It is some 13 years since the ripples of the Joanna Briggs Institute (JBI pebble) first reached the southern east coast of Africa. The first African collaborating center was established at the University of KwaZulu-Natal and was known as the South African Centre for Evidence-based Nursing and Midwifery. In 2007, with the support of the WHO, JBI conducted a comprehensive systematic review training workshop in Cape Town. This resulted in the ripples moving inland and spreading as far north as Ethiopia. Currently there are five collaborating centers and two evidence-synthesis groups in Africa making up the Central Region of JBI.
While the African JBI centers share many similar problems, there are also many differences. Some of the centers are located within universities whilst others are located in health services. The centers receive varying degrees of support from the host institutions. The great distances between the centers - some 4080 kms between Jimma University in Ethiopia and Johannesburg in the south - make regional face-to-face meetings difficult.
The disease profile across Africa has been greatly influenced by the HIV/AIDS epidemic, which can be argued has placed a huge burden on its health systems. There is no doubt that the burden of health across African countries is influenced by HIV/AIDS, as well as tuberculosis and malaria. Furthermore, diagnoses of diabetes and hypertension are rapidly increasing as populations adopt a more Westernized lifestyle and diet. In many areas, the high maternal and neonatal mortality rates contribute to the burden of health care systems.
Country needs
Cameroon experiences several public health challenges and limited human and financial resources. Evidence is not synthesized and consequently decision-makers have little reliable information on which to base policy. The positive news from Cameroon is the development of a Cochrane Centre and dialogue with the JBI center have begun. These two entities have resolved to work together to generate government interest in evidence synthesis and ultimately to influence policy. There is also a desire to encourage institutions of higher learning to consider offering studies related to evidence synthesis.
Kenya is currently undergoing a transition to a devolved system of government that encompasses health care. This devolution has not been easy. Problems related to service delivery, healthcare worker strikes and medication shortages have been experienced. Recent improvements in transport and road infrastructure have resulted in a greater incidence of trauma due to motor vehicle accidents, especially among the younger age groups.
Ghana has seen an improvement in its health indicators over the last decades, with significant reductions in infant and child mortality rates. Despite this, neonatal and perinatal mortality rates remain high and while the maternal mortality rate has seen significant reductions, the Millennium Development Goal (MDG) 51 target has not been reached yet. Ghana's current focus in health care is on the adolescent. Both national and international organizations are developing programs around adolescent sexual and general wellbeing.
Ethiopia's health needs include both communicable and non-communicable diseases, and issues related to nutrition. Other aspects which the university has identified as being in need of attention are health system and policy development. The Ethiopian JBI center has made strides in extending the JBI ripple to Nigeria and Uganda through conducting systematic review workshops in these two countries. Within Jimma University, courses have been established in knowledge synthesis and transfer.
The South African health care system has undergone many positive changes since 1994, but with the advent of health care being available to all came the huge impact of increasing HIV/AIDS numbers, the political decision of the Mbeki era not to provide anti-retroviral drugs as part of care and the concurrent impact that the disease has on those already infected with tuberculosis (TB). Poor adherence and failure to complete TB treatment have resulted in XDR tuberculosis. There is always much enthusiasm for systematic review training, but sadly, to date, this has not impacted on policy development. South Africa, together with Botswana, is not considered a 'developing country' and therefore is not eligible for a number of funding schemes available to other African countries.
The effects of the ripple in Africa
While the above may paint a gloomy picture of health in Africa, there are positive effects from the JBI ripple. The contribution of the ripple to education and capacity building in Africa about evidence-based practice cannot be underestimated. It has highlighted for policy makers the need for policies to be made based on sound, empirical data. The JBI ripple has brought professionals from several countries together, promoting the sharing of ideas and experiences that would otherwise not have happened. The group of JBI centers from Africa has in turn had the opportunity to collaborate and communicate with others from other continents, with friendships and partnerships formed, ideas generated and contributions made to discussions on several levels.
We take this opportunity to congratulate the Joanna Briggs Institute on their 20th Anniversary and look forward to the next 20 years as a period of greater growth in knowledge development and transfer and the wisdom to use all for the greater good of all sectors of global health.
Acknowledgements
I would like to thank the Center Directors from Cameroon, Ethiopia, Kenya and Ghana for their contribution to this editorial.
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