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Vílchez-Román C, Paucar-Caceres A, Quispe-Prieto S. The impact of research on health education/health literacy on policymaking in Latin America and the Caribbean Region. AIMS Public Health 2024; 11:330-348. [PMID: 39027398 PMCID: PMC11252583 DOI: 10.3934/publichealth.2024017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/19/2024] [Accepted: 01/28/2024] [Indexed: 07/20/2024] Open
Abstract
Background In this study, we addressed the gap between health research and policymaking in Latin America and the Caribbean (LAC), focusing on health education/health literacy. Despite growing research, translating findings into effective policies needs to be improved. We explored the factors that make research on health education and health literacy to be referenced and mentioned in policy documents in LAC (and in Peru). We proposed a model based on the hypothesis that the relationship between research and policymaking depends on the research strength of scientific evidence, timing, and social media activity. Methods A mixed-methods approach was employed, combining quantitative and qualitative data analysis. Quantitative data sources included multidisciplinary databases, altmetric data, and citations of policy documents. For data analysis, we obtained descriptive statistics to identify patterns and then verified the association between variables using χ2. The negative binomial regression was used to test the empirical model introduced above. Quantitative analysis was complemented by analysis of responses to a set of open questions from a sample of Peruvian health policymakers. Results We found that timing, strength of evidence, and social media activity were significant predictors of research cited in policy documents. Policy documents tended to rely more on qualitative evidence. A positive correlation between timing and cites in policy documents highlighted the importance of timely dissemination, whereas social media activity, while having an impact, had a relatively minor effect. Peruvian policymakers' responses emphasized the role of political context, the relevance of results, and policymakers' commitment to incorporating research into policies. Conclusion Strength of evidence, social media engagement, and publication timing are key predictors of citations for health education/literacy research in LAC policy documents. However, qualitative findings highlight challenges, including some distrust in research findings, together with limited access to relevant research. The findings offer opportunities to enhance evidence-informed health education/health literacy policy decisions. Implications To increase the influence on health policymakers, researchers should prioritize the timely dissemination of solid evidence, considering both traditional and digital platforms. Policymakers should focus on the quality and relevance of evidence when formulating policies.
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Affiliation(s)
- Carlos Vílchez-Román
- Research Department, CENTRUM Católica Graduate Business School (CCGBS), Pontificia Universidad Católica del Perú (PUCP), Lima 15023, Perú
| | - Alberto Paucar-Caceres
- Department for Operations, Technology, Events and Hospitality Management, Manchester Metropolitan University, Manchester, M15 6BH, United Kingdom
| | - Silvia Quispe-Prieto
- School of Nursing, Faculty of Health Sciences, Universidad Nacional Jorge Basadre Grohmann, Grohmann, Tacna 23000, Perú
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Akter K, Shawar YR, Tesfa A, Howell CD, Seruwagi G, Kyamulabi A, Dube A, Gonfa G, Mwaba K, Kinney M, English M, Shiffman J, Djellouli N, Colbourn T. Influences on policy-formulation, decision-making, organisation and management for maternal, newborn and child health in Bangladesh, Ethiopia, Malawi and Uganda: The roles and legitimacy of a multi-country network. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001742. [PMID: 37988328 PMCID: PMC10662733 DOI: 10.1371/journal.pgph.0001742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 10/12/2023] [Indexed: 11/23/2023]
Abstract
The Network for Improving Quality of Care for Maternal, Newborn and Child Health (QCN) is intended to facilitate learning, action, leadership and accountability for improving quality of care in member countries. This requires legitimacy-a network's right to exert power within national contexts. This is reflected, for example, in a government's buy-in and perceived ownership of the work of the network. During 2019-2022 we conducted iterative rounds of stakeholder interviews, observations of meetings, document review, and hospital observations in Bangladesh, Ethiopia, Malawi, Uganda and at the global level. We developed a framework drawing on three models: Tallberg and Zurn which conceptualizes legitimacy of international organisations dependent on their features, the legitimation process and beliefs of audiences; Nasiritousi and Faber, which looks at legitimacy in terms of problem, purpose, procedure, and performance of institutions; Sanderink and Nasiritousi, to characterize networks in terms of political, normative and cognitive interactions. We used thematic analysis to characterize, compare and contrast institutional interactions in a cross-case synthesis to determine salient features. Political and normative interactions were favourable within and between countries and at global level since collective decisions, collaborative efforts, and commitment to QCN goals were observed at all levels. Sharing resources and common principles were not common between network countries, indicating limits of the network. Cognitive interactions-those related to information sharing and transfer of ideas-were more challenging, with the bi-directional transfer, synthesis and harmonization of concepts and methods, being largely absent among and within countries. These may be required for increasing government ownership of QCN work, the embeddedness of the network, and its legitimacy. While we find evidence supporting the legitimacy of QCN from the perspective of country governments, further work and time are required for governments to own and embed the work of QCN in routine care.
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Affiliation(s)
- Kohenour Akter
- Perinatal Care Project, Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Yusra Ribhi Shawar
- Bloomberg School of Public Health, John Hopkins University, Baltimore, United States of America
- Paul H. Nitze School of Advanced International Studies, John Hopkins University, Washington, D.C., United States of America
| | - Anene Tesfa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | | | - Gloria Seruwagi
- School of Public Health, Makerere University, Kampala, Uganda
| | - Agnes Kyamulabi
- School of Public Health, Makerere University, Kampala, Uganda
| | - Albert Dube
- Parent And Child Health Initiative PACHI, Lilongwe, Malawi
| | - Geremew Gonfa
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Kasonde Mwaba
- Institute for Global Health, University College London, London, United Kingdom
| | | | - Mary Kinney
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Mike English
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Jeremy Shiffman
- Bloomberg School of Public Health, John Hopkins University, Baltimore, United States of America
- Paul H. Nitze School of Advanced International Studies, John Hopkins University, Washington, D.C., United States of America
| | - Nehla Djellouli
- Institute for Global Health, University College London, London, United Kingdom
| | - Tim Colbourn
- Institute for Global Health, University College London, London, United Kingdom
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Ramani-Chander A, Thrift A, van Olmen J, Wouters E, Delobelle P, Vedanthan R, Miranda JJ, Sherwood S, Teede HJ, Joshi R. Prioritising and planning scale-up research projects targeting non-communicable diseases: a mixed-method study by the Global Alliance for Chronic Diseases upscaling working group. BMJ Glob Health 2023; 8:e012804. [PMID: 37963611 PMCID: PMC10649516 DOI: 10.1136/bmjgh-2023-012804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/07/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION Governments must scale-up evidence-based interventions to reduce the burden of non-communicable diseases (NCDs). Implementation research can help develop contextually appropriate strategies and optimise interventions for scale-up. We aimed to determine the priorities of the Global Alliance for Chronic Diseases (GACD) 2019 funding round for scale-up research targeting NCD interventions. The research questions were: (a) What was the purpose of the call and what were the specific issues considered by funders when supporting the selected projects? (b) How did the selected research projects align with the objectives of GACD scale-up call? METHODS We undertook a mixed-methods study to examine the projects funded by the GACD in 2019. We completed semistructured interviews with representatives from 5 out of 8 funding agencies and complemented this by reviewing project documents from 21 (78%) of the 27 funded studies. A literature review of scale-up frameworks informed the interview guide and data extraction template. The transcripts were open-coded using thematic analysis to identify critical issues for funders. Data were extracted to identify the common elements considered when planning, implementing and evaluating interventions for scale-up. RESULTS Interviews with the funders revealed three enabling themes related to scale-up: local research priorities (contextualisation through engagement), capacity building (developing knowledge base) and connections (networking opportunities). We further identified that timelines (more flexibility) and equity (funding low-income and middle-income researchers) could be considered for future funding investments. Multidisciplinary international research teams led the development of diverse studies to address funder's priorities. The detailed plans included a range of implementation frameworks to help develop contextual scale-up strategies. CONCLUSIONS Fundamental to NCD scale-up research are (1) funding opportunities that reflect the complexity and time necessary to enable contextualisation; (2) investment in building multidisciplinary research capacity and leadership and (3) better networking to encourage cohesive action and align NCD-related scale-up research activities globally.
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Affiliation(s)
- Anusha Ramani-Chander
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Melbourne, Australia
| | - Amanda Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Melbourne, Australia
| | - Josefien van Olmen
- Department of Family Health and Population Medicine, University of Antwerp, Antwerpen, Belgium
| | - Edwin Wouters
- Department of Sociology, Centre for Population, Family & Health, Faculty of Social Sciences, University of Antwerp, Antwerpen, Belgium
| | - Peter Delobelle
- Department of Public Health, Vrije Universiteit Brussel, Brussels, Belgium
- Chronic Diseases Initiative for Africa, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Rajesh Vedanthan
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Stephen Sherwood
- Fundación EkoRural, Quito, Ecuador
- Knowledge, Technology and Innovation, Wageningen University, Wageningen, Netherlands
| | - Helena J Teede
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - Rohina Joshi
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health India, New Delhi, India
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Robson RC, Thomas SM, Langlois ÉV, Mijumbi R, Kawooya I, Antony J, Courvoisier M, Amog K, Marten R, Chikovani I, Nambiar D, Ved RR, Bhaumik S, Balqis-Ali NZ, Sararaks S, Md. Sharif S, Kangwende RA, Munatsi R, Straus SE, Tricco AC. Embedding rapid reviews in health policy and systems decision-making: Impacts and lessons learned from four low- and middle-income countries. Health Res Policy Syst 2023; 21:45. [PMID: 37280697 PMCID: PMC10243686 DOI: 10.1186/s12961-023-00992-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/09/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Demand for rapid evidence-based syntheses to inform health policy and systems decision-making has increased worldwide, including in low- and middle-income countries (LMICs). To promote use of rapid syntheses in LMICs, the WHO's Alliance for Health Policy and Systems Research (AHPSR) created the Embedding Rapid Reviews in Health Systems Decision-Making (ERA) Initiative. Following a call for proposals, four LMICs were selected (Georgia, India, Malaysia and Zimbabwe) and supported for 1 year to embed rapid response platforms within a public institution with a health policy or systems decision-making mandate. METHODS While the selected platforms had experience in health policy and systems research and evidence syntheses, platforms were less confident conducting rapid evidence syntheses. A technical assistance centre (TAC) was created from the outset to develop and lead a capacity-strengthening program for rapid syntheses, tailored to the platforms based on their original proposals and needs as assessed in a baseline questionnaire. The program included training in rapid synthesis methods, as well as generating synthesis demand, engaging knowledge users and ensuring knowledge uptake. Modalities included live training webinars, in-country workshops and support through phone, email and an online platform. LMICs provided regular updates on policy-makers' requests and the rapid products provided, as well as barriers, facilitators and impacts. Post-initiative, platforms were surveyed. RESULTS Platforms provided rapid syntheses across a range of AHPSR themes, and successfully engaged national- and state-level policy-makers. Examples of substantial policy impact were observed, including for COVID-19. Although the post-initiative survey response rate was low, three quarters of those responding felt confident in their ability to conduct a rapid evidence synthesis. Lessons learned coalesced around three themes - the importance of context-specific expertise in conducting reviews, facilitating cross-platform learning, and planning for platform sustainability. CONCLUSIONS The ERA initiative successfully established rapid response platforms in four LMICs. The short timeframe limited the number of rapid products produced, but there were examples of substantial impact and growing demand. We emphasize that LMICs can and should be involved not only in identifying and articulating needs but as co-designers in their own capacity-strengthening programs. More time is required to assess whether these platforms will be sustained for the long-term.
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Affiliation(s)
- Reid C. Robson
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON M5B 1T8 Canada
| | - Sonia M. Thomas
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON M5B 1T8 Canada
| | - Étienne V. Langlois
- Partnership for Maternal, Newborn and Child Health (PMNCH), World Health Organization, Geneva, Switzerland
- Alliance for Health Policy and Systems Research, Science Division, World Health Organization (WHO), Geneva, Switzerland
| | - Rhona Mijumbi
- The Center for Rapid Evidence Synthesis (ACRES), Regional East African Policy Initiative, Uganda Node, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ismael Kawooya
- The Center for Rapid Evidence Synthesis (ACRES), Regional East African Policy Initiative, Uganda Node, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jesmin Antony
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON M5B 1T8 Canada
| | - Melissa Courvoisier
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON M5B 1T8 Canada
| | - Krystle Amog
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON M5B 1T8 Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Robert Marten
- Alliance for Health Policy and Systems Research, Science Division, World Health Organization (WHO), Geneva, Switzerland
| | - Ivdity Chikovani
- Research Department, Curatio International Foundation, Tbilisi, Georgia
| | - Devaki Nambiar
- The George Institute for Global Health, New Delhi, India
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | | | - Soumyadeep Bhaumik
- Meta-Research & Evidence Synthesis Unit, The George Institute for Global Health, New Delhi, India
| | - Nur Zahirah Balqis-Ali
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Putrajaya, Malaysia
| | - Sondi Sararaks
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Putrajaya, Malaysia
| | - Shakirah Md. Sharif
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Putrajaya, Malaysia
| | | | - Ronald Munatsi
- Zimbabwe Evidence-Informed Policy Network (ZeipNET), Harare, Zimbabwe
| | - Sharon E. Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON M5B 1T8 Canada
- Department of Geriatric Medicine, University of Toronto, Toronto, ON Canada
| | - Andrea C. Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 209 Victoria Street, 7th Floor, East Building, Toronto, ON M5B 1T8 Canada
- Epidemiology Division and Institute for Health, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
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Uneke CJ, Okedo-Alex IN, Akamike IC, Uneke BI, Eze II, Chukwu OE, Otubo KI, Urochukwu HC. Institutional roles, structures, funding and research partnerships towards evidence-informed policy-making: a multisector survey among policy-makers in Nigeria. Health Res Policy Syst 2023; 21:36. [PMID: 37237324 DOI: 10.1186/s12961-023-00971-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/27/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Evidence-informed policy-making aims to ensure that the best and most relevant evidence is systematically generated and used for policy-making. The aim of this study was to assess institutional structures, funding, policy-maker perspectives on researcher-policy-maker interactions and the use of research evidence in policy-making in five states in Nigeria. METHODS This was a cross-sectional study carried out among 209 participants from two geopolitical zones in Nigeria. Study participants included programme officers/secretaries, managers/department/facility heads and state coordinators/directors/presidents/chairpersons in various ministries and the National Assembly. A pretested semi-structured self-administered questionnaire on a five-point Likert scale was used to collect information on institutional structures for policy and policy-making in participants' organizations, the use of research evidence in policy and policy-making processes, and the status of funding for policy-relevant research in the participants' organizations. Data were analysed using IBM SPSS version 20 software. RESULTS The majority of the respondents were older than 45 years (73.2%), were male (63.2) and had spent 5 years or less (74.6%) in their present position. The majority of the respondents' organizations had a policy in place on research involving all key stakeholders (63.6%), integration of stakeholders' views within the policy on research (58.9%) and a forum to coordinate the setting of research priorities (61.2%). A high mean score of 3.26 was found for the use of routine data generated from within the participants' organizations. Funding for policy-relevant research was captured in the budget (mean = 3.47) but was inadequate (mean = 2.53) and mostly donor-driven (mean = 3.64). Funding approval and release/access processes were also reported to be cumbersome, with mean scores of 3.74 and 3.89, respectively. The results showed that capacity existed among career policy-makers and the Department of Planning, Research and Statistics to advocate for internal funds (mean = 3.55) and to attract external funds such as grants (3.76) for policy-relevant research. Interaction as part of the priority-setting process (mean = 3.01) was the most highly rated form of policy-maker-researcher interaction, while long-term partnerships with researchers (mean = 2.61) had the lower mean score. The agreement that involving policy-makers in the planning and execution of programmes could enhance the evidence-to-policy process had the highest score (mean = 4.40). CONCLUSION The study revealed that although institutional structures such as institutional policies, fora and stakeholder engagement existed in the organizations studied, there was suboptimal use of evidence obtained from research initiated by both internal and external researchers. Organizations surveyed had budget lines for research, but this funding was depicted as inadequate. There was suboptimal actual participation of policy-makers in the co-creation, production and dissemination of evidence. The implementation of contextually relevant and sustained mutual institutional policy-maker-researcher engagement approaches is needed to promote evidence-informed policy-making. Thus there is a need for institutional prioritization and commitment to research evidence generation.
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Affiliation(s)
- Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University (EBSU), Abakaliki, Nigeria.
| | - Ijeoma Nkem Okedo-Alex
- African Institute for Health Policy and Health Systems, Ebonyi State University (EBSU), Abakaliki, Nigeria
| | - Ifeyinwa Chizoba Akamike
- African Institute for Health Policy and Health Systems, Ebonyi State University (EBSU), Abakaliki, Nigeria
| | - Bilikis Iyabo Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University (EBSU), Abakaliki, Nigeria
| | - Irene Ifeyinwa Eze
- African Institute for Health Policy and Health Systems, Ebonyi State University (EBSU), Abakaliki, Nigeria
| | - Onyekachi Echefu Chukwu
- African Institute for Health Policy and Health Systems, Ebonyi State University (EBSU), Abakaliki, Nigeria
| | - Kingsley Igboji Otubo
- African Institute for Health Policy and Health Systems, Ebonyi State University (EBSU), Abakaliki, Nigeria
| | - Henry C Urochukwu
- African Institute for Health Policy and Health Systems, Ebonyi State University (EBSU), Abakaliki, Nigeria
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Strachan DL, Teague K, Asefa A, Annear PL, Ghaffar A, Shroff ZC, McPake B. Using health policy and systems research to influence national health policies: lessons from Mexico, Cambodia and Ghana. Health Policy Plan 2022; 38:3-14. [PMID: 36181467 PMCID: PMC9849714 DOI: 10.1093/heapol/czac083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 07/22/2022] [Accepted: 09/30/2022] [Indexed: 01/22/2023] Open
Abstract
Health system reforms across Africa, Asia and Latin America in recent decades demonstrate the value of health policy and systems research (HPSR) in moving towards the goals of universal health coverage in different circumstances and by various means. The role of evidence in policy making is widely accepted; less well understood is the influence of the concrete conditions under which HPSR is carried out within the national context and which often determine policy outcomes. We investigated the varied experiences of HPSR in Mexico, Cambodia and Ghana (each selected purposively as a strong example reflecting important lessons under varying conditions) to illustrate the ways in which HPSR is used to influence health policy. We reviewed the academic and grey literature and policy documents, constructed three country case studies and interviewed two leading experts from each of Mexico and Cambodia and three from Ghana (using semi-structured interviews, anonymized to ensure objectivity). For the design of the study, design of the semi-structured topic guide and the analysis of results, we used a modified version of the context-based analytical framework developed by Dobrow et al. (Evidence-based health policy: context and utilisation. Social Science & Medicine 2004;58:207-17). The results demonstrate that HPSR plays a varied but essential role in effective health policy making and that the use, implementation and outcomes of research and research-based evidence occurs inevitably within a national context that is characterized by political circumstances, the infrastructure and capacity for research and the longer-term experience with HPSR processes. This analysis of national experiences demonstrates that embedding HPSR in the policy process is both possible and productive under varying economic and political circumstances. Supporting research structures with social development legislation, establishing relationships based on trust between researchers and policy makers and building a strong domestic capacity for health systems research all demonstrate means by which the value of HPSR can be materialized in strengthening health systems.
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Affiliation(s)
- Daniel Llywelyn Strachan
- *Corresponding author. The Nossal Institute for Global Health, University of Melbourne, 333 Exhibition Street, Melbourne, VIC 3004, Australia. E-mail:
| | - Kirsty Teague
- The Nossal Institute for Global Health, The University of Melbourne, 333 Exhibition Street, Melbourne, VIC 3004, Australia
| | - Anteneh Asefa
- The Nossal Institute for Global Health, The University of Melbourne, 333 Exhibition Street, Melbourne, VIC 3004, Australia,Institute of Tropical Medicine, Kronenburgstraat 43, Antwerp (ITM) 2000, Belgium
| | - Peter Leslie Annear
- The Nossal Institute for Global Health, The University of Melbourne, 333 Exhibition Street, Melbourne, VIC 3004, Australia
| | - Abdul Ghaffar
- The Alliance for Health Policy and Systems Research, WHO, 20 Avenue Appia, Geneva 1211, Switzerland
| | - Zubin Cyrus Shroff
- The Alliance for Health Policy and Systems Research, WHO, 20 Avenue Appia, Geneva 1211, Switzerland
| | - Barbara McPake
- The Nossal Institute for Global Health, The University of Melbourne, 333 Exhibition Street, Melbourne, VIC 3004, Australia
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Swedberg C, Mazeri S, Mellanby RJ, Hampson K, Chng NR. Implementing a One Health Approach to Rabies Surveillance: Lessons From Integrated Bite Case Management. FRONTIERS IN TROPICAL DISEASES 2022; 3:829132. [PMID: 36945698 PMCID: PMC7614337 DOI: 10.3389/fitd.2022.829132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
As part of the 'Zero by 30' strategy to end human deaths from dog-mediated rabies by 2030, international organizations recommend a One Health framework that includes Integrated Bite Case Management (IBCM). However, little is understood about the implementation of IBCM in practice. This study aims to understand how IBCM is conceptualized, exploring how IBCM has been operationalized in different contexts, as well as barriers and facilitators to implementation. Semi-structured interviews were conducted with seventeen practitioners and researchers with international, national, and local expertise across Africa, Asia, and the Americas. Thematic analysis was undertaken using both inductive and deductive approaches. Four main themes were identified: 1) stakeholders' and practitioners' conceptualization of IBCM and its role in rabies elimination; 2) variation in how IBCM operates across different contexts; 3) barriers and facilitators of IBCM implementation in relation to risk assessment, PEP provisioning, animal investigation, One Health collaboration, and data reporting; and 4) the impact of the COVID-19 pandemic on IBCM programs. This study highlights the diversity within experts' conceptualization of IBCM, and its operationalization. The range of perspectives revealed that there are different ways of organizing IBCM within health systems and it is not a one-size-fits-all approach. The issue of sustainability remains the greatest challenge to implementation. Contextual features of each location influenced the delivery and the potential impact of IBCM. Programs spanned from highly endemic settings with limited access to PEP charged to the patient, to low endemicity settings with a large patient load associated with free PEP policies and sensitization. In practice, IBCM was tailored to meet the demands of the local context and level of rabies control. Thus, experts' experiences did not necessarily translate across contexts, affecting perceptions about the function, motivation for, and implementation of IBCM. To design and implement future and current programs, guidance should be provided for health workers receiving patients on assessing the history and signs of rabies in the biting animal. The study findings provide insights in relation to implementation of IBCM and how it can support programs aiming to reach the Zero by 30 goal.
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Affiliation(s)
- Catherine Swedberg
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Stella Mazeri
- Royal (Dick) School of Veterinary Studies and the Roslin Institute, University of Edinburgh, Easter Bush Campus, Roslin, United Kingdom
| | - Richard J. Mellanby
- Royal (Dick) School of Veterinary Studies and the Roslin Institute, University of Edinburgh, Easter Bush Campus, Roslin, United Kingdom
| | - Katie Hampson
- Institute of Biodiversity, Animal Health and Comparative Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Nai Rui Chng
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
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Knight F, Bourassa MW, Ferguson E, Walls H, de Pee S, Vosti S, Martinez H, Levin C, Woldt M, Sethurman K, Bergeron G. Nutrition modeling tools: a qualitative study of influence on policy decision making and determining factors. Ann N Y Acad Sci 2022; 1513:170-191. [PMID: 35443074 PMCID: PMC9546113 DOI: 10.1111/nyas.14778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Nutrition modeling tools (NMTs) generate evidence to inform policy and program decision making; however, the literature is generally limited to modeling methods and results, rather than use cases and their impacts. We aimed to document the policy influences of 12 NMTs and identify factors influencing them. We conducted semistructured interviews with 109 informants from 30 low‐ and middle‐income country case studies and used thematic analysis to understand the data. NMTs were mostly applied by international organizations to inform national government decision making. NMT applications contributed to enabling environments for nutrition and influenced program design and policy in most cases; however, this influence could be strengthened. Influence was shaped by processes for applying the NMTs; ownership of the analysis and data inputs, and capacity building in NMT methods, encouraged uptake. Targeting evidence generation at specific policy cycle stages promoted uptake; however, where advocacy capacity allowed, modeling was embedded ad hoc into emerging policy discussions and had broader influence. Meanwhile, external factors, such as political change and resource constraints of local partner organizations, challenged NMT implementation. Importantly, policy uptake was never the result of NMTs exclusively, indicating they should be nested persistently and strategically within the wider evidence and advocacy continuum, rather than being stand‐alone activities.
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Affiliation(s)
- Frances Knight
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.,Nutrition Division, United Nations World Food Programme, Rome, Italy
| | | | - Elaine Ferguson
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Helen Walls
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Saskia de Pee
- Nutrition Division, United Nations World Food Programme, Rome, Italy.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts.,Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - Stephen Vosti
- Department of Agricultural and Resource Economics, University of California, Davis, Davis, California
| | | | - Carol Levin
- Department of Global Health, University of Washington, Seattle, Washington
| | - Monica Woldt
- Helen Keller International, Washington, District of Columbia.,USAID Advancing Nutrition, Arlington, Virginia.,Formerly with Food and Nutrition Technical Assistance Project (FANTA), Washington, District of Columbia
| | - Kavita Sethurman
- Formerly with Food and Nutrition Technical Assistance Project (FANTA), Washington, District of Columbia
| | - Gilles Bergeron
- New York Academy of Sciences, New York, New York.,Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia
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9
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Improving Experiences of the Menopause for Women in Zimbabwe and South Africa: Co-Producing an Information Resource. SOCIAL SCIENCES-BASEL 2022. [DOI: 10.3390/socsci11040143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Women in sub-Saharan Africa report multiple impacts of menopause on daily life and have requested further information to support themselves. This study co-produced contextually relevant resources—booklets and poster—about menopause with women in Zimbabwe and South Africa. The study was conducted in four stages: interviews with women about the menopause; the development of prototype information resources; workshops with women to discuss country-specific resources; and the refinement of resources. During the interviews, women explained that they had not received or accessed much information about the menopause and thought the physical and psychological issues associated with the menopause had to be “endured”. Prototype information resources comprised booklets and a poster with contextually relevant images and information. Workshop participants suggested several changes, including the addition of more diverse images and further information about treatments. The resources were refined, translated into several African languages, and endorsed by the Ministry of Health in Zimbabwe and the South African Menopause Society in South Africa. Women will be able to access resources through healthcare clinics, community groups and churches. Working with women and other stakeholders enabled a development that was cognisant of experiences and needs. Work is now needed to improve access to treatments and support for menopause to reduce health inequities.
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10
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Political economy analysis of universal health coverage and health financing reforms in low- and middle-income countries: the role of stakeholder engagement in the research process. Health Res Policy Syst 2021; 19:143. [PMID: 34895251 PMCID: PMC8665578 DOI: 10.1186/s12961-021-00788-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 10/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Progress towards universal health coverage (UHC) is an inherently political process. Political economy analysis (PEA) is gaining momentum as a tool to better understand the role of the political and economic dimensions in shaping and achieving UHC in different contexts. Despite the acknowledged importance of actors and stakeholders in political economy considerations, their role in the PEA research process beyond “study subjects” as potential cocreators of knowledge and knowledge users has been overlooked so far. We therefore aimed to review the approaches with reference to stakeholder engagement during the research process adopted in the current published research on the political economy of UHC and health financing reforms, and the factors favouring (or hindering) uptake and usability of PEA work. Methods We reviewed the literature to describe whether, when and how stakeholders were involved in the research process of studies looking at the political economy of UHC and health financing reforms, and to identify challenges and lessons learned on effective stakeholder engagement and research uptake. We used a standardized search strategy with key terms across several databases; we screened and included articles that focused on PEA and UHC. Additionally, we conducted a short survey of the authors of the included studies to complement the information retrieved. Results Fifty articles met the inclusion criteria and were included in the analysis. We found overall little evidence of systematic engagement of stakeholders in the research process, which focused mostly on the data collection phase of the research (i.e., key informant interviews). Our study identifies some reasons for the varying stakeholder engagement. Challenges include PEA requiring specific skills, a focus on sensitive issues, and the blurriness in researchers’ and stakeholders’ roles and the multiple roles of stakeholders as research participants, study subjects and research users. Among the approaches that might favour usability of PEA work, we identified early engagement, coproduction of research questions, local partners and personal contact, political willingness, and trust and use of prospective analysis. Conclusions Stakeholder engagement and research uptake are multifaceted concepts and complex processes, particularly when applied to PEA. As such, stakeholder engagement in the research process of PEA of UHC and health financing reforms is limited and underreported. Despite the challenges, however, stakeholder engagement remains key to ensuring relevance, usability and research uptake of PEA studies. More efforts are required to ensure engagement at different stages of the research process and better reporting in published articles.
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11
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Puspitaningtyas H, Espressivo A, Hutajulu SH, Fuad A, Allsop MJ. Mapping and Visualization of Cancer Research in Indonesia: A Scientometric Analysis. Cancer Control 2021; 28:10732748211053464. [PMID: 34702111 PMCID: PMC8554557 DOI: 10.1177/10732748211053464] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction The incidence of cancer and its prevalence are increasing in Indonesia. It is crucial to ensure national cancer policies are evidence-based and promote research. While cancer research is being conducted across Indonesia, the extent and focus of research activities are not known, with no existing synthesis of the cancer research landscape. We seek to address this gap by characterising trends in the extent and types of cancer research conducted in Indonesia. Methods Scientometric study using descriptive analyses to determine annual growth patterns in publications across all cancer research literature from Indonesia. We developed a classification system for both research type and study design which was applied to all included publications. A visualisation software tool (VOSviewer) was used to explore the geographical distribution of research activity. The Wilcoxon rank-sum test was used to determine the influence of international collaboration on the impact factor of journals in which articles were published. Results We retrieved 1773 cancer-related articles published by Indonesia-affiliated authors from 1961 to 2020, with notable year-on-year increases in the annual total number of published articles since 2015. Most articles (84.0%) were published by authors affiliated with institutions on Java Island. The most commonly published article type was basic research and discovery science (28.8%), using a one-group analytical study design (28.8%). International collaboration was significantly correlated with a higher h-index of the journal in which research was published (P < .0001, r = .317). Conclusion An increase in the number and range of topics explored in cancer-related publications over time was identified. The summary of the current corpus of cancer-related research for Indonesia can be used to direct the development of the national cancer control plan alongside informing the national cancer research strategy. Our novel and feasible scientometric approach can be used to direct future national and regional mapping of cancer research.
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Affiliation(s)
| | | | | | - Anis Fuad
- 59166Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Matthew J Allsop
- Leeds Institute of Health Sciences, 4468University of Leeds, Leeds, UK
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12
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McNair D, Lumpkin M, Kern S, Hartman D. Use of RWE to Inform Regulatory, Public Health Policy, and Intervention Priorities for the Developing World. Clin Pharmacol Ther 2021; 111:44-51. [PMID: 34655224 PMCID: PMC9298255 DOI: 10.1002/cpt.2449] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 10/05/2021] [Indexed: 12/28/2022]
Abstract
For low‐ and middle‐income countries (LMICs) to benefit from real‐world evidence (RWE)/real‐world data (RWD) in both product registration (“regulatory”) decision making and in product utilization policy (“policy”) decision making, they need to overcome several challenges. They need to deploy more electronic health records systems (EHRs), adjust for confounder variables, build trust between stakeholders, and create laws and regulations for local generation of data that are assented for secondary use. The role of procurers and their use of RWE/RWD in the LMIC context likewise is in a state of ongoing development. Procurers of health products are strong players currently in the “access” chain as LMICs continue to work on strengthening governmental health technology assessment (HTA) bodies. Procurers’ use of RWE is presently at an early stage and is mostly indirect, leveraging RWE results that are produced by researchers in high‐income countries (HICs), often under considerably different regulatory and policy objectives and constraints compared to LMICs’ epidemiology and priorities. Pending wider deployment of EHRs and other RWE sources, stakeholders must realize that populations from HIC RWE (i) can be devised to closely resemble phenotypic patterns in LMIC populations and (ii) can be analyzed to align with LMICs’ unmet needs.
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Affiliation(s)
- Douglas McNair
- Global Health, Integrated Development, Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - Murray Lumpkin
- Global Health, Integrated Development, Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - Steven Kern
- Global Health, Integrated Development, Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | - Daniel Hartman
- Global Health, Integrated Development, Bill & Melinda Gates Foundation, Seattle, Washington, USA
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13
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Madia Lourenço LH, Baker BL, Dias Junior AG, Jamieson NE, Pacheco de Almeida R, Queiroz Gurgel R, Campello Bresani Salvi C, de Souza CG, Longo E, Gomes B, Rocha David M, Galvão Pavan M, Pereira de Castro D, Lacerda Nogueira M, Lang T. Engaging local health research communities to enhance long-term capacity building in Brazil. BMJ Glob Health 2021; 6:e007131. [PMID: 34670775 PMCID: PMC8529619 DOI: 10.1136/bmjgh-2021-007131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 09/14/2021] [Indexed: 11/03/2022] Open
Abstract
The '2019 Research Capacity Network (REDe) workshop series' was an initiative led by Brazil-based REDe coordinators and The Global Health Network (TGHN) in partnership with Brazilian researchers interested in arboviruses. This workshop initiative has provided crucial training to the local research community offering transferable skills to effectively respond to health emergencies, with an impact beyond arboviral diseases, as evidenced by further activities undertaken during the COVID-19 pandemic. The success of this approach resulted from several factors, especially the workshops' local leadership and the combination of in-person training with online sharing of the resources generated in the local language. Analytics data from REDe online platform evidenced the wider reach of the shared resources to a larger audience than the workshop attendees. Importantly, the impact of this approach extends beyond the workshop series per se, with workshop participants afforded access to wider training, career development and collaborative opportunities through REDe and TGHN platforms. In addition, this initiative design resulted in the development of new collaborations between the workshop leaders and other local researchers, who have been jointly writing research projects and applying for grants. As a result, REDe has become a highly dynamic community of practice for health researchers in the region, strengthening the research culture and improving connectivity. Here, we describe the design and implementation of this initiative and demonstrate the value of integrating local expertise, and a practical workshop series format with digital dissemination of research resources and training materials to generate a vibrant and robust community of practice.
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Affiliation(s)
| | - Bonny Louise Baker
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | | | - Nina E Jamieson
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | | | | | | | - Clécio Gabriel de Souza
- Faculty of Health Sciences - Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
| | - Egmar Longo
- Faculty of Health Sciences - Trairi, Federal University of Rio Grande do Norte, Santa Cruz, Brazil
| | - Bruno Gomes
- Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | | | | | | | - Trudie Lang
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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14
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Ozano K, Dean L, Adekeye O, Bettee AK, Dixon R, Gideon NU, Gwani N, Isiyaku S, Kollie K, Lar L, Oluwole A, Piotrowski H, Siakeh A, Thomson R, Yashiyi J, Zawolo G, Theobald S. Guiding principles for quality, ethical standards and ongoing learning in implementation research: multicountry learnings from participatory action research to strengthen health systems. Health Policy Plan 2021; 35:ii137-ii149. [PMID: 33156936 PMCID: PMC7646736 DOI: 10.1093/heapol/czaa123] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 12/17/2022] Open
Abstract
Global health gains can be achieved through strengthening health systems to identify and address implementation challenges in low- and middle-income countries. Participatory research, that promotes joint problem and solution finding between communities and different health systems actors, supports policy implementation analysis at all levels. Within the neglected tropical disease programmes in Liberia and Nigeria, we applied participatory action research (PAR) to address programmatic and health system bottlenecks with health systems strengthening embedded. This paper shares learning from 20 interviews with co-researchers, from national and sub-national levels and academic researchers who worked collaboratively to understand challenges, co-create solutions and advocate for policy change. Through analysis and reflections of existing PAR principles, we inductively identified five additional guiding principles for quality, ethical standards and ongoing learning within PAR projects that aim to strengthen health systems. (1) Recognize communities as units of identity and define stakeholder participation to ensure equitable engagement of all actors; (2) enable flexible action planning that builds on existing structures whilst providing opportunities for embedding change; (3) address health systems and research power differentials that can impede co-production of knowledge and solution development; (4) embed relational practices that lead to new political forms of participation and inquiry within health systems and (5) develop structures for ongoing learning at multiple levels of the health system. PAR can strengthen health systems by connecting and co-creating potentially sustainable solutions to implementation challenges. Additional research to explore how these five additional principles can support the attainment of quality and ethical standards within implementation research using a PAR framework for health systems strengthening is needed.
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Affiliation(s)
- Kim Ozano
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L35QA, UK
| | - Laura Dean
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L35QA, UK
| | - Oluwatosin Adekeye
- Sightsavers, Nigeria Country Office, Golf Course Road, City Centre, Kaduna, Nigeria
| | - Anthony K Bettee
- Ministry of Health, Government of Liberia, SKD Boulevard, Monrovia, Liberia
| | - Ruth Dixon
- Sightsavers, 35 Perrymount Rd, Haywards Heath RH16 3BZ, UK
| | - Ntuen Uduak Gideon
- Ministry of Health, Government of Nigeria, Federal Secretariat, Complex Garki PMB, 83 Abuja, Nigeria
| | - Noela Gwani
- Sightsavers, Nigeria Country Office, Golf Course Road, City Centre, Kaduna, Nigeria
| | - Sunday Isiyaku
- Sightsavers, Nigeria Country Office, Golf Course Road, City Centre, Kaduna, Nigeria
| | - Karsor Kollie
- Ministry of Health, Government of Liberia, SKD Boulevard, Monrovia, Liberia
| | - Luret Lar
- Sightsavers, Nigeria Country Office, Golf Course Road, City Centre, Kaduna, Nigeria
| | - Akinola Oluwole
- Sightsavers, Nigeria Country Office, Golf Course Road, City Centre, Kaduna, Nigeria
| | - Helen Piotrowski
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L35QA, UK
| | - Alice Siakeh
- Pacific Institute for Research and Evaluation UL-PIRE Africa Center, University of Liberia, Capitol Hill Liberia
| | - Rachael Thomson
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L35QA, UK
| | - James Yashiyi
- Sightsavers, Nigeria Country Office, Golf Course Road, City Centre, Kaduna, Nigeria
| | - Georgina Zawolo
- Pacific Institute for Research and Evaluation UL-PIRE Africa Center, University of Liberia, Capitol Hill Liberia
| | - Sally Theobald
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L35QA, UK
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15
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Park JJH, Grais RF, Taljaard M, Nakimuli-Mpungu E, Jehan F, Nachega JB, Ford N, Xavier D, Kengne AP, Ashorn P, Socias ME, Bhutta ZA, Mills EJ. Urgently seeking efficiency and sustainability of clinical trials in global health. Lancet Glob Health 2021; 9:e681-e690. [PMID: 33865473 PMCID: PMC8424133 DOI: 10.1016/s2214-109x(20)30539-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 12/22/2022]
Abstract
This paper shows the scale of global health research and the context in which we frame the subsequent papers in the Series. In this Series paper, we provide a historical perspective on clinical trial research by revisiting the 1948 streptomycin trial for pulmonary tuberculosis, which was the first documented randomised clinical trial in the English language, and we discuss its close connection with global health. We describe the current state of clinical trial research globally by providing an overview of clinical trials that have been registered in the WHO International Clinical Trial Registry since 2010. We discuss challenges with current trial planning and designs that are often used in clinical trial research undertaken in low-income and middle-income countries, as an overview of the global health trials landscape. Finally, we discuss the importance of collaborative work in global health research towards generating sustainable and culturally appropriate research environments.
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Affiliation(s)
- Jay J H Park
- Department of Experimental Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute and School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | | | - Fyezah Jehan
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Jean B Nachega
- Department of Medicine and Center for Infectious Diseases, Stellenbosch University, Cape Town, South Africa; Department of Epidemiology and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology and Department of Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Nathan Ford
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Denis Xavier
- Department of Pharmacology and Division of Clinical Research, St John's Medical College, Bangalore, India
| | - Andre P Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Per Ashorn
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Maria Eugenia Socias
- Fundación Huésped, Buenos Aires, Argentina; British Columbia Centre for Substance Use, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, ON, Canada; Institute of Global Health and Development, and Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Edward J Mills
- School of Public Health, University of Rwanda, Kigali, Rwanda; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Cytel, Vancouver, BC, Canada.
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16
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Okedo-Alex IN, Akamike IC, Olisaekee GO, Okeke CC, Uneke CJ. Identifying advocacy strategies, challenges and opportunities for increasing domestic health policy and health systems research funding in Nigeria: Perspectives of researchers and policymakers. Health Res Policy Syst 2021; 19:41. [PMID: 33752682 PMCID: PMC7983353 DOI: 10.1186/s12961-021-00701-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/03/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction Poor funding for Health Policy and Systems Research (HPSR) is a major constraint to the development, generation and uptake of HPSR evidence in Low and Middle-Income countries. The study assessed the status of HPSR domestic funding and advocacy strategies for improving HPSR funding in Nigeria. It equally explored the knowledge and perception of the domestic funding status of HPSR and the effect of capacity building on the knowledge of domestic funding for HPSR in Nigeria. Methods This was a sub-national study involving policymakers and researchers from Enugu and Ebonyi States in Southeast Nigeria who participated in the sub-national Health Systems Global convening for the African region. A before-after study design (workshop) was utilized. Data collection employed semi-structured questionnaires, group and panel discussions. The workshop facilitated knowledge of HPSR, funding processes, and advocacy strategies for increased domestic funding for HPSR. Pre and immediate post-workshop knowledge assessments were done. Data were analyzed using SPSS version 25 and thematic analysis. Results Twenty-six participants were involved in the study. Half were females (50.0%) and 46.2% were aged 35–44 years. Policymakers constituted 23.1% of the participants. Domestic funding for HPSR in Nigeria was adjudged to be grossly inadequate. Identified barriers to domestic funding of HPSR included bureaucratic bottlenecks, political and policy transitions, and corruption. Potential opportunities centered on existing policy documents and emerging private sector willingness to fund health research. Multi-stakeholder advocacy coalitions, continuous advocacy and researcher skill-building on advocacy with active private sector involvement were the strategies proffered by the participants. Pre-workshop, understanding of the meaning of HPSR had the highest mean ratings while knowledge of budgeting processes and use of legal action to enable opportunities for budget advocacy for HPSR funding had the lowest mean ratings. Following the capacity-building workshop, all knowledge and understanding parameters markedly improved (percentage increase of 12.5%–71.0%). Conclusion This study found that there was paucity of domestic funding for HPSR in Nigeria alongside poor knowledge of budgeting and advocacy strategies among both policymakers and researchers. We recommend the deployment of these identified strategies and wider national and regional stakeholder engagement towards prioritizing and improving domestic funding for HPSR.
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Affiliation(s)
- Ijeoma Nkem Okedo-Alex
- African Institute for Health Policy and Health Systems, Ebonyi State University (EBSU), Abakaliki, Nigeria. .,Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria.
| | - Ifeyinwa Chizoba Akamike
- African Institute for Health Policy and Health Systems, Ebonyi State University (EBSU), Abakaliki, Nigeria.,Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | | | | | - Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University (EBSU), Abakaliki, Nigeria
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17
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Kumar MB, Madan JJ, Auguste P, Taegtmeyer M, Otiso L, Ochieng CB, Muturi N, Mgamb E, Barasa E. Cost-effectiveness of community health systems strengthening: quality improvement interventions at community level to realise maternal and child health gains in Kenya. BMJ Glob Health 2021; 6:e002452. [PMID: 33658302 PMCID: PMC7931757 DOI: 10.1136/bmjgh-2020-002452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Improvements in maternal and infant health outcomes are policy priorities in Kenya. Achieving these outcomes depends on early identification of pregnancy and quality of primary healthcare. Quality improvement interventions have been shown to contribute to increases in identification, referral and follow-up of pregnant women by community health workers. In this study, we evaluate the cost-effectiveness of using quality improvement at community level to reduce maternal and infant mortality in Kenya. METHODS We estimated the cost-effectiveness of quality improvement compared with standard of care treatment for antenatal and delivering mothers using a decision tree model and taking a health system perspective. We used both process (antenatal initiation in first trimester and skilled delivery) and health outcomes (maternal and infant deaths averted, as well as disability-adjusted life years (DALYs)) as our effectiveness measures and actual implementation costs, discounting costs only. We conducted deterministic and probabilistic sensitivity analyses. RESULTS We found that the community quality improvement intervention was more cost-effective compared with standard community healthcare, with incremental cost per DALY averted of $249 under the deterministic analysis and 76% likelihood of cost-effectiveness under the probabilistic sensitivity analysis using a standard threshold. The deterministic estimate of incremental cost per additional skilled delivery was US$10, per additional early antenatal care presentation US$155, per maternal death averted US$5654 and per infant death averted US$37 536 (2017 dollars). CONCLUSIONS This analysis shows that the community quality improvement intervention was cost-effective compared with the standard community healthcare in Kenya due to improvements in antenatal care uptake and skilled delivery. It is likely that quality improvement interventions are a good investment and may also yield benefits in other health areas.
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Affiliation(s)
- Meghan Bruce Kumar
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- MARCH Centre, London School of Hygiene & Tropical Medicine, London, UK
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
| | - Jason J Madan
- University of Warwick, Warwick Medical School, Coventry, UK
| | - Peter Auguste
- University of Warwick, Warwick Medical School, Coventry, UK
| | - Miriam Taegtmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Tropical Infectious Diseases Unit, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | | | | | - Nelly Muturi
- Research and Strategic Information, LVCT Health, Nairobi, Kenya
| | - Elizabeth Mgamb
- Department of Health, Migori County Government, Migori, Kenya
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
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18
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Agyepong IA, Godt S, Sombie I, Binka C, Okine V, Ingabire MG. Strengthening capacities and resource allocation for co-production of health research in low and middle income countries. BMJ 2021; 372:n166. [PMID: 33593725 PMCID: PMC7879269 DOI: 10.1136/bmj.n166] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Irene Akua Agyepong
- Ghana Health Service, Research and Development Division, Dodowa Health Research Center, Dodowa, Ghana
- Ghana College of Physicians and Surgeons, Accra, Ghana
| | | | | | | | - Vicky Okine
- Alliance for Reproductive Health Rights, Accra, Ghana
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19
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Bharatan T, Devi R, Huang PH, Javed A, Jeffers B, Lansberg P, Sidhu K, Subramaniam K. A Methodology for Mapping the Patient Journey for Noncommunicable Diseases in Low- and Middle-Income Countries. J Healthc Leadersh 2021; 13:35-46. [PMID: 33542673 PMCID: PMC7853412 DOI: 10.2147/jhl.s288966] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/10/2021] [Indexed: 12/12/2022] Open
Abstract
Noncommunicable diseases (NCDs) are responsible for 71% of all worldwide mortality each year, and have an exceptionally large impact in low- and middle-income countries (LMICs). However, there is often a lack of local data from these countries to inform practice and policy improvements. Generating locally contextualized evidence base for NCDs that can help identify gaps, aid decision-making and improve patient care in LMICs needs an innovative approach. The approach used in Mapping the Patient Journey Towards Actionable Beyond the Pill Solutions (MAPS) is designed to quantitatively map different stages of the patient journey in four critical NCDs, ie, hypertension, dyslipidemia, depression, and pain (chronic and neuropathic) across selected LMICs in Africa, the Middle East, South East Asia, and Latin America. The key touchpoints along the patient journey include awareness, screening, diagnosis, treatment, adherence, and control or remission. MAPS employs an evidence mapping methodology that follows a three-step semi-systematic review: 1) systematic peer-reviewed database search; 2) unstructured searches of local or real-world data; and 3) expert opinion. Evidence generation and visualization is based on locally validated and deduplicated data published over the last 10 years. This approach will be the first to provide quantitative mapping of the different stages of the patient journey for selected NCDs in LMICs. By focusing on local, patient-centric data, the goal of the MAPS initiative is to address and prioritize local research and knowledge gaps, then contribute to evidence-based, high-quality, and affordable advances in the management of NCDs in LMICs. This will ultimately improve patient outcomes and contribute towards the achievement of global NCD targets.
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Affiliation(s)
- Tanaya Bharatan
- Research Development & Medical, Upjohn Division, Pfizer Ltd, Mumbai, India
| | - Ratna Devi
- Executive Office, Daksham A Health and Education, Gurgaon, India
- International Alliance of Patient Organizations, London, UK
| | | | - Afzal Javed
- Warwick Medical School, University of Warwick, Warwick, UK
| | | | - Peter Lansberg
- Department of Pediatrics, University Medical Center, Groningen, the Netherlands
| | - Kaveri Sidhu
- Research Development & Medical, Upjohn Division, Pfizer Ltd, Mumbai, India
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Onwujekwe O, Etiaba E, Mbachu C, Arize I, Nwankwor C, Ezenwaka U, Okeke C, Ezumah N, Uzochukwu B. Does improving the skills of researchers and decision-makers in health policy and systems research lead to enhanced evidence-based decision making in Nigeria?-A short term evaluation. PLoS One 2020; 15:e0238365. [PMID: 32881986 PMCID: PMC7470383 DOI: 10.1371/journal.pone.0238365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 08/14/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Health care decision makers require capacity to demand and use research evidence for effective decision making. Capacity to undertake health policy and systems research (HPSR) and teaching is low in developing countries. Strengthening the capacity of producers and users of research is a more sustainable strategy for developing the field of HPSR in Africa, than relying on training in high-income countries. METHODS Data were collected from 118 participants who had received the capacity building, using a pre-tested questionnaire. Respondents included health research scientists from institutions (producers) and decision makers (users) in the public health sector, in Anambra and Enugu states, southeast Nigeria. Data were collected on participants' progress with proposed group activities in their short- term goals; effects of these activities on evidence-informed decision making and constraints to implementing activities. Univariate analysis was done using SPSS version 16. FINDINGS All prioritised activities were carried out. However, responses were low. Highest response for an activity amongst producers was 39.1%, and 44.4% for users. Some of the activities implemented positively influenced changes in practice; like modification of existing policies and programme plans. There was a wide range of responses between producers of evidence (0.0-39.1%) and users (2.7-44.4%) across both study states. Lack of authority to implement activities was the major constraint (42-9-100.0% across activities), followed by financial constraints (70.6%). CONCLUSION Capacity building intervention improved skills of a critical mass of research scientists, policymakers and practitioners, towards evidence-based decision making. Participants committed to undertake proposed activities but faced a number of constraints. These need to be addressed, especially the decision space and authority, improving funding to implement activities that influence Getting Research into Policy & Practice (GRIPP). Being at different stages of planning and implementing proposed activities; participants require continuous technical and financial support to successfully implement activities and engage meaningfully within and across professional boundaries and roles, in order to achieve short-, medium- and long- term goals.
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Affiliation(s)
- Obinna Onwujekwe
- Department of Health Administration and Management, University of Nigeria, Enugu Campus, Enugu Town, Nigeria
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu Town, Nigeria
| | - Enyi Etiaba
- Department of Health Administration and Management, University of Nigeria, Enugu Campus, Enugu Town, Nigeria
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu Town, Nigeria
- * E-mail:
| | - Chinyere Mbachu
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu Town, Nigeria
- Department of Community Medicine, University of Nigeria, Enugu Campus, Enugu Town, Nigeria
| | - Ifeyinwa Arize
- Department of Health Administration and Management, University of Nigeria, Enugu Campus, Enugu Town, Nigeria
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu Town, Nigeria
| | - Chikezie Nwankwor
- Department of Health Administration and Management, University of Nigeria, Enugu Campus, Enugu Town, Nigeria
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu Town, Nigeria
| | - Uchenna Ezenwaka
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu Town, Nigeria
| | - Chinyere Okeke
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu Town, Nigeria
- Department of Community Medicine, University of Nigeria, Enugu Campus, Enugu Town, Nigeria
| | - Nkoli Ezumah
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu Town, Nigeria
| | - Benjamin Uzochukwu
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu Town, Nigeria
- Department of Community Medicine, University of Nigeria, Enugu Campus, Enugu Town, Nigeria
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Kumar MB, Taegtmeyer M, Madan J, Ndima S, Chikaphupha K, Kea A, Barasa E. How do decision-makers use evidence in community health policy and financing decisions? A qualitative study and conceptual framework in four African countries. Health Policy Plan 2020; 35:799-809. [PMID: 32516361 PMCID: PMC7487332 DOI: 10.1093/heapol/czaa027] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2020] [Indexed: 11/29/2022] Open
Abstract
Various investments could help countries deliver on the universal health coverage (UHC) goals set by the global community; community health is a pillar of many national strategies towards UHC. Yet despite resource mobilization towards this end, little is known about the potential costs and value of these investments, as well as how evidence on the same would be used in related decisions. This qualitative study was conducted to understand the use of evidence in policy and financing decisions for large-scale community health programmes in low- and middle-income countries. Through key informant interviews with 43 respondents in countries with community health embedded in national UHC strategies (Ethiopia, Kenya, Malawi, Mozambique) and at global institutions, we investigated evidence use in community health financing and policy decision-making, as well as evidentiary needs related to community health data for decision-making. We found that evidence use is limited at all levels, in part due to a perceived lack of high-quality, relevant evidence. This perception stems from two main areas: first, desire for local evidence that reflects the context, and second, much existing economic evidence does not deal with what decision-makers value when it comes to community health systems-i.e. coverage and (to a lesser extent) quality. Beyond the evidence gap, there is limited capacity to assess and use the evidence. Elected officials also face political challenges to disinvestment as well as structural obstacles to evidence use, including the outsized influence of donor priorities. Evaluation data must to speak to decision-maker interests and constraints more directly, alongside financiers of community health providing explicit guidance and support on the role of evidence use in decision-making, empowering national decision-makers. Improved data quality, increased relevance of evidence and capacity for evidence use can drive improved efficiency of financing and evidence-based policymaking.
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Affiliation(s)
- Meghan Bruce Kumar
- Community Health Systems Group, Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- MARCH Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Miriam Taegtmeyer
- Community Health Systems Group, Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Tropical Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Jason Madan
- Centre for Health Economics at Warwick, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sozinho Ndima
- Community Health Department, Faculty of Medicine, University Eduardo Mondlane, Maputo, Mozambique
| | | | - Aschenaki Kea
- School of Public and Environmental Health, Hawassa University, Hawassa, Ethiopia
- Center for International Health, University of Bergen, Bergen, Norway
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
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