Monitoring equity and research policy

Implementation of Urban Health Equity Assessment and Response Tool: a Case of Matsapha, Swaziland.
Makadzange K; Radebe Z; Maseko N; et al: Journal of Urban Health, doi: 10.1007/s11524-018-0241-y, 2018

This paper illustrates a case of applying the Urban Health Equity Assessment and Response Tool in Matsapha, Swaziland. A descriptive single-case study design using qualitative research methods was adopted to collect data from purposively selected respondents. The study revealed that residents of the Matsapha peri-urban informal settlements faced challenges with conditions of daily living which impacted negatively on their health. There were health equity gaps. The application of the tools was facilitated by the formation of an all-inclusive team, intersectoral collaboration and incorporating strategies for improving urban health equity into existing programmes and projects.

Mobilization initiative on gender equity in health research launched
TDR: World Health Organisation, Geneva, February 2018

TDR Global has launched a 3-month mobilization initiative on gender equity in health research. The aim is to enhance women’s position in health research and to address the impact of gender on infectious diseases of poverty through research. The initiative will share experience and thoughts on gender equity in health research. Challenge-solving workshops are being planned to identify local challenges, create local teams and offer training. TDR Global talks are opportunities to share best practices and experiences on enhancing gender equity in health research. Working groups on specific issues are options for organizing webinars, training and sharing ideas.

Research gaps and emerging priorities in sexual and reproductive health in Africa and the eastern Mediterranean regions
Ali M; Farron M; Ouedraogo L; et al: Reproductive Health 15(39) doi:, 2018

This paper presented the results of a priority setting exercise that brought together researchers and program managers from the World Health Organization Africa and Eastern Mediterranean regions to identify key sexual reproductive health issues. In June 2015, researchers and program managers from the World Health Organization Africa and Eastern Mediterranean regions met for a three-day meeting to discuss strategies to strengthen research capacity in the regions. A prioritization exercise was carried out to identify key priority areas for research in sexual reproductive health. The process included five criteria which are answerability, effectiveness, deliverability and acceptability, potential impact of the intervention/program to improve reproductive, maternal and newborn health substantially, and equity. The six main priorities were identified as creation and investment in multipurpose prevention technologies, addressing adolescent violence and early pregnancy, improved maternal and newborn emergency care, increased evaluation and improvement of adolescent health interventions including contraception, further focus on family planning uptake and barriers, and improving care for mothers and children during childbirth. They indicate that setting priorities is the first step in a dynamic process to identify where research funding should be focused to maximize health benefits. A focus on priority setting suggests a need to identify who is thus involved in this process.

Child Gauge 2017: Investing in children for sustainable development - Survive. Thrive. Transform
Jamieson L; Berry L; Lake L: The Children's Institute, South Africa, 2017

The South African Child Gauge® is published annually by the Children’s Institute, University of Cape Town, to monitor progress towards realising children’s rights. This issue focuses on children and the Sustainable Development Goals (SDGs). Part one summarises and comments on policy and legislative developments that affect children. These include developments in international and South African law. Part two motivates for greater investment to ensure South Africa’s children not only survive but thrive and reach their full potential, by focusing on the SDGs, ensuring that the 2030 Global Agenda promotes children’s survival and development, identifying local priorities, promoting nurturing care, creating safe environments, improving child nutrition, getting reading right, creating inclusive and enabling environments and reflecting on progress and calling for action. Part three presents child-centred data 2002-2015 to monitor progress and track the realisation of children’s socio-economic rights in South Africa. A set of key indicators tracks progress in demography, income poverty, unemployment and social grants, child health and access to education, housing and basic services.

Data-driven quality improvement in low-and middle-income country health systems: lessons from seven years of implementation experience across Mozambique, Rwanda, and Zambia
Wagenaar B; Hirschhorn L; Henley C; et al: BMC Health Services Research 17 (Suppl 3), doi:10.1186/s12913-017-2661-x, 2017

This paper describes the similar and divergent approaches to increase data-driven quality of care improvements and implementation challenge and opportunities encountered in these three countries. Eight semi-structured in-depth interviews were administered to program staff working in each country. Project successes ranged from over 450 collaborative action-plans developed, implemented, and evaluated in Mozambique, to an increase from 80% of basic clinical protocols followed in intervention facilities in rural Zambia, and a shift from a lack of awareness of health data among health system staff to collaborative ownership of data and using data to drive change in Rwanda. Based on common successes across the country experiences, the authors recommend future data-driven quality improvement interventions begin with data quality assessments to promote that rapid health system improvement is possible, ensure confidence in available data, serve as the first step in data-driven targeted improvements, and improve staff data analysis and visualization skills. They pose that explicit Ministry of Health collaborative engagement can ensure performance review is collaborative and internally-driven rather than viewed as an external “audit.”

Research capacity building integrated into PHIT projects: leveraging research and research funding to build national capacity
Hedt-Gauthier B L; Chilengi R; Jackson E; et al,: BMC Health Services Research 17 (Suppl 3) doi: 10.1186/s12913-017-2657-6, 2017

This paper analyses the implementation of health systems strengthening initiatives inclusive of research capacity building. During Population Health Implementation and Training, specific research capacity building activities varied across countries. However, all five countries used African Health Initiative funding to improve research administrative support and infrastructure, implement research training and support mentorship activities and research dissemination. Funders were recommended to provide adequate and flexible funding for research capacity building activities and for institutions to offer a spectrum of research capacity building activities to enable continued growth, provide adequate mentorship for trainees and systematically monitor research capacity building activities.

A comparable yardstick: adjusting for education bias in South African health system responsiveness ratings
Rossouw L; Smith A: Health Policy and Planning 32(Suppl3) iii67–iii74, 2017

Health-system responsiveness (HSR) measures the experience of health-system users in terms of the non-clinical aspects of the health system. The authors explore the association between education levels and reporting behaviour in terms of HSR in South Africa using data from the World Health Organization Study on Global Ageing and Adult Health for South Africa (WHO SAGE) conducted in 2007 and 2008. The authors consider the reporting behaviour of 1499 adults aged 50 and older in terms of the reported HSR for their most recent outpatient provider visit during the preceding 12 months. More specifically, they explore whether there are systematic biases in reporting behaviour by education levels and other socio-economic covariates through the use of data from anchoring vignettes. Large differences were found in HSR ratings between the lowest and highest education groups after adjusting for reporting bias using the anchoring vignettes. This finding holds across all seven HSR domains captured in the WHO SAGE dataset. In the most extreme case, individuals with no education are likely to underreport poor HSR by between 2.6 and 9.4% percentage points compared with individuals with secondary schooling or higher. It is proposed that policy-makers take cognizance of potential reporting biases in HSR ratings and make the necessary adjustments to obtain data that are as true and accurate as possible. The need for this is seen to be especially acute in a country such as South Africa with large socio-economic inequalities and disparities in access to healthcare.

Assessing the health workforce implications of health policy and programming: how a review of grey literature informed the development of a new impact assessment tool
Nove A; Cometto G; Campbell J: Human Resources for Health 15(79), doi:, 2017

In their adoption of WHA resolution 69.19, World Health Organization Member States requested all bilateral and multilateral initiatives to conduct impact assessments of their human resources for health funding. No standard tools exist for assessing the impact of global health initiatives on the health workforce, but tools exist from other fields. This paper describes how a review of grey literature informed the development of a draft health workforce impact assessment tool and how to introduce the tool. A search of grey literature yielded 72 examples of impact assessment tools and guidance from a wide variety of fields including gender, health and human rights. These examples were reviewed, and information relevant to the development of a health workforce impact assessment was extracted from them using an inductive process. A number of good practice principles were identified from the review. These informed the development of a draft health workforce impact assessment tool, based on an established health labour market framework. The tool consists of a relatively short and focused screening module to be applied to all relevant initiatives, followed by a more in-depth assessment to be applied only to initiatives for which the screening module indicates that significant implications for HRH are anticipated. It thus aims to strike a balance between maximizing rigour and minimising administrative burden. The authors propose that the new tool will help to ensure that health workforce implications are incorporated into global health decision-making processes from the outset and to enhance positive human resources for health impacts and avoid, minimise or offset negative impacts.

The change-makers of West Africa
Godt S; Mhatre S; Schryer-Roy AM: Health Research Policy and Systems 15 (52), doi:, 2017

This journal supplement is a contribution to changing practice by putting the perspectives, experiences and knowledge of West Africans on the table. It presents findings from a series of research and capacity development projects in West Africa funded by the International Development Research Centre's Maternal and Child Health programme. The evidence presented centres around two key themes. First, the theme that context matters. The evidence shows how context can change the shape of externally imposed interventions or policies resulting in unintended outcomes. At the same time, it highlights evidence showing how innovative local actors are developing their own approaches, usually low-cost and embedded in the context, to bring about change. The collection of articles discusses the critical need to overcome the existing fragmentation of expertise, knowledge and actors, and to build strong working relationships amongst all actors so they can effectively work together to identify priority issues that can realistically be addressed given the available windows of opportunity. Vibrant West African-led collaborations amongst researchers, decision-makers and civil society, which are effectively supported by national, regional and global funding, need to foster, strengthen and use locally-generated evidence to ensure that efforts to strengthen health systems and improve regional health outcomes are successful. The authors argue that the solutions are not to be found in the ‘travelling models’ of standardised interventions.

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.