews) as an information input when shaping policies and programmes.

Closing the evidence gap for public health interventions in developing countries
Obermeyer Z: Young Voices in Research For Health, Global Health Research Forum, 2007

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.

Collaboration between infection control and occupational health in three continents: a success story with international impact
Yassi A, Bryce EA, Breilh J, Lavoie M, Ndelu L, Lockhart K and Spiegel J: BMC International Health and Human Rights 11(Suppl 2):S8, 8 November 2011

Canadian occupational health and infection control researchers have found that training is key to a positive safety culture, leading them to develop information and communication technology (ICT) tools to promote occupational health and infection control. The South African government invited the Canadian team to work with local colleagues, resulting in an improved web-based health information system to track incidents, exposures, and occupational injury and diseases, just in time for the H1N1 pandemic. Research from these experiences led to strengthened focus on building capacity of health and safety committees, and new modules are thus being created, informed by that work. The international collaboration between occupational health and infection control researchers in Canada, Ecuador and South Africa led to the improvement of the research framework and development of tools, guidelines and information systems. Furthermore, the research and knowledge-transfer experience highlighted the value of partnership amongst Northern and Southern researchers in terms of sharing resources, experiences and knowledge.

Commitment to Development Index 2009
Centre for Global Development: 2009

The Commitment to Development Index (CDI) rates 22 rich countries on how much they help poor countries build prosperity, good government, and security. Each rich country gets scores in seven policy areas, which are averaged for an overall score. The policy areas include foreign aid, commerce, migration, the environment and military affairs. This website provides an interactive resource for determining scores. You can browse the charts by clicking bars, country names and policy components and explore the data maps to see results in another way. In 2009, Sweden, Denmark, the Netherlands, Norway and New Zealand ranked highest, while South Korea, Japan, Switzerland and Greece ranked lowest.

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