BACKGROUND: Increasing chronic diseases challenges the health systems of low- and middle-income countries, including Cameroon. Type 1 diabetes (T1D), among the most common chronic diseases in children, poses particular care delivery challenges AIM: We examined social representations of patients' roles and implementation of T1D care among political decision-makers, healthcare providers and patients within families. SETTING: The study was conducted in Yaoundé, Cameroon. METHODS: Eighty-two individuals were included in the study. The authors conducted semi-structured interviews with policy makers (n = 5), healthcare professionals (n = 7) and patients 'parents (n = 20). Questionnaires were administered to paediatric patients with T1D (n = 50). The authors also observed care delivery at a referral hospital and at a T1D-focused non-governmental organisation over 15 days. Data were analysed using thematic content analysis and descriptive statistics. RESULTS: Cameroonian health policy portrays patients with T1D as passive recipients of care. While many practitioners recognised the complex social and economic determinants of adherence to T1D care, in practice interactions focused on specific biomedical issues and offered brief guidance. Cultural barriers and policy implementation challenges prevent patients and their families from being fully active participants in care. Parents and children prefer an ongoing relationship with a single clinician and interactions with other patients and families. CONCLUSION: Patients and families mobilise experience and lay knowledge to complement biomedical knowledge, but top-down policy and clinical practice limit their active engagement in T1D care. CONTRIBUTION: Children with T1D and their families, policy makers, healthcare professionals, and civil society have new opportunities to contribute to person-centred care, as advocated by the Sustainable Development Goals.

This article examines the perspectives of governmental and nongovernmental stakeholders in South Africa on the dynamics of human trafficking in South Africa, and on efforts to protect the human rights of rescued victims of human trafficking prior to the promulgation of human trafficking legislation in the country. The authors seek to understand the range of views and approaches of stakeholders to trafficking, including possible links to HIV, as human trafficking is commonly discussed in the media, but empirical research on the scale, dynamics, and impacts of trafficking in South Africa is scarce. This exploratory situation analysis involves desk review and 24 key informant interviews, using purposive and sequential referral sampling. Respondents included government departments and non-governmental organisations working at a border-crossing site (Musina), and two major destination sites for irregular migrants, including trafficked people (Johannesburg and Cape Town). Almost all respondents reported that human trafficking is significant and complex, and that both cross-border and internal movement of trafficked victims violate victims' rights in several ways. While they suffer at the hands of organised crime syndicates, their rights are further violated even after rescue, prior to the recently-promulgated human trafficking legislation in the country. Victims' access to justice is also either delayed or denied in many cases due to the inability to prosecute the perpetrators. The study concludes that, despite the recent giant step in the right direction in promulgating human trafficking legislation in South Africa, there is a need for further efforts by the South African government to take additional proactive and practical measures for optimum effectiveness of the law without which the goal of the Act may remain a tall dream.

The Pan American Health Organization (PAHO) and International Development Research Centre (IDRC) have promoted a joint initiative to design, implement, and evaluate innovative strategies for the Extension of Social Protection in Health (SPH) in Latin America and the Caribbean (LAC), involving active partnership between researchers and research users. This initiative was based on a previous review of research on health sector reforms and the recommendations of the workshop on "Health Sector Reforms in the Americas: Strengthening the Links between Research and Policy" (Montreal, Canada, 2001). In its first phase, the initiative supported the development of proposals aiming to extend SPH, elaborated jointly by researchers and decision-makers. In the second phase, the implementation of five of these proposals was supported in order to promote the development of new SPH strategies and new stakeholder interaction models. In this edition of the journal, the process of linking researchers and decision-makers will be analyzed in the context of the five projects supported by this initiative.

La Organización Panamericana de la Salud (OPS) y el Centro Internacional de Investigaciones para el Desarrollo de Canadá (IDRC) han promovido una iniciativa conjunta para el diseño, ejecución y evaluación de estrategias de extensión de la protección social en salud en América Latina y el Caribe. Esta propuesta se basó en una revisión previa de la investigación sobre reformas del sector salud y en las recomendaciones del Taller La Reforma del Sector Salud en las Américas: Fortaleciendo los Vínculos entre Investigación y Políticas (Montreal, Canadá, 2001). En su primera fase la iniciativa impulsó el desarrollo de propuestas sobre extensión de la protección social en salud que fueron elaboradas en forma conjunta por investigadores y tomadores de decisión. En la segunda fase se apoyó la implementación de cinco de estas propuestas con el propósito de promover el desarrollo de nuevas estrategias de protección social en salud y fomentar nuevos modelos de interacción entre actores. En este número de la revista se analizan los procesos de vinculación entre investigadores y tomadores de decisión en los cinco proyectos apoyados por esta iniciativa.

The Pan American Health Organization (PAHO) and International Development Research Centre (IDRC) have promoted a joint initiative to design, implement, and evaluate innovative strategies for the Extension of Social Protection in Health (SPH) in Latin America and the Caribbean (LAC), involving active partnership between researchers and research users. This initiative was based on a previous review of research on health sector reforms and the recommendations of the workshop on "Health Sector Reforms in the Americas: Strengthening the Links between Research and Policy" (Montreal, Canada, 2001). In its first phase, the initiative supported the development of proposals aiming to extend SPH, elaborated jointly by researchers and decision-makers. In the second phase, the implementation of five of these proposals was supported in order to promote the development of new SPH strategies and new stakeholder interaction models. In this edition of the journal, the process of linking researchers and decision-makers will be analyzed in the context of the five projects supported by this initiative.

La Organización Panamericana de la Salud (OPS) y el Centro Internacional de Investigaciones para el Desarrollo de Canadá (IDRC) han promovido una iniciativa conjunta para el diseño, ejecución y evaluación de estrategias de extensión de la protección social en salud en América Latina y el Caribe. Esta propuesta se basó en una revisión previa de la investigación sobre reformas del sector salud y en las recomendaciones del Taller La Reforma del Sector Salud en las Américas: Fortaleciendo los Vínculos entre Investigación y Políticas (Montreal, Canadá, 2001). En su primera fase la iniciativa impulsó el desarrollo de propuestas sobre extensión de la protección social en salud que fueron elaboradas en forma conjunta por investigadores y tomadores de decisión. En la segunda fase se apoyó la implementación de cinco de estas propuestas con el propósito de promover el desarrollo de nuevas estrategias de protección social en salud y fomentar nuevos modelos de interacción entre actores. En este número de la revista se analizan los procesos de vinculación entre investigadores y tomadores de decisión en los cinco proyectos apoyados por esta iniciativa.

Special studies and isolated initiatives over the past several decades in low-, middle- and high-income countries have consistently shown inequalities in health among socioeconomic groups and by gender, race or ethnicity, geographical area and other measures associated with social advantage. Significant health inequalities linked to social (dis)advantage rather than to inherent biological differences are generally considered unfair or inequitable. Such health inequities are the main object of health development efforts, including global targets such as the Millennium Development Goals, which require monitoring to evaluate progress. However, most national health information systems (HIS) lack key information needed to assess and address health inequities, namely, reliable, longitudinal and representative data linking measures of health with measures of social status or advantage at the individual or small-area level. Without empirical documentation and monitoring of such inequities, as well as country-level capacity to use this information for effective planning and monitoring of progress in response to interventions, movement towards equity is unlikely to occur. This paper reviews core information requirements and potential databases and proposes short-term and longer term strategies for strengthening the capabilities of HIS for the analysis of health equity and discusses HIS-related entry points for supporting a culture of equity-oriented decision-making and policy development.

Estudios especiales e iniciativas aisladas llevadas a cabo durante los últimos decenios en países de ingresos bajos, medios y altos han mostrado sistemáticamente desigualdades en salud entre grupos socioeconómicos, así como por género, raza o grupoétnico, zona geográfica y otros indicadores de ventajas sociales. Las desigualdades en salud significativas ligadas a (des)ventajas sociales en lugar de a diferencias biológicas se consideran en general injustas o inequitativas. Esas desigualdades son el principal objeto de las iniciativas de desarrollo sanitario, incluidas metas mundiales tales como los Objetivos de Desarrollo del Milenio, que requieren actividades de vigilancia para evaluar los progresos. Sin embargo, la mayor parte de los sistemas de información sanitaria (SIS) nacionales carecen de la información básica requerida para evaluar y corregir las inequidades en salud, esto es, de datos longitudinales fiables y representativos que relacionen indicadores de salud con indicadores del estatus o las ventajas sociales a nivel individual o en zonas reducidas. Sin documentación empírica y sin actividades de monitoreo de esas inequidades, y si los países carecen de capacidad para usar esa información para planificar y vigilar eficazmente los progresos en respuesta a las intervenciones, es improbable que se logre avanzar hacia la equidad. En este artículo se consideran los requisitos de información básica y las posibles bases de datos, se proponen estrategias a corto y largo plazo que pueden fortalecer la capacidad de los SIS para analizar la equidad sanitaria y se examinan los puntos de acceso relacionados con los SIS en apoyo de una cultura de adopción de decisiones y desarrollo de políticas orientada a la equidad.

Des études spécifiques et des initiatives isolées, menées au cours des dernières décennies dans des pays ayant des niveaux de revenus très divers, ont régulièrement mis en évidence des inégalités face à la santé entre les groupes socioéconomiques d'une part et en fonction du sexe, de la race et de l'origine ethnique ou géographique, ou autre paramètre associé à des avantages sociaux encore, d'autre part. Les inégalités importantes en matière de santé liées à des avantages ou des désavantages sur le plan social plutôt qu'à des différences biologiques propres aux individus sont généralement considérées comme injustes ou inéquitables. Ces injustices touchant à la santé sont la principale cible des efforts de développement sanitaire, parmi lesquels les Objectifs de développement pour le Millénaire, qui exigent un suivi pour évaluer les progrès accomplis. Cependant, il manque à la plupart des systèmes d'information sanitaire (SIS) les informations clés permettant d'évaluer et de combattre les injustices en matière de santé, à savoir des données fiables, longitudinales et représentatives, reliant les mesures de l'état de santé aux mesures du statut ou des avantages sociaux au niveau individuel ou à petite échelle. En l'absence de documentation factuelle et de surveillance de ces injustices, ainsi que de moyens à l'échelon national pour exploiter ces informations en vue d'une planification efficace et d'un suivi des progrès résultant des interventions, il est peu probable qu'une évolution plus favorable à l'équité s'opère. Le présent article examine les besoins essentiels en matière d'information et les bases de données susceptibles d'être utilisées. Il propose des stratégies à court et long termes pour renforcer la capacité des SIS à analyser les questions d'équité face à la santé et évoque les points d'entrée liés aux SIS qui permettraient d'appuyer l'intégration d'une culture de recherche de l'équité dans la prise de décisions et le développement de politiques.