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Daily report - 25 June 2008

Source: TropIKA.net editorial team

Translating research into policy

So far, the conference has tackled the important question of how to boost the amount of health research done in Africa and how to direct that research. Today dealt with what is arguably an even more important question – how can health research feed into health policy? (See Ridley presentation)

A key issue is that research does not automatically translate into action or policy. The research produced needs to be efficiently managed and publicized, but scientists also need feedback on their work both from the community and the government.

Policymakers are also not a homogeneous lot: while some make decisions on cultural issues, others make decisions on political and financial issues. Directors and chief officials who work closely with the ministers could, for example serve as links between the researchers and the policymakers to help bridge the gap between these two groups and help promote research that informs policy. (See Paraje presentation)

Participants in this session argued that most of the health problems of Africa today can be solved using existing technologies. The critical issue in research is getting the questions right and not just focusing on tools.

Health information systems

This session shared issues with that presented yesterday on how to strengthen the information needed to improved health and health systems. African countries do not systematically collect key types of data such as those from: population censuses, vital registrations, routine service statistics, health facility assessment and demographic surveillance sites. A lot of useful data relevant to health is generated outside the health sector, making it vital that health ministers liaise with other government ministers. (See HIS presentation)

So what data is needed and why? Population and demographic data can offer insights into trends in diseases, for example, which is why vital registration is so crucial. Despite its importance, only four African countries – Algeria, Mauritius, Namibia and South Africa have such data for more than 90 per cent of the population.

One of the reasons for this poor coverage could be that there is no penalty for not registering a vital event and the public do not see the need to register such events. In most countries, where this is the case, the government focuses on the census figures as a denominator to derive the health indices. However, the availability of the census is also an issue; some countries such as the Democratic Republic of Congo and Eritrea have not conducted a census in the last 10 years. Only in South Africa has a census been conducted every 5 years. Failing sufficiently frequent census data, African countries rely on household surveys like the Demographic and Health Surveys (DHS). Limitations include the inability to disaggregate data.

Some of the challenges faced in implementing a good health information systems include: human resource capacity in terms of data collection and analyses, lack of standardisation in the tools, analyses and assumptions; programmes that are vertically structured rather than horizontal, which can hamper feedback to local stakeholders, and may increase fragmentation. Having multiple sources of data is important but because of the paucity of data, countries often rely heavily on a single source, such as survey data.

Knowledge systems

A survey of the knowledge environment of African health systems, based on questionnaire data from 46 countries in Africa, covered the use of knowledge in health policy formulation, and provision of clinical services. Knowledge is created and used in different ways: in many countries, the ministry of health is involved in health policy formulation, direction and guidance, as well as provision of clinical services, but policy implementation was mostly done at the local level in the majority of the countries assessed.

Where knowledge comes from is an important issue. In this report, the WHO, as well as regional and national networks were important sources for the dissemination of evidence, while the internet and systematic databases, such as the Cochrane review, were rarely used. Electronic medical records were rarely used for the provision of clinical services. A notable observation was the low availability of books, journals, computers and internet connection in teaching hospitals, with fewer still in health centers.

The most common format for the dissemination of knowledge on health policy was through printed documents and publications. Education and networking among health service providers was mainly through local communication, medical education conferences, and by communication with peers abroad. There was a gap in monitoring and evaluation in both policy formulation and the provision of clinical services.

Disseminating knowledge is crucial. Delegates highlighted the role and inclusion of the media and other stakeholders in bridging the gap between researchers, policymakers and the population, as well as simplifying the often-complex research findings. They also suggested that WHO could play a role as a knowledge broker in partnership with donors.

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