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Martins N, Gusmao C, Soares D, Laot M, Amaral S, Messner J, Yan J, Francis JR. Strengthening Health Research and Ethics Systems in Timor-Leste. WHO South East Asia J Public Health 2023; 12:63-70. [PMID: 37843183 DOI: 10.4103/who-seajph.who-seajph_184_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Introduction Meaningful health research should lead to evidence-based decision-making that can be translated into policy and practice. Every country needs to have a well-functioning and resourced ethics review and clearance system to ensure health and medical research is conducted in line with ethical standards, preventing harm to research participants, and contributing to better health outcomes and national priorities. The purpose of this study is to describe the origins of the system for managing health research and ethics in Timor-Leste and how it has evolved over time; to identify the strengths and limitations of the current system; and to recommend areas for improvement. Materials and Methods A narrative review of the literature (published papers, gray literature, and unpublished data) was conducted alongside key informant interviews with 15 Ministry of Health (MOH) policymakers and National Institute of Health staff between October 2020 and March 2021. Results The system for managing health research and ethics in Timor-Leste has remained largely the same since it was first established in 2009, with some adaptations to cope with a progressively increasing workload. Main findings include: the Department of Research and Studies (DRS) oversees complex ethics approval process in addition to other responsibilities; the DRS lacks the legal authority, policies, and procedures to help implement its full range of functions and responsibilities; national research priorities should be identified; MOH experiences difficulties in securing funding to support health research; training in health research, ethics and governance is an important priority for DRS. Conclusion It is timely and important to invest in strengthening key components of health research and ethics systems in Timor-Leste. Despite limited resources, improvements can be achieved in key areas with focused assistance and collaboration with local, national, and international partners.
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Affiliation(s)
- Nelson Martins
- Department for Research and Study, National Institute of Public Health of Timor-Leste; Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Caetano Gusmao
- Department for Research and Study, National Institute of Public Health of Timor-Leste, Dili, Timor-Leste
| | - Dirce Soares
- Department for Research and Study, National Institute of Public Health of Timor-Leste, Dili, Timor-Leste
| | - Meri Laot
- Department for Research and Study, National Institute of Public Health of Timor-Leste, Dili, Timor-Leste
| | - Salvador Amaral
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Julia Messner
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Jennifer Yan
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
| | - Joshua Reginald Francis
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
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Hedquist A, Jones CM, Mijumbi RM, Sobngwi-Tambekou J, Parkhurst J, Wenham C. Mapping regional cooperation of state actors for health research systems in Africa: A social network analysis. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001142. [PMID: 36962649 PMCID: PMC10022136 DOI: 10.1371/journal.pgph.0001142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/12/2022] [Indexed: 03/26/2023]
Abstract
Regional bodies can potentially play an important role in improving health research in Africa. This study analyses the network of African state-based regional organisations for health research and assesses their potential relationship with national health research performance metrics. After cataloguing organisations and their membership, we conducted a social network analysis to determine key network attributes of national governments' connections via regional organisations supporting functions of health research systems. This data was used to test the hypothesis that state actors with more connections to other actors via regional organisations would have higher levels of health research performance across indicators. With 21 unique regional organisations, the African continent is densely networked around health research systems issues. In general, the regional network for health research is inclusive. No single actor serves as a nexus. However, when statistics are grouped by African Union regions, influential poles emerge, with the most predominate spheres of influence in Eastern and Western Africa. Further, when connectivity data was analysed against national health research performance, there were no statistically significant relationships between increased connectivity and higher performance of key health research metrics. The inclusive and dense network dynamics of African regional organisations for health research strengthening present key opportunities for knowledge diffusion and cooperation to improve research capacity on the continent. Further reflection is needed on appropriate and meaningful ways to assess the role of regionalism and evaluate the influence of regional organisations in strengthening health research systems in Africa.
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Affiliation(s)
- Aaron Hedquist
- LSE Health, London School of Economics and Political Science, London, United Kingdom
| | - Catherine M Jones
- LSE Health, London School of Economics and Political Science, London, United Kingdom
| | - Rhona M Mijumbi
- The Centre for Rapid Evidence Synthesis, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Justin Parkhurst
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Clare Wenham
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
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Nabyonga-Orem J, Asamani JA, Makanga M. The state of health research governance in Africa: what do we know and how can we improve? Health Res Policy Syst 2021; 19:11. [PMID: 33482839 PMCID: PMC7821686 DOI: 10.1186/s12961-020-00676-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/21/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The developments in global health, digital technology, and persistent health systems challenges, coupled with global commitments like attainment of universal health coverage, have elevated the role of health research in low- and middle-income countries. However, there is a need to strengthen health research governance and create a conducive environment that can promote ethics and research integrity and increase public trust in research. OBJECTIVE To assess whether the necessary structures are in place to ensure health research governance. METHODS Employing a cross-sectional survey, we collected data on research governance components from 35 Member States of the World Health Organization (WHO) African Region. Data were analysed using basic descriptive and comparative analysis. RESULTS Eighteen out of 35 countries had legislation to regulate the conduct of health research, while this was lacking in 12 countries. Some legislation was either grossly outdated or too limiting in scope, while some countries had multiple laws. Health research policies and strategies were in place in 16 and 15 countries, respectively, while research priority lists were available in 25 countries. Overlapping mandates of institutions responsible for health research partly explained the lack of strategic documents in some countries. The majority of countries had ethical committees performing a dual role of ethical and scientific review. Research partnership frameworks were available to varying degrees to govern both in-country and north-south research collaboration. Twenty-five countries had a focal point and unit within the ministries of health (MoH) to coordinate research. CONCLUSION Governance structures must be adaptive to embrace new developments in science. Further, strong coordination is key to ensuring comprehensiveness and complementarity in both research development and generation of evidence. The majority of committees perform a dual role of ethics and scientific review, and these need to ensure representation of relevant expertise. Opportunities that accrue from collaborative research need to be seized through strong MoH leadership and clear partnership frameworks that guide negotiations.
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Affiliation(s)
- Juliet Nabyonga-Orem
- Inter-Country Support Team for Eastern and Southern Africa, UHC Life Course Cluster, World Health Organization, 82-86 Enterprise/Glenara Roads, Highlands, P.O Box CY 348; Causeway, Harare, Zimbabwe
| | - James Avoka Asamani
- Inter-Country Support Team for Eastern and Southern Africa, UHC Life Course Cluster, World Health Organization, 82-86 Enterprise/Glenara Roads, Highlands, P.O Box CY 348; Causeway, Harare, Zimbabwe
| | - Micheal Makanga
- The European & Developing Countries Clinical Trials Partnership (EDCTP), Anna van Saksenlaan 51, 2593 HW The Hague, The Netherlands
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Hanney SR, Kanya L, Pokhrel S, Jones TH, Boaz A. How to strengthen a health research system: WHO's review, whose literature and who is providing leadership? Health Res Policy Syst 2020; 18:72. [PMID: 32571364 PMCID: PMC7308111 DOI: 10.1186/s12961-020-00581-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/21/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Health research is important for the achievement of the Sustainable Development Goals. However, there are many challenges facing health research, including securing sufficient funds, building capacity, producing research findings and using both local and global evidence, and avoiding waste. A WHO initiative addressed these challenges by developing a conceptual framework with four functions to guide the development of national health research systems. Despite some progress, more is needed before health research systems can meet their full potential of improving health systems. The WHO Regional Office for Europe commissioned an evidence synthesis of the systems-level literature. This Opinion piece considers its findings before reflecting on the vast additional literature available on the range of specific health research system functions related to the various challenges. Finally, it considers who should lead research system strengthening. MAIN TEXT The evidence synthesis identifies two main approaches for strengthening national health research systems, namely implementing comprehensive and coherent strategies and participation in partnerships. The literature describing these approaches at the systems level also provides data on ways to strengthen each of the four functions of governance, securing financing, capacity-building, and production and use of research. Countries effectively implementing strategies include England, Ireland and Rwanda, whereas West Africa experienced effective partnerships. Recommended policy approaches for system strengthening are context specific. The vast literature on each function and the ever-growing evidence-base are illustrated by considering papers in just one key journal, Health Research Policy and Systems, and analysing the contribution of two national studies. A review of the functions of the Iranian system identifies over 200 relevant and mostly national records; an analysis of the creation of the English National Institute for Health Research describes the key leadership role played by the health department. Furthermore, WHO is playing leadership roles in helping coordinate partnerships within and across health research systems that have been attempting to tackle the COVID-19 crisis. CONCLUSIONS The evidence synthesis provides a firm basis for decision-making by policy-makers and research leaders looking to strengthen national health research systems within their own national context. It identifies five crucial policy approaches - conducting situation analysis, sustaining a comprehensive strategy, engaging stakeholders, evaluating impacts on health systems, and partnership participation. The vast and ever-growing additional literature could provide further perspectives, including on crucial leadership roles for health ministries.
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Affiliation(s)
- Stephen R. Hanney
- Health Economics Research Group, Institute of Health, Environment and Societies, Brunel University London, Uxbridge, UB8 3PH United Kingdom
| | - Lucy Kanya
- Health Economics Research Group, Institute of Health, Environment and Societies, Brunel University London, Uxbridge, UB8 3PH United Kingdom
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Subhash Pokhrel
- Health Economics Research Group, Institute of Health, Environment and Societies, Brunel University London, Uxbridge, UB8 3PH United Kingdom
| | - Teresa H. Jones
- Health Economics Research Group, Institute of Health, Environment and Societies, Brunel University London, Uxbridge, UB8 3PH United Kingdom
| | - Annette Boaz
- Faculty of Health, Social Care and Education, a partnership between Kingston University and St George’s, University of London, London, United Kingdom
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Llop-Gironés A, Cash-Gibson L, Chicumbe S, Alvarez F, Zahinos I, Mazive E, Benach J. Health equity monitoring is essential in public health: lessons from Mozambique. Global Health 2019; 15:67. [PMID: 31847863 PMCID: PMC6918557 DOI: 10.1186/s12992-019-0508-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 10/11/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Countries must be able to describe and monitor their populations health and well-being needs in an attempt to understand and address them. The Sustainable Development Goals (SDGs) have re-emphasized the need to invest in comprehensive health information systems to monitor progress towards health equity; however, knowledge on the capacity of health information systems to be able do this, particularly in low-income countries, remains very limited. As a case study, we aimed to evaluate the current capacity of the national health information systems in Mozambique, and the available indicators to monitor health inequalities, in line with SDG 3 (Good Health and Well Being for All at All Ages). METHODS A data source mapping of the health information system in Mozambique was conducted. We followed the World Health Organization's methodology of assessing data sources to evaluate the information available for every equity stratifier using a three-point scale: 1 - information is available, 2 - need for more information, and 3 - an information gap. Also, for each indicator we estimated the national average inequality score. RESULTS Eight data sources contain health information to measure and monitor progress towards health equity in line with the 27 SDG3 indicators. Seven indicators bear information with nationally funded data sources, ten with data sources externally funded, and ten indicators either lack information or it does not applicable for the matter of the study. None of the 27 indicators associated with SDG3 can be fully disaggregated by equity stratifiers; they either lack some information (15 indicators) or do not have information at all (nine indicators). The indicators that contain more information are related to maternal and child health. CONCLUSIONS There are important information gaps in Mozambique's current national health information system which prevents it from being able to comprehensively measure and monitor health equity. Comprehensive national health information systems are an essential public health need. Significant policy and political challenges must also be addressed to ensure effective interventions and action towards health equity in the country.
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Affiliation(s)
- Alba Llop-Gironés
- Health Inequalities Research Group-Employment Conditions Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain
- Johns Hopkins University University Pompeu Fabra Public Policy Center, Barcelona, Spain
- GREDS-EMCONET, Department of Political and Social Sciences, Universitat Pompeu Fabra, Ramon Trias Fargas 25-27, 08003 Barcelona, Spain
| | - Lucinda Cash-Gibson
- Health Inequalities Research Group-Employment Conditions Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain
- Johns Hopkins University University Pompeu Fabra Public Policy Center, Barcelona, Spain
- GREDS-EMCONET, Department of Political and Social Sciences, Universitat Pompeu Fabra, Ramon Trias Fargas 25-27, 08003 Barcelona, Spain
| | - Sergio Chicumbe
- National Institute of Health, Ministry of Health of Mozambique, Maputo, Mozambique
- Instituto Nacional de Saude, Eduardo Mondlane Ave, 1008 Maputo, Mozambique
| | - Francesc Alvarez
- Medicus Mundi Mediterrània, Secretari Coloma st 112, 08024 Barcelona, Spain
| | - Ivan Zahinos
- Medicus Mundi Mediterrània, Secretari Coloma st 112, 08024 Barcelona, Spain
| | - Elisio Mazive
- National Institute of Statistics of Mozambique, Maputo, Mozambique
- Instituto Nacional de Estatística, 24 de Julho Ave, 1989 Maputo, Mozambique
| | - Joan Benach
- Health Inequalities Research Group-Employment Conditions Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain
- Johns Hopkins University University Pompeu Fabra Public Policy Center, Barcelona, Spain
- GREDS-EMCONET, Department of Political and Social Sciences, Universitat Pompeu Fabra, Ramon Trias Fargas 25-27, 08003 Barcelona, Spain
- Grupo de Investigación Transdisciplinar sobre Transiciones Socioecológicas (GinTRANS2), Universidad Autónoma de Madrid, Madrid, Spain
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Assessing policy-makers', academics' and experts' satisfaction with the performance of the Palestinian health research system: a qualitative study. Health Res Policy Syst 2018; 16:66. [PMID: 30045746 PMCID: PMC6060523 DOI: 10.1186/s12961-018-0341-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 06/22/2018] [Indexed: 11/21/2022] Open
Abstract
Background There is a growing demand within international health agencies to ensure health research systems (HRSs) are strengthened and well-functioning to support healthcare systems (HCSs). Understanding HRS performance through system actors is an indispensable move in analysing this system. This study aims to examine policy-makers’, academics’ and experts’ satisfaction with overall HRS performance, while also investigating their perceptions about political will and attention towards health research. Ultimately, we want to identify gaps related to performance and generate insights on how to move forward for HRS performance strengthening. Methods This study was carried out in Palestine, targeting three sectors, namely government institutions, public health universities, and major local and international health non-governmental organisations (NGOs). Semi-structured, in-depth interviews (IDIs) and focus group discussions (FGDs) were conducted with participants. The institutions from the three sectors were selected based on stated criteria and peer reviews. Data were translated from Arabic into English, transcribed, content checked by the principal investigator, imported to a software programme (MAXQDA 12), and then coded. Thematic content analysis was used. Results A total of 104 experts participated in 52 IDIs and 52 experts participated in 6 FGDs. Findings revealed three principal domains. First, the HRS in Palestine is remarkably underperforming, and the majority of experts were unsatisfied. Participants perceived the system as ineffective and inefficient, poorly managed and lacking systematic assessment. Second, the factors behind system underperformance were (1) an unstructured system and the lack of a research culture as well as of a governing body or policies; (2) health research was seen as individualistic, non-development driven and unutilised in policy decisions; and (3) considerably deficient coordination and essential resources. The third finding showed inadequate political support and engagement, which then also related to system underperformance. Conclusions The Palestinian HRS is perceived as underperforming by health experts at different levels, where research is not on the leadership agendas. Potential actions should be taken to actively engage the state health decision-makers and inform them of the importance, uses and impacts of performance assessment. Findings urge policy-makers and legislators to build an inclusive and national body of governance with agreed strategies including fundamentally hybrid and aligned performance assessment mechanisms, such as a research observatory platform. In addition, it is recommended to establish a strategic plan to expand professionals’ research awareness and abilities, as well as empower the institution’s research monitoring and evaluation capacities. Electronic supplementary material The online version of this article (10.1186/s12961-018-0341-x) contains supplementary material, which is available to authorized users.
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AlKhaldi M, Abed Y, Pfeiffer C, Haj-Yahia S, Alkaiyat A, Tanner M. Understanding the concept and importance of the health research system in Palestine: a qualitative study. Health Res Policy Syst 2018; 16:49. [PMID: 29914533 PMCID: PMC6007061 DOI: 10.1186/s12961-018-0315-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 04/12/2018] [Indexed: 12/22/2022] Open
Abstract
Background The importance of a health research system (HRS), namely an instrument for developing and enabling health systems, is increasing, particularly in developing countries. Assessing the perceptions of system performers is a necessary part of system analysis, which seeks to recognize a system’s strengths and limitations aiming towards improvement. This study assesses the perceptions of policy-makers, academicians and experts regarding the HRS concept and its importance to generate insights for system strengthening. In Palestine, HRS is just emerging, helping to address the many public health-related challenges faced by the country. Methods The study was implemented from January until July 2016, targeting three sectors, namely relevant government institutions, schools of public health, and major local and international health agencies. Data was collected through 52 in-depth interviews and six focus group discussions (FGDs) with policy-makers, academics, directors and experts. Participants and institutions were selected based on stated criteria and peer review. Data were translated, transcribed, checked and then imported to a software program (MAXQDA 12) for thematic and content analysis. Results A total of 104 experts participated, wherein 52 were interviewed and 52 participated in the six FGDs. The HRS concept, as defined by WHO, was conceptualized differently among participants with unclear delineations between various components. Inconsistencies appeared when participants attempted to conceptualize HRS in broader contexts, though HRS goals and functions were sufficiently delineated. The majority of participants agreed that HRS correlates with notions of ‘improvement’ and recognized HRS ‘as a significant gain’. Neglect of HRS was perceived as a big loss. Conclusions The study revealed that the level of understanding of HRS among health experts in Palestine is inadequate and not sufficiently conceptualized for its application. Findings also underlined the need to establish a central governance coordination body that promotes HRS understanding, awareness and culture as an enabler for HRS strengthening. Electronic supplementary material The online version of this article (10.1186/s12961-018-0315-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mohammed AlKhaldi
- Swiss Tropical and Public Health Institute, Socinstr. 57, 4002, Basel, Switzerland. .,University of Basel, Petersplatz 1, 4003, Basel, Switzerland. .,Najah National University, Faculty of Medicine and Health Sciences, Nablus, Palestine.
| | - Yehia Abed
- Al-Quds University, Faculty of Public Health, Jerusalem, Palestine
| | - Constanze Pfeiffer
- Swiss Tropical and Public Health Institute, Socinstr. 57, 4002, Basel, Switzerland.,University of Basel, Petersplatz 1, 4003, Basel, Switzerland
| | - Saleem Haj-Yahia
- University Teaching Hospital, Najah National University, Nablus, Palestine.,Najah National University, Faculty of Medicine and Health Sciences, Nablus, Palestine.,Bristol University, School of Clinical Sciences, Bristol, United Kingdom
| | - Abdulsalam Alkaiyat
- Swiss Tropical and Public Health Institute, Socinstr. 57, 4002, Basel, Switzerland.,University of Basel, Petersplatz 1, 4003, Basel, Switzerland.,Najah National University, Faculty of Medicine and Health Sciences, Nablus, Palestine
| | - Marcel Tanner
- Swiss Tropical and Public Health Institute, Socinstr. 57, 4002, Basel, Switzerland.,University of Basel, Petersplatz 1, 4003, Basel, Switzerland
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Hanney SR, González-Block MA. 'Knowledge for better health' revisited - the increasing significance of health research systems: a review by departing Editors-in-Chief. Health Res Policy Syst 2017; 15:81. [PMID: 28965493 PMCID: PMC5623979 DOI: 10.1186/s12961-017-0248-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 09/06/2017] [Indexed: 01/22/2023] Open
Abstract
How can nations organise research investments to obtain the best bundle of knowledge and the maximum level of improved health, spread as equitably as possible? This question was the central focus of a major initiative from WHO led by Prof Tikki Pang, which resulted in a range of developments, including the publication of a conceptual framework for national health research systems - Knowledge for better health - in 2003, and in the founding of the journal Health Research Policy and Systems (HARPS). As Editors-in-Chief of the journal since 2006, we mark our retirement by tracking both the progress of the journal and the development of national health research systems. HARPS has maintained its focus on a range of central themes that are key components of a national health research system in any country. These include building capacity to conduct and use health research, identifying appropriate priorities, securing funds and allocating them accountably, producing scientifically valid research outputs, promoting the use of research in polices and practice in order to improve health, and monitoring and evaluating the health research system. Some of the themes covered in HARPS are now receiving increased attention and, for example, with the assessment of research impact and development of knowledge translation platforms, the journal has covered their progress throughout that expansion of interest. In addition, there is increasing recognition of new imperatives, including the importance of promoting gender equality in health research if benefits are to be maximised. In this Editorial, we outline some of the diverse and developing perspectives considered within each theme, as well as considering how they are held together by the growing desire to build effective health research systems in all countries.From 2003 until mid-June 2017, HARPS published 590 articles on the above and related themes, with authors being located in 76 countries. We present quantitative data tracing the journal's growth and the increasing external recognition of its role. We thank the many colleagues who have kindly contributed to the journal's success, and finish on an exciting note by welcoming the new Editors-in-Chief who will take HARPS forward.
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Affiliation(s)
- Stephen R. Hanney
- Health Economics Research Group, Institute of Environment, Health and Societies, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH United Kingdom
| | - Miguel A. González-Block
- Universidad Anáhuac, Av. Universidad Anáhuac 46, Lomas Anáhuac, 52786 Huixquilucan Mexico City, Mexico
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Sombié I, Aidam J, Montorzi G. Evaluation of regional project to strengthen national health research systems in four countries in West Africa: lessons learned. Health Res Policy Syst 2017; 15:46. [PMID: 28722552 PMCID: PMC5516846 DOI: 10.1186/s12961-017-0214-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since the Commission on Health Research for Development (COHRED) published its flagship report, more attention has been focused on strengthening national health research systems (NHRS). This paper evaluates the contribution of a regional project that used a participatory approach to strengthen NHRS in four post-conflict West African countries - Guinea-Bissau, Liberia, Sierra Leone and Mali. METHODS The data from the situation analysis conducted at the start of the project was compared to data from the project's final evaluation, using a hybrid conceptual framework built around four key areas identified through the analysis of existing frameworks. The four areas are governance and management, capacities, funding, and dissemination/use of research findings. RESULTS The project helped improve the countries' governance and management mechanisms without strengthening the entire NHRS. In the four countries, at least one policy, plan or research agenda was developed. One country put in place a national health research ethics committee, while all four countries could adopt a research information management system. The participatory approach and support from the West African Health Organisation and COHRED were all determining factors. CONCLUSION The lessons learned from this project show that the fragile context of these countries requires long-term engagement and that support from a regional institution is needed to address existing challenges and successfully strengthen the entire NHRS.
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Affiliation(s)
- Issiaka Sombié
- West Africa Health Organisation, BP 153, Bobo-Dioulasso, Burkina Faso.
| | - Jude Aidam
- West Africa Health Organisation, BP 153, Bobo-Dioulasso, Burkina Faso
| | - Gabriela Montorzi
- Council on Health Research for Development (COHRED), Geneva, Switzerland
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Mbondji PE, Kebede D, Zielinski C, Kouvividila W, Sanou I, Lusamba-Dikassa PS. Overview of national health research systems in sub-Saharan Africa: results of a questionnaire-based survey. J R Soc Med 2014; 107:46-54. [PMID: 24914128 DOI: 10.1177/0141076814530600] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To assess the state of national health research systems of countries in the World Health Organization (WHO) African Region. DESIGN A questionnaire-based survey METHODS: Structured questionnaires were used to solicit health research systems' relevant information from key informants in each country. SETTING Forty-six Member States of the WHO African Region. PARTICIPANTS Key informants from the ministry of health in each country, with the support of WHO Country Offices. MAIN OUTCOME MEASURES Presence of national health research policy or strategy, priority setting and ethical review of research. RESULTS Of the 44 responding countries, 39 (89%) reportedly had an official national health policy and 37 (84%) had a strategic health plan. A total of 16 (36%) countries reportedly had a functional national health research governance mechanism, nine of which had clear terms of reference; nine (20%) countries had a functional national health research management forum. Functional ethical review committees were reported in 33 countries (75%). CONCLUSIONS National health research systems were weak in the countries assessed. Significantly more resources should be allocated to strengthening these systems.
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Affiliation(s)
| | - Derege Kebede
- World Health Organization Regional Office for Africa, PO Box 6, Brazzaville, Congo
| | - Chris Zielinski
- World Health Organization Regional Office for Africa, PO Box 6, Brazzaville, Congo
| | | | - Issa Sanou
- World Health Organization Regional Office for Africa, PO Box 6, Brazzaville, Congo
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Sundby J. A rollercoaster of policy shifts: global trends and reproductive health policy in The Gambia. Glob Public Health 2014; 9:894-909. [PMID: 25203251 PMCID: PMC4166968 DOI: 10.1080/17441692.2014.940991] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 06/17/2014] [Indexed: 11/23/2022]
Abstract
Global trends influence strategies for health-care delivery in low- and middle-income countries. A drive towards uniformity in the design and delivery of healthcare interventions, rather than solid local adaptations, has come to dominate global health policies. This study is a participatory longitudinal study of how one country in West Africa, The Gambia, has responded to global health policy trends in maternal and reproductive health, based on the authors' experience working as a public health researcher within The Gambia over two decades. The paper demonstrates that though the health system is built largely upon the principles of a decentralised and governed primary care system, as delineated in the Alma-Ata Declaration, the more recent policies of The Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria and the GAVI Alliance have had a major influence on local policies. Vertically designed health programmes have not been easily integrated with the existing system, and priorities have been shifted according to shifting donor streams. Local absorptive capacity has been undermined and inequalities exacerbated within the system. This paper problematises national actors' lack of ability to manoeuvre within this policy context. The authors' observations of the consequences in the field over time evoke many questions that warrant discussion, especially regarding the tension between local state autonomy and the donor-driven trend towards uniformity and top-down priority setting.
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Affiliation(s)
- Johanne Sundby
- Institute of Health and Society, University of Oslo, Oslo, Norway
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Abstract
Global health is a varied field that comprises research, evaluation and policy that, by its definition, also occurs in disparate locations across the world. This forum article is introduced by our guest editor of the Medicine for Global Health article collection, Gretchen Birbeck. Here, experts based across different settings describe their personal experiences of global health, discussing how evidence-based medicine in resource-limited settings can be translated into improved health outcomes.
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13
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Chanda-Kapata P, Campbell S, Zarowsky C. Developing a national health research system: participatory approaches to legislative, institutional and networking dimensions in Zambia. Health Res Policy Syst 2012; 10:17. [PMID: 22672331 PMCID: PMC3463500 DOI: 10.1186/1478-4505-10-17] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 05/16/2012] [Indexed: 11/10/2022] Open
Abstract
For many sub-Saharan African countries, a National Health Research System (NHRS) exists more in theory than in reality, with the health system itself receiving the majority of investments. However, this lack of attention to NHRS development can, in fact, frustrate health systems in achieving their desired goals. In this case study, we discuss the ongoing development of Zambia's NHRS. We reflect on our experience in the ongoing consultative development of Zambia's NHRS and offer this reflection and process documentation to those engaged in similar initiatives in other settings. We argue that three streams of concurrent activity are critical in developing an NHRS in a resource-constrained setting: developing a legislative framework to determine and define the system's boundaries and the roles all actors will play within it; creating or strengthening an institution capable of providing coordination, management and guidance to the system; and focusing on networking among institutions and individuals to harmonize, unify and strengthen the overall capacities of the research community.
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14
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Martins N, Hawkins Z. Striving for better health through health research in post-conflict Timor-Leste. Health Res Policy Syst 2012; 10:13. [PMID: 22490170 PMCID: PMC3359172 DOI: 10.1186/1478-4505-10-13] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 04/10/2012] [Indexed: 12/03/2022] Open
Abstract
The Cabinet of Health Research and Development (CHRD) has recently been established as the first health research institute in one of the world's newest nations, Timor-Leste. We discuss the development of this initiative to build health research capacity within the context of Timor-Leste's health system, history and future goals.
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Affiliation(s)
- Nelson Martins
- Minister of Health, Democratic Republic of Timor-Leste, Ministry of Health,Caicoli, Dili, Timor-Leste
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15
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Kok MO, Rodrigues A, Silva AP, de Haan S. The emergence and current performance of a health research system: lessons from Guinea Bissau. Health Res Policy Syst 2012; 10:5. [PMID: 22321566 PMCID: PMC3295730 DOI: 10.1186/1478-4505-10-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 02/09/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about how health research systems (HRS) in low-income countries emerge and evolve over time, and how this process relates to their performance. Understanding how HRSs emerge is important for the development of well functioning National Health Research Systems (NHRS). The aim of this study was to assess how the HRS in Guinea Bissau has emerged and evolved over time and how the present system functions. METHODS We used a qualitative case-study methodology to explore the emergence and current performance of the HRS, using the NHRS framework. We reviewed documents and carried out 39 in-depth interviews, ranging from health research to policy and practice stakeholders. Using an iterative approach, we undertook a thematic analysis of the data. RESULTS The research practices in Guinea Bissau led to the emergence of a HRS with both local and international links and strong dependencies on international partners and donors. The post-colonial, volatile and resource-dependent context, changes in donor policies, training of local researchers and nature of the research findings influenced how the HRS evolved. Research priorities have mostly been set by 'expatriate' researchers and focused on understanding and reducing child mortality. Research funding is almost exclusively provided by foreign donors and international agencies. The training of Guinean researchers started in the mid-nineties and has since reinforced the links with the health system, broadened the research agenda and enhanced local use of research. While some studies have made an important contribution to global health, the use of research within Guinea Bissau has been constrained by the weak and donor dependent health system, volatile government, top-down policies of international agencies, and the controversial nature of some of the research findings. CONCLUSIONS In Guinea Bissau a de facto 'system' of research has emerged through research practices and co-evolving national and international research and development dynamics. If the aim of research is to contribute to local decision making, it is essential to modulate the emerged system by setting national research priorities, aligning funding, building national research capacity and linking research to decision making processes. Donors and international agencies can contribute to this process by coordinating their efforts and aligning to national priorities.
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Affiliation(s)
- Maarten O Kok
- Department of Health Sciences, VU University, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Amabelia Rodrigues
- Instituto Nacional da Saúde Pública, CP 861, 1004 Bissau Cedex, Bissau. República da Guiné-Bissau
| | - Augusto Paulo Silva
- Minsterio da Saúde Pública, Avenida Unidade Africana, Caixa Postal 50, 1013, Bissau Cedex, República da Guiné-Bissau
| | - Sylvia de Haan
- Council on Health Research for Development (COHRED), 1-5 Route des Morillons, 1211 Genève, Switzerland
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16
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Hummers-Pradier E, Beyer M, Chevallier P, Eilat-Tsanani S, Lionis C, Peremans L, Petek D, Rurik I, Soler JK, Stoffers HE, Topsever P, Ungan M, Royen PV. The Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe. Part 1. Background and methodology1. Eur J Gen Pract 2010; 15:243-50. [DOI: 10.3109/13814780903452184] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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