Health Policy and Planning: Our Global Impact on Health Systems Policy

By Antonella Di Marzio (Oxford University Press) and Natasha Salaria (London School of Hygiene & Tropical Medicine)

With more than 1,100 papers mentioned by policy sources so far, Health Policy and Planning is increasingly demonstrating its impact on health systems policy at a global level, thus helping bridge the gap between academic research and its real-life application.

A new collection from Health Policy and Planning provides recent examples of high-impact work in health policy and systems research focusing on low- and middle-income countries. Covering multiple topics and regions, the papers featured span across several article types, and have been cited by organisations such as the WHO, the FAO, the World Bank, and many more.

Keep reading on the Health Policy and Planning journal site, and re-discover our policy highlights!

Read the collection of articles here.

Class of 1921

As we welcome new students to the London School of Hygiene & Tropical Medicine, it seems appropriate that we reflect on the students who attended 100 years ago, the class of 1921. Unfortunately, we do not have a photo of this session which we do for some other years.

The 67th session ran from September to December. In 1921, there were three sessions a year. 62 students attended the School, of these 54 were men and 8 were women. They came from the following services:

  • Colonial Service: 15
  • Indian Medical Service: 2
  • Royal Army Medical Corps: 1
  • Egyptian Medical Service: 3
  • Missions: 6
  • Private: 35

The School’s student registers record a number of details about the students including their destination on leaving, the majority of students went to India (22), and the next most popular destinations were Egypt (7), West Africa (7) and East Africa but students ended up all over the world including China, Japan, West Indies Norway.

As is shown, many of the students came from the Colonial Service and went onto work in British Colonies. LSHTM is currently researching its colonial origins and the legacy of our past on our current staff and students. Find out more about the LSHTM and Colonialism research project.

The LSHTM Archives Service has begun to re-examine the collections we hold, the stories we tell and the role we can play in critically engaging with the School’s colonial legacy. We have developed a set of principles for decolonising the archive which we are incorporating into our daily working practice.

Page from student register showing summary of 67th session

This page in the student’s register gives a summary of the year but also includes the total number of students that had attended the School since it opened in 1899: 2365. 2207 of these were men and 158 women.

The students were taught in Endsleigh Gardens, this was a former hotel that was converted to a hospital for officers during the First World War. This building is still standing in Gordon Street and is now the student union for University College London. The School moved from its original home in the Albert Docks in early 1920, although the building wasn’t officially opened until November 1920. The School remained here until 1929 when we moved to the Keppel Street site.

Endsleigh Gardens

There was a link with Keppel Street as three of the students lived in the Indian YMCA which was on the Keppel Street site. In August 1916 a wooden mock-Tudor YMCA Hut opened on the corner of Keppel and Gower Street in London’s Bloomsbury.  “The Shakespeare Hut” as it was called became a home from home for predominantly Anzac soldiers on leave from the Front and remained so until 1919 when it briefly housed  the Indian YMCA before it was pulled down in 1920s to make way eventually for the London School of Hygiene & Tropical Medicine which still occupies this site today.

The Shakespeare Hut on Keppel Street

For further information on the material featured in this blog, please contact archives@lshtm.ac.uk

Who writes what? Responsible authorship recognition in co-produced research

DEPTH team members collating research themes

New term, new research! We’re very excited to publish our latest article: ‘Reimagining authorship guidelines to promote equity in co-produced academic collaborations’, open access in Global Public Health. This piece brings together our thoughts on academic authorship from our recent ACCESS project on sexual and reproductive health and rights (SRHR) for marginalised populations, with our thinking on knowledge co-production from the project ‘This Sickle Cell Life’, a sociological study of young people’s experiences of paediatric to adult healthcare transitions

The call for papers for a special issue of Global Public Health on ‘(Re)imagining Research, Activism, and Rights at the Intersections of Sexuality, Health, and Social Justice’ offered us the perfect opportunity to crystallise some of the discussions we had and are still having as a research team about health co-production, academic research, authorship, and social justice. We take collaboration and engagement very seriously in DEPTH here at LSHTM, and felt that established authorship guidelines, while excellent benchmarks for ethical research and publication practices, aren’t always fit for purpose when it comes to co-produced work with different stakeholders. As we reflect in our Discussion:

There are numerous structural barriers to full collaboration that have an impact on authorship. The structural barriers to collaboration in general can be revealed in decisions about authorship – they are highlighted in who makes authorship decisions, and who benefits from them, and the structures and conventions that support and entrench inequities and devalue collaborative in favour of competitive working. 

In light of these tricky contextual norms, we found numerous questions that needed unpacking: who is an author, and what do they contribute? When does a person’s place in the acknowledgements change to place on the author list, and when should it? How might we think more deeply about academic products and knowledge so that we do not inadvertently help supress voices that are already less heard? These voices are often less heard in academia because of the structures and customs of the academic system, so what impediments can we sidestep while acknowledging we still function within that system?

The result of our discussions is the article, which starts to explore how we might more explicitly pursue recognition of co-produced contributions to academic research. One way to hold ourselves and each other to account in equitable ways of working is through authorship guidelines, which we hope will prove useful as a jumping-off point for others engaged in collaborative work – especially with practitioners, activists, or non-academics, whose contributions and knowledges don’t always fit neatly into academic ‘boxes’. Having reflected on who tends to be disadvantaged by the current systems, we suggest that spending time thinking critically (and sometimes painfully) about these positions and relations can help to scaffold authorship norms that are fairer and more transparent.

You can read the whole piece here, free and open-access. But in this blog I wanted to highlight our authorship guidelines specifically. They are amended from existing excellent offerings of ICMJE and BSA, and move beyond them in that here we incorporate more explicit attention to different stakeholder contributions, and also to co-produced outputs. These are both themes that are long overdue more sustained reflection, and in an academic context of ever-increasing cross-disciplinary and cross-country collaboration and co-production with communities, we hope they prove useful for other researchers out there. 

Take a look at our suggested authorship guidelines and see what you think – and reply to this post if you have suggestions for improvements or any other comments:

 1.      The nature of academic publication processes and authorship conventions should be explained to all partners so that the meaning of authorship and involvement is clear to all parties regardless of university affiliation or discipline.
 2.      The project research/writing team should list details of expected papers early in any sub-project, including expected authorship and author order (especially first author).
 3.      The rationale for authorship and author order should be transparent. All authors must make a substantive contribution to the intellectual content of the publication.
 4.      Non-academic project partners should be invited to co-author the work, with plans in place early on about how to handle suitable contributions. Level of input required must be discussed and agreed early on to ensure clarity on how authorship is allocated.
 5.      Contributors whose contribution does not in the final product meet the criteria for authorship should be named in the acknowledgements. Named individuals must be informed so that they can withdraw their name if they wish.
 6.      Where used, translators/interpreters must be named in the acknowledgements.
 7.      Lead author must draft the paper, with input from other authors, and be responsible for submitting the paper and making any revisions in response to referee comments. The lead author must not submit any paper without the agreement of the named authors.
 8.      All academic publications should contain a statement about the contribution of each named author.
 9.      The PI must approve submission of academic articles from the project and must be named as author if criteria for authorship are met.
 10.    Academic journal publication must be supplemented with publication of findings in other channels to ensure inclusive dissemination (e.g. tweets, policy document, media article, public workshop).
 11.    The particular needs of members of the team should be considered in arranging publication strategy (e.g. need to gain experience of lead authorship). However, any named author must fulfil the requirements for their authorship position.
 12.    Sole authorship will not generally be possible or desirable within the project because of the collaborative nature of the work and our recognition that knowledge is co-produced through these collaborative relationships.
 13.    Consider adding the consortium or project name to all work with numerous contributors who do not meet the criteria for authorship and listing key contributors to the paper in the acknowledgements.
 14.    In the event of any disagreements or confusion about authorship or author order, please refer to these guidelines within the writing team. If there is still confusion, please request assistance from the PI as the question may need to be referred for a wider discussion and/or the guidelines may need to be clarified.
DEPTH Authorship Guidelines, 2021

Library inductions for new students 2021/22 – Welcome to LSHTM!

Library Inductions for new students.

A very warm welcome to all our new students!

We recognise there is a lot of information for new arrivals to take in during Welcome Week. If you do find yourself with a free moment though, please feel free to contact the Library (library@lshtm.ac.uk) with any questions that you have about our services – the staff here will be happy to help you with anything related to our online services and facilities, information resources and information skills training.

To help you get started using our resources and services, please attend one of our Induction sessions in Week 1:

Library Induction: using the Library, finding and accessing resources

Mon 27th September – Friday 1st October 2020

Monday 27 September13:00 – 14:00
Tuesday 28 September16:00 – 17:00
Wednesday 29 September12:00 – 13:00
Thursday 30 September09:30 – 10:30
Friday 1 October13:00 – 14:00
(NB – you only need to book one session.)

How to book on a session:
1. go to the Library Moodle page: tinyurl.com/ismoodle

2. Scroll down to the section headed “Attention NEW MSc students 2021-22” on the Library Moodle page and use the booking link.

3. On the day of the session, come back to the Library Moodle page above and click on the Zoom session link that you want to attend. You can join a session up to 15 minutes before the start time.

This session will give you an introduction to the Library services, help you understand your reading list, and ensure you’re ready to find and access books, journals, articles and databases at LSHTM.

It is aimed at Masters-level students, but anybody is welcome to attend. The class is delivered live using Zoom.

We look forward to meeting you and supporting you in your studies this year.

Economic factors can play an important role in raising tobacco taxes and advancing public health goals in LMICs

By Ayotemide Akin-Onitolo (London School of Hygiene & Tropical Medicine) and Benjamin Hawkins (University of Cambridge)

The World Health Organisation (WHO) established the Framework Convention on Tobacco Control (FCTC) that recommends six evidence-based tobacco control measures: monitoring tobacco use and prevention policies, protecting people from tobacco smoke, offering help to quit, warning about the dangers, enforcing advertising bans and raising taxes.

Raising taxes on tobacco is considered the most effective measure to reduce consumption; however, it is often difficult to implement because of the opposition of powerful With the vast economic and human resources available to them, the tobacco industry has been shown to expend considerable resources to protect its corporate interests. In some settings like the US, the industry successfully prevented tax increases.

Our recent article in Health Policy and Planning demonstrates how the tobacco industry also attempts to undermine tobacco control policies in Nigeria, including weakening the 1990 tobacco control decree 20 and arguing against successive policy efforts. Nevertheless, tobacco control efforts continued, suggesting the government’s commitment to FCTC compliance. In 2015, the government revised the National Tobacco Control Act, increasing restrictions on smoking and advertising. In 2016, the government raised the tobacco import duty and, in 2018, increased local excise taxes alongside other products.

The tobacco industry and its allies sought to intervene in the ensuing public debate over the taxes in an attempt to sway public opinion; however, the policy was sustained. Our article examines why these tax policy initiatives proved successful despite significant industry opposition. It analyses the efforts of multiple actors to push supporting and opposing interpretations of the policy of tax rises between 2016 and 2018, and how these efforts may have influenced the policy. Our findings suggest that economic factors were largely responsible for the success, and we identified two major themes in the discourses:

  1. Favourable political and economic climate

Shortly before the policy passed, Nigeria exited a recession that was partly attributed to the 2014-16 fall in crude oil prices globally. As the country is largely dependent on crude oil exports for income, the need to diversify its revenue base was glaring. Accordingly, the 2017 Economic Recovery Growth Plan prioritized macroeconomic stability including tax administration amongst other objectives.

The Economic Community of West African States (ECOWAS) also established new tobacco tax directives in 2017, raising the minimum ad valorem tax from 15% to 50% alongside other changes. These factors likely created a conducive moment for the uptake of tobacco tax raises. Advocates need to identify and leverage such opportunities for effective public health advancement.

  1. Use of evidence-based economic arguments by advocates in the public debate

In addition to the presence of a favourable economic climate for tax rises, the successful passage of this policy was influenced by the ability of advocates to provide evidence and data to support the policy in a timely manner. Policymakers were able to draw on this evidence to advance positive interpretations of the policy and secure public support. Successful arguments, put forward by tobacco control advocates and policymakers, emphasized the economic impact of tobacco consumption and quantified the anticipated revenue increment.

Advocates also used other arguments such as improving health, the vulnerability of certain population groups, and meeting international recommendations. However, on both sides of the debate, economic arguments were the most used. Whilst emphasizing the advantages of raising tobacco taxes on health, it is critical for advocates to clearly demonstrate how these taxes can impact the economy, particularly in low-and middle-income countries (LMICs) where such income may be crucial for development.

Conclusion

Tobacco control advocates in Nigeria can celebrate the successful passage of the tobacco tax policy, however, there is much room for progress towards fully achieving FCTC recommendations. Currently, tobacco taxes in Nigeria account for only 30% of the retail price which is considerably lower than the 75% advised by the WHO. Given the potentially positive health impact of tobacco control, more effective engagement in policy-making is required. Tobacco control advocates can tailor their use of economic and other relevant contextual factors to secure political support in Nigeria and other LMICs.

MRC LID is a partnership between St George’s, University of London and London School of Hygiene & Tropical Medicine.

MRC LID is delighted to have received a new MRC Doctoral Training Partnership Award in summer 2021, which continues our highly successful DTP. The new award provides six notional PhD studentships per year, with a further three studentships per year funded by LSHTM & SGUL. The themes are global health, health data science, infectious disease and translational and implementation research.

In preparing our DTP bid we recognised the importance of tackling systemic barriers experienced by students in progressing to postgraduate research degree programmes and of taking a proactive approach to EDI. We have made widening participation and cultivating a supportive, inclusive, and diverse community of future scientific leaders core aspects of our approach to developing the DTP. This includes a ring-fenced scheme for UK students from ethnic minority backgrounds.

Further information about our DTP and the studentships available is available from the drop-down menus.

Inexpensive, readily available treatment for fungal keratitis shows promise in Africa

Dr Abel Ebong, one of the registrars at Mbarara University tertiary eye hospital in Uganda administers Chlorhexidine eye drops to a patient with Fungal Keratitis

A new treatment option for a potentially blinding disease has shown promise in a sub-study in Uganda.

Keratitis is an inflammation of the clear tissue at the front of the eye, known as the cornea. When caused by a fungal infection, it can be extremely painful and can even lead to the loss of an eye. Globally, the incidence of fungal keratitis (FK) is estimated to be more than one million cases per year, representing a significant public health concern when potential blindness is taken into account.  It is particularly common in lower-income countries and amongst manual labourers such as farmers who are prone to damaging their eye, leading to infection.

The current standard treatment for FK is the antifungal natamycin, delivered in eyedrops. However, the drug is not effective in all cases, with some on treatment progressing further towards blindness. Additionally, natamycin is not readily available in many countries in sub-Saharan Africa and is relatively expensive.

A research team led by the Mbarara University of Science and Technology in Uganda and the International Centre for Eye Health decided to investigate a different treatment, chlorhexidine gluconate, as part of a wider study on the disease. The sub-study followed pilot trials in South Asia which suggested that chlorhexidine could be equally or more effective than natamycin. It was also known that in Uganda, the majority of keratitis cases are caused by fungi, and the outcomes for fungal infections are more likely to be worse.

Participants in the original keratitis study who were not responding to natamycin (5%) were given an additional treatment with topical chlorhexidine (0.2%). Following up with the patients, 75% of those who had been deteriorating on natamycin alone showed signs of responding after receiving chlorhexidine, with ulcers caused by the infections healing and inflammation subsiding. Whilst a small case series, the results show that chlorhexidine could be a viable further option for patients with these infections who are not responding to treatment. Additionally, the chlorhexidine used in the study was 15 times cheaper than natamycin, making it a practical option which warrants further investigation. With few current available FK treatments, further research following this study has the potential to improve care for FK patients.

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Multisectoral Governance for Reproductive Health: Challenges and Lessons from the Philippines

By Vanessa T. Siy Van (Health Sciences Program, Ateneo de Manila University) and Jhanna Uy (Research Department, Philippine Institute for Development Studies; Health Sciences Program, Ateneo de Manila University)

What is Multisectoral Governance?

Since the twentieth century, governments have recognized that health is as much a product of social, economic, and political conditions as it is of health system performance. Many of these determinants fall outside the purview of health programs, and thus improving health requires multisectoral action. In the case of reproductive health (RH), multisectoral action is instrumental to not only improving indicators such as maternal and child mortality, but also empowering individuals and the sustainable growth of populations, human capital, and economies. However, governing multisectoral action has historically been difficult, especially in low-and-middle-income countries (LMICs) because of weak public administration, chronic underfunding, and limited skilled human resources. While laws are usually deemed the most formal and binding form of policy, many LMICs struggle with obtaining the commitment of non-health sector leaders to commit and operationalize policy implementation in their spheres. Such has been the case for the Philippines, where we found that even with a policy-neutral, rights-based national law, the interest and buy-in of non-health state actors cannot be assumed. The case presents lessons for implementing multisectoral policies, as the presence of policy may not always translate into practice.

Philippines’ Reproductive Health Law

The Philippines is a unitary democratic LMIC where legislation and priority-setting are done at the national level, and social services are decentralized to regional offices and delivered by local government units (LGUs). The Responsible Parenthood and Reproductive Health (RPRH) Law of 2012 was passed in this context after decades of opposition and public debate. Immediately after passage, the RPRH Law’s enactment was delayed twice by the judiciary. Only after concerted efforts by national government agencies (NGAs), civil-society organizations (CSOs), and multilaterals, restrictions were lifted in 2017. Despite these challenges, the law remains one of few national RH policies in Southeast Asia and is celebrated for its explicit call for collaboration among health, education, economic, and social welfare sectors. However, nearly a decade later, the landmark legislation did not translate into significant improvements in RH outcomes: maternal mortality is twice that of the target set by the Sustainable Development Goals; Philippine HIV incidence is one of the fastest-growing in the region; and in 2020, a-third of Filipino children were stunted.

Challenges of Putting Policy into Practice

Through semi-structured interviews with national RPRH implementers, we examined national multisectoral governance practices and identified intersectoral coordination challenges. These were supported with document reviews and meeting transcripts of the RPRH National Implementation Team (NIT), composed of government agencies, CSOs, and multilaterals.

Our analysis found three main themes over seven years of RPRH operations:

1.National leaders, particularly the health sector, were unable to rally non-health sector actors around RPRH.

  • Despite a lack of conflicts in sector objectives, there were no concrete strategies and operational plans for integrated RPRH service delivery across sectors.
  • Most NGAs did not make formal changes to their organizational structures for RPRH activities, dedicate funds for RPRH, or develop intra-agency policies to institutionalize RPRH, causing delays in program implementation.
  • The NIT’s Planning, Monitoring, and Evaluation Guide was developed in 2015 after implementation had already begun. The guide does not prescribe concrete targets and meeting mandates are left to the discretion of individual organizations.
  • Multisectoral collaboration was hindered by pressure to preserve each agency’s image and NGAs’ frequent leadership and priority changes.

2.NGAs channel multiple paternalistic directives for RPRH down to smaller subnational units with larger burden for implementation but limited human resources.

  • In the Philippines’ decentralized government, one LGU is expected to implement multiple parallel programs from over a dozen NGAs.
  • Poorer LGUs must forgo some programs and responsibilities or be reliant on NGA resources for RPRH, which themselves are not stable.
  • Due to their legal autonomy, LGUs have only weak accountability to national and regional offices; LGUs are also unrepresented in the NIT.

3.CSOs were important partners in implementation, but failure to manage their expectations and conflicts of interest decreased the effectiveness of the NIT as a platform for multisectoral governance.

  • Given variability of LGU performance, CSOs were invaluable local implementation partners.
  • However, CSOs had private, community-level interests that occasionally put them at odds with national priorities, making NIT unconducive for coordination.

Lessons for the Future

The absence of multi-agency plans, targets, and accountability systems fostered a culture of siloed opportunism. Local resource limitations associated with decentralization were exacerbated by paternalistic financing, coordination, and monitoring. Conflicts in interests and perspectives between state and civil-society actors went unmanaged. Future policy responses built on these system failures, as opposed to first addressing them, will contribute to inconsiderable gains in RH over the next decade. Formal legal policies alone are insufficient to institutionalize whole-of-government action. Advocacy and intersectoral discourse can bridge sectors’ understanding of the scope and depth of the problem, in line with WHO’s recommendations to make health equity a government-wide indicator for national development.


Image credit: Wayne S. Grazio

Universal health coverage policies may fail to ensure the provision of primary care for all without a stronger commitment to community health

By Andres Garchitorena (Institut de Recherche pour le Developpement and NGO PIVOT), Felana A. Ihantamalala (Harvard Medical School and NGO PIVOT), and Matthew H. Bonds (Harvard Medical School and NGO PIVOT).

Background

Nearly half of the world’s population lacks access to essential health services. To address this, most countries have committed to Universal Health Coverage (UHC), with the goal of ensuring the provision of primary health services that are “high quality, safe, comprehensive, integrated, accessible, available, and affordable for everyone everywhere”. Accordingly, UHC policies focus on reducing user fees at health facilities via fee exemptions or national health insurances, and on improving the quality of primary care through health systems strengthening. In practice, ensuring that health systems are capable of reaching everyone is both a design and a data problem. Health systems, after all, lack information on those who do not already access them, and a key determinant of that access is geography: many populations in rural areas of low- and middle-income countries need to walk several hours to consult at a health facility when they need care.

So we ask, how can health policies such as UHC be better designed to achieve universal access to primary health care? How can these information gaps be filled so that health systems are optimized to meet population needs?

To address these issues, the nongovernmental health organization, Pivot, recently partnered with the government of Madagascar to create a model of Universal of Health Coverage in the remote district of Ifanadiana.  This program includes many of the elements encouraged for national UHC policies, such as removal of user fees at health facilities, and improvements to healthcare quality via support to health system readiness and to clinical programs. It also strengthened the local community health program. These programs, which have evolved over time, have been integrated from the beginning with a unique dataset of geocoded patient records encompassing all health center visits in the district over the first four years (nearly 300,000 consultations), along with a vast geographic information system that maps over 20,000km of footpath, 100,000 houses, and every health facility. The result of the analysis of these data are published in our recent study “Geographic barriers to achieving universal health coverage: evidence from rural Madagascar”, which examined the contribution and limitations of policies for UHC and community health towards the realization of universal access to primary health care.

What did we find?

We found that the geographic reach of facility-based primary care is quite limited, even after fees are removed at the point of service and quality of services are improved. Half of all consultations in strengthened facilities were from patients who lived within 2 km. Those that lived within 5 km of a strengthened facility experienced substantial increases in utilization – exceeding 1 visit per person-year. But those who lived more than 5km from a strengthened facility accessed care less frequently than those who live near facilities which were never strengthened at all. Importantly for rural Madagascar and many other similar settings, most of the population (75%) lives more than 5km from a health facility. Using results from our statistical models, we predict that scaling up facility-based interventions alone (removing user fees, improving health system readiness), would only achieve modest increases in geographic coverage, with three quarters of the population consulting at facilities less than once per person-year.

However, there are solutions: strengthening community-health can have substantial impacts on the geographic reach of the health system. Community health workers (CHWs) are trained to provide a small subset of clinical services within their community, such as diagnose and treat common illnesses in children under five years. In Madagascar, there are two CHWs for each fokontany (a village or small group of villages), so even remote populations live in close proximity to a CHW. The effect of geography on primary care access in Ifanadiana was greatly reduced when accounting for community health consultations, reaching over 2 consultations per child-year regardless of distance to a health facility. CHWs were the main source of health care delivery for children in remote populations, representing 90% of primary care visits for those living further than 15 km from a health facility. Yet, less than 20% of the district population are part of the target age of CHWs (children under five years), leaving the vast majority of the population in remote areas with virtually no access to care. Further, community health programs are still under-resourced in many countries, where CHWs are considered local volunteers, are poorly compensated, and lack dedicated supervision and adequate training.

What does this mean?

These analyses show how powerful insights arise when comprehensive health reform occurs alongside data systems that are built to shed light on the complexity and heterogeneity of many global health challenges, and are tied to specific policy goals that are actionable. For Madagascar and similar low-income countries, wider support to community health is necessary to achieve universal access to primary care. In response to this evidence, Pivot has piloted a new program with the government of Madagascar to further strengthen the role of community health. In this new program, CHWs proactively visit every household at least once per month, receive biweekly direct supervision and training, and are paid the national minimum wage. This is in line with the recently updated World Health Organization guidelines on community health worker programs, which advise that CHWs should be professionalized – i.e., paid, trained and directly supervised. Yet most countries have not yet adopted policies based on these new guidelines. Our results provide the best evidence to date of the substantial gaps in care that will persist until public health systems adequately integrate professional community health programs. Though there remains debate on how to optimize community health, a greater ability for populations everywhere to access the formal health system is clearly fundamental to any hopes of achieving UHC. And we need the right data to identify who is missing. Professionalized CHWs can contribute to both the clinical and data gaps if they could further expand the scope of primary care services across a greater range of clinical cases and demographic groups.


N.B. Some authors are current or former employees of institutions discussed in this article, including the NGO PIVOT.

Image credit: NGO Pivot

Health Policy and Planning’s Top 10 Articles Contributing to the 2020 Impact Factor

By Natasha Salaria (London School of Hygiene & Tropical Medicine)

The 2020 impact factors are now out as of this month and what a year it has been. We are pleased to announce we have seen an increase in our impact factor which has gone up to 3.344 with our 5-year impact factor coming in at 3.902. This keeps us in Quartile 1 of the Health Policy and Services category (19th out of 88 journals).

As we are all aware, the usage of impact factors is widely contested as a means of assessing journal impact, and we at the London School of Hygiene & Tropical Medicine have signed the Declaration on Research Assessment (DORA) which recognises the need to improve how research is assessed. However it is undeniably still widely recognised by authors, publishers, libraries and academic departments as an indicator of citation rates to journal articles.

After delving into some of the citation data, we would like to share our top 10 most highly cited articles that contributed to the 2020 impact factor in Health Policy and Planning:

  1. Original article: Disrespectful and abusive treatment during facility delivery in Tanzania: a facility and community survey
  2. Original article: The cost of not breastfeeding: global results from a new tool
  3. JOINT 3RD
    – Review: The impact of cash transfers on social determinants of health and health inequalities in sub-Saharan Africa: a systematic review
    – Review: Integrated mental health services in China: challenges and planning for the future
  4. Original article: How do external donors influence national health policy processes? Experiences of domestic policy actors in Cambodia and Pakistan
  5. JOINT 5TH:
    – Original article: Towards an understanding of resilience: responding to health systems shocks
    – 10 best resources: 10 best resources on power in health policy and systems in low- and middle-income countries
    – Review: The silencing of political context in health research in Ethiopia: why it should be a concern
  6. Original article: Mental health system costs, resources and constraints in South Africa: a national survey
  7. Original article: Jeopardizing quality at the frontline of healthcare: prevalence and risk factors for disrespect and abuse during facility-based childbirth in Ethiopia
  8. JOINT 8th:
    – Review: Community health volunteers could help improve access to and use of essential health services by communities in LMICs: an umbrella review
    – Original article: Priority setting for health in the context of devolution in Kenya: implications for health equity and community-based primary care
    – Original article: The investment case for hepatitis B and C in South Africa: adaptation and innovation in policy analysis for disease program scale-up
  9. Original article: Dissatisfaction with current integration reforms of health insurance schemes in China: are they a success and what matters?
  10. Original article: Strengthening mental health system governance in six low-and middle-income countries in Africa and south Asia: challenges, needs and potential strategies
Contributions by country/region Count Contributions by organizations Count
UNIVERSITY OF LONDON 50 USA 104
LONDON SCHOOL OF HYGIENE TROPICAL MEDICINE 44 ENGLAND 73
HARVARD UNIVERSITY 27 SOUTH AFRICA 26
JOHNS HOPKINS UNIVERSITY 15 CANADA 23
UNIVERSITY OF CALIFORNIA 13 AUSTRALIA 22
UNIVERSITY OF CAPE TOWN 11 SWITZERLAND 18
WORLD HEALTH ORGANIZATION 11 KENYA 14
MAKERERE UNIVERSITY 9 INDIA 13
RUPRECHT KARLS UNIVERSITY HEIDELBERG 8 TANZANIA 11
UNIVERSITY OF SYDNEY 8 GERMANY 10

*These data summarize the top 10 countries/institutions for papers published in 2018 and 2019 i.e. the impact factor window. The ‘record count’ values mean that at least one author listed on any paper is affiliated with the named institution or is from the listed country. It is meant to be descriptive rather than comparative.

Our top 10 contributions by organizations include high performing higher education institutions such as Johns Hopkins, Harvard University, University of Cape Town, University of Makerere and the World Health Organization.

The journal has wide reach and publishes papers from authors in over 75 countries, many from low- and middle-income countries who are able to utilise our reduced rate or free access countries list.

In 2020, our blog audience included readers from Kenya, India, UK, USA, South Africa, Nigeria, Myanmar, Ghana, Australia and Brazil.

Altmetric

Altmetric is an alternative metric to the impact factor, used to demonstrate engagement with journals on an individual article level. Altmetric collects data on universal popularity and uptake, including within policy documents to show how research has influenced health policy as well as media outlets and social media platform discussions.

There have been 61 policy documents including out content by 12 unique policy sources in 8 countries including policy documents in the World Bank, the National Institute for Health and Care Excellence, Food and Agriculture Organization of the United Nations and the World Health Organization.

Here are the Top 10 articles from 2020 with the highest Altmetric score published in Health Policy and Planning:

  1. Commentary: Tuberculosis control and care in the era of COVID-19
  2. Commentary: What role can health policy and systems research play in supporting responses to COVID-19 that strengthen socially just health systems?
  3. Original article: Providers’ perceptions of disrespect and abuse during childbirth: a mixed-methods study in Kenya
  4. Original article: The state of diet-related NCD policies in Afghanistan, Bangladesh, Nepal, Pakistan, Tunisia and Vietnam: a comparative assessment that introduces a ‘policy cube’ approach
  5. Review: Social values and health systems in health policy and systems research: a mixed-method systematic review and evidence map
  6. Commentary: Climate change: an urgent priority for health policy and systems research
  7. Original article: Intersectoral (in)activity: towards an understanding of public sector department links between water, sanitation and hygiene (WASH) and childhood undernutrition in South Africa
  8. Methodological Musing: Document analysis in health policy research: the READ approach
  9. Review: Health system resilience: a literature review of empirical research
  10. Original article: Applying a complex adaptive systems approach to the evaluation of a school-based intervention for intimate partner violence prevention in Mexico

Don’t forget to check out our latest outputs including:

  • [RESEARCH COLLECTION] Evidence to inform the COVID-19 Response
  • [PODCASTS]
    – To Bend without Breaking: A Qualitative Study on Leadership by Doctors in Sierra Leone
    – Effectiveness of containment and closure policies across income levels during the COVID-19 pandemic
    – Impact of campaign-style delivery of routine vaccines using routine health services data in India
  • [SUPPLEMENTS] Watch this space for a 2021 supplement publishing in November in collaboration with Health Systems Global
  • [EDITOR’S CHOICE ARTICLES]
  • [NEW INNOVATION & PRACTICE REPORTS GUIDELINES]
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