1. Regional Strategy on Research for Health 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, October, 2011

2. 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

3. 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

4. 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

5. 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.

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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.

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. THANK YOU