This research aimed to elaborate a theory of knowledge translation (KT) in Uganda that could also serve as a reference for other low- and middle income countries. The researchers employed qualitative approaches to examine the principal barriers and facilitating factors to KT. A review of the literature revealed that the most common factors facilitating knowledge uptake included institutional strengthening, research characteristics, dissemination processes, partnerships and political context. The analysis of interviews conducted by the researchers, however, showed that policymakers and researchers ranked institutional strengthening for KT, research characteristics and partnerships as the most important. Respondents rasied the importance of mainstreamed structures within the Ministry of Health to coordinate and disseminate research, the separation of roles between researchers and policymakers, and the role of communities and civil society in KT. The study tests a framework that can be more widely used in empirical research on the process of KT on specific policy issues.
Monitoring equity and research policy
In September 2011, it was announced that Dutch, Japanese and American scientists had independently genetically altered the H5N1 avian influenza virus, transforming it into a highly lethal, airborne strain that could conceivably spread easily between humans. The studies were funded by the United States (US) and the US National Science Advisory Board for Biosecurity (NSABB) then prevented the researchers from releasing their findings on the grounds that the experiment could be replicated by terrorists. The scientists involved in the H5N1 research have questioned the need for redacting the studies’ findings, arguing that “there is already enough information publicly available” to reproduce their experiments and that withholding the information only serves to disadvantage legitimate scientific research. The incident has sparked intense international public debate, clearly dividing much of the scientific and policy-making community. Some commentators have argued that an international consensus on appropriate approaches is needed, as national governments can only control matters in their own jurisdiction and this is an international question. The World Health Organisation, which has maintained a relatively low profile regarding the controversial H5N1 studies so far, agreed to host a technical meeting on 16-17 February 2012 to discuss the issues.
In this analysis of participatory civil society assessments, the authors make a number of important points. A new generation of country-led civil society assessments is now required, which will address important fundamental issues of philosophy, principle and methods and should be tailored to national and historical contexts. New approaches to civil society assessment need to shift from mapping and reporting to forecasting and foresight to be more relevant to civil society and policymakers. Diminishing returns of international comparative civil society assessments means that the time has come to expand and disaggregate assessment tools to make them progressively more meaningful and valid locally. The range of tools should be versatile to satisfy different stakeholders and stakeholders should question the applicability of “Western‟ theories and approaches to non-western societies. When conducting assessments in restrictive and culturally sensitive environments, certain factors, such as collective work, mutual trust and self-criticism, are needed to achieve positive results. A multi-stakeholder approach should be taken that represents government, business and the organised citizenry. It is also time to go beyond NGOs and public formal organisations to include informal organisations, which often have greater importance for the health of society. Final recommendations include going beyond a sectoral approach, using a domain approach to civil society assessments, adopting a clearer multi-centred theory of governance and recognising norm-free assessment as a fallacy.
The non-profit Universities Allied for Essential Medicines (UAEM) is a student-driven movement to promote equitable global access and innovation in publicly funded medical research. Through UAEM’s advocacy, universities that license medical research to industry have now begun to include requirements for generic production or “at cost” provisions for low- and middle-income countries. These “global access” provisions lower the price of the final products for poor patients, and have been adopted by leading institutions including Harvard, Yale, the University of British Columbia, and the US National Institutes for Health (NIH). While over 30 research institutions worldwide have endorsed a “Statement of Principles and Strategies” supporting global access to their medical discoveries, the students of UAEM want to ensure that this translates into real-world impact. They argue that the statement itself should be strengthened, and individual universities can adopt more robust policies. Most importantly, however, universities must demonstrate that they are regularly including global access provisions in their licensing negotiations with pharmaceutical companies. Improving the transparency of universities and their licensing practices is critical. Not only do universities need to ensure affordable access to their medical breakthroughs, but they also need to show that they are committing resources, both human and financial, to research on neglected diseases.
Canadian occupational health and infection control researchers have found that training is key to a positive safety culture, leading them to develop information and communication technology (ICT) tools to promote occupational health and infection control. The South African government invited the Canadian team to work with local colleagues, resulting in an improved web-based health information system to track incidents, exposures, and occupational injury and diseases, just in time for the H1N1 pandemic. Research from these experiences led to strengthened focus on building capacity of health and safety committees, and new modules are thus being created, informed by that work. The international collaboration between occupational health and infection control researchers in Canada, Ecuador and South Africa led to the improvement of the research framework and development of tools, guidelines and information systems. Furthermore, the research and knowledge-transfer experience highlighted the value of partnership amongst Northern and Southern researchers in terms of sharing resources, experiences and knowledge.
This supplement of BMC International Health and Human Rights consists of a collection of 10 case studies showcasing effective global health research. The collection provides practical, transferable lessons for research partnerships working to address health inequities. In the context of increasing competition for individual or institutional "leadership" of the field (and business) of global health, these papers instead speak of active and sustained collaboration - listening, responsiveness, flexibility, willingness and capacity to follow as well as to lead - in learning what to transform or sustain, and how, in order to move towards greater equity in both health and health research. In addition, they challenge conventional models of research focused on narrowly defined research questions and a narrow range of pre-specified research methods, documenting instead how both the research questions and the methods most appropriate to address them change over time. Finally, they challenge both the idea of "pure" science undertaken by independent researchers on behalf of science and specific communities, and the conventional wisdom that North-South and research-research user-community partnerships are necessarily either North and researcher-driven, or scientifically dubious.
This paper explores the current situation in universities with respect to research practice. The author observes that the market-driven model is dominant in African universities. The consultancy culture it has nurtured has had negative consequences for postgraduate education and research. Consultants presume that research is all about finding answers to problems defined by a client. They think of research as finding answers, not as formulating a problem. The consultancy culture is institutionalized
through short courses in research methodology, courses that teach students
a set of tools to gather and process quantitative information, from which
to cull answers. The author calls in contrast for an intellectual environment strong enough to sustain a meaningful intellectual culture.
Unless African governments increase their funding for and engagement in HIV research, the continent cannot hope to attain equal status in determining its research agenda and priorities, speakers said at the 16th International Conference on AIDS and Sexually Transmitted Infections (STIs) in Africa, held in December 2011 in Ethiopia. Most African health research is driven by external funders, which often means that research starts and ends on the say-so of the funders, rather than being based on a country's needs. Prof Nelson Sewankambo, principal of the College of Health Sciences at Uganda's Makerere University, said heavy external funder involvement in local research can actually harm existing national institutions, which may lose strategic direction and become retarded by the loss of key staff to research projects and distortion of institutional structures and governance. He argued that inequities in collaboration can lead to lack of transparency in the decision-making process, as well as disputes over publication rights, ownership of data, specimens and equipment. Other speakers also noted that inadequate community engagement was common when partnerships were skewed in favour of funders’ priorities and ethical violations occurred in research projects, such as the use of placebos in studies on mother-to-child HIV transmission. They called for new, more equitable partnership models and expansion of local capacity to sustain research activities once externally funded projects ended.
In the context of recent global calls for strengthening the field of health policy and systems research (HPSR) as a critical input to strengthening health systems, the authors of this paper assessed the extent to which progress has been achieved in this regard. Two sources of data were used: a bibliometric analysis to assess growth in production of HPSR between 2003 and 2009, and a 2010 survey of 96 research institutions to assess capacity and funding availability to undertake HPSR. Both analyses focused on HPSR relevant to low-income and middle-income countries (LMICs). Overall, the authors found an increasing trend of publications on HPSR in LMICs, although only 4% were led by authors from low-income countries (LICs). Improvements were noted in infrastructure of research institutions in LICs, but more limited gains in the level of experience of researchers within institutions. There has been only a modest increase in availability of funding for LICs.
This is the third of a series of three papers addressing the current challenges and opportunities for the development of Health Policy and Systems Research (HPSR). The authors of this paper assert that there is an urgent need to build the Health Policy and Systems Research (HPSR) field and in particular to develop understanding across different disciplinary boundaries. The development of HPSR is impeded by a cluster of related issues: a heavy reliance on international funding for HPSR; an excessive focus on the direct utility of HPSR findings from specific studies; and a tendency to under-value contributions to HPSR from social sciences. Innovations in funding HPSR are needed so that local actors, including policy-makers, civil society, and researchers, have a greater say in determining the nature of HPSR conducted. Strategic investment should be made in promoting a greater shared understanding of theoretical frames and methodological approaches for HPSR including, for example, the development of HPSR journals, methodological workshops, and shared HPSR teaching curricula. Dedicated and supportive homes for HPSR need to be found within universities, and also be developed as independent research institutes, the authors conclude.