South Africa’s first bio-bank, a cold storage facility where samples from HIV clinical trials and other diseases can be stored for years to support future medical research, was launched in Johannesburg. Bio-banking is a novel concept on the African continent and South Africa is the first country to introduce it. ‘Bio-banking ensures that the integrity of the samples is kept so that when you do run the test, you’re able to get sense out of the result’, explained Jessica Trusler, medical director of Bio-analytical Research Corporation (BRAC) South Africa. Peter Cole, chief executive officer of BRAC, noted: ‘The ability to store samples long term, including the RNA and DNA of these infectious pathogens means that we can do things like look at resistance patterns to drugs, we can use the DNA in the future for vaccine development, we can store TB DNA looking at resistance patterns against the various drugs and the role of what we call MOTTS, the non-tuberculous organisms in the immuno-compromised patients. So, there’s a lot of unique stuff that we can do here’, he added.
Monitoring equity and research policy
Promoting the use of research-based knowledge in public health becomes more complex when public health includes interventions on health determinants. This article examines strategies for knowledge synthesis, translation and exchange (KSTE) in the context of public health in Canada, making reference to the work of the recently established National Collaborating Centres for Public Health (NCCs). NCCs simultaneously pursue KSTE and study how KSTE strategies meet different needs. Because NCCs are focused on interventions and policies, they must address the relationship between knowledge and policy, and how amenable it is to change. KSTE can seek to respond to and inform an existing policy agenda, but it can also seek to shape, frame and change that agenda. The two paths might call for different approaches, and for expanding the boundaries of KSTE in health.
Health research generates knowledge that can be utilized to improve health system performance and, ultimately, health and health equity. The authors of this article propose a conceptual framework for health research systems (HRSs) that defines their boundaries, components, goals, and functions. The framework adopts a systems perspective towards HRSs and serves as a foundation for constructing a practical approach to describe and analyse HRSs. The analysis of HRSs should, in turn, provide a better understanding of how research contributes to gains in health and health equity.
Does research influence public policy and decision-making and, if so, how? This book is the most recent to address this question, investigating the effects of research in the field of international development. It starts from a sophisticated understanding about how research influences public policy and decision-making. It shows how research can contribute to better governance in at least three ways: by encouraging open inquiry and debate, by empowering people with the knowledge to hold governments accountable, and by enlarging the array of policy options and solutions available to the policy process. Knowledge to Policy examines the consequences of 23 research projects funded by Canada’s International Development Research Centre. Key findings and case studies from Asia, Africa, and Latin America are presented in a reader-friendly, journalistic style, giving the reader a deeper grasp and understanding of approaches, contexts, relationships and events.
Several South African organisations have recently joined together to form the Budget and Expenditure Monitoring Forum (BEMF). The forum advocates for reasonable and sufficient funds to be allocated to health care based on the best evidence available, particularly for HIV programmes, and for those funds to be spent in a reasonable and constitutionally valid manner. It will work to ensure that there are no further treatment interruptions and moratoriums, that there is proper monitoring and evaluation of the highly active antiretroviral treatment (HAART) and prevention of mother-to-child transmission (PMTCT) programmes, and that the national departments of health and finance intervene in provinces not delivering these programmes adequately. In the last financial year several budgeting decisions were made which the member organisations of the BEMF believe violated the legal rights of individuals. The most visible was the moratorium on the initiation of patients onto HAART in the Free State from November 2008 through March 2009. The Southern African HIV Clinicians Society estimated that at least 30 lives a day were lost as a result this decision.
RESYST is a new international research consortium funded by the United Kingdom’s Department for International Development. It aims to enhance the resilience and responsiveness of health systems globally to promote health and health equity and reduce poverty. RESYST conducts research in a variety of countries in Africa and Asia, including low- and middle-income countries, seeking to identify lessons that are transferable across contexts. Research is conducted in three areas: financing (focusing on how best to finance universal health coverage in low and middle-income countries); health workforce (identifying effective, practical interventions to address human resource constraints); and governance (studying the relationships among frontline actors and mid-level management, and leadership in health policy implementation processes).
According to this article, the latest estimates of under-five mortality from the United Nations Inter-agency Group for Child Mortality Estimation (IGME) show a one-third decline at the global level of under-five mortality rates from 89 deaths per 1000 livebirths in 1990 to 60 in 2009. Over the same period, the total number of under-five deaths has decreased from 12.4 million in 1990 to 8.1 million in 2009. The article argues that this constitutes evidence that progress on child mortality is being made across all regions of the world, with many regions having reduced the under-five mortality rate by 50% or more. With only five years left until the 2015 deadline to achieve the Millennium Development Goals (MDGs), progress needs to be accelerated. These IGME estimates are the latest available information on child mortality to provide a basis for assessing progress and reaching consensus for action.
In Mozambique most of demographic data are obtained using census or sample survey including indirect estimations. A method of collecting longitudinal demographic data was introduced in southern Mozambique since 1996 (DSS -Demographic Surveillance System in Manhiça district, Maputo province), but the extent to which it yields demographic measures that are typical of southern rural Mozambique has not been evaluated yet.
Neal Halfon and Miles Hochstein, The Milbank Quarterly, 2002
This article describes the Life Course Health Development (LCHD) framework, which was created to explain how health trajectories develop over an individual’s lifetime and how this knowledge can guide new approaches to policy and research. Based on the relationship between experience and the biology and psychology of development, the LCHD framework offers a conceptual model for health development and a more powerful approach to understanding diseases. The article illustrates how risk factors, protective factors, and early-life experiences affect people’s long-term health and disease outcomes. A better understanding of health development should enable us to manipulate early risk factors and protective factors and help shift our emphasis on treatment in the later stages of disease to the promotion of earlier, more effective preventive strategies and interventions focused on maximizing optimal health development.
The need for legislative information and research, especially in developing and transition countries, is growing as policy-making processes become more complex, particularly in the context of globalisation, regional integration and decentralisation. Since the executive branch of governments generally has access to a larger pool of knowledge and expertise than the national legislature, there is a need to address the imbalance in access to knowledge between the executive, legislature and judiciary in order to promote better quality policy-making. Better access to information and research can help empower legislatures to formulate and pass effective legislation and perform effective scrutiny of government. Using the Research and Policy in Development (RAPID) framework, this study maps the links between researchers and legislators in a number of transition and developing countries; explores the role of politics in influencing researcher–legislator linkages; and comments on the type of research produced as well as the credibility of the research/researchers. Civil society organisations (CSO) particularly in Sub-Saharan Africa, perhaps because of weak political parties, play a key role in representing grassroots constituencies in legislative processes. Legislative committee hearings across all legislatures tend to be a key mechanism through which researchers’ voices can be heard in the processes of law-making and oversight. Some legislatures, particularly those in East Asia, have substantial in-house technocratic capacity, including library and research services and the capacity to commission research. In Sub-Saharan Africa, a number of (donor-funded) organisations have been set up to provide the legislature with input and capacity, particularly on management of public finances. Researcher–legislator linkages, particularly in Sub-Saharan Africa, tend to be stronger or more visible in areas that are perceived to require hard data, such as quantitative analyses. These include public financial management, particularly budgeting and budget control. In Sub-Saharan Africa, these formal mechanisms were found in the study to be externally funded and/or -inspired. Where hard data is concerned, research tends to be demand-oriented; in the softer sectors, CSOs have tended to take the initiative to engage legislators. The relationship between political context factors and researcher–legislator links was found to be complex. Legislators’ personal motivations, such as the desire for political advancement, to influence policy, for power in a legislative body and for private gain, can affect the way they view or use evidence in the policy process. The capacity provided by a legislature’s procedures, structures and support mechanisms also influences the role of research in law-making and oversight processes. They propose that researchers work harder to ensure evidence is accessible by legislators and related to legislative decisions, that fits tightly with legislative processes. Legislators emphasised the need for researchers to go beyond stating research findings to actually narrate a compelling story with practical policy recommendations. Moreover, evidence is more likely to be taken up if messages resonate with broader national policy agendas, such as economic growth. Given the pressures on their time and relatively low research literacy levels, research intended for legislators needs to be presented in short summaries, where possible illustrated by pictures and/or charts. Nevertheless, Legislators’ staff prefer formats that present more detail.