This blog relates to the Evidence Synthesis Research Award report and summary across health related research, from 122 research grants awarded by the Economic and Social Research Council (ESRC) and UK Department for International Development (DFID) Joint Fund for Poverty Alleviation Research since 2005. The ESRA report was written by Sridhar Venkatapuram, King's College London, Adam Coutts, University of Cambridge and Pooja Mall, consultant. The research has deepened understanding in how non health services focused projects--such as those on social protection and education--also have potential links and relevance for health. The evidence reviewed, therefore, also provides a guide for non-health sector policy makers and practitioners.
What does a decade of social sciences research tell us about health?
The Sustainable Development Goals call for an end to the injustices that underpin poor health and development outcomes. Goal three in particular focuses on health: Ensure healthy lives and promote well-being for all at all ages. It aims to end the epidemics of AIDS, tuberculosis, malaria and other communicable diseases by 2030, and to achieve universal health coverage, and provide access to safe and effective medicines and vaccines for all.
New evidence from ten years of ESRC-DFID funded research studies can inform future policies and programmes to help meet SDG3.
Health is fundamental to poverty alleviation and successful international development.
"The biggest enemy of health in the developing world is poverty." as Kofi. Annan once said when addressing the 2001 World Health Assembly in his role as UN Secretary-General.
This idea is echoed in the report, ‘Review and Synthesis - Ten Years of Research Evidence in Health and Development’ which recommends that any poverty alleviation effort should to some extent, acknowledge the inputs and outputs of health in their activities.
This report focuses on the significant knowledge about health and health services in low to middle income countries (LMICs) that has been generated by the social science research funded by the ESRC-DFID Joint Fund for Poverty Alleviation Research between 2005 and 2015. It is based on a review of 121 research projects funded by the scheme, 69 of which were identified as health related.
Pathways between poverty and health
The report looks at how projects have produced evidence and knowledge about factors directly and indirectly linked to health. Direct impacts refer to study findings which examine classic health and development topics such as maternal and child health, hygiene and sanitation, nutrition and access to essential health care services. Indirect impacts refer to research that addresses distal factors such as social protection, education, and the political economy.
Direct Impacts
Health systems and services are viewed as directly linked to health with inadequate access to health services leading to preventable mortality, morbidity and inequalities in health status. The research studies referred to in this report have focused on interventions not only reducing economic, geographic, social barriers to accessing health services, but also those enabling local community participation in the delivery of Primary Health Care services, as well as those providing incentives to improve service performance, and strengthening governance for health. All conclude that interventions enabling people’s access to health services in LMICs are key.
For instance, the research of Theobold and Porter et al finds that access presents a major obstacle to health service use for children. In their study of children’s access to health care in Ghana they find that travel costs are the main barrier to children accessing healthcare. Health service access is also limited by treatment cost and the perception that providers will provide poor quality care but, like school attendance, geographical proximity and physical access are key determinants of the health care usage.
Indirect Impacts
In terms of indirect health links, the report examined studies which have generated evidence that may be used to explain the links between poverty and health.
The research has deepened understanding in how non health services focused projects also have potential links and relevance for health. The review shows that two main pathways or mechanisms are common amongst studies namely via social protection policies and interventions and education which can used to help examine the relationship between poverty and health.
Social protection and conditional cash transfer (CCT) interventions can effectively improve health at individual and community level. A study in South Africa by May and Timaeus (2014) analysed the progress made in the under-five nutritional status. Results indicate that since 1993 there has been an increase in the heights and weights of children under the age of five. The improvement in nutritional well-being may have been as a result of the Child Support Grant, improvements in health care, better access to clean water and sanitation and the education of women.
The research has made a significant contribution to global health discussions, the evidence base on poverty alleviation, health and development broadly. Evidence has been generated across a range of areas such as health services, poverty and health, and on the links between non- healthcare policies and health. Given that health is fundamental to poverty alleviation, a key takeaway from this report is that health related information should be captured in future research projects irrespective of their primary focus.
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The reports
The reports are licensed under a Creative Commons Attribution-NonCommercial Licence (CC BY-NC 3.0).
Health and Development Evidence Synthesis Research Award
Venkatapuram., S., King's College London, Coutts, A., University of Cambridge, and Mall, P., 2016
A review of all the funded projects was undertaken as evidence related to health requires looking for both proximate (such as access to clean water and medical services) as well as distal pathways (such as education and social protection systems), beyond just clinical or public health interventions. 69 of 121 (57%) funded research studies examined or produced evidence which have a direct or indirect relevance and impact on health/health services.
PDF 1.2 Mb
Ten Years of Research Evidence in Health and Development
Venkatapuram., S., King's College London, Coutts, A., University of Cambridge, and Mall, P., 2016
Summary of the review and synthesis
PDF 317Kb
Follow the link to the ESRA introduction and overview including further ESRA -- Research Methods, Children and Young People, and the role of Gender in Poverty -- and the ESRC and DFD response.
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