1. Stewardship of National Health Research Systems Issues and Challenges Tikki Pang Research Policy & Cooperation WHO, Geneva, Switzerland

2. Pang et al, Bulletin WHO, 2003, 81. 815-820.

3. Skills needed Formulate vision, mission, & goals Set priorities Ethics Monitoring & evaluation Design & implement effective policies Nuyens, 2005

4. What? Governance Leadership Guidance Harmonization Coordination Direction Steering

5. Pang et al, Bulletin WHO, 2003, 81. 815-820.

6. "Clearly, decision-making and executive functions are important. But other important elements of stewardship include vision and oversight. These are more difficult to specify in terms of what they look like when done well, and in terms of what capacities are important" E. Gadsby In the context of fundamental values and principles, what are the drivers, enabling factors or elements for effective vision and oversight?

7. Elements of a Vision (1) Focus on Goal Focus on the ultimate goal-research to improve health outcome and health equity How? 1. Getting balances right 2. Managing research, not just doing it 3. Ensure a systems view; and integrated and linked to program implementation 4. Flexible, responsive to new needs & threats 5. Ensure continuity and sustainability

8. Biomedical researchHealth policy and systems research Social sciences and behavioral research Operational research Basic research: physical and biological sciences including chemistry, pharmacology, toxicology, genetics, etc Research on policy formulation, relationship to evidence, prioritization, etc R&D for drugs, vaccines, diagnostics, appliances, etc Research on health systems management, functions, efficiency, effectiveness, system factors affecting access scale-up, monitoring and evaluation, etc Research on social and behavioural factors influencing health and their relation to equity, access, lifestyle and health- seeking behaviours, etc Research on factors affecting functioning of programs, effectiveness of targeting, impact on behavior, disease burdens and public health, etc Understanding the biological nature of diseases; creating products to prevent or treat disease states Understanding how to test, scale-up and follow through the introduction of interventions and optimize their benefits Innovation Impact The spectrum of health research

9. The 3P Balance PUBLICATIONS PROFESSORSHIPS PATENTS POLICY PRACTICE PEOPLE

10. From World Report on Knowledge for Better Health, WHO, 2004

11. There is nothing a politician likes so little as to be well informed, it makes decision making so much more complex and difficult. John Maynard Keynes (1883-1946)

12. Scientific findings do not fall on blank minds that get made up as a result. Science engages with busy minds that have strong views about how things are and ought to be Sir Michael Marmot

13. Can it work? Will it work? Is it worth it? Tan Sr Dr Abu Bakar Suleiman Former DG of Health Malaysia

14. What is Promote systematic use of evidence in policy- making in low and middle-income countries Promotes partnerships at country level between policy-makers, researchers and civil society to facilitate policy development and implementation through best use of scientific evidence EVIDENCE-INFORMED POLICY NETWORK

15. EVIPNet BUILDING BLOCKS Country teams and regional and global support structures Research synthesis & Policy briefs Capacity development & empowerment Country dialogues (safe harbor) Monitoring and evaluation; Development of new methodologies

17. Balances between…. …different types of research …curiosity for new knowledge vs economic returns …needs of researchers vs needs of policy makers …doing research vs managing it …curiosity-driven (researchers) vs needs-driven research (users) …more research vs health information (cart before the horse) …national vs regional vs global priorities

18. Tanzania Essential Health InterventionsProject(TEHIP) Community-based, participatory research for more effective health systems

19. "Health information is critical for management, monitoring & evaluation, and decision- making, and as the core and foundation for health systems and policy research" Proposal for WHO to lead the development of a Global Health Information Network

20. Whether or not knowledge is global, the use of knowledge is always local Photo: UNICEF

21. Elements of a Vision (1) Focus on Goal Focus on ultimate goal-research to improve health outcome and health equity How? 1. Getting balances right 2. Managing research, not just doing it 3. Ensure a systems view; integrated and linked to program implementation 4. Flexible, responsive to new needs & threats 5. Ensure continuity and sustainability

22. Enabling factors for health research Asia-Pacific Preparatory Meeting for Bamako Forum, Bangkok, June 10-12, 2008

24. "There is a pathway from good science to publication to evidence, and to programs that work. In this way research becomes an inherent part of problem-solving and policy implementation" Julio Frenk Former Mexican Minister of Health

25. Elements of a Vision (2) Holistic & Inter-Sectoral Dont look at HRS in isolation-more holistic view of HRS and its links to health systems Look at inter-sectoral links and need for multi-disciplinary views & approaches Seek congruence, complementarity & synergy with external initiatives in health research and health sectors, and beyond

26. Research system Innovation system Health research system Health sector HS Other sectors- social, economic, political NationalGlobal

27. Science 311, 162-167, 2006 Science, Jan 13, 2006

29. Bilateral Donor Support to Tanzania, 2000-2002 Source: Foreign Policy, Ranking the Rich 2004

30. CountryExternal resources for health as % of total expenditure on health (2003) Tuvalu70.5 Solomon Islands68.5 Rwanda54.5 Zambia44.7 Afghanistan45.6 Mozambique40.8 Data from World Health Report 2006

31. HIV/AIDS assistance: money available, by funder? Ethiopia? Uganda www.cgdev.org/content/publications/detail/13029

32. IHT Apr 26, 2007 Who "pulls the levers" and controls the policy agenda?

33. Elements of a Vision (3) Research Push the frontiers of knowledge "Health outcomes, yes-but dont forget to ask why" (Anne Mills) Need to do "research on research" …and build appropriate capacity Adopt an iterative attitude of a "learning" research system

34. Unanswered research questions (1) What is the best model and mechanism for governance and organization of health research systems? Can we learn from other disciplines and new fields of research? What are the best indicators to measure good stewardship and governance? How do we assess impact of global health initiatives on fragile health systems? What is the best mix of research to reach goals & objectives?

38. Unanswered research questions (1) What is the best model and mechanism for governance and organization of health research systems? Can we learn from other disciplines and new fields of research? What are the best indicators to measure good stewardship and governance? How do we assess impact of global health initiatives on fragile health systems? What is the best mix of research to reach goals & objectives?

39. Unanswered research questions (2) What is the evidence that community and civil society participation leads to more relevant research and effective policies? What are the best methods to inform the public of the results and value of health research? How to best ensure that voices of research users are heard and considered? What is the role of tacit knowledge, "know- how", "experience"-how do we capture, systematize and disseminate it?

40. From a leader….. "Against the advice of experts, I made a decision to cull 1.5 million chickens in order to control the epidemic. This decision was based more on faith in my own personal experience than on solid scientific evidence" WHO Director-General Dr Margaret Chan Jan 25, 2007 Describing her experience as HK Secretary of Health during the H5N1 flu epidemic in 1997

41. Elements of a Vision (4) Public Trust Build public trust based on fundamental values and principles: ethical conduct, equitable relationships, transparency and accountability, inclusiveness, sensitivity & responsiveness Get broad based political, community and media support to ensure sustainability

44. Nature, May 31, 2008

45. International Herald Tribune, May 31, 2007

47. International Herald Tribune 29-30 Sept, 2007

48. http://www.who.int/ictrp

49. Central Repository Database Data downloaded every Tuesday Searched using Primary Registry Primary Registry Primary Registry Primary Registry Primary Registry Primary Registry Primary Registries & Search Portal

52. saxenaa@who.int

53. Nature Nov 22, 2007

54. From World Report on Knowledge for Better Health, WHO, 2004

55. 1.KEEP SIGHT OF ULTIMATE GOAL 2.DEVELOP BROADER HORIZONS & MORE INCLUSIVE PARTNERSHIPS 3.PUSH KNOWLEDGE FRONTIERS 4.GET PUBLIC TRUST THE FOUR ELEMENTS

56. Skills needed Formulate vision, mission, and goals Priority setting Ethics Monitoring & evaluation Design & implement effective policies Managing, "bridging" & "political" skills "Out of box" thinking: moulding inter- and multi- disciplinary approaches; networking skills Capacity for "research on research" Communications & dissemination

57. 1.KEEP SIGHT OF ULTIMATE GOAL 2.DEVELOP BROADER HORIZONS & MORE INCLUSIVE PARTNERSHIPS 3.PUSH KNOWLEDGE FRONTIERS 4.GET PUBLIC TRUST THE FOUR ELEMENTS

58. "If you want to go fast, go alone….. If you want to go far, go together….." Dr Margaret Chan, WHO Director General March 19, 2008

59. MISSION The attainment by all peoples of the highest possible level of health