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Managing research and innovation systems for better health

Source: TropIKA.net editorial team

Title of presentation: Managing research and innovation systems for better health

Date: 18 Nov 2008

Location: Salle Plénière

Chair: Walter Erdelen, Assistant Director-General, Natural Sciences, UNESCO

Presenters:

• Alice Dautry, Présidente, Institut Pasteur, France
• Hannah Akuffo, Research Director, SAREC, SiDA, Sweden
• Farhat Moazam, Chair, Center of Biomedical Ethics and Culture, Pakistan

TropIKA Rapporteurs: Francis Anto

Major topics: Managing research and innovation systems for better health

Scope:

1. Effective research and innovation systems: challenges and opportunities
2. Harmonization, alignment and coherence
3. Ethics, social justice and public trust

Global, regional; national; international cooperation; health; research; culture

Overview

One of the three speakers, Alice Dautry, President of the Pasteur Institute started the session with an overview of the works of the various departments and units of the Pasteur Institute in France. The Institute’s research activities cut across various aspects and levels of biomedical research including: virology, bacteriology, immunology and basic sciences. She elaborated on how the Institute is collaborating with researchers in other countries and has established centres across the world with about 9 centres in Africa including one in Niger where the capacity for the development of Rapid Diagnostic Tests (RDT) for cerebrospinal meningitis (CSM) has been designed as a platform to support capacity building in Africa. The Niger Centre also provides training for field and technical staff. Such capacity building, she said, can help prevent brain drain from developing countries. She indicated that most of their collaborators are in Africa and South-East Asia and 20% only in Europe.

Context and issues

A modern research institution would need to have modern tools and well trained personnel. Such institutions would need to work in collaboration with other research institutions. Some of the requirements for a well functioning modern health research institution would include:

1. trained researchers
2. safe space that promotes work
3. environment where people can have a future
4. adequate funding for research
5. adequate remuneration for work
6. ability and opportunity to publish research findings and
7. political support for research

The presenter concluded by saying that money is not everything and expressed her gratitude and privilege to having had 30 minutes of the time of the President of the Republic of Mali to discuss research issues.

Dr. Hannah Akuffo, Research Director, Department for Research Cooperation (SAREC), Swedish International Development Cooperation Agency (CIDA) speaking on harmonization, alignment and coherence of research, emphasized the need for robust in-country research capacity. She stressed that low income countries also need health research institutions. These national research institutions require commitment and the capacity to become part of the international research group. These institutions, she said, would need good policy environments, would have to be agents of change, and have skilled personnel with innovation capability. Additionally, the institutions would need national budgetary support, should develop a culture of enquiry, acquire skills to manage research and improve teaching and training.

Donors, Akuffo suggested, should revisit and change their approaches, moving away from their traditional method and criteria for funding, and to align with the needs of partner countries. Donors should base their overall support on partner countries’ national development frameworks. Research funds should be better channeled, use uniform reporting format and mechanisms to support mutual accountability, and adhere to the Paris Declaration to set and achieve goals and priorities.

With regard to health research financing, governments should prioritize the health research needs of their countries and make corresponding budgetary provisions to which funders can contribute in support of the national health research agenda.

Funders, in turn, should work together, align and harmonize their operations to support and fund health research. ESSENCE was an interesting example of a group of funders who have come together to provide concerted support to low income countries in the area of health research.

Dr. Farhat Moazam emphasized the vital role of ethics. Without ethics, she suggested, research and health would be like a two-legged stool which can never stabilize and so will not be trusted by users. She stressed the need to develop national research ethics capacity; regional collaboration and the development of curriculum for the teaching of research ethics in health care related colleges would be important tools.

An increasing number of clinical trials are being carried out in Africa and low income countries in other regions. Thus clinical trials are shifting from the North to the South, where regulations may be missing or lax and not binding, and those involved in the studies are mainly the poor and illiterate. Specific examples were given of * issues related to the absence or inadequacy of guidelines, regulatory frameworks, and ethics committees; * economic pressure to attract trials-related funding from abroad (estimated as a potential inflow of US$ 1.2 billion for a country like India).

Ethical reviews must be carried out and integrated as part of good research practices. Ethical review committees should be autonomous and transparent, supported by national guidelines and legislation.

Dr Ariel Pablos-Mendez, Managing Director, The Rockefeller Foundation, introduced the Foundation’s programme to promote e-health in support of health systems research and service delivery. This initiative by the foundation was strongly supported by the Nobel Peace prize winner Archbishop Desmond Tutu in a video message delivered at the session (See video). Worldwide, there is considerable potential for the application of e-health to reach remote areas and underserved populations and thus reduce avoidable number of deaths..

Professor Were Miriam, the first winner of the Noguchi award, urged the global community to view the global health situation as a chain and the health status of its weakest component as critical to the viability of the whole. The death of a mother affects not only her children but also her family and surrounding community. Weak linkages in the health systems compound the impact of poverty and infectious diseases. In Africa and South-East Asia, AIDS, respiratory tract infections and malnutrition take a particularly heavy toll. She challenged the “global village” to show resolve not just in words but through action, against poverty and to improve health worldwide. She described poor nations as ‘communities in paralysis’ suffering from physical and economic exhaustion as a result of illness in the extended family, where relatives just watch or fall sick in turn.

Issues raised, obstacles, difficulties

1. Are low income countries ready to provide budgetary funds for research?
2. Can low income countries prioritize their health research needs?
3. Will health research be able to compete for funds with other pressing needs of low income countries?
4. Where is the evidence needed to support decision making?
5. There will be an increase in the 10/90 gap.
6. Who is setting the health and the research agenda? and
7. Who is benefiting from the agenda?

New ideas, progress, successes

Some suggestions were made during the open discussion.

1. research social determinants of health
2. focus on health research and not medical research
3. reduce the 10/90 gap
4. devise new forms of grant
5. develop partnerships, north-south partnerships
6. tap into NGO driven research to action
7. governments to be committed to equity
8. focus on appropriate research
9. advocacy and support must grow from below.

Main points of agreement

Standards and best practices should be in place and capacity built up to ensure that research will do no harm

Recommendations

Support for individual research projects should be sustained

Operational aspects/Recommendations

Researchers need to:

1. Ask the right questions
2. Know current with knowledge
3. Use standard methodologies
4. Build capacity for health systems research
5. Build capacity for basic research

Personal observations from rapporteur

It was an impressive, educational, diverse and thought provoking session

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