Ethics in practice: the state of the debate on promoting the social value of global health research in resource poor settings particularly Africa
Keywords
Health and health policyPublic Health
Ethics (Moral philosophy)
Ethics and communication in health care
social value
health research
Full record
Show full item recordOnline Access
http://www.biomedcentral.com/bmcmedethics/Abstract
<p>Background: Promoting the social value of global health research undertaken in resource poor settings has become a key concern in global research ethics. The consideration for benefit sharing, which concerns the elucidation of what if anything, is owed to participants, their communities and host nations that take part in such research, and the obligations of researchers involved, is one of the main strategies used for promoting social value of research. In the last decade however, there has been intense debate within academic bioethics literature seeking to define the benefits, the beneficiaries, and the scope of obligations for providing these benefits. Although this debate may be indicative of willingness at the international level to engage with the responsibilities of researchers involved in global health research, it remains unclear which forms of benefits or beneficiaries should be considered. International and local ethics guidelines are reviewed here to delineate the guidance they provide.</p><p>Methods: We reviewed documents selected from the international compilation of research ethics guidelines by the Office for Human Research Protections under the US Department of Health and Human Services.</p><p>Results: Access to interventions being researched, the provision of unavailable health care, capacity building for individuals and institutions, support to health care systems and access to medical and public health interventions proven effective, are the commonly recommended forms of benefits. The beneficiaries are volunteers, disease or illness affected communities and the population in general. Interestingly however, there is a divide between 'global opinion' and the views of particular countries within resource poor settings as made explicit by differences in emphasis regarding the potential benefits and the beneficiaries.</p><p>Conclusion: Although in theory benefit sharing is widely accepted as one of the means for promoting the social value of international collaborative health research, there is less agreement amongst major guidelines on the specific responsibilities of researchers over what is ethical in promoting the social value of research. Lack of consensus might have practical implications for efforts aimed at enhancing the social value of global health research undertaken in resource poor settings. Further developments in global research ethics require more reflection, paying attention to the practical realities of implementing the ethical principles in real world context.</p>© 2011 Lairumbi et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Date
2011-NovemberType
textIdentifier
oai:uuid:60d59344-f8e4-4266-a26b-78ab60a8cb08oai:uuid:60d59344-f8e4-4266-a26b-78ab60a8cb08
oai:doi: 10.1186/1472-6939-12-22
oai:issn: 1472-6939
oai:Oxford Research Archive internal ID: ora:5963
http://www.biomedcentral.com/bmcmedethics/
oai:ora:5963
oai:urn:uuid:60d59344-f8e4-4266-a26b-78ab60a8cb08
Copyright/License
http://creativecommons.org/licenses/by/2.0Related items
Showing items related by title, author, creator and subject.
-
Good Practices in Health Financing : Lessons from Reforms in Low and Middle-Income CountriesWaters, Hugh R.; Schieber, George J.; Gottret, Pablo (Washington, DC : World Bank, 2012-05-25)This volume focuses on nine countries that have completed, or are well along in the process of carrying out, major health financing reforms. These countries have significantly expanded their people's health care coverage or maintained such coverage after prolonged political or economic shocks. In doing so, this report seeks to expand the evidence base on good performance in health financing reforms in low- and middle-income countries. The countries chosen for the study were Chile, Colombia, Costa Rica, Estonia, the Kyrgyz Republic, Sri Lanka, Thailand, Tunisia, and Vietnam. With health at the center of global development policy on humanitarian as well as economic and health security grounds, the international community and developing countries are closely focused on scaling up health systems to meet the Millennium Development Goals (MDGs), improving financial protection, and ensuring long-term financing to sustain these gains. With the scaling up of aid, both donors and countries have come to realize that money alone cannot buy health gains or prevent impoverishment due to catastrophic medical bills. This realization has sent policy makers looking for reliable evidence about what works and what does not, but they have found little to guide their search.
-
Better Outcomes through Health Reforms in the Russian Federation : The Challenge in 2008 and BeyondMarquez, Patricio V. (World Bank, Washington, DC, 2008-02)The purpose of this discussion paper is
 to discuss selected health challenges in the Russian
 Federation, focusing on outcomes, expenditures and options
 for policy and institutional reforms in the health care
 system. The areas covered in the paper draw on recent
 studies and reports, and take into account lessons derived
 from the implementation of the World Bank-funded Health
 Reform Implementation Project (HRIP) at the federal level
 and in the Chuvash Republic and the Voronezh Oblast-the
 pilot regions of the project, over the 2005-2007 period.
-
Who pays? Out-of-Pocket Health Spending and Equity Implications in the Middle East and North AfricaElgazzar, Heba; Arfa, Chokri; Salti, Nisreen; Majbouri, Mehdi; Salehi-Isfahani, Djavad; Raad, Firas; Chaaban, Jad; Fesharaki, Sanaz; Mataria, Awad (World Bank, Washington, DC, 2013-05-29)Ensuring affordable, effective health care and financial protection against the adverse effects of household out-of-pocket (OOP) health expenditures represents an important policy objective in most countries, yet relatively little evidence exists regarding patterns and implications of household health expenditures in the Middle East and North Africa (MENA) region. This paper examines the scope of out-of-pocket expenditures and their implications on living standards and policy reforms in six MENA countries including Yemen, the West Bank and Gaza, Egypt, Iran, Tunisia, and Lebanon. Results show that OOP payments represent a relatively high share of total national health care financing at 49 percent on average in the MENA region as of 2006. Households pay an average of 6 percent of their total household expenditure on health. Most of this OOP is spent on medications, doctor visits and diagnostic services. Lower-income and rural households generally face greater financial risk; yet this is reversed where private health services are utilized and paid for more frequently by higher-income groups. 7 to 13 percent of households face particularly high OOP payments, or catastrophic expenditures equal to at least 10 percent of household spending. Poverty rates tend to increase by up to 20 percent after health care spending is accounted for. Results are discussed in light of ongoing policy efforts to strengthen social protection for health care.