http://www.health-policy-systems.com The latest research articles published by Health Research Policy and Systems 2009-06-17T00:00:00Z This is an RSS newsfeed from BioMed Central It is intended to be used with an RSS reader. For more information about RSS newsfeeds from BioMed Central, visit http://www.biomedcentral.com/info/about/rss/ ObjectiveCommunity Advisory Boards are now seen as standard practice for clinical vaccine and drug trials worldwide. In the past, most Community Advisory Boards (CABs) were established by activists and lobbyists to monitor HIV/AIDS vaccine and drug trials in developed countries. In Africa the first CAB was established in Uganda in 1990 in conjunction with an HIV vaccine project and has since been followed by others in South Africa, Zimbabwe, and Kenya. In 2007, the Bagamoyo branch of the Ifakara Health Institute initiated the formation of a CAB. The aim was to properly educate and empower elected CAB members to become full partners in all research activities concerning the public within the Bagamoyo area.Methods and ResultsBeginning in 2007, staff visited each of the 24 villages within the study area to inform the communities about the proposed CAB and asked them to elect two individuals to represent their village on the CAB. The first attempt was hampered by community leaders selecting themselves, which led to inconsistent attendance, gender imbalance, and political infighting. New criteria for the selection of representatives were implemented to exclude governmental leaders, illiterate representatives and to promote a one-to-one gender balance. The newly appointed representatives underwent training and have participated in CAB meetings largely devoid of the negative issues previously encountered. Conclusion: The successfully established CAB has led to improved relations with the community and facilitated the recruitment of study subjects. Our experiences show that, it is possible to establish a non-specific CAB in a low-income setting. http://www.health-policy-systems.com/content/7/1/16 Kafuruki Shubis Omar Juma Rahiya Sharifu Brandt Burgess Salim Abdulla Health Research Policy and Systems 2009, 7:16 2009-06-17T00:00:00Z doi:10.1186/1478-4505-7-16 Health Research Policy and Systems 1478-4505 7 16 2009-06-17T00:00:00Z XML Background: 'Evidence-based policy making' for immigrants is a complicated undertaking. In striving toward this goal, federal Canadian partners created the Metropolis Project in 1995 to optimize a two-way transfer of knowledge (researchers - policy makers) within five Canadian Centres of Excellence focused on migrants newly arrived in Canada. Most recently, Metropolis federal partners, including the Public Health Agency of Canada, defined one of six research priority areas as, immigrant 'families, children, and youth'. In order to build on previous work in the partnership, we sought to determine what has been studied within this research-policy partnership about immigrant 'families, children, and youth' since its inception. Methods: Annual reports and working papers produced in the five Centres of Excellence between 1996-2006 were culled. Data on academic works were extracted, results coded according to eleven stated federal policy priority themes, and analyzed descriptively. Results: 139 academic works were reviewed. All federal priority themes, but few specific policy questions were addressed. The greatest volume of policy relevant works were identified for Services (n = 42) and Education and Cultural Identity (n = 39) priority themes. Conclusions: Research conducted within the last 10 years is available to inform certain, not all, federal policy questions. Greater specificity in federal priorities can be expected to more clearly direct future research within this policy-research partnership. http://www.health-policy-systems.com/content/7/1/15 Anita Gagnon Marie-Pier Joly Jacqueline Bocking Health Research Policy and Systems 2009, 7:15 2009-06-10T00:00:00Z doi:10.1186/1478-4505-7-15 Health Research Policy and Systems 1478-4505 7 15 2009-06-10T00:00:00Z PDF Background: The increasing resources available for and number of partners providing health sector aid have stimulated innovations, notably, the Paris Declaration on Aid Effectiveness, which aim to improve aid coordination. In this, one of the first studies to analyse implementation of aid coordination below national level, the aim was to investigate the effect of the Paris Declaration on coordination of health sector aid at the district level in Zambia. Methods: The study was carried out in three districts of Zambia. Data were collected via interviews with health centre staff, district managers and officials from the Ministry of Health, and from district action plans, financial reports and accounts, and health centre ledger cards. Four indicators of coordination related to external-partner activity, common arrangements used by external partners and predictability of funding were analysed and assessed in relation to the 2010 targets set by the Paris Declaration.FindingsWhile the activity of external partners at the district level has increased, funding and activities provided by these partners are often not included in local plans. HIV/AIDS support show better integration in planning and implementation at the district level than other support. Regarding common arrangements used for fund disbursement, the share of resources provided as programme-based support is not increasing. The predictability of funds coming from outside the government financing mechanism is low. Conclusion: Greater efforts to integrate partners in district level planning and implementation are needed. External partners must improve the predictability of their support and be more proactive in informing the districts about their intended contributions. With the deadline for achieving the targets set by the Paris Declaration fast approaching, it is time for the signatories to accelerate its implementation. http://www.health-policy-systems.com/content/7/1/14 Jesper Sundewall Birger Forsberg Kristina Jonsson Collins Chansa Goran Tomson Health Research Policy and Systems 2009, 7:14 2009-06-08T00:00:00Z doi:10.1186/1478-4505-7-14 Health Research Policy and Systems 1478-4505 7 14 2009-06-08T00:00:00Z XML In developing countries building national health research systems is a movement similar to a political leadership contest. Increasingly, political campaigns to select leaders depend less on ideologies and political messages and more on promising change that will promptly improve the quality of life of the voters. In this process the benefits and risks of every action and statement made by the candidates are carefully assessed.Approaches currently promoted to strengthen health research within ministries of health in developing countries place emphasis on implementing logical steps towards building national health research systems including developing a national health research policy and strategic plan, conducting a situational analysis of research in the country, setting a national health research agenda, establishing research ethics and scientific committees, and building human and institutional capacity for health research management and conduct. Although these processes have successfully improved the standards of health research in some settings, many developing countries struggle to get the process going. One reason is that this approach does not deal with basic questions posed within a ministry of health, namely, "What is the political benefit of the ministry assuming control of the process?" and "What are the political implications for the ministry if another institution spearheads the process?"Seen from the perspective of non-governmental organizations, academic institutions and donors trying to support the processes of strengthening national health research systems, one of the foremost activities that needs to be undertaken is to analyze the political context of national health research and, on that basis, plan and implement appropriate political health research advocacy initiatives. This includes the development of explicit messages on the political benefits to the leadership in the ministry of health of their role in the conduct, management and dissemination of health research within the country. Civil society organizations, with links to both government and non-governmental organizations, are well placed to play the role of advocates.It is only through broad and active participation of stakeholders that the process of developing effective and sustainable national health research systems will truly become a national movement inspired, led and sustained by ministries of health. http://www.health-policy-systems.com/content/7/1/13 Ayo Palmer Samuel Anya Paul Bloch Health Research Policy and Systems 2009, 7:13 2009-05-29T00:00:00Z doi:10.1186/1478-4505-7-13 Health Research Policy and Systems 1478-4505 7 13 2009-05-29T00:00:00Z XML Globally, health research organizations are called upon to re-examine their policies and practices to more efficiently and effectively address current scientific and social needs, as well as increasing public demands for accountability.Through a case study approach, the authors examine an effort undertaken by the National Institute of Allergy & Infectious Diseases (part of the National Institutes of Health, Department of Health & Human Services, United States Government) to develop an evaluation system for its recently restructured HIV/AIDS clinical trials program. The challenges in designing, operationalizing, and managing global clinical trials programs are considered in the context of large scale scientific research initiatives.Through a process of extensive stakeholder input, a framework of success factors was developed that enables both a prospective view of the elements that must be addressed in an evaluation of this research and a current state assessment of the extent to which the goals of the restructuring are understood by stakeholders across the DAIDS clinical research networks. http://www.health-policy-systems.com/content/7/1/12 Jonathan Kagan Mary Kane Kathleen Quinlan Scott Rosas William Trochim Health Research Policy and Systems 2009, 7:12 2009-05-21T00:00:00Z doi:10.1186/1478-4505-7-12 Health Research Policy and Systems 1478-4505 7 12 2009-05-21T00:00:00Z XML Background: Primary health care research is under pressure to be accountable to funders in terms of benefits for practice and policy. However, methods to assess the impact of primary health care research must be appropriate to use with the diverse topics, settings and approaches of this sector. This project explored the feasibility of using the Buxton and Hanney Payback Framework to determine the impact of a stratified random sample (n = 4) of competitively funded, primary health care research projects. Methods: The project conducted telephone interviews based on the Payback Framework with leaders of the research teams and nominated users of their research, used bibliometric methods for assessing impact through publication outputs and obtained documentary evidence of impact where possible. The purpose was to determine the effectiveness of the data collection methods and the applicability of the Payback Framework, and any other issues which arose around the assessment of impact of primary health care research.Results and discussionThe thirteen interviews were resource intensive to organise conduct and analyse but provided better information about impact than bibliometric analysis or documentary analysis. Bibliometric analysis of the papers published from the four projects was hampered by the inclusion of only one of the journals in major citation indexes. Document analysis provided more evidence of dissemination than of impact.The payback framework and logic model were a sound basis for assessing impact. Chief investigators and nominated users of research provided substantial information relevant to the impact categories closest to their spheres of influence and awareness, but less about the impact their research had on the wider health sector, population health or economic benefits. An additional category of impact emerged from the interviews, that of strengthening research networks which could enhance the impact of later work. The framework provided rich information about the pathways to impact, better understanding of which may enhance impact. Conclusion: It is feasible to use the Buxton and Hanney Payback framework and logic model to determine the proximal impacts of primary health care research. Though resource intensive, telephone interviews of chief investigators and nominated users provided rich information. http://www.health-policy-systems.com/content/7/1/11 Elizabeth Kalucy Eleanor Jackson-Bowers Ellen McIntyre Richard Reed Health Research Policy and Systems 2009, 7:11 2009-05-08T00:00:00Z doi:10.1186/1478-4505-7-11 Health Research Policy and Systems 1478-4505 7 11 2009-05-08T00:00:00Z XML Background: Clinical practice guidelines (CPGs) are commonly used to support practitioners to improve practice. However many studies have raised concerns about guideline quality. The reasons why guidelines are not developed following the established development methods are not clear.The SEA-ORCHID project aims to increase the generation and use of locally relevant research and improve clinical practice in maternal and perinatal care in four countries in South East Asia. Baseline data highlighted that development of evidence-based CPGs according to recommended processes was very rare in the SEA-ORCHID hospitals. The project investigators suggested that there were aspects of the recommended development process that made it very difficult in the participating hospitals.We therefore aimed to explore the experience of guideline development and particularly the enablers of and barriers to developing evidence-based guidelines in the nine hospitals in South East Asia participating in the SEA-ORCHID project, so as to better understand how evidence-based guideline development could be facilitated in these settings. Methods: Semi-structured, face-to-face interviews were undertaken with senior and junior healthcare providers (nurses, midwives, doctors) from the maternal and neonatal services at each of the nine participating hospitals. Interviews were audio-recorded, transcribed and a thematic analysis undertaken. Results: Seventy-five individual, 25 pair and eleven group interviews were conducted. Participants clearly valued evidence-based guidelines. However they also identified several major barriers to guideline development including time, lack of awareness of process, difficulties searching for evidence and arranging guideline development group meetings, issues with achieving multi-disciplinarity and consumer involvement. They also highlighted the central importance of keeping guidelines up-to-date. Conclusion: Healthcare providers in the SEA-ORCHID hospitals face a series of barriers to developing evidence-based guidelines. At present, in many hospitals, several of these barriers are insurmountable, and as a result, rigorous, evidence-based guidelines are not being developed. Given the acknowledged benefits of evidence-based guidelines, perhaps a new approach to supporting their development in these contexts is needed. http://www.health-policy-systems.com/content/7/1/10 Tari Turner Jacki Short The SEA-ORCHID Study Group Health Research Policy and Systems 2009, 7:10 2009-05-08T00:00:00Z doi:10.1186/1478-4505-7-10 Health Research Policy and Systems 1478-4505 7 10 2009-05-08T00:00:00Z XML Background: Recognising the potential of clinical practice guidelines (CPGs) to improve practice, one of the strategies of the SEA-ORCHID project was to facilitate the development of evidence-based CPGs, and to support clinical staff in each of the four countries to build their skills in development of CPGs in the nine participating hospitals in Thailand, Malaysia, Philippines and Indonesia. This study was undertaken to investigate the impact of the SEA-ORCHID project on development of evidence-based CPGs. Methods: Data on the CPGs available to support maternal and perinatal healthcare were collected by SEA-ORCHID team members at each hospital before and after the intervention period of the project. Results: There were only a few evidence-based CPGs available in the SEA-ORCHID hospitals before the intervention period. After the intervention period, in the SEA-ORCHID hospitals in Malaysia and Indonesia there was no change in evidence-based CPG development activity in maternal and perinatal care. In Thailand and The Philippines there was a small increase in evidence-based CPG development activity in maternal and perinatal care. Conclusion: Despite the wide range of interventions to support evidence-based CPG development implemented in the hospitals participating in the SEA-ORCHID, very little change was seen in the development of evidence-based CPGs. http://www.health-policy-systems.com/content/7/1/9 Jadsada Thinkhamrop Tari Turner Sivasangari Subramaniam The SEA-ORCHID Study Group Health Research Policy and Systems 2009, 7:9 2009-05-08T00:00:00Z doi:10.1186/1478-4505-7-9 Health Research Policy and Systems 1478-4505 7 9 2009-05-08T00:00:00Z XML Background: In 1985 medical schools were integrated into the Ministry of Health, and the Ministry of Health and Medical Education was created in Iran. Under this infrastructure education, research and service provision are unified, and it is expected that collaboration between researchers and decision makers become easier in such an integrated context.The question here is how the researchers behavior in the biggest medical university of the country towards collaboration is, i.e. how much do decision makers participate in different stages of research? Which factors affect it?MethodologyThe samples under study were all Tehran University of Medical Sciences (TUMS) completed research projects that had gotten grants in 2004 and were over by the time this study was done. Two questionnaires were designed for this study: i) the research checklist which was filled for 301 projects, ii) the researcher's questionnaire, which was sent to principle investigators, 208 of which were collected. Multiple linear regression analysis was used for evaluating the potential factors affecting individuals 'collaboration score'. Results: Only 2.2 percent of TUMS' projects initiated in 2004 have had collaboration as a joint PI or co-investigator from non-academic organizations. The principle investigators mean collaboration score was 2.09, where 6 was the total score. So the collaboration score obtained was 35%. The 'type of research' had significant association with the collaboration score which is shown in the linear regression; collaboration was seen more in clinical (p = 0.007) and health system researches (p = 0.001) as compared to basic research. Conclusion: The present study shows that not many individuals collaborated as co-investigators from outside the university. This finding shows that research policy makers need to introduce interventions in this field. And assessment of barriers to collaboration and its facilitating factors should be considered in order to make it actually happen. http://www.health-policy-systems.com/content/7/1/8 Reza Majdzadeh Saharnaz Nedjat Jaleh Gholami Sima Nedjat Katayoun Maleki Mostafa Qorbani Mostafa Shokoohi Mahnaz Ashoorkhani Health Research Policy and Systems 2009, 7:8 2009-04-22T00:00:00Z doi:10.1186/1478-4505-7-8 Health Research Policy and Systems 1478-4505 7 8 2009-04-22T00:00:00Z XML Background: Improving health workers' performance is vital for achieving the Millennium Development Goals. In the literature on human resource management (HRM) interventions to improve health workers' performance in Low and Middle Income Countries (LMIC), hardly any attention has been paid to the question how HRM interventions might bring about outcomes and in which contexts. Such information is, however, critical to assess the transferability of results. Our aim was to explore if realist review of published primary research provides better insight into the functioning of HRM interventions in LMIC.MethodologyA realist review not only asks whether an intervention has shown to be effective, but also through which mechanisms an intervention produces outcomes and which contextual factors appear to be of critical influence. Forty-eight published studies were reviewed. Results: The results show that HRM interventions can improve health workers' performance, but that different contexts produce different outcomes. Critical implementation aspects were involvement of local authorities, communities and management; adaptation to the local situation; and active involvement of local staff to identify and implement solutions to problems. Mechanisms that triggered change were increased knowledge and skills, feeling obliged to change and health workers' motivation. Mechanisms to contribute to motivation were health workers' awareness of local problems and staff empowerment, gaining acceptance of new information and creating a sense of belonging and respect. In addition, staff was motivated by visible improvements in quality of care and salary supplements. Only a limited variety of HRM interventions have been evaluated in the health sector in LMIC. Assumptions underlying HRM interventions are usually not made explicit, hampering our understanding of how HRM interventions work. Conclusion: Application of a realist perspective allows identifying which HRM interventions might improve performance, under which circumstances, and for which groups of health workers. To be better able to contribute to an understanding of how HRM interventions could improve health workers' performance, a combination of qualitative and quantitative research methods would be needed and the use of common indicators for evaluation and a common reporting format would be required. http://www.health-policy-systems.com/content/7/1/7 Marjolein Dieleman Barend Gerretsen Gert Jan van der Wilt Health Research Policy and Systems 2009, 7:7 2009-04-17T00:00:00Z doi:10.1186/1478-4505-7-7 Health Research Policy and Systems 1478-4505 7 7 2009-04-17T00:00:00Z XML