Monitoring equity and research policy

The Commission on Social Determinants for Health has recommended assessment of health equity effects of public policy decisions, and this study provides guidance on assessing equity for users and authors of systematic reviews of interventions. Particular challenges occur in seven components of such reviews: developing a logic model; defining disadvantage and for whom interventions are intended; deciding on appropriate study design(s); identifying outcomes of interest; process evaluation and understanding context; analysing and presenting data; and judging applicability of results. The study concludes that greater focus on health equity in systematic reviews may improve their relevance for both clinical practice and public policy making.

No national South African institution provides a coherent suite of support, available skills and training for clinicians wishing to conduct randomised controlled trials (RCTs) in the public sector. This study assesses the need for establishing a national South African Clinical Trials Support Unit. Key informant interviews were conducted with senior decision-makers at institutions with a stake in the South African public sector clinical trials research environment. The study found that trial conduct in South Africa faces many challenges, including lack of dedicated funding, the burden on clinical load, and lengthy approval processes. Strengths include the high burden of disease and the prevalence of treatment-naïve patients. Participants expressed a significant need for a national initiative to support and enhance the conduct of public sector RCTs. Research methods training and statistical support were viewed as key. There was a broad range of views regarding the structure and focus of such an initiative, but there was agreement that the national government should provide specific funding for this purpose. In conclusion, stakeholders generally support the establishment of a national clinical trials support initiative. Consideration must be given to the sustainability of such an initiative, in terms of funding, staffing, expected research outputs and permanence of location.

This paper presents the first comprehensive effort to provide an overview of the research associated with the World Health Organization (WHO) headquarters in 2006/07. Information was obtained by questionnaire and interviews with senior staff operating at WHO headquarters in Geneva. The paper found that 45% of WHO permanent staff are involved with health research and the WHO's approach to research is predominantly focused on policy, advocacy, health systems and population based research. The Organization principally undertakes secondary research using published data and commissions others to conduct this work through contracts or research grants. This approach is broadly in line with the stated strategy of the Organization. The researchers note that the difficulty in undertaking this survey highlights the complexity of obtaining an organisation-wide assessment of WHO’s research activity in the absence of common standards for research classification, methods for priority setting and a mechanism across WHO, or within the governance of global health research more generally, for managing a research portfolio. As the rollout of the WHO strategy on research for health proceeds, the researchers expressed hope that similar exercises will be undertaken at the WHO Regional Offices and in support of capacity building of national health research systems within Member States.

This article discuss the work of the Global Forum, a global body of health decision-makers that focuses on questions of equity, advocating for more research to address the health problems of those most in need – essentially the poor and marginalised –and providing evidence to support greater investments in neglected areas. Since the Forum’s previous conference in 2009, the article notes that a paradigm shift has taken place from ‘health research’ to ‘research for health’. This new approach promotes greater understanding among all stakeholders of the impact on health of policies, programmes, processes, actions or events originating from other sectors. It also is intended to assist in developing interventions that will help prevent or mitigate any adverse impact on health and contribute to the achievement of health equity. While the number of resources, actors and efforts to address the health problems of the poor have grown signifi cantly in recent years, the range of health challenges faced by low- and middle-income countries has expanded considerably, demanding a more extensive research portfolio. Challenges include countries that are not on track to reaching the Millennium Development Goals, rising rates of chronic non-communicable diseases in low- and middle-income countries, urbanisation, demographic shifts, climate change, food security, the threat of pandemics, and the global financial crisis.