Monitoring equity and research policy

An Annotated Bibliography on Policy Processes
Overseas Development Institute

The term 'policy process' is based on the notion that policies are formulated and implemented in particular social and historical contexts, and that these contexts matter - for which issues are put on the policy agenda, for the shape of policies and policy institutions, for budget allocations, for the implementation process and for the outcome of the policies. The idea of 'policy process' stands opposed to that of 'policy as prescription', which assumes that policies are the result of a rational process of problem identification by a benevolent agency (usually the state). While the 'policy as prescription' approach is still important - both in much of the public administration literature as well as in the heads of many policy-makers - there is a fast expanding body of literature that analyses, explains or conceptualises the process dimensions of policy. This literature is a blend of political science, sociology and anthropology. It does not assume that policies are 'natural phenomena' or 'automatic solutions' resulting from particular social problems and it does not privilege the state as an actor fundamentally different from other social actors. The why, how and by whom questions are treated as empirical questions; it is only concrete empirical research that can generate the answers. It is this body of literature that is included in this bibliography.

An assessment of interactions between global health initiatives and country health systems
World Health Organization Maximizing Positive Synergies Collaborative Group: The Lancet 373(9681):2137 - 2169, 20 June 2009

Have disease-specific global health initiatives (GHIs) burdened health systems that are already fragile in poor countries or have they been undermined by weak health systems? This study reviews and analyses existing data and 15 new studies that were submitted to the World Health Organization for the purpose of writing this report. It makes some general recommendations and identifies a series of action points for international partners, governments, and other stakeholders that will help ensure that investments in GHIs and country health systems can fulfil their potential to produce comprehensive and lasting results in disease-specific work, and advance the general public health agenda. If adjustments to the interactions between GHIs and country health systems will improve efficiency, equity, value for money and outcomes in global public health, then these opportunities should not be missed.

An assessment of Makerere University College of Health Sciences: Optimising health research capacity to meet Uganda’s priorities
Nankinga Z, Kutyabami P, Kibuule D, Kalyango J, Groves S, Bollinger RC, Obua C: BMC International Health and Human Rights 11(Suppl 1):S12, 9 March 2011

In this study, researchers investigated the alignment of health research capacity at Makerere College of Health Sciences (MakCHS) with the health needs and priorities of Uganda, as outlined in the country’s Health Sector Strategic Plan (HSSP). They assessed MakCHS’s research grants and publication portfolio, as well as all the university’s publications, between January 2005 and December 2009. A total of 58 active grants were identified, of which 18 had been initiated prior to 2005 and there were an average of about eight new grants per year. Most grants funded basic and applied research, with major focus areas being HIV and AIDS (44%), malaria (19%), maternal and child health (14%) and tuberculosis (11%). A total of 837 publications were identified, with an average of 167 publications per year, 66% of which addressed the country’s priority health areas, and 58% had MakCHS faculty members or students as first authors. Findings indicate that the research grants and publications at MakCHS are generally well-aligned with Ugandan Health Ministry priorities. Greater efforts to establish centralised and efficient grants management procedures are needed, the researchers argue. In addition, efforts are needed to expand capacity for MakCHS faculty leadership of grants, as well as to continue to expand the contribution of MakCHS faculty to lead research publications.

An innovative partnership for research and innovation system strengthening
Kubata B: NEPAD, 23 April 2012

This presentation, delivered at Forum 2012 in April 2012, describes a partnership between the Dutch Council on Health Research for Development (COHRED), the African Union (AU) and the NEPAD Agency (a technical arm of the AU) to help African countries develop their national health research agendas. The partnership aims to support Africans’ ownership and optimal utilisation of research for health to achieve health and health equity, reduce poverty, and contribute to the socio-economic development of countries, regions and the continent. It is also intended to strengthen the existing capacity of African institutions and networks to support the process of capacity building at the governance and policy levels of national research systems. At the initial phase, three countries have been identified and selected to participate in the programme: Mozambique, Senegal and Tanzania. In Mozambique, a national priority setting process is being carried out, while in Tanzania, national research priorities and agenda have been set and the partnership has developed a ‘research ethics ‘management’ platform, as well as a national research for health management information system.

An Integrated Framework for Developing Health, Policy, and Research
From the Milbank Quarterly, Volume 80 Number 3, 2002

This article describes the Life Course Health Development (LCHD) framework, which was created to explain how health trajectories develop over an individual’s lifetime and how this knowledge can guide new approaches to policy and research. The Life Course Health Development (LCHD) framework offers a new approach to health measurement, health system design, and long-term investment in health development and also suggests new directions for research.

An Open Letter to the Executive Director of The Global Fund to Fight AIDS, Tuberculosis, and Malaria
Wilkerson M: AIDS-Free World, July 2013

According to this letter, the Global Fund indicators that have been used in the past do not reflect a commitment to strengthening the response for women and girls. Many key indicators of progress do not address the differing realities for women and girls versus men and boys. For example, the indicator for new HIV infections is not disaggregated by sex. Similarly, the Global Fund has administered many grants with a focus on orphans and vulnerable children (OVC), but few of the programmes use indicators that reflect that the experiences of orphans and vulnerable children who are girls will differ from those of boys, both in the opportunities and obstacles they will encounter. The author argues that failure to measure progress in preventing new infections among women, or to measure the effects of OVC programmes on girls, means there is no incentive for countries that receive Global Fund grants to ensure that their efforts are addressing the specific challenges faced by women and girls. Other necessary indicators must be developed about the specific effects of HIV and AIDS on women, such as access to testing, counseling, and treatment among women who are not pregnant. Integration of HIV services and contraception provision, as well as violence experienced by all women - not just those who are married or cohabiting – need to be addressed, especially as research has repeatedly shown that sexual violence puts women and girls at elevated risk of contracting HIV.

Further details: /newsletter/id/38577
Analysing Health Equity Using Household Survey Data: A Guide to techniques and their implementation
O'Donnell O, van Doorslaer E, Wagstaff A, Lindelow M: The World Bank

Health equity has become an increasingly popular research topic during the course of the past 25 years. Many factors explain this trend, including a growing demand from policymakers, better and more plentiful household data, and increased computer power. But progress in quantifying and understanding health equities would not have been possible without appropriate analytic techniques. These techniques can provide researchers and analysts with a step-by-step practical guide to the measurement of a variety of aspects of health equity, with worked examples and computer code, mostly for the computer program Stata.

Analysis of pan-African Centres of Excellence in health innovation highlights opportunities and challenges for local innovation and financing in the continent
Nwaka S, Ochem A, Besson D, Ramirez B, Fakorede F, Botros S et al: BMC International Health and Human Rights 12:11, 27 July 2012

A pool of 38 pan-African Centers of Excellence (CoEs) in health innovation has been selected and recognised by the African Network for Drugs and Diagnostics Innovation (ANDI), through a competitive criteria based process. The process identified a number of opportunities and challenges for health research and development (R&D) and innovation in the continent. The CoEs are envisioned as an innovative network of public and private institutions with a critical mass of expertise and resources to support projects and a variety of activities for capacity building and scientific exchange, including hosting fellows, trainees, scientists on sabbaticals and exchange with other African and non-African institutions. The authors argue that a credible and sustainable solution to the health challenges in Africa must leverage existing R&D, manufacturing and commercialisation capacity across the continent to support integrated capacity utilisation and economic development. They call for greater and better integrated funding for health R&D. As a pan-African initiative focusing on health R&D, promoting local manufacturing and access to medicines, the ANDI initiative is in a good position to contribute in the actualisation of an integrated and coordinated product R&D platform in the African continent, the authors conclude.

Applying clinical epidemiological methods to health equity: the equity effectiveness loop
Tugwell P, deSavigny D, Hawker G: British Medical Journal 2006, 332:358-361

We propose the "equity effectiveness loop" framework (fig 1) to highlight equity issues inherent in assessing health needs, effectiveness, and cost effectiveness of interventions, and the development and evaluation of evidence based health policy. This framework provides a method to calculate the "equity effectiveness ratio," which assesses the impact of various factors on the gap in the effectiveness of interventions across socioeconomic gradients.

Applying policy analysis in tackling implementation gaps

Ultimately any policy or health system change, whether generated from within or outside national environments, has to work through those responsible for service delivery, and their interactions with the intended beneficiaries of those changes. Yet we continue to know too little about the experiences of these groups, including how their words, actions and beliefs shape the practice of implementation. This paper used policy analysis to understand these implementation gaps.

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