Transcript World Health Report 2012 No Health Without Research

World Health Report 2012
No Health Without Research
Chapter 4
Effective Governance
Knowing That We Are on the Right Track
Bahareh Yazdizadeh
Introduction: Key Roles for Governance
• Governance of a health research system: the
formal and informal institutions, norms and
processes which govern or directly influence
health research policy and outcomes.
• Role of Governance:
1. managing and coordinating the NHRS
2. to monitoring and evaluating its performance
3. monitoring future trends in research of relevance to the
NHRS and its activities
• A starting point for good governance is a
robust national health research policy.
• e.g: national health research (or medical research) council
COHRED survey
Example: Paraguay
• In an encouraging development, in January 2011
Paraguay adopted a National Policy on Research,
Technological Development and Innovation for
Health. The policy, backed by a Presidential
Decree, places Paraguay in the group of countries
that have moved beyond health research – that
develops medicines and interventions – to a
broader country research strategy that mobilizes
science and technology to improve health and
prevent illness.
First role:
Coordination and Management of NHRS
• Example: Philippines & Malaysia
Second role:
Monitoring and Evaluation
• If research has really had an impact on
improving health outcomes
• If the NHRS is thus performing optimally
Importance of M&E of NHRS
• The CHRD in 1990 : "the establishment of an
international mechanism to monitor progress in
health research“.
• the Bamako Global Ministerial Forum on
Research for Health in 2008 identified an
immediate need "to establish a monitoring
mechanism that can track progress against stated
intentions, so that next time it will be possible to
assess what has been achieved and by whom".
• WHO's Advisory Committee on Health
Research (ACHR) highlighted this issue
previously when they stated that "perhaps the
most effective way for WHO to gain 142
support among Member States, funders,
potential partners, and the public for its
mandate in health research would be to
ensure the implementation of methodologies,
to ensure good returns on investments in the
research endeavour".
• International Development Research Centre's
project titled Accountability Principles for
Research Organizations.
• WHO's IMCI (Integrated Management of
Childhood Illness)initiative was subjected to a
rigorous evaluation process.
• Importantly, there is a second dimension
which also needs to be addressed:
• The use of scientifically rigorous research
methods to evaluate public health
programmes, policies and institutions more
generally.
"Our hope is that if governments and
development practitioners can make policy
decisions based on evidence—including
evidence generated through impact
evaluation—development resources will be
spent more effectively to reduce poverty and
improve people’s lives“.
• At the institutional level:
The recent 5 year evaluation of the Global
Fund to Combat HIV/AIDS, TB and Malaria.
Evaluations of GAVI's Health Systems
Strengthening Initiative and the World Bank's
Health, Nutrition and Population programme.
a key question is :
What scientifically rigorous methods are suitable for evaluations of these
very complex 'interventions'?
Evaluation of a NHRS
Approaches and Indicators
• An effective M&E process has three main
objectives/goals:
1. To provide information to manage existing
research
2. To enable improved allocation of resources
between competing research activities
3. To justify the overall level of research
expenditure
• It has also been suggested that a monitoring
system should not attempt to set uniform
targets in advance but, instead, strive to meet
an alternative set of five criteria:
1.
2.
3.
4.
5.
Relevance to funder's objectives
Be decision-relevant
Encourage truthful compliance
Minimize unintended consequences
Have acceptable net costs
Impact evaluation: example
• scientific quality:
o Times Higher Education World University Rankings
o the Shanghai Jiao Tong World University Rankings
• The Council for Medical Sciences of the Royal
Netherlands Academy of Arts and Sciences,
The Societal Impact of Applied Health
Research, 2002:
o scientific quality + societal impact
o Tool
www.societalimpact.info
• The tool evaluates factors :
 The aim of the published paper;
 The extent to which authors try to translate their
findings into actions which benefit society;
 The level, status and target group of this
translation
 To assess the level of translation
(provincial, national, regional, global)
 The target group for translation
(individuals, population subgroups, public).
• Research impact framework:
1. Research related impacts;
2. Policy impacts;
3. Service impacts (health and intersectoral);
4. Societal impacts
Kuruvilla S, Mays N, Pleasant A, et al. 2006. Describing the impact
of health research: a research impact framework. BMC Health
Services Research 6, 134. doi:10.1186/1472-6963-6-134.
• Making an Impact – A Preferred Framework
and Indicators to Measure Returns on
Investment in Health Research,2009:
1.
2.
3.
4.
5.
advancing knowledge
capacity building
informing decision making
health impacts
broad economic and social impacts
• sets of indicators, rather than single ones, provide a more
accurate assessment of impact.
Although some of these methodologies have
been applied in developed countries, its value,
usefulness and feasibility in resource-limited
settings are unknown.
comparative (cost) effectiveness research
• the generation and synthesis of evidence that
compares the benefits and harms of
alternative methods to prevent, diagnose,
treat, and monitor a clinical condition, or to
improve the delivery of care.
• compare drugs, medical devices, tests,
surgeries, or ways to deliver health care.
• the Patient-Centered Outcome Research
Institute and NICE.
• The basic tenet of making decisions based on scientific
evidence can also be extended more broadly beyond
the health sector as illustrated by the well-known
Foresight programmes in Japan and the UK designed to
develop visions of the future.
• These programmes aim to bring about a culture change
in the way business and the science base relate to each
other based on the predicate that all organizations
need knowledge of what the future might hold to
inform current decision making.
Evaluation at the Global Level?
• Evaluating the impact of various global programmes and
initiatives which provide support for strengthening health
research in countries, especially in the developing world.
• Going a step further, a similar approach should be applied in
future to evaluating the various modes and mechanisms for
improved harmonization and coordination of global health
research which can be referred to as 'evidence-informed'
governance of global health research.
• Effective evaluation and monitoring of untested interventions
and strategies: population screening programmes for genetic
risk to chronic diseases, personalized medicine
Third Role:
Monitoring research trends
what will research look like in the future?
• Governance has 'scoping' and intelligence
function in identifying new and breaking
trends and challenges in research.
• How research for health will be done in the
future.
Monitoring research trends - what will
research look like in the future?
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Biomedical and Epigenomics
Ggenomics to public health
malERA (Malaria Eradication Research Agenda)
Clinical research: stem cell therapy
Vaccines
Non-communicable diseases
Health systems and health services research
Traditional medicine
Do research on research
Information and communication technologies
how to promote better inter-sectoral and inter-disciplinary
approaches
Health systems and health services research:
1. More definitional clarity as to what constitutes health systems research
2. A move towards more robust methodological approaches, e.g. the use of
a gold standard, randomized control design of a study to implement a
universal health insurance scheme in Mexico
3. Better guidance and clarity on the type and quality of evidence needed for
health systems strengthening
4. Implementation and evaluation of the 'systems thinking' framework
Do research on research:
1. The challenge of coming up with a universal
standard for research classification
(a Babel fish for research)
1. Global health research governance (GHRG)
2. How to develop better research networks?
World Bank: Open Data, Open Knowledge, Open Solutions
“elite retail” model of economic research
Four levels of cross-disciplinary interactions
Key Messages
• Effective coordination of a NHRS
• Evaluation of the impact of research
• Exciting new trends and developments
Links to Chapter 5
• The focus of the present Chapter is on the role of
effective governance in ensuring coordination and
evaluation of the NHRS and monitoring scientific
trends. But effective governance should be translated
into an effective blueprint or plan of action based on a
'roadmap' which describes the final destination.
• Such a road map will be described in the next chapter
which will serve as a guide to Member States for
implementing the key recommendations contained in
the Report.