"...As studies have shown, evidence is rarely applied to decision making in accordance with a rational, linear model. In practice, evidence is often generated through doing – in the enactment of policy. Evidence may be only one component of any decision making process, but it can be made an integral part of a culture of inquiry based on continual learning and development. Leaders and managers need to appreciate the complex relationship between research evidence and practice, and to ensure the right conditions are created to allow practitioners to reflect on, and learn from, the practice of what they do and how they do it. In this way, learning becomes a supply of evidence to be drawn on as practitioners continue to implement and reshape policy..."
Monitoring equity and research policy
Despite the benefits to collaborative approaches and sharing of best practices, none of this can take place in the absence of adequate funding, the authors of this article argue. They call for re-examination of funding initiatives that bypass academic institutions because of a reluctance to fund ‘Ivory Tower’ initiatives. Recent initiatives will invest approximately US$130 million over the next five years to strengthen Africa’s educational institutions to produce the quantity and quality of scientists and health care workers needed to address the healthcare problems in the region. Whereas this represents a step in the right direction, substantially more funding will be required, including funding from the African governments themselves, to address national health priorities. The authors challenge conventional notions that academia is hesitant to come down from their ivory towers. Universities can and must be socially relevant. Funding and investments are needed now to make these collaborations sustainable, they conclude.
In May 2006, the Ministers of Health of all African countries, at a special session of the African Union, undertook to institutionalise efficiency monitoring within their respective national health information management systems. The specific objectives of this study were: (i) to assess the technical efficiency of National Health Systems (NHSs) of African countries for measuring male and female life expectancies, and (ii) to assess changes in health productivity over time with a view to analysing changes in efficiency and changes in technology. The analysis was based on a five-year panel data (1999-2003) from all 53 countries. Data Envelopment Analysis (DEA) − a non-parametric linear programming approach − was employed to assess the technical efficiency. Malmquist Total Factor Productivity (MTFP) was used to analyse efficiency and productivity change over time among the 53 countries' national health systems. The data consisted of two outputs (male and female life expectancies) and two inputs (per capital total health expenditure and adult literacy). All the 53 countries' national health systems registered improvements in total factor productivity, attributable mainly to technical progress. Over half of the countries' national health systems had a pure efficiency index of less than one, signifying that those countries' NHSs pure efficiency contributed negatively to productivity change.
Of the US$73 billion spent globally every year on health research only about 10% is actually allocated for research into 90% of the world’s health problems. This is what is known as the 10/90 gap. This third landmark report of the Global Forum for Health Research underlines the crucial role that health and health research funding plays in breaking the cycle of poverty.
The 46 African member states of the World Health Organisation (WHO) have commended WHO for operating the African Health Observatory (AHO) and requested that individual countries be assisted to establish their own national health observatories (NHOs). The need for NHOs was highlighted by the concerns raised by a number of countries at a regional committee meeting on the unavailability of timely information as hampering progress in providing quality health services in their countries. Zambia called for the inclusion of ‘community information systems’ to complement conventional data gathering. A number of countries raised the issue of integrating the NHOs into national health information systems (NHIS) as crucial to avoid burdening the NHIS. They noted that the NHOs should be simple and work towards harmonising data collection and coordination. Most countries saw the establishment of NHOs through technical support from the WHO as an opportunity to deal with the challenges of data fragmentation and the attendant problems of policy incoherencies.
Ministers and representatives of ministries of health, science and technology, education, foreign affairs, and international cooperation from 53 countries signed the Bamako Call to Action to promote health research in Africa. This document contains many references to improving the current state of affairs in Africa, where Africans are the objects of foreign research instead of conducting the research themselves. Efforts to build capacity, ensure equity, co-operate regionally, use knowledge translation, include all stakeholders and put appropriate legislation in place will be needed urgently if things are to change for Africa. The Call to Action pledges many grand promises for Africa’s future and the scope of action is wide indeed.
The BIAS FREE Framework provides a useful tool for the identification and elimination of bias in health research. The utility of The BIAS FREE Framework goes beyond the specific context of health research and extends to human subject research generally and to the policy and law reform contexts as well. The BIAS FREE Framework is posited on the equal entitlement of all people to be treated with dignity and respect and on the inviolability of human rights and it uses a rights-based model of health and well being.
This journal supplement is a contribution to changing practice by putting the perspectives, experiences and knowledge of West Africans on the table. It presents findings from a series of research and capacity development projects in West Africa funded by the International Development Research Centre's Maternal and Child Health programme. The evidence presented centres around two key themes. First, the theme that context matters. The evidence shows how context can change the shape of externally imposed interventions or policies resulting in unintended outcomes. At the same time, it highlights evidence showing how innovative local actors are developing their own approaches, usually low-cost and embedded in the context, to bring about change. The collection of articles discusses the critical need to overcome the existing fragmentation of expertise, knowledge and actors, and to build strong working relationships amongst all actors so they can effectively work together to identify priority issues that can realistically be addressed given the available windows of opportunity. Vibrant West African-led collaborations amongst researchers, decision-makers and civil society, which are effectively supported by national, regional and global funding, need to foster, strengthen and use locally-generated evidence to ensure that efforts to strengthen health systems and improve regional health outcomes are successful. The authors argue that the solutions are not to be found in the ‘travelling models’ of standardised interventions.
Perceptions in health research are a product of the circumstances within the society, where the research activities are situated. In East Africa there has been a change in conceptualisation over a period of time from an elitist de-linked status to the present, which has evolved to embrace the local community. In this paper, researchers trace the changes and highlight some occurrences that exerted the greatest influence in shaping the notions that currently dominate in research. They conclude that the paradigm shift is a positive development and that the present conception is suitable for heath research at this point in time.
This paper explores parasite movements as a source of valuable information for planning control strategies for malaria. Mobile parasite carrying individuals can instigate transmission in receptive areas, spread drug resistant strains and reduce the effectiveness of control strategies. The identification of mobile groups, their routes of travel and how these movements connect differing transmission zones, potentially enables limited resources for interventions to be efficiently targeted over space, time and populations. National data on population and migration were linked to migration, travel, and other data to understand malaria movement patterns. Together with existing spatially referenced malaria data and mathematical models, network analysis techniques were used to quantify the demographics of human and malaria movement patterns in Kenya, Uganda and Tanzania. Patterns of human and malaria movements varied between demographic groups, within country regions and between countries. Migration rates were highest in 20–30 year olds in all three countries, but when accounting for malaria prevalence, movements in the 10–20 year age group became more important.