The World Social Science Forum 2015 served as a platform for presenting new knowledge and insights, re-thinking received wisdom, charting new directions, promoting innovation in the research-policy-action nexus, and nurturing new international partnerships. Issues of justice and growing inequalities at global, regional, national and local levels and their impact on the quality of life of populations as well as on the sustainability of resources justified the theme: 'Transforming Global Relations for a Just World'. Participants declared their concern with the consequences of injustice and inequality for the quality of life for global populations as well as with the sustainability of global resources. The participants declared to: (a) Pursue theoretical and empirical research including development of reliable and multi-dimensional indicators on inequalities and injustices; (b) Produce evidence to highlight issues requiring urgent attention and action, support advocacy and inform policies to respond to them; (c) Support efforts to address asymmetries, disparities, divides, and lack of autonomy in knowledge production through the creation of transformative knowledge programs; (d) Participate in programs and efforts that aim to end injustice and inequality; (e) Make every effort to reduce income inequalities and promote equity, starting with scientific institutions where they have influence; (f) Support measurable progress to overcome inequalities, including through the implementation of the Sustainable Development Goals; (g) Promote policies, programs, and values that act to end gender inequality; (h) Promote the integration of youth in work places through providing them with the necessary skills to enter the labour force; (i) Support efforts to achieve legally binding and universal agreement on avoiding dangerous anthropogenic interference with the climate system; and (j) Promote inclusive societies based on universal values and human rights.
Monitoring equity and research policy
The new Alliance for Accelerating Excellence in Science in Africa (AESA) was launched on the 10th of September 2015 in Nairobi, Kenya. AESA, which is hosted at AAS headquarters in Nairobi, is intended to bring the centre of gravity for health research funding decision-making from places such as Seattle in the United States and London in the United Kingdom to Africa itself. Its African backers include the New Partnership for Africa’s Development, a continental policy implementation agency. Three big international research funders — the UK-based Wellcome Trust, the UK's Department for International Development (DFID) and the Bill and Melinda Gates Foundation in the United States — have earmarked funding programmes that they plan to let AESA administer. From next year, AESA is expected to take over the management of the Wellcome Trust's five-year US$70 million DELTAS programme, which involves seven new African centres of health research and training excellence in subjects ranging from biostatistics to mental health in six African countries: Ghana, Kenya, Mali, South Africa, Uganda and Zimbabwe.
The individual household method (IHM) provides estimates of household income, with detailed information on household assets, demography and specific income sources. This data can be used to support the design and evaluation of programmes, and seeks to collect information on actual households directly from their members. This enables IHM studies to identify more complex variation across populations and to model the impact of changes on a much wider range of population groups, with data disaggregated by demographics (gender and age), income levels and other chosen characteristics.
A recent World Bank press release on a World Bank and WHO report announced that "400 million people do not have access to essential health services.” The author argues in this article that this would be a highly over-optimistic misread of what WHO and the World Bank found. By more reasonable understandings of how many people lack access to essential health services, untold hundreds of millions more than 400 million people lack access to essential health services. He notes that the road ahead to universal health coverage is considerably longer than the headline figure implies. The report itself – beneath the headlines – covers many concerns and raises issues of quality and other concerns in a more complex reality. The author of this article notes that official monitoring should capture this complexity as what is monitored may well affect what governments prioritize, and the health services people actually receive, and so that a singular focus on access does not hide other aspects of people’s right to health – including the quality of health services and their acceptability.
This study reported on research production and publications on health inequalities through a bibliometric analysis covering publications from 1966 to 2014 and a content analysis of the 25 most-cited papers. A database of 49,294 references was compiled from the search engine Web of Science. The first article appears in 1966 and deals with equality and civil rights in the United States and the elimination of racial discrimination in access to medical care. By 2003, the term disparity has gained in prominence relative to the term inequality which was initially elected by the researchers. The paper shows that research on health inequalities grown exponentially in the last 30 years; the terms inequity, inequality and disparity have been inconsistently used over time; the most-cited papers studied socioeconomic factors and impacts on health inequities with first reports studying relations of socioeconomic conditions and health outcomes and research growing toward theoretical models and proposals on methodological approaches.
Between June and October 2014, the Maternal Health Task Force (MHTF) consulted 26 international maternal health researchers to gather perspectives on the most critical and neglected areas for knowledge generation to improve maternal health in low- and middle-income countries. The MHTF asked respondents to identify research and evaluation priorities in three broad areas: 1) persistent and critical knowledge gaps that need to be filled to accelerate reductions in maternal mortality and morbidity in low-and middle income countries; 2) crucial maternal health issues that have not been given adequate attention by research and donor communities; and 3) new situations and emerging challenges that require research to improve maternal health outcomes. The report presents the results of the interview responses on issues that will shape the landscape of maternal health over the next decade. This included strengthening health service delivery; improving distribution and retention of healthcare workers; the increasing burden of non-communicable diseases among pregnant women and women of reproductive age; the persistence of social and economic inequality and vulnerability; and urbanization. The need to attend to geopolitical determinants of maternal health, such as climate change and food insecurity, the proliferation of conflict and humanitarian crises, and the rise of religious fundamentalism, was also mentioned.
Monitoring pro-poor health policies at the regional level can support countries and regional bodies to identify gaps in addressing poverty and health, strengthen the link between regions and member states and hold actors accountable to their commitments. The Southern African Development Community (SADC) has conducted work in understanding how poor health and poverty coincide, are mutually reinforcing, and socially-structured by gender, age, class, ethnicity and location, with health policy documents on the issues. Yet guidelines and policies have been unevenly implemented. The Poverty Reduction and Regional Integration (PRARI) project seeks to support the development of a monitoring system to measure the contribution of regional governance in the development of pro-poor health policies in collaboration with key stakeholders in the region. The paper describes the system. It builds on existing efforts in the region and focuses on policy areas such as the social determinants of health; HIV/AIDS, TB and malaria; non-communicable diseases; maternal and child health; human resources for health; pharmaceuticals; among others. Global developments such as those related to the incoming Sustainable Development Goals (SDGs) are also considered. In order for this indicator-based monitoring system to be effective and to have an impact, it is argued to require regional ownership, active participation of national and regional experts throughout the process of indicator development, implementation and evaluation and evidence that it will address health priorities for the region.
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 understanding of the sex- and gender-based health implications of the 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.
This study assessed the methods used in the evaluation of measles vaccination coverage in 2012/3 in eastern and southern Africa, identified quality concerns and made recommendations for improvement. Of the 13 reports the authors reviewed, there were weaknesses in 10 of them for ethical clearance, 9 for sample size calculation, 6 for sampling methods, 12 for training structures, 13 for supervision structures and 11 for data analysis. The authors recommend improvements in the documentation of routine and supplementary immunisation, via home-based vaccination cards or other records. They recommend that standards be developed for report templates and for the technical review of protocols and reports. This would ensure that the results of vaccination coverage surveys are accurate, comparable, reliable and valuable for programme improvement.
There is a growing interest in the ethics of health systems research, and some debate about whether a specific ethical framework or set of guidance is needed. The authors provide a framework to begin to think about this, organised around eight considerations: (1) the nature of intervention; (2) types of research subjects; (3) units of intervention and observation; (4) informed consent; (5) controls and comparisons; (6) risk assessment; (7) inclusion of vulnerable groups within different contexts, and; (8) benefits of research. This is a starting place for researchers interested in health systems research ethics. The authors note several challenges to thinking about the ethics of health systems research, including the diverse range of studies and disciplines involved, the grey zone between research and non-research, and the many overlaps of issues with other types of health research. They call for more conceptual work and empirical research aimed at better understanding this topic.