Translating evidence into policy for cardiovascular disease control in India

Cardiovascular diseases (CVD) are leading causes of premature mortality in India. Evidence from developed countries shows that mortality from these can be substantially prevented using population-wide and individual-based strategies. Policy initiatives for control of CVD in India have been suggested but evidence of efficacy has emerged only recently. These initiatives can have immediate impact in reducing morbidity and mortality. Of the prevention strategies, primordial involve improvement in socioeconomic status and literacy, adequate healthcare financing and public health insurance, effective national CVD control programme, smoking control policies, legislative control of saturated fats, trans fats, salt and alcohol, and development of facilities for increasing physical activity through better urban planning and school-based and worksite interventions. Primary prevention entails change in medical educational curriculum and improved healthcare delivery for control of CVD risk factors-smoking, hypertension, dyslipidemia and diabetes. Secondary prevention involves creation of facilities and human resources for optimum acute CVD care and secondary prevention. There is need to integrate various policy makers, develop effective policies and modify healthcare systems for effective delivery of CVD preventive care.     

Translating HIV/AIDS research findings into policy: lessons from a case study of 'the Mwanza trial'

The scale and severity of the impact of the global HIV/AIDS pandemic on low-income countries, mainly those in sub-Saharan Africa, is almost unimaginable to people in high-income countries. There is a particularly pressing need to understand better how to ensure the translation into policy and practice of important research findings in HIV/AIDS prevention and care in countries threatened by fast spreading HIV epidemics. The purpose of this paper is to review the findings and implications of a policy analysis case study of an HIV/AIDS clinical trial that has been successful in influencing HIV prevention policy relevant to low-income countries, in order to identify illustrative lessons for HIV/AIDS researchers in the future. The case study sought to detail the interaction between researchers and policy-makers for this particular case study to ascertain detailed analysis by these two groups on the interaction between research and policy. The major findings of the policy analysis case study were that policy shift was a cumulative but non-linear process, with the Mwanza trial placing a crucial role in both boosting and confirming existing policy movements. Researchers and policy-makers held similar longitudinal views of the process and political environment. Key moments of communication tended to involve personal contact. The important role played by people and organizations who could work in both the research and policy communities was often mentioned as crucial in enabling research relevant policy shifts. Researchers may absorb themselves in the technicalities of their study without considering their role in pursuing the wider policy implications. The impact of research on policy must be an integral element of every stage of the research process. The case study illustrates the need to take a contextual view of the interaction between research and policy, and understand how changing political contexts affect receptivity to research outcomes. This will increase the likelihood of research findings having an impact on policy. The review reflects the authors' experiences of working for organizations in non-governmental organization, bilateral development agency and academic settings.     

发展中国家儿童营养政策的经验和教训

在我国进行儿童营养干预和制定儿童营养政策的时候要充分借鉴其他国家的经验。在对一些发展中国家儿童营养政策回顾的基础上,通过经验和教训两方面的案例探索成功实施儿童营养政策的共同点。在儿童营养政策的领导和组织方面,要有坚定的政治承诺,并与其他公共政策紧密结合;在制度和机制设计方面,要保证可持续筹资、社区充分参与,并有针对母亲和儿童的食品补贴政策;在政策实施上,要保证其有效执行和发挥母亲在政策中的关键作用。     

Translating clinical practice into health policy: an example from China

Understanding a health problem and even having the technological capability to solve it are often not enough to lead to changes in health policy. To help accomplish such policy changes, we propose a five-step approach that involves (1) specifying the disciplines; (2) developing multidisciplinary hypotheses; (3) investigating the hypotheses; (4) developing a policy 'story'; and (5) advocating these solutions to policy makers. We use the example of neonatal hypothermia in Eastern China to illustrate this approach. We found that the approach both better informed policy and better motivated policy change. Using the approach extended our involvement from the hospital to a wider population; in addition our initial solutions expanded from clinical interventions to broader public health approaches that proved to be quite different from our original recommendations.     

The use of private-sector contracts for primary health care: theory, evidence and lessons for low-income and middle-income countries

Contracts for the delivery of public services are promoted as a means of harnessing the resources of the private sector and making publicly funded services more accountable, transparent and efficient. This is also argued for health reforms in many low- and middle-income countries, where reform packages often promote the use of contracts despite the comparatively weaker capacity of markets and governments to manage them. This review highlights theories and evidence relating to contracts for primary health care services and examines their implications for contractual relationships in low- and middle-income countries.     

Translating research into policy and practice in developing countries: a case study of magnesium sulphate for pre-eclampsia

Background  

The evidence base for improving reproductive health continues to grow. However, concerns remain that the translation of this evidence into appropriate policies is partial and slow. Little is known about the factors affecting the use of evidence by policy makers and clinicians, particularly in developing countries. The objective of this study was to examine the factors that might affect the translation of randomised controlled trial (RCT) findings into policies and practice in developing countries.     

Improving antibiotic use in low-income countries: an overview of evidence on determinants

The inappropriate use of antibiotics has often been identified as a problem in effective health care delivery. High levels of antibiotics use, often clinically unnecessary, have led to a steady increase in drug resistance. Low-income countries, home to the majority of the world's population, are believed to have an important role in this phenomena. Effective intervention in these practices is often constrained by the paucity of information on determinants of antibiotic use.This review provides information from studies on the factors that influence the use of antibiotics by health providers, dispensers and community members in low-income countries. A proper understanding of these factors should be seen as a precondition for the development of more effective policies and programmes to address inappropriate antibiotic use.The review encompasses physicians' practices, the role of drug dispensers, and the influences on patterns of drug use across community members. Although a set of papers with useful research data was identified, probably the most important finding of the review was the scarcity of research. If interventions into antibiotic use are to be effective, future research must explore in more depth the socio-cultural rationality of antibiotic usage. The most productive approach would be to combine quantitative studies of the patterns of antibiotic use with the rich variety of qualitative methods like case simulations, focus group discussions, in-depth interviews, informal interviews, or illness diaries to explore determinants.Research programmes alone are unlikely to improve antibiotic use. Priority programme activities would include a carefully designed mix of activities by governments, health delivery systems, health training institutions, professional societies, pharmaceutical companies, consumer organisations, and international organisations. Strategies that lean too heavily on professional education are unlikely to result in large-scale or long-lasting improvement.     

Community-based health insurance in low-income countries: a systematic review of the evidence

Health policy makers are faced with competing alternatives, and for systems of health care financing. The choice of financing method should mobilize resources for health care and provide financial protection. This review systematically assesses the evidence of the extent to which community-based health insurance is a viable option for low-income countries in mobilizing resources and providing financial protection. The review contributes to the literature on health financing by extending and qualifying existing knowledge. Overall, the evidence base is limited in scope and questionable in quality. There is strong evidence that community-based health insurance provides some financial protection by reducing out-of-pocket spending. There is evidence of moderate strength that such schemes improve cost-recovery. There is weak or no evidence that schemes have an effect on the quality of care or the efficiency with which care is produced. In absolute terms, the effects are small and schemes serve only a limited section of the population. The main policy implication of the review is that these types of community financing arrangements are, at best, complementary to other more effective systems of health financing. To improve reliability and validity of the evidence base, analysts should agree on a more coherent set of outcome indicators and a more consistent assessment of these indicators. Policy makers need to be better informed as to both the costs and the benefits of implementing various financing options. The current evidence base on community-based health insurance is mute on this point.     

中国卫生应急管理体系建设调查分析

  目的  比较分析中国一线城市卫生应急管理评估体系。  方法  全面检索中国知网（CNKI）、万方数据知识服务平台(WANFANG DATA)和维普数据库（VIP））,限定从建库的1988年1月 — 2019年3月,制定纳入、排除标准,采用框架整合法,从卫生应急管理主体分类角度出发,对中国一线城市的卫生应急管理评估体系进行整合。  结果  纳入6篇研究,以政府和卫生行政部门、疾病预防控制机构、医疗卫生机构、卫生监督机构为卫生应急管理主体,共性指标分别为8、10、4和5项。个性指标更为细致化。  结论  共性指标统一性和引领性仍需加强,个性指标兼容性和关联性有待完善,应用性和推广性还需提高。另外,中国卫生应急管理评估体系多为“结果”式评估,“过程”式的评估体系和作用机制的探索还有极大的研究空间。     

Translating evidence-based practices into policy: a case study in Texas

Screening and brief intervention (SBI) in health care settings is an evidence-based practice for substance misuse. The Uniform Accident and Sickness Policy Provision Law (UPPL) discourages providers from carrying out SBI by allowing insurers in 26 states to refuse coverage for injuries resulting from intoxication. This project used a qualitative case study methodology to understand how policy-advocacy communication may have impacted the success of UPPL repeal efforts in Texas. Results showed bill progress could have been impeded due to less-effective communication from advocates. These findings suggest the quality of communication may influence the success of evidence-based policy-advocacy for UPPL repeal.     

Bridging the gap: Translating research into policy and practice

Effective physical activity interventions do not achieve their full potential if they are not applied beyond their original testing in research studies. Potentially effective interventions can be adopted in community settings through the efforts of numerous agencies, organizations, and individuals. This paper highlights the important roles of public health practitioners and policy makers, who differ in their decision-making processes. To enhance the uptake of evidence-based interventions, several steps are needed to: build the science by moving upstream, increase the understanding of practice-based evidence, move beyond the “what” to the “how,” re-frame the dissemination challenges, place greater emphasis on workforce development, and make research more accessible for policy audiences. The most effective strategies to bridge the gap between research and practice, will have at their heart, effective academic-practice-policy maker partnerships.     

Health insurance in developing countries: lessons from experience

Many developing countries are currently considering the possibility of introducing compulsory health insurance schemes. One reason is to attract more resources to the health sector. If those who, together with their employers, can pay for their health services and are made to do so by insurance, the limited tax funds can be concentrated on providing services for fewer people and thus improve coverage and raise standards. A second reason is dissatisfaction with existing services in which staff motivation is poor, resources are not used to best advantage and patients are not treated with sufficient courtesy and respect. This article describes the historical experience of the developed countries in introducing and steadily expanding the coverage of health insurance, sets out the consensus which has developed about health insurance (at least in Western European countries) and describes the different forms which health insurance can take. The aim is to bring out the advantages and disadvantages of different approaches from this experience, to set out the options for developing countries and to give warnings about the dangers of some approaches.     

Political economy of tobacco control in low-income and middle-income countries: lessons from Thailand and Zimbabwe. Global Analysis Project Team

Crucial to the success of the proposed Framework Convention on Tobacco Control will be an understanding of the political and economic context for tobacco control policies, particularly in low-income and middle-income countries. Policy studies in Thailand and Zimbabwe employed the analytical perspective of political economy and a research strategy that used political mapping, a technique for characterizing and evaluating the political environment surrounding a policy issue, and stakeholder analysis, which seeks to identify key actors and to determine their capacity to shape policy outcomes. These policy studies clearly revealed how tobacco control in low-income and middle-income countries is also being shaped by developments in the global and regional political economy. Hence efforts to strengthen national control policies need to be set within the context of globalization and the international context. Besides the transnational tobacco companies, international tobacco groups and foreign governments, international agencies and nongovernmental organizations are also playing influential roles. It cannot be assumed, therefore, that the tobacco control strategies being implemented in industrialized countries will be just as effective and appropriate when implemented in developing countries. There is an urgent need to expand the number of such tobacco policy studies, particularly in low-income and middle-income countries. Comprehensive guidelines for tobacco policy analysis and research are required to support this process, as is a broader international strategy to coordinate further tobacco policy research studies at country, regional and global levels.     

Public health policy, evidence, and causation: lessons from the studies on obesity

The paper addresses the question of how different types of evidence ought to inform public health policy. By analysing case studies on obesity, the paper draws lessons about the different roles that different types of evidence play in setting up public health policies. More specifically, it is argued that evidence of difference-making supports considerations about ‘what works for whom in what circumstances’, and that evidence of mechanisms provides information about the ‘causal pathways’ to intervene upon.     

Safe Motherhood interventions in low-income countries: an economic justification and evidence of cost effectiveness

It is estimated that 1600 women die world-wide each day as a result of problems during pregnancy or childbirth. A large proportion of these deaths is preventable. This article examines the economic case for investing in safe motherhood interventions, and reviews key evidence of the cost effectiveness of safe motherhood interventions. According to one study, antenatal and maternal services comprise two of the six most cost effective sets of health interventions in low-income countries. However, little detailed evidence exists regarding the relative cost effectiveness of antenatal care, post-abortion care and essential obstetric care. Despite this there is clear evidence that interventions such as substituting manual vacuum aspiration for dilatation and curettage can result in significant savings both for health facilities and patients. The paper estimates first that 26% of maternal deaths are avoidable through antenatal/community-based interventions, costing around 30% of the WHO Mother Baby Package; and secondly that access to quality essential obstetric care can prevent a further 48% of maternal deaths, consuming 24% of total Mother Baby Package costs. Further work on the cost effectiveness of safe motherhood interventions would provide useful information for policy makers concerned with reducing maternal mortality in the most efficient manner possible.     

From prohibition to regulation: lessons from alcohol policy for drug policy

Like current drug prohibition, alcohol prohibition in the 1920s produced a large criminalized industry. Post-repeal alcohol regulation, which tended to limit overall consumption, suggests that the legal regulated sale of currently illicit substances is technically practical and reasonable. However, no such radical change in drug policy will be politically feasible until well into the twenty-first century. Nevertheless, the failures and costs of the War on Drugs make moderate reform a more promising prospect.