The purpose of this report was to assess the application of clinical predictors for the diagnosis of the HIV infections, including AIDS, among TB-positive subjects enrolled within an urban heterosexual sero-discordant couple (one partner HIV-positive and the other HIV-negative) cohort study at an HIV prevention and research centre in Lusaka, Zambia. The report documents the relative effectiveness of the World Health Organisation clinical case definition for HIV/AIDS (WHOCCDA) in predicting HIV/AIDS cases and discusses the health and policy implications.
Monitoring equity and research policy
Predictors of HIV/AIDS among Individuals with Tuberculosis: Health and Policy Implications
Pressure to publish is choking the academic profession
Vale P; Karataglidis S: The Conversation, 6 July 2016
The regime of publication pervades contemporary academic life across countries. The obligation that academic staff must publish is invariably presented as a virtuous thing. It is right and proper for academics to expand and extend the boundaries of their respective disciplines by publishing in outlets, as approved by their peers. Moreover, a public that is often sceptical of the usefulness of universities is often told that academics publish in “the public good”. But, the authors ask, if academic publishing is so significant in the profession, why is it that the young and talented in the academy increasingly resist it, calling it formulaic, at best, and, at worst, a sweatshop? And they ask, why is it that old academic hands are simply no longer interested in contributing to the peer-review system that is at the heart of the system and without which the standing of the entire industry will falter? For one thing, the authors argue, there is a dark side in the ceaseless pressure to publish. Funding agencies use publication records to distribute money or rank scholars and academic managers use the publication record as a means to manage people. For another, the current system privileges the journal over the book, which is argued to be damaging to the humanities. They argue for the need to recognise that “slow scholarship” is as important as it is necessary, and that deep research – especially, but not exclusively in the humanities – requires what strategic theorist Albert Wohlstetter once called a high thought to publication ratio. Research and publishing is the oxygen of academic life, but the authors suggest that the regimes of control that surround contemporary approaches to publishing are choking creativity and, with it, the profession itself.
Priorities for research to take forward the health equity policy agenda
WHO Task Force on Research Priorities for Equity in Health
Despite impressive improvements in aggregate indicators of health globally over the past few decades, health inequities between and within countries have persisted, and in many regions and countries are widening. We recommend that highest priority be given to research in five general areas: (1) global factors and processes that affect health equity and/or constrain what countries can do to address health inequities within their own borders; (2) societal and political structures and relationships that differentially affect people's chances of being healthy within a given society; (3) interrelationships between factors at the individual level and within the social context that increase or decrease the likelihood of achieving and maintaining good health; (4) characteristics of the health care system that influence health equity and (5) effective policy interventions to reduce health inequity in the first four areas.
Priority setting and health policy and systems research
Ranson MK and Bennett SC: Health Research Policy and Systems 7(27), 4 December 2009
This paper aims to assess current priority setting methods and the extent to which they adequately include health policy and systems research (HPSR) and to draw out lessons regarding how HPSR priority setting can be enhanced to promote relevant HPSR and to strengthen developing country leadership of research agendas. Priority setting processes can be distinguished by the level at which they occur, their degree of comprehensiveness in terms of the topic addressed, the balance between technical versus interpretive approaches and the stakeholders involved. When HPSR is considered through technical, disease-driven priority setting processes it is systematically under-valued. More successful approaches for considering HPSR are typically nationally driven, interpretive and engage a range of stakeholders. There is still a need however for better defined approaches to enable research funders to determine the relative weight to assign to disease specific research versus HPSR and other forms of cross-cutting health research. While country-level research priority setting is key, there is likely to be a continued need for the identification of global research priorities for HPSR. The paper argues that such global priorities can and should be driven by country level priorities.
Priority setting for health policy and systems research
Alliance for Health Policy and Systems Research Briefing Note 3: September 2009
The main pattern of research funding is driven by the interests of research funders, who are often external rather than domestic actors. When priority-setting processes do occur, they are typically disease-driven and without a broader, more integrated systems-level perspective (for example, determining how research might address one or more health-system building blocks). As a result, there is rarely consensus on national evidence needs, few national research priorities are set, and research in low- to middle-income countries (LMICs) continues to follow the fleeting and shifting priorities of global funders. This brief discusses the fundamental concepts of priority setting exercises; explores the priority-setting dynamic between the national and global levels; describes priority setting exercises specific to health policy and systems research; and details the work of the in driving global priorities based on the evidence needs of LMIC policy-makers through a three-step approach. It concludes with recommendations for how researchers, LMIC policy-makers and the global community might increasingly promote, fund and convene priority-setting exercises in health policy and systems research.
Producing home grown solutions: Think tanks and knowledge networks in international development
Datta A: Open Development, World Bank Institute, September 2011
In this article, the author argues that international agreements and planning instruments such as the World Bank’s Poverty Reduction Strategy Papers (PRSPs) often fail to question the parameters within which national plans are prepared. Home grown solutions can only be produced from knowledge and policies that are locally generated and context specific. Southern knowledge centres (or think tanks) – which are estimated to number about 2,000 – then have a crucial role to play in promoting economic and social development in the global South, particularly in the poorer economies. In an increasingly interconnected world, Northern and Southern think tanks are joining forces in partnerships and networks to generate and use knowledge more systematically to address national, regional, and global challenges. A number of examples of North-South collaborations are discussed in the article, including the Chronic Poverty Research Centre and the Climate and Development Knowledge Network. Networks of think tanks can provide an extremely effective mechanism for learning and innovation, the author notes, and they can enable collaboration beyond the usual institutional, cultural, and functional boundaries of an organisation.
Progress in promoting data sharing in public health emergencies
Littler K; Boon W; Carson G et al.: Bulletin of the World Health Organisation 95(4) 2017
In February 2016, the World Health Organisation (WHO) declared the Zika virus-related cluster of microcephaly cases and other neurological disorders reported in Brazil, a Public Health Emergency of International Concern (PHEIC). Following the declaration, over 30 global health bodies issued a joint statement committing to data sharing to ensure that the global response to the Zika virus and future emergencies, could be informed by the best and most current evidence. The statement represented a concerted effort by those involved to address past failures of timely access to relevant data. It also highlighted the lack of a clear path to implementation for data sharing during public health emergencies. In March 2016, the Global Research Collaboration for Infectious Disease Preparedness established a data-sharing working group which has been working in coalition with other stakeholders including WHO, scientists, nongovernmental organisations, journals and other agencies. This group is working to identify barriers to data sharing in public health emergencies that should be addressed to better prepare for any future epidemic. The experiences from the 2013–2016 Ebola virus disease outbreak and the 2015 Zika virus outbreak demonstrated the importance of research in public health emergencies and the difficulties associated with sharing research findings rapidly and outside of conventional scientific publications. The WHO consensus and policy statements called for a paradigm shift in information sharing in public health emergencies and described the particularities to consider in dealing with different data types. Despite these efforts, rapid data sharing during public health emergencies remains challenging for various reasons. First, there are limited incentives for researchers and other people responding to the emergency to share data. Second, there is a lack of appropriate infrastructure for data sharing such as repositories and information technology platforms. Such rapid data sharing requires a clear governance structure that ensures a balance between privacy and access, as well as adheres to national and international ethical and legal requirements. The GloPID-R working group has developed, and requests comment on, a set of principles to underpin future implementation of timely data sharing. These new principles draw on others, such as the FAIR Guiding Principles for scientific data management and stewardship, and are intended to provide an initial framework for discussion. The collective work is intended to support WHO’s Research and Development Blueprint and include other stakeholders, such as the Global Outbreak Alert and Response Network and the Coalition for Epidemic Preparedness. Effective data sharing requires flexibility by all stakeholders to adapt to unforeseen events and challenges. A data-sharing system needs to allow collaboration between stakeholders in the absence of pre-existing relationships and all collaborators need to adhere to fundamental ethical principles of data use. Above all, it must ensure that people in all affected countries benefit from timely access to evidence-based interventions in emergencies.
Projections of global mortality and burden of disease from 2002 to 2030.
Mathers CD, Loncar,D: Plos Medicine 3(11): e442-e442
Global and regional projections of mortality and burden of disease by cause for the years 2000, 2010, and 2030 were published by Murray and Lopez in 1996 as part of the Global Burden of Disease project. To address the widespread demand for information on likely future trends in global health, and thereby to support international health policy and priority setting, the authors have prepared new projections of mortality and burden of disease to 2030 starting from World Health Organization estimates of mortality and burden of disease for 2002. This paper describes the methods, assumptions, input data and results.
Public Health: Disconnections between policy, practice and research
Jansen MW, Van Oers HA, Kok G and de Vries NK: Health Research Policy and Systems 8(37), 31 December 2010
Collaboration between policy, practice and research is imperative to obtaining more solid evidence in public health. However, the three domains do not easily work together because they emanate from three more-or-less independent 'niches', the authors of this study argue. They conducted a literature review of qualitative descriptive research published in English and Dutch between 1980 and 2006, and analysed literature according to the four steps of the policy, practice and research work cycles: problem recognition, approach formulation, implementation and evaluation. They found conspicuous differences in approach formulation and implementation that strengthen the niche character of each domain and hamper integration and collaboration. Disconnections ranged from formulating priorities in problem statements to power roles, appraisal of evidence, work attitudes, work pace, transparency of goals, evaluation and continuation strategies and public accountability. Creating awareness of these disconnections may result in more compatibility between researchers, policy makers and practitioners. This analysis can be used by public health services-related researchers, practitioners and policy makers to take into account the risk for disconnections. The authors recommend practice- and policy-based research networks to establish strong links between researchers, policy makers and practitioners to improve public health.
Pushing the international health research agenda towards equity and effectiveness
Despite substantial sums of money being devoted to health research, most of it does not benefit the health of poor people living in developing countries, a matter of concern to civil society networks, such as the People's Health Movement. Health research should play a more influential part in improving the health of poor people, not only through the distribution of knowledge, but also by answering questions, such as why health and healthcare inequities continue to grow despite greatly increased global wealth, enhanced knowledge, and more effective technologies.