From May 2011 to May 2012, with funding from the South Africa’s national Department of Health, an audit of every health facility in the public health sector was conducted by a consortium of partners. The audit assessed infrastructure, classification of facilities, compliance to priority areas of quality and function, human resources, access and range of services offered, and geographic positioning (GPS) for location of facilities and photographs. The overall objective of the audit was to collect baseline data from all public health facilities in the country using standardised and existing measurement tools provided by the national Department of Health. The data collected were captured into the National Core Standards database established by the national Department of Health. Data collected from each of the facilities were aggregated to sub-district, district and national averages that are presented by theme in a variety of dashboards and can be accessed centrally from the web-based reporting database. This national summary report provides a succinct and high level interpretation of the results and summary of the findings of the audit. This information is essential to identify health system strengths and gaps, to assess current and future needs and for planning investments and future services such as the National Health Insurance.
Monitoring equity and research policy
This paper explores how Aid for Trade (AfT) projects and programmes are currently evaluated, focusing particularly on the assessment of the impact on poverty and/or poor and excluded groups. The authors found that little publicly available information on whether AfT projects programmes are impacting on poverty. There is typically a gap between strategic ambitions and statements on poverty reduction and the actual project and programme design, implementation and monitoring and evaluation. Generally, poverty reduction is measured only at the goal level (macro‐level) and AfT projects and programmes often focus on institutional strengthening and improving policy making (or negotiation) processes, with only long‐term indirect impacts on poverty. In these cases, the effects on poverty reduction and/or poor and excluded groups are typically not assessed. By and large, causal links between what a project delivers and the impact on poverty is based on a series of assumptions (and, in some cases, a leap of logic) unless poor people are direct beneficiaries of the project/programme. The authors call for more rigorous and realistic impact assessments on poverty impacts, and greater funder accountability and transparency, with regular, independent evaluations that go beyond reporting monitoring information only. Funders must commit to provide much-needed data for decision making.
Sharing research findings with participants living with HIV enrolled in observational research in rural sub-Saharan Africa presents significant challenges with respect to literacy, language, logistics, and confidentiality. In this study, researchers communicated research findings to 540 participants enrolled in an ongoing seven-year prospective cohort study of HIV treatment in Mbarara, Uganda. The researchers followed a six-step process, beginning with an exploration of acceptability, format and content to participants and culminating in a conference of all participants. The dissemination conference provided a formal mechanism for the research assistants to share participants' concerns and questions with the entire investigator team. Disseminating the scientific findings was reported to be highly rewarding for participants, research staff, and investigators. It improved communication between participants and research staff, strengthened the relationship between research staff and investigators, and created a sense of community among participants. Finally, the event generated a research agenda directly from those most affected by HIV in a rural, resource-constrained setting. The authors recommend this format as a guide to dissemination of study findings to study participants in similar settings.
According to this paper, African research institutions have developed and demonstrated a great capacity to undertake clinical trials in accordance to the International Conference on Harmonisation-Good Clinical Practice (ICH-GCP) standards in the last decade, particularly in the field of malaria vaccines and anti-malarial drugs. This capacity is a result of networking among African scientists in collaboration with other partners, traversing both clinical trials and malaria control programmes as part of the Global Malaria Action Plan (GMAP). GMAP outlined and support global strategies toward the elimination and eradication of malaria in many areas, translating in reduction in public health burden, especially for African children. In the sub-Saharan region the capacity to undertake more clinical trials remains small in comparison to the actual need, the authors point out, but they argue that sustainability of Africa’s already developed capacity is crucial for the evaluation of different interventions and diagnostic tools/strategies for other diseases like TB, HIV, neglected tropical diseases and non-communicable diseases. They call for innovative mechanisms to promote the sustainability and expansion of clinical trial capacity in sub-Saharan Africa.
Mozambique has completed its first HIV vaccine trial and is set to embark on a second, a demonstration of the country's increased HIV research capacity. According to Ilesh Jani, director general of Mozambique's National Institute of Health, the studies, while small, mark important first steps towards bolstering clinical trial and research capacity for diseases such as HIV and malaria. He argued that Mozambique needs to get involved in HIV research and take leadership to find the solutions. Even though the country didn’t yet have the capacity to develop the vaccines in the laboratory, he said it was important to recognise Mozambique had the capacity to test them and accelerate discovery. The trials were conducted at Polana Cancio, a health centre that is located on the outskirts of the capital city, Maputo, which could become a clinical research site for larger, more advanced HIV vaccine trials.
A smartphone, a strip of double-sided tape and a simple glass lens could have a significant impact on the diagnosis of helminths, intestinal parasites that affect millions in remote, rural parts of the world. In this proof-of-concept study in rural Tanzania, researchers compared the effectiveness of a lens attached to an iPhone with the effectiveness of a standard light microscope in searching for roundworm and hookworm eggs in 199 children's stool samples. Although not as sensitive as the light microscope, the mobile phone microscope revealed a sensitivity of 69.4% and a specificity of 61.5% for detecting any soil-transmitted helminth infection. The advantages of the mobile phone microscope are that it can be used with any smart phone, a lay health worker can operate it and it’s portable. The standard diagnostic process requires a microscope, a person trained to use one, electricity and a decent light source, which are often not widely available in rural areas.
In this study, researchers aimed to develop and assess inter-rater agreement for an algorithm for systematic review authors to predict whether differences in effect measures are likely for disadvantaged populations relative to advantaged populations. They developed a health equity plausibility algorithm with three items that dealt with the plausibility of differences in relative effects across sex or socioeconomic status (SES) due to: patient characteristics; intervention delivery (i.e. implementation); and comparators. Thirty-five respondents (consisting of clinicians, methodologists and research users) assessed the likelihood of differences across sex and SES for ten systematic reviews with these questions. The proportion agreement was 66% for patient characteristics, 67% for intervention delivery and 55% for the comparator. Users of systematic reviews rated that important differences in relative effects across sex and socioeconomic status were plausible for a range of individual and population-level interventions. However, there was very low inter-rater agreement for these assessments. There is an unmet need for discussion of plausibility of differential effects in systematic reviews. Increased consideration of external validity and applicability to different populations and settings is warranted in systematic reviews to meet this need, the authors conclude.
In this audit of the International Finance Corporation (IFC), the World Bank’s private lending arm, the CAO found that the IFC has processed most of its investments in compliance with the organisation’s own environmental and social policy requirements, but it was difficult to make an accurate assessment of the actual impact of the projects it invested in. Despite outward appearances, the CAO argues that many Social and Environmental Management Systems (SEMSs) for development projects have become mere window dressing, rather than a genuine means to improved environmental and social (E&S) outcomes on the ground. At the same time, the IFC’s E&S procedures and impact assessment measurements are not optimally designed to support broader environmental and social outcomes. To achieve those broader objectives, the IFC would need to focus on facilitating a self-sustaining cultural change within client organisations, raising their level of understanding and management of environmental and social risk. This implies a more sophisticated approach to the analysis of client commitment, and interventions that align E&S issues with relevant business and socioeconomic drivers of change, rather than focusing on systems compliance. It would also require a systematic methodology for measuring impact at the subclient level.
The Orphaned and Separated Children's Assessments Related to their Health and Well-Being (OSCAR) project is a longitudinal cohort of orphaned and non-orphaned children in Kenya. To date the study has enrolled 3,130 orphaned and separated children. In this paper, the authors use this project to describe how community-based participatory research (CBPR) approaches and principles can be incorporated and adapted into study design and methods. Preliminary results suggest that community engagement and participation was integral in refining the study design and identifying research questions that were impacting the community. Through the participation of village chiefs and elders, researchers were able to successfully identify eligible households and randomise the selection of participants. The on-going contribution of the community in the research process was also vital to participant retention and data validation while ensuring cultural and community relevance and equity in the research agenda. In conclusion, the authors argue that CBPR methods can strengthen epidemiological and public health research in sub-Saharan Africa within the social, political, economic and cultural contexts of the diverse communities on the continent, provided that the methods are adapted to the local context.
Qualitative and quantitative indicators are useful tools for promoting and monitoring the implementation of human rights. International human rights treaties and jurisprudence of the human rights treaty bodies call for the development of statistical indicators in compliance with international human rights norms and principles. The Office of the High Commissioner for Human Rights (OHCHR) has published this guide to assist in developing quantitative and qualitative indicators to measure progress in the implementation of international human rights norms and principles. The Guide describes the conceptual and methodological framework for human rights indicators recommended by international and national human rights mechanisms and used by a growing number of governmental and non-governmental actors. It provides concrete examples of indicators identified for a number of human rights - all originating from the Universal Declaration of Human Rights - and other practical tools and illustrations, to support the realization of human rights at all levels. It will be of interest to human rights advocates as well as policymakers, development practitioners, statisticians and others who are working to make human rights a reality for all.