- Email: [email protected]
Round Up: Research
www.rhm-elsevier.com
© 2010 Reproductive Health Matters. All rights reserved. Reproductive Health Matters 2010;18(36):196 0968-8080/10 $ – see front matter PII: S 0 9 6 8 - 8 0 8 0 ( 1 0 ) 3 6 5 4 1 - 4
www.rhmjournal.org.uk
ROUND UP
Research Health systems financing research priorities in developing countries
Worldwide mortality in men and women aged 15–59 years
Donor funding for health systems financing research is inadequate and often poorly aligned with national priorities. This study aimed to generate consensus about a core set of research issues that require urgent attention in order to facilitate policy development. Inputs into the priority-setting process included key informant interviews with health policy makers, researchers, community and civil society representatives across 24 low- and middle-income countries in four regions; an overview of relevant reviews to identify research completed; and inputs from 12 key informants (largely researchers) at a consultative workshop. 19 priority research questions emerged from the key informant interviews. The overview of reviews showed how some health financing topics have had relatively little written about them, despite being identified as important. Despite differences between countries' health financing challenges, there is consensus around the type of policy problems faced. Improved evidence – particularly around universal financial protection, ways of identifying the poor, ways of extending benefits to the poor, demandside financing and cost-effectiveness of service delivery models – is urgently needed. The list of high priority research questions is being communicated to research funders and researchers in order to influence global patterns of health systems financing research funding and activity. A “bottom up” approach to setting research priorities, such as that employed here, should ensure that priorities are more sensitive to user needs.1
Every year, more than 7.7 million children die before age five; however, nearly 24 million adults die under the age of 60. The prevention of premature adult death is just as important for global health policy as the improvement of child survival, but has received little attention. This study estimated worldwide mortality in men and women aged 15–59 (45q15) by compiling a database of 3,889 measurements of adult mortality for 187 countries from 1970 to 2010 using vital registration data, census and survey data. Adult mortality varied substantially across countries and over time. In 2010, the countries with the lowest risk of mortality for men and women were Iceland and Cyprus, respectively. In Iceland, male 45q15 is 65 per 1,000; in Cyprus, female 45q15 is 38 per 1,000. Highest risk of mortality by age 60 was seen in Swaziland for men (765 per 1,000) and Zambia for women (606 per 1,000). Between 1970 and 2010, substantial increases in adult mortality occurred in sub-Saharan Africa because of the HIV epidemic and in countries in or related to the former Soviet Union. There has been a stagnation in the decline of adult mortality for large countries in Southeast Asia, but a striking decline in female mortality in South Asia. Risk of mortality is generally higher for men than for women, and the gap is widening. The global health community needs to broaden its focus and ensure that those who survive to adulthood will also survive until old age. Routine monitoring of adult mortality should be given much greater emphasis.1
1. Ranson K, Law TJ, Bennett S. Establishing health systems financing research priorities in developing countries using a participatory methodology. Social Science and Medicine 2010;70(12):1933–42.
1. Rajaratnam JK, Marcus JR, Levin-Rector A, et al. Worldwide mortality in men and women aged 15–59 years from 1970 to 2010: a systematic analysis. Lancet 2010;375(9727):1704–20.
196
© 2010 Reproductive Health Matters. All rights reserved. Reproductive Health Matters 2010;18(36):196 0968-8080/10 $ – see front matter PII: S 0 9 6 8 - 8 0 8 0 ( 1 0 ) 3 6 5 4 1 - 4
www.rhmjournal.org.uk
ROUND UP
Research Health systems financing research priorities in developing countries
Worldwide mortality in men and women aged 15–59 years
Donor funding for health systems financing research is inadequate and often poorly aligned with national priorities. This study aimed to generate consensus about a core set of research issues that require urgent attention in order to facilitate policy development. Inputs into the priority-setting process included key informant interviews with health policy makers, researchers, community and civil society representatives across 24 low- and middle-income countries in four regions; an overview of relevant reviews to identify research completed; and inputs from 12 key informants (largely researchers) at a consultative workshop. 19 priority research questions emerged from the key informant interviews. The overview of reviews showed how some health financing topics have had relatively little written about them, despite being identified as important. Despite differences between countries' health financing challenges, there is consensus around the type of policy problems faced. Improved evidence – particularly around universal financial protection, ways of identifying the poor, ways of extending benefits to the poor, demandside financing and cost-effectiveness of service delivery models – is urgently needed. The list of high priority research questions is being communicated to research funders and researchers in order to influence global patterns of health systems financing research funding and activity. A “bottom up” approach to setting research priorities, such as that employed here, should ensure that priorities are more sensitive to user needs.1
Every year, more than 7.7 million children die before age five; however, nearly 24 million adults die under the age of 60. The prevention of premature adult death is just as important for global health policy as the improvement of child survival, but has received little attention. This study estimated worldwide mortality in men and women aged 15–59 (45q15) by compiling a database of 3,889 measurements of adult mortality for 187 countries from 1970 to 2010 using vital registration data, census and survey data. Adult mortality varied substantially across countries and over time. In 2010, the countries with the lowest risk of mortality for men and women were Iceland and Cyprus, respectively. In Iceland, male 45q15 is 65 per 1,000; in Cyprus, female 45q15 is 38 per 1,000. Highest risk of mortality by age 60 was seen in Swaziland for men (765 per 1,000) and Zambia for women (606 per 1,000). Between 1970 and 2010, substantial increases in adult mortality occurred in sub-Saharan Africa because of the HIV epidemic and in countries in or related to the former Soviet Union. There has been a stagnation in the decline of adult mortality for large countries in Southeast Asia, but a striking decline in female mortality in South Asia. Risk of mortality is generally higher for men than for women, and the gap is widening. The global health community needs to broaden its focus and ensure that those who survive to adulthood will also survive until old age. Routine monitoring of adult mortality should be given much greater emphasis.1
1. Ranson K, Law TJ, Bennett S. Establishing health systems financing research priorities in developing countries using a participatory methodology. Social Science and Medicine 2010;70(12):1933–42.
1. Rajaratnam JK, Marcus JR, Levin-Rector A, et al. Worldwide mortality in men and women aged 15–59 years from 1970 to 2010: a systematic analysis. Lancet 2010;375(9727):1704–20.
196