A functional national health research system (NHRS) is crucial in strengthening a country’s health system to promote, restore and maintain the health status of its population. Progress towards the goal of universal health coverage in the post-2015 sustainable development agenda will be difficult for African countries without strengthening of their NHRS to yield the required evidence for decision-making. This study developed a barometer to facilitate monitoring of the development and performance of NHRSs in WHOs African Region. The African national health research systems barometer algorithm was developed in response to a recommendation of the African Advisory Committee for Health Research and Development of WHO. Survey data collected from all the 47 Member States in the WHO African Region using a questionnaire were entered into an Excel spreadsheet and analysed. The barometer scores for each country were calculated and the performance interpreted according to a set of values ranging from 0% to 100%. The overall NHRS barometer score for the African Region was 42%, which is below the average of 50%. Among the 47 countries, the average NHRS performance was less than 20% in 10 countries, 20–40% in 11 countries, 41–60% in 16 countries, 61–80% in nine countries, and over 80% in one country. The performance of NHRSs in 30 (64%) countries was below 50%. An African NHRS barometer with four functions and 17 sub-functions was developed to identify the gaps in and facilitate monitoring of NHRS development and performance. The NHRS scores for the individual sub-functions can guide policymakers to locate sources of poor performance and to design interventions to address them.
Monitoring equity and research policy
This report presents findings of a European-Africa consultation on the research agenda for non-communicable diseases. The workshop found that research in Africa can draw from different environmental and genetic characteristics to understand the causes of non-communicable diseases, while economic and social factors are important in developing relevant strategies for prevention and treatment. The suggested research needs include better methods for description and recording, clinical studies, understanding cultural impacts, prevention strategies, and the integrated organisation of care. Specific fields proposed for research are listed in the report. Although the European Union Seventh Framework Research Programme prioritises biomedical and clinical research, it recommends that research for Africa should also address broader social and cultural research and intervention research for greatest impact. Research policy leaders in Africa must engage national governments and international agencies as well as service providers and research communities. None can act effectively alone.
In recent decades there has been increasing evidence of a relationship between self-reported racism and health. Although a plethora of instruments to measure racism have been developed, very few have been described conceptually or psychometrically. Furthermore, this research field has been limited by a dearth of instruments that examine reactions/responses to racism and by a restricted focus on African American populations. In response to these limitations, the 31-item Measure of Indigenous Racism Experiences (MIRE) was developed to assess self-reported racism for Indigenous Australians. This paper describes the development of the MIRE together with an opportunistic examination of its content, construct and convergent validity in a population health study involving 312 Indigenous Australians. The MIRE has considerable utility as an instrument that can assess multiple facets of racism together with responses/reactions to racism among indigenous populations and, potentially, among other ethnic/racial groups.
A measurement tool for the assessment of multiple systematic reviews (AMSTAR) was developed. The tool consists of 11 items and has good face and content validity for measuring the methodological quality of systematic reviews. Additional studies are needed with a focus on the reproducibility and construct validity of AMSTAR, before strong recommendations on its use can be made.
The purpose of this study was to develop a core set of indicators that could be used for measuring and monitoring the performance of primary health care organizations' capacity and strategies for enhancing equity-oriented care. Indicators were constructed based on a review of the literature and a thematic analysis of interview data with patients and staff using procedures for qualitatively derived data. Indicators were considered part of a priority set of health equity indicators if they received an overall importance rating of>8.0, on a scale of 1–9, where a higher score meant more importance. Seventeen indicators make up the priority set. Items were eliminated because they were rated as low importance (<8.0) in both rounds and were either redundant or more than one participant commented that taking action on the indicator was highly unlikely. The indicators assess performance of staff and outcomes which can be directly attributable to equity responsive primary health care.
The Directory of Training Programs in Health Services Research and Health Policy provides key information about U.S., Canadian, and European post-baccalaureate certificate, master's, doctoral, and postdoctoral programs in the fields of health services research and health policy. Each program profile lists: program objectives, program focus, degree(s) offered, program director(s), senior faculty and primary research interests, tuition, financial aid, average completion time, average number of students, start date, program structure, language of instruction, application requirements, and contact information. The training directory is an online resource that is updated continuously as we receive new and updated program information.
Sharing research findings with participants living with HIV enrolled in observational research in rural sub-Saharan Africa presents significant challenges with respect to literacy, language, logistics, and confidentiality. In this study, researchers communicated research findings to 540 participants enrolled in an ongoing seven-year prospective cohort study of HIV treatment in Mbarara, Uganda. The researchers followed a six-step process, beginning with an exploration of acceptability, format and content to participants and culminating in a conference of all participants. The dissemination conference provided a formal mechanism for the research assistants to share participants' concerns and questions with the entire investigator team. Disseminating the scientific findings was reported to be highly rewarding for participants, research staff, and investigators. It improved communication between participants and research staff, strengthened the relationship between research staff and investigators, and created a sense of community among participants. Finally, the event generated a research agenda directly from those most affected by HIV in a rural, resource-constrained setting. The authors recommend this format as a guide to dissemination of study findings to study participants in similar settings.
Primary health care (PHC) in South Africa forms an integral part of both the country's health policies and health system and has been prioritised as a major strategy in achieving health for all. On the eve of the 30th anniversary of the Alma Ata Declaration, PHC is once again in the spotlight. How far have we come in the last 30 years? How far in the last three? The third edition of the District Health Barometer, the 2006/07 report sheds some light by monitoring the trend of key health and financial indicators in PHC over the last three years by district and province.
The quality of health care, including access to HIV prevention and testing services, depends to a large extent on which of South Africa's 52 districts you happen to live in. Major inequities were noted between urban and rural areas, as rural areas were usually underserved. Some of the inequities highlighted by the District Health Barometer (DHB) can be traced to differences in health spending, with different districts spending different amounts. The uneven distribution of HIV infection in South Africa also influenced ratings: higher rates of Caesareans were linked to higher HIV rates in pregnant women. Writing in the DHB, Dr Tanya Doherty attributed a lack of improvement in child and maternal mortality rates to the HIV epidemic – under-five mortality barely shifted from 60 per 1,000 births in 1990, to 59 in 2007, while maternal mortality actually increased. Prevention of mother-to-child HIV transmission (PMTCT) is vital to reducing maternal and child mortality and combating HIV, but health authorities have failed to properly monitor PMTCT interventions. ‘This is indicative of management neglect of the programme from national to facility level,’ she wrote.
The annually published District Health Barometer (DHB) in South Africa is designed and compiled to assist South Africa’s National Department of Health in making health and related information available for monitoring progress in health service delivery at district level. The Barometer provides current information on functioning and associated fluctuations in all the country’s health districts, describing performance over time in relation to previous years as well as between districts. Each edition highlights problem areas, data quality issues, sustained and notable progress, and aspects requiring deeper research into underlying factors contributing to the indicator values and trends. This 10th edition of the DHB presents data on 44 indicators, with trend illustrations and health profiles for South Africa as a whole, the nine provinces and the 52 districts, as well as a chapter on the country’s burden of disease. As in previous years, a varied picture emerges in terms of the national profile. Significant gains are noted in the rates of stillbirth; early mother-to-child transmission of HIV; cure among new pulmonary smear-positive TB patients; couple year protection; women under age 18 delivering babies in hospital; case fatality among children under five years of age from diarrhoea with dehydration and from pneumonia; and antenatal clients initiated on ART. However, persistent challenges prevail with regard to the Caesarean section rate in district hospitals, the school Grade 1 screening coverage, the measles 2nd dose coverage, and the case fatality rate for severe acute malnutrition in children under five years of age.