Tackling health inequalities must be a central plank of public policy for any Government, and this report is intended to help to shape the policy direction, and influence the targeting and delivery of services, in tackling inequalities. The evidence base about “what works” is still fairly weak, but there is now a commitment to address this. Resources are going into research and development to advance our knowledge and understanding of what works. This report works in parallel to that research, in terms of measuring inequalities in order to plan, set targets, monitor and evaluate. The authors recommend establishing mechanisms to monitor inequalities in health and to evaluate the effectiveness of measures taken to reduce them. This report is relevant to anyone involved in addressing health inequalities, as it presents the complicated science of the measurement of inequalities in a rigorous but accessible way.
Monitoring equity and research policy
This paper provides an overview of recent work on measuring the quality of medical care in four low- and middle-income countries: India, Indonesia, Tanzania, and Paraguay. The authors describe methods of testing and watching doctors that are relatively easy to implement and yield important insights about the nature of medical care in these countries. The paper discusses the properties of these measures and how they may be used to evaluate policy change. Finally, it outlines an agenda for further research and quality measurement tools. Researchers found the competence of doctors in low-income countries to be insufficient, quality of patient care is even worse than suggested by doctors' competence levels and the poor have access to worse quality care than the rich, in both public and private sectors. Standard measures of health care quality in low-income countries, which are based on an assessment of physical infrastructure, are inadequate. Further research with better methods of measuring of these aspects of quality is required.
This article critiques the limitations of gross domestic product (GDP) as a measurement of a nation's success – do individuals living in countries with a high GDP really have a better life than those who don't? It discusses the work of the Stiglitz-Sen-Fitoussi Commission in attempting to find a set of indicators that better represent individuals’ circumstances today, recommending that every country should also apply other indicators to capture what is happening economically, socially and environmentally. Most criticisms of GDP fall into two distinct camps: some maintain that GDP itself needs to be fixed, while others seek to recast the criticism of GDP from an accounting debate to a philosophical one, as our reliance on such a measure suggests that we may still be equating economic growth with progress on a planet that is already overburdened by human consumption and pollution. One measure has succeeded in challenging the hegemony of growth-centric thinking – the Human Development Index (HDI), which turns 20 this year and is still used by the United Nations. The HDI incorporates a nation’s GDP and two other modifying factors: its citizens’ education, based on adult literacy and school-enrolment data, and its citizens’ health, based on life-expectancy statistics. But the HDI has plenty of critics. For example, a slight drop in literacy rates can have a disproportionate effect on a nation's HDI ranking. As a result, researchers are continuing their search for a set of indicators that will reliably measure progress for all nations.
This report aims to provide guidance to governments, institutions, and development partners on how to approach the provision of advanced information and communication technology (ICT) services to the higher education and research community in Africa. It coincides with a transformation in the telecom infrastructure and services on the continent as fibre optic connectivity, both undersea and on land, is expanding at a rapid pace. The report suggests that the organisation of ICT services and connectivity is best provided by a dedicated organisation called the National Research and Education Network (NREN) based on international best practice and the current plans of the stakeholders in the region. The nature of NRENs and the case for their establishment is outlined and the story of their development in Africa to their current status is described. The report also provides guidance on how to establish or strengthen an NREN, with recommendations to the government, the private sector, institutions, development partners.
This article presents the most recent World Health Organisation framework for strengthening health systems and considers how health economics research can be used to measure achievements against each of the goals of the framework. Benefits to health systems strengthening of incorporating health economics tools into operational research are highlighted. Finally, health economic tools are placed within an impact assessment framework that facilitates the capture of health systems considerations in implementation research for innovations in tuberculosis diagnosis.
This article covers the opening address of the Tanzanian Minister of Health and Social Welfare at the 22nd Annual Joint Scientific Conference of the National Institute for Medical Research, Arusha Tanzania, 7 March 2007.
Global health research is essential for development. A major issue is the inequitable distribution of research efforts and funds directed towards populations suffering the world's greatest health problems. This imbalance is fostering major attempts at redirecting research to the health problems of low and middle income countries. This article concludes that there is a need to more effectively include NGOs in all aspects of health research in order to maximize the potential benefits of research. NGOs, moreover, can and should play an instrumental role in coalitions for global health research.
This report begins by identifying six problems which make developing the evidence base on the social determinants of health potentially difficult. In order to overcome these difficulties a number of principles are described which help move the measurement of the social determinants forward. The report proceeds by describing in detail what the evidence based approach entails including reference to equity proofing. The implications of methodological diversity are also explored. A framework for developing, implementing, monitoring and evaluating policy is outlined. At the centre of the framework is the policy-making process which is described beginning with a consideration of the challenges of policies relating to the social determinants.
International collaboration for health system development has been identified as a critical input to meet pressing global health needs. North-South collaboration has the potential to benefit both parties, while South-South collaboration offers promise to strengthen capacity rapidly and efficiently across developing countries. There is an emerging trend to analyze the fruits of such collaboration. This paper builds on this trend by applying an innovative concept-based bibliometric method to identify the international scope of collaboration within the field of health policy and systems research. Two key questions are addressed: to what extent are papers comparing developing countries as against reporting on single country studies? To what extent are papers in either case being produced by researchers within their respective countries or through North-South or South-South collaboration?
The Sustainable Development Goals strongly focus on equity. Goal 5 explicitly aims to empower all women and girls, reinforcing the need to have a reliable indicator to track progress. This study developed a novel women’s empowerment indicator from widely available data sources, broadening opportunities for monitoring and research on women’s empowerment. The authors used Demographic and Health Survey data from 34 African countries, targeting currently partnered women. They identified items related to women’s empowerment present in most surveys, and used principal component analysis to extract the components. The authors carried out a convergent validation process using coverage of three health interventions as outcomes; and an external validation process by analysing correlations with the Gender Development Index. Findings 15 items related to women’s empowerment were selected. They retained three components (50% of total variation) which, after rotation, were identified as three dimensions of empowerment: attitude to violence, social independence, and decision making. All dimensions had moderate to high correlation with the Gender Development Index. Social independence was associated with higher coverage of maternal and child interventions; attitude to violence and decision making were more consistently associated with the use of modern contraception. Interpretation The index, named Survey-based Women’s emPowERment index, is argued to have the potential to widen the research on women’s empowerment and to give a better estimate of its effect on health interventions and outcomes. It allows within-country and between-country comparison, as well as time trend analysis, which no other survey based index provides.