Country teams from ten low- and middle-income countries (LMICs), including Tanzania, participated in the development and testing of a questionnaire to assist researchers, policymakers, and healthcare providers to describe and monitor changes in efforts to bridge the gaps among research, policy and practice. The study found that internal consistency (Cronbach's alpha) for sets of related items was very high, ranging from 0.89 to 0.96, suggesting some item redundancy. Both face and content validity were determined to be high. Assessments of construct validity using criterion-related measures showed statistically significant associations for related measures. Assessments using convergent measures also showed significant associations. In conclusion, while no direct comparison can be made to a comparable questionnaire, the findings do suggest a number of strengths of the questionnaire but also the need to reduce item redundancy and to test its capacity to monitor changes over time.
Monitoring equity and research policy
Country teams from ten low- and middle-income countries, including Tanzania, participated in the development, translation, pilot-testing and administration of a questionnaire designed to measure health-care providers' views and activities related to improving their clinical practice and their awareness of, access to and use of research evidence, as well as changes in their clinical practice that they attribute to particular sources of research evidence that they have used. The study found that the questionnaire had high internal consistency, with Cronbach's alphas between 0.7 and 0.9 for 16 of 20 domains and sub-domains (identified by factor analyses). Cronbach's alphas were greater than 0.9 for two domains, suggesting some item redundancy. In conclusion, the analysis points to a number of strengths of the questionnaire – high internal consistency (reliability) and good face and content validity – but also to areas where it can be shortened without losing important conceptual domains.
This study looks at the enduring issue of how to strengthen the informational base on which funders make their social investment decisions. It asks two questions: How can we help donors make smart philanthropic decisions? How can we ensure that the strongest, most effective nonprofits get the resources they need? The report complements the recommendations in Keystone's report, Online Philanthropy Markets: From Feel-good Giving to Effective Social Investing, by enabling donors to think as social investors, providing comparative data on the performance and impact of social purpose organisations, and working towards a common reporting framework. However, unlike Keystone's report, this study puts the strategic focus on major donors.
The successful implementation of health policy requires the backing of health care practitioners, managers, and patients. In South Africa, the introduction of free health care, although supported in principal by nurses and health facility managers, faced resistance as workloads increased and staff felt excluded from a centrally prescribed policy. Proponents of a 'street-level bureaucracy' approach to policy implementation acknowledge the day-to-day methods to cope with pressures that are adopted by frontline health care providers in the face of high demand for their services. It is these mechanisms, they argue, that effectively become public policy, rather than the decisions taken by central government.
So will open access build a bridge to reduce health inequity? The potential is certainly great but the digital divide remains large, with estimates that only 13% of the developing world uses the internet, often on slow and expensive connections. Therefore, the inequity in accessing information and communication technology infrastructure will need to improve to allow people to get a foot onto the information bridge. But even once they are there, they will still only be able to access information that has been paid for – even when that information was created using taxpayers’ money. There is a role for more research funders and donors to support open access as an integral cost of undertaking the research itself to ensure public access. While the United Nations might be seen as having a ‘slow bandwidth’ approach to this issue, things are moving ahead with the work of the International Telecommunications Union on promoting greater access to information and communication technology worldwide and the newly developed World Health Organization strategy on research for health.
The act of telling a story is a deceptively simple and familiar process, a way to evoke powerful emotions and insights. By contrast, working with stories in organisational settings – to aid reflection, build communities, transfer practical learning or capitalise experiences – is more complicated. This guide is designed to create story-telling skills and confidence. It provides ideas about development cooperation contexts in which stories can be an effective communication tool. The authors argue that story telling is not suitable for every situation. Methodologies should be selected by practitioners with due care to the wider working context and intention. Some methods, for example the systemic introduction of story into core organisational processes such as evaluation, need patience and management backing over a long period, for the right approach to be developed through trial and error.
Building Capacity to Use Research Evidence (BCURE) is a programme of work funded by the UK Department for International Development (DFID) which aims to build the skills, knowledge and systems that will allow policy makers and practitioners in low income countries to access, appraise and use rigorous evidence. BCURE works through a consortium of organisations, focusing on building capacity to make evidence informed decisions. Examples of some of the different interventions are incorporating processes to improve evidence use by Cabinet Ministers, using innovative online training methods to improve the skills of individuals to make evidence informed decisions, establishing open policy dialogues between government officials, civil society and the research sector to promote the use of evidence in decision making and developing the African Evidence Network – where policy makers and practitioners can discuss and share lessons on evidence use. Each project has a primary provider, who oversees the management of that work. BCURE is being delivered with a specific focus on building the capacity of locally based partner organisations in the countries where projects are operating, as essential for the sustainability of the programme.
Decision-makers in countries around the world face a series of common problems as they aim to make appropriate choices to improve the performance of their health systems. With eight per cent of the world's economic output invested in health systems, the way these systems are organized to collect resources and transform them into services for people in need can profoundly influence health outcomes for populations. Yet the scientific evidence-base to inform critical health system decisions is much weaker than the evidence-base to inform individual clinical decisions. This volume reports on a large body of work led by the World Health Organisation that is intended to strengthen the foundations for evidence-based policies aimed at health systems development.
Health information systems (HIS) are increasingly being recognised as the ‘central nervous system’ of the health sector, with the information they generate being used for decision making to improve health system performance, accountability and health outcomes. To guide countries in developing and strengthening their HIS, Health Metrics Network (HMN) has developed a standard reference for health information systems development, the HMN Framework. This brief report demonstrates the widespread application of the Framework and the growing body of evidence that better health information improves health outcomes and contributes to saving lives. By 2010, HMN tracked a cumulative total of US$ 514 million from a limited number of domestic and donor sources that was invested in HIS strengthening globally. Although estimates show an upward trend in investment, the brief argues that further resources are needed to meet the increasing demand from countries for HIS investment. It argues that a strengthened HIS produces better quality information for use in decision making, and that information-driven decisions lead to cost savings, more efficient use of resources, better quality essential health services, improved coverage and more lives saved.
The authors discuss the impact of high-income country investigators conducting research in low- and middle-income countries and explore lessons from the effective and equitable relationships that exist. Global health has increased the number of high-income country (HIC) investigators conducting research in low- and middle-income countries (LMICs). They note that partnerships with local collaborators rather than extractive research are needed. They conclude that LMICs have to take an active role in leading or directing these research collaborations in order to maximize the benefits and minimize the harm of inherently inequitable relationships.