In this blog from the Second Global Symposium on Health Systems Research, held in Beijing in October 2012, the author discusses the Emerging Voices programme for the Conference. The first part involved an introduction to new methods of presenting scientific research findings to a diverse audience in an effective way: Pecha Kucha and the Prezi. The author considered these picture-based alternatives better the traditional text-based PowerPoint presentation. Secondly, participants went on cultural and field visits to local Chinese traditional sites and were introduced to the Chinese health system. The author visited a district health office and two health centres in a rural area and was particularly impressed by the integration of Chinese traditional medicine with the Western medicine within the mainstream health system. This means that the Chinese give both disciplines and approaches adequate resources and attention in terms of developing them further. The conference offered a great opportunity to meet senior health systems researchers who could share their participatory action research methodologies.
Monitoring equity and research policy
Diseases such as malaria and HIV that disproportionately affect the developing world cause immense suffering and ill health. Medical innovation has the potential to deliver new medicines, vaccines, and diagnostics to overcome these diseases, yet few treatments have emerged. Current efforts to resolve the crisis are inadequate: financing for research and development (R&D) is insufficient, uncoordinated, and mostly tied to the system of intellectual property rights. Delivering appropriate medicines and vaccines requires reforms to the existing R&D system and a willingness to invest in promising new approaches. Ultimately, it is a combined responsibility of all countries to find ways to ensure global R&D is organized to improve human health; inability to pay should not disenfranchise a large majority of the world’s population from access to effective healthcare.
Health impact assessment differs from other purposes for which evidence is collated in a number of ways. This has implications for commissioning and conducting reviews. Methods must be developed to: facilitate comprehensive searching across a broad range of disciplines and information sources; collate appropriate quality criteria to assess a range of study designs; synthesise different kinds of evidence; and facilitate timely stakeholder involvement. Good practice standards for reviews are needed to reduce the risk of poor quality recommendations. Advice to decision makers must make explicit limitations resulting from absent, conflicting, or poor quality evidence.
How do health policies spread from one country to the next? Transfer without ownership may make implementation difficult. Researchers from the London School of Hygiene and Tropical Medicine look at the development of international policy on tuberculosis (TB) control over the last two decades. Do policy-makers adopt and adapt health policies voluntarily, after learning about experiences in other countries, or do international organisations or donors more often impose policies? The researchers posed these and other questions during interviews with 40 key players in TB policy development.
The annual meetings of the Global Forum are premier international events for stakeholders in health research for development. This Forum 11 report provides an overview and synthesis of the key issues discussed and conclusions reached. These include: the need for additional research; better systems of organizing and funding research, for ensuring participation in the process by all the stakeholders and for facilitating research to ensure impact on the health of those in need. Other central themes include: expanding the use of evidence in policy- and decision-making; equity and human rights (access and inclusion); encouraging innovation in research; research priority setting; research capacity strengthening; possibilities with inter-sectoral collaboration; advocacy for more research and resources; and communication of research results.
2001, 169p., ISBN 92 75 12288 1
The concept of equity has emerged as a primary guiding for the work of the Pan American Sanitary Bureau. The Bureau has been gathering information on and examining issues related to disparities in health in the Americas, especially as they relate to socioeconomic factors. The articles gathered in this publication represent an important step toward a more equitable distribution of health conditions and health related services, insofar as they represent the status of the issues and dilemmas faced by that Bureau in making equity an operational concept for its work in the Region. The authors have attempted to show how equity and the insights it yields into the distribution of health-dependent as this is on differences in education, income, class, ethnicity and race, geographic location, gender, and other distinctions-can underpin the Bureau's work at the operational level and be incorporated into technical cooperation activities.
In this paper, the authors report on a qualitative interviewing study in which they involved 17 genomics researchers in Africa. The authors describe their perceptions and expectations of international genomics research and biobanking initiatives in Africa. All interviewees were of the view that externally funded genomics research and biobanking initiatives have played a critical role in building capacity for genomics research and biobanking in Africa and in providing an opportunity for researchers in Africa to collaborate and network with other researchers. Whilst the opportunity to collaborate was seen as a benefit, some interviewees stressed the need for these collaborations to have mutual benefits for all partners, including their collaborators in high income countries. They voiced two major concerns of being part of these collaborative initiatives: the possibility of exploitation of African researchers and the non-sustainability of research capacity building efforts. They thus recommended genuine efforts to create transparent and equitable international health research partnerships through,: having rules of engagement, enabling African researchers to contribute to the design and conduct of international health projects in Africa, and mutual and respectful exchange of experience and capacity between research collaborators. These were identified as hallmarks to equitable international health research collaborations in Africa.
Monitoring inequalities in health is fundamental to the equitable and progressive realization of universal health coverage (UHC). A successful approach to global inequality monitoring must be intuitive enough for widespread adoption, yet maintain technical credibility. This article discusses methodological considerations for equity-oriented monitoring of UHC, and proposes recommendations for monitoring and target setting. Inequality is multidimensional, such that the extent of inequality may vary considerably across different dimensions such as economic status, education, sex, and urban/rural residence. Hence, global monitoring should include complementary dimensions of inequality (such as economic status and urban/rural residence) as well as sex. For a given dimension of inequality, subgroups for monitoring must be formulated taking into consideration applicability of the criteria across countries and subgroup heterogeneity. For economic-related inequality, the authors recommend forming subgroups as quintiles, and for urban/rural inequality the authors recommend a binary categorization. Inequality spans populations, thus appropriate approaches to monitoring should be based on comparisons between two subgroups (gap approach) or across multiple subgroups (whole spectrum approach). When measuring inequality absolute and relative measures should be reported together, along with disaggregated data; inequality should be reported alongside the national average. The authors recommend targets based on proportional reductions in absolute inequality across populations. Building capacity for health inequality monitoring is timely, relevant, and important. The development of high-quality health information systems, including data collection, analysis, interpretation, and reporting practices that are linked to review and evaluation cycles across health systems, will enable effective global and national health inequality monitoring. These actions will support equity-oriented progressive realization of UHC.
This paper examines the challenges and opportunities in establishing and sustaining north– south research partnerships in Africa through a case study of the UK-Africa Academic Partnership on Chronic Disease, which brought together multidisciplinary chronic disease researchers based in the UK and Africa to collaborate on research, inform policymaking, train and support postgraduates and create a platform for research dissemination. During the funded period researchers created a platform for research dissemination through international meetings and publications, but other goals, such as engaging in collaborative research and training postgraduates, were not as successfully realised. Enabling factors included trust and respect between core working group members, a shared commitment to achieving partnership goals, and the collective ability to develop creative strategies to overcome funding challenges. Barriers included limited funding, administrative support, and framework for monitoring and evaluating some goals. As chronic disease research partnerships in low-income regions operate within health systems that prioritise infectious diseases, their long-term sustainability will therefore depend on integrated funding systems that help build capacity, the authors argue. They identify social capital, measurable goals, administrative support, creativity and innovation and funding as five key ingredients that are essential for sustaining research partnerships.
In this commentary, the authors summarize the key milestones in the rise of digital health, illustrating efforts to bridge gaps in the evidence base, a shifting focus to scale-up and sustainability, growing attention to the precise costing of these strategies, and an emergent implementation science agenda to better characterize the necessary ecosystem of scale—the social, political, economic, legal, and ethical context that supports digital health implementation. In 2016, WHO established a guidelines development group to assess current evidence and recommendations for digital strategies. The guidelines development process recommends strategies that are adequately supported by sufficient evidence but also highlights promising strategies that currently have a low threshold of evidence that require future research, with a particular eye toward health system integration of these strategies. The evidence base of digital health approaches that have been successfully scaled up is growing, and new technology and shared standards provide a framework that can decrease the risk and amplify the promises of digital health investments. The authors argue that digital health innovations are increasing accessibility, promoting transparency, and have the capacity to increase accountability—all necessary facets of lasting health systems strengthening.