In this study, researchers systematically reviewed the evidence on the impact of interventions for seeking, appraising, and applying evidence from systematic reviews in decision-making by health policymakers or managers. A total of 11,297 titles and abstracts were reviewed leading to retrieval of 37 full-text articles for assessment; four of these articles met all inclusion criteria. Three articles described one study where five systematic reviews were mailed to public health officials and followed up with surveys at three months and two years. The studies found that from 23% to 63% of respondents had used the systematic reviews in policymaking decisions. One trial indicated that tailored messages combined with access to a registry of systematic reviews had a significant effect on policies made in the area of healthy body weight promotion by health departments.
Monitoring equity and research policy
Despite increasing attention and investment for maternal, neonatal, and child health, stillbirths remain invisible - not counted in the Millennium Development Goals, nor tracked by the UN, nor in the Global Burden of Disease metrics. At least 2.65 million stillbirths were estimated worldwide in 2008, of which 98% occured in low-income and middle-income countries. Worldwide, 67% of stillbirths occur in rural families, 55% in rural sub-Saharan Africa and south Asia, where skilled birth attendance and caesarean sections are much lower than that for urban births. National estimates of causes of stillbirths are scarce, and multiple classification systems impede international comparison. Immediate data improvements are feasible through household surveys and facility audit, and improvements in vital registration, including specific perinatal certificates and revised International Classification of Disease codes, are needed, according to the authors of this article.
According to this paper, science is increasingly being applied to systems that are complex, non-linear and dynamic, including questions about climate, environment, society, health and human behaviour, with limited results. At the beginning of the 21st century, policy makers and their expert advisors are working in an environment where the values and outputs of science are questioned by an increasingly informed, involved and vociferous society. Science and technology are now focused on complex systems, in part because it is around such complexity that governments must make decisions. Broadly, improvement in the use of science-based evidence is likely to be gradual and incremental and will require ‘buy-in’ from many stakeholders. The author argues that progress will be dependent on attitudes and approaches taken by agency heads. Other areas may need additional work – for example in establishing across-government principles for protecting the integrity of scientific advice.
Despite substantial investment in health capacity building in developing countries, evaluations of capacity building effectiveness are scarce. By analysing projects in Africa that had successfully built sustainable capacity, the authors of this stuy aimed to identify evidence that could indicate that capacity building was likely to be sustainable. Four projects were selected as case studies using pre-determined criteria, including the achievement of sustainable capacity. The authors found that indicators of sustainable capacity building increased in complexity as projects matured and included: early engagement of stakeholders; improved resources; and funding for core activities secured, with management and decision-making led by Southern partners. Projects became sustainable after a median of 66 months. The authors identified the main challenges to achieving sustainability as high turnover of staff and stakeholders, and difficulties in embedding new activities into existing systems, securing funding and influencing policy development.
According to Mozambique’s scorecard, a national IHP+ Compact was signed in 2008. Prior to that, a SWAp and pooled fund mechanism was in place from 2007. A National Health Sector Plan/Strategy is in place with current targets and budgets that have been jointly assessed. There is currently a costed and evidence based HRH plan in place that is integrated with the national health plan. In 2009 Mozambique allocated 6.8% of its approved annual national budget to health. In 2009, 73% of health sector funding was disbursed against the approved annual budget. In 2009 there was a transparent and monitorable performance assessment framework in place to assess progress against the national development strategies relevant to health and against health sector programmes. Mutual assessments are being made of progress implementing commitments in the health sector, including on aid effectiveness.
In the April 2010 issue of the Bulletin, Date et al. expressed concern over the slow scale-up in low-income settings of two therapies for the prevention of opportunistic infections in people living with the human immunodeficiency virus: co-trimoxazole prophylaxis and isoniazid preventive therapy. In this short paper, the authors discuss the important ways in which policy analysis can be of use in understanding and explaining how and why certain evidence makes its way into policy and practice and what local factors influence this process. Key lessons about policy development are drawn from the research evidence on co-trimoxazole prophylaxis, as such lessons may prove helpful to those who seek to influence the development of national policy on isoniazid preventive therapy and other treatments. Researchers are encouraged to disseminate their findings in a manner that is clear, but they must also pay attention to how structural, institutional and political factors shape policy development and implementation. Doing so will help them to understand and address the concerns raised by Date et al. and other experts. Mainstreaming policy analysis approaches that explain how local factors shape the uptake of research evidence can provide an additional tool for researchers who feel frustrated because their research findings have not made their way into policy and practice.
The Consultative Expert Working Group on Research and Development (CEWG) met from 5-7 April 2011. It was the first meeting of the group, set up at the last WHA, to succeed to a previous group, the Expert Working Group(EWG), whose work was criticised by member states and stakeholders as lacking transparency and being tainted with conflict of interest. The mandate given by the WHA to the CEWG was to take the work of the EWG forward, according to the CEWG Chairperson. The group decided that its core mandate was to help deliver on two elements of the Global Strategy and Plan of Action on Public Health, Innovation and Intellectual Property (GSPOA). These are element 2 on “promoting research and development”, and element 7 on “promoting sustainable financing mechanisms.” The EWG’s work was mainly focused on element 7 of the strategy. Beyond those two core elements, the group also sees its work as an integral part of the global strategy and will take into account the interrelation with other elements of the strategy, such as prioritising research and development needs, building and improving innovative capacity, transfer of technology and application and management of intellectual property to contribute to innovation and promote public health.
This paper identifies some of the advantages and disadvantages of a global health research and development (R&D) tax credit and considers whether it would succeed in increasing the overall volume of global health R&D. In his analysis, the author remains uncertain whether the tax could increase pharmaceutical firms’ return on investments for global health products with small commercial markets or if it could bring down the costs of philanthropic research and help maintain private sector participation in global health. Since there are minimal profits to be reaped from charitable research and benefits, a tax credit is unlikely to appeal to many firms who are not already interested in supporting global health, the author argues. His findings suggest that a global health tax credit is unlikely to result in significantly more or better global health R&D, but he emphasises the limitations of his research, calling for more research into existing fiscal incentives for R&D to clarify the decision-making process that drives global health research in pharmaceutical firms.
In this study, the authors outline some of the challenges faced when carrying out a financing incidence analysis (FIA) in Ghana, Tanzania and South Africa and illustrate how innovative techniques were used to overcome data weaknesses in these settings. They conducted a FIA for tax, insurance and out-of-pocket payments, drawing data from the Living Standards Measurement Surveys (LSMSs) and household surveys conducted in each of the countries. They found that LSMSs are likely to underestimate financial contributions to health care by individuals. For tax incidence analysis, reported income tax payments from secondary sources were severely under-reported. Income tax payers and shareholders could not be reliably identified. The use of income or consumption expenditure to estimate income tax contributions was found to be a more reliable method of estimating income tax incidence. Assumptions regarding corporate tax incidence had a huge effect on the progressivity of corporate tax and on overall tax progressivity. In terms of policy development, the authors show how data constraints can be overcome for FIA in lower-income countries and provide recommendations for future studies.
The 20th anniversary of the report of the Commission on Health Research for Development inspired a Symposium to assess progress made in strengthening essential national health research capacity in developing countries and in global research partnerships. Significant aspects of the health gains achieved in the 20th century can be attributed to the advancement and translation of knowledge, the authors of this paper argue, and knowledge continues to occupy center stage amidst growing complexity that characterises the global health field. The authors propose a way forward that will entail the reinvigoration of research-generated knowledge as a crucial ingredient for global co-operation and global health advances. However, a number of divisions are identified that need to be addressed, such as the divide between domestic and global health, and the divide among the disciplines of research (biomedical, clinical, epidemiological, health systems), as well as divisions between clinical and public health approaches, between public and private investments, and between knowledge gained and action implemented. Overcoming these obstacles can accelerate progress towards research for equity in health and development.