A disparate series of contemporary lists of health service providers were used to update a public health facility database in Kenya, last compiled in 2003. These new lists were derived primarily through the national distribution of antimalarial and antiretroviral commodities since 2006. A combination of methods were used to map service providers and analyse disparity in geographic access to public health care. The update shows that, with concerted effort, a relatively complete inventory of mapped health services is possible, with enormous potential for improving planning. Expansion in public health care in Kenya has resulted in significant increases in geographic access, although several areas of the country need further improvements. This information will be key to future planning for Kenya’s public health sector.
Monitoring equity and research policy
Current systematic reviews have a utilitarian bias – they tend to be concerned more with the effects on populations and average effects than with distributional effects and impacts in disadvantaged sub¬groups. the author poses that systematic reviews should routinely consider the effects of interventions on health inequities. The Cochrane Health Equity Field was set up explicitly to further this agenda, to encourage systematic review authors to explicitly assess the effects of interventions not only on the whole population, but on the disadvantaged. Evidence on interventions to improve public health is in short supply, partic¬ularly evidence on social determinants. Public health systematic reviewers need to continue to develop new methods and better frameworks to inform decision-making.
The World Health Organization is soliciting new ideas for funding sources to stimulate research and development on diseases predominantly afflicting developing countries, with some in developed countries. The web-based public hearing, being held online from 7 March to 15 April 2009, will contribute to an intergovernmental mandate to come up with ways to address the shortage of research in this area. The expert group hopes to solicit additional ideas from member states and other stakeholders for its consideration. The final report will be presented at the May 2010 Health Assembly. The web-based public hearing is open to individuals, civil society groups, government institutions, academic and research institutions, the private sector and other interested parties. The link to the online public hearing is: http://www.who.int/phi/public_hearings/third/en/index.html
The potential for research to influence policy, and for researchers to influence policy actors, is significant. The purpose of this qualitative study was to explore the experiences of health services researchers engaging in (or not able to engage in) policy-relevant research. Semistructured telephone interviews were completed with 23 experienced researchers. The results paint a complex and dynamic picture of the policy environment and the relationship between government officials and academic researchers. Elements of this complexity included diverse understandings of the nature of policy and how research relates to policy; dealing with multiple stakeholders in the policy-making process; and identifying strategies to manage the different cultures of government and academia.
Promoting the use of research-based knowledge in public health becomes more complex when public health includes interventions on health determinants. This article examines strategies for knowledge synthesis, translation and exchange (KSTE) in the context of public health in Canada, making reference to the work of the recently established National Collaborating Centres for Public Health (NCCs). NCCs simultaneously pursue KSTE and study how KSTE strategies meet different needs. Because NCCs are focused on interventions and policies, they must address the relationship between knowledge and policy, and how amenable it is to change. KSTE can seek to respond to and inform an existing policy agenda, but it can also seek to shape, frame and change that agenda. The two paths might call for different approaches, and for expanding the boundaries of KSTE in health.
This short-term review of the International Health Partnership (IHP+) was commissioned by the IHP+ Scaling-up Reference Group to assess whether programme partners are adhering to their commitments and to review what progress has been made in implementing an IHP+ interagency common work-plan. The review was undertaken between May and August 2008 and is based on the opinions of 100 key informants who represent a cross-section of partner agencies, civil society and national ministries of health in the initial IHP+ countries and at the international level. It found that the relevance of IHP+ is not widely understood, transparency is essential for ensuring accountability (which also depends on the availability of reliable information). If well designed, the planned annual external monitoring and evaluation review of the IHP+ could potentially function as the key global accountability mechanism and it is still too early to assess what impacts or external effects that can be attributed to the IHP+.
The Mexico City Ministerial Summit in 2004 made the problem of poor knowledge translation (KT) a priority, and a solution imperative. Summiteers called for the increased involvement of the demand side in the research process, emphasising knowledge brokering and other mechanisms for ‘involving the potential users of research in setting research priorities’. Though the declaration was made with enthusiasm – and echoed in many follow-up meetings and papers – there was little guidance on how to actually bring together research and research-users. This guide addresses that gap. It discusses three core KT principles: knowledge, which depends on a robust, accessible and contextualised knowledge base, regular dialogue between all stakeholders and strengthened capacity, where researchers, decision-makers and other research users require a strengthened skill-base to create and respond to KT opportunities.
Adopted on 19 November – the final day of the Global Ministerial Forum on Research for Health hosted by the government of Mali in Bamako – the Call to Action urges national governments to allocate at least 2% of budgets of ministries of health to research. In parallel, funders of research and innovation, together with international development agencies, are urged to invest at least 5% of development assistance funds earmarked for the health sector in research, according to recipient country-led research strategies, instead of allowing the current situation to continue, where donor countries push their own agendas, thus shaping the agenda on behalf of recipient countries. The signatories have called for greater equity by increasing spending on researching the health challenges that disproportionately affect the poor, marginalised and disadvantaged.
An important focus of the Bamako Call to Action was to ensure that research priorities were determined by countries, not global institutions. To this end, the multilateral contributors to Bamako – WHO, UNESCO and the World Bank – were asked to promote, expand and implement research strategies with an emphasis on listening to country agendas and responding to their priorities. The idea of 18 November as an annual World Day of Research for Health was proposed as one means to maintain attention on this lever for health improvement. The Call to Action will now go to WHO’s Executive Board in January 2009, where they will do their utmost to ensure implementation of these urgent country requests. 2009 needs to be a year of action, not empty promises.
Progress since the last WHO ministerial summit in Mexico in 2004 is not striking, though there is the clinical trials platform, as well as new initiatives for knowledge translation networks like EVIDnet, and other local and regional projects that have achieved fragmented success. The Mexico declaration called for health ministries to dedicate at least 2% of their budgets to research. For most developing countries this remains an aspiration, with most still well below 1%. The problem is that research is a hard thing to sell where resources are tight. Convincing the public that research is not a luxury can be difficult. Hopefully, by the next ministerial summit in 2012, the discussion will no longer be about research for the world’s poorest nations but research by them for themselves. But, sadly, it seems all too possible that four years from now participants will be having exactly the same conversations.