Global investment in biomedical research has grown significantly over the last decades, reaching approximately a quarter of a trillion US dollars in 2010. However, not all of this investment is distributed evenly by gender. It follows, arguably, that scarce research resources may not be optimally invested (by either not supporting the best science or by failing to investigate topics that benefit women and men equitably). Women across the world tend to be significantly underrepresented in research both as researchers and research participants, receive less research funding, and appear less frequently than men as authors on research publications. There is also some evidence that women are relatively disadvantaged as the beneficiaries of research, in terms of its health, societal and economic impacts. Historical gender biases may have created a path dependency that means that the research system and the impacts of research are biased towards male researchers and male beneficiaries, making it inherently difficult (though not impossible) to eliminate gender bias. In this commentary, we – a group of scholars and practitioners from Africa, America, Asia and Europe – argue that gender-sensitive research impact assessment could become a force for good in moving science policy and practice towards gender equity. Research impact assessment is the multidisciplinary field of scientific inquiry that examines the research process to maximise scientific, societal and economic returns on investment in research. It encompasses many theoretical and methodological approaches that can be used to investigate gender bias and recommend actions for change to maximise research impact. We offer a set of recommendations to research funders, research institutions and research evaluators who conduct impact assessment on how to include and strengthen analysis of gender equity in research impact assessment and issue a global call for action.

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Background: Iron and Folic Acid are two of the micronutrients recommended for pregnant women to support optimal maternal outcomes with regard to preventing anaemia and foetal birth defects. It is difficult to establish if women provided with iron and folic acid supplementation in Zambia benefit from it and how well it is implemented. The overall objective of this study was to determine the levels of uptake and compliance to iron and folic acid in pregnancy among women of child-bearing age in Zambia, with a focus on both supply and demand factors. Methods: A cross sectional, mixed method study was done. Data was collected in August and September 2015 from six of the 14 districts in which Scaling Up Nutrition interventions were being undertaken as well as Lusaka district. A household survey covering 402 males and females of child-bearing age, 27 key informant interviews amongst key stakeholders and 12 focus group discussions at community level were conducted. Results: Antenatal clinic attendance was almost universal (98.7%); the majority of both men (92.1%) and women (97.4%) had heard messages about iron and folic acid supplementation; the majority (96.5%) of women reported having taken iron and folic acid tablets during their last pregnancy, with 61.3% starting in the second trimester, 27.2% during the first trimester, and 7.7% in their third trimester. Eighty-five per cent (80.5%) of the women reported that they had taken all the tablets they were given with about 13.4% not taking all the tablets received. Conclusions: Root cause analysis, using both qualitative and quantitative findings, showed that the main challenges faced were long distances to health facilities and high transport costs; some women not being reached with supplementation messaging; lack of formalised and uniform training around delivery of antenatal messages across health care workers; women not attending antenatal monthly to replenish supplements; and forgetfulness to take the drugs daily. While male involvement may be a supportive factor, it sometimes hinders women from accessing antenatal services. Results showed that both uptake and compliance to iron and folic acid supplementation in pregnancy in Zambia were sub-optimal.

IntroductionZambia is facing a chronic shortage of health care workers. The paper aimed at understanding how the Medical Education Partnership Initiative (MEPI) program facilitated strengthening and expanding of the national capacity and quality of medical education as well as processes for retaining faculty in Zambia.MethodsData generated through documentary review, key informant interviews and observations were analyzed using a thematic approach.ResultsThe MEPI program triggered the development of new postgraduate programs thereby increasing student enrollment. This was achieved by leveraging of existing and new partnerships with other universities and differentiating the old Master in Public Health into specialized curriculum. Furthermore, the MEPI program improved the capacity and quality of training by facilitating installation and integration of new technology such as the eGranary digital library, E-learning methods and clinical skills laboratory into the Schools. This technology enabled easy access to relevant data or information, quicker turn around of experiments and enhanced data recording, display and analysis features for experiments. The program also facilitated transforming of the academic environment into a more conducive work place through strengthening the Staff Development program and support towards research activities. These activities stimulated work motivation and interest in research by faculty. Meanwhile, these processes were inhibited by the inability to upload all courses on to Moodle as well as inadequate operating procedures and feedback mechanisms for the Moodle.ConclusionExpansion and improvement in training processes for health care workers requires targeted investment within medical institutions and strengthening local and international partnerships.

Vaccination, like most other public health services, relies on a complex package of intervention components, functioning systems and committed actors to achieve universal coverage. Despite significant investment in immunization programmes, national coverage trends have slowed and equity gaps have grown. This paper describes the design and implementation of the Gavi Full Country Evaluations, a multi-country, prospective, mixed-methods approach whose goal was to monitor and evaluate processes, inputs, outputs and outcomes of immunization programmes in Bangladesh, Mozambique, Uganda and Zambia. We implemented the Full Country Evaluations from 2013 to 2018 with the goal of identifying the drivers of immunization programme improvement to support programme implementation and increase equitable immunization coverage. The framework supported methodological and paradigmatic flexibility to respond to a broad range of evaluation and implementation research questions at global, national and cross-country levels, but was primarily underpinned by a focus on evaluating processes and identifying the root causes of implementation breakdowns. Process evaluation was driven by theories of change for each Gavi funding stream (e.g. Health Systems Strengthening) or activity, ranging from global policy development to district-level programme implementation. Mixing of methods increased in relevance and rigour over time as we learned to build multiple methods into increasingly tailored evaluation questions. Evaluation teams in country-based research institutes increasingly strengthened their level of embeddedness with immunization programmes as the emphasis shifted over time to focus more heavily on the use of findings for programme learning and adaptation. Based on our experiences implementing this approach, we recommend it for the evaluation of other complex interventions, health programmes or development assistance.