საინფორმაციო ბიულეტენი N 1 (2016)


State budget transfers to Health Insurance Funds for universal health coverage: institutional design patterns and challenges of covering those outside the formal sector in Eastern European high-income countries

Ileana Vilcu, Inke Mathauer

International Journal for Equity in Health (2016) 15:7

Published online: 15 January 2016


Introduction: Many countries from the European region, which moved from a government financed and provided health system to social health insurance, would have had the risk of moving away from universal health coverage if they had followed a “traditional” approach. The Eastern European high-income countries studied in this paper managed

to avoid this potential pitfall by using state budget revenues to explicitly pay health insurance contributions on behalf of certain (vulnerable) population groups who have difficulties to pay these contributions themselves. The institutional design aspects of their government revenue transfer arrangements are analysed, as well as their impact on universal health coverage progress. Methods: This regional study is based on literature review and review of databases for the performance assessment. The analytical framework focuses on the following institutional design features: rules on eligibility for contribution exemption, financing and pooling arrangements, and purchasing arrangements and benefit package design.

Results: More commonalities than differences can be identified across countries: a broad range of groups eligible for exemption from payment of health insurance contributions, full state contributions on behalf of the exempted groups, mostly mandatory participation, integrated pools for both the exempted and contributors, and relatively comprehensive benefit packages. In terms of performance, all countries have high total population coverage rates, but there are still challenges regarding financial protection and access to and utilization of health care services, especially for low income people. Conclusion: Overall, government revenue transfer arrangements to exempt vulnerable groups from contributions are one option to progress towards universal health coverage.


Universal Health Coverage; Vulnerable Population Groups Outside Formal Sector Work; Government Subsidization of Health Insurance

State Budget Transfers; Financial Protection



2. Systems science and systems thinking for public health: a systematic review of the field

Gemma Carey, Eleanor Malbon, Nicole Carey, Andrew Joyce, Brad Crammond

Alan Carey

BMJ Open 2015;5:

Published online: 30 December 2015


Objectives: This paper reports on findings from a systematic review designed to investigate the state of systems science research in public health. The objectives were to: (1) explore how systems methodologies are being applied within public health and (2) identify fruitful areas of activity. Design: A systematic review was conducted from existing literature that draws on or uses systems science (in its various forms) and relates to key public health areas of action and concern, including tobacco, alcohol, obesity and the social determinants of health. Data analysis: 117 articles were included in the review. An inductive qualitative content analysis was used for data extraction. The following were systematically extracted from the articles: approach, methodology, transparency, strengths and weaknesses. These were then organised according to theme (ie, commonalities between studies within each category), in order to provide an overview of the state of the field as a whole. The assessment of data quality was intrinsic to the goals of the review itself, and therefore, was carried out as part of the analysis. Results: 4 categories of research were identified from the review, ranging from editorial and commentary pieces to complex system dynamic modelling. Our analysis of each of these categories of research highlighted areas of potential for systems science to strengthen public health efforts, while also revealing a number of limitations in the dynamic systems modelling being carried out in public health. Conclusions: There is a great deal of interest in how the application of systems concepts and approach might aid public health. Our analysis suggests that soft systems modelling techniques are likely to be the most useful addition to public health, and align well with current debate around knowledge transfer and policy. However, the full range of systems methodologies is yet to be engaged with by public health researchers..


Public Health; Social Determinants of Health; Health Policy; Research in Health



3. Good practices in strengthening health systems for the prevention and care of tuberculosis and drug-resistant tuberculosis (2015)

2015, viii + 104 pages

ISBN 978 92 890 5129 3

This publication is only available online.

In response to the burden of multidrug- and extensively drug-resistant tuberculosis (M/XDR-TB), all 53 Member States in the WHO European Region endorsed the Consolidated Action Plan to Prevent and Combat Multidrug- and Extensively Drug-resistant Tuberculosis in the WHO European Region 2011–2015 at the 61st session of the WHO Regional Committee for Europe.

To improve the transfer of knowledge and experience among countries and their use of the health-system approach to tackle health problems, the WHO Regional Office for Europe has collected and disseminated good examples of the prevention, control and care of TB in the Region. In this second compendium, it presents 45 examples of good practice in strengthening health systems for the prevention and care of TB and drug-resistant TB from 21 countries, including 14 countries of high priority for MDR-TB and countries with high and low TB incidence. This compendium complements the final report of implementation of the Consolidated Action Plan and can be used to scale up effective interventions in line with the proposed European TB action plan for 2016–2020. It is intended as a resource for stakeholders at all levels of health systems.



4. Health risk assessment of air pollution. General principles (2016)

SBN 978 92 890 5131 6

This publication is only available online. 

An air pollution health risk assessment estimates the health impact to be expected from measures that affect air quality, in different socioeconomic, environmental and policy circumstances. It is therefore an important tool for informing public policy decisions. 

This publication introduces the concept of air pollution health risk assessment, describes in broad terms how the health risks of outdoor air pollution and its sources are estimated, and gives an overview of the general principles for the proper conduct of an assessment for various scenarios and purposes. The information is aimed at a broad audience of readers who do not need to know how to apply the tools, but seek a general understanding of the concepts, scope and principles of such assessments.



5. European Food and Nutrition Action Plan 2015–2020


English (PDF, 2.6 MB)

Pусский (PDF, 2.2 MB)

2015, v + 31 pages

ISBN 978 92 890 5123 1

The Action Plan is intended to significantly reduce the burden of preventable diet-related noncommunicable diseases, obesity and all other forms of malnutrition still prevalent in the WHO European Region. It calls for countries to act, using a whole-of-government, health-in-all-policies approach. Its priority actions will contribute to improving food-system governance and the overall quality of the European population's diet and nutritional status.

The WHO Regional Committee for Europe unanimously adopted the Action Plan in September 2014. Health ministers and representatives from the 53 countries in the Region gave their overwhelming support to the Action Plan and its priority policies.



6. Taking a participatory approach to development and better health. Examples from the Regions for Health Network (2015)

English (PDF, 1.3 MB)

2015, xii + 55 pages

ISBN 978 92 890 5112 5

CHF 30.00/US$ 36.00

In developing countries: CHF 21.00/US$ 25.20

This publication documents the experiences of participatory approaches for development and better health taken by Region Skåne (Sweden) and three other regions, described in case studies: the Autonomous Province of Trento (Italy), the Autonomous Community of Andalusia (Spain) and Wales (United Kingdom).

If the ultimate goal of all development is to improve the prerequisites for long-term survival and the well-being of the population in a region, this entails action for increased social inclusion and a more equitable distribution of the social determinants of health. The intentional consequences of participatory approaches go far beyond the health sector, into the realm of creating positive sustainable social change. Through the engagement of stakeholders, recognizing the value of each person's contribution to the process is not only practical but also collaborative and empowering in finding solutions together. WHO's Health 2020 policy calls for a whole-of-government and whole-of-society approach that involves a range of stakeholders at all levels.



 7. European facts and the Global status report on road safety 2015


 English (PDF, 4.8 MB)

 Pусский (PDF, 4.9 MB)

By: Josephine Jackisch, Dinesh Sethi, Francesco Mitis, Tomasz Szymañski and Ian Arra

2015, iv + 15 pages

ISBN 978 92 890 5126 2

CHF 15.00/US$ 18.00

In developing countries: CHF 10.50/US$ 12.60

Order no. 13400166

In 2013, almost 85 000 people died from road-traffic injuries in the WHO European Region. Although the regional mortality rate is the lowest among WHO regions (9.3 deaths per 100 000 population), the rates of road traffic deaths vary widely in between European countries. More systematic efforts are needed if the global target of a 50% reduction in road crash deaths is to be achieved by 2020. 

This publication assesses countries' laws and practices on key risk factors – such as regulating speed appropriate to road type, drink–driving, and use of seat belts, motorcycle helmets and child restraints – for their effectiveness in reducing the risk injury. The assessment shows that many countries need to strengthen their road safety legislation and its enforcement to protect their populations, improve road users' behaviour and reduce the number of crashes. For example, while comprehensive laws on seat belts in line with best practice cover 95% of the Region's population, laws for speed adequately protect only 47%; the corresponding figures for use of helmets, against drink–driving and for use of child restraints are 45%, 33% and 71%, respectively. Much can be gained from improving the safety of vehicles, improving road infrastructure and promoting sustainable, physically active forms of mobility as alternatives to car use. Concerted policy efforts with safe systems approaches are needed to protect all road users in the Region.



8. Food systems in correctional settings. A literature review and case study (2015)


English (PDF, 4.8 MB)

Pусский (PDF, 1.6 MB)

By Amy B. Smoyer and Linda Kjær Minke

2015, vii + 20 pages

ISBN 978 92 890 5115 6

CHF 20.00/US$ 24.00

In developing countries: 14.00/US$ 16.80

Order no. 13400167

Food is a central component of life in correctional institutions and plays a critical role in the physical and mental health of incarcerated people and the construction of prisoners' identities and relationships. An understanding of the role of food in correctional settings and the effective management of food systems may improve outcomes for incarcerated people and help correctional administrators to maximize their health and safety. 

This report summarizes existing research on food systems in correctional settings and provides examples of food programmes in prison and remand facilities, including a case study of food-related innovation in the Danish correctional system. It offers specific conclusions for policy-makers, administrators of correctional institutions and prison-food-service professionals, and makes proposals for future research.



9. Measuring health inequities in low and middle income countries for the development of observatories on inequities and social determinants of health

German Guerr; Elis Borde; V. Nelly Salgado de Snyder

International Journal for Equity in Health, 2016, 15:9

Published online: 19 January 2016


Background. Almost seven years after the publication of the final report of the World Health Organization’s Commission on Social Determinants of Health (CSDH), its third recommendation has not been attended to properly. Measuring health inequities (HI) within countries and globally, in order to develop and evaluate evidence-based policies and actions aimed at the social determinants of health (SDH), is still a pending task in most low and middle income countries (LMIC) in the Latin American region. In this paper we discuss methodological and conceptual issues to measure HI in LMIC and suggest a three-stage methodology for the creation of observatories on health inequities (OHI) and social determinants of health, based on the experience of the Brazilian Observatory on Health Inequities (BOHI) that has been successfully operating since 2010 at the Fundação Oswaldo Cruz (FIOCRUZ). Methods. A three-stage methodology for the creation of an OHI was developed based on a literature review on the following topics: SDH, HI measurement, and the process of setting-up of health observatories; followed by semi-structured interviews with key informants from the BOHI. We describe the three stages and discuss the replicability of this methodology in other Latin American countries. We also carried out a search of suitable national information systems to feed an OHI in Mexico, along with an outline of the institutional infrastructure to sustain it. Results. When implementing the methodology for an OHI in LMIC such as Mexico, we found that having strong infrastructure of information systems for measuring HI is required, but not sufficient to build an OHI. Adequate funding and intersectoral network collaborations lead by a group of experts is a requirement for the consolidation and sustainability of an OHI in LMIC. Conclusion. According to the described methodology, and the available information systems on health, the creation of an OHI in LMIC, particularly in Mexico, is plausible in the near future. However, institutional support (in academic, financial, and policymaking terms) is essential to materialize such needed instance, thus locally contributing to attain health equity. 


Social Determinants of Health; Health Status Disparities; Methods; Data Collection



10. A world of cities and the end of TB

Amit Prasada, Alex Ross, Paul Rosenberg, Christopher Dye

Trans R Soc Trop Med Hyg 2016; 110: 151–152

Published online: February 2016


Forty-three million people [≈ population of Ibadan, Nigeria] with TB have been successfully treated by combination chemotherapy between 2000 and 2014. Globally, TB incidence has been falling by 1.65% annually over the past decade, barely satisfying the Millennium Development Goal (MDG) of reversing incidence rates by 2015. Looking to the future, WHO’s End TB Strategy envisions a world free of TB. This includes ambitious targets to reduce TB deaths by 95% and to cut new cases by 90% between 2015 and 2035. In 2013, 9 million new cases of TB were reported and 1.5 million people [≈ population of Kampala, capital city of Uganda] died from the disease. TB ranks as a leading cause of death, alongside HIV.1 Every country continues to have a national TB program because every country still has TB. Achieving the End TB Strategy targets will require a mix of optimizing the effectiveness of current TB control programs and the development of more potent drugs, diagnostics and vaccines. Although directly transmitted infections, such as TB, are more easily spread under crowded conditions, urbanization provides an opportunity to combat infectious diseases like TB. As the proportion of people living in urban areas is projected to increase from 50% in 2008 to 66% in 2050, more people will potentially have access to better infrastructure and services, including housing and medical care that help combat poverty and inequality. In China in 2010, for example, not only was the prevalence of bacteriologically positive TB in urban areas (73 per 100 000) less than half that of rural areas (163 per 100 000), the rate of decrease in prevalence between 2000 and 2010 was nearly twice as fast….


Health inequality; Sustainable Development Goals; Tuberculosis; Urbanization; Global Health.



11. Editorial

Advancing health equity to improve health: The time is now

Jackson B, Huston P 

CCDR: Volume 42S-1, Feb, 2016: Social Determinants of Health

Published online: 18 February 2016


Health inequities, or avoidable inequalities in health between groups of people, are increasingly recognized and tackled to improve public health. Canada’s interest in health inequities goes back over 40 years, with the landmark 1974 Lalonde report, and continues with the 2011 Rio Political Declaration on Social Determinants of Health, which affirmed a global political commitment to implementing a social determinants of health approach to reducing health inequities. Research in this area includes documenting and tracking health inequalities, exploring their multidimensional causes, and developing and evaluating ways to address them. Inequalities can be observed in who is vulnerable to infectious and chronic diseases, the impact of health promotion and disease prevention efforts, how disease progresses, and the outcomes of treatment. Many programs, policies and projects with potential impacts on health equity and determinants of health have been implemented across Canada. Recent theoretical and methodological advances in the areas of implementation science and population health intervention research have strengthened our capacity to develop effective interventions.

With the launch of a new health equity series this month, the journals Canada Communicable Disease Report (CCDR) and Health Promotion and Chronic Disease Prevention in Canada: Research, Policy and Practice (HPCDP Journal) will continue to reflect and foster analysis of social determinants of health and focus on intervention studies that advance health equity.


Health Equity; Social Determinants of Health; Canada



12. Commentary

What can public health do to address inequities in infectious disease? 

Jackson B, Huston P 

CCDR: Volume 42S-1, Feb, 2016: Social Determinants of Health

Published online: 18 February 2016


Health inequities, or avoidable inequalities in health between groups of people, are increasingly recognized and tackled to improve public health. Canada’s interest in health inequities goes back over 40 years, with the landmark 1974 Lalonde report, and continues with the 2011 Rio Political Declaration on Social Determinants of Health, which affirmed a global political commitment to implementing a social determinants of health approach to reducing health inequities. Research in this area includes documenting and tracking health inequalities, exploring their multidimensional causes, and developing and evaluating ways to address them. Inequalities can be observed in who is vulnerable to infectious and chronic diseases, the impact of health promotion and disease prevention efforts, how disease progresses, and the outcomes of treatment. Many programs, policies and projects with potential impacts on health equity and determinants of health have been implemented across Canada. Recent theoretical and methodological advances in the areas of implementation science and population health intervention research have strengthened our capacity to develop effective interventions.

With the launch of a new health equity series this month, the journals Canada Communicable Disease Report (CCDR) and Health Promotion and Chronic Disease Prevention in Canada: Research, Policy and Practice (HPCDP Journal) will continue to reflect and foster analysis of social determinants of health and focus on intervention studies that advance health equity.


Health Equity; Social Determinants of Health; Canada



13. Planning, monitoring and evaluation: Framework for research capacity strengthening

Revision 2016

ESSENCE Good practice document series

Published online: 24 February 2016


The ESSENCE on Health Research collaboration has released their updated publication, Planning, Monitoring and Evaluation Framework for research capacity strengthening. The framework was used at the Research Impact Assessment workshop of the Southern African Research and Innovation Management Association 21 - 24 February in Cape Town, South Africa. ESSENCE, which is hosted at TDR, provides a mechanism for collaboration between funders – as well as between funders and recipient countries – with the aim of coordinating, harmonizing and aligning funding and research activities with countries’ health agendas.

The group has published a series of good practice documents to enhance both research capacity and the conditions for doing research in low- and middle-income countries. Changes in this framework document include the ESSENCE definition of research capacity strengthening and expansion of the principles of participation and alignment, local strengths and long-term commitment. It also added a new principle of ensuring equity.

In addition, a new section on practical considerations was created; the environment component was divided into 3 levels, and a matrix for research networks was added. Sources were updated to include more recent literature.


Research in Health; Research Capacity; International Agenda; 



14Scoping review: national monitoring frameworks for social determinants of health and health equity 

Leo Pedrana, Marina Pamponet, Ruth Walker, Federico Costa, Davide Rasella

Global Health Action 2016, vol 9: 28831.

Published online: 5 February 2016


Background: The strategic importance of monitoring social determinants of health (SDH) and health equity and inequity has been a central focus in global discussions around the 2011 Rio Political Declaration on SDH and the Millennium Development Goals. This study is part of the World Health Organization (WHO) equity-oriented analysis of linkages between health and other sectors (EQuAL) project, which aims to define a framework for monitoring SDH and health equity.

Objectives: This review provides a global summary and analysis of the domains and indicators that have been used in recent studies covering the SDH. These studies are considered here within the context of indicators proposed by the WHO EQuAL project. The objectives are as follows: to describe the range of international and national studies and the types of indicators most frequently used; report how they are used in causal explanation of the SDH; and identify key priorities and challenges reported in current research for national monitoring of the SDH.

Design: We conducted a scoping review of published SDH studies in the PubMed® database to obtain evidence of socio-economic indicators. We evaluated, selected, and extracted data from national scale studies published from 2004 to 2014. The research included papers published in English, Italian, French, Portuguese, and Spanish.

Results: The final sample consisted of 96 articles. SDH monitoring is well reported in the scientific literature independent of the economic level of the country and magnitude of deprivation in population groups. The research methods were mostly quantitative and many papers used multilevel and multivariable statistical analyses and indexes to measure health inequalities and SDH. In addition to the usual economic indicators, a high number of socio-economic indicators were used. The indicators covered a broad range of social dimensions, which were given consideration within and across different social groups. Many indicators included in the WHO EQuAL framework were not common in the studies in this review due to their intersectoral and interdisciplinary nature.

Conclusions: Our review illustrates that the attention to SDH monitoring has grown in terms of its importance and complexity within the scientific health literature. We identified a need to make indicators more wide-ranging in order to include a broader range of social conditions. The WHO EQuAL framework can provide intersectoral and interdisciplinary means of building a more comprehensive standardised approach to monitoring the SDH and improving equity in health.


Scoping Review; Social Determinants of Health; Health Inequity; Equity; Inequality; Indicators; Global Health



15Greece: assessing health-system capacity to manage sudden, large influxes of migrants (2015)


English (PDF, 714.5 KB)

2015, vii + 20 pages

ISBN 978 92 890 5117 0

After increasingly large numbers of migrants crossed the borders of Greece, the Greek Government invited the WHO Regional Office for Europe to organize a joint mission with Greek institutions to assess the health system's capacity to manage such influxes. The mission took place in December 2014 and had three aims: to assess the ongoing preparedness and response activities of the local health system, to plan ad hoc technical assistance if required, and to pilot-test the WHO toolkit for assessing health systems' capacity to manage large influxes of migrants in the acute phase. The members of the assessment team visited first reception centres and pre-departure facilities, and conducted interviews with all key stakeholders. From the assessment findings, the team made recommendations for, for example, improving living conditions in migrant centres, preparing a national multisectoral contingency plan, and developing a harmonized health data collection system and a stronger policy on immunizing migrants.



16. Children’s rights in primary health care series (2015)

This publication presents a Manual and Tools for the assessment and improvement of children's rights in primary health care (PHC) for five groups of stakeholders, namely PHC services' management, health professionals, parents and carers, children aged 6-11 and children and adolescents aged 12-18. The Manual contains a short methodological guide and the five tools, which may be used through focus group discussions or as a survey.



17. Making things happen 2014-2015. Implementing the European policy framework for health and well-being Health 2020 in the former Yugoslav Republic of Macedonia (2015)

English (PDF, 3.0 MB)

This publication provides an overview of the WHO activities and achievements in the former Yugoslav Republic of Macedonia in the period 2014–2015, focusing on the implementation at national level of Health 2020, the WHO European policy framework for health and well-being.



18. Practical steps in enhancing road safety: Lessons from the Road safety in 10 countries project in the Russian Federation (2015)

English (PDF, 1.2 MB)

Pусский (PDF, 2.7 MB)

This report describes an intersectoral road safety project implemented in two regions of the Russian Federation, Lipetsk and Ivanovo, between 2010 and 2014. 

Best practices identified from the global literature were used to target behaviour change in road users with regard to three main factors which influence outcomes in road traffic accidents – speed, wearing seat-belts and use of child restraints. The activities comprised social marketing, coupled with enhanced enforcement, and resulted in increases in the use of seat-belts and child restraints by 25–41 and 33–69 percentage points respectively and reduced speeding by 8–17 percentage points, as assessed by regular roadside measurements. Capacity-building workshops were held for traffic police and administrators and first aid training was provided for traffic police and at driving schools. The project structure, main achievements and lessons learned are discussed. 

The experience from this project, and in particular the social marketing, evaluation and training materials developed, would be valuable for road safety authorities, regional road safety managers and local authorities that would like to implement similar activities. Materials developed in the Russian language are available on the project website.



19. Moving global health forward in academic institutions

Didier Wernli, Marcel Tanner, Ilona Kickbusch, Gérard Escher, Fred Paccaud, Antoine Flahault

 J Glob Health. 2016 Jun; 6(1): 010409

 Published online: 20 February 2016


Global health has attracted growing attention from academic institutions. Its emergence corresponds to the increasing interdependence that characterizes our time and provides a new worldview to address health challenges globally. There is still a large potential to better delineate the limits of the field, drawing on a wide perspective across sciences and geographical areas. As an implementation and integration science, academic global health aims primarily to respond to societal needs through research, education, and practice. From five academic institutions closely engaged with international Geneva, we propose here a definition of global health based on six core principles:

1) cross–border/multilevel approach,

2) inter–/trans–disciplinarity,

3) systems thinking,

4) innovation,

5) sustainability, and

6) human rights/equity.

This definition aims to reduce the century–old divide between medicine and public health while extending our perspective to other highly relevant fields. Overall, this article provides an intellectual framework to improve health for all in our contemporary world with implications for academic institutions and science policy.


Global Health; Equity in Health; Research in Health; Human Rights; Universities.



20. Health literacy: applying current concepts to improve health services and reduce health inequalities

R.W. Batterham, M. Hawkins, P.A. Collins, R. Buchbinder, R.H. Osborne 

Public Health; Volume 132, March 2016, Pages 3-12

Published online: 9 February 2016


The concept of ‘health literacy’ refers to the personal and relational factors that affect a person's ability to acquire, understand and use information about health and health services. For many years, efforts in the development of the concept of health literacy exceeded the development of measurement tools and interventions. Furthermore, the discourse about and development of health literacy in public health and in clinical settings were often substantially different. This paper provides an update about recently developed approaches to measurement that assess health literacy strengths and limitations of individuals and of groups across multiple aspects of health literacy. This advancement in measurement now allows diagnostic and problem-solving approaches to developing responses to identified strengths and limitations. In this paper, we consider how such an approach can be applied across the diverse range of settings in which health literacy has been applied. In particular, we consider some approaches to applying health literacy in the daily practice of health-service providers in many settings, and how new insights and tools – including approaches based on an understanding of diversity of health literacy needs in a target community – can contribute to improvements in practice. Finally, we present a model that attempts to integrate the concept of health literacy with concepts that are often considered to overlap with it. With careful consideration of the distinctions between prevailing concepts, health literacy can be used to complement many fields from individual patient care to community-level development, and from improving compliance to empowering individuals and communities.


Health Literacy; Inequalities in Health; Community Participation; Health Systems.



21. Enhancing evidence informed policymaking in complex health systems: lessons from multi-site collaborative approaches

Etienne V. Langlois, Victor Becerril Montekio, Taryn Young, Kayla Song, Jacqueline Alcalde-Rabanal, Nhan Tran

Health Research Policy and Systems 14 (2016): 20

Published online: 17 March 2016


Background: There is an increasing interest worldwide to ensure evidence-informed health policymaking as a means to improve health systems performance. There is a need to engage policymakers in collaborative approaches to generate and use knowledge in real world settings. To address this gap, we implemented two interventions based on iterative exchanges between researchers and policymakers/implementers. This article aims to reflect on the implementation and impact of these multi-site evidence-to-policy approaches implemented in low-resource settings.

Methods: The first approach was implemented in Mexico and Nicaragua and focused on implementation research facilitated by communities of practice (CoP) among maternal health stakeholders. We conducted a process evaluation of the CoPs and assessed the professionals’ abilities to acquire, analyse, adapt and apply research. The second approach, called the Policy BUilding Demand for evidence in Decision making through Interaction and Enhancing Skills (Policy BUDDIES), was implemented in South Africa and Cameroon. The intervention put forth a ‘buddying’ process to enhance demand and use of systematic reviews by sub-national policymakers. The Policy BUDDIES initiative was assessed using a mixed-methods realist evaluation design.

Results: In Mexico, the implementation research supported by CoPs triggered monitoring by local health organizations of the quality of maternal healthcare programs. Health programme personnel involved in CoPs in Mexico and Nicaragua reported improved capacities to identify and use evidence in solving implementation problems. In South Africa, Policy BUDDIES informed a policy framework for medication adherence for chronic diseases, including both HIV and non-communicable diseases. Policymakers engaged in the buddying process reported an enhanced recognition of the value of research, and greater demand for policy-relevant knowledge.

Conclusions: The collaborative evidence-to-policy approaches underline the importance of iterations and continuity in the engagement of researchers and policymakers/programme managers, in order to account for swift evolutions in health policy planning and implementation. In developing and supporting evidence-to-policy interventions, due consideration should be given to fit-for-purpose approaches, as different needs in policymaking cycles require adapted processes and knowledge. Greater consideration should be provided to approaches embedding the use of research in real-world policymaking, better suited to the complex adaptive nature of health systems.


Capacity Strengthening; Complex Health System; Decision making, Embedded Research; Evidence-Informed Policy; Health Policy, Health Systems Research;

Low- and Middle-income Countries; Policymaking, Systematic Reviews, Use of Evidence.



22. Healthy Ageing: Raising Awareness of Inequalities, Determinants, and What Could Be Done to Improve Health Equity

Ritu Sadana, Erik Blas, Suman Budhwani, Theadora Koller, Guillermo Paraje 

Gerontologist, 2016, Vol. 56, No. S2, S178–S193

Published online: January 2016


Purpose of the Study: Social and scientific discourses on healthy ageing and on health equity are increasingly available, yet from a global perspective limited conceptual and analytical work connecting both has been published. This review was done to inform the WHO World Report on Ageing and Health and to inform and encourage further work addressing both healthy aging and equity.

Design and Methods: We conducted an extensive literature review on the overlap between both topics, privileging publications from 2005 onward, from low-, middle-, and high-income countries. We also reviewed evidence generated around the WHO Commission on Social Determinants of Health, applicable to ageing and health across the life course.

Results: Based on data from 194 countries, we highlight differences in older adults’ health and consider three issues: First, multilevel factors that contribute to differences in healthy ageing, across contexts; second, policies or potential entry points for action that could serve to reduce unfair differences (health inequities); and third, new research areas to address the cause of persistent inequities and gaps in evidence on what can be done to increase healthy ageing and health equity.

Implications: Each of these areas warrant in depth analysis and synthesis, whereas this article presents an overview for further consideration and action.


Healthy Life Expectancy; Life Course; Social Determinants of Health; Health Policy; Research Agenda; Equity in Health; Inequalitie