In this study, the Lives Saved Tool (LiST) model was used to quantify the likely impact that malaria prevention intervention scale-up has had on malaria mortality over the past decade (2001-2010) across 43 malaria endemic countries in sub-Saharan African. The likely impact of insecticide-treated nets (ITNs) and malaria prevention interventions in pregnancy (intermittent preventive treatment [IPTp] and ITNs used during pregnancy) over this period was assessed. Results indicated that malaria prevention intervention scale-up over the past decade has prevented 842,800 child deaths due to malaria in the 43 countries, compared to a baseline of the year 2000. Over the entire decade, this represents an 8.2% decrease in the number of malaria-caused child deaths that would have occurred over this period had malaria prevention coverage remained unchanged since 2000. The biggest impact occurred in 2010 with a 24.4% decrease in malaria-caused child deaths compared to what would have happened had malaria prevention interventions not been scaled-up beyond 2000 coverage levels. ITNs accounted for 99% of the lives saved. The results suggest that funding for malaria prevention in Africa over the past decade has had a substantial impact on decreasing child deaths due to malaria. Rapidly achieving and then maintaining universal coverage of these interventions should be an urgent priority for malaria control programmes in the future, the authors argue. Successful scale-up in many African countries will likely contribute substantially to meeting Millennium Development Goal (MDG) 4 to reduce child mortality, as well as succeed in meeting MDG 6 (Target 1) to halt and reverse malaria incidence by 2015.
Monitoring equity and research policy
Incidence is a better measure than prevalence for monitoring AIDS, but it is not often used because longitudinal HIV data from which incidence can be computed is scarce. The objective of this study was to estimate the force of infection and incidence of HIV in Malawi using crosssectional HIV sero-prevalence data from the Malawi Demographic and Health Survey conducted in 2004. The researchers estimated population incidence from the force of infection by accounting for the prevalence, as the force of infection applies only to the HIV-negative part of the population. The estimated HIV population incidence per 100,000 person-years among men is 610 for the 15–24 year age range, 2,700 for the 25–34 group and 1,320 for 35–49 year olds. For females, the estimates are 2,030 for 15–24 year olds, 1,710 for 25–34 year olds and 1,730 for 35–49 year olds. In conclusion, the researchers assert that their method provides a simple way of simultaneously estimating the incidence rate of HIV and the age-specific population prevalence for single ages using population-based crosssectional sero-prevalence data. The estimated incidence rates depend on the HIV and natural mortalities used in the estimation process.
The San of South Africa are one of the most researched communities in the world. Their indigenous knowledge and genetic makeup have been of great interest to researchers as they are ancestors of the first hunter-gatherers in Africa. While the media and researchers have continued to want to engage with the community, TRUST, a global initiative which seeks to reduce exploitation in North-South research collaborations, alongside the San Council created a contract to protect the community from exploitation, and to ensure that the San also benefit from any research. This paper outlines a locally driven Code of Ethics for involving San people in research that has been initiated by a range of organisations in Southern Africa. Referencing the original research and media contract, this is now being finalised into the first indigenous-developed ethics code in Africa.
These four briefs (separately shown on this site) provide information on evaluation of social participation and power in health to support capacity and practice. They are intended primarily for those working directly with social participation and power in health systems, but also for managers, funders and others who engage with them. They intend to inform thinking and approaches and provide links to deeper resources and do not intend to prescribe or be a ’how to’ toolkit. The four briefs address:
BRIEF 1: The concepts and approaches applied in ‘monitoring and evaluation processes at www.tarsc.org/publications/documents/Shapinghealth%20eval%20brief%201%20May2018.pdf
BRIEF 2: Approaches to assessing change in social participation and power in health at www.tarsc.org/publications/documents/Shaping%20health%20eval%20brief%202%202018.pdf
BRIEF 3: The methods used for participatory evaluation at www.tarsc.org/publications/documents/Shaping%20health%20eval%20brief%203%202018.pdf
BRIEF 4: Engaging funders and formal systems on evaluations of social power in health at www.tarsc.org/publications/documents/Shaping%20health%20eval%20brief%204%202018.pdf
This paper describes and evaluates health research priority-setting in Zambia from the perspectives of key stakeholders using an internationally validated evaluation framework. This was a qualitative study based on 28 in-depth interviews with stakeholders who had participated in the priority-setting exercises. An interview guide was employed. Emerging themes were, in turn, compared to the framework parameters. Although there is apparent commitment to health research in Zambia, health research priority-setting is limited by lack of funding, and consistently used explicit and fair processes. The designated national research organisation and the availability of tools that have been validated and pilot tested within Zambia provide an opportunity for focused capacity strengthening for systematic prioritisation, monitoring and evaluation. The authors observe that the utility of the evaluation framework in Zambia could indicate potential usefulness in similar low-income countries.
The authors of this paper assessed recent evaluations of health systems (HS) strengthening interventions in low- and middle-income countries from 2009–10. Out of 106 evaluations, less than half (43%) asked broad research questions to allow for a comprehensive assessment of the intervention’s effects across multiple HS building blocks. Only half of the evaluations referred to a conceptual framework to guide their impact assessment. Overall, 24% and 9% conducted process and context evaluations, respectively, to answer the question of whether the intervention worked as intended, and if so, for whom, and under what circumstances. None incorporated evaluation designs that took into account the characteristics of complex adaptive systems such as non-linearity of effects or interactions between the HS building blocks. The authors call for more comprehensive evaluations of the range of effects of an intervention, when appropriate. They identify some barriers to more comprehensive evaluations as limited capacity, lack of funding, inadequate time frames, lack of demand from both researchers and research funders, or difficulties in undertaking this type of evaluation.
In this report, the author explores how the evaluation of intersectoral action for health (IAH) and health in all policies (HiAP) is being implemented from the experience of expertise directly involved in such work. The World Health Organisation (WHO) selected 11 respondents for their involvement in work on IAH and systems scale analysis. They were interviewed and the documents they provided were reviewed. The respondents were drawn from local government, national- and global-level institutions, mainly from high-income countries with only two from middle- or low-income countries. The findings suggest that having an explicit and shared conceptual framework for IAH work at inception is necessary to clarify the pathways for change, the outcomes and measures for assessing performance and impact, to prioritise action and to test the thinking informing IAH work. While the learning from this may be context-specific, learning networks provide a means for a meta-analysis of case studies, to build more generic knowledge around conceptual frameworks. For most respondents, a model of reflexive or negotiated evaluations was seen as most useful for concept, performance and impact evaluation, embedded within the planning and implementation of IAH, with knowledge jointly constructed by different actors, including local communities, and linked to the review of practice. All those interviewed encouraged further work to develop approaches and methods for the evaluation of IAH. While noting the limitations on generalisations due to the small sample, the findings suggest some recommendations for supporting promising practice on the evaluation of IAH.
In this study, researchers evaluated the effectiveness of South Africa’s national prevention programme for mother-to-child transmission (PMTCT) of HIV. They included a total of 10,820 eligible infants from 572 facilities in their survey, conducted 10,735 interviews and drew 10,178 dried blot spot specimens. Findings indicated a 3.5% national MTCT rate in pregnancy and intrapartum with varying distribution across the nine provinces (1.4% to 5.9%). Maternal HIV acquisition since the last HIV test was potentially high at 4.1% and therefore repeat HIV testing at 32 weeks pregnancy and couple testing is critical, the authors argue. While uptake of PMTCT services is over 90%, CD4 testing and early infant diagnosis (EID) uptake are considerably lower and represent on-going missed opportunities in the PMTCT programme. The authors call for a review of EID strategies that routinely offer infant HIV testing only to known HIV-exposed infants, as virtual elimination of paediatric HIV infection is possible with intensified effort. Only 20% of HIV-positive women were exclusively breastfeeding, 62% were formula feeding and 18% were practicing high-risk mixed feeding, suggesting a need for increased attention to infant feeding.
In this article the authors argue that many African governments have so far responded more proactively and effectively to Covid-19 than some governments in high income countries (HICs). Much of this capacity to respond effectively can be explained by an existing culture of using evidence to inform policy decision-making. African researchers are producing evidence on how to protect and prioritise already existing health interventions which can increase health system resilience and preparedness for Covid-19. The authors argue that African nations have generated and used evidence for decision- making on solutions to tackle the pandemic. Data-poverty and technology deficits are a challenge. The authors note that partnerships to assist with production, collation, and use of evidence are appearing nationally, regionally, and globally to support quick but measured evidence-informed decisions.
Three years ago, the Society of General Internal Medicine's Evidence-based Medicine Task Force began an inquiry to integrate evidence-based medicine (EBM) and the learning organization (LO), an approach to training from a systems-based perspective, into one model to address the knowing-doing gap problem. The authors of this study searched several databases for relevant LO frameworks and their related concepts by using a broad search strategy. They found seven LO frameworks particularly relevant to evidence-based practice innovations in organisations. These were integrated to form the new Evidence in the Learning Organization (ELO) model, which can be used by health organisations to identify their capacities to learn and share knowledge about evidence-based practice innovations.