World Health Organization 28 March 2017 WHO Strategy on Research for Health Rob Terry – Project Manager, RPC

WHO Strategy on Research for Health World Health Organization WHO Strategy on Research for Health 28 March 2017 WHO’s role in research for health….. and the role of research in WHO… Recognizes research as central to progress in global health Identifies how WHO can work with Member States and partners to harness knowledge, science and technology to produce research evidence and tools to improve health outcomes.

Sustained Global interest World Health Organization 28 March 2017 1990: Commission on Health Research for Development 1996: Ad Hoc Committee on Health Research Relating to Future Intervention Options 2000: International Conference on Health Research for Development (Bangkok) 2004: Ministerial Summit on Health Research (Mexico) 2008: Bamako Ministerial Forum on Research for Health Tracks the milestone reports within the last two decades

Complex array of initiatives World Health Organization 28 March 2017 Complex array of initiatives Member States looking to WHO for guidance and leadership Not all of these have a research component but it reinforces the point that there is a strong interest and support for global health initiative but this has created a complicated environment, duplication of efforts and an array of (competing) funding sources . Suggests there is a need for greater alignment. Member States looking for WHO to provide leadership and guidance.

World Health Organization 28 March 2017 Mandate Resolution WHA60.15 at 60th World Health Assembly May 2007 requesting the DG… "to submit to the Sixty-Second World Health Assembly (2009) a strategy on the management and organization of research activities within WHO" 5

Strategy development - a participatory process Evaluation Framework Implementation Planning INPUTS Rolling Dialogue: Virtual & Face-to-Face Emergent Themes SharePoint Emergent Themes Working drafts IGWG Public health and innovation Regional offices Special Programmes, HQ CCs Executive Board Jan 09 EB124/4.9 Strategy development - a participatory process WHO Research Strategy – WHA 2009 100 Stakeholder Interviews Online & Face to face workshops Strategy+ annexes Advisory Committee on Health External & Internal Reference Groups

Guidance from the Director General World Health Organization 28 March 2017 Guidance from the Director General "….not spread our resources too thin…know our comparative advantage …stick with activities that WHO is uniquely well-suited to perform" "make evidence have the right impact… strengthen the legitimacy, quality and efficiency of our policy development processes" "...ensure that the best practices that science can devise are being followed" "….integrate WHO's research activities to more strategically address a common health research agenda" The guidance from the DG demonstrates the leadership from the top and the reality that WHO has to identify its unique role and play to its strengths

What we heard from the consultation Bridge gap between policy makers and researchers. Champion cause that evidence is needed to address priority public health needs “Get out of the health box”- links with economic, social, cultural factors. How these factors shape health outcomes and how health impacts on them. Translate research questions and findings into terms (e.g. cost savings) that policy makers and practitioners find persuasive Focus on application or implementation of existing know-how Build, in pragmatic ways, local capacity (individuals and institutions) to develop and use relevant evidence

What we heard from the consultation Conducted according to sound standards and ethical principles Well communicated and used locally Use a shared, broader definition of research: Application, Implementation and Evaluation. WHO to support and guide countries; decision making and accountability is countries' responsibility. Evidence-based policy vital in WHO’s work and core public health function

World Health Organization 28 March 2017 WHO Strategy on Research for Health

Research for health – Three principles World Health Organization 28 March 2017 Quality - WHO commits itself to high-quality research that is ethical, expertly reviewed, efficient, effective, accessible to all, and carefully monitored and evaluated. Impact - WHO gives priority to research and innovation that has the greatest potential to improve global health security, accelerate health-related development, redress health inequities and help to attain the Millennium Development Goals. Inclusiveness - The Secretariat undertakes to work in partnership with Member States and stakeholders, to take a multisectoral approach to research for health, and to support and promote the participation of communities and civil society in the research process. Three principles which inform the whole approach to WHO and research for health. NB The definition of Secretariat means the whole of the WHO from HQ, to Regional Offices and country representatives.

World Health Organization 28 March 2017 ORGANIZATION Strengthen the research culture across WHO STANDARDS Promote good research practice TRANSLATION Strengthen links between research, policy and practice CAPACITY Support the development of robust national health research systems PRIORITIES Champion research that addresses priority health needs WHO STRATEGY ON RESEARCH FOR HEALTH VISION decisions and actions to improve health and enhance health equity are grounded in evidence from research. MISSION WHO, Member States and partners work together to harness knowledge, science and technology to produce research evidence and tools to improve health 5 Goals Five interrelated goals have been defined for WHO to achieve the strategy’s vision of research for health Organization – this involves the strengthening of the research culture across WHO Priorities – this concerns the reinforcement of research (at national, regional and global levels, and within WHO) in response to priority health needs Capacity – this relates to the provision of support to the strengthening of national systems for health research Standards – this concerns the promotion of good practice in research, drawing on WHO’s core function of setting norms and standards Translation – this involves the strengthening of links between the policy, practice and products of research.

World Health Organization 28 March 2017 Working with Member States and partners, WHO will: Establish governance structures to lead, manage, coordinate and maintain accountability for research within WHO; Develop and implement a WHO Code of Good Research Practice; Strengthen existing mechanisms for good research practice; Enhance professional staff competencies; Improve access to WHO-affiliated research by developing a publicly accessible repository; Improve performance in research partnerships by: i) reviewing partnership admin processes; and ii) proactively seeking to engage with partners across all sectors that impact on research for health; Improve communications on the Organization’s involvement in research, monitoring and evaluation of this strategy. What success will look like: WHO staff better understand, value and use evidence in planning, implementing and evaluating programmes and activities and in setting norms and standards; All research supported by WHO adheres to the Organization’s Code of Good Research Practice and is subject to scientific review and, where appropriate, ethical review; every guideline and recommendation is evidence-based and every article is peer reviewed; WHO’s role in research and the role of research within WHO are clearly communicated; WHO is widely regarded as a credible, evidence-based organization; a leader in supporting or performing high- quality research; a champion of the need for research and for being an effective partner in facilitating high- quality research at global, regional and country level; WHO commits sufficient resources to support core functions necessary for the implementation of the strategy. Code of good Research practice WHO a more effective partner in research The intention of this slide is NOT to list all the activities and you can draw one or two examples particularly those that will be pertinent to the previous discussions. The animation brings up the headline message for each goal. A code of good research practice covers: Planning and conducting the research Management of research data and primary materials Supervision Publication and dissemination of research findings Authorship Peer review Conflicts of interest Collaborative research across institutions Applying and exploiting the results Misconduct in Research Initially for WHO and its staff but could form the basis for a move towards a global standard.

World Health Organization Priorities World Health Organization 28 March 2017 Working with Member States and partners, WHO will: Ensure mechanisms are in place to synthesize data on gaps in research relating to current health and health system challenges at national and global levels; Convene high-level consultations to identify and build consensus around priorities; Produce a report every four years on global research priorities with an assessment of the alignment of financial and human resources with research agendas; Develop comprehensive research agendas for specific priority areas and develop resource-mobilization plans for such research agendas; Advocate support for research areas; Strengthen the coherence of WHO research activities by establishing mechanisms for periodically reviewing the portfolio of research agendas, including decision criteria for initiation, course corrections and exit strategies of programmes. What success will look like: greater awareness of, and action on, research priorities at a national level; greater awareness of, and action on, research priorities at a regional and global level; improved cooperation and coordination among research funders and other key partners to align global resources to meet priority health research needs; more robust agendas for research on specific priority areas that are facilitated by WHO. Greater coherence and clarity on how WHO is supporting/actively engaged in these specific agendas. Convene high-level Consultation of funders Better alignment of funders around priority areas This should be a strong theme in Bamako – about how to maximize the impact with what we have, improve the partnerships that exist and ensure resources are focussed in the best possible way to achieve a beneficial health impact.

World Health Organization Capacity World Health Organization 28 March 2017 Working with Member States and partners, WHO will: Strengthen advocacy for the value of research and for the development of robust national health research systems; Develop tools and guidelines for strengthening national capacity; Promote the development of comprehensive health information systems to inform national research priorities; Develop and use standardized indicators to enable self- reporting of the performance of national health research systems and monitor global progress; Facilitate technical assistance to support the strengthening of national health research systems; Develop institutional capacity, regional and global networks, involvement of WHO Collaborating Centres, to report and share good practice; Maximize the impact of research capacity- strengthening efforts through improved alignment of WHO’s research programmes and activities. What success will look like: Greater investment in research for health by countries and from other sectors; All countries, especially low- and middle-income ones, have national research strategies; External stakeholders align their research investments with national research strategies; WHO guidelines on research capacity-strengthening, including indicators for measuring progress, have been developed and are being used; WHO reports progress periodically on national research capacity and activities through its governing bodies and information databases; Networks of researchers and communities of practice are actively exchanging experiences and identifying good practices in strengthening research capacity; WHO’s research capacity-strengthening efforts in- country are aligned with country needs, resulting in higher-quality, better-coordinated research activities. All countries have national health research strategies Advocate for strong NHRS This will be a strong them in Bamako about each Member State setting the research for health agenda that is right for them in their region and globally.

World Health Organization Standards World Health Organization 28 March 2017 Working with Member States and partners, WHO will: Develop a systematic method for selecting, developing, implementing and evaluating new standards and norms in line with priorities in research for health; Develop norms and standards, in line with the guiding principles of this strategy, for best practice in the management and use of research; Continue to facilitate the development of and set standards for publicly accessible registries of clinical trials; Engage in technical cooperation with Member States to enable them to adapt, implement and monitor adherence and compliance to the norms and standards for research. What success will look like: Public support and trust for health and medical research is strengthened; WHO has implemented an improved method for selecting, developing, implementing and evaluating its work on norms and standards related to research; Greater awareness, acceptance, implementation and compliance with standards for the management and use of research leading to an improved quality, efficiency, transparency, accountability and equity in the research process; Improved acceptance and compliance with ethical principles in the conduct of research, and standards established for accreditation of ethics committees; Registration of clinical trials according to WHO standards is adopted by all countries. Better awareness, acceptance & compliance Which standards? Standards are difficult and require a lot of resource to get right. We need a more transparent system to ensure we put our energies into the generation of standards that are needed and will have the most beneficial impact. Health informatics and the need for a common standard for the collection, storage and sharing of health data is a good example and highlighted in the Translation goal.

World Health Organization Translation World Health Organization 28 March 2017 Working with Member States and partners, WHO will: Identify promising translation activities, promote their use to support decision-making based on the best available research evidence; Promote the use of effective technology transfer models and the evaluation of promising models to support the timely creation of new products and services in Member States; Work towards the creation of and compliance with international standards on health informatics for research; Develop, strengthen and evaluate mechanisms for the systematic development of evidence summaries and guidance for citizens, patients, clinicians, managers and policy-makers in Member States; Systematically analyze barriers and encourage the development or modification of existing mechanisms to promote greater access to research results; Develop and articulate a WHO position on open access to research outputs. What success will look like: Decision-makers act as informed consumers of research; Researchers are more responsive to the demand side; institutional mechanisms are in place for capturing and sharing lessons learned from research on the demand for research and how evidence is used in policy and practice at country level; Research to understand the translation of evidence into policy and practice is in place and recognized; internationally agreed standards are created and widely applied for the collection, storing and sharing of health informatics; repositories inclusive of WHO research literature are established, well populated, regularly updated and well used; Reliable, relevant, appropriate and timely information is freely available to both producers and users of research in a format and language they understand; WHO plays a more prominent role in identifying effective health interventions and strategies, and promoting their implementation in Member States. Identify best translation activities Research informs policy & policy informs research Translation was mentioned very often as a key area that needs further research and particularly by those people that use research outputs but are not undertaking research themselves. This is not a passive exercise it needs real effort to get the evidence in the right format so it is understood and valued by policy makers and practitioners. Effort is also need to ensure where policy need can appropriately influence the research agenda.

World Health Organization 28 March 2017 ORGANIZATION Strengthen the research culture across WHO STANDARDS Promote good research practice TRANSLATION Strengthen links between research, policy and practice CAPACITY Support the development of robust national health research systems PRIORITIES Champion research that addresses priority health needs WHO STRATEGY ON RESEARCH FOR HEALTH VISION decisions and actions to improve health and enhance health equity are grounded in evidence from research. MISSION WHO, Member States and partners work together to harness knowledge, science and technology to produce research evidence and tools to improve health 5 Goals Five interrelated goals have been defined for WHO to achieve the strategy’s vision of research for health Organization – this involves the strengthening of the research culture across WHO Priorities – this concerns the reinforcement of research (at national, regional and global levels, and within WHO) in response to priority health needs Capacity – this relates to the provision of support to the strengthening of national systems for health research Standards – this concerns the promotion of good practice in research, drawing on WHO’s core function of setting norms and standards Translation – this involves the strengthening of links between the policy, practice and products of research.

A framework for research for health priorities World Health Organization 28 March 2017 Research on neglected priority needs Measurement of the problem – diagnosis Understand causes of the problem – determinants Development of solutions Translation and delivery of the solution impact of the solution Evaluation of the The term "research for health" reflects the fact that improving health outcomes requires the involvement of many sectors and disciplines. As identified in the work of the Global Forum for Health Research, research of this type seeks to perform the functions of understanding the impact on health of policies, programmes, processes, actions or events originating in any sector; of assisting in developing interventions that will help prevent or mitigate that impact; and of contributing to the achievement of the Millennium Development Goals, heath equity and better health for all. Research for health covers the full spectrum of research, which spans the following five generic areas of activity: measuring the magnitude and distribution of the health problem[1] understanding the diverse causes or the determinants of the problem, whether they are due to biological, behavioural, social or environmental factors developing solutions or interventions that will help to prevent or mitigate the problem implementing or delivering solutions through policies and programmes evaluating the impact of these solutions on the level and distribution of the problem. [1] The term "health problem" is used in this strategy to refer to a major cause of ill-health or health inequity, whether actual or prospective. It includes the following: diseases such as HIV/AIDS or mental illness; risks to health such as obesity, poverty or climate change; and obstacles to effective systems performance, such as unsafe care or inequitable financing of health services.

Research and Training in Tropical Diseases (TDR) World Health Organization 28 March 2017 Neglected priority needs Measurement of the problem – diagnosis Understand causes of the problem – determinants Development of solutions Translation and delivery of the solution TDR Selected drug development and field interventions (TB/HIV, helminths, other NTD ) Innovate vector control interventions Evidence for antimalarial policy and access Visceral leishmaniasis elimination Integrated community-based interventions Lead discovery for drugs (screening/optimizing drug leads for tropical diseases Innovation and access in diagnosis TDR Research business lines impact of the solution Evaluation of the These two examples (next slide) show how this framework describe the strategic approach and priority setting that currently exists in two programmes that WHO is a partner in. For TDR the main emphasis is catalysing efforts to develop and deliver solution in areas of neglected tropical diseases.

World Health Organization Research strategy on Foodborne Disease Burden, its impact and on effective interventions World Health Organization 28 March 2017 Research on neglected priority needs Measurement of the problem – diagnosis Understand causes of the problem – determinants Development of solutions Translation and delivery of the solution Priority No 1No global burden of FBD estimates currently exist Priority No 2 Determinants of burden partially known but not synthesized Solutions fairly well described but not always evidence-based – this might have to be revisited after strategy has been executed in its entirety Priority No 4 Solutions often not linked to evidence – this requires re-examination and new application Priority No 3 Food Safety standard setting, control and interventions are well described but impact often not known FOS impact of the solution Evaluation of the For Food Safety the priority is measuring the scale of the problem and a standard approach to doing this as well as evaluating the impact of existing responses.

Links to Bamako and the Global Strategy Plan of Action (from the IGWG) World Health Organization 28 March 2017 WHO Strategy Global Strategy Plan of Action – No. elements Bamako Ministerial Forum Call for Action by Ministers Priorities 1- priorities 2 - cooperation 7- sustainable funding Set priorities 2% health budget for research Capacity 3 – capacity R&D for products Build institutional capacity Regional Cooperation Build capacity in science through education Standards 6 – ethical review, QA Clinical trials Open access to research outputs, products and technologies Translation 2 – strengthen national health research Promote translation - 5% of funding to support this Research in all policies The three areas were developed using different approaches but what this table summarizes is the synergies between the WHO strategy (as a result of consultation) and the outcome of the Intergovernmental Working Group's global strategy and plan of action on public health, innovation and intellectual property and the agenda and Call to Action here at Bamako. It seems there is an agreed approach to move forward the research for health agenda by focussing on priorities, capacity, standards and translation. Of these it is capacity that is mentioned most frequently – how can this be done particularly in low and middle income countries.

World Health Organization Implementation 28 March 2017 Approval by Member States at EB and WHA in 2009 Review, discussion of governance, financing A strategy for implementation; detailed plan needed Decentralized implementation-key role for Regional Offices to implement strategy after alignment with agendas, plans and strategies Incorporation into work plans, country cooperation strategy

World Health Organization Evaluation 28 March 2017 Evaluation framework developed to give impact-focussed approach for assessing achievement of vision, mission and goals Framework components: inputs/activities, outputs, outcomes and impacts Indicators for each component defined for tracking purposes Report on progress to governing bodies in 2012

World Health Organization 28 March 2017 "Through the research strategy, what can WHO do to help democratize R&D so that knowledge is not just for the rich and is equitably used to improve health for all peoples?" Dr Anarfi Asamoa-Baah WHO Deputy Director-General November, 2007

World Health Organization Many thanks 28 March 2017 Further information can be obtained from: SharePoint: http://www.who.int/rpc/research_strategy Robert Terry Project Manager - WHO Research Strategy, Research Policy & Cooperation (RPC/IER), World Health Organization Email: terryr@who.int Tel No : +41 22 7912632 Mob No:+41 792446091 http://www.who.int/rpc Acknowledgements The WHO strategy on research for health was developed with support from : The Bill and Melinda Gates Foundation The Wellcome Trust The Department of Health, UK