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Ministerial discussions – Overview and report from the Algiers preparatory meeting, and report from other preparatory meetings related to the Bamako Call for Action

Source: TropIKA.net editorial team

 

Title of presentation: Overview and report from the Algiers preparatory meeting, and report from other preparatory meetings related to the Bamako Call for Action

Date: 17 Nov 2008

Location: Salle Ovale

Chair:

  • Discussion 1: Mr Oumar I Touré, Minister of Health, Mali
  • Discussion 2: Mr. Karman Lankarani, Minister of Health from the Islamic Republic of Iran

Moderator: Norman Swan, Australian Broadcasting Corporation

TropIKA Rapporteurs: Rodrigo Correa, Edith Certain

Major topics: Budget specification on the call for action; database development of open access; comments on the text

Scope:

Overview

The sessions served as an introduction to the ministerial sections of the forum and reviewed recent history of global cooperation on research for health beginning with the commission on health research for development in 1990, through the Mexico summit on health research in 2004 (See "The Road to Bamako"). A report from the Algiers preparatory meeting was presented by Mr. Said Barkat, Minister of Health Population and Hospital Reform, Algiers. Dr. Tikki Pang of WHO reported on a synthesis of regional preparatory meetings and call for action (See "Synthesis of Regional Preparatory Meetings and Development of the Call to Action").

Context and issue

Issues raised, obstacles, difficulties

Budget specification on the call for action: There is clearly a great gap between budget commitments of countries and the budget level stated on the Bamako call for action. Not all countries have decided to allocate budgets to research for health, and significant gaps exist in the understanding of governments of the impact that research for health may have on economic growth, by increasing the working capacity of the population. A major hurdle to be overcome remains the fact that congress/parliaments make budget allocations. Stakeholders appear to lack understanding of the importance of investment in research for health. Several delegates discussed the fact that Ministries of Health alone cannot advocate for higher budgets for research for health or clearly identify research questions in many cases. There is a clear need for co-operation with Ministries of Science and Technology to address jointly the investments on research for health.

Database development of open access: This ongoing issue has been an important hurdle in developing collaborative programs. While several institutions would like to have all data collected from countries where diseases of the poor are prevalent placed on open access databases, this was not accepted by the countries where highly structured institutions use data that is generated at great cost by low and middle income countries at no cost. The generation and analysis of these data should be shared before it is open to other institutions. This is also an intellectual property issue needing further discussion. Investment in data collection and generation is high and there is little mutual collaboration between developed countries using data from developing countries. It was clear that capacity building for data analysis and translation of findings for improving health, together with new research questions to be addressed needed further discussion. A system needs to be developed where different stakeholders will participate and share findings.

Questions raised from open debate:

What will change in four years after the Bamako meeting and the achievements of the Bamako Call to Action?

The meeting heard that there was an explosion in science in health systems, and countries needed to understand how science could be more efficient and accountable. New sets of research challenges needed to be developed, and countries needed to learn how to make research occur in sections and areas.

How do ministries of health expect research for health impact to meet their needs?

  • Implementation of health policy research to improve health system
  • Development of databases to improve translation of research results
  • Set up networks for decisions on research matters
  • Establish a research network to develop evidence-based research agendas
  • Commitment to the development of drugs and vaccines
  • Build capacity on knowledge management
  • Increase networks of researchers by collaborative north-south and south-south programs
  • Support the creation of regional and sub-regional health centers (research centers?)
  • Implementation of African peer review process of health activities
  • Increase multidisciplinary research in countries where the diseases are prevalent

What is needed for the region in relation to the Call for Action and the way forward?

  • Need to develop a structure where the Ministries of Health, and Science and Technology will work together to develop research on specific areas and in capacity building
  • Develop a database system for the organization of available information
  • Develop capacity in diseases diagnosis
  • Increase the understanding of countries’ governing bodies on the need for investment on research.
  • Partner with other agencies to address issues on health identified by the different countries

Lessons learned

  • Morocco is facing the brain drain issue in a very positive way, ie. although researchers trained in developing country go to the developed countries where they find better jobs, these countries should not stop training them. A small proportion always returns and bring new ideas, collaboration and will certainly contribute to the country’s scientific growth.
  • Both Mexico and Brazil cited their examples on scientific growth, specifically growth in health research.
  • Sweden mentioned that it was time to stop discussing what to do but start to address how to do so that the main questions can be tackled.

Personal observations from rapporteur: Regional Perspective

Latin America faces very similar issues and problems regarding investment in health research discussed on the two sessions. However, the issues relating to health research and lack of government awareness on the need for allocating budgets for investing in health research is more uniform in Africa than in Latin America. Here, differences between countries are distinct and the majority, while aware of the need for investment on research for health have not yet made the final commitment.

Several issues are still the same, such as the difficulties on international cooperation where ownership of data and information are shared. There is still some level of scientific control via the use of ‘fund power’ i.e., those who fund want the first word on what will be done. This is true both for proposal- and hypothesis-driven research. It is still difficult to overcome some of these issues when the funding agencies have already decided on what is important based on the data provided by the international communities outside of the countries where the diseases are endemic or by researchers on the developed countries.

It is interesting that in some cases, agencies do not take into consideration information that is obtained in the country by their scientists when developing agendas. Countries need to take ownership of their agendas, establish priorities and fund the research as clearly stated during this meeting. Awareness of needs should be promoted to governing bodies in such a way that international cooperation is truly international. Furthermore, countries can help themselves by making governments aware of the need for investment in research for health. Cooperation between the countries is crucial. In Latin America, countries are developing co-funded programs of cooperation. This is a crucial step for raising awareness of the importance of budget allocation, and as proposed by the Bamako meeting, should be seriously considered. South-south cooperation is very important and the countries should learn from each other’s experience as well as cooperate in capacity building. This by no means excludes the need for international north-south or multilateral cooperation.

A critical issue facing Latin America and raised in this forum relates to innovation. This will be solved only with long term investment and commitment to support research for health. As research investment increases, the number of patents will increase, bringing the development of tools for addressing national and international health problems. Technological transfer is an important process for capacity building. However, nations should not rely on transfer only but should also invest in development of technology. Some Latin American countries are close to reaching this, although still at a small scale. For the development of health research, hypothesis-driven research should not be forgotten and I believe that too much emphasis is given to implementation, applied and translational research in this forum. If hypothesis-driven research is not funded and new technologies or new findings occur, nothing will be available to implement, apply or transfer to improve the health conditions of populations.

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