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

Stewardship of National Health Research Systems

Issues and Challenges

Tikki PangResearch Policy & Cooperation

WHO, Geneva, Switzerland

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

Skills needed

• Formulate vision, mission, & goals

• Set priorities

• Ethics

• Monitoring & evaluation

• Design & implement effective policies

Nuyens, 2005

What?• Governance

• Leadership

• Guidance

• Harmonization

• Coordination

• Direction

• Steering

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

"Clearly, decision-making and executivefunctions are important. But other importantelements of stewardship include vision andoversight. These are more difficult to specifyin 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 elementsfor effective vision and oversight?

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 right2. Managing research, not just doing it3. Ensure a systems view; and integrated and

linked to program implementation4. Flexible, responsive to new needs & threats5. Ensure continuity and sustainability

Biomedical research Health policy and systemsresearch

Social sciences andbehavioral research

Operational research

Basic research:physical and biological

sciences includingchemistry,

pharmacology, toxicology, genetics, etc

Research onpolicy formulation, relationship

to evidence,prioritization, etc

R&D for drugs, vaccines,

diagnostics, appliances, etc

Research onhealth systems management,

functions, efficiency, effectiveness, system factors

affecting accessscale-up, monitoring and

evaluation, etc

Research onsocial and behavioural

factors influencing health and their relation

to equity, access, lifestyle and health-seeking behaviours,

etc

Research onfactors

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

InnovationImpact

The spectrum of health research

The 3P Balance

• PUBLICATIONS

• PROFESSORSHIPS

• PATENTS

• POLICY

• PRACTICE

• PEOPLE

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

“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)

“Scientific findings do not fallon blank minds that get madeup as a result. Science engages with busy minds that have strongviews about how things are and ought to be”

Sir Michael Marmot

• Can it work?

• Will it work?

• Is it worth it?Tan Sr Dr Abu Bakar SuleimanFormer DG of Health Malaysia

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

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

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

Tanzania Tanzania Essential HealthEssential HealthInterventions Interventions ProjectProject(TEHIP)(TEHIP)

Community-based, participatoryresearch for more effective health systems

"Health information is criticalfor management, monitoring & evaluation, and decision-making, and as the core andfoundation for health systems and policy research"

Proposal for WHO to lead the development of a Global Health Information Network

Whether or not knowledge is global, the use of knowledge is always local

Photo: UNICEF

Elements of a Vision (1)Focus on Goal

• Focus on ultimate goal-research to improve health outcome and health equity

• How?1. Getting balances right2. Managing research, not just doing it3. Ensure a systems view; integrated and

linked to program implementation4. Flexible, responsive to new needs & threats5. Ensure continuity and sustainability

Enabling factors for health research

0.00

1.00

2.00

3.00

4.00

5.00Govt policy on R

Govt spending on R

Govt spending on R capacity

R capacityIncentive for R

Capacity to use R

Experience of getting R to policy

All 16 countries SEARO WPRO

Asia-Pacific Preparatory Meeting for Bamako Forum, Bangkok, June 10-12, 2008

"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

Elements of a Vision (2)Holistic & Inter-Sectoral

• Don’t 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

Research system

Innovation system

Health research system

Health sector

HS

Other sectors-social, economic, political

National Global

Science 311, 162-167, 2006

Science, Jan 13, 2006

Science, Jan 13, 2006

Bilateral Donor Support to Tanzania, 2000-2002

Source: Foreign Policy, Ranking the Rich 2004

Country External resources for health as % of total expenditure on health (2003)

Tuvalu 70.5

Solomon Islands 68.5

Rwanda 54.5

Zambia 44.7

Afghanistan 45.6

Mozambique 40.8

Data from World Health Report 2006

HIV/AIDS assistance: money available, by funder?

Ethiopia?

Uganda

www.cgdev.org/content/publications/detail/13029

IHT Apr 26, 2007

Who "pulls the levers"and controls the policyagenda?

Elements of a Vision (3)Research

• Push the frontiers of knowledge

• "Health outcomes, yes-but don’t 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

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?

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?

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?

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 ChanJan 25, 2007

Describing her experience as HK Secretary ofHealth during the H5N1 flu epidemic in 1997

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

Nature, May 31, 2008

International Herald Tribune, May 31, 2007

International Herald Tribune 29-30 Sept, 2007

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Nature Nov 22, 2007

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

1. KEEP SIGHT OF ULTIMATE GOAL

2. DEVELOP BROADER HORIZONS & MORE INCLUSIVE PARTNERSHIPS

3. PUSH KNOWLEDGE FRONTIERS

4. GET PUBLIC TRUST

THE FOUR ELEMENTS

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

1. KEEP SIGHT OF ULTIMATE GOAL

2. DEVELOP BROADER HORIZONS & MORE INCLUSIVE PARTNERSHIPS

3. PUSH KNOWLEDGE FRONTIERS

4. GET PUBLIC TRUST

THE FOUR ELEMENTS

"If you want to go fast, go alone….. If you want to go far, go together….."

Dr Margaret Chan,WHO Director GeneralMarch 19, 2008

MISSION

The attainment by allpeoples of the highestpossible level of health