This article seeks to identify the role of databases in health policy. Access to information and communication technologies has changed traditional relationships between the state and professionals, creating new systems of surveillance and control. As a result,databases may have a profound effect on controlling clinical practice. The results demonstrate that policy makers hardly used the databases, neither for cost control nor for quality assurance. Further analysis revealed that these databases facilitated self-regulation and quality assurance by (national) bodies of professionals, resulting in restrictive prescription behavior amongst physicians.
Monitoring equity and research policy
Databases as policy instruments: About extending networks as evidence-based policy
de Bont A, Stoevelaar H and Bal R: BMC Health Services Research 7:200, 7 December 2007
Databases as policy instruments: About extending networks as evidence-based policy
de Bont A, Stoevelaar H and Bal R: BMC Health Services Research 7(200), 7 December 2007
This article seeks to identify the role of databases in health policy. Access to information and communication technologies has changed traditional relationships between the state and professionals, creating new systems of surveillance and control. As a result, databases may have a profound effect on controlling clinical practice. Three case studies were undertaken to reconstruct the development and use of databases as policy instruments. Our results demonstrate that policy makers hardly used the databases, neither for cost control nor for quality assurance. Further analysis revealed that these databases facilitated self-regulation and quality assurance by (national) bodies of professionals, resulting in restrictive prescription behavior amongst physicians. The databases fulfill control functions that were formerly located within the policy realm. The databases facilitate collaboration between policy makers and physicians, since they enable quality assurance by professionals. Delegating regulatory authority downwards into a network of physicians who control the use of pharmaceuticals seems to be a good alternative for centralized control on the basis of monitoring data.
Death, data and demographics: AIDS and adult mortality in Africa
Adult mortality is increasing in many parts of Africa. Is this due to AIDS? Can existing data answer this question? What other statistics are needed to document the spread of the AIDS epidemic in Africa? Research from the London School of Hygiene and Tropical Medicine examines the impact of HIV/AIDS on adult mortality in five African countries. It shows that increases in adult mortality correspond to high levels of HIV infection. However, there is a pressing need to collect more data on adult mortality in Africa, and to exploit more fully existing data sources.
Declaration of the 3rd World Social Science Forum
Council for the Development of Social Science Research in Africa (CODESRIA): September 2015
The World Social Science Forum 2015 served as a platform for presenting new knowledge and insights, re-thinking received wisdom, charting new directions, promoting innovation in the research-policy-action nexus, and nurturing new international partnerships. Issues of justice and growing inequalities at global, regional, national and local levels and their impact on the quality of life of populations as well as on the sustainability of resources justified the theme: 'Transforming Global Relations for a Just World'. Participants declared their concern with the consequences of injustice and inequality for the quality of life for global populations as well as with the sustainability of global resources. The participants declared to: (a) Pursue theoretical and empirical research including development of reliable and multi-dimensional indicators on inequalities and injustices; (b) Produce evidence to highlight issues requiring urgent attention and action, support advocacy and inform policies to respond to them; (c) Support efforts to address asymmetries, disparities, divides, and lack of autonomy in knowledge production through the creation of transformative knowledge programs; (d) Participate in programs and efforts that aim to end injustice and inequality; (e) Make every effort to reduce income inequalities and promote equity, starting with scientific institutions where they have influence; (f) Support measurable progress to overcome inequalities, including through the implementation of the Sustainable Development Goals; (g) Promote policies, programs, and values that act to end gender inequality; (h) Promote the integration of youth in work places through providing them with the necessary skills to enter the labour force; (i) Support efforts to achieve legally binding and universal agreement on avoiding dangerous anthropogenic interference with the climate system; and (j) Promote inclusive societies based on universal values and human rights.
Declining child mortality in northern Malawi despite high rates of infection with HIV
Jahn A, Floyd S, Crampin AC, Mvula H, Mwinuka V, Mwaiyeghele E et al: Bulletin of the World Health Organization 88(10): 746–753, October 2010
This study aimed to determine whether routine surveys, such as the Demographic and Health Surveys (DHS), have underestimated child mortality in Malawi. Rates and causes of child mortality were obtained from a continuous-registration demographic surveillance system (DSS) in Malawi for a population of 32,000. Between August 2002 and February 2006, 38,617 person-years of observation were recorded for 20,388 children aged < 15 years. There were 342 deaths. Re-census data, follow-up visits at 12 months of age and the ratio of stillbirths to neonatal deaths suggested that death registration by the DSS was nearly complete. Infant mortality was 52.7 per 1000 live births, under-5 mortality was 84.8 per 1000 and under-15 mortality was 99.1 per 1000. One-fifth of deaths by age 15 were attributable to HIV infection. Child mortality rates estimated with the DSS were approximately 30% lower than those from national estimates as determined by routine surveys. The fact that child mortality rates based on the DSS were relatively low in the study population is encouraging and suggests that the low mortality rates estimated nationally are an accurate reflection of decreasing rates.
Delivering on the MDGs: Equity and maternal health in Ghana, Ethiopia and Kenya
Wirth M, Delamonica E, Sacks E, et al: World Institute for Development Research (WIDER), 2006
The Millennium Development Goals (MDGs) have put maternal health in the mainstream, but there is a need to go beyond the MDGs to address equity within countries. Maternal health indicators from three countries in sub-Saharan Africa show the continent is lagging far behind other regions on health indicators. In the past decade, maternal mortality has increased in some countries, in large part due to health system collapse, increasing poverty among women, lack of access to skilled care for delivery, weak national human resource management and lack of resources.
Demanding Innovation:
articulating policies for demand-led research and research capacity building in the South
This website has supported the high-level international seminar ‘Demanding Innovation: articulating policies for demand-led research and research capacity building in the South’ .
Under the Main Menu you will find basic information on the workshop, such as the programme, the names of the participants, keynote speeches, proceedings and background documents.
Determinants of fertility in rural Ethiopia: The case of Butajira Demographic Surveillance System (DSS)
Mekonnen W and Worku A: BMC Public Health 11(782), 10 October 2011
In this study, reproductive-age women were recruited from the Butajira Demographic Surveillance System (DSS) database to analyse the determinants of fertility in rural Ethiopia. A district health survey maternity history questionnaire was administered to 9,996 participants. Results showed that delayed marriage, a higher level of education, a smaller family, absence of child death experience and living in food-secured households were associated with a smaller number of children. Fertility was significantly higher among women with no child-sex preference. However, migration status of women was not statistically significant. The researchers argue that policy makers should focus on increasing women’s secondary school enrollment and age at first marriage. The community should also be made aware on the negative impact of fertility on household economy, the environment and the country's socio-economic development at large.
Developing a national health research system: Participatory approaches to legislative, institutional and networking dimensions in Zambia
Chanda-Kapata P, Campbell S and Zarowsky C: Health Research Policy and Systems 10(17), 6 June 2012
For many sub-Saharan African countries, a National Health Research System (NHRS) exists more in theory than in reality, with the health system itself receiving the majority of investments. However, this lack of attention to NHRS development can, in fact, frustrate health systems in achieving their desired goals. In this case study, the authors discuss the ongoing development of Zambia's NHRS. They reflect on their experience in the ongoing consultative development of Zambia's NHRS and offer this reflection and process documentation to those engaged in similar initiatives in other settings. Their critical argument is that three streams of concurrent activity are central to developing an NHRS in a resource-constrained setting: developing a legislative framework to determine and define the system's boundaries and the roles all actors will play within it; creating or strengthening an institution capable of providing coordination, management and guidance to the system; and focusing on networking among institutions and individuals to harmonise, unify and strengthen the overall capacities of the research community.
Developing health systems research capacities through North-South partnership: An evaluation of collaboration with South Africa and Thailand
Mayhew SH, Doherty J and Pitayarangsarit S: Health Research Policy and Systems 6(8), 2008
Over the past ten years calls to strengthen health systems research capacities in low- and middle-income countries have increased. One mechanism for capacity development is the partnering of northern and southern institutions; however, detailed case-studies of north-south partnerships, at least in the domain of health systems research, remain limited. This study aims to evaluate the partnerships developed between the Health Economics and Financing Programme of the London School of Hygiene & Tropical Medicine and three research partners in South Africa and Thailand to strengthen health economics-related research capacity. Five years of formal partnership resulted in substantial strengthening of individual research skills and moderate institutionalised strengthening in southern partner institutions. Activities included joint proposals, research and articles, staff exchange and post-graduate training. In South Africa, local post-graduate teaching programs were strengthened, regular staff visits/exchanges initiated and maintained and funding secured for several large-scale, multi-partner projects. These activities could not have been achieved without good personal relationships between members of the partner institutions, built on trust developed over twenty years. In South Africa, a critical factor was the joint appointment of a London staff member on long-term secondment to one of the partner institutions. As partnerships mature the needs of partners change and new challenges emerge. Partners' differing research priorities need to be balanced and equitable funding mechanisms developed recognising the needs and constraints faced by both southern and northern partners. Institutionalising partnerships (through long-term development of trust, engagement of a broad range of staff in joint activities and joint-appointment of staff), and developing responsive mechanisms for governing these partnerships (through regular joint negotiation of research priorities and funding issues), can address these challenges in mutually acceptable ways. Most importantly, this study has shown that it is possible for long-term north-south partnership commitments to yield fruit and to strengthen the capacities of public health research and training institutions in less developed countries.