Recent estimates of malaria-attributable under-five deaths prevented using the Lives Saved Tool (LiST) confirm the substantial impact and good cost-effectiveness that insecticide-treated nets (ITNs) and indoor residual spraying have achieved in high-endemic sub-Saharan Africa. ITNs, the author argues, have an additional indirect mortality impact by preventing deaths from other common child illnesses, to which malaria contributes as a risk factor. As conventional ITNs are being replaced by long-lasting insecticidal nets and scale-up is expanded, additional lives may be saved, and these figures may be calculated using LiST. LiSt combines key indicators for time trend analysis with dynamic transmission models, fitted to long-term trend data on vector, parasite and human populations over successive phases of malaria control and elimination. The author argues that policy makers and programme planners should use LiST as a planning tool, but notes that this will require enhanced monitoring and evaluation of the national programme and its impact.
Monitoring equity and research policy
Several African governments have in recent years set themselves ambitious poverty reduction strategies. What impact have the institutional mechanisms had for mainstreaming the goal of poverty-reduction into processes of government decision-making? Preliminary findings from current research on institutional and process issues in national poverty policy at IDS suggests that practice on policy processes and institutions relating to poverty reduction has improved. In many sub-Saharan African countries, there has been considerable progress in information collection about poverty levels, characteristics and trends and, increasingly, an attempt to find mechanisms to ensure that the evidence on poverty informs the design of policy. Perhaps the most fundamental evidence of a heightened focus on poverty reduction in policy concerns the extent to which it is identified as a priority in a country’s national development strategy.
In November 2016, the global health systems research community gathered in Vancouver, Canada, for the Fourth Global Symposium on Health Systems Research. The current movement for health systems research developed out of a need to strengthen health systems in low-income and middle-income countries. More than 25 years ago, the Commission on Health Research for Development published a report that represented a pivotal change in thinking about health research for development. The main argument of the report was that research contributed little to health in low-income and middle-income countries, because it matched poorly with needs in the global South, was dominated by researchers from the North, and had a narrow biomedical focus. While health systems research has taken off in some high-income countries, progress in low-income and middle-income countries has not kept up. The 2008 Global Ministerial Forum on Research for Health in Bamako, Mali, concluded with the recommendation to increase investments in health systems research and organise a global symposium specifically focused on improving health systems in low-income and middle-income countries. Since then, the field has expanded rapidly. To contribute to the debate concerning the status and future of the health systems research field, the authors assessed the research presented at the previous global symposia. They systematically analysed the 1816 abstracts that were presented at the global symposia in Beijing (2012) and Cape Town (2014) and the participant lists of the Cape Town, Beijing, and Montreux (2010) symposia. The findings present several promising developments but also highlight that research inequities persist. While the authors observe a gender balance (51% of first authors are female) and substantial contributions from countries such as India, China, and South Africa, the North-South imbalance that was described 26 years ago remains.
Exploring some of the assumptions underlying ‘evidence based’ approaches to poverty reduction, this paper argues that the discourse of Evidence-Based Policy (EBP) offers poor guidance to those who seek to ensure that social policy making is informed by the findings of social science. EBP discourse relies on a technocratic, linear understanding of the policy making process and on a naïve empiricist understanding of the role of evidence. This renders it unable to engage with the role of the underlying discursive frameworks and paradigms that render evidence meaningful and invest it with consequence: EBP discourse does not help us understand either how policy changes, or what is at stake in dialogue across the ‘research-policy divide’. Rather than simply focusing on evidence, approaches to policy change need to focus on how evidence is used in the politically loaded and ideologically compelling ‘policy narratives’ that contest rival policy frameworks. The paper considers an example from the South African context – the shift to the ‘two economies’ framework and the policy interventions associated with the Accelerated and Shared Growth Initiative for South Africa (ASGISA)– and explores the implications for approaches to research more attuned to the realities of the policymaking process. It concludes with a discussion of the implications for social researchers and policy makers.
In preparation for the Science Online London 2010 Conference, which will be held from 3-4 September 2010 in London, United Kingdom, this video provides information on how the web is changing the way researchers conduct, communicate, share, and evaluate their work. The video is a panel discussion with Jimmy Watson, Stephen Friend and John Wilbanks, which is moderated by Tim O’Reilly. Some of the topics they talk about will also be discussed at Science Online London, such as new platforms for collaboration, networking and sharing research.
Every year about 24 million African women become pregnant in areas where the risk of malaria is high. They are more likely than other adults to become infected and this increases the risk of poor pregnancy outcome. Results of a study, funded by the UK Medical Research Council and conducted in The Gambia, emphasise the need for improved management of pregnancy and labour. Since the first study 20 years ago, several trials have produced recommendations on strategies to tackle maternal malaria. This serious public health problem may persist due to a lack of collaboration between scientists and policy-makers or because existing policy is not fully implemented. The researchers suggest that policy-makers should: Implement effective malaria control strategies for pregnant women, including the use of insecticide-treated bednets, and drugs to prevent and treat malaria; Ensure that control measures start as early as possible in pregnancy; Strengthen their working links with researchers and; Conduct community-level research to guide programmes, and monitor and evaluate success.
Malawi has launched a pilot project to investigate ways of reducing the number of mothers and children who die every year to help it reach its millennium development goals (MDGs) by 2015. Hudson Kubwalo, Health Information and Promotion Officer in the Malawi office of the UN's World Health Organisation (WHO), said a needs assessment had found that the unavailability of basic healthcare was one of the major causes of the high infant and maternal mortality in the three districts. Poor roads, a lack of transport to reach the nearest healthcare facility and a high illiteracy rate - around 58 percent among women - were other reasons given for the high level of maternal deaths.
Algorithms act according to what they are trained for, and human beings are the ones training them. Therefore, when algorithms are clearly reinforcing existing inequalities, it is crucial to question who writes these algorithms, and in whose interests they are writing them. More importantly, these people should be held accountable for the socio-spatial effects of their products. As local governments have failed to build a good spatial data infrastructure for informal settlements, other stakeholders are stepping in and the authors raise the threat posed by algorithms moderated by big tech corporations deciding the boundaries ad features of neighbourhoods.
In this study, the authors aim to provide a comprehensive description of available data sources, propose a set of indicators for monitoring the global landscape of health research and development (R&D), and present a sample of country indicators on research inputs (investments), processes (clinical trials), and outputs (publications), based on data from international databases. Total global investments in health R&D (both public and private sector) in 2009 reached US$240 billion. Only about 1% of all health R&D investments were allocated to neglected diseases in 2010. Diseases of relevance to high-income countries were investigated in clinical trials seven-to-eight-times more often than were diseases whose burden lies mainly in low-income and middle-income countries. This report confirms that substantial gaps in the global landscape of health R&D remain, especially for and in low-income and middle-income countries. Too few investments are targeted towards the health needs of these countries. Better data are needed to improve priority setting and coordination for health R&D, the authors argue, ultimately to ensure that resources are allocated to diseases and regions where they are needed the most. The establishment of a global observatory on health R&D, which is being discussed at WHO, could address the absence of a comprehensive and sustainable mechanism for regular global monitoring of health R&D.
Maternal mortality remains poorly researched in Africa, and is likely to worsen dramatically as a consequence of HIV/AIDS. The 2001 census of South Africa included a question on deaths in the previous 12 months, and two questions on external causes and maternal mortality, defined as "pregnancy-related deaths". A microdata sample from the census permits researchers to assess levels and differentials in maternal mortality, in a country severely affected by high death rates from HIV/AIDS and from external causes. After correcting for several minor biases, our estimate of the Maternal Mortality Ratio (MMR) in 2001 was 542 per 100,000 live births. This level is much higher than previous estimates dating from pre-HIV/AIDS times. This high level occurred despite a relatively low proportion of maternal deaths (6.4%) among deaths of women aged 15-49 years, and was due to the astonishingly high level of adult mortality, some 4.7 times higher than expected from mortality below age 15 or above age 50. The main reasons for these excessive levels were HIV and AIDS and external causes of deaths. The differentials in MMR were considerable: 1 to 9.2 for population groups (race), 1 to 3.2 for provinces, and 1 to 2.4 for levels of education. Relationship with income and wealth were complex, with highest values for middle income and middle wealth index. Demographic census microdata offer the opportunity to conduct an epidemiologic analysis of maternal mortality. Indirect causes of maternal deaths appear much more important than direct obstetric causes. The MMR appears no longer to be a reliable measure of the quality of obstetric care or a measure of safe motherhood.