Lesotho

Participation in this research has enhanced the skills of the team members in conducting qualitative research especially interviewing high profile people on Governance, Human Resource and Equity and Access to Health Services in Lesotho. Members of the team have gained skills in content analysis and report writing through the support of international partners. Dissemination of research findings to the high profile people which was a challenge gave a significant experience to team members. Report writing and writing papers for publications (as a local and international team) was a significant challenge. Collaboration and networking with experienced researchers from various international institutions was an important milestone during various workshops and conferences.

Malawi

The importance of an efficient and effective health system in the achievement of health-related millennium development goals (MDGs) cannot be overemphasized. Without a functioning health system to deliver basic health care and actions to tackle critical issues such as shocking levels of infant and maternal morbidity and mortality as well as to combat HIV/AIDS and other diseases like malaria and tuberculosis, these health problems are likely to escalate. An efficient health system with effective health governance structures, adequate and appropriate human resources for health and measures to promote access and equity to healthcare services could be a key to the attainment of health related millennium development goals.  Hence, the purpose of this review is to come up with a country level report on the knowledge and research gaps related to governance, access and equity and human resources in the health system in Malawi and how they affect the attainment of health-related MDGs 4, 5 and 6 in Malawi.

Using a review of literature, the study conducted a SWOT analysis of governance, human resources for health and access and equity issues in the health system of Malawi to identify strengths, weakness/challenges, opportunities and gaps in these themes that could affect the achievement of health-related MDGs (MDG 4, 5 and 6) in Malawi. Both electronic and hard copies of strategic documents and implementation/progress reports related to MDGs 4, 5 and 6 in Malawi were reviewed.

The review results showed that lack of capacity to participate effectively in the health governance by some stakeholders, limited or poor links between the health system and the communities, ineffective policies and strategies, lack of effective measures to promote access and equity of health services, lack of effective inter-and-multi-sectoral collaborations, lack of good monitoring structures for health information, inadequate capacity to use health data for planning, inadequate human resources for health and lack of appropriate training and deployment of health workers can lead to the inefficiency and ineffectiveness of the health system to promote activities that can facilitate the attainment of health related MDGs (4, 5 and 6).

The review concludes that unless the health system in Malawi is strengthened to ensure that there is capacity development within key health staff both in terms of technical as well as managerial skills; improve the health governance structures to promote equal participation in decision-making related to health issues (particularly those covered by MDG 4, 5 and 6), and increase measures that can promote access and equity to health care services by all people including the marginalized, the health system in Malawi cannot facilitate the attainment of health-related MDGs (4, 5 and 6).

The review hence recommends that further research should be done investigating issues highlighted to impact on governance, human resources and access and equity. Besides, it also recommends that measures that can strengthen the health system in the aforementioned themes should be considered.

Mozambique

Currently not available

Sierra Leone

The mapping of our existing knowledge and knowledge gaps to produce a synthesis was conducted to  enable identification of priority research questions for the health system in Sierra Leone.

This was achieved by making a comprehensive inventory of (research) literature and documents on health systems in Sierra Leone and reviewing relevant documents to identify existing gaps in knowledge and information regarding health systems in Sierra Leone. Verification of the existing knowledge and additions to that knowledge was provided through semi-structured interviews and a 2-day workshop (in April 2009) with key health system stakeholders such as the Ministry of Health and Sanitation (MoHS) Directors and Managers of programs, senior staff of NGOs, United Nations (UN) agencies including  the World Health Organisation (WHO), UN Population Fund (UNFPA), United Nations Children’s Fund (UNICEF), and bilateral/multilateral donors (Irish Aid, United Kingdom Department for International Development (DFID) etc.).

In general research in/ around the health system in Sierra Leone appears to be donor driven, with many (partial) health sector or district health system reviews and surveys. Detailed research with more specific research questions and applied research studying pilot / new interventions is not very common. Research capacity small, fragmented and not well coordinated.

Human Resources for Health in Sierra Leone with respect to numbers, type of staff and their training is extensively documented; mostly as (part of) human resources and/or health sector reviews. More detailed research or documentation regarding HRH is mostly absent and research areas to be considered could include negative and positive contributions of TBAs and related community health workers to maternal and child health; push and pull factors for middle and higher level health staffs, possibilities within the exiting structures (pay roll not under direct control of MoHS) to practice effective human resource management at the various levels, use of performance based salaries/incentives etc. etc.  Although some NGOs did research on equity and access to health especially regarding free service versus cost recovery, there is no mainstream research ongoing in these areas. More detailed areas within this theme like gender and cultural access are mostly uncovered.  Governance, although reasonable well described in many review documents, has not been a topic of research, but more part of reviews and needs assessments. Specific aspects of governance could be relevant as priority research questions for later stages of CHRAIC research.

Sudan

Process of Knowledge Synthesis: Northern Sudan

North Sudan CHRAIC team started knowledge synthesis activities in July 2010, after the transfer of funding problem, which prevailed for over a year, was solved by the end of June 2010.   After the receipt of the first instalment, a reprofiled budget for the North Sudan was carried out by CHRAIC, and accordingly a series of meetings took place between representatives of UMST and NMoH. The decisions stemmed out of this meeting were that it is important to conduct a workshop for stakeholders, in order to select the appropriate partners for the knowledge synthesis activity.

The national ministry of health had signed a memorandum of understanding with University of Medical Science and Technology, in order to generate the knowledge to strengthen health systems and achieve the MDGs4, 5 and 6 which is the main project funded by (CHRAIC). A technical working group was formed, with members from the relevant departments at the ministry of health and also members from other academic institutions interested in health research. Technical working group met twice to discuss the preparations for the stakeholder’s workshop, which was considered as the most important activity to take place for the knowledge synthesis.

Stakeholder’s workshop took place on the 29^th of September 2010 and invitees included representatives from all academic institutions interested in health research policies, NGOs, ethical committee at NMoH.  The design of the knowledge synthesis exercise would be based on the national policies and strategies of the ministry of health, and a  survey done by Ahfad University for Women-Sudan, on the dimension of access and equity to health, in which all the policies of the minister were analyzed.  Furthermore, legislations, guidelines and laws related to the health system are not well disseminated, and this need could be tackled very well in this synthesis and suitable ways for dissemination of this synthesis through the system would be needed.  A crucial point was mentioned that the universities should be involved in this study and there feedback regarding the conducted studies which related to the project is very important so as not to waste the resources on those studies. A clear defined framework  is to be designed to guide the study.

Executive Summary Knowledge Synthesis Report: Southern Sudan

Southern Sudan is a nation area emerging from two decades of conflict and as such health research has not been a priority. The amount of published literature before the conflict is minimal and would have covered Sudan as a whole rather than focusing specifically on Southern Sudan. Since the signing of the Comprehensive Peace Agreement (CPA) in 2005 there has been a huge influx of International Non Governmental Organisations (INGOs) into Southern Sudan, many of which have a focus on health. The Southern Sudan Ministry of Health has also firmly established itself over the past few years, and many systems and policies have now been put in place.

Unlike other countries where long established functioning health care systems have allowed for active health research projects and the collection of reliable data for informative decision making, Southern Sudan is only now in a position to begin supporting health research.

While compiling the information for this knowledge synthesis report, it became clear that although much is known about the state of health systems in Southern Sudan through people’s experience and personal knowledge there is little published research. Therefore there are considerable knowledge gaps in all areas related to health research and in order for sound evidence-based policy making to become the norm, more active reputable health research needs to be carried out.

A huge step towards achieving that goal has now been taken through the establishment of the Research and Health Systems Development Directorate and the Monitoring and Evaluation (M&E) Units have begun to take a leading role in research projects in Southern Sudan.

Uganda

Currently not available