This paper examines the recommendations of the World Health Organization's Commission on the Social Determinants of Health regarding the need for improved research on determinants of health inequity and discusses the following barriers to implementation of those recommendations: the power of the biomedical imagination in health and medical research; emphasis on vertical health programming; ideological biases outweighing evidence in policy decisions; and academic reward systems, including the inherent conservatism of peer review. The paper concludes with suggestions for changing research funding and assessment systems to overcome these barriers, for example by setting the agenda for social determinants research in consultation with researchers, policy actors and, wherever possible, relevant affected communities.
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 are attributed to the advancement and translation of knowledge, and knowledge continues to occupy center stage amidst growing complexity that characterizes the global health field. The way forward is argued to entail a reinvigoration of research-generated knowledge as a crucial ingredient for global cooperation and global health advances. The authors argue that this needs to overcome in the divides between domestic and global health, among the disciplines of research (biomedical, clinical, epidemiological, health systems), between clinical and public health approaches, public and private investments, and between knowledge gained and action implemented.
Scoping is a novel methodology for systematically assessing the breadth of a body of literature in a particular research area. The objectives of this review were to showcase the scoping review methodology in the review of health system quality reporting, and to report on the extent of the literature in this area. A scoping review was performed based on the York methodology. The researchers searched fourteen peer-reviewed and grey literature databases, specific websites, reference lists and key journals for relevant material and also solicited input from key stakeholders. A total of 1,222 articles were included. These were categorised and catalogued according to the inclusion criteria, and further subcategories were identified through the charting process. Topic areas represented by this review included the effectiveness of health system report cards (194 articles), methodological issues in their development (815 articles), stakeholder views on report cards (144 articles), and ethical considerations around their development (69 articles). The review concluded that the scoping review methodology allowed for the convenient characterisation and cataloguing of the extensive body of literature pertaining to health system report cards. The resulting literature repository from this review could prove useful to researchers and health system stakeholders interested in the topic of health system quality measurement and reporting.
This paper presents the first comprehensive effort to provide an overview of the research associated with the World Health Organization (WHO) headquarters in 2006/07. Information was obtained by questionnaire and interviews with senior staff operating at WHO headquarters in Geneva. The paper found that 45% of WHO permanent staff are involved with health research and the WHO's approach to research is predominantly focused on policy, advocacy, health systems and population based research. The Organization principally undertakes secondary research using published data and commissions others to conduct this work through contracts or research grants. This approach is broadly in line with the stated strategy of the Organization. The researchers note that the difficulty in undertaking this survey highlights the complexity of obtaining an organisation-wide assessment of WHO’s research activity in the absence of common standards for research classification, methods for priority setting and a mechanism across WHO, or within the governance of global health research more generally, for managing a research portfolio. As the rollout of the WHO strategy on research for health proceeds, the researchers expressed hope that similar exercises will be undertaken at the WHO Regional Offices and in support of capacity building of national health research systems within Member States.
Field trials require extensive data preparation and complex logistics. The use of personal digital assistants (PDAs) can bypass many of the traditional steps that are necessary in a paper-based data entry system. In this study, the authors programmed, designed and supervised the use of PDAs for a large survey enumeration and mass vaccination campaign. The project was implemented in Zanzibar, Tanzania. Zanzibar is composed of two main islands, Unguja and Pemba, where outbreaks of cholera have been reported since the 1970s. PDAs allowed the researchers to digitise information at the initial point of contact with the respondents. Immediate response by the system in case of error helped ensure the quality and reliability of the data. PDAs provided quick data summaries that allowed subsequent research activities to be implemented in a timely fashion. Portability, immediate recording and linking of information was found to enhance structured data collection in the study. The study recommends PDAs as more useful than paper-based systems for data collection in the field, especially in impoverished settings in developing countries.
This book captures developments in Participatory Action Research (PAR), exploring the justification, theorisation, practice and implications of PAR. It offers a critical introduction to understanding and working with PAR in different social, spatial and institutional contexts. The authors engage with PAR’s radical potential, while maintaining a critical awareness of its challenges and dangers. The book is divided into three parts. The first part explores the intellectual, ethical and pragmatic contexts of PAR; the development and diversity of approaches to PAR; recent poststructuralist perspectives on PAR as a form of power; the ethic of participation; and issues of safety and well-being. Part two is a critical exploration of the politics, places and practices of PAR. Contributors draw on diverse research experiences with differently situated groups and issues including environmentally sustainable practices, family livelihoods, sexual health, gendered experiences of employment, and specific communities such as people with disabilities, migrant groups, and young people. The principles, dilemmas and strategies associated with participatory approaches and methods including diagramming, cartographies, art, theatre, photovoice, video and geographical information systems are also discussed. Part three reflects on how effective PAR is, including the analysis of its products and processes, participatory learning, representation and dissemination, institutional benefits and challenges, and working between research, action, activism and change.
An evaluation exercise was carried out to assess the performance of Community Animal Health Workers (CAHWs) in the delivery of animal health care services in Karamoja region, identify capacity gaps and recommend remedial measures. Participatory methods were used to design data collection tools. Questionnaires were administered to 204 CAHWs, 215 farmers and 7 District Veterinary Officers (DVOs) to collect quantitative data. Seven DVOs and 1 Non Government Organisation (NGO) representative were interviewed as key informants and one focus group discussion was conducted with a farmer group in Nakapiripirit to collect qualitative data. Key messages from interviews and the focus group discussion were recorded in a notebook and reported verbatim. 70% of the farmers revealed that CAHWs are the most readily available animal health care service providers in their respective villages. CAHWs were instrumental in treatment of sick animals, disease surveillance, control of external parasites, animal production, vaccination, reporting, animal identification, and performing minor surgeries. Regarding their overall performance 88.8% of the farmers said they were impressed. The main challenges faced by the CAHWs were inadequate facilitation, lack of tools and equipment, unwillingness of government to integrate them into the formal extension system, poor information flow, limited technical capacity to diagnose diseases, unwillingness of farmers to pay for services and sustainability issues. CAHWs remain the main source of animal health care services in Karamoja region and their services are largely satisfactory. The technical deficits identified are argued to require continuous capacity building programs, close supervision and technical backstopping and strategic deployment of paraprofessionals that are formally recognised by the traditional civil service.
At Forum 2012, held in Cape Town in April 2012, a session was convened to explore the current roles and future potential of international partnerships in advancing African development through health research. Attendees sought to identify the elements of partnerships that would bring the greatest benefits to research and capacity development in Africa and, at the same time strengthen health and development systems on the continent. COHRED said that funders and research programmes must consciously build systems and capacity in their areas that can extend beyond silos and support other campaigns. Participants developed a number of specific and general recommendations. Most crucially, perhaps, research for health programmes must design capacity building for development and health systems into their programmes from the earliest stages, i.e., this must be a goal and not merely an incidental, even unexpected collateral benefit. Partnering organisations should be selected with attention to their commitment to ensuring that the infrastructure and human expertise which will be developed for the programme is sustainable and transferable. Country ownership will benefit from locally anchored partners, such as national universities, who will still be there when a particular research programme is concluded.
How do health policies spread from one country to the next? Transfer without ownership may make implementation difficult. Researchers from the London School of Hygiene and Tropical Medicine look at the development of international policy on tuberculosis (TB) control over the last two decades. Do policy-makers adopt and adapt health policies voluntarily, after learning about experiences in other countries, or do international organisations or donors more often impose policies? The researchers posed these and other questions during interviews with 40 key players in TB policy development.
The contemporary public health effort sees much debate about the concepts of “evidence” and “the evidence base”, and the usefulness and relevance of such terms to both policymaking and practice. A key challenge to public health is to better contextualize evidence for more effective policymaking and practice. Theory on the translation of research findings into policy and practice, and on knowledge utilization, offers only part of the solution to this complex task. The policymaking context is highly political and rapidly changing, and depends on a variety of factors, inputs, and relationships.