In this paper, the author considers how operational research and management science can improve the design of health systems and the delivery of health care, particularly in low-resource settings. He identifies some gaps in the way operational research is typically used in global health and proposes steps to bridge them, before outlining some analytical tools of operational research and management science and illustrating how their use can inform some typical design and delivery challenges in global health. The paper concludes by considering factors that will increase and improve the contribution of operational research and management science to global health.
Monitoring equity and research policy
Meeting global health challenges through operational research and management science
Royston G: Bulletin of the World Health Organisation 89(9): 683-688, September 2011
World Social Science Report 2010
United Nations Educational, Scientific and Cultural Organisation (UNESCO): 2010
According to this report by UNESCO, in sub-Saharan Africa, social science themes have over the years evolved from topics such as structural adjustment, poverty, gender, the spread of armed confl icts, and HIV and AIDS to more recent concerns such as citizenship and rights in an era of crisis, and the response to neoliberalism. The big challenge, however, is to reconstruct autonomous social science research in Africa. But as the Council for the Development of Social Science Research in Africa (CODESRIA) points out, the lack of a research infrastructure prevents social scientists from contributing as much as they could to these social endeavours. In low-income countries, the increasing role of consultancy firms and NGOs in social science research follows the relative or absolute shrinking of public funds allocated to universities, for research in general and for the social sciences in particular. In such conditions, academics rarely have the chance of working on long-term projects involving strong theoretical considerations. The report also points to the corrosive effect of the ‘brain drain’ on research in low-income countries and acknowledges many of these countries have instituted measures to help retain professionals, but the efficiency of these measures remains limited as long as working conditions do not improve significantly.
A grander challenge: the case of how Makerere University College of Health Sciences (MakCHS) contributes to health outcomes in Africa
Pariyo G, Serwadda D, Sewankambo NK, Groves S, Bollinger RC, Peters DH: BMC International Health and Human Rights 11(Suppl 1): S2, 9 March 2011
In 2008, Makerere University began a radical institutional change to bring together four schools under one College of Health Sciences. This paper’s objective is to demonstrate how the University’s leadership in training, research and services has impacted health in Uganda. Data were collected through analysis of key documents; systematic review of MakCHS publications and grants; surveys of patients, students and faculty; and key informant interviews of the College’s major stakeholders. The researchers found that the University inputs to the health sector include more than 600 health professionals graduating per year, many of whom assume leadership positions. University contributions to processes include strengthened approaches to engaging communities, standardised clinical care procedures and evidence-informed policy development. Outputs include the largest number of out-patients and in-patient admissions in Uganda. Outcomes include an expanded knowledge pool, and contributions to coverage of health services and healthy behaviours. Pilot projects have applied innovative demand and supply incentives to create a rapid increase in safe deliveries (three-fold increase after three months), and increased quality and use of HIV services with positive collateral improvements on non-HIV health services at community clinics.
Challenges in linking health research to policy: a commentary on developing a multi-stakeholder response to orphans and vulnerable children in Ghana
Gyapong J, Selby R and Anakwah K: Health Research Policy and Systems 9(Suppl 1): S14, 16 June 2011
The Ghanaian government’s strategy on orphans and vulnerable children (OVCs) recommends they should be encouraged to live in their home communities rather than in institutions. The paper presents lessons here on efforts to use research to build a response across different agencies to address the problems that communities and families face in caring for these children in their communities. This approach to building consensus on research priorities points to the value of collaboration and dialogue with multiple stakeholders as a means of fostering ownership of a research process and supporting the relevance of research to different groups. The authors argue that if the context within which researchers, policy makers and stakeholders work were better understood, the links between them were improved and research were communicated more effectively, then better policy making which links across different sectors may follow. At the same time, collaboration among these different stakeholders to ensure that research meets social needs, must also satisfy the requirements of scientific rigour.
National policy development for cotrimoxazole prophylaxis in Malawi, Uganda and Zambia: the relationship between context, evidence and links
Hutchinson E, Parkhurst J, Phiri S, Gibb DM, Chishinga N, Droti B and Hoskins S: Health Research Policy and Systems 9(Suppl 1): S6, 16 June 2011
In this study, researchers conducted a comparative analysis of cotrimoxazole preventive therapy (CPT) in Malawi, Uganda and Zambia. They held 47 in-depth interviews to examine the influence of context, evidence and the links between researcher, policy makers and those seeking to influence the policy process. In relation to context, they found a number of factors to be influential, including government structures and their focus, funder interest and involvement, healthcare infrastructure and other uses of cotrimoxazole and related drugs in the country. In terms of the nature of the evidence, the researchers found that how policy makers perceived the strength of evidence behind international recommendations was crucial (if evidence was considered weak then the recommendations were rejected). Finally, the links between different research and policy actors were considered of critical importance, with overlaps between researcher and policy maker networks crucial to facilitate knowledge transfer. Within these networks, in each country the policy development process relied on a powerful policy entrepreneur who helped get CPT onto the policy agenda.
Strategies and tensions in communicating research on sexual and reproductive health, HIV and AIDS: a qualitative study of the experiences of researchers and communications staff
Crichton J and Theobald S: Health Research Policy and Systems 9(Suppl 1): S4, 16 June 2011
This qualitative study focuses on the research communication and policy-influencing objectives, strategies and experiences of four research consortia working in sexual and reproductive health, HIV and AIDS in nine countries in sub-Saharan Africa and Asia. The authors carried out 22 in-depth interviews with researchers and communications specialists to identify factors that affect the interaction of research evidence with policy and practice, using an adapted version of the Overseas Development Institute’s RAPID analytical framework. Results indicated that the characteristics of researchers and their institutions, policy context, the multiplicity of actors, and the nature of the research evidence all play a role in policy influencing processes. Research actors perceived a trend towards increasingly intensive and varied communication approaches. Effective influencing strategies include making strategic alliances and coalitions and framing research evidence in ways that are most attractive to particular policy audiences. Tensions include the need to identify and avoid unnecessary communication or unintended impacts, challenges in assessing and attributing impact and the need for adequate resources and skills for communications work. The authors conclude that the adapted RAPID framework can serve as a useful tool for research actors to use in resolving tensions.
The impact of HIV and AIDS research: a case study from Swaziland
Whiteside A and Henry FE: Health Research Policy and Systems 9(Suppl 1): S9, 16 June 2011
In this study, researchers analysed the impact of the report ‘Reviewing ‘Emergencies’ for Swaziland: Shifting the Paradigm in a New Era’, which was published in 2007 and built a picture of the HIV and AIDS epidemic as a humanitarian emergency, requiring urgent action from international organisations, external funders and governments. Following a targeted communications effort, the report was believed to have raised the profile of the issue and Swaziland - a success story for HIV and AIDS research. The authors conducted a literature search on the significance of understanding the research-to-policy interface, using the report as a case study. They explored key findings from the assessment, suggesting lessons for future research projects. They demonstrate that, although complex, and not without methodological issues, impact assessment of research can be of real value to researchers in understanding the research-to-policy interface. Only by gaining insight into this process can researchers move forward in delivering effective research, they argue.
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.
What shapes research impact on policy? Understanding research uptake in sexual and reproductive health policy processes in resource-poor contexts
Sumner A, Crichton J, Theobald S, Zulu E and Parkhurst J: Health Research Policy and Systems 9(Suppl 1): S3, 16 June 2011
Assessing the impact that research evidence has on policy is complex, the authors of this paper argue, and they review some of the main conceptualisations of research impact on policy, including generic determinants of research impact identified across a range of settings, as well as the specificities of sexual and reproductive health (SRH) in particular. They identify aspects of the policy landscape and drivers of policy change commonly occurring across multiple sectors and studies to create a framework that researchers can use to examine the influences on research uptake in specific settings, to guide attempts to ensure uptake of their findings. The framework distinguishes between pre-existing factors influencing uptake and the ways in which researchers can actively influence the policy landscape and promote research uptake through their policy engagement actions and strategies. The authors conclude by highlighting the need for continued multi-sectoral work on understanding and measuring research uptake and for prospective approaches to receive greater attention from policy analysts.
Investing in the future: lessons learnt from communicating the results of HSV/ HIV intervention trials in South Africa
Delany-Moretlwe S, Stadler J, Mayaud P and Rees H: Health Research Policy and Systems 9(Suppl 1):S8, 16 June 2011
This case study from South Africa focuses on the lessons learnt from communicating the results of four trials evaluating treatment for herpes simplex virus type 2 (HSV-2) as a new strategy for HIV prevention. The authors show that contextual factors such as misunderstandings and mistrust played an important role in defining the communications response. Use of different approaches in combination was found to be most effective in building understanding, credibility and trust in the research process. During the communication process, researchers acted beyond their traditional role of neutral observers and became agents of social change. This change in role is in keeping with a global trend towards increased communication of research results and presents both opportunities and challenges for the conduct of future research. Despite disappointing trial results which showed no benefit of HSV-2 treatment for HIV prevention, important lessons were learnt about the value of the communication process in building trust between researchers, community members and policy-makers, and creating an enabling environment for future research partnerships.