The current globally agreed definition of cumulative anti-retroviral therapy (ART) coverage is expressed as the number of individuals receiving ART at a point in time divided by the number of individuals who are eligible to receive treatment at the same point in time (including those who are already receiving ART). The authors of this paper acknowledge that so far it has proved an invaluable tool for promoting the systematic estimation of ART coverage at country level and for holding countries accountable through reporting requirements, such as those requested by the United Nations General Assembly Special Session on HIV/AIDS (UNGASS). But, as programmes mature and funding for ART becomes more uncertain, the increasing number of patients on ART included in the definition render the measure increasingly insensitive to annual changes in ART enrolment, the authors argue. In response to the need to expand reporting of ART access to include measures of recent enrolment, they propose a new definition to complement the existing UNGASS definition of ART coverage. The ratio of ART initiation to HIV progression is not only a better reflection of recent programme performance, the authors argue, but also a more robust measure that is less sensitive to model assumptions and to changes in ART eligibility criteria.
Monitoring equity and research policy
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.
A gap often exists between research findings and the desired outcome of putting them into use to improve health service delivery, policies, and practices. But this issue of Network highlights several factors that can facilitate the speed and ease of moving research to practice. How various factors can coincide to produce rapid utilization of research findings is illustrated by acceptance of the antiretroviral nevirapine to prevent mother-to-child transmission of HIV in the developing world.
To ask why COVID-19 hasn’t been deadlier in Africa is to suggest that more Africans should be dying. We need better questions. Almost every major international news outlet has asked a variation of the question. Some speculate that something structural or physiological has dampened the impact of COVID-19 on Africa’s population; otherwise, Africa would be faring worse. Others argue that African governments are simply doing a better job of managing the disease than other regions, despite evidence to the contrary. Neither analysis reflects the complex realities of COVID-19 in Africa. The question itself, in its crudest form, has provoked considerable, justifiable anger on social media in various African countries. Yet as the deaths mount in Brazil, India, the United States, and the UK, and as Europe prepares for its second wave, the official death toll in African countries remains low. Even in South Africa, the most severely affected African country, confirmed deaths are far fewer than predicted. Experts are left wondering why their predictions were wrong. To ask why more Africans aren’t dying of COVID-19 exposes the expectation that when the world suffers, Africa must suffer more. We can learn collectively from the questions we ask. Knowledge-making is about grappling with useful questions—those that move humanity toward a greater understanding of shared circumstances. But questions that distract from meaningful comparisons dominate the current moment. “Why aren’t more Africans dying of COVID-19,” like so many questions about Africa, fails to illuminate.
Qualitative and quantitative indicators are useful tools for promoting and monitoring the implementation of human rights. International human rights treaties and jurisprudence of the human rights treaty bodies call for the development of statistical indicators in compliance with international human rights norms and principles. The Office of the High Commissioner for Human Rights (OHCHR) has published this guide to assist in developing quantitative and qualitative indicators to measure progress in the implementation of international human rights norms and principles. The Guide describes the conceptual and methodological framework for human rights indicators recommended by international and national human rights mechanisms and used by a growing number of governmental and non-governmental actors. It provides concrete examples of indicators identified for a number of human rights - all originating from the Universal Declaration of Human Rights - and other practical tools and illustrations, to support the realization of human rights at all levels. It will be of interest to human rights advocates as well as policymakers, development practitioners, statisticians and others who are working to make human rights a reality for all.
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.
In South Africa, the number of papers produced in health and rehabilitation sciences is insignificant compared with other health-related disciplines, according to the authors of this paper. To identify strategies to increase the number of these papers, the authors reviewed published papers that examined the effectiveness of interventions designed to promote research publications among academics and clinicians in health and rehabilitation sciences programmes. Seven of the papers reported on interventions for academics, and six reported on the interventions for academics in the nursing profession. The most common interventions were ‘writing support groups’, ‘writing retreats’, and ‘writing courses’ that lasted from three days to five years. The interventions were designed to meet the needs of the participants for structured time, motivation, improved writing skills and peer support. All the interventions produced significant research output relating to submission or publication of academic papers. The implementation of these interventions by South African tertiary institutions where health and rehabilitation sciences are offered may improve the number of papers published by the health research community, the authors conclude.
Canada ’s IDRC and the SSHRC have signed an agreement to invest up to $6.27 million over the next six years to support international research alliances. This partnership will engage teams from Canada and developing countries in comparing and collaborating on their research, while working with people in communities that will directly benefit from the research. This partnership is a practical expression of the idea that new knowledge, generated through research, is key for people to improve their futures. The joint program will encourage strategic research in four areas: environment and natural resource management; information and communication technologies for development; the impact of science, technology and innovation policies on development; social and economic policy related to poverty reduction, growth, health and human rights.
This paper illustrates a case of applying the Urban Health Equity Assessment and Response Tool in Matsapha, Swaziland. A descriptive single-case study design using qualitative research methods was adopted to collect data from purposively selected respondents. The study revealed that residents of the Matsapha peri-urban informal settlements faced challenges with conditions of daily living which impacted negatively on their health. There were health equity gaps. The application of the tools was facilitated by the formation of an all-inclusive team, intersectoral collaboration and incorporating strategies for improving urban health equity into existing programmes and projects.
A major obstacle to the progress of the Millennium Development Goals has been the inability of health systems in many low- and middle-income countries to effectively implement evidence-informed interventions. This paper looks at the relationships between implementation research and knowledge translation and identifies the role of implementation research in the design and execution of evidence-informed policy. After a discussion of the benefits and synergies needed to translate implementation research into action, the authors consider how implementation research can be used along the entire continuum of the use of evidence to inform policy. The paper provides specific examples of the use of implementation research in national level programmes by looking at the scale up of zinc for the treatment of childhood diarrhoea in Bangladesh and the scaling up of malaria treatment in Burkina Faso. A number of tested strategies to support the transfer of implementation research results into policy-making are provided to help meet the standards that are increasingly expected from evidence-informed policy-making practices.