 Filling a gap in the area of health systems research HEARD's Health Systems project provides valuable insights through co-ordinated research in three countries: South Africa, Tanzania and Zambia. Conference on Urban Health: Urgent Action Needed The first of its kind to be held in Africa the 8th International Conference on Urban Health (ICUH) took place on 18 - 23 October in Nairobi, Kenya. Assessing the Benefits of Community Based Rehabilitation A study conducted in 2008 explored some of the implications of a NGO initiated Community Based Rehabilitation (CBR) programme.   | Newsletter Issue 2 December 2009 What Constitutes Evidence?
Prof. Tim Quinlan - HEARD's Research Director The government's recent exhortations to tackle HIV/AIDS sound good but there isn't much substance behind them. The new strategy of the Department of Health calls for decisive action. The global dictum for an 'emergency response' has been around for more than 20 years; nonetheless, belated in South Africa is better than never. The 2007-2011 National Strategic Plan is big on proclaiming the need to reach 80% of this or 90% of that; but there aren't any absolute numbers behind the percentages because no one actually knows what they are. There is a dearth of sound national statistics on patterns and trends in the spread of the epidemic, on which to establish a baseline and to measure progress of interventions; for example, on HIV incidence and numbers of people adhering to treatment, let alone on treatment. Instead, statisticians battle gamely on to make sense of ante-natal and other clinic data which all scientists know to be riddled with error. This is the year in which we should be hearing about steps to draft the next plan, an 'NSP 2012-2016', on the basis of achievements to date and analysis of changes in patterns and trends of the epidemic. Instead there is a WHO informed 'strategy', a step back from a plan and admission that there aren't many achievements on which to base a plan. Déjà vu: there wasn't any evidence to take from the NSP of 2000-2005 and so, not surprisingly, the current NSP's focus on percentages rather than numbers (as well as it being written more than a year after the previous one had expired). There is, however, a deeper malaise. SA does not have a national mechanism to monitor progress and to refine national strategies and 'plans' over time, in part because the government is still transfixed to the ideal of basing interventions on quantitative research. That is 'evidence' in the minds of government and the scientists that influence governments. The lack of such evidence has been an excuse for inaction and a mental block against action planning. Notably, the government has been averse to synthesising and using the wealth of qualitative research on many features of the epidemic, including interventions, and analyses which use quantitative data where possible. Witness the travails of the South African National AIDS Council to change mindsets within the government. Qualitative research identifies the problems arising from the epidemic, the challenges for mobilising resources to intervene, and more; it is usually conducted in ways that relate interpretations of data to context and analysis usually suggests coherent ways to use the information in planning interventions. It has been the basis for the pockets of action planning and achievement in SA to date. I refer to the endeavours of civil society organisations, programmes in the private sector and also the spirited interventions of some health managers in rural areas that occasionally get revealed in the press. These agencies have had no qualms against acting on the basis of whatever information is available, refining plans and interventions as more information becomes available and, most importantly, exploring different opportunities suggested by analysis of data and experience. This is an outlook which favours 'evidence-informed' rather than 'evidence-based' interventions.
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