Following the five days of keynotes, plenaries, concurrent sessions, satellites and informal discussions and debates at the November 16-19 2010 First Global Symposium on Health Systems Research (HSR), Montreux, Switzerland, the final statement to the conference from the Steering Committee recognized “that there is an enormous energy to move forward with a further agenda of action reflecting the spirit and commitment that brought us to Montreux from Mexico and Mali”. The steering committee initiated a new alliance of actors globally with an agenda of work to:
o electronically archive and disseminate the papers and debates at the conference
o create an international society for health systems research, knowledge and innovation, to build greater constituency, credibility and capacity for improved and interdisciplinary HSR globally, and to provide visibility and support to regional, national and collaborative efforts on HSR;
o work with the priority agendas related to the recently agreed United Nations SG strategy on maternal, neo-natal and child health; and the upcoming UNGASS related to non communicable diseases to bring more effective health systems strengthening to accelerate universal health coverage.
A Second Global Symposium on Health Systems Research is planned for 2012 or 2013 to evaluate progress, share insights and recalibrate the agenda of science to accelerate universal health coverage, hosted by China.
Monitoring equity and research policy
This book captures developments in Participatory Action Research (PAR), exploring the justification, theorisation, practice and implications of PAR. It offers a critical introduction to understanding and working with PAR in different social, spatial and institutional contexts. The authors engage with PAR’s radical potential, while maintaining a critical awareness of its challenges and dangers. The book is divided into three parts. The first part explores the intellectual, ethical and pragmatic contexts of PAR; the development and diversity of approaches to PAR; recent poststructuralist perspectives on PAR as a form of power; the ethic of participation; and issues of safety and well-being. Part two is a critical exploration of the politics, places and practices of PAR. Contributors draw on diverse research experiences with differently situated groups and issues including environmentally sustainable practices, family livelihoods, sexual health, gendered experiences of employment, and specific communities such as people with disabilities, migrant groups, and young people. The principles, dilemmas and strategies associated with participatory approaches and methods including diagramming, cartographies, art, theatre, photovoice, video and geographical information systems are also discussed. Part three reflects on how effective PAR is, including the analysis of its products and processes, participatory learning, representation and dissemination, institutional benefits and challenges, and working between research, action, activism and change.
The 15 countries evaluated in this report card - including Angola, Democratic Republic of the Congo, Kenya, Tanzania and Uganda - account for nearly three-quarters of all pneumonia deaths worldwide. The card provides a total score for each country by evaluating data on seven key interventions identified by the Global Action Plan for the Prevention and Control of Pneumonia (GAPP), which indicated that up to two-thirds of child pneumonia deaths could be prevented if at least 90% of children had access to a few simple, effective pneumonia interventions. GAPP’s recommended 90% coverage on the interventions is based on the need to reach Millennium Development Goal targets for child survival by 2015. The interventions include prevention measures, protection measures and treatment. The card finds that country scores fall far short, ranging from 61 to 23% on these measures combined. While some pneumonia vaccines like measles and pertussis are already in widespread use, the card shows that new pneumonia vaccines against Hib and pneumococcal infections have not yet been adopted in all countries. With support from the GAVI Alliance, nearly all of these countries are expected to increase coverage of existing vaccines, as well as introduce Hib and pneumococcal vaccines, in the next five years.
This article argues that mobile phone connectivity in developing countries facilitates social and economic development through increased access to people, information and services such as health care, education, employment opportunities and market information. In developing countries, which lack the physical and technical infrastructure present in more developed nations, cell phone surveys provide an inexpensive and feasible way to conduct population-based data collection. However, the authors point out several issues that should be considered when conducting cell phone surveys in developing countries. Reception may not be available in rural zones, and it may be difficult to sample owners from cell phone registration lists if most users are unregistered. In addition, one needs to be aware of the cost that cell phone subscribers pay to receive a call and offer reimbursement for the time spent responding to the survey. Selection of one adult respondent from a sample household should always include consideration of the number of adults with cell phones in the household and whether people share cell phones. Text messages rather than voice calls may also be the primary means of cell phone communication in developing countries. The authors conclude that cell phone health surveys may come into wider use if the above issues can be addressed.
This paper was commissioned as a background discussion paper for the Global Symposium on Health Systems Research, held in Switzerland from 16-19 November 2010. It discusses how best to enhance capacity for health systems research (HSR), with a particular focus on low- and middle-income countries (LMICs). A systematic review was conducted of initiatives and interventions that have sought to enhance capacity for health systems research. The review sought to identify and include all papers that described a capacity development initiative for health systems or health services research. Out of 73 articles identified, 24 papers were concerned with LMICs. The articles found in the review focused primarily on the individual and organisational levels and paid less attention to the broader environment such as national research funding systems and their links to HSR. This may be because many of the papers were from high-income countries, where the challenges faced are somewhat different in nature to LMICs. Given the very weak evidence found through the systematic review, the recommendations build upon the findings from the review, but also draw upon the experience of the authors, to identify promising avenues for capacity development in the future.
A new platform for scaling up drugs and other health interventions to meet national and regional needs in developing countries was launched at the opening of the First Global Symposium on Health Systems Research, held from 16-19 November 2010 in Switzerland. The platform is a new collaboration of several organisations at the World Health Organization, with funding from the Norwegian Agency for Development Co-operation (NORAD) and the Swedish International Development Co-operation Agency (SIDA). The first seven projects were announced, which include projects in Kenya and Uganda. The platform is guided by an open, transparent selection of proposals and has been set up to help build evidence for the health-related Millennium Development Goals to improve child and maternal health and reduce HIV/AIDS, and to build capacity for health systems research and knowledge translation, particularly in low- and middle-income countries. The platform is intended to allow a greater degree of ‘inter-disciplinarity’ to strengthen the whole health system. It will examine the interface between scale-up and implementation of health services.
India and South Africa will launch a joint research project to find vaccines for HIV strains common to both countries. The project was formally approved by the governments of both countries last spring and is expected to be launched by the end of 2010. Virander Chauhan, director of the International Centre for Genetic Engineering and Biotechnology, New Delhi, said that the five-year, US$1 million dollar project will involve around five research groups from each country with core competence in basic and HIV vaccine research. A successful partnership could serve as a model for similar South–South collaborations and inspire other developing countries to go the same route.
Infectious diseases are bound by a complex interplay of factors related as much to the individual as to the physical, social, cultural, political and economic environments. Furthermore each of these factors is in a dynamic state of change, evolving over time as they interact with each other. Simple solutions to infectious diseases are therefore rarely sustainable solutions, this article argues. This calls for interdisciplinary approaches that address complexity. The article proposes that research and the largely biomedical interventions for neglected tropical diseases, largely neglect the social and ecological contexts that lead to the persistence of these diseases.
This background paper was prepared for the Global Symposium on Health Systems Research, held from 16-19 November 2010 in Switzerland, and it is concerned with how best to enhance capacity for health systems research (HSR), with a particular focus on low- and middle-income countries (LMICs). A systematic review was conducted of initiatives and interventions that have sought to enhance capacity for health systems research, and 73 research papers were included - 49 papers from high-income countries (HICs) and 24 from low- and middle-income countries. The review found that capacity building initiatives focused primarily on the individual and organisational levels and paid less attention to the broader environment, such as national research funding systems and their links to HSR. Governments, donors and non-governmental organisations are urged to invest in co-ordinated efforts to develop additional capacity for health systems research, partly by re-directing funding that currently goes to short-term technical assistance towards longer-term institutional support.
This study aimed to determine whether routine surveys, such as the Demographic and Health Surveys (DHS), have underestimated child mortality in Malawi. Rates and causes of child mortality were obtained from a continuous-registration demographic surveillance system (DSS) in Malawi for a population of 32,000. Between August 2002 and February 2006, 38,617 person-years of observation were recorded for 20,388 children aged < 15 years. There were 342 deaths. Re-census data, follow-up visits at 12 months of age and the ratio of stillbirths to neonatal deaths suggested that death registration by the DSS was nearly complete. Infant mortality was 52.7 per 1000 live births, under-5 mortality was 84.8 per 1000 and under-15 mortality was 99.1 per 1000. One-fifth of deaths by age 15 were attributable to HIV infection. Child mortality rates estimated with the DSS were approximately 30% lower than those from national estimates as determined by routine surveys. The fact that child mortality rates based on the DSS were relatively low in the study population is encouraging and suggests that the low mortality rates estimated nationally are an accurate reflection of decreasing rates.