Monitoring equity and research policy

For many sub-Saharan African countries, a National Health Research System (NHRS) exists more in theory than in reality, with the health system itself receiving the majority of investments. However, this lack of attention to NHRS development can, in fact, frustrate health systems in achieving their desired goals. In this case study, the authors discuss the ongoing development of Zambia's NHRS. They reflect on their experience in the ongoing consultative development of Zambia's NHRS and offer this reflection and process documentation to those engaged in similar initiatives in other settings. Their critical argument is that three streams of concurrent activity are central to developing an NHRS in a resource-constrained setting: developing a legislative framework to determine and define the system's boundaries and the roles all actors will play within it; creating or strengthening an institution capable of providing coordination, management and guidance to the system; and focusing on networking among institutions and individuals to harmonise, unify and strengthen the overall capacities of the research community.

Many food-related diseases and conditions – including undernutrition, micronutrient deficiency, and obesity as well as food safety risks and farmworker health – are interlinked, according to this report. Sustainable food policies that place the promotion and protection of health at the core of strategies from the farm field to the dinner plate can help advance the provision of sustainable, quality foods for all, across the supply chain and the human life-cycle, the World Health Organisation (WHO) argues. WHO offers three health indicators that can be used to monitor progress. 1. Health outcomes: prevalence of anaemia in women of reproductive age; prevalence of stunting in children under 5 years; and prevalence of obesity in children under five and in adults. 2. Food access and dietary quality in association with sustainable foods production: adequate access to protein supply; excessive adult saturated fat consumption; household dietary diversity; and prevalence/incidence of foodborne disease outbreaks. 3. Food market/trade policies supporting health and sustainability: foods that comply with international food safety standards, including hormone, pesticides and antibiotic residues; number of countries that have phased out use of antibiotics as growth promoters; and assessment of health and sustainability impacts in agricultural trade negotiations, policies and plans.

CEWG, the expert working group advising the World Health Organisation (WHO) on research and development, has recommended that the May 2012 World Health Assembly adopt an international convention on research and development (R&D) that will bind member states to action and catalyse new knowledge for diseases that primarily affect the global poor but for which patents provide insufficient market incentives. In this editorial, the chairpersons of the expert group summarise the recommendations and report of CEWG, which they say constitute a transformative change for achieving access to medicines. They argue that financial contributions should be determined based on the concept that both the costs and benefits of R&D should be shared. They recommend a role for WHO in the stronger coordination of R&D and suggest pooling of financial investments to secure efficient allocations to where demands and opportunities are identified through active participation of developing countries. An international convention, the authors argue, is a way to secure a systemic and sustainable solution since it creates a formalised platform for the future where countries can be held accountable.

Participants at Forum 2012, held in Cape Town in April 2012, have argued that it is a misconception that developing countries rely purely on international aid, as they remain the major funders of research in their countries, despite finding it difficult to meet recommended targets for research and development spending. They called for greater collaboration with neighbouring countries, such as pooling resources and knowledge, as well as better cooperation between different sectors within countries to drive improved health outcomes. Innovation was also identified as a key factor in compensating for the lack of infrastructure and resources, especially in the form of new information and communication technologies (ICTs), with virtual collaboration, sharing of data and mobile health technology to reach rural areas, being some of the exciting possibilities. At the Forum, participants had the opportunity to share experiences on how to set their own priorities for research, build capacities and provide incentives for innovation, with the need to always ensure the involvement of communities in setting the priorities for health research being a strong and recurring theme. Also high on the Forum 2012 agenda was the issue of women’s health, although it was stressed that the focus should be on sexual and reproductive health and not simply on maternal health.