The potential for academic research institutions to facilitate knowledge exchange and influence evidence-informed decision-making has been gaining ground. Schools of public health (SPHs) may play a key knowledge brokering role—serving as agencies of and for development. Understanding academic-policymaker networks can facilitate the enhancement of links between policymakers and academic faculty at SPHs, as well as assist in identifying academic knowledge brokers (KBs). Using a census approach, the authors administered a sociometric survey to academic faculty across six SPHs in Kenya to construct academic-policymaker networks and identified academic KBs using social network analysis (SNA). Results indicate that each SPH commands a variety of unique as well as overlapping relationships with national ministries in Kenya. Of 124 full-time faculty, they identified 7 KBs in 4 of the 6 SPHs. KBs were also situated in a wide range along a 'connector/betweenness’ measure. The authors propose that SNA is a valuable tool for identifying academic-policymaker networks in Kenya. More efforts to conduct similar network studies would permit SPH leadership to identify existing linkages between faculty and policymakers, shared linkages with other SPHs and gaps so as to contribute to evidence-informed health policies.
Monitoring equity and research policy
The GAVI Alliance was created in 2000 to increase access to vaccines. More recently, GAVI has supported evidence-based health systems strengthening to overcome barriers to vaccination. The objectives of this study were: to explore countries' priorities for health systems strengthening; to describe published research summaries for each priority area in relation to their number, quality and relevance; and to describe the use of national data from surveys in identifying barriers. From 44 health systems-strengthening proposals submitted to GAVI in 2007 and 2008, the researchers analysed the topics identified, the coverage of these topics by existing systematic reviews, and the use of nation-wide surveys with vaccination data to justify the needs identified in the proposals. Thirty topics were identified and grouped into three thematic areas: health workforce, organisation and management, and supply, distribution and maintenance. The researchers found no reviews that dealt with health information systems, however. Only seven of the reviews were categorised as ‘highly relevant for policy’. In conclusion, researchers found little quality research that was relevant to managers’ needs. Few proposals used national surveys evidence to identify barriers to vaccination. The author recommends that researchers generating or adapting evidence about health systems need to be more responsive to managers' needs.
Research plays a crucial role in developing solutions to the health problems suffered by the populations of low and middle income countries. Most health research for and in low and middle income countries is funded from external sources. And most of this externally funded research takes the form of 'vertical' - condition-specific - programmes. This paper begins by highlighting four important problems that result from reliance on this type of funding; including an unduly narrow focus of research on conditions for which international funding is available (mostly HIV and AIDS, tuberculosis, and malaria); lack of interest in leaving behind sustainable capacity in research after the research projects have ended; and loss of interest in the local programme at the time when research findings should be translated into action.
No national South African institution provides a coherent suite of support, available skills and training for clinicians wishing to conduct randomised controlled trials (RCTs) in the public sector. This study assesses the need for establishing a national South African Clinical Trials Support Unit. Key informant interviews were conducted with senior decision-makers at institutions with a stake in the South African public sector clinical trials research environment. The study found that trial conduct in South Africa faces many challenges, including lack of dedicated funding, the burden on clinical load, and lengthy approval processes. Strengths include the high burden of disease and the prevalence of treatment-naïve patients. Participants expressed a significant need for a national initiative to support and enhance the conduct of public sector RCTs. Research methods training and statistical support were viewed as key. There was a broad range of views regarding the structure and focus of such an initiative, but there was agreement that the national government should provide specific funding for this purpose. In conclusion, stakeholders generally support the establishment of a national clinical trials support initiative. Consideration must be given to the sustainability of such an initiative, in terms of funding, staffing, expected research outputs and permanence of location.
Good public policy decisions require reliable information about the causal relationships among variables. Policymakers must understand the way the world works and the likely effects of manipulating the variables that are under their control. The purpose of this paper from The Robert Wood Johnson Foundation's Changes in Health Care Financing and Organisation (HCFO) is to assist policymakers by providing an introduction to some of the problems associated with causal inference from empirical data. The paper also will be helpful to researchers who are attempting to draw causal inferences from data, or explain their results to policymakers.
In countries where routine vital registration data are scarce, Demographic Surveillance Sites (DSS: locally defined populations under longitudinal surveillance for vital events and other characteristics) and Demographic and Health Surveys (DHS: periodic national cluster samples responding to cross-sectional surveys) have become standard approaches for gathering at least some data. This paper aims to compare DSS and DHS approaches, seeing how they complement each other in the specific instance of child and adolescent mortality in Ethiopia. Data from the Butajira DSS 1987-2004 and the Ethiopia DHS rounds for 2000 and 2005 formed the basis of comparative analyses of mortality rates among those aged under 20 years, using Poisson regression models for adjusted rate ratios. Patterns of mortality over time were broadly comparable using DSS and DHS approaches. DSS data were more susceptible to local epidemic variations, while DHS data tended to smooth out local variation, and be more subject to recall bias. Both DSS and DHS approaches to mortality surveillance gave similar overall results, but both showed method-dependent advantages and disadvantages. In many settings, this kind of joint-source data analysis could offer significant added value to results.
In this study, researchers conducted a quasi-formative evaluation between October and December 2011 on four regional-led African research networks: Central Africa Network on Tuberculosis, HIV/AIDS and Malaria (CANTAM); East African Consortium for Clinical Research (EACCR); West African Network of Excellence for TB, AIDS and Malaria (WANETAM), and the Trials of Excellence for Southern Africa (TESA) launched between 2009 and 2010. They shared a participatory appraisal of field reports, progress reports and presentations from each network to jointly outline the initial experiences of the merits, outputs and lessons learnt. Results showed that the self-regulating democratic networks, with 64 institutions in 21 African countries, have trained over 1, 000 African scientists, upgraded 36 sites for clinical trials, leveraged additional € 24 million and generated 38 peer-reviewed publications through networking and partnerships. The shared initial merits and lessons learnt portray in part the strengthened capacity of these networks for improved research coordination and conduct of planned multi-centre clinical trials in Africa. Increased funding by African agencies, governments and international health partners will ensure sustainability of these networks for research capacity development and demonstrate their commitment to achieving the Millennium Development Goals in Africa.
Despite spending huge sums of money on health every year the African regions burden of disease is persistently high. Weaknesses are identified in factors as health leadership and governance, service delivery, health workforce, medicines, vaccines, and health technologies; health information; and health system financing that have undermined the capacity of health systems of countries in the region to improve population health without wastage of resources. In this book, the author applies a data envelopment analysis technique, interlacing lecture notes with research articles and case studies to equip students and practitioners of economics, operations research, management science, and public health with knowledge and skills for undertaking technical efficiency, allocative efficiency, cost efficiency, and total factor productivity analyses.
This literature review was conducted to identify examples of embedded health policy and systems research (HPSR) used to inform decision-making in low- and middle-income countries (LMICs). The authors found that multiple forces converge to create context-specific pathways through which evidence enters into decision-making. Depending on the decision under consideration, the literature indicates that decision-makers may call upon an intricate combination of actors for sourcing HPSR. While proximity to decision-making does have advantages, it is not the position of the organisation within the network, but rather the qualities the organisation possesses, that enable it to be embedded. These findings suggest that four qualities influence embeddedness: reputation, capacity, quality of connections to decision-makers, and quantity of connections to decision-makers and others. In addition to this, the policy environment (e.g. the presence of legislation governing the use of HPSR, presence of strong civil society, etc.) strongly influences uptake. The authors’ conceptual model highlights several important considerations for decision-makers and researchers about the arrangement and interaction of evidence-generating organisations in health systems.
This study describes the issue of research use in decision making from the perspective of embeddedness of research institutions in policy making. Its findings suggest that multiple forces converge to create context-specific pathways through which research enters the policymaking environment. The authors argue that while proximity to a decision making core does have advantages, it is not the position of the institution within the network, but rather, the qualities that institution possesses that enable it to be embedded: reputation, capacity, quality, and quantity of connections to decision makers. They also expected the policy environment to influence the uptake of research. Decision makers sourced evidence from research institutions in a variety of ways - leveraging personal networks, accessing peer-reviewed publications, developing formal links with national statistics agencies, academic, or independent research institutions, or by assembling expert committees for a well-defined task. However, findings from key informants suggested that the quality – and not the quantity – of connections was important for embedding research institutions in policy making, particularly where researchers were involved in policy making, where research institutions were part of the decision making body or where collaborative planning occurred to identify and prioritise research needs.