Monitoring equity and research policy

Using health-facility data to assess subnational coverage of maternal and child health indicators, Kenya
Maina I; Wanjala P; Soti D; et al: Bulletin World Health Organisation 95(10) 683–694, 2017

This study seeks to develop a systematic approach to obtain the best possible national and subnational statistics for maternal and child health coverage indicators from routine health-facility data. The approach aimed to obtain improved numerators and denominators for calculating coverage at the subnational level from health-facility data. This involved assessing data quality and determining adjustment factors for incomplete reporting by facilities, then estimating local target populations based on interventions with near-universal coverage. The authors applied the method to Kenya at the county level, where routine electronic reporting by facilities is in place via the district health information software system. Reporting completeness for facility data were well above 80% in all 47 counties and the consistency of data over time was good. Coverage of the first dose of pentavalent vaccine, adjusted for facility reporting completeness, was used to obtain estimates of the county target populations for maternal and child health indicators. The country and national statistics for the four-year period 2012/13 to 2015/16 showed good consistency with results of the 2014 Kenya demographic and health survey. The results indicated a stagnation of immunization coverage in almost all counties, a rapid increase of facility-based deliveries and caesarean sections and limited progress in antenatal care coverage. While surveys will continue to be necessary to provide population-based data, web-based information systems for health facility reporting provide an opportunity for more frequent, local monitoring of progress, in maternal and child health.

Using hospital discharge data for determining neonatal morbidity and mortality: a validation study
Ford JB, Roberts CL, Algert CS, Bowen JR, Bajuk B and Henderson-Smart DJ: BMC Health Services Research 7(188), 20 November 2007

Despite widespread use of neonatal hospital discharge data, there are few published reports on the accuracy of population health data with neonatal diagnostic or procedure codes. The aim of this study was to assess the accuracy of using routinely collected hospital discharge data in identifying neonatal morbidity during the birth admission compared with data from a statewide audit of selected neonatal intensive care (NICU) admissions. Although under-ascertained, routinely collected hospital discharge data had high PPVs for most validated items and would be suitable for risk factor analyses of neonatal morbidity. Procedures tended to be more accurately recorded than diagnoses.

Using knowledge brokering to promote evidence-based policy-making: The need for support structures
van Kammen J, de Savigny D, Sewankambo N: WHO Bulletin 84, August 2006

Knowledge brokering is a promising strategy to close the “know–do gap” and foster greater use of research findings and evidence in policy-making. It focuses on organising the interactive process between the producers and users of knowledge so that they can co-produce feasible and research-informed policy options. This paper describes a recent successful experience with this novel approach in the Netherlands and also discusses the potential of this approach to assist health policy development in low-income countries based on the experience of developing the Regional East-African Health (REACH)- Policy Initiative.

Using participatory methods and GIS to prepare for an HIV community-based trial in Vulindlela, South Africa
Chirowodza A, van Rooyen H, Joseph P, Sikotoyi S, Richter L and Coates T: Journal of Community Psychology 37(1): 41–57, 21 September 2009

Recent attempts to integrate geographic information systems (GIS) and participatory techniques have given rise to terminologies such as participatory GIS and community-integrated GIS. Although GIS was initially developed for physical geographic application, it can be used for the management and analysis of health and health care data. Geographic information systems, combined with participatory methodology, have facilitated the analysis of access to health facilities and disease risk in different populations. Little has been published about the usefulness of combining participatory methodologies and GIS technology in an effort to understand and inform community-based intervention studies, especially in the context of HIV. This paper attempts to address this perceived gap in the literature. The authors describe the application of participatory research methods with GIS in the formative phase of a multisite community-based social mobilisation trial, using voluntary counselling and testing and post-test support as the intervention.

Using relative and absolute measures for monitoring health inequalities: experiences from cross-national analyses on maternal and child health
Houweling TAJ, Kunst AE, Huisman M and Mackenbach JP: International Journal for Equity in Health 6(15), 29 October 2007

As reducing socio-economic inequalities in health is an important public health objective, monitoring of these inequalities is an important public health task. The specific inequality measure used can influence the conclusions drawn, and there is no consensus on which measure is most meaningful. The key issue raising most debate is whether to use relative or absolute inequality measures. Our paper aims to inform this debate and develop recommendations for monitoring health inequalities on the basis of empirical analyses for a broad range of developing countries.

Using research to influence sexual and reproductive health practice and implementation in Sub-Saharan Africa: a case-study analysis
Tulloch O, Mayaud P, Adu-Sarkodie Y, Opoku BK, Lithur NO, Sickle E et al: Health Research Policy and Systems 9(Suppl 1):S10, 16 June 2011

In the case-studies presented in this paper, the authors analyse findings from sexual and reproductive health (SRH) and HIV research programmes in sub-Saharan Africa. In their analysis, they emphasise the relationships and communications involved in using research to influence policy and practice and recognises a distinction whereby practice is not necessarily influenced as a result of policy change – especially in SRH – where there are complex interactions between policy actors. Policy networks, partnership and advocacy are critical in shaping the extent to which research is used and the importance of on-going and continuous links between a range of actors to maximise research impact on policy uptake and implementation. The case-studies illustrate the importance of long-term engagement between researchers and policy makers and how to use evidence to develop policies which are sensitive to context: political, cultural and practical.

Using research to influence sexual and reproductive health practice and implementation in Sub-Saharan Africa: a case-study analysis
Tulloch O, Mayaud P, Adu-Sarkodie Y, Opoku B, Lithur N, Sickle E et al: Health Research Policy and Systems 9(Suppl 1): S10, 16 June 2011

The case-studies presented in this paper analyse findings from sexual and reproductive health and HIV research programmes in sub-Saharan Africa, including Ghana, South Africa and Tanzania. The analysis emphasises the relationships and communications involved in using research to influence policy and practice and recognises a distinction whereby practice is not necessarily influenced as a result of policy change – especially in SRH – where there are complex interactions between policy actors. Both frameworks demonstrate how policy networks, partnership and advocacy are critical in shaping the extent to which research is used and the importance of on-going and continuous links between a range of actors to maximise research impact on policy uptake and implementation. The case-studies illustrate the importance of long-term engagement between researchers and policy makers and how to use evidence to develop policies which are sensitive to context: political, cultural and practical.

Utilisation Survey on the District Health Barometer
Monticelli F: Health System Trust, 21 February 2008

This report and summary deals with the findings of the survey that deal with the District Health Barometer (DHB) publication. The DHB aims at improving the quality of and access to primary health care through monitoring important aspects of the health system at a district level by analysing and comparing a carefully selected range of health indicators.

Validating a work group climate assessment tool for improving the performance of public health organizations
Perry C, LeMay N, Rodway G, Tracy A, Galer J: Human Resources for Health 2005, 3:10

This article describes the validation of an instrument to measure work group climate in public health organizations in developing countries. The instrument, the Work Group Climate Assessment Tool (WCA), was applied in Brazil, Mozambique, and Guinea to assess the intermediate outcomes of a program to develop leadership for performance improvement. Findings discussed include how the WCA is useful for comparing the climates of different work groups, tracking the changes in climate in a single work group over time, or examining differences among individuals' perceptions of their work group climate.

Validating child vaccination status in a demographic surveillance system using data from a clinical cohort study: Evidence from rural South Africa
Ndirangu J, Bland R, Barnighausen T and Newell M: BMC Public Health 11(372), May 2011

In this study, researchers aimed to validate vaccination data from a longitudinal population-based demographic surveillance system (DSS) against data from a clinical cohort study. The sample included 821 children in the Vertical Transmission cohort Study (VTS), and researchers found that vaccination data in matched children in the DSS was based on the vaccination card in about two-thirds of the cases and on maternal recall in about one-third. In conclusion, the addition of maternal recall of vaccination status of the child to the child’s card information significantly increased the proportion of children known to be vaccinated across all vaccines in the DSS. The authors recommend that information based on both maternal recall and vaccination cards should be used to identify which children have received a vaccination and which have not.

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