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International Health

Health Systems Program

Date: Sep 2017

The African Bioethics Consortium* has released a toolkit to aid in evaluating the operational needs of Research Ethics Committees (RECs). The tool, called the Research Ethics Committee Assessment Toolkit, or RECAT, was created to facilitate efficient, high quality ethics review of research protocols in any setting.

The RECAT can be used by RECs—also known as Institutional Review Boards (IRBs)—to identify:

  1. Baseline operational conditions of a REC
  2. Areas for the development of targeted interventions to improve REC functioning 
  3. Change in REC quality and efficiency over time across multiple domains

The evaluation process combines data gathered through various methods, including interviews, focus groups, document review, and direct observation. This mixed methods approach allows the assessment to capture both written policies and procedures of the REC as well as actual day-to-day practices. It incorporates perspectives from multiple key stakeholders including: institutional leadership, REC chairpersons, REC administrators, REC members, and researchers who submit applications to the REC. Data collection checklists and templates, section-by-section instructions, and sample reports are included in the toolkit.

The RECAT also provides a detailed reporting template, and sample report, to help evaluators organize the collected information around core areas and identify the resources needed to address committee needs.  

The toolkit is published open-access and can be used free of charge for non-commercial purposes. The developers would appreciate feedback on users’ experiences with the RECAT in order to make improvements.  Feedback can be sent via email to

*The African Bioethics Consortium’s members include the Johns Hopkins University-Fogarty African Bioethics Training Program, the University of Zambia School of Medicine, the University of Botswana Office of Research & Development, and the Makerere University College of Health Sciences. 

Dr. Henry Perry, senior scientist in the Health Systems Program, and his colleagues recently published a major new series of articles published in the Journal of Global Health on the evidence of the effectiveness of community-based primary health care (CBPHC). The new series, published in July 2017, is a comprehensive review that describes all of the findings that assess the effectiveness of CBPHC in defined geographic populations for maternal, neonatal and child health (MNCH).

The comprehensive review is 10 years in the making and is comprised of 700 documents, going as far back as 1950. Community-based primary health care has been growing slowly in importance over the last 50 years, and while rigorous evidence of its effectiveness has increased substantially in recent years, international organizations have been slow to invest in capacity-building for successful CBPHC programs.

The series summarizes the extensive evidence that demonstrates that MNCH can be improved through community-based approaches such as use of community health workers and volunteers, and community engagement for planning, implementation and evaluation.

One of the major findings from this comprehensive review focuses on the implications for the health-related sustainable development goals (SDGs). In order to fulfill the SDGs of universal health care coverage and ending preventable maternal, neonatal and child deaths by 2030, greater investments in community-based primary health care will be required.

The majority of health care funding in low-income countries currently goes for services provided at health facilities. However, the evidence that investments in health facilities alone without investments in CBPHC will reduce mortality in geographically-defined populations is extremely limited. In resource-constrained settings, the mothers and children that do obtain care at health facilities tend to be those who are better-off and live closer to the facility. CBPHC fulfills the SDG equity indicators by expanding access to basic services in areas where facilities are often far away.

One example of a successful, national, community-based health care program is in Ethiopia, where over the past 15 years marked improvements have been achieved through the deployment of 40,000 salaried community health workers with one year of formal training (health extension workers) and three million volunteer community health workers (called the Health Development Army). Ethiopia has become a global leader in CBPHC and has recently established the International Institute for Primary Health Care in Ethiopia (IIfPHC-E), which will provide opportunities for training and research in primary health care with a focus on community-based approaches. Faculty at Johns Hopkins Bloomberg School of Public Health, including Dr. Perry, are supporting Ethiopia’s Ministry of Health in this effort so that Ministries of Health in other countries can learn how to strengthen their own primary health care system.

The journal series is publicly available online, (see Research Theme 5), and will also be published soon as a book that will be sold on Amazon. In addition to Dr. Perry, 150 other students, researchers and experts were involved in this project, including Department of International Health faculty Drs. Robert Black, Mary Carol Jennings, Meike Schleiff and Emma Sacks. Most of the students involved were from the Department of International Health.

The Health Systems Program is focused on achieving accessible, cost-effective health care and healthy outcomes across the lifespan for families, communities and nations. In the past decade, the Program has conducted projects in over 50 countries, with particular expertise in South Asia and sub-Saharan Africa, where the greatest number of people continue to struggle with deep poverty and unmet health needs.

For more information, please contact Melissa Reed, communications and program specialist, at