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.
Monitoring equity and research policy
The aim of this study was to review and assess the factors that facilitate the development of sustainable health policy analysis institutes in low and middle income countries and the nature of external support for capacity development provided to such institutes. Comparative case studies of six health policy analysis institutes (three from Asia and three from Africa) were conducted. The findings are organised around four key themes. (i) Financial resources: Three of the institutes had received substantial external grants at start-up, however two of these institutes subsequently collapsed. At all but one institute, reliance upon short term, donor funding, created high administrative costs and unpredictability. (ii) Human resources: The retention of skilled human resources was perceived to be key to institute success but was problematic at all but one institute. (iii) Governance and management: Boards made important contributions to organisational capacity through promoting continuity, independence and fund raising. (iv) Networks: Links to policy makers helped promote policy influences, while external networks with other research organisations helped promote capacity. Overall, health policy analysis institutes remain very fragile. A combination of more strategic planning, active recruitment and retention strategies, and longer term, flexible funding, for example through endowments, needs to be promoted.
Globally, concerted efforts and substantial financial resources have gone toward strengthening national monitoring and evaluation (M&E) systems for HIV programmes. This paper explores whether those investments have made a difference in terms of data availability, quality and use for assessing whether national programmes are on track to achieve the 2015 Millennium Development Goal of halting and reversing the global HIV epidemic. It found a marked increase in the number of countries where the prerequisites for a national HIV M&E system are in place, as well as in human resources devoted to M&E at the national level. However, crucial gaps remain, such as available M&E data and data quality assurance. The extent to which data are used for programme improvement is difficult to ascertain. There is a potential threat to sustaining the current momentum in M&E, as governments have not committed long-term funding and current M&E-related expenditures are below the minimum needed to make M&E systems fully functional. Nonetheless, essential data gaps will need to be filled urgently to provide quality data to guide future decision making.
Many countries in Africa are planning to provide highly active antiretroviral therapy (HAART) to millions of people with acquired immune deficiency syndrome. This will be a highly complex therapy programme. Physician-based models of care adapted from industrialized countries will not succeed in providing treatment to the majority of those who need it in resource-constrained settings. Many current ART support programmes are making little or no investment in research, but answering important questions on delivery of HAART will be essential if HAART programmes are to be successful in African nations with a high burden of human immunodeficiency virus infection.
Scoping studies have been used across a range of disciplines for a wide variety of purposes. However, their value is increasingly limited by a lack of definition and clarity of purpose. The UK's Service Delivery and Organisation Research Programme (SDO) has extensive experience of commissioning and using such studies; twenty four have now been completed. This review article has four objectives; to describe the nature of the scoping studies that have been commissioned by the SDO Programme; to consider the impact of and uses made of such studies; to provide definitions for the different elements that may constitute a scoping study; and to describe the lessons learnt by the SDO Programme in commissioning scoping studies. Scoping studies are imprecisely defined but usually consist of one or more discrete components; most commonly they are non-systematic reviews of the literature, but other important elements are literature mapping, conceptual mapping and policy mapping. Some scoping studies also involve consultations with stakeholders including the end users of research. Scoping studies have been used for a wide variety of purposes, although a common feature is to identify questions and topics for future research. The reports of scoping studies often have an impact that extends beyond informing research commissioners about future research areas; some have been published in peer reviewed journals, and others have been published in research summaries aimed at a broader audience of health service managers and policymakers. Key lessons from the SDO experience are the need to relate scoping studies to a particular health service context; the need for scoping teams to be multi-disciplinary and to be given enough time to integrate diverse findings; and the need for the research commissioners to be explicit not only about the aims of scoping studies but also about their intended uses. This necessitates regular contact between researchers and commissioners. Scoping studies are an essential element in the portfolio of approaches to research, particularly as a mechanism for helping research commissioners and policy makers to ask the right questions. Their utility will be further enhanced by greater recognition of the individual components, definitions for which are provided.
Health policy and systems research (HPSR) is increasing in prominence in low and middle income countries, stimulated by social and political pressure towards health system equity and efficiency. Yet the institutional capacity to fund and produce quality research and to have a positive impact on health system development has been little examined and touches mainly on specific areas such as malaria research or the impact of research on health reforms. In general, however, there is increasing pressure to direct research investments on the basis of evidence of policy relevance and impact. Indeed, in this decade of efforts to link development, health and research world-wide, there is little enquiry into the role of scientific capacity in general. This paper seeks to develop an empirical basis for assisting decisions on what are likely to be good investments to increase capacity in health policy and systems research (HPSR) in developing countries. It presents the results of a survey undertaken by the Alliance for Health Policy and Systems Research (Alliance-HPSR) in 2000 and 2001 to analyse institutional structure and characteristics, engagement with stakeholders, institutional capacity, level of attainment of critical mass and the process of knowledge production by institutions in low and middle income countries.
Health policy and systems research (HPSR) is increasing in prominence in low and middle income countries, stimulated by social and political pressure towards health system equity and efficiency. Yet the institutional capacity to fund and produce quality research and to have a positive impact on health system development has been little examined and touches mainly on specific areas such as malaria research or the impact of research on health reforms. This paper seeks to develop an empirical basis for assisting decisions on what are likely to be good investments to increase capacity in health policy and systems research (HPSR) in developing countries.
Communities of Practice (CoPs) are groups of people that interact regularly to deepen their knowledge on a specific topic. Thanks to information and communication technologies, CoPs can involve experts distributed across countries and adopt a ‘transnational’ membership. This has allowed the strategy to be applied to domains of knowledge such as health policy with a global perspective. CoPs represent a potentially valuable tool for producing and sharing explicit knowledge, as well as tacit knowledge and implementation practices. They may also be effective in creating links among the different ‘knowledge holders’ contributing to health policy (e.g., researchers, policymakers, technical assistants, practitioners, etc.). CoPs in global health are growing in number and activities. As a result, there is an increasing need to document their progress and evaluate their effectiveness. This paper represents a first step towards such empirical research as it aims to provide a conceptual framework for the analysis and assessment of transnational CoPs in health policy. The framework is developed based on the findings of a literature review as well as on the authors' experience, and reflects the specific features and challenges of transnational CoPs in health policy. It organizes the key elements of CoPs into a logical flow that links available resources and the capacity to mobilize them, with knowledge management activities and the expansion of knowledge, with changes in policy and practice and, ultimately, with an improvement in health outcomes. Additionally, the paper addresses the challenges in the operationalization and empirical application of the framework
The Commission on Social Determinants for Health has recommended assessment of health equity effects of public policy decisions, and this study provides guidance on assessing equity for users and authors of systematic reviews of interventions. Particular challenges occur in seven components of such reviews: developing a logic model; defining disadvantage and for whom interventions are intended; deciding on appropriate study design(s); identifying outcomes of interest; process evaluation and understanding context; analysing and presenting data; and judging applicability of results. The study concludes that greater focus on health equity in systematic reviews may improve their relevance for both clinical practice and public policy making.
For the first time since 1996, the United Nations Food and Agriculture Organisation (FAO) has significantly revised how estimates the number of hungry people in the world. When the new methodology is used to generate estimates for the past 20 years, the figures show a steady decline, running counter to previous estimates, which showed a continual increase in the number of undernourished people from the mid-1990s up to the late 2000s. What lies behind the FAO’s revised prevalence of undernourishment estimates are changes in the methodology used to arrive at the estimate and newer, more complete data used for the building blocks of the FAO model. The methodological innovations may be found in the assumed distribution of dietary energy consumption, and the way in which variations in habitual food consumption are estimated. The most important data change is that estimates of food losses at the retail distribution level, not only at the production and storage levels, are taken into account. The FAO is in the process of developing a range of additional food security indicators, intended to reflect changes in ‘determinants of (or inputs to) food security’ and to capture how food prices evolve in relation to consumer prices in general in developing countries.