This paper sought to identify potential research priorities concerning social protection and health in low and middle-income countries, from multiple perspectives. Priority research questions were identified through research reviews on social protection interventions and health, interviews with 54 policy makers from Ministries of Health, multi-lateral or bilateral organizations, and NGOs. Data was collated and summarized using a framework analysis approach. The final refining and ranking of the questions were completed by researchers from around the globe through an online platform. The overview of reviews identified 5 main categories of social protection interventions: cash transfers; financial incentives and other demand side financing interventions; food aid and nutritional interventions; parental leave; and livelihood/social welfare interventions. Policy-makers focused on the implementation and practice of social protection and health, how social protection programs could be integrated with other sectors, and how they should be monitored/evaluated. A collated list resulted in 31 priority research questions. Scale and sustainability of social protection programs ranked highest. The top 10 research questions focused heavily on design, implementation, and context, with a range of interventions that included cash transfers, social insurance, and labour market interventions. The authors observe that there is potentially a rich field of enquiry into the linkages between health systems and social protection programs, but research within this field has focused on a few relatively narrowly defined areas. The SDGs provide an impetus to the expansion of research of this nature, with priority setting exercises such as this helping to align funder investment with researcher effort and policy-maker evidence needs.
Monitoring equity and research policy
In the 2011 Rio Political Declaration on Social Determinants of Health, World Health Organization Member States pledged action in five areas crucial for addressing health inequities. Their pledges referred to better governance for health and development, greater participation in policymaking and implementation, further reorientation of the health sector towards reducing health inequities, strengthening of global governance and collaboration, and monitoring progress and increasing accountability. The authors describe the selection of indicators proposed to be part of the initial World Health Organization global system for monitoring action on the social determinants of health. The authors describe the processes and criteria used for selecting social determinants of health action indicators that were of high quality and the described the challenges encountered in creating a set of metrics for capturing government action on addressing the Rio Political Declaration’s five Action Areas. The authors developed 19 measurement concepts, identified and screened 20 indicator databases and systems, including the 223 Sustainable Development Goals indicators, and applied strong criteria for selecting indicators for the core indicator set. They identified 36 suitable existing indicators, which were often Sustainable Development Goals indicators.
This paper implemented a qualitative analysis of wellbeing in life history interviews in Chiawa, rural Zambia. The enquiry goes beyond simply reading across methods, disciplines and contexts, to consider fundamental differences in constructions of the human subject, and how these relate to understandings of wellbeing. Field research took place in two periods, August–November, 2010 and 2012. Analysis drew on 46 individual case studies, conducted through open-ended interviews. These were identified through a survey with an average of 390 male and female household heads in each round, including 25% female headed households. As social determinants theory predicts, the interviews confirm elements of autonomy, competence and relatedness as vital to wellbeing. However, these are expressed in ways that highlight material and relational, rather than psychological, factors. The authors endorsed social determinants theory’s utility in interdisciplinary approaches to wellbeing, but only if it admits its own cultural grounding in the construction of socially and culturally distinctive questions on basic psychological needs.
An article published in the journal Nature on July 5 puts forward a new technique for the evaluation of research on development. It marks a departure from conventional approaches that, according to the author, have significant weaknesses. This new method for the evaluation of development research — known as RQ+ or Research Quality Plus — emphasises the crucial importance of context, local knowledge and the views of the populations whose lives the research aims to improve. Conventional approaches to evaluating scientific endeavours are argued by the author to have a number of inbuilt constraints. For example, they focus primarily on peer assessment or bibliometrics but don’t explicitly pass judgement on the originality or usefulness of the research, nor do they look at the degree of respect for local knowledge. The RQ+ approach goes beyond an evaluation focused solely on the scientific merit of research outputs and includes other dimensions that are essential to measuring the value and quality of research. RQ+ takes account of what evaluators have to say, but their views should be evidence-based, rather than a simple opinion. Those carrying out the evaluation should take into consideration external points of view — for example those of users targeted by the research or of the communities it is supposed to benefit — as well as the perspectives of other researchers working in the same field.
Community-based information systems (CBIS) are key to understanding how HIV programs are working to control the epidemic at the local level in countries with high burden. MEASURE Evaluation developed this collection of indicators to guide community-based HIV programs in monitoring their performance and thereby enhance informed decision making by governments, major donors, and implementing partners. The indicators cover the following themes: vulnerable children, prevention of mother-to-child transmission, key populations, HIV prevention, home-based care and data use cases. The site also provides useful resources and a summary list of indicators.
The authors report on conflicting figures for pregnancy and childbirth related deaths in Zimbabwe from 525 to 960 maternal deaths for every 100,000 live births. It would seem to be a relatively straightforward task to measure maternal mortality, but they note that in reality, that is not the case. Ideally, you would analyse death certificates, but even in countries with well-functioning birth and death registration systems, they report that the number of maternal deaths is routinely undercounted. This is because death certificates are not always complete and in some cases, the person signing a death certificate may not be aware that the woman was pregnant or that her pregnancy contributed in some way to her death. In some instances, health facilities have been known to try and conceal maternal mortalities because of political pressure to reduce the numbers. Zimbabwe is classified as a country with incomplete birth and death records by the UN. Researchers therefore rely on censuses and surveys to estimate maternal deaths. Household surveys reported 614 deaths / 100,000 live births for the period between 2007 and 2014, and 581 / 100 000 for 2009 to 2014, within the range of global organisations’ estimates.
Energy is crucial for achieving almost all of the sustainable development goals (SDGs), from eradication of poverty through advancements in health, education, water supply and industrialization to combating air pollution and climate change. This new report includes updated data from WHO on household air pollution showing that 3 billion people – or more than 40% of the world’s population – still do not have access to clean cooking fuels and technologies. Household air pollution from burning solid fuels and using kerosene for cooking alone are responsible for some 4 million deaths a year, with women and children being at greatest risk. The report provides a comprehensive summary of the world’s progress towards the global energy targets on access to electricity, clean cooking fuels, renewable energy and energy efficiency. It was launched at the Sustainable Energy for All forum held on 2 May 2018 in Lisbon, Portugal.
These four briefs (separately shown on this site) provide information on evaluation of social participation and power in health to support capacity and practice. They are intended primarily for those working directly with social participation and power in health systems, but also for managers, funders and others who engage with them. They intend to inform thinking and approaches and provide links to deeper resources and do not intend to prescribe or be a ’how to’ toolkit. The four briefs address:
BRIEF 1: The concepts and approaches applied in ‘monitoring and evaluation processes at www.tarsc.org/publications/documents/Shapinghealth%20eval%20brief%201%20May2018.pdf
BRIEF 2: Approaches to assessing change in social participation and power in health at www.tarsc.org/publications/documents/Shaping%20health%20eval%20brief%202%202018.pdf
BRIEF 3: The methods used for participatory evaluation at www.tarsc.org/publications/documents/Shaping%20health%20eval%20brief%203%202018.pdf
BRIEF 4: Engaging funders and formal systems on evaluations of social power in health at www.tarsc.org/publications/documents/Shaping%20health%20eval%20brief%204%202018.pdf
The authors propose that there are some underlying differences between the disciplines of epidemiology and economics how trials are used and conducted and how their results are reported and disseminated. They hypothesize that evidence-based public health could be strengthened by understanding these differences, harvesting best-practice across the disciplines and breaking down communication barriers between economists and epidemiologists who conduct trials of public health interventions. Differences between disciplines suggests that more can be done to incorporate behavioural theory into trials and to improve the reporting of trial results and share data. The authors hypothesize that evidence-based public health can be strengthened by understanding differences in how economists and epidemiologists conduct trials of public health interventions and harvesting best-practice across the disciplines.
This paper assessed, whether and how, two knowledge translation platforms housed in government-affiliated institutions in Cameroon and Uganda have influenced health system policy-making processes and decisions aiming at supporting achievement of the health millennium development goals and the general climate for evidence-informed health system policy-making. The authors conducted an embedded comparative case study of four policy processes in which Evidence Informed Policy Network Cameroon and Regional East African Community Health Policy Initiative Uganda were involved between 2009 and 2011. The authors combined a documentary review and semi structured interviews of 54 stakeholders. A framework-guided thematic analysis, inspired by scholarship in health policy analysis and knowledge utilization was used. The coproduction of evidence briefs combined with tacit knowledge gathered during inclusive evidence-informed stakeholder dialogues helped to reframe health system problems, unveil sources of conflicts, open grounds for consensus and align viable and affordable options for achieving the health millennium development goals thus leading to decisions. New policy issue networks have emerged. Knowledge translation platforms were perceived as change agents with positive impact on the understanding, acceptance and adoption of evidence-informed health system policy-making because of their complementary work in relation to capacity building, rapid evidence syntheses and clearinghouse of policy-relevant evidence. The authors indicate that this embedded case study illustrates how two knowledge translation platforms influenced policy decisions through pathways involving policy issue networks, interest groups interaction and evidence-supported ideas and how they influenced the general climate for evidence-informed health system policy.