Promoting the use of research-based knowledge in public health becomes more complex when public health includes interventions on health determinants. This article examines strategies for knowledge synthesis, translation and exchange (KSTE) in the context of public health in Canada, making reference to the work of the recently established National Collaborating Centres for Public Health (NCCs). NCCs simultaneously pursue KSTE and study how KSTE strategies meet different needs. Because NCCs are focused on interventions and policies, they must address the relationship between knowledge and policy, and how amenable it is to change. KSTE can seek to respond to and inform an existing policy agenda, but it can also seek to shape, frame and change that agenda. The two paths might call for different approaches, and for expanding the boundaries of KSTE in health.
Monitoring equity and research policy
This short-term review of the International Health Partnership (IHP+) was commissioned by the IHP+ Scaling-up Reference Group to assess whether programme partners are adhering to their commitments and to review what progress has been made in implementing an IHP+ interagency common work-plan. The review was undertaken between May and August 2008 and is based on the opinions of 100 key informants who represent a cross-section of partner agencies, civil society and national ministries of health in the initial IHP+ countries and at the international level. It found that the relevance of IHP+ is not widely understood, transparency is essential for ensuring accountability (which also depends on the availability of reliable information). If well designed, the planned annual external monitoring and evaluation review of the IHP+ could potentially function as the key global accountability mechanism and it is still too early to assess what impacts or external effects that can be attributed to the IHP+.
The Mexico City Ministerial Summit in 2004 made the problem of poor knowledge translation (KT) a priority, and a solution imperative. Summiteers called for the increased involvement of the demand side in the research process, emphasising knowledge brokering and other mechanisms for ‘involving the potential users of research in setting research priorities’. Though the declaration was made with enthusiasm – and echoed in many follow-up meetings and papers – there was little guidance on how to actually bring together research and research-users. This guide addresses that gap. It discusses three core KT principles: knowledge, which depends on a robust, accessible and contextualised knowledge base, regular dialogue between all stakeholders and strengthened capacity, where researchers, decision-makers and other research users require a strengthened skill-base to create and respond to KT opportunities.
Adopted on 19 November – the final day of the Global Ministerial Forum on Research for Health hosted by the government of Mali in Bamako – the Call to Action urges national governments to allocate at least 2% of budgets of ministries of health to research. In parallel, funders of research and innovation, together with international development agencies, are urged to invest at least 5% of development assistance funds earmarked for the health sector in research, according to recipient country-led research strategies, instead of allowing the current situation to continue, where donor countries push their own agendas, thus shaping the agenda on behalf of recipient countries. The signatories have called for greater equity by increasing spending on researching the health challenges that disproportionately affect the poor, marginalised and disadvantaged.
An important focus of the Bamako Call to Action was to ensure that research priorities were determined by countries, not global institutions. To this end, the multilateral contributors to Bamako – WHO, UNESCO and the World Bank – were asked to promote, expand and implement research strategies with an emphasis on listening to country agendas and responding to their priorities. The idea of 18 November as an annual World Day of Research for Health was proposed as one means to maintain attention on this lever for health improvement. The Call to Action will now go to WHO’s Executive Board in January 2009, where they will do their utmost to ensure implementation of these urgent country requests. 2009 needs to be a year of action, not empty promises.
Progress since the last WHO ministerial summit in Mexico in 2004 is not striking, though there is the clinical trials platform, as well as new initiatives for knowledge translation networks like EVIDnet, and other local and regional projects that have achieved fragmented success. The Mexico declaration called for health ministries to dedicate at least 2% of their budgets to research. For most developing countries this remains an aspiration, with most still well below 1%. The problem is that research is a hard thing to sell where resources are tight. Convincing the public that research is not a luxury can be difficult. Hopefully, by the next ministerial summit in 2012, the discussion will no longer be about research for the world’s poorest nations but research by them for themselves. But, sadly, it seems all too possible that four years from now participants will be having exactly the same conversations.
This study looks at the enduring issue of how to strengthen the informational base on which funders make their social investment decisions. It asks two questions: How can we help donors make smart philanthropic decisions? How can we ensure that the strongest, most effective nonprofits get the resources they need? The report complements the recommendations in Keystone's report, Online Philanthropy Markets: From Feel-good Giving to Effective Social Investing, by enabling donors to think as social investors, providing comparative data on the performance and impact of social purpose organisations, and working towards a common reporting framework. However, unlike Keystone's report, this study puts the strategic focus on major donors.
Ministers and representatives of ministries of health, science and technology, education, foreign affairs, and international cooperation from 53 countries signed the Bamako Call to Action to promote health research in Africa. This document contains many references to improving the current state of affairs in Africa, where Africans are the objects of foreign research instead of conducting the research themselves. Efforts to build capacity, ensure equity, co-operate regionally, use knowledge translation, include all stakeholders and put appropriate legislation in place will be needed urgently if things are to change for Africa. The Call to Action pledges many grand promises for Africa’s future and the scope of action is wide indeed.
The World Health Organization has called on governments to prioritise health research and echoed a proposal by the Commission on Social Determinants of Health for the inclusion of health in the policies of all government ministries and departments. The call was made by WHO Director-General, Dr Margaret Chan, in a statement to the Global Ministerial Forum on Research for Health Research in Bamako, Mali. Dr Chan underlined the key role of research in keeping health high on the political agenda saying: 'We must have evidence and we need the right kind of evidence … because in most countries, an appeal to health equity will not be sufficient to gain high-level political commitment. It will not be enough to persuade other sectors to take health impacts into account in all policies. In matters of health, equitable access to care is a matter of life or death. When equity is at stake, the health sector must take on a proactive role, even if this means stepping into territories outside the usual domain of public health.'
Diseases such as malaria and HIV that disproportionately affect the developing world cause immense suffering and ill health. Medical innovation has the potential to deliver new medicines, vaccines, and diagnostics to overcome these diseases, yet few treatments have emerged. Current efforts to resolve the crisis are inadequate: financing for research and development (R&D) is insufficient, uncoordinated, and mostly tied to the system of intellectual property rights. Delivering appropriate medicines and vaccines requires reforms to the existing R&D system and a willingness to invest in promising new approaches. Ultimately, it is a combined responsibility of all countries to find ways to ensure global R&D is organized to improve human health; inability to pay should not disenfranchise a large majority of the world’s population from access to effective healthcare.