Evaluating agency initiatives: building social science capability in tropical disease research

John R. A human rights-based framework to assess gender equality in health systems: the example of Zika virus in the Americas

BACKGROUND

The right to health was enshrined in the constitution of the World Health Organization (WHO) in 1946 and in the Universal Declaration of Human Rights in 1948. The latter Declaration, which also guaranteed women's rights, was signed by almost all countries in the world. Subsequent international conventions reinforced these rights, requiring that women be able to realize their fundamental freedoms and dignity. Although the value of incorporating gender into health systems has been increasingly acknowledged over the years, gender inequalities in health persist.

OBJECTIVE

To introduce a tool to help countries assess their performance in addressing gender inequalities in their health systems, using the example of the Zika virus (ZIKV) in countries of the Americas.

METHODS

This paper is based on comprehensive reviews of the literature on the links between gender equality, health systems and human rights, and available scientific evidence about an adequate response to ZIKV.

RESULTS

The authors present a simple two-part framework from the human rights perspectives of the health system as duty bearer, incorporating WHO's six health system building blocks, and of its clients as rights holders. The authors apply the framework to ZIKV in the Americas, and identify strengths and weaknesses at every level of the health system. They find that when considering gender, health systems have focused mainly on dichotomous sex differences, failing to consider broader gender relations and processes affecting access to services, quality of care, and health outcomes.

CONCLUSIONS

The authors' framework will permit countries to assess progress toward gender equality in health, within the context of their human rights commitments, by examining each health system building block, and the degree to which clients are realizing their rights. By applying the framework to specific health conditions, gender-related achievements and shortcomings can be identified in each health system component, fostering a more comprehensive and gender-sensitive response.

Infectious disease research and the gender gap

Historically, women have been less likely to be supported through higher degree training programmes, and they continue to hold more junior positions in science. This paper reviews the current gender research and gender capacity-building efforts led by the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR). Created more than 40 years ago as the only United Nations-based Special Programme dedicated to research and research capacity building on infectious diseases, TDR has a longstanding track record both in supporting research into gender-specific questions and in research capacity strengthening among women scientists. We provide an overview of these approaches, then describe a recent pilot programme on Women in Science, designed to understand and remedy the gender gaps in health research. The programme focused on Africa, but it is hoped that the replication of such schemes in TDR and other international funding agencies will lead to more attention being given to women in infectious diseases research in other continents.

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Impact of health research capacity strengthening in low- and middle-income countries: the case of WHO/TDR programmes

Background

Measuring the impact of capacity strengthening support is a priority for the international development community. Several frameworks exist for monitoring and evaluating funding results and modalities. Based on its long history of support, we report on the impact of individual and institutional capacity strengthening programmes conducted by the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) and on the factors that influenced the outcome of its Research Capacity Strengthening (RCS) activities.

Methodology and Principal Findings

A mix of qualitative and quantitative methods (questionnaires and in-depth interviews) was applied to a selected group of 128 individual and 20 institutional capacity development grant recipients that completed their training/projects between 2000 and 2008. A semi-structured interview was also conducted on site with scientists from four institutions. Most of the grantees, both individual and institutional, reported beneficial results from the grant. However, glaring inequities stemming from gender imbalances and a language bias towards English were identified. The study showed that skills improvement through training contributed to better formulation of research proposals, but not necessarily to improved project implementation or communication of results. Appreciation of the institutional grants' impact varied among recipient countries. The least developed countries saw the programmes as essential for supporting basic infrastructure and activities. Advanced developing countries perceived the research grants as complementary to available resources, and particularly suitable for junior researchers who were not yet able to compete for major international grants.

Conclusion

The study highlights the need for a more equitable process to improve the effectiveness of health research capacity strengthening activities. Support should be tailored to the existing research capacity in disease endemic countries and should focus on strengthening national health research systems, particularly in the least developing countries. The engagement of stakeholders at country level would facilitate the design of more specific and comprehensive strategies based on local needs.

The UNICEF/UNDP/World Bank /WHO Special Programme for Research and Training in Tropical Diseases (TDR) has over the 2000–2008 period supported the development of individual and institutional grants. Although the TDR research capacity development programmes has had a substantial impact on the development of tropical disease research and research capacity in disease endemic countries, a review of the lessons learnt and benefits of this approach has never been completed. A study was conducted to analyse TDR's inputs in research capacity in endemic countries and to assist TDR in the improvement of its future activities. An analysis (by variables of gender, age, language, country of origin, country of studies, type of grant, scientific interest etc) of the grantees that have benefited from TDR support in terms of their career development and research capacity, including any important financial implications was conducted. The study identify opportunities that are a broader relevance to objectives to international development agencies such as addressing inequities such as the gender imbalance language bias towards English and building a supportive research environment in DECs in which researchers can develop their scientific career and pursue their research.

Health systems research training enhances workplace research skills: a qualitative evaluation

INTRODUCTION

In-service education is a widely used means of enhancing the skills of health service providers, for example, in undertaking research. However, the transfer of skills acquired during an education course to the workplace is seldom evaluated. The objectives of this study were to assess learner, teacher, and health service manager perceptions of the usefulness, in the work setting, of skills taught on a health systems research education course in South Africa and to assess the extent to which the course stimulated awareness and development of health systems research in the work setting.

METHODS

The education course was evaluated using a qualitative approach. Respondents were selected for interview using purposive sampling. Interviews were conducted with 39 respondents, including all of the major stakeholders. The interviews lasted between 20 and 60 minutes and were conducted either face to face or over the telephone. Thematic analysis was applied to the data, and key themes were identified.

RESULTS

The course demystified health systems research and stimulated interest in reading and applying research findings. The course also changed participants' attitudes to routine data collection and was reported to have facilitated the application of informal research or problem-solving methods to everyday work situations. However, inadequate support within the workplace was a significant obstacle to applying the skills learned.

DISCUSSION

A 2-week intensive, experiential course in health systems research methods can provide a mechanism for introducing basic research skills to a wide range of learners. Qualitative evaluation is a useful approach for assessing the impacts of education courses.

Applying medical anthropology in the control of infectious disease

This paper focuses on two roles of anthropology in the control of infectious disease. The first is in identifying and describing concerns and understandings of disease, including local knowledge of cause and treatment relevant to disease control. The second is in translating these local concerns into appropriate health interventions, for example, by providing information to be incorporated in education and communication strategies for disease control. Problems arise in control programmes with competing knowledge and value systems. Anthropology's role conventionally has been in the translation of local concepts of illness and treatment, and the adaptation of biomedical knowledge to fit local aetiologies. Medical anthropology plays an important role in examining the local context of disease diagnosis, treatment and prevention, and the structural as well as conceptual barriers to improved health status. National (and international) public health goals which respect local priorities are uncommon, and generic health goals rarely coincide with specific country and community needs. The success of interventions and control programmes is moderated by local priorities and conditions, and sustainable interventions need to acknowledge and address country-specific social, economic and political circumstances.

North-South health research collaboration: challenges in institutional interaction

North-South health development cooperation often includes research financed largely by external donors. The cooperation varies between projects and programmes with regard to subject area, mix of disciplines involved, research methods, training components and project management arrangements. A variety of problems is encountered, but they are rarely described and discussed in published project reports. We authors conducted a study of a small number of European health researchers collaborating with researchers from the Third World. We focused upon projects involving both biomedical and social science researchers, and apart from a literature review three methods were applied: self-administered questionnaires to European researchers, semistructured interviews with five IHCAR researchers, and written summaries by the three authors, each on one recent or ongoing collaborative project of their choice. Most collaborative projects were initiated from the North and are monodisciplinary or partly interdisciplinary in the sense that researchers did independent data collection preceded by joint planning and followed by joint analysis and write-up. There may be disagreements concerning remuneration such as allowances in relation to fieldwork and training. Socio-cultural misunderstanding and conflict was reportedly rare, and no serious problems were reported regarding authorship and publishing. It is concluded that collaborative research is a complex and poorly understood process with considerable potential and worth pursuing despite the problems. Difficulties related to logistics and finance are easily and freely discussed, while there is little evidence that transdisciplinary research is conducted or even discussed. We recommend that published and unpublished reports on collaborative research projects include more detailed accounts of the North-South collaborative arrangements and their management, ethical and financial aspects.

Recent developments in hygiene behaviour research: an emphasis on methods and meaning

This paper discusses some of the recent developments in hygiene behaviour research, focusing on operational research. A series of "rapid' assessments of hygiene behaviour were carried out in Kenya, Tanzania and Ethiopia with a view to preparing a field handbook entitled Hygiene Evaluation Procedures (HEP). The HEP handbook is intended primarily for field personnel in water supply, sanitation and health/hygiene education projects who want to design and conduct their own systematic assessments of hygiene behaviour in their localities. The short studies provided useful practical insights into the concerns and needs of project staff for whom research allowances (human, material and time resources) are often very limited. In this paper emphasis is placed on both methodological and heuristic developments as the two are inseparable. It is suggested that in the domestic sphere, hygiene behaviour with respect to the disposal of children's faeces and domestic water use are two of the key areas that remain of universal relevance to water/sanitation related interventions. These can be assessed rapidly and effectively by using two indicators: means of disposal of children's faeces and handwashing at 'critical' times--after defaecation, after handling and/or disposing of children's faeces, before handling food and before feeding young children and eating. Appropriate combinations of anthropological methods and participatory tools for measuring these indicators are described. The practical relevance of the resulting data for project design and implementation is highlighted.

Setting up a scientific community by means of a small grants program: the Latin American experience

The study of tropical diseases in Latin America has been dominated by the biomedical sciences, and whilst recently social science health research has been developed, there has been little collaboration between the two. The Latin American Small Grants Programme for Social and Economic Aspects of Tropical Diseases, launched by WHO/TDR in 1990, aimed to attract junior researchers into the area of social sciences and tropical diseases, and to create among them a scientific community. The program is unique in that it has involved the transfer of decision-making power from an international organisation (WHO/TDR) to a regional group. This article discusses the organisational structure of the program, the methods by which the program handled proposals, the evaluation process, the types of research proposals received, a profile of applicants, and the results of the applications. There was a balance of biomedical and social science applications. We conclude that the Small Grants Programme has been successful in fulfilling its objectives, due to the design of the grants scheme itself.

Promoting interdisciplinary collaboration in health research in developing countries: lessons from the Triangle Programme in Sri Lanka

The Triangle Programme (1989-1992) aimed at strengthening the institutional capacity for health social science research and intervention in Sri Lanka through the promotion of appropriate international and national partnerships. First, it involved an international partnership (Triangle 1) among two universities in the developed world, i.c. University of Antwerp in Belgium and the University of Connecticut in the USA, and one university in the developing world, i.c. the University of Peradeniya, Sri Lanka. This partnership facilitated the transfer of knowledge, experience, skills across national boundaries and the North/South divide. Second, it developed a national/local partnership (Triangle 2) among the Faculties of Arts, Agriculture and Medicine at the University of Peradeniya by involving them in a joint programme of health social science research and training covering the entire range of activities from proposal development to dissemination of research results. Focusing on the latter aspect (Triangle 2) this paper reviews the results of the programme from the angle of cross-fertilization of disciplines through their collaboration in applied health research in a developing country setting.

Capacity building for health social science: the International Clinical Epidemiology Network (INCLEN) social science program and the International Forum for Social Science in Health (IFSSH)

This paper describes the unfolding of two complementary efforts to build global capacity in health social science. The INCLEN model aims to infuse a genuine transdisciplinary perspective into international health through equipping social scientists to speak a common language with clinical epidemiologists and sensitising clinicians to the ways social sciences contribute to research and policy. Issues are raised pertinent to the model's viability, including recruitment of scholars for fellowships, curriculum substance, and mechanisms for integrating social science fellows when they return home. The future success of the INCLEN program, and comparable donor initiatives, depends upon a wider infrastructure of career supports played out at the international level in which donor and operating agencies nourish the emergence of an expanded body of health social scientists. The International Forum for Social Sciences in Health (IFSSH) has been formed to help build this infrastructure and provide impetus for a viable scientific community of health social scientists. The IFSSH 'global agenda' is portrayed and an illustration is given of how this agenda is being implemented in the Asia and Pacific region.

Strengthening research capability, funding and sustainability: a personal perspective

The need to strengthen research capability has led organizations to provide research-oriented training programs, including various short courses and protocol development workshops, at the end of which it is anticipated that the participants will be able to carry out the research work. However, to do research needs more than just training; it also requires funds, a research infrastructure, technical back-up and other support. This paper compares two of these programs from the perspective of an attendant: WHO/TDR's Fieldlincs program and the CAPS (Center for AIDS Prevention Studies) International Program. The paper also describes the experience of the approaches that have been used to get research funding. In addition, issues related to sustaining researchers in the field are discussed.