Health and Demographic Surveillance System Sites: Reflections on Global Health Research Ethics

Abstract

Although there should be no ambivalence regarding the importance of the Health and demographic surveillance System (HDSS), surveillance and research on human populations is beset with a variety of ethical issues.This is particularly true in the area of global health research, which merits attention in health policies related to research ethics. The objective of this paper is to analyzethe use of HDSS sites to obtain data and to resolve ethical conflicts over HDSS approaches, such as those related to data collection, surveillance, and research.This analysis is donein light of guidance on central ethical issues relating to health research such as the International Ethical Guidelines for Health Research.This paper is a critical review of literature of ethics in health and demographic research and surveillance, which has identified and analyzed the major areas of contemporary ethical concerns with respect to surveillance and research conducted by HDSS in accordance with existing ethical guidelines for health research. Concerns addressed in this paper are an overt admonishment about the importance of a range of issues from informed consent, beneficence, and justice,to advice on the best means to utilizesurveillance data. Although use of HDSS allows for invaluable contributions by providing longitudinal data for in-depth understanding of surveillance areas, which indirectly guides policies, programs, and interventions at national and international levels, studies using this means of gathering data are beset with multidimensional ethical concerns with respect to the research and surveillance they carry out. Many of the ethical concerns cannot be resolved under the broader ethical standards set by the major sources of international ethical guidelines or frameworks.Thus, the paper stresses that different and innovative lines of thinking and approaches are required for studies employing HDSS to ensure the best ethical conduct in health research for the improvement of global health.