In 2007, the 60th World Health Assembly endorsed a Global Plan of Action on Workers’ Health for 2008-2017 and urged WHO member states to devise national policies and plans for its implementation. To establish a baseline for measuring progress, information was collected in 2008-2009 from Member States – this report presents the findings of that survey. While most countries have introduced ways of addressing risks at the workplace such as integrated management of chemicals and tobacco smoking bans, enforcement of regulations for workplace health protection remains insufficient. Less than half of countries surveyed have endorsed or drafted a national plan of action on workers’ health. Only one third of countries cover more than 30% of their workers with occupational health services. Although half the countries have national workers’ health profiles with data on occupational diseases, injuries, and legislation, information about communicable and non-communicable diseases among workers and about lifestyle risks are the least-covered topics. Workers’ health issues feature in policies concerning management of chemicals, emergency preparedness and response, employment strategies, and vocational training. However, workers’ health is seldom considered in policies regarding climate change, trade, economic development, poverty reduction, and general education.
Monitoring equity and research policy
For the first time since 1996, the United Nations Food and Agriculture Organisation (FAO) has significantly revised how estimates the number of hungry people in the world. When the new methodology is used to generate estimates for the past 20 years, the figures show a steady decline, running counter to previous estimates, which showed a continual increase in the number of undernourished people from the mid-1990s up to the late 2000s. What lies behind the FAO’s revised prevalence of undernourishment estimates are changes in the methodology used to arrive at the estimate and newer, more complete data used for the building blocks of the FAO model. The methodological innovations may be found in the assumed distribution of dietary energy consumption, and the way in which variations in habitual food consumption are estimated. The most important data change is that estimates of food losses at the retail distribution level, not only at the production and storage levels, are taken into account. The FAO is in the process of developing a range of additional food security indicators, intended to reflect changes in ‘determinants of (or inputs to) food security’ and to capture how food prices evolve in relation to consumer prices in general in developing countries.
In this study, researchers conducted a quasi-formative evaluation between October and December 2011 on four regional-led African research networks: Central Africa Network on Tuberculosis, HIV/AIDS and Malaria (CANTAM); East African Consortium for Clinical Research (EACCR); West African Network of Excellence for TB, AIDS and Malaria (WANETAM), and the Trials of Excellence for Southern Africa (TESA) launched between 2009 and 2010. They shared a participatory appraisal of field reports, progress reports and presentations from each network to jointly outline the initial experiences of the merits, outputs and lessons learnt. Results showed that the self-regulating democratic networks, with 64 institutions in 21 African countries, have trained over 1, 000 African scientists, upgraded 36 sites for clinical trials, leveraged additional € 24 million and generated 38 peer-reviewed publications through networking and partnerships. The shared initial merits and lessons learnt portray in part the strengthened capacity of these networks for improved research coordination and conduct of planned multi-centre clinical trials in Africa. Increased funding by African agencies, governments and international health partners will ensure sustainability of these networks for research capacity development and demonstrate their commitment to achieving the Millennium Development Goals in Africa.
For many years, economic indicators were considered the ultimate measure of a country’s well-being. But the general happiness of a country doesn’t always correlate with its wealth. In fact, economic indicators don’t match up with a number of important indicators about well-being. Hence the Social Progress Index, an initiative from the Social Progress Imperative and Harvard Business School Professor Michael Porter that examines how 50 countries perform on 52 indicators related to basic human needs, the foundations of well-being, and opportunity. The index looks at social and environmental outcomes directly rather than proxies of economic indicators. These social and environmental components include personal safety, ecosystem sustainability, health and wellness, shelter, sanitation, equity and inclusion, and personal freedom and choice. Each component is calculated based on specific outcomes: health and wellness, for example, is determined by life expectancy, obesity, cancer death rate, and other factors. The author argues that the index will allow businesses to better articulate the purpose they serve, and how business can collectively shape, influence and be a co-collaborator in some of the bigger social progress issues.
During the March 2013 Council on Health Research for Development (COHRED) Colloquium, participants highlighted the value of research and development in supporting public health in developing countries and the importance of building self-reliance for countries through government investment. Although the meeting was not aiming at consensus, a few key themes emerged. Participants widely agreed that countries should increase their own investments in research for health to attract external funding and ensure fairer collaboration. And in the context of the global economic crisis, participants also took note of an emerging trend among external funders toward implementation research, which looks at how to effectively translate findings into practice, and suggested that governments should do the same. With less funding available, governments increasingly have to justify additional spending on health research, show the value of investment and increase efficiency. Participants called on countries to look at the knowledge and technology interventions they already have, invest in research to examine why they are or not working, and focus on optimising them.
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.
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.