Regional Strategy on Research for Health 2012-2016 Dr Poonam Khetrapal Singh Deputy Regional Director WHO SEAR Research for Health reflects the fact.

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Regional Strategy on Research for Health 2012-2016 Dr Poonam Khetrapal Singh Deputy Regional Director WHO SEAR Research for Health reflects the fact that improving health outcome requires the involvement of many sector and disciplines (source: Annex A63/22: WHO Strategy on research for health ) This Regional Strategy on research for health is a “forward looking “ strategy to guide SEAR member countries to strengthen or to revise their national health research for the upcoming period of 5 years, namely 2012 to 2016. 32nd Session of South-East Asia Advisory Committee for Health Research, Bangkok, 11-13 October, 2011

From Health Research to Research for Health November 2008: Bamako Global Ministerial Forum on Research for Health embryo of Research for Health July 2009: 31st SEA ACHR recommended to develop Regional Strategy on Research for Health May 2010: 63rd WHA adopted a resolution on WHO Strategy on Research for Health July 2011: the final draft of the Regional Strategy on Research for Health was discussed and finalized at the Regional consultation in Kathmandu. The Bamako Global Ministerial Forum on Research for Health was the embryo of Research for Health . It was convened by 5 other partners: the Gov of Mali, UNESCO, the World Bank, the Global Forum for Health Research and the Council on Health Research for Development Regional meetings were held in all WHO regions (SEAR in Bangkok? ) to prepare the Forum In that Forum, Research for Health is reflected as the need to link health research with research in non health sectors e.g. agriculture, environment , social and behavioral The Bamako calls for 1) the ministries of health to allocate at least 2% of their budgets of health to research and for 2) the funders of research and international development agencies to invest at least 5% of the development assistance funds earmarked for the health sector in research In July 2011 the draft of the Regional Strategy on Research for Health was revised and finalized at the Regional Consultation meeting in Kathmandu, participated by research experts from 11 member countries from health sector, animal research dept of Ministry of agriculture and 2 NGOs working on environmental research and climate change

Research for Health Seeks to: Understand the impact on health of policies, programs, actions, events in non health sectors Assist in developing interventions to prevent or mitigate that impact Accelerate the achievement of MDGs, Health equity and HFA

Research for Health Encourages partners and stakeholders to : Harness the potential of research to address priority health challenges Mobilize around an agenda of research to improve the performance of health systems based on PHC Link to recommendations of the WHO Commission on Social Determinants of Health Link to Global Strategy and Plan of Action on Public Health, Innovation and Intellectual property Rights as recommended by CIPIH, IGWG and CEWG Source: EB124/12 Add.2, Bamako Global Ministerial Forum on Research for Health, Report by the Secretariat, page 5 Guided by the Bamako principles in leadership , engagement and accountability, WHO calls for action by All partners and Stakeholders on the above 5 actions

Research for Health Spans the five generic areas of activity: Measuring the magnitude and distribution of health problems Understanding the diverse causes of health problems Developing interventions to prevent or mitigate the problems Implementing solutions through policies and programmes Monitoring and Evaluating the impact of these solutions.

Research for health beyond the health sector Examples of collaboration with non health sectors Zoonoses: Veterinary Sciences, Agriculture, Animal Husbandry, Animal Health Laborataries SARS, Avian Influenza, Rabies Climate change: Environment, Water, Sanitation, Education, Industry, Local Govt,  Increased incidence of water and vector borne diseases Traffic accidents and injuries: Transport, PWD, Urban Development, Police, Education  Physical impairments and disabilities due to accidents Health Equity: Social, economic, cultural and behavioral research to identify barriers in accessing Health for All

Research for Health Another example NCDs: Multisectoral Research on the four primary risk factors - unhealthy diets - lack of physical activity - harmful use of alcohol - tobacco use Issues of poverty that relate to the increased incidence of NCDs - Economic sectors and Socio Behavioral sciences Gender role towards effective prevention of risk factors of NCDs: Social Welfare, Women’s Affairs, Education, Rural Development, Culture, Anthropology Source: A prioritized research agenda for prevention and control on NCDs, WHO 2011

Multidisciplinary research is imperative for addressing non communicable diseases The four major NCDs – cardiovascular disease, cancer, chronic respiratory disease and diabetes – share four common modifiable behavioral risk factors, namely unhealthy diet, tobacco use, physical inactivity and harmful use of alcohol. Interventions to reduce these risk factors are largely lie in sectors outside the health sector, for example, food and agriculture, urban development, education etc. Needless to say, intersectoral and multidisciplinary research is imperative for evidence-based prevention and control of NCDs. Some examples of priority research needed in various sectors are: Social determinants: Research to develop policies and interventions for reducing social inequities in access to prevention and control of NCDs. Economic: Research to estimate the impact of tax and price policies on tobacco use and tobacco control Food/ agriculture and trade: Research to determine effective agriculture and trade policies (including legislation and price control) to improve nutrition and reduce the risk of obesity (e.g. eliminate trans fat, reduce salt in processed food and improve access to fruit and vegetables and low-fat products) Education sector: Developing and validating health promotion approaches to improve nutrition programmes in schools, worksites and government institutions Urban development: Research on effects of rural–urban migration and changing food preferences, physical activity patterns and transportation policies on physical activity and sedentary behaviours

The Guiding Principles of Research for Health Quality Scientific merit, efficient, effective, expertly reviewed Ethical Monitored and evaluated Impact Potential to attain health related development, health equity and MDGs Inclusiveness Partnerships with stakeholders - other sectors, research community, non governmental organizations, civil society, governments, development and donor agencies It is very obvious that Research for Health emphasizes on collaboration and partnerships, not only with non health sectors but also in a wider sense, with all parties involved in research such as research institutions, health and non health professionals, NGOs, INGOs, donors and funding agencies and importantly, civil society whenever appropriate. Source:Annex, WHO Strategy on Research for |health , doc A63/22

Vision and Mission Vision Mission Evidence from research is the basis for strengthening national health policies, strategies and plans to achieve Health for All (HFA) and other health related Millennium Development Goals (MDGs) Mission Member countries in collaboration with WHO and development partners in research work together to harness science, technology and broader knowledge in producing research-based evidence and tools

Goal and Objectives Goal To assist member countries in strengthening research capacity for achieving the national health and international health goals Objectives Provide a generic framework to formulate strategies towards strengthening national health research Strengthen national health research policy and setting health research priorities Develop capacity of human resources Develop solutions for current operational issues and challenges in specific health programmes Address policy questions in health systems reform

CONCEPTUAL FRAMEWORK: STRATEGIC DIRECTIONS FOR RESEARCH FOR HEALTH Politics Economics Environmental Education Nutrition Culture Social Agriculture Challenges More evidence for health system based on PHC Strengthening national health research Bridging gap between research and policy making Improving ethics in research Enhance and sustain resources for research for health Promoting and Strengthening multisectoral research in health Issues Weak health systems Insufficient health research Lack of evidence based policy making Inadequate protection of human participants Inadequate resources for research Strategic Directions Prioritization for research for health Capacity building in health research Research ethics Management of research for health Managing research knowledge to bridge the research-policy gap Monitoring and evaluation of research for health Output Strong and functioning national health research Evidence based policy for effective and efficient Health systems Outcome Accelerations of efforts to achieve MDGs and Other Development Goals The conceptual framework depicts the most important issues and challenges of health development including research in its efforts to accelerate the achievement of the health-related MDGs and other development goals. Research will provide valid information to make interventions and policy changes to improve its performance in achieving MDGs, HFA and other development goals. Research in the countries is part of the bigger system which poses additional challenges to use scientific evidence for health system interventions. These include among others 1) the social, political, economic and beyond-health factors e.g. agriculture, environment hazards, 2) the complexity of the health system itself, 3) the sensitive ethical factors when dealing with research involving human subjects, 4) the multiple players in health and 5) the meager resources for undertaking research. Challenges in dealing with or for overcoming the issues are identified and strategic directions were formulated and aligned to the extent possible with the five issues and challenges. July 14,2011

Issues and Challenges in Research for Health Weak health systems Insufficient capacity of health research Lack of evidence based policy making Inadequate protection of human participants Inadequate resources for research Challenges More evidence for health systems Strengthening national health research Bridging gap between research and policy making Improving ethics in research Enhance and sustain resources for research for health Promoting and Strengthening multisectoral research in health Weak health systems: -Resources are skewed toward medical care -Weakness in health systems can be attributed to one or more building blocks of health systems : leadership, service delivery, health workforce, financing, medical products and technologies , health information system. -Challenge: much is unknown about health systems and factors affecting health systems, hence there is an urgent need for more evidence for health systems Insufficient capacity of health research: -Many health research organizations donot have sound conceptual framework / nor clear research plan, hence research are carried out in fragmented manner -The big paucity of human resources in research for health -Challenge: is to strengthen all aspects of national health research Lack of evidence based policy making -Low utilization of research results is due to poor quality of research and due to weak research culture among policy makers not practising evidence based policy development. -Challenge: how to bridge the gap between research and policy making

Strategic Direction 1 Prioritization of research for health Inclusion of priorities in the national health research policy One size does not fit all --> Member States to use prioritization tools/ models to suit their needs Areas of research that can be prioritized: Health problems Health Systems strengthening based on PHC Global Strategy and Plan of action - Intellectual Property Rights, Innovation and Public Health Social Determinants of Health -Prioritizing health research is to champion research that addresses the priority health needs in the country -Each country has a responsibility to develop its own research agenda to respond to the health needs which is important to the population -Many models as well as tools to prioritize research agenda are available, country to select the ones that suit their capacity and needs -With the PHC reform, health systems is an area to be strengthened, hence much still need to be explored. -The six building blocks in health systems are: 1) leadership and governance,2) service delivery packages and models, 3) financing, 4) human resources for health,5) health information, 6) medical products, vaccines and technology -On 7 October, 2011, CEWG of IPR and PH held a regional meeting in New Delhi to examine proposals to get a South-East Asia perspective on proposals under consideration with the CEWG under the parameters of: Potential public health impact on developing countries Rational and equitable use of resources/ efficiency considerations Cost effectiveness Technical feasibility, scaling up potential, replicability, speed of implementation Financial feasibility and sustainability Additionality Intellectual property management issues Potential for delinking research and development costs and price of products Equity /distributive effect, including on availability and affordability of products on access and delivery Accountability/ participation in governance and decision-making Impact on capacity building in and transfer of technology to developing countries Potential synergy with other mechanisms/ potential for combining with others.

The Primary Health Care Reform Four areas of reform in PHC for strengthening health systems: Service delivery: to have people-centered health services –respond to people’s needs and expectations Universal coverage: to ensure health systems respond to health equity, social justice and end of exclusion Leadership: to encourage inclusive, participatory, negotiation based leadership of the government Healthy Public policies: to have health in the policies across sectors and strengthening public health interventions World Health Report 2008 Primary Health Care

Iceberg of health problems Acknowledging the iceberg of health problems , research should pay moer attention to the layers that are under the surface , which are unseen e.g. on identification what factors lead the people to become sick and to find interventions to reduce the episodes of sickness as to prevent them from death. Little is also known in the areas of prevention, promotion and maintenance of health. Some examples on what are much still unknown are on the NCDs : cardiovascular disease , cancer, chronic respiratory diseases which includes asthma and chronic obstructive pulmonary disease (COPD) , Diabetes and its risk factors and also on Mental disorders . Research for health aims to “demistify” the unknown and unseen health problems

Strategic Direction 2 Capacity Building Develop a comprehensive human resource plan at the country level in keeping with National Health Research Policy Strengthen both demand and supply side Enhance institutional and individual capacities in preparing good quality research proposals based on sound research methodology Develop technical content based on varying needs (research management, research ethics, scientific writing, dissemination) Promote Twinning mechanism through horizontal collaboration Bhutan-India, Maldives-Srilanka, and Timor-Leste-Indonesia Capacity building could be strategized through various paths as follow: focusing on various players in research e.g. capacity building for researchers, for research managers and students. Orientation programme could be designed for policy makers on the importance of using research results for making decision, focusing on institutions that deal with research e.g. public health faculty-s, medical schools, nursing and midwifery schools, research institutions and Non Government Organizations (NGOs) that focus on research work, focusing on research cycle e.g. development of research proposal , the conduct of research , data collection and analysis, writing research report, dissemination techniques and transforming research results into publication paper and into policy paper, research ethics focusing on types of research e.g. biomedical and clinical research, social and behavioral research, health research, public health research, health system research etc. focusing on components of research management e.g. governance, capacity building, research policy development, research prioritization, networking and resource mobilization in research Visits to Maldives , Bhutan and Timor Leste to strengthening capacity in health research have been carried out by research experts fo SEARO and have arrived with salient recommendations points

Strategic Direction 3 Research Ethics Ethical review to be mandatory Ethical Review Boards (ERBs) to be in position in all research institutes in the country Capacity of ERB members in research ethics be enhanced Uniform curriculum on research ethics for different target groups be developed Standard Operating Procedures and Guidelines for dealing with unethical practices be formulated Placing high on ethics in the national policy of health Mapping of ethical review boards in member countries, studying its strength and challenges of ERBs Ensure proper mechanisms and proper functioning ERBs Enhance capacity of ERB members on research ethics review board members and health programmers Establish appropriate agreements on transfer of technology before starting a collaboration between two parties especially in the conduct of sensitive issues in research e.g. vaccine research, bioengineering research, genetic research. Develop clear SOP and guidelines to deal with unethical practices e.g. conflict of interest, incentives for research subjects, inadequate compensation in case of harm to the subject, sample storage and sharing , and ownership Developing curriculum on bioethics/research ethics for students in academic institutions, researchers, ethical

Enhance cost efficiency in conducting research by avoiding duplication Strategic Direction 4 Enhance management Improve stewardship in research for health at the institutional, national and regional level Enhance cost efficiency in conducting research by avoiding duplication Create partnerships with clear role and functions Pool donor commitments to maximize resources Stewardship and governance in research for health at three administrative levels i.e institutional, national and regional level have different emphasis. At the institutional level, the management is toward the operation of research At the national level, the governance of research for health is more toward coordination, mobilizing resources, conduct evidence based policy dialogue At the regional level, the governance of research for health is more on multicountry research, developed and developing countries collaboration in research

Bridge the research– policy gap Strategic Direction 5 Bridge the research– policy gap Improve access to Research links and connections through maximum use of existing information technology Capacity building in analysis and transfer of knowledge to policy Create forum for researcher-policy maker interface Use of media as vehicle for influencing policy makers Use of network among researchers, policy makers and society for advocacy More publications and dissemination of research findings for building awareness Many ways and alternatives are available to carry out this Strategic Direction as follow: Maximizing the use of already available existing information technology network e.g. the nets and webs of WHO eg, WHOCC, Health InterNetwork Access to Research Initiative (HINARI), Health Literature, Library and Information Services (HELLIS), Evidence-informed policy network for better health policy-making ( EVIPNET) Building effective stewardship for knowledge management, one way is to create a national knowledge management body that recognizes and support the importance of producing, sharing and using knowledge. Developing a culture of client oriented research activities where to involving programmes and decision makers in the whole process of research from research prioritization to adoption of research findings as to issue new or amend existing policy to betterment of health system based on PHC Involving decision makers, program planners, health managers from the first stage of research Translation of research results using various mechanisms of research utilization e.g. Mapping of institutions, libraries, information and media centers who work on information and knowledge management and form network

Strategic Direction 6 Monitoring and Evaluation Two levels of monitoring and evaluation: At the Strategic Direction level Relevant indicators to measure success in achieving Outputs of each Strategic Direction Strengthening national health research as a whole Relevant indicators to measure success of Strategic Directions as a whole to strengthen national health research Feedback mechanism at both levels of M and E M & E at the Strategic Direction level. The monitoring and evaluation is to ensure that the actions developed under the selected Strategy Direction(s) are implemented and are evaluated that will lead toward the success in implementing the strategy. E.g. Some indicators for Strategic Direction 5 on research dissemination / utilization could be: The number of publications and patents The number of policy recommendation papers for policy makers (policy papers, policy briefs) The number of policy forums conducted (interface between researchers and policy makers) The number of policies based on research results M & E of strengthening national health research as a whole. The indicators are is to measure whether the selected Strategic Direction(s) as a whole has strengthened/improved the national health research in order to become and viable and well functioning national health research. E.g. some indicators: the impact factor of findings of research for health toward mitigating a certain health problem

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