Publications scientifiques du Courtier
The state of the research for health environment in the ministries of health of the Economic Community of the West African States (ECOWAS)
Background: An assessment of the state of the Research for Health (R4H) environment can provide relevant information about what aspects of national health research systems needs strengthening, so that research output can be relevant to meet national priorities for decision-making. There is limited information on the state of the R4H environment in the Economic Community of West African States (ECOWAS). This article describes the state of the R4H environment within the Ministries of Health of the ECOWAS member states and outlines of some possibilities to strengthen health research activities within the ECOWAS region.
Methods: Information on the national-level R4H environment (governance and management; existence of a national policy; strategic and research priorities documents; ethics committees; research funds; coordination structures; monitoring and evaluation systems; networking and capacity building opportunities) was collected from the Ministries of Health research units in 14 ECOWAS countries using self-administered questionnaires. A workshop was held where country report presentations and group discussions were used to review and validate responses. Data from the discussions was transcribed using Nvivo, and strengths, weaknesses, opportunities and threats (SWOT) analysis of the functioning of the units was done using Robert Preziosi’s organisational diagnosis tool.
Results: The findings indicate that as of January 2011, 50% of ECOWAS countries had established directorates for health research with defined terms of reference. The existing funding mechanisms were inadequate to support the research structures within and outside the MoHs, and for building the capacity of researchers. Networking and monitoring activities were weak and only 7% of the directors of research units were trained in research
management. The majority (85.7%) of countries had broader national health policies, and 57% of the countries had some form of policy or strategic document for research development. Half of the countries had developed national research priorities.
Conclusions: These results call for urgent action to improve the research environment in the Ministries of Health in
the West African sub-region.
Keywords: National research systems, Research environment, Research for health, Research governance, Research management, West Africa
Evidence-based policy-making: The implications of globally-applicable research for context-specific problem-solving in developing countries
In the past 15 or so years, the ‘‘evidence-based medicine’’ (EBM) framework has become increasingly institutionalized, facilitating its transfer across the globe. In the late 1990s, the basic principles of EBM began to have a marked inﬂuence in a number of non-clinical public policy arenas. Policy-makers working in these areas are now being urged to move away from developing policies according to political ideologies to a more legitimate approach based on ‘‘scientiﬁc fact,’’ a process termed ‘‘evidence-based policy-making’’ (EBPM). The conceptual diffusion of EBM to non-clinical arenas has exposed epistemologically destabilizing views regarding the deﬁnition of ‘‘science,’’ particularly as it relates to the demands of global versus national/sub-national policy-making. Using the maternal and neonatal subﬁeld as an ethnographic case-study, this paper explores the effects of these divergences on EBPM in 5 developing countries (Bangladesh, Burkina Faso, Ghana, Malawi and Nepal). In doing so, our analysis aims to explain why EBPM has thus far had a limited impact in the area of context-speciﬁc programmatic policy-development and implementation at the national and sub-national levels. Results highlight that the political contexts in which EBPM is played out promote uniformity of methodological and policy approaches, despite the fact that disciplinary diversity is being called for repeatedly in the public health literature. Even in situations where national EBPM diverges from international priorities, national evidence-based policies are found to hold little weight in countering global policy interests, which some informants claim are themselves legitimated, rather than informed, by evidence. Informants also highlight the way interpretations of research ﬁndings are shaped by the broader political context within which donors set priorities and distribute limited resources – contexts that are driven by the need to provide generalisable research recommendations based on scientiﬁcally replicable methods. Added to
this are clear rifts between senior and junior-level experts within countries that constrain national and sub-national research agendas from serving as tools for empowered knowledge production and problem-solving. We conclude by arguing for diverse forms of research that can more effectively address context-speciﬁc problems. While such diversity may render EBPM more conﬂict-ridden, debate is by no means an undesirable characteristic in any evolving system of knowledge, for it has the potential to foster critical insight and localized change.
What prevent women for a sustainable use of maternal care in Burkina Faso? a qualitative study
Caractéristiques de la communication parents-adolescentes sur la sexualité et le VIH à Bobo-Dioulasso, Burkina Faso
Les adolescentes constituent une des principales cibles de la lutte contre les infections sexuellement transmissibles et le VIH en Afrique sub-saharienne. Le rôle des familles dans l’éducation et l’information des adolescentes est très faible en Afrique, suggérant un sujet encore tabou. L’objectif de la présente étude est d’aborder sous l’angle qualitatif la communication parents et adolescentes en explorant les caractéristiques et la qualité de cette communication. Une étude transversale a été réalisée d’avril à septembre 2009 à Bobo-Dioulasso. Elle a inclus 40 couples parents-adolescentes scolarisées et non scolarisées.
Des entretiens individuels par un questionnaire et des focus group ont été réalisés. Les données ont été traitées par les logiciels Stata version 9.1 (données quantitatives) et QSR Nvivo 2.0 (données qualitatives). Il y avait 74 % (14/19) d’adolescentes non scolarisées qui communiquaient avec leurs parents par rapport aux adolescentes scolarisées (45 %) p = 0,07. La mère était la personne avec qui les échanges se réalisaient le plus souvent : 59 %
(13/22) des familles où la communication au sujet de la sexualité et du VIH existait. Les facteurs d’une meilleure communication chez les adolescentes non scolarisées devraient faire l’objet d’une analyse plus approfondie.
Mots-clés : Communication parent-enfant - sexualité - VIH.
Women's perceptions of homebirths in two rural medical districts in Burkina Faso: a qualitative study
Background: In developing countries, most childbirth occurs at home and is not assisted by skilled attendants. The situation increases the risk of death for both mother and child and has severe maternal complications. The purpose of this study was to describe women’s perceptions of homebirths in the medical districts of Ouargaye and Diapaga.
Methods: A qualitative approach was used to gather information. This information was collected by using focus group discussions and individual interviews with 30 women. All the interviews were tape recorded and managed by using QSR NVIVO 2.0, qualitative data management software.
Results: The findings show that homebirths are frequent because of prohibitive distance to health facilities, fast labour and easy labour, financial constraints, lack of decision making power to reach health facilities.
Conclusion: The study echoes the need for policy makers to make health facilities easily available to rural inhabitants to forestall maternal and child deaths in the two districts.