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
http://www.who.int/ictrp
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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