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Medical Research Council

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    Medical Research Council Medical Research Council Presentation Transcript

    • Out of the Sectoral Box
      The Paradigm Shift to Research for Health
      Prof A D Mbewu MBBS MD FRCP
      President : South African Medical Research Council
      Co-Chair Inter Academy Medical Panel
      Global Ministerial Forum on Research for Health
      Bamako, Mali
      19, November 2008
    •  Health Inequities
      One of the objectives of GFHR is to ‘harness the power of research and innovation to accelerate health improvements and health equity to overcome health disparities worldwide’
      This in a world where most of the $160 billion spent annually on health research addresses primarily the needs of rich countries
       
      Health is a public good - yet the Global Burden of Disease Report Update 2004 shows persistent huge disparities in mortality and morbidity between HIC and LIC, MIC
       
      Huge inequities also exist within countries between rich and poor, urban and rural, educated and uneducated; with women, mothers and children often disproportionately affected
      Often these inequities are growing rather than shrinking
    • '10/90
      Gap'
      US$ bn
      140
      120
      125.8
      160
      100
      105.9
      7.0bn/yr
      10.0bn/yr
      80
      84.9
      4.9 bn/yr
      60
      55.8
      4.3 bn/yr
      40
      30
      20
      0
      1986
      1992
      1998
      2001
      2003
      US$ 1.6 bn (5%) for LMIC health needs
      Monitoring Financial Flows for Health Research 2006
      Global Forum for Health Research, Geneva
      Global Health Research
      Expenditure
      45%
      Public
      48%
      Private
      For
      profit
      7%
      Not for
      profit
      2006
    •  A Paradigm Shift to ‘Research for Health’
      Over the past 10 years GFHR and other actors have sought to shift research priorities to address health problems of poor people – with some success (PDPs, global funds for health product procurement, and to stimulate product development)
       
      This Forum however has developed the argument further into a paradigm shift from health research to ‘Research for Health’
       
      This is partly due to a growing realization of the intersectoral nature of heath – that most of the determinants of health lie outside the health sector (Commission on the Social determinants of Health, 2008).
      ‘Improving health outcomes therefore requires engagement across many sectors and disciplines. It is research that seeks to understand the impact on health of policies, programmes, processes, actions or events originating in any sector’.
       
      Research for health is also multidisciplinary, multi-institutional and often participatory.
       
      The private sector and civil society often need to be involved.
       
    • Health sector
      Other sectors
      Research system
      Health research system
      Innovation system
      National
      Global
    • What is Health? What is Research for Health?
      ‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
      The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.’
      WHO Constitution 1948
      The spectrum of research for health for development
      Biological, economic, environmental, political andsocialdeterminantsof health
      Biomedical research
      Health policy and systems
      research
      Social sciences and
      behavioural research
      Operational research
    • Increased Investment in Research for Health 
      Research for Health will not happen unless it is funded
       
      The first WHO Ministerial Summit on Health Research in Mexico City in 2004 made the case for increased investment in health systems research; and repeated the call, endorsed by WHO, and the African Health Ministers of the African Union; for investment of the equivalent of 2% of the national health budget on health research
       
      Such investments would need to be closely monitored in order to ensure that they are wisely used in addressing national health priorities
       
      In addition donors were exhorted to commit at least 5% of their health sector funds to health research
       
    • Making the Case for Research for Health
      Policymakers need to be persuaded that health is an investment not an expense. It should be placed on the asset side of the balance sheet, not on the liabilities side
      Investing in health not only improves the health status of the nation, and creates a healthy workforce who are more productive. It also directly induces economic growth through mechanisms that are still ill understood
      Policy makers should be reminded that Research is central to progress in global health because Health investments alone, particularly in resource constrained environments, fail to deliver benefits unless directed and sustained by health research evidence
      This is because health investments are often expensive, and the tradeoffs that are necessary even in rich countries can be grossly wasteful and ineffective unless backed up by robust evidence of efficacy and cost effectiveness.
       
      Foolish and irrational health investments drain valuable investment dollars rands from other needed social investments such as water, housing and social welfare that in themselves can engender health, welfare and economic growth
       
       
    • Interministerial Policy Coordination and Intersectoral Collaboration 
      Interministerial policy coordination will be needed to ensure that wise investments are made in sectors outside the health sector that nevertheless impact upon health
      A good start has been made by the attendance at this Forum of not only Ministers of Health, but also Ministers of Research, Science and Technology, and Biotechnology; Ministers of Education; Ministers of Social Services, Ministers of Food and Agriculture, Environment Ministers; as well as Pharmacists, Statisticians etc
      Countries will need to ensure that all these policymakers and technocrats, in sectors that impinge upon health; continue the dialogue once they return home; and coordinate their efforts in programmes that affect health
      This will mean the inclusion of a health dimension in all policies, not just those of the health sector
       
    • Interministerial Policy Coordination and Intersectoral Collaboration 
      This will require both interministerial policy coordination as well as intersectoral collaborations
      Possible models include Cabinet level Sociql qnd Heqlth clusters such as exist in South Africa; and the National AIDS Councils that mobilized and coordinated activities across all sectors of society in the fight against HIV/AIDS
      The various and relevant sectors will need to collaborate in implementing :
      * The WHO Strategy on Research for Health
      * The Global Strategy and Plan of Action on Public Health, Innovation and
      Intellectual Property
      * The report of the WHO Commission on Social Determinants for Health
      * The work of the high level Task Force on scaling-up research to strengthen health
      systems
    • Interministerial Policy Coordination and Intersectoral Collaboration
      There will need to be dramatically expanded efforts in capacity building in research for health; and national health research systems, and regulatory systems will need to be established for medicines, ICT systems etc
      Regional and global networks of health research institutions need to be set up to facilitate capacity building; and enable sharing of best practices; and establishment of common data sets in indicators of health and social determinants
       
      Systems will need to be set up to ensure standards, ethical practice, transparency, and accountability in research for health
      Stakeholders will need to ensure reliable health information and other data is used in a free and unrestricted fashion; utilizing the best and most appropriate information and communication technologies
    • Fragmentation in international effort ….
    • Interministerial Policy Coordination and Intersectoral Collaboration
      Innovation and intellectual property management must ensure that social and technological innovations are used
      Public private partnerships and innovative financing mechanisms such as prizes and advanced market commitments should be fostered in order to ensure health products and medical devices are developed despite ‘market failure’
      Research and development should take place in LIC and MIC as well as in HIC
      Stakeholders will need to promote translation of research into evidence that can inform policy, practice and health behavior
       
      Monitoring and evaluation of progress made in the impact of research and innovation on health is vital
      Health system observatories will help countries to assess health system performance
       
       
    • Building a healthy nation through research
      http://www.mrc.ac.za