The purpose of this article is twofold: to explore the entry process in community-based research when researching sensitive topics; and to suggest a framework for entry that utilises the values of participatory action research (PAR). The article draws on a collaborative community-university research study that took place in the Waterloo and Toronto regions of Ontario, Canada, from 2005–2010. The article emphasises that community entry is not only about recruitment strategies for research participants or research access to community but it is also concerned with the ongoing engagement with communities during various stages of the research study. The indicator of success is a well established and trusted community-researcher relationship. This article first examines this broader understanding of entry, then looks at how community research entry can be shaped by an illustrative framework, or guide, that uses a combination of participatory action research (PAR) values and engagement strategies.
Monitoring equity and research policy
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 explores experiences of and factors that influence how knowledge from health systems research (HSR) is translated into policy and practice, particularly at the national level, in low- and middle-income countries (LMICs). It found that whether the knowledge from health systems research (HSR) is used in policy and practice in low- and middle-income countries (LMICs) depends on the political economy context, the policy environment, institutional capacities and practice in the health system, and the research community. The study aims to link these four ‘streams’ and their impact on HSR. Although not always well documented, there is experience within LMIC on the strategic use of HSR. There are also some conditions that appear to be a greater challenge for LMICs, particularly low-income countries (LICs). International agencies have a more powerful influence on research agendas and resources in LICs, while resources for sustained research programmes and interaction are limited, as are the incentives, time, resources and authority for local personnel to gather and use evidence. Much LIC research is poorly published in accessible databases and a significant digital divide discourages HSR and its use. Local level personnel, especially in peripheral areas, face these constraints most sharply.
The burden of chronic, non-communicable diseases in low-income and middle-income countries is increasing. This study outlines a framework for monitoring of such diseases and reviews the mortality burden and the capacity of countries to respond to them. It draws on World Health Organization (WHO) data and published work for prevalence of tobacco use, overweight, and cause-specific mortality in 23 low-income and middle-income countries with a high burden of non-communicable disease. Although reliable data for cause-specific mortality was scarce, non-communicable diseases were estimated to be responsible for 23.4 million (or 64% of the total) deaths in the 23 countries that were analysed, with 47% occurring in people who were younger than 70 years. Tobacco use and overweight were found to be common in most of the countries and populations we examined, but coverage of cost-effective interventions to reduce these risk factors is low. Capacity for prevention and control of non-communicable diseases, including monitoring and surveillance operations nationally, is inadequate. A surveillance framework, including a minimum set of indicators covering exposures and outcomes, is essential for policy development and assessment and for monitoring of trends in disease, the study argues. However, technical, human and fiscal resource constraints are major impediments to the establishment of effective prevention and control programmes. Despite increasing awareness and commitment to address chronic disease, the study found that concrete actions by global partners to plan and implement cost-effective interventions were inadequate.
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.
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.