The GAVI Alliance was created in 2000 to increase access to vaccines. More recently, GAVI has supported evidence-based health systems strengthening to overcome barriers to vaccination. The objectives of this study were: to explore countries' priorities for health systems strengthening; to describe published research summaries for each priority area in relation to their number, quality and relevance; and to describe the use of national data from surveys in identifying barriers. From 44 health systems-strengthening proposals submitted to GAVI in 2007 and 2008, the researchers analysed the topics identified, the coverage of these topics by existing systematic reviews, and the use of nation-wide surveys with vaccination data to justify the needs identified in the proposals. Thirty topics were identified and grouped into three thematic areas: health workforce, organisation and management, and supply, distribution and maintenance. The researchers found no reviews that dealt with health information systems, however. Only seven of the reviews were categorised as ‘highly relevant for policy’. In conclusion, researchers found little quality research that was relevant to managers’ needs. Few proposals used national surveys evidence to identify barriers to vaccination. The author recommends that researchers generating or adapting evidence about health systems need to be more responsive to managers' needs.
Monitoring equity and research policy
Malaria is highly endemic in the Democratic Republic of Congo (DRC), but the limits and intensity of transmission within the country are unknown. It is important to discern these patterns as well as the drivers which may underlie them in order for effective prevention measures to be carried out, the authors of this study argue. Using the 2007 Demographic and Health Survey (DHS) for the DRC, the authors generated prevalence estimates and explored the ecological drivers of malaria. Of the 7,746 respondents, 29.3% were parasitaemic, with males were more likely to be parasitaemic than older people or females, while wealthier people were at a lower risk. Increased community use of bed nets and community wealth were protective against malaria at the community level but not at the individual level. This research demonstrates the feasibility of using population-based behavioural and molecular surveillance in conjunction with DHS data and geographic methods to study endemic infectious diseases. The authors suggest that spatial information and analyses can enable the DRC government to focus its control efforts against malaria.
In this study, researchers aimed to validate vaccination data from a longitudinal population-based demographic surveillance system (DSS) against data from a clinical cohort study. The sample included 821 children in the Vertical Transmission cohort Study (VTS), and researchers found that vaccination data in matched children in the DSS was based on the vaccination card in about two-thirds of the cases and on maternal recall in about one-third. In conclusion, the addition of maternal recall of vaccination status of the child to the child’s card information significantly increased the proportion of children known to be vaccinated across all vaccines in the DSS. The authors recommend that information based on both maternal recall and vaccination cards should be used to identify which children have received a vaccination and which have not.
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.
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.