This article covers the opening address of the Tanzanian Minister of Health and Social Welfare at the 22nd Annual Joint Scientific Conference of the National Institute for Medical Research, Arusha Tanzania, 7 March 2007.
Monitoring equity and research policy
The role of health research institution in social development in Africa
Mwakusya DA: Tanzania Health Research Bulletin 9(2): 140-143, 2007
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.
WHO publishes new standard for documenting the health of children and youth
The World Health Organisation (WHO), 30 October 2007
WHO publishes the first internationally agreed upon classification code for assessing the health of children and youth in the context of their stages of development and the environments in which they live. The International Classification of Functioning, Disability and Health for Children and Youth (ICF–CY) confirms the importance of precise descriptions of children's health status through a methodology that has long been standard for adults. Viewing children and youth within the context of their environment and development continuum, the ICF–CY applies classification codes to hundreds of bodily functions and structures, activities and participation, and various environmental factors that restrict or allow young people to function in an array of every day activities.
Methods for analysing cost effectiveness data from cluster randomised trials
Bachmann MO, Fairall L, Clark A, et al: Cost Effectiveness and Resource Allocation, 5: 12, 6 September 2007
Measurement of individuals' costs and outcomes in randomised trials allow uncertainty about cost effectiveness to be quantified. Uncertainty is expressed as probabilities that an intervention is cost effective, and confidence intervals of incremental cost effectiveness ratios. Randomising clusters instead of individuals tends to increase uncertainty but such data are often analysed incorrectly in published studies. The authors used data from a cluster randomized trial to demonstrate five appropriate analytic methods: 1) joint modeling of costs and effects with two-stage non-parametric bootstrap sampling of clusters then individuals, 2) joint modeling of costs and effects with Bayesian hierarchical models and 3) linear regression of net benefits at different willingness to pay levels using a) least squares regression with Huber-White robust adjustment of errors, b) a least squares hierarchical model and c) a Bayesian hierarchical model. All five methods produced similar results, with greater uncertainty than if cluster randomisation was not accounted for. Cost effectiveness analyses alongside cluster randomised trials need to account for study design. Several theoretically coherent methods can be implemented with common statistical software.
Science at WHO and UNICEF: The corrosion of trust
Editorial: Lancet 370 (9592), 22 September 2007.
This issue of the Lancet publishes two papers of critical interest to child survival. Unfortunately, both have stirred concerns about misuse of data by UN agencies. Here, they review the allegations and try to draw lessons about the place of independent scientific inquiry in the arena of global health policymaking. Greg Fegan and colleagues report the success of an expanded insecticide-treated bednet programme in Kenya . The full paper reveals the strengths and limitations of the study, and provides important estimates of uncertainty. No such statistical caution was expressed in the WHO statement about these data, released on Aug 16. Indeed, WHO claimed that this finding "ends the debate about how to deliver long-lasting insecticidal nets". Yet communications between the Kenyan research team and WHO suggest an ill-considered rush by WHO against the advice of wiser scientific minds.
World Health Statistics 2007
World Health Organization , 2007
World health statistics 2007, published by the World Health Organization (WHO), presents the most recent health statistics for WHO’s 193 Member States. The core set of indicators was selected on the basis of their relevance to global health, the availability and quality of the data, and the accuracy and comparability of estimates. The core indicators do not aim to capture all relevant aspects of health but to provide a comprehensive summary of the current status of a population’s health and the health system at country level. These indicators include: mortality outcomes, morbidity outcomes, risk factors, coverage of selected health interventions, health systems, inequalities in health, and demographic and socioeconomic statistics.
Geographical disparities in core population coverage indicators for roll back malaria in Malawi
Kazembe LN, Appleton CC, Kleinschmidt I: International Journal for Equity in Health, 2007, 6 : 5, 4 July 2007
Implementation of known effective interventions would necessitate the reduction of malaria burden by half by the year 2010. Identifying geographical disparities of coverage of these interventions at small area level is useful to inform where greatest scaling-up efforts should be concentrated. They also provide baseline data against which future scaling-up of interventions can be compared. However, population data are not always available at local level. This study applied spatial smoothing methods to generate maps at subdistrict level in Malawi to serve such purposes.
IDRC and SSHRC : Social science and humanities expertise to be harnessed for international impact
International Development Research Centre, Social Sciences and Humanities Research Council
Canada ’s IDRC and the SSHRC have signed an agreement to invest up to $6.27 million over the next six years to support international research alliances. This partnership will engage teams from Canada and developing countries in comparing and collaborating on their research, while working with people in communities that will directly benefit from the research. This partnership is a practical expression of the idea that new knowledge, generated through research, is key for people to improve their futures. The joint program will encourage strategic research in four areas: environment and natural resource management; information and communication technologies for development; the impact of science, technology and innovation policies on development; social and economic policy related to poverty reduction, growth, health and human rights.
Assessing outcomes of health and medical research: do we measure what counts or count what we can measure?
Wells R and Whitworth JA: Australia and New Zealand Health Policy 4:14, 28 June 2007
Governments world wide are increasingly demanding outcome measures to evaluate research investment. Health and medical research outputs can be considered as gains in knowledge, wealth and health. Measurement of the impacts of research on health are difficult, particularly within the time frames of granting bodies. Thus evaluations often measure what can be measured, rather than what should be measured. Traditional academic metrics are insufficient to demonstrate societal benefit from public investment in health research. New approaches that consider all the benefits of research are needed.
Generating political priority for global health initiatives: A framework and case study of maternal mortality
Shiffman J: Global Center for Development, July 2007
The author developed this framework while conducting an in-depth case study of the safe motherhood initiative and supplemented the findings with research done on AIDS, reproductive health, and other health initiatives. At its core, the framework posits eleven factors under four key categories (actor capability, framing, political opportunities, and issue characteristics) driving the success or failure of health initiatives (i.e. polio eradication, the AIDS movement, etc).