Monitoring equity and research policy

Trials and tribulations: cross-learning from the practices of epidemiologists and economists in the evaluation of public health interventions
Powell-Jackson T; Davey C; Masset E; et al.: Health Policy and Planning 33(5) 702–706, 2018

The authors propose that there are some underlying differences between the disciplines of epidemiology and economics how trials are used and conducted and how their results are reported and disseminated. They hypothesize that evidence-based public health could be strengthened by understanding these differences, harvesting best-practice across the disciplines and breaking down communication barriers between economists and epidemiologists who conduct trials of public health interventions. Differences between disciplines suggests that more can be done to incorporate behavioural theory into trials and to improve the reporting of trial results and share data. The authors hypothesize that evidence-based public health can be strengthened by understanding differences in how economists and epidemiologists conduct trials of public health interventions and harvesting best-practice across the disciplines.

Turning Research into Action

For over twenty years, managers of health programs have relied on many types of research to help answer strategic and programmatic questions. Demographic surveys, rapid assessments, operations research, and sociological and economic studies contribute significantly to the manager's ability to formulate appropriate goals, determine strategies, and assess the achievement of program goals. Such contributions are leading program managers to appreciate research as an important management tool. To use this tool effectively, managers must be able to systematically transform research results into decisions. They will need support from decision makers who understand the implications of research findings, and who are ready to advocate for action. This issue of The Manager presents a process known as "decision-linked research," the goal of which is to establish effective partnerships between researchers and decision makers so that the research findings can be transformed into programmatic actions. The issue focuses on how to formulate these partnerships, how to forge common interests between researchers and the users of research results, how to make research understandable to those who will be affected by the results, and finally, how to transform research results into actions aimed at improving policies, strategies, and programs.

Turning science into action to improve people's health

The objective of this World Health Organisation report is to describe strategies to reduce global disparities in health through improvements in health research systems at national and international levels and systematic application of evidence-based knowledge. The Report focuses on bridging of the "know do" gap, the gulf between what we know and what we do in practice, between scientific potential and health realization. The bridging of this gap is central to achieving the health-related Millennium Development Goals (MDG’s) by 2015. The gap exists for each of the MDG’s and represents a fundamental and pragmatic knowledge translation challenge that must be addressed to strengthen health systems performance towards achieving the MDG’s.

UN Women Calls for Integration of Violence Against Women Data and Services in COVID-19 Surveys
UN Women East & Southern Africa: Kenya, 2020

To understand better both impact of and responses to COVID-19, UN Women is recommending stand-alone surveys or integration of questions on violence against women in socio-economic and gender surveys to assess the prevalence and responses to gender based violence during COVID-19. This data is argued to be critical to support evidence-based interventions and to make available lifesaving services. UN Women in East and Southern Africa is working closely with the partner agencies and providing technical support to develop model surveys and guidelines to support quality assessments. This briefing also provides case study analyses of gendered effects of COVID-19 in Uganda, Kenya, South Africa, Ethiopia, Burundi, Zimbabwe, Mozambique and Malawi.

UNGASS reporting and implementation on national monitoring and evaluation systems: Lessons from 4 countries
Kusek JZ, Delay P, Rao KS, Osindo B: The Sixteenth International AIDS Conference, August 2006

As clearly shown in the 2005 UNGASS Country Progress Reports, AIDS resources have grown rapidly in recent years from US$300 million in 1996 to US$8 billion in 2005. One critical need is to ensure that available resources are used effectively, which requires that countries must invest in a sound monitoring and evaluation system to help provide feedback on whether projects, programs, and policies are achieving (or not) their expected results. A major emphasis has been put on integrating the various M&E efforts in support of the three ones principle of “One National Monitoring and Evaluation System”. Four countries were invited to participate in a feedback session, including Botswana of Southern Africa.

Unhealthy Health Policy: A Critical Anthropological Examination
Edited by Arachu Castro and Merrill Singer

This new collection turns a critical anthropological eye on the nature of health policy internationally. The authors reveal that in light of prevailing social inequalities, health policies may intend to protect public health, but in fact they often represent significant structural threats to the health and well being of the poor, ethnic minorities, women, and other subordinate groups. The volume focuses on the "anthropology of policy," which is concerned with the process of decision-making, the influences on decision-makers, and the impact of policy on human lives. This collaboration will be a critical resource for researchers and practitioners in medical anthropology, applied anthropology, medical sociology, minority issues, public policy, and health care issues.

Universities and global access to essential medicines
Kiddell-Monroe R, Collinsworth B and Musselwhite L: Health Diplomacy Monitor 3(1): 2-3, February 2012

The non-profit Universities Allied for Essential Medicines (UAEM) is a student-driven movement to promote equitable global access and innovation in publicly funded medical research. Through UAEM’s advocacy, universities that license medical research to industry have now begun to include requirements for generic production or “at cost” provisions for low- and middle-income countries. These “global access” provisions lower the price of the final products for poor patients, and have been adopted by leading institutions including Harvard, Yale, the University of British Columbia, and the US National Institutes for Health (NIH). While over 30 research institutions worldwide have endorsed a “Statement of Principles and Strategies” supporting global access to their medical discoveries, the students of UAEM want to ensure that this translates into real-world impact. They argue that the statement itself should be strengthened, and individual universities can adopt more robust policies. Most importantly, however, universities must demonstrate that they are regularly including global access provisions in their licensing negotiations with pharmaceutical companies. Improving the transparency of universities and their licensing practices is critical. Not only do universities need to ensure affordable access to their medical breakthroughs, but they also need to show that they are committing resources, both human and financial, to research on neglected diseases.

Urban Health Research in Africa: Themes and Priority Research Questions
Oni T; Smit W; Matzopoulos R; Adams J et al.: Initiative for Cities and Health (RICHE) members: Journal of Urban Health 93(4) 722-730, 2016

In Africa, urbanisation and urban growth are dramatically restructuring the nature of cities. The growing majority of urban dwellers now live in informal conditions that, without access to basic services or public amenities, expose residents to greater health risk, and health-care systems are unable to provide affordable or comprehensive cover. The differential exposure to these urban conditions is compounded by social and economic vulnerability, resulting in health inequities. Yet despite pressing needs driven by Africa’s considerable and complex burden of disease and high levels of health inequity, urban health and urban health equity have not yet emerged as major research and policy priorities in Africa. This commentary presents a conceptual framework, using a public health approach, for interdisciplinary research aimed at contributing to the understanding and mitigation of urban health issues and challenges in Africa. It identifies downstream and upstream factors, based on published literature, associated with key determinants in each theme. It represents a collective effort by interdisciplinary academics from public health; anthropology; civil engineering; architecture, planning and geomatics; human biology; psychiatry and mental health; medicine; pathology; and paediatrics, from the Research Initiative for Cities and Health (RICHE), University of Cape Town, to generate African perspectives on urban health and urban health equity. The six focus areas identified as important include obesity and food insecurity, the urban context as a tool for health promotion, urban health governance and policy, community strengthening for healthy inclusive cities, health systems in an urbanising context and migration, urbanisation and health. The authors argue that a complex systems approach is required to investigate and improve understanding of health and well-being in a changing urban context with a view to developing sustainable and cost-effective interventions. This acknowledges the different dimensions of determinants that influence health and understands the need to address gaps in data and access to information from across these dimensions, and to engage all relevant stakeholders across sectors prioritise the interventions to improve health.

Use of evidence to support healthy public policy: a policy effectiveness–feasibility loop
Bowman S, Unwin N, Critchley J, Capewell S, Husseini A, Maziak W et al: Bulletin of the World Health Organization 90(11): 847-853, November 2012

This paper presents a pragmatic framework for developing and prioritising policy interventions tailored to local epidemiological, political and social conditions. The “policy effectiveness–feasibility loop” (PEFL) framework was developed as part of a multinational project aiming to inform policy for the prevention and control of cardiovascular diseases and diabetes in four middle-income territories. Central to the proposed approach is the involvement of policy-makers in the collection of evidence and its appraisal. The PEFL framework resembles a “equity effectiveness loop”, which is intended to estimate the impact of interventions to reduce socioeconomic inequalities. The major difference is that the PEFL approach includes assessing the local context and the feasibility of potential interventions. Furthermore, its focus is on policy-level interventions, and hence the situation analysis involves local policy-makers. The situation analysis and option appraisal stages of the framework are analogous to policy dialogue, as they facilitate discussion between stakeholders and researchers on policies and how to implement them. The outputs resulting from application of the framework can be used to prepare policy briefs for informing stakeholder discussions on policy options.

Using Geographic Information System applications to improve coverage, access and targeting of HIV/AIDS interventions
Taruberekera N, Chieza F, Madan Y: The Sixteenth International AIDS Conference, August 2006

Zimbabwe is in the mature stage of a generalised HIV/AIDS epidemic. However, HIV prevalence is unevenly distributed with respect to age, gender and locality. The objective of the mapping exercise was to focus limited project resources for improving linkages and ensuring maximum impact of prevention interventions. Use of GIS systems helped improve linkages between communication activities and product delivery to create informed demand and improve off-take of male and female condoms.

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