Africa's neglected area of human resources for health research - the way forward.

Building the skills for doing, managing and delivering health research is essential for every country's development. Yet, human resources for health research (HRHR) are seldom considered in Africa and elsewhere. Africa's health research capacity has grown considerably, with potential to increase this growth. However, a systemic way of defining, co-ordinating and growing the HRHR needed to support health systems development is missing. Reviewing the status of HRHR in Africa, we assert that it consists of uncoordinated, small-scale activities, primarily driven from outside Africa. We present examples of ongoing HRHR capacity building initiatives in Africa. There is no overarching framework, strategy or body for African countries to optimise research support and capacity in HRHR. A simple model is presented to help countries plan and strategise for a comprehensive approach to research capacity strengthening. Everyone engaged with global, regional and national research for health enterprises must proactively address human resource planning for health research in Africa. Unless this is made explicit in global and national agendas, Africa will remain only an interested spectator in the decisions, prioritisation, funding allocations, conduct and interpretation, and in the institutional, economic and social benefits of health research, rather than owning and driving its own health research agendas.

[Financing of drug addiction programs in Mexico City: 1990-1994]. / Financiamiento de programas de farmacodependencia en la ciudad de México: 1990-1994.

OBJECTIVE: To analyze the financial flows in the drug dependency programs in México City, their financial source, and the way how funding monies are spent. MATERIAL AND METHODS: A discrete number of institutions devoted to drug dependency control in Mexico City was selected. Analysis of financial flows was carried out using the National Health Accounts methods. Questionnaires to quantify resources were applied to health service managers and users. In addition to collection of financial flow data, we calculated the expenditures per user for each institution. For the period 1990-1993, expenditures were estimated from financial budgets allocated to each program in 1990, at constant values to eliminate the effects of inflation. RESULTS: Financial sources identified were: the federal budget allocation (50-90%), user fees (10-20%), and non-governmental organization contributions (15-80%). CONCLUSIONS: Even though budgets in participant institutions have increased in the last four years, they are still inadequate to cover the large demand of services. It is important to identify new ways to increase the availability of resources as well as to ensure their efficient use. Continuing financial analysis of these programs will allow the assessment of changes to guide optimal financial decision making.

Predictors of death from pulmonary tuberculosis: the case of Veracruz, Mexico.

OBJECTIVES: To identify factors (particularly social, economic and cultural), associated with the risk of death from pulmonary tuberculosis in Mexico. METHODS: A case-control study of patients receiving medical attention from the official health services of Veracruz, Mexico. Cases were deaths from pulmonary tuberculosis in 1993. Controls were survivors randomly selected from the State Tuberculosis Case Registry. Next of kin provided information for both cases and controls. RESULTS: Multivariate analysis of 161 cases and 161 controls showed an increased risk of dying for those patients who withdrew from treatment (odds ratio [OR] = 3.52), who were refused medical attention during some period of time in any health center (OR = 4.45), and who had a concomitant disease at the time of diagnosis (OR = 2.62). A linear trend with age was observed (OR = 1.02 per year), as well as a lower risk for those patients who were compliant with treatment and optimistic about surviving the disease (OR = 0.17). The risk of death was not associated with the presence of a health care unit in the town, time spent to get to the health center, or the residence of a patient in an urban area. CONCLUSIONS: These findings indicate that deaths due to tuberculosis in this area are not related to the geographical distribution of health services but to delays in treatment after the onset of disease and to the low adherence of patients to the treatment regimen.

[Sociodemographic characteristics of people who died from pulmonary tuberculosis in Veracruz, Mexico, 1993]. / Características sociodemográficas de personas que murieron por tuberculosis pulmonar en Veracruz, México, 1993.

OBJECTIVE: We describe the socio-demographic and medical care characteristics of people who died of pulmonary tuberculosis in 1993 in the state of Veracruz, Mexico. MATERIAL AND METHODS: Once selected, through death certificate, an interview and verbal autopsy was applied to the closest available relative. RESULTS: A total of 300 interviews were carried out. Half of the deaths were diagnosed with tuberculosis the same year they died. Approximately half of the deceased withdrew from treatment and 40% reported abuse of alcohol consumption. Patients who died of pulmonary tuberculosis belonged to the most vulnerable social groups. 35% were illiterate or had no education, and 67% lacked a regular job. There were no differences found between those who used private medical services and those who used official or public services. CONCLUSIONS: Important findings include the high proportion of patients diagnosed in advanced stages of the disease, alcoholism, adverse reactions to drugs as a cause of withdrawal from treatment, and other current diseases at the time of tuberculosis diagnosis.