In this paper, the authors argue that the successful application of technologies for the management of environmental risks to human health relies on a country’s capacity to assess risks and potential health impacts, as well as develop and implement appropriate policies, monitor and evaluate the effectiveness of these policies, and engage and communicate with stakeholders. The authors identify the main challenges to most African countries as lack of access to relevant tools and reduced the capacity to deliver vital evidence-based knowledge on the links between the environment and health. The translation of evidence into policies and programmes is often a complex issue, and legal and regulatory frameworks in Africa remain largely limited or ineffective. This paper describes useful tools for policy making and proposes that governments integrate health and environmental impact considerations into economic development processes, identify knowledge gaps, support local applied research to build technical capacity and strengthen cooperation among key actors to answer practical policy questions.
Useful Resources
With the goal of improving health service delivery on a global scale, this new portal offers a one-stop-shop where users can efficiently search for, organise, adapt and use up-to-date, evidence-based health information. The portal features a search tool, powered by Google Search Appliance, that enables users to quickly find resources from select sources, including the K4Health site, a range of health databases, and top quality health web sites, in addition to the web. Toolkits are available to give users access to specialised collections of resources on family planning, reproductive health, and population and environment. A toolkit application has also been supplied that allows users to design, develop, and share their own toolkits. Discussion forums have been set up to provide users with access to a community of experts around the world.
The Africa4All project will provide the participating African countries of Kenya, Lesotho, Namibia, Tanzania and Uganda with an information and communication technologies (ICT) solutions that will enable citizens and politicians to better appreciate the impact of legislation, making the complex political debate meaningful and interesting for all citizens. The overall objective of the Africa4All project is to help African, Caribbean and Pacific (ACP) governments build sustainable capacity to adapt and implement international good practice in leveraging ICT in Parliaments of ACP States. The specific objectives of the project are to educate members of Parliament, Parliamentary ICT staff and citizens to leverage technology to support collaboration and active engagement in decision making processes in society, to identify the challenges and barriers from the introduction of ICT in everyday functioning of Parliaments and to contribute to the bridging the digital divide, enhancing the use of ICT as key enablers for poverty reduction.
Debates and struggles over how to define a problem are a critically important part of the policymaking process. The outcome of these debates and struggles will influence whether and, in part, how policymakers take action to address a problem. Efforts at problem clarification that are informed by an appreciation of concurrent developments are more likely to generate actions. These concurrent developments can relate to policy and programme options (e.g. the publication of a report demonstrating the effectiveness of a particular option) or to political events (e.g. the appointment of a new Minister of Health with a personal interest in a particular issue). This article suggests questions that can be used to guide those involved in identifying a problem and characterising its features: What is the problem? How did the problem come to attention and has this process influenced the prospect of it being addressed? What indicators can be used, or collected, to establish the magnitude of the problem and to measure progress in addressing it? How can the problem be framed (or described) in a way that will motivate different groups?
Policymakers and those supporting them may find themselves in a number of situations that will require them to characterise the costs and consequences of options to address a problem. For example, a decision may already have been taken and their role is to maximise the benefits of an option, minimise its harms, optimise the impacts achieved for the money spent, and (if there is substantial uncertainty about the likely costs and consequences of the option) to design a monitoring and evaluation plan. Research evidence, particularly about benefits, harms, and costs, can help to inform whether an option can be considered viable. This article offers questions that can be used to guide policymakers: Has an appropriate set of options been identified to address a problem? What benefits and harms are important to those who will be affected? What are the local costs of each option, including cost-effectiveness? What adaptations might be made? Which stakeholder views and experiences might influence an option's acceptability and its benefits, harms and costs?
Evidence about local conditions is evidence that is available from the specific setting(s) in which a decision or action on a policy or programme option will be taken. Such evidence is always needed, together with other forms of evidence, in order to inform decisions about options. Global evidence is the best starting point for judgements about effects, factors that modify those effects, and insights into ways to approach and address problems. But local evidence is needed for most other judgements about what decisions and actions should be taken. This article suggests five questions that can help to identify and appraise the local evidence that is needed to inform a decision about policy or programme options: What local evidence is needed to inform a decision about options? How can the necessary local evidence be found? How should the quality of the available local evidence be assessed? Are there important variations in the availability, quality or results of local evidence? How should local evidence be incorporated with other information?
After a policy decision has been made, the next key challenge is transforming this stated policy position into practical actions. What strategies, for instance, are available to facilitate effective implementation, and what is known about the effectiveness of such strategies? This article suggests five questions that can be considered by policymakers when implementing a health policy or programme: What are the potential barriers to the successful implementation of a new policy? What strategies should be considered in planning the implementation of a new policy in order to facilitate the necessary behavioural changes among healthcare recipients and citizens? What strategies should be considered in planning the implementation of a new policy in order to facilitate the necessary behavioural changes in healthcare professionals? What strategies should be considered in planning the implementation of a new policy in order to facilitate the necessary organisational changes? What strategies should be considered in planning the implementation of a new policy in order to facilitate the necessary systems changes?
Now in its third phase, the Municipal Services Project (MSP) is exploring and evaluating models of service delivery that are deemed to be successful alternatives to commercialisation, in an effort to understand the conditions required for their sustainability and reproducibility. The focus is on the water, electricity and primary health care sectors in Africa, Asia and Latin America. The project is composed of academic, labour, NGO and social movement partners from around the world. The site features a diversity of publications and materials, from academic journal articles to video and audio documentaries. MSP is an inter-sectoral and inter-regional research project that systematically explores alternatives to the privatisation and commercialisation of service provision in the health, water, sanitation and electricity sectors. Having spent the first two phases of the project (2000-2007) critiquing privatisation, this phase of the project (2008-2013) will analyse service delivery models that are successful alternatives to commercialisation in an effort to better understand the conditions required for their sustainability and reproducibility. The website for the project has been updated and provides new resources on this issue.
It is thirty years since the Alma Ata Declaration which outlined an international consensus on the need to provide universal access to primary health care (PHC). During the ensuing years some countries established and consolidated well-organised government health services in which PHC played an important role. Many others were less successful. Some countries have experienced major reversals in life expectancy after a long period of steady improvement and their health systems have deteriorated. There is a growing concern by national governments and the international community to expand access to PHC and they have committed a lot of money for this purpose. But there have been many major changes in these last three decades that pose big challenges for the future configurations of PHC. This key issues guide unpacks some of the challenges for the future of PHC and highlights promising models of health system arrangement and service delivery that are improving access for the poorest and most marginalised. It focuses on four main areas: the increasing marketisation of health and how governments respond; the challenge of responding to progressive and chronic illnesses; the emergence of new epidemics and the globalisation of public health responses; and the pressure to keep up with new treatments and technologies.
This is an online ten-unit short course on health systems and their functioning. Like organ systems, health systems break down in predictable patterns and lead to syndromes that can be diagnosed and addressed. Dysfunctional health systems are why thousands of effective low-cost health interventions remain on the shelves while people suffer and die. Dysfunctional health systems leave people vulnerable to financial catastrophe. Failure to manage health resources judiciously permits not just waste, but the delivery of inappropriate or harmful services. While many lament how little research addresses the development of ‘new cures’ for the diseases of the poor, the inexcusable tragedy is the world’s failure to deliver affordable and effective ‘old cures’ to treatable and preventable diseases. Diarrhoea, pneumonia, tuberculosis and malaria are all easily and cheaply treatable. Their persistence around the world is a testament to failed health systems more so than a lack of scientific prowess.