Criteria for prioritizing health-related problems for research

1. Criteria for prioritizing health-related problems for research

3. Objectives 1. Identify criteria for selecting health-related problems to be given priority in research. 2. Use group concensensus technique to set priorities for research, applying the selected criteria on a number of topics. 3. Select an appropriate subject for a research proposal that will be developed by group during the course.

4. Topic Identification • A number of research questions have to be posed at the various levels of the health systems research that could be grouped into three categories. • Categories of research questions depends on the type of information sought: 1.Description of the health situation, required for planning interventions. Planners have to know for example, the magnitude and distribution of health needs in a population and the services. 2.Information required to evaluate ongoing interventions, for example, with respect to: -coverage of priority health needs -coverage of target group(s) -Acceptability and quality -Cost effectiveness -Impact on health access progress and the need for adjustment on a routine basis.

5. Topic identification cont. 3.Information required to define problem situations in interventions in any of the fields mentioned under number 2, and to analyze possible causes in order to find solutions. Conditions for problem solving research depends on the following; 1.A perceived difference or discrepancy between what exists and the ideal or planned situations. 2.The unclear reason(s) above that leads to development of research question(s) 3.There must be more than one possible answer to a question or more than the solution to the problem For example: District X (population 145,000) they are living in poor sanitary conditions, 5% of households have latrines and the disease connected with poor sanitation are very common. The MOHSW initiates a sanitary project that aims at increasing percentage of households with latrines by 15% per year. The project provides materials, the population provides labour. Two years later, less than half of the target percent has been reached. Discrepancy: 35% of the households should have latrines, but only 15% do have them. Research question: What factors explains this difference?

6. Topic identification cont. Possible answers: -Service –related factors, such as bottlenecks in supply of materials, lack of co-operation between sectors, difference btn training and effectiveness of sanitary staff -Population related factors, such as, a knowledge lag btn disease and sanitation that they are close related, or due to other factors, such as, poverty that is considered more important to them. -Physical factors/ecosystems, such as hard soil, or land subjected to frequent flooding.

7. Criteria for prioritizing topics for research The health systems research is intended to provide reliable information for decision-making in the improvement of health care, therefore, the selection of research topic and analysis should involve the key persons responsible for the health care improvement of the community. -Each topic proposed for research should be scrutinized based on underlying guide lines, such as:

8. Some guidelines for research topic selection 1. Relevance -The topic chosen must be a priority problem to targeted population. -Questions to be asked include; How large is the problem? Who is affected? How severe is the problem? Also, consider the question of who perceives the problem as important, e.g., health managers, health staff and community members may each look at the same problem from different perspectives. It is therefore important to explore the perceptions of all involved parties in reaching a consensus. 2.Avoidance of duplication Before deciding to carry out a study research, it is important to find out whether the suggested topic has been investigated before, either within the proposed study area or in another area with similar condition. 3. Urgency of data needed(timeliness). How urgently are the results needed for making a decision or developing interventions at various levels. Consider which research should be done first and which can be done later. 4.Political acceptability It is advisable to research a topic that has the interest and support of the local/national authorities. This increases the chances for the study results to be implemented. 5. Feasibility. Cross-examine the project being proposed and consider the complexity of the problem and the resources required to carry out the study. consideration should be given first to manpower, time, equipment and money locally available for the study, then later explore the possibility of obtaining technical and financial assistance from external sources later.

9. Guidelines for research topic cont. 6.Applicability of possible results/recommendations. -Is it more or less likely that the recommendations from the study will be applied? -Is there enough resources for implementing the recommendations? -Will the opinion of the potential clients and of responsible staff likely to influence the implementation of recommendations? 7.Ethical acceptability. -The researcher should consider important ethical issues that may inflict, or harm on others while carrying out the research, these are: 1.How acceptable is the research to those who are being studied?, is the problem shared by target group and health staff/researchers? (Cultural sensitivity must be given careful consideration) 2.Can informed consent be obtained from the research subjects? 3.Will the condition of the subjects be taken into account? 4.Will the results be shared with those who are being studied? 5.Will the results be helpful in improving the lives or health of those studied?

10. Scales for rating research topic 1.Relevance -Not relevance -Relevant -Very relevant 2.Avoidance of duplication -Sufficient information already available -some information available but major issues not covered -No sound information available on which to base problem-solving 3.Urgency -information not urgently needed -Information could be used right away but a delay of some months would be acceptable -Data very urgently needed for decision-making

11. Rating scales cont. 4.Political acceptability -Topic not acceptable to high level policy makers -Topic more or less acceptable -Topic fully acceptable 5.Feasibility -Study not feasible, considering available resources -Study very feasible, considering available resources. -Study feasible, considering available resources 6.Applicability -No chance of recommendations being implemented -Some chance of recommendations being implemented -Good chance of recommendations being implemented 7.Ethical acceptability -Major ethical -Minor ethical problems -No ethical problems

12. Dimensions of health research to be prioritized There are at least four dimensions in health research that have to be prioritized against others, i.e. methodologies for priority- setting and cross-cutting issues in health research, such as policies, poverty and health, gender and health, and research capacity strengthening, diseases and conditions and health determinants themselves to be prioritized, and are competing for the same funding as disease-focused priorities. Therefore, it is proposed that the prioritization in health research take into account all four dimensions in summary as follows:

13. Dimensions of health research cont. • 1.Research on diseases and conditions • 2.Research on health determinants and risk factors • 3. Research on priority-setting methodologies • 4. Research on policies and cross-cutting issues affecting health and health research.

14. Dimensions of health research cont. • A recent study in Tanzania has indicated that health financing and human resources for health, integrated health care(Briggs & Carner, 2001), multi-sectoral approach to interventions and HIV and food insecurity should be considered as the most important priorities in policy formulation (Mboera et al;2009). This means, that there is a general need for increased investment in HSR, monitoring and evaluation of interventions. Also, there is a need to make research as one of the compulsory components prior addressing health priorities in all programs in order to have evidence based information in the endeavor to implement the respective national health programs.

15. ASSIGNMENT/GROUP WORK • Meet in your working groups to list and rank the health research topics that you want to consider for the research proposal you will develop, as a team, during the course • Choose a reporter who will present in plenary the topics you have considered and your final choice. • Omit research topics that are less relevant or too difficult to carry out. Ideally you should select no more than five to six topics for individual rating.