Developing national capacity for research and research ethics to improve decision-making for health

1. 64th
Session of
the Regional Committee
for the Eastern Mediterranean
Islamabad, Pakistan
9–12 October 2017
DEVELOPING NATIONAL CAPACITY FOR
RESEARCH & ETHICS TO IMPROVE
DECISION MAKING FOR HEALTH
9 October 2017

2. Outline
• Overview of where we are in the EMR
• Challenges in the production and use of
research evidence for ethical health care
decision making
• How national institutional capacities can be
improved for evidence informed policy making
2

3. Calls for furthering use of research
evidence in decision making
• establish mechanisms to transfer knowledge in
support of evidence-based health-related
policies
58th WHA
2005
• raise awareness among policymakers about
using research evidence in decision-making
• establish research units in the MoH
55th RC
2008
• increase collaboration between health
researchers and policymakers
World
Health
Report
2013
3

4. Limited progress in establishing evidence-
informed policy making?
Probably due to
mismatch between
research evidence
and policy needs and
expectations
4

5. America
Europe
Western Pacific
South-East Asia
Eastern Mediterranean
Africa
Financial investment in R&D and health research
35.8%
28.9%
30.6%
2.9%
1.1%
0.8%
Gross domestic expend on R&D
(GERD)
30.2%
28.7%
25.0%
8.7%
4.6%
2.7%
Gross Income
Global share of
research resources
from EMR: 1.1%.
5
4.6% of the world’s
financial resources
produced in EMR.

6. Comparatively Limited health research
conducted in EMR
5 countries account for 80% of research
(3 universities produce 10% of EMR research)
Research studies often not focused on
national or regional challenges
National mechanisms for research priority
setting and stewardship are not strong
Research designs not conducive to produce
robust evidence for decision making
6
Disjointed
and
inadequate
research
evidence

7. Policy maker
demand for
research
evidence
Knowledge
Translation
&
Exchange
Availability
of valid
evidence
7

8. Limited capacity to absorb research
evidence for decision making
Health
Technology
Assessment
structures are
limited in the
region
• 2 countries
Few programs
to develop or
adapt national
evidence based
clinical and
public health
guidelines
• 3-4 countries
Health care
policies often
not supported
or accompanied
by policy briefs
8

9. Progress in ethical decision making in health
care
• Many countries in the region benefit from national
ethics or bioethics committees (16 countries)
– Important progress!
• Nevertheless, important policy decisions e.g. related
to health care delivery, licensing, market entry and
marketing are not always based on ethical principles
– (e.g. management of conflicts of interests)
9

10. Examples of related WHO regional initiatives
• Priority setting for health research at EMRO
• Consultation on evidence based guideline
development and adaptation
• Planned consultation on fostering institutional
capacity for evidence-informed decision making
• Role of Advisory Committee for Health Research
in EMR decisions related to health research
10

11. Examples of related WHO regional initiatives
• Capacity building/ funding for implementation
research
– EMR-RPPH grants
– iPIER-AHPSR
– TDR grants
• Capacity building (ToT) on development of
policy briefs (2015/2016)
• Regular intercountry meetings on ethics
– Incl. in collaboration with UNESCO
11

12. Existence of structural platforms for improved
action
• Most MoHs benefit from one or more of
below structural arrangements:
– Research and Development units
– Health Policy Units
– Planning Departments
• Can internal modalities be used to improve
evidence based decision making?
– While there are important limitations as described
12

13. Main questions
• What are the most effective modalities to
improve evidence-informed decision making?
– Within-MoH technical units?
– MoH-linked institutions with academic
capabilities? (e.g. NPHI, NIH, NIHR, NICE)
– Institutional partnership with academic centers of
excellence (i.e. universities)?
• In what circumstances such modalities work
best?
13

14. Main questions
• What are the main barriers to improve
evidence based decision making in the region,
and how to overcome them?
• How countries in the region can benefit from
each other experiences and capabilities?
• How WHO can support countries in this
direction?
14

15. 64th
Session of
the Regional Committee
for the Eastern Mediterranean
Islamabad, Pakistan
9–12 October 2017
‫شکریه‬
‫شکرا‬
Merci
‫سپاس‬
Thank you