Attention to the concepts of ‘sex’ and ‘gender’ is increasingly being recognised as contributing to better science through an augmented understanding of how these factors impact on health inequities and related health outcomes. However, the ongoing lack of conceptual clarity in how sex and gender constructs are used in both the design and reporting of health research studies remains problematic. Conceptual clarity among members of the health research community is central to ensuring the appropriate use of these concepts in a manner that can advance our understanding of the sex- and gender-based health implications of our research findings. During the past twenty-five years much progress has been made in reducing both sex and gender disparities in clinical research and, to a significant albeit lesser extent, in basic science research. Why, then, does there remain a lack of uptake of sex- and gender-specific reporting of health research findings in many health research journals? This question, the authors argue, has significant health equity implications across all pillars of health research, from biomedical and clinical research, through to health systems and population health.
Monitoring equity and research policy
The purpose of this study was to develop a core set of indicators that could be used for measuring and monitoring the performance of primary health care organizations' capacity and strategies for enhancing equity-oriented care. Indicators were constructed based on a review of the literature and a thematic analysis of interview data with patients and staff using procedures for qualitatively derived data. Indicators were considered part of a priority set of health equity indicators if they received an overall importance rating of>8.0, on a scale of 1–9, where a higher score meant more importance. Seventeen indicators make up the priority set. Items were eliminated because they were rated as low importance (<8.0) in both rounds and were either redundant or more than one participant commented that taking action on the indicator was highly unlikely. The indicators assess performance of staff and outcomes which can be directly attributable to equity responsive primary health care.
Monitoring progress towards achieving Universal Health Coverage (UHC) is seen to be critical at both country and global level, and a monitoring framework for UHC was proposed by a joint WHO/World Bank discussion paper in December 2013. This study determined the feasibility of the proposed framework in Kenya. The study used the WHO/World Bank UHC monitoring framework and the Bellagio meeting report sponsored by WHO and the Rockefeller Foundation to informed the list of indicators used to determine the feasibility of the framework using published literature. Kenya has yet to establish an official policy on UHC that provides a clear mandate on the goals, targets and monitoring and evaluation of performance. The country has the capacity to reasonably report on five out of the seven proposed UHC indicators, but very limited capacity to report on the two service coverage indicators for the chronic condition and injury interventions and wider systemic challenges to meet the data requirements of the proposed UHC monitoring framework.
This edition presents a set of five articles that, through synthesis of available research, seek to consolidate and develop the body of health policy analysis work in low- and middle-income countries. This work is found to be currently fragmented across geographic settings and policy issues, is more descriptive than analytic and is weakly theorized.
Examining the non-communicable disease (NCD) profile for South Africa (SA) is crucial when developing health interventions that aim to reduce the burden of NCDs. The objective was to review NCD indicators in national data sources in order to describe the burden of NCDs in SA, using hypertension as an example. Age, gender, district of death and underlying cause of death data were obtained for 2008 and 2009 mortality unit records from Statistics SA and adjusted using STATA 11. Data for raised blood pressure were obtained from four national household surveys: the South African Demographic and Health Survey 1998, the Study on Global Ageing and Adult Health 2007, and the National Income Dynamics Study 2008 and 2010. The proportion of years of life lost due to NCDs was highest in the metros and least-deprived districts, with all metros (especially Mangaung) showing high age-standardised mortality rates for ischaemic heart disease, cerebrovascular disease and hypertensive disease. The prevalence of hypertension has increased since 1998. National household surveys showed a measured hypertension prevalence of over 40% in adults aged ¬25 years in 2010. Treatment coverage was 35.7%. Only 36.4% of hypertensive cases (on treatment) were controlled. Further work is needed if NCD monitoring is to be enhanced. Priority targets for NCDs must be integrated into national health planning processes. Surveillance requires integration into national health information systems. Within primary healthcare, a larger focus on integrated chronic care is essential.
This book is offered as a first attempt to understand what responsible data means in the context of international development programming. It takes a broad view of development and also anticipates that some of the methods and lessons may have resonance for related fields and practitioners. It is intended to support thoughtful and responsible thinking as the development community grapples with relatively new social and ethical challenges stemming from data use. This book builds on a number of resources and strategies developed in academia, human rights and advocacy, but aims to focus on international development practitioners so touches primarily upon issues specifically relevant to development practitioners and intermediaries working to improve the lives and livelihoods of people.
Equity should be implicit within universal health coverage (UHC) however, emerging evidence is showing that without adequate focus on measurement of equity, vulnerable populations may continue to receive inadequate or inferior health care. This narrative review aims to: (i) elucidate how equity is contextualised and measured within UHC, and (ii) describe tools, resources and lessons which will assist decision makers to plan and implement UHC programmes which ensure equity for all. Eighteen journal articles consisting mostly of secondary analysis of country data and qualitative case studies in the form of commentaries/reviews, and 13 items of grey literature, consisting largely of reports from working groups and expert meetings focusing on defining, understanding and measuring inequity in UHC (including recent drafts of global/country monitoring frameworks) were included. The literature advocates for progressive universalism addressing monetary and non-monetary barriers to access and strengthening existing health systems. This however relies on countries being effectively able to identify and reach disadvantaged populations and estimate unmet need. Recently published resources contextualise equity as a measurable component of UHC and propose several useful indicators and frameworks. Country case-studies also provide useful lessons and recommendations for planning and implementing equitable UHC which will assist other countries to consider their own requirements for UHC monitoring and evaluation.
Health systems research is increasingly being funded by international donors and conducted in low and middle-income countries but little conceptual work has been done to clarify the field’s ethical dimensions. This is problematic because health systems research has distinctive features relative to clinical research that may restrict the applicability of existing ethical guidance. This webinar asks: What makes health systems research different from clinical research? What are the key ethical issues in externally-funded health systems research in low and middle-income countries? And do they deserve special consideration in, for example, project design and ethics review? The moderated discussion covers the features of health systems research and examples of what it entails in practice, distinctive ethical issues that arise during the conduct of such research and challenges faced by ethics review committees when considering health systems research projects.
This paper uses available data to describe health inequalities experienced by diverse Aboriginal peoples in Canada. Its method is useful for those working on indigenous people's health in other regions. The data are organized around social determinants of health across the life course and provide evidence that not only demonstrates important health disparities within Aboriginal groups and compared to non-Aboriginal people, but also links social determinants, at proximal, intermediate and distal levels, to health inequalities. The Integrated Life Course and Social Determinants Model of Aboriginal Health is introduced as a promising conceptual framework for understanding the relationships between social determinants and various health dimensions, as well as examining potential trajectories of health across the life course. Data from diverse and often limited literature is provided to support claims made by the authors of this paper and others about health disparities among Aboriginal peoples and the degree to which inequalities in the social determinants of health act as barriers to addressing health disparities.
In this video researchers from Kemri Wellcome Trust in Kenya outline some of the ethical dilemmas that they encounter in their day to day lives. RinGs is a project and learning platform that aims to support researchers on understanding and integrating gender and ethics into their work.