Monitoring equity and research policy

There is a growing interest in the ethics of health systems research, and some debate about whether a specific ethical framework or set of guidance is needed. The authors provide a framework to begin to think about this, organised around eight considerations: (1) the nature of intervention; (2) types of research subjects; (3) units of intervention and observation; (4) informed consent; (5) controls and comparisons; (6) risk assessment; (7) inclusion of vulnerable groups within different contexts, and; (8) benefits of research. This is a starting place for researchers interested in health systems research ethics. The authors note several challenges to thinking about the ethics of health systems research, including the diverse range of studies and disciplines involved, the grey zone between research and non-research, and the many overlaps of issues with other types of health research. They call for more conceptual work and empirical research aimed at better understanding this topic.

ince the publication of the reports by the Commission on Social Determinants of Health (CSDH), many research papers have documented inequities, explaining causal pathways in order to inform policy and programmatic decision-making. At the international level, the sustainable development goals (SDGs) reflect an attempt to bring together these themes and the complexities involved in defining a comprehensive development framework. However, to date, much less has been done to address the monitoring challenges, that is, how data generation, analysis and use are to become routine tasks. In an attempt to explore these monitoring challenges, indicators covering a wide range of social determinants were tested in four country case studies (Bangladesh, Brazil, South Africa, and Vietnam) for their technical feasibility, reliability, and validity, and their communicability and usefulness to policy-makers. Twelve thematic domains with 20 core indicators covering different aspects of equity, human rights, gender, and SDH were tested through a review of data sources, descriptive analyses, key informant interviews, and focus group discussions. To test the communicability and usefulness of the domains, domain narratives that explained the causal pathways were presented to policy-makers, managers, the media, and civil society leaders. For most countries, monitoring is possible, as some data were available for most of the core indicators. However, a qualitative assessment showed that technical feasibility, reliability, and validity varied across indicators and countries. Producing understandable and useful information proved challenging, and particularly so in translating indicator definitions and data into meaningful lay and managerial narratives, and effectively communicating links to health and ways in which the information could improve decision-making. This exercise revealed that for monitoring to produce reliable data collection, analysis, and discourse, it will need to be adapted to each national context and institutionalised into national systems. This will require that capacities and resources for this and subsequent communication of results are increased across countries for both national and international monitoring, including the successful implementation of the SDGs.

Over the past two decades, Africa has returned to academic agendas outside of the continent. At the same time, the field of African Studies has come under increasing criticism for its marginalisation of African voices, interests, and agendas. This article explores how the complex transformations of the academy have contributed to a growing division of labour. Increasingly, African scholarship is associated with the production of empirical fact and socio-economic impact rather than theory, with ostensibly local rather than international publication, and with other forms of disadvantage that undermine respectful exchange and engagement. This article suggests ways of understanding and engaging with these inequalities.

This article argues that mobile phone connectivity in developing countries facilitates social and economic development through increased access to people, information and services such as health care, education, employment opportunities and market information. In developing countries, which lack the physical and technical infrastructure present in more developed nations, cell phone surveys provide an inexpensive and feasible way to conduct population-based data collection. However, the authors point out several issues that should be considered when conducting cell phone surveys in developing countries. Reception may not be available in rural zones, and it may be difficult to sample owners from cell phone registration lists if most users are unregistered. In addition, one needs to be aware of the cost that cell phone subscribers pay to receive a call and offer reimbursement for the time spent responding to the survey. Selection of one adult respondent from a sample household should always include consideration of the number of adults with cell phones in the household and whether people share cell phones. Text messages rather than voice calls may also be the primary means of cell phone communication in developing countries. The authors conclude that cell phone health surveys may come into wider use if the above issues can be addressed.