Creating a Knowledge Translation Platform: nine lessons from the Zambia Forum for Health Research

Background

Public health research provides evidence for practice across fields including health care, health promotion and health surveillance. Levels of public health research vary markedly across European Union (EU) countries, and are lowest in the EU's new member states (in Central and Eastern Europe and the Mediterranean). However, these countries now receive most of the EU's Structural Funds, some of which are allocated to research.

Methods

STEPS, an EU-funded study, sought to assess support for public health research at national and European levels. To identify support through the Structural funds, STEPS drew information from country respondents and internet searches for all twelve EU new member states.

Results

The EU allocates annually around ?7 billion through the Structural Funds for member states' own use on research. These funds can cover infrastructure, academic employment, and direct research grants. The programmes emphasise links to business. Support for health research includes major projects in biosciences, but direct support for public health research was found in only three countries - Cyprus, Latvia and Lithuania.

Conclusions

Public health research is not prioritised in the EU's Structural Funds programme in comparison with biomedicine. For the research dimension of the new European programme for Structural Funds 2014-2002, ministries of health should propose public health research to strengthen the evidence-base for European public health policy and practice.     

Gesundheitswissenschaften in Europa

Background

Research provides an important evidence base for public health practice. This was the basis for a comparison of current support for public health research within European countries.

Methods

Within a collaborative study SPHERE (Strengthening Public Health Research in Europe) an e-mail questionnaire concerning current priorities in public health research was developed, which was sent to 93 representatives of national member associations of the European Public Health Association (EUPHA). The answers were compared with reference to three macro-areas: Northern, Southern and Eastern Europe.

Results

Responses were received from 22 out of 39 European countries (56% country response rate). Current priorities at national level were health services and patient safety for Northern Europe, infectious diseases, health services and cardiovascular diseases for Southern Europe and food safety and nutrition, environmental and occupational health for Eastern Europe. Respondents reported fewer priorities in international research. In Northern Europe the priorities emphasized were health promotion, prevention and education (26.3%), injuries and alcohol habits (26.3%), in Southern and Eastern Europe health economics, health impact assessment and evaluations of services and programmes were prioritized by 30% and 41.7%, respectively.

Conclusions

Support for public health research differs across Europe, and barriers to undertaking better research include structural obstacles and insufficient personnel. National public health associations and public authorities should cooperate in order to find effective answers to common problems.     

Preferences on Policy Options for Ensuring the Financial Sustainability of Health Care Services in the Future: Results of a Stakeholder Survey

Background

Universal access to health care in most western European countries has been a given for many decades; however, macroeconomic developments and increased pressure on health care budgets could mean the status quo cannot be maintained. As populations age, a declining proportion of economically active citizens are being required to support a larger burden of health and social care, while increasing availability of novel technologies for extending and improving life continues to push health care costs upwards. With health expenditure continuing to rise as a proportion of national income, concerns are raised about the current and future financial sustainability of Organisation for Economic Co-Operation and Development (OECD) health care systems. Against this backdrop, a discussion about options to fund health care in the future, including whether to raise additional health care finance (and the ways to do so), reallocate resources and/or ration services becomes very pertinent.

Objective

This study elicits preferences among a group of key stakeholders (payers, providers, government, academia and health-related industry) on the issue of health care financial sustainability and the future funding of health care services, with a view to understanding the different degrees of acceptability between policy interventions and future funding options as well as their feasibility.

Study Design and Participants

We invited 842 individuals from academia, other research organisations (eg. think tanks), national health services, providers, health insurance organisations, government representatives and health-related industry and related advisory stakeholders to participate in an online survey collecting preferences on a variety of revenue-generating mechanisms and cost/demand reducing policies. Respondents represented the 28 EU member states as well as Norway, Iceland, Switzerland, Australia, Russian Federation, Canada and New Zealand.

Results

We received 494 responses to our survey from all stakeholder groups. Across all groups, the highest preference was for policies to modify lifestyle and implement more extensive screening within risk groups for high burden illnesses. There was a broad consensus not to reallocate resources from social security/education. Between stakeholders, there were differences of opinion between industry/advisory and a range of other groups, with industry being generally more in favour of market-based interventions and an increased role for the private sector in health care financing/delivery. Conversely, stakeholders from academia, government, national health services and insurance were relatively more in favour of more restrictive purchasing of new and expensive technologies, and (to varying extent) of higher income/corporate taxes. Taxes on cigarettes/alcohol were by far considered the most politically feasible option.

Conclusions

According to this study, policy options that are broadly acceptable across stakeholder groups with different inherent interests exist but are limited to lifestyle modification, screening interventions and excise taxes on harmful products. Representatives from the private sector tend to view solutions rooted in the private sector as both effective and politically feasible options, while stakeholders from academia and the public sector seem to place more emphasis on solutions that do not disproportionately impact certain population groups.     

Is peer review useful in assessing research proposals in Indigenous health? A case study

Background

There has been considerable examination and critique of traditional (academic) peer review processes in quality assessment of grant applications. At the same time, the use of traditional research processes in Indigenous research has been questioned. Many grant funding organisations have changed the composition of their peer review panels to reflect these concerns but the question remains do these reforms go far enough? In this project we asked people working in areas associated with Aboriginal health research in a number of capacities, their views on the use of peer review in assessing Indigenous research proposals.

Methods

In semi-structured interviews we asked 18 individuals associated with an Australian Indigenous research funding organisation to reflect on their experience with peer review in quality assessment of grant applications. We also invited input from a steering group drawn from a variety of organisations involved in Aboriginal research throughout Australia and directly consulted with three Aboriginal-controlled health organisations.

Results

There was consensus amongst all participants that traditional academic peer review is inappropriate for quality assessment in Indigenous research. Many expressed the view that using a competitive grant review system in Aboriginal health was counterintuitive, since good research transfer is based on effective collaboration. The consensus within the group favoured a system which built research in a collaborative manner incorporating a variety of different stakeholders in the process. In this system, one-off peer review was still seen as valuable in the form of a "critical friend" who provided advice as to how to improve the research proposal.

Conclusion

Peer review in the traditional mould should be recognised as inappropriate in Aboriginal research. Building research projects relevant to policy and practice in Indigenous health may require a shift to a new way of selecting, funding and conducting research.     

Non-communicable diseases: mapping research funding organisations,funding mechanisms and research practices in Italy and Germany

Background

Evidence shows that territorial borders continue to have an impact on research collaboration in Europe. Knowledge of national research structural contexts is therefore crucial to the promotion of Europe-wide policies for research funding. Nevertheless, studies assessing and comparing research systems remain scarce. This paper aims to further the knowledge on national research landscapes in Europe, focusing on non-communicable disease (NCD) research in Italy and Germany.

Methods

To capture the architecture of country-specific research funding systems, a three-fold strategy was adopted. First, a literature review was conducted to determine a list of key public, voluntary/private non-profit and commercial research funding organisations (RFOs). Second, an electronic survey was administered qualifying RFOs. Finally, survey results were integrated with semi-structured interviews with key opinion leaders in NCD research. Three major dimensions of interest were investigated – funding mechanisms, funding patterns and expectations regarding outputs.

Results

The number of RFOs in Italy is four times larger than that in Germany and the Italian research system has more project funding instruments than the German system. Regarding the funding patterns towards NCD areas, in both countries, respiratory disease research resulted as the lowest funded, whereas cancer research was the target of most funding streams. The most reported expected outputs of funded research activity were scholarly publication of articles and reports.

Conclusions

This cross-country comparison on the Italian and German research funding structures revealed substantial differences between the two systems. The current system is prone to duplicated research efforts, popular funding for some diseases and intransparency of research results. Future research will require addressing the need for better coordination of research funding efforts, even more so if European research efforts are to play a greater role.

     

Cross sectional study of childhood obesity and prevalence of risk factors for cardiovascular disease and diabetes in children aged 11–13

Background

European and Developing Countries Clinical Trials Partnership (EDCTP) was founded in 2003 by the European Parliament and Council. It is a partnership of 14 European Union (EU) member states, Norway, Switzerland, and Developing Countries, formed to fund acceleration of new clinical trial interventions to fight the human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS), malaria and tuberculosis (TB) in the sub-Saharan African region. EDCTP seeks to be synergistic with other funding bodies supporting research on these diseases.

Methods

EDCTP promotes collaborative research supported by multiple funding agencies and harnesses networking expertise across different African and European countries. EDCTP is different from other similar initiatives. The organisation of EDCTP blends important aspects of partnership that includes ownership, sustainability and responds to demand-driven research. The Developing Countries Coordinating Committee (DCCC); a team of independent scientists and representatives of regional health bodies from sub-Saharan Africa provides advice to the partnership. Thus EDCTP reflects a true partnership and the active involvement and contribution of these African scientists ensures joint ownership of the EDCTP programme with European counterparts.

Results

The following have been the major achievements of the EDCTP initiative since its formation in 2003; i) increase in the number of participating African countries from two to 26 in 2008 ii) the cumulative amount of funds spent on EDCTP projects has reached € 150 m, iii) the cumulative number of clinical trials approved has reached 40 and iv) there has been a significant increase number and diversity in capacity building activities.

Conclusion

While we recognise that EDCTP faced enormous challenges in its first few years of existence, the strong involvement of African scientists and its new initiatives such as unconditional funding to regional networks of excellence in sub-Saharan Africa is envisaged to lead to a sustainable programme. Current data shows that the number of projects supported by EDCTP is increasing. DCCC proposes that this success story of true partnership should be used as model by partners involved in the fight against other infectious diseases of public health importance in the region.     

Studying policy implementation using a macro, meso and micro frame analysis: the case of the Collaboration for Leadership in Applied Health Research & Care (CLAHRC) programme nationally and in North West London

Background

The publication of Best research for best health in 2006 and the ??ring-fencing?? of health research funding in England marked the start of a period of change for health research governance and the structure of research funding in England. One response to bridging the ??second translational gap?? between research knowledge and clinical practice was the establishment of nine Collaborations for Leadership in Applied Health Research and Care (CLAHRCs). The goal of this paper is to assess how national-level understanding of the aims and objectives of the CLAHRCs translated into local implementation and practice in North West London.

Methods

This study uses a variation of Goffman??s frame analysis to trace the development of the initial national CLAHRC policy to its implementation at three levels. Data collection and analysis were qualitative through interviews, document analysis and embedded research.

Results

Analysis at the macro (national policy), meso (national programme) and micro (North West London) levels shows a significant common understanding of the aims and objectives of the policy and programme. Local level implementation in North West London was also consistent with these.

Conclusions

The macro-meso-micro frame analysis is a useful way of studying the transition of a policy from high-level idea to programme in action. It could be used to identify differences at a local (micro) level in the implementation of multi-site programmes that would help understand differences in programme effectiveness.     

Availability of indicators of migration in the surveillance of HIV, tuberculosis and hepatitis B in the European Union – a short note

Background and aim

Data regarding infectious diseases in migrant populations in Europe are scarce. We aimed to assess whether information on migration status is collected in countries of the European Union (EU) as part of their national surveillance systems for major infectious diseases (HIV/AIDS, tuberculosis (TB) and hepatitis B infection).

Methods

Using different electronic sources we collected information about whether indicators of migration status were collected in national infectious diseases surveillance systems in European countries.

Results

Of 27 EU countries, migration status was recorded in all 27 countries for TB surveillance (100%), in 22 countries for HIV (~82%) and in 23 countries for AIDS (~85%). Eight of 20 countries (40%) recorded migration status in hepatitis B surveillance systems. The most commonly recorded indicator of migration status was country of birth. Among countries which conducted migrant specific surveillance, country of birth was collected in ~82% of TB, ~86% of HIV, and ~83% of AIDS surveillance systems. Other indicators of the migration status were ethnicity (used in HIV and AIDS surveillance) and citizenship (TB surveillance).

Conclusion

We showed differences in how migration status is recorded in surveillance systems from European countries. This was especially true for tuberculoses and hepatitis B, whereas data collection as part of HIV/AIDS surveillance was nearly uniform. These results suggest the need for a more uniform reporting of migration status as part of infectious disease surveillance in EU countries.     

Education and training of public health professionals in the European Region: variation and convergence

Objectives

To assess the exit competences of public health graduates across a diverse European landscape.

Methods

The target population comprised 80 full institutional members of the Association of Schools of Public Health in the European Region with a participation rate 82.5 %. The web-based questionnaire covered institutional profiles and the ranking of exit competences for master of public health programmes, grouped according to WHO Essential Public Health Operations.

Results

European schools and departments usually are small units, funded from tax money. A total of 130 programmes have been indicated, together releasing 3,035 graduates in the last year before the survey. All competence groups showed high reliability and high internal consistency (α > 0.75, p < 0.01). The best teaching output has been assessed for health promotion, followed by disease prevention and identification of health hazards in the community, the least in emergency preparedness.

Conclusions

Given the fragmentation of the institutional infrastructure, the harmonisation of programme content and thinking is impressive. However, the educational capacity in the European Region is far from being sufficient if compared to aspired US levels.     

Public preferences for government spending in Canada

Introduction

Tuberculosis remains a major public health problem in India with the country accounting for one-fifth or 21% of all tuberculosis cases reported globally. The purpose of the study was to obtain an understanding on pro-poor initiatives within the framework of tuberculosis control programme in India and to identify mechanisms to improve the uptake and access to TB services among the poor.

Methodology

A national level workshop was held with participation from all relevant stakeholder groups. This study conducted during the stakeholder workshop adopted participatory research methods. The data was elicited through consultative and collegiate processes. The research study also factored information from primary and secondary sources that included literature review examining poverty headcount ratios and below poverty line population in the country; and quasi-profiling assessments to identify poor, backward and tribal districts as defined by the TB programme in India.

Results

Results revealed that current pro-poor initiatives in TB control included collaboration with private providers and engaging community to improve access among the poor to TB diagnostic and treatment services. The participants identified gaps in existing pro-poor strategies that related to implementation of advocacy, communication and social mobilisation; decentralisation of DOT; and incentives for the poor through the available schemes for public-private partnerships and provided key recommendations for action. Synergies between TB control programme and centrally sponsored social welfare schemes and state specific social welfare programmes aimed at benefitting the poor were unclear.

Conclusion

Further in-depth analysis and systems/policy/operations research exploring pro-poor initiatives, in particular examining service delivery synergies between existing poverty alleviation schemes and TB control programme is essential. The understanding, reflection and knowledge of the key stakeholders during this participatory workshop provides recommendations for action, further planning and research on pro-poor TB centric interventions in the country.     

Programme und Projekte zum Abbau sozial bedingter Ungleichheit von Gesundheitschancen in Deutschland und Europa

Background

Health inequalities have been documented for all European countries. Also in Germany there is a clear association of social status and health, and there are many activities to tackle disparities in health status.

Aim

This contribution documents some existing strategies on the national level and focuses on two large-scale projects which are being coordinated by the German Federal Centre for Health Education (BZgA): the national cooperation project Gesundheitsförderung bei sozial Benachteiligten (health promotion in the socially disadvantaged) and the European project “Closing the Gap: Strategies for Action to Tackle Health Inequalities in Europe”. Both projects aim at identifying effective strategies to reduce inequalities in health, at exchanging expertise within the peer group of health professionals and at developing good practice.

Conclusion

Networking activities on the national and international level contribute to exchanging ideas, projects and even overarching strategies. This exchange helps to promote the field of ‘tackling health inequalities’.     

Which level of competence and performance is expected? A survey among European employers of public health professionals

Objectives

To explore largely unknown experience and expectations of European employers of public health professionals with regard to competences required to perform in the best way for the public health.

Methods

A survey targeting employers in Europe was carried out September 2011–October 2012. The web-based questionnaire on public health competences and expected performance levels was returned by 63 organisations out of 109 contacted (57.8 %) as provided by Schools and Departments of Public Health (SDPH) in 30 European countries.

Results

The assessment of the current and desired levels of performance did not show significant differences between employer categories. However, current and desired levels across all employers differ significantly (p < 0.001), varying around a difference of one rank of a five-point scale. On the other hand, SDPH rank the exit qualifications of their graduates with one exception (presumed competences in preparedness for public health emergencies) higher than the current performance level as determined by employers, i.e. closer to their expectations.

Conclusions

SDPH should reconsider priorities and question their estimate of exit qualifications in close contact with potential employers of their graduates.     

Gesundheitsförderung durch Organisationsentwicklung

Background

The Ottawa Charter presents with its setting approach a strategy for health promotion and prevention, which reacts to specific living conditions in the late modern world society.

Aims

This contribution analyses, by using systems theoretical concepts and assumptions, the understanding of health and health promotion of the Ottawa Charter. It discusses characteristics of settings relevant for health promotion, especially those of organisations and regional political units.

Results

Strategic options for influencing health are provided by using a simple model of action which identifies different entry points for health promoting interventions in organisations. How organisations influence the health of different stakeholders and how they can alter these influences by implementing sustainable health promotion interventions is demonstrated.

Conclusions

General transformation strategies for organisations can be used and adapted successfully for implementing health promotion, as the WHO Network of Health Promoting Hospitals e.g. shows.     

Gesundheitsförderung und Prävention als integrierende Aufgaben europäischer Politik

Background

The European integration poses a challenge for European health and social systems. Although the responsibility for health and social systems lies in the member states, the sovereignty of national actors is undermined by other European policies and by the jurisdiction of the European Court of Justice by applying the rules of the internal market to the health sector.

Aims

In this article general developments and problems of health policies and health promotion on a European level are outlined. This forms a basis to formulate the necessity for a public debate about a European social model and the necessity for action.

Conclusion

The concept of health promotion is introduced to structure this debate. The differentiation of political action areas and the participatory approach of health promotion opens up the possibility for a democratic re-formation of European health and social systems and to outline essential forms of a European social model.     

Health conditions in regions of Eastern and Western Europe

Objectives

We report health conditions in the regions of the European Union (EU) from both objective and subjective perspectives and verify whether drawing conclusions regarding the health conditions in different countries without considering the countries’ sub-national variability may lead to inaccurate results.

Methods

To depict health conditions in the EU regions, two classification methods are used: (1) hierarchical clustering with Ward’s method and squared Euclidean distance and (2) k-mean clustering. To illustrate the intra-country variability of health conditions, the coefficients of variation are computed.

Results

Health conditions are considerably better in the western regions of the EU. Objective and subjective health measures do not always coincide. Extensive within-country differences in health conditions exist.

Conclusions

The EU is clearly split into the EU-15 and Central and Eastern European countries; however, this division is observed with respect to objective health conditions only. Inclusion of self-perceived health status in the analysis measures considerably changes this picture.     

Towards a common public health strategy for the region of South Eastern Europe

Aim

A seminar organised in the framework of the Public Health Collaboration in South Eastern Europe programme (PH-SEE), Belgrade, Serbia and Montenegro, 23–28 August 2004, aimed to answer the question: Is there a real need for a regional public health policy framework in South Eastern Europe (SEE)? The answer is probably yes because the specific situation in the SEE region has to be taken into account for the development of relevant and realistic public health goals.

Methods

To evaluate the current situation in the SEE region, Strengths, Weaknesses, Opportunities and Threats (SWOT) methodology was applied. A set of key messages and recommendations have been formulated. Based on the priorities identified and agreed upon, PH-SEE experts formulated five goals.

Results

The result of very intensive work was a framework for a regional SEE public health strategy being drafted during the seminar. An initial 5-year term was established beginning in 2005. This framework represents only a first step towards an officially agreed upon regional strategy framework.

Conclusions

The purpose of that exercise was to demonstrate the benefits of regional collaboration by using the technical competence and experience of public health professionals in the region. Moreover, the harmonisation with European Union (EU) public health standards and policies must be considered in health policy development in the region.     

Strange bedfellows: bridging the worlds of academia,public health and the sex industry to improve sexual health outcomes

Background

There is increasing interest in building the capacity of researchers in low and middle income countries (LMIC) to address their national priority health and health policy problems. However, the number and variety of partnerships and funding arrangements can create management problems for LMIC research institutes. This paper aims to identify problems faced by a health research institute in Bangladesh, describe two strategies developed to address these problems, and identify the results after three years of implementation.

Methods

This paper uses a mixture of quantitative and qualitative data collected during independent annual reviews of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) between 2006 and 2010. Quantitative data includes the number of research activities according to strategic priority areas, revenues collected and expenditure. Qualitative data includes interviews of researchers and management of ICDDR,B, and of research users and key donors. Data in a Monitoring and Evaluation Framework (MEF) were assessed against agreed indicators.

Results

The key problems faced by ICDDR,B in 2006 were insufficient core funds to build research capacity and supporting infrastructure, and an inability to direct research funds towards the identified research priorities in its strategic plan. Two strategies were developed to address these problems: a group of donors agreed to provide unearmarked pooled core funding, and accept a single common report based on an agreed MEF. On review after three years, there had been significant increases in total revenue, and the ability to allocate greater amounts of money on capacity building and infrastructure. The MEF demonstrated progress against strategic objectives, and better alignment of research against strategic priorities. There had also been changes in the sense of ownership and collaboration between ICDDR,B's management and its core donors.

Conclusions

The changes made to funding relationships supported and monitored by an effective MEF enabled the organisation to better align funding with research priorities and to invest in capacity building. This paper identified key issues for capacity building for health research in low and middle income countries. The findings have relevance to other research institutes in similar contexts to advocate and support research capacity strengthening efforts.     

Gesundheits?konomische Evaluationen in der Pr?vention und Gesundheitsf?rderung

Background

Data on the efficiency of prevention, health promotion and education (HPE) provide basic information for the evaluation and implementation of programmes. However, such data are still insufficient.

Method

On the basis of select research results, the current state of discussion, central topics and methodological gaps are illustrated, and contributions from the Federal Research Ministry??s funding initiative??Prevention Research?? are outlined.

Results

The data are heterogeneous; systematic reviews show that primary interventions have cost-effectiveness ratios similar to treatments. Economic evaluation does not exist for all preventive themes. ROI ranges from 2.3:1 to 5.9:1, or even to 10.1:1 when considering absenteeism. Similarly, specific target group programmes for preschool children yielded ROI from 1.0:1 up to 10.2:1. The incentive systems currently under discussion may be recommended only if adapted for specific health behaviours and target groups.

Conclusion

Economic evaluations of multi-medical interventions are necessary. As a basis for economic assessments in prevention, health promotion and education, short instruments for the measurement of costs and benefits should be developed.