An article published in the journal Nature on July 5 puts forward a new technique for the evaluation of research on development. It marks a departure from conventional approaches that, according to the author, have significant weaknesses. This new method for the evaluation of development research — known as RQ+ or Research Quality Plus — emphasises the crucial importance of context, local knowledge and the views of the populations whose lives the research aims to improve. Conventional approaches to evaluating scientific endeavours are argued by the author to have a number of inbuilt constraints. For example, they focus primarily on peer assessment or bibliometrics but don’t explicitly pass judgement on the originality or usefulness of the research, nor do they look at the degree of respect for local knowledge. The RQ+ approach goes beyond an evaluation focused solely on the scientific merit of research outputs and includes other dimensions that are essential to measuring the value and quality of research. RQ+ takes account of what evaluators have to say, but their views should be evidence-based, rather than a simple opinion. Those carrying out the evaluation should take into consideration external points of view — for example those of users targeted by the research or of the communities it is supposed to benefit — as well as the perspectives of other researchers working in the same field.
Monitoring equity and research policy
Author(s): Winch, P.J.; Wagman, J.A; .Malouin, R.A.; Mehl, G.L.
This guide is designed for program managers, researchers, funders of health programs, and others who are considering using qualitative research methods to help them design more effective health programs and/or evaluate the strengths and weaknesses of existing programs. It is assumed that the reader already has some familiarity with the basic methods in the "qualitative research toolbox" such as in-depth interviews, focus groups, and participant observation. This guide describes some of the existing manuals for conducting qualitative research on health and provides information to help would-be users select the manuals that are most appropriate to their needs. This guide does not attempt to review the available qualitative research tools related to prevention and treatment of chronic and non-infectious diseases, including tobacco control, obesity prevention, or management of such diseases as diabetes or epilepsy.
This edition presents a set of five articles that, through synthesis of available research, seek to consolidate and develop the body of health policy analysis work in low- and middle-income countries. This work is found to be currently fragmented across geographic settings and policy issues, is more descriptive than analytic and is weakly theorized.
The quality of care provided by health systems contributes towards efforts to reach sustainable development goal 3 on health and well-being. There is growing evidence that the impact of health interventions is undermined by poor quality of care in lower-income countries. Quality of care will also be crucial to the success of universal health coverage initiatives; citizens unhappy with the quality and scope of covered services are unlikely to support public financing of health care. Moreover, an ethical impetus exists to ensure that all people, including the poorest, obtain a minimum quality standard of care that is effective for improving health. However, the measurement of quality today in low- and middle-income countries is argued to be inadequate to the task. Health information systems provide incomplete and often unreliable data, and facility surveys collect too many indicators of uncertain utility, focus on a limited number of services and are quickly out of date. Existing measures poorly capture the process of care and the patient experience. Patient outcomes that are sensitive to health-care practices, a mainstay of quality assessment in high-income countries, are rarely collected. The authors propose six policy recommendations to improve quality-of-care measurement and amplify its policy impact: (i) redouble efforts to improve and institutionalise civil registration and vital statistics systems; (ii) reform facility surveys and strengthen routine information systems; (iii) innovate new quality measures for low-resource contexts; (iv) get the patient perspective on quality; (v) invest in national quality data; and (vi) translate quality evidence for policy impact.
Since 1990, the World Health Organization has used the disability-adjusted life year (DALY) statistic to quantify the burden of diseases. This indicator quantifies both morbidity and mortality due to diseases. This article notes that estimating DALYs is intrinsically problematic since, for some conditions, only limited data is available. For several tropical diseases, especially those affecting people in the poorest countries, it has been argued that DALYs are systematically underestimated. Because it is considered economically unprofitable, virtually no new drugs are being developed for this group of conditions. Being underestimated and lacking targeted drug development programmes, these conditions have been termed neglected tropical diseases (NTDs). Although there may be room for improvement in the calculation of DALYs related to NTDs, the article acknowledges that governments and policy makers use them to determine priorities in prevention and health care and therefore they cannot be ignored. It argues that research efforts targeted at a disease should ideally be in proportion to its global health impact. It considers that NTDs may be neglected twice: once by being attributed an underestimated DALY and again by limited scientific attention.
The Agency for Healthcare Research and Quality (AHRQ) Report No.47, 2002 AHRQ's Evidence-based Practice Center at Research Triangle Institute/University of North Carolina.
The report identifies and compares systems that rate the quality of evidence in individual research studies and compilations of studies addressing a common scientific issue. The report also provides guidance on the leading approaches currently in use for improving the quality of scientific evidence. Using well-specified criteria, the researchers identified 19 study-quality and 7 strength-of-evidence grading systems that people conducting systematic reviews and technology assessments can use as starting points for future evidence-based research projects.
Community-based monitoring and planning (CBMP) of health services in Maharashtra state, India represents an innovative participatory approach to improving accountability and healthcare delivery. Supported by diverse stories of change, the paper shows how this process created various forums and spaces for dialogue and led to systematic data collection on health indicators that point to greater accessibility and quality of services at village as well as primary health centre levels. The authors ask whether this experience could inform ‘communitization’ of health services in diverse contexts, as an alternative to privatization and as a means to enhancing the ‘publicness’ of health services.
Performance targets for global TB control were first formulated in 1991 at the 44th World Health Assembly. National TB control programmes were encouraged to achieve CDRs of at least 70% and cure rates in excess of 85%. However, even in situations where both targets were reached and achievements sustained, incidence rates failed to decline as predicted. The vast differences that exist between endemic and non-endemic areas (in other words, case density) and the impact this has on transmission dynamics within communities are rarely appreciated. Most source cases have fairly fixed circles of social interaction. This implies that once the majority of close contacts have been infected, the risk of infecting new people may decline even though the source case remains highly infectious. This phenomenon is referred to as transmission saturation. There is a need to reconsider the accuracy and applicability of current mathematical models and to identify pragmatic ways of quantifying additional factors that may be at play in endemic areas. The incorporation of case density and transmission saturation in future mathematical models may assist.
Linking computerized health insurance records with routinely collected survey data is becoming increasingly popular in health services research. However, if consent is not universal, the requirement of written informed consent may introduce a number of research biases. The participants of a national health survey in Taiwan were asked to have their questionnaire results linked to their national health insurance records. This study compares those who consented with those who refused.
The introduction of information and communications technology into a developing nation setting poses unique challenges. A recent randomised controlled trial done in Luanda, Angola, surveyed 231 people to assess their risk for HIV infection. In half of the surveys, the interviewers used a PDA to note participant responses. In the other half, the interviewers used paper and pencil. Other than the difference in these tools to record responses, the two groups were essentially the same. People in the PDA group gave, on average, 2.4 socially desirable responses (out of 9 possible), compared to 1.4 for participants in the paper-and-pencil group. That is, people seemed to exaggerate how safe their behaviours were when they were faced with an interviewer using a PDA. This finding suggests that the good intentions of introducing ICT into health-care settings in low-income countries may have unintended consequences if tests of its effects are not done beforehand.