Browsing by Subject "Science policy"
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- ItemOpen AccessAlignment between chronic disease policy and practice: case study at a primary care facility(Public Library of Science, 2014) Draper, Claire A; Draper, Catherine E; Bresick, Graham FBACKGROUND: Chronic disease is by far the leading cause of death worldwide and of increasing concern in low- and middle-income countries, including South Africa, where chronic diseases disproportionately affect the poor living in urban settings. The Provincial Government of the Western Cape (PGWC) has prioritized the management of chronic diseases and has developed a policy and framework (Adult Chronic Disease Management Policy 2009) to guide and improve the prevention and management of chronic diseases at a primary care level. The aim of this study is to assess the alignment of current primary care practices with the PGWC Adult Chronic Disease Management policy. METHODS: One comprehensive primary care facility in a Cape Town health district was used as a case study. Data was collected via semi-structured interviews (n = 10), focus groups (n = 8) and document review. Participants in this study included clinical staff involved in chronic disease management at the facility and at a provincial level. Data previously collected using the Integrated Audit Tool for Chronic Disease Management (part of the PGWC Adult Chronic Disease Management policy) formed the basis of the guide questions used in focus groups and interviews. RESULTS: The results of this research indicate a significant gap between policy and its implementation to improve and support chronic disease management at this primary care facility. A major factor seems to be poor policy knowledge by clinicians, which contributes to an individual rather than a team approach in the management of chronic disease patients. Poor interaction between facility- and community-based services also emerged. A number of factors were identified that seemed to contribute to poor policy implementation, the majority of which were staff related and ultimately resulted in a decrease in the quality of patient care. CONCLUSIONS: Chronic disease policy implementation needs to be improved in order to support chronic disease management at this facility. It is possible that similar findings and factors are present at other primary care facilities in Cape Town. At a philosophical level, this research highlights the tension between primary health care principles and a diseased-based approach in a primary care setting.
- ItemOpen AccessBuilding the field of health policy and systems research: an agenda for action(Public Library of Science, 2011) Bennett, Sara; Agyepong, Irene Akua; Sheikh, Kabir; Hanson, Kara; Ssengooba, Freddie; Gilson, LucyThe lack of clarity and shared understanding regarding the scientific foundations of Health Policy and Systems Research (HPSR) [1] potentially has very negative consequences for the field [2]. Disagreement over the value of different types of theoretical frameworks and research methods can lead to inappropriate evaluations of research proposals, contradictory reviews of the same paper, and delays in publication. Excessive time may be spent communicating broad frameworks to other researchers within HPSR, inhibiting progression to more detailed and specific conversations. Communication barriers may discourage inter-disciplinary collaboration, driving researchers back to their disciplinary safety zones, and creating potential for conflict that may discourage younger researchers who may be less secure in their career from staying in the field. As the second paper in this series concluded [1], there is an urgent need to build understanding across disciplinary boundaries. This final paper in the "Building the Field of HPSR" series turns to practical questions concerning how to remove structural barriers that currently inhibit the development of the HPSR field and thus unlock HPSR capacities. HPSR suffers from many of the same problems as other branches of health research in low- and middle-income countries (LMICs): major imbalances between the resources available in high- versus low- and middle-income contexts [3], acute shortages of skilled researchers (especially senior ones), and relatively few organizations that house HPSR expertise [4]. Historically, low levels of funding for HPSR compared to clinical or biomedical research have compounded these problems. Many papers provide relevant recommendations to address health research capacity issues in LMICs [5]–[8]. However, there is also a nexus of issues specific to HPSR that currently constrains development of the field. This paper builds on the analysis of the previous papers in this series [1],[9] to investigate the practical problems faced and then develops an agenda for building the HPSR field.
- ItemOpen AccessBuilding the field of health policy and systems research: social science matters(Public Library of Science, 2011) Gilson, Lucy; Hanson, Kara; Sheikh, Kabir; Agyepong, Irene Akua; Ssengooba, Freddie; Bennett, SaraThe first paper in this series on building the field of Health Policy and Systems Research (HPSR) in low- and middle-income countries (LMICs) [1] outlined the scope and questions of the field and highlighted the key challenges and opportunities it is currently facing. This paper examines more closely one key challenge, the risk of disciplinary capture - the imposition of a particular knowledge frame on the field, privileging some questions and methodologies above others. In HPSR the risk of disciplinary capture can be seen in the current methodological critique of the field, with consequences for its status and development (especially when expressed by research leaders). The main criticisms are reported to be: that the context specificity of the research makes generalisation from its findings difficult; lack of sufficiently clear conclusions for policy makers; and questionable quality and rigour [2]. Some critique is certainly warranted and has come from HPS researchers themselves. However, this critique also reflects a clash of knowledge paradigms, between some of those with clinical, biomedical, and epidemiological backgrounds and those with social science backgrounds. Yet, as HPSR is defined by the topics and questions it considers rather than a particular disciplinary approach, it requires engagement across disciplines; indeed, understanding the complexity of health policy and systems demands multi- and inter-disciplinary inquiry [3].
- ItemOpen AccessGuidance for evidence-informed policies about health systems: Linking guidance development to policy development(Public Library of Science, 2012) Lavis, John N; Røttingen, John-Arne; Bosch-Capblanch, Xavier; Atun, Rifat; El-Jardali, Fadi; Gilson, Lucy; Lewin, Simon; Oliver, Sandy; Ongolo-Zogo, Pierre; Haines, AndyIn the second paper in a three-part series on health systems guidance, John Lavis and colleagues explore the challenge of linking guidance development and policy development at global and national levels.
- ItemOpen AccessGuidance for evidence-informed policies about health systems: Linking guidance development to policy development(Public Library of Science, 2012) Bosch-Capblanch, Xavier; Lavis, John N; Lewin, Simon; Atun, Rifat; Røttingen, John-Arne; Dröschel, Daniel; Beck, Lise; Abalos, Edgardo; El-Jardali, Fadi; Gilson, Lucy; Oliver, Sandy; Wyss, Kaspar; Tugwell, Peter; Kulier, Regina; Pang, Tikki; Haines, AndyPresent trends suggest that many of the poorest countries in the world, including many in sub-Saharan Africa, will not meet the health-related Millennium Development Goals [1] (MDGs), especially MDG 4 (reducing under-five mortality) and MDG 5 (reducing maternal mortality) [2]. Even in those countries that are on track to meet health MDGs, striking inequities exist among countries and among socioeconomic groups within them [3], despite effective and cost-effective interventions being available to improve population health, including that of vulnerable groups [4]. Such interventions are delivered through health systems, which consist of "all organisations, people and actions whose primary intent is to promote, restore or maintain health" [5], but, in many settings, interactions between weakened health systems and the sometimes conflicting demands of single-disease intervention programmes are hindering the uptake and implementation of life-saving interventions [6]–[8]. A growing number of governments, international institutions, and funding agencies have therefore recognised the urgent need to coordinate and harmonise investments in health systems strengthening in low- and middle-income countries (LMICs) to provide universal social protection and effective coverage of essential health interventions [9].
- ItemOpen AccessPRIME: a programme to reduce the treatment gap for mental disorders in five low-and middle-income countries(Public Library of Science, 2012) Lund, Crick; Tomlinson, Mark; De Silva, Mary; Fekadu, Abebaw; Shidhaye, Rahul; Jordans, Mark; Petersen, Inge; Bhana, Arvin; Kigozi, Fred; Prince, MartinCrick Lund and colleagues describe their plans for the PRogramme for Improving Mental health carE (PRIME), which aims to generate evidence on implementing and scaling up integrated packages of care for priority mental disorders in primary and maternal health care contexts in Ethiopia, India, Nepal, South Africa, and Uganda.
- ItemOpen AccessPriorities for research on equity and health: towards an equity-focused health research agenda(Public Library of Science, 2011) Östlin, Piroska; Schrecker, Ted; Sadana, Ritu; Bonnefoy, Josiane; Gilson, Lucy; Hertzman, Clyde; Kelly, Michael P; Kjellstrom, Tord; Labonté, Ronald; Lundberg, OlleA 2009 World Health Assembly resolution on reducing health inequities through action on social determinants of health [1] calls for stakeholders, including researchers and research funders, to give this topic high priority. In 2004, the World Health Organization (WHO) established a Task Force on Research Priorities to outline a global research agenda on equity and social determinants of health. Its 2005 report [2] contributed to the selection of themes for nine Knowledge Networks set up by WHO to support the Commission on Social Determinants of Health (CSDH) during 2005–2008. CSDH defined health equity as the absence of systematic differences in health, between and within countries, that are avoidable by reasonable action. Using health equity as the foundation of its approach, CSDH concluded [3] that "[s]ocial injustice is killing people on a grand scale" and made three overarching recommendations: improve people's daily living conditions; tackle the inequitable distribution of power, money, and resources; and measure and understand the problem and assess the impact of action. CSDH emphasized that knowledge gaps must not be used as a reason for postponing action on the ample body of evidence already available, but also highlighted the need for ongoing research with a focus on social determinants of health and health equity.
- ItemOpen AccessResponsible governance for mental health research in low resource countries(Public Library of Science, 2011) Yasamy, M Taghi; Maulik, Pallab K; Tomlinson, Mark; Lund, Crick; Van Ommeren, Mark; Saxena, Shekharaghi Yasamy and colleagues identify challenges facing good research governance in low- and middle-income countries and provide suggestions for a way forward.