Monitoring equity and research policy

A Proposal for an Essential Health R&D Treaty

Biomedical science and technology are developing at a more rapid pace than ever. Investments in health research and development (R&D) have never been higher—global spending on health research increased from US$30 billion in 1990 to US$105.9 billion in 2001. But despite advances in technology and unparalleled research spending, the medical needs of many of the world's population go unmet. For example, only 1% of new drugs approved between 1975 and 1999 were specifically developed for tropical diseases and tuberculosis—diseases that account for over 10% of the global disease burden. There is a growing demand from many quarters for a new international policy framework. A new international treaty on essential health R&D could provide a binding framework to redirect today's knowledge and scientific expertise to priority health needs. The treaty could help to cement new political commitments and coordinate complementary partnerships aimed at generating and rewarding health innovation as a global public good. This is according to a paper produced by the The Neglected Diseases Group.

A quality of development assistance index
Kharas H: Brookings Institution, 24 March 2010

This article begins by acknowledging that numerous obstacles exist to improving on current development assistance indices, including: attribution across multiple donors, long time lags between aid and results with unknown lag times, the micro-macro paradox (where donor projects are deemed successful but results are not translated to macro indicators) and difficulties in aggregating across different components of 'development' such as poverty reduction, service delivery and economic growth. The article puts forward a model for measuring quality of development assistance and recommends benchmarking against specific quality indicators, based on literature, with a focus on aid processes not outcomes. It states that the index should require that large number of donors are compared to establish the 'best in class'. Quantitative indices and indices that measure change over time should also be developed and linked to changes in management decisions in aid agencies. Four indices are proposed to measure different aspects of aid effectiveness: maximising impact; reducing burden; foster institutions; and transparency.

A research agenda for malaria eradication: health systems and operational research
MalERA Consultative Group on Health Systems and Operational Research: PLoS Medicine 8(1), 25 January 2011

Greater health systems research and development is needed to support the global malaria eradication agenda, argues the malERA Consultative Group on Health Systems and Operational Research. In this paper, the Group focuses on the health systems needs of the elimination phase of malaria eradication and analyses groupings of countries at different stages along the pathway to elimination. It examines the difference between the last attempt at eradication of malaria and more recent initiatives, and considers the changing health system challenges as countries make progress towards elimination. The paper contains a review of recent technological and theoretical developments related to health systems and the renewed commitment to strengthening health systems for universal access and greater equity. The Group identifies a number of needs for research and development, including tools for analysing and improving effective coverage and strengthening decision making and discuss the relevance of these needs at all levels of the health system from the community to the international level.

A resolution by the World Health Assembly: Will there finally be a cure for diseases that affect the poor?
Correa C: South Views 42, South Centre, 12 November 2012

In this article, the author argues that, in order to promote development of new products and their access to populations, especially in developing countries, it is necessary to change the current pharmaceutical research and development (R&D) model. The cost of research should be delinked from the prices of the products generated. The challenge is not only about increasing investment in research or improving the rate of innovation. This will not suffice if the new products are not effectively accessible for those who need them. It is a responsibility of States to provide effective solutions to the health problems of the majority of the planet’s population, he argues, calling for the establishment of a binding convention on R&D for new medicines, vaccines and other pharmaceutical products and technologies. A global binding agreement, negotiated in the World Health Organisation, could be an important part of the solution. Naturally, reaching consensus for its adoption will not be a simple task, neither can it be expected to be instantaneous. It would probably require some years of intense negotiation. However, it will be worth the effort if it can avoid the early death or improve the quality of life of millions of people by creating, on a solid foundation, a new paradigm for research and access to health products, the author concludes.

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A Review of Conceptual Barriers and Opportunities Facing Health Systems Research to Inform a Strategy from the World Health Organisation
Hoffman SJ, Røttingen J, Bennett S, Lavis JN, Edge JS and Frenk J: World Health Organisation: June 2012

Health systems research is widely recognised as essential for strengthening health systems, getting cost-effective treatments to those who need them, and achieving better health status around the world. However, there is significant ambiguity and confusion in this field’s characteristics, boundaries, definition and methods. Adding to this ambiguity are major conceptual barriers to the production, reproduction, translation and implementation of health systems research relating to both the complexity of health systems and research involving them. These include challenges with epistemology, applicability, diversity, comparativity and priority-setting. According to this report, three promising opportunities exist to mitigate these barriers and strengthen the important contributions of health systems research. First, health systems research can be supported as a field of scientific endeavour, with a shared language, rigorous interdisciplinary approaches, cross-jurisdictional learning and an international society. Second, national capacity for health systems research can be strengthened at the individual, organisational and system levels. Third, health systems research can be embedded as a core function of every health system. Addressing these conceptual barriers and supporting the field of health systems research promises to both strengthen health systems around the world and improve global health outcomes, the authors conclude.

A review of selected research priority setting processes at national level in low and middle income countries: Towards fair and legitimate priority setting
Tomlinson M, Chopra M, Hoosain N and Rudan I: Health Research Policy and Systems 9(19), 15 May 2011

It is estimated that more than US$130 billion is invested globally into health research each year, yet, according to this paper, priority setting in health research investments remain inequitable. The authors reviewed selected priority-setting processes at national level in low and middle income countries, and outlined a set of criteria to assess the process of research priority setting and use these to describe and evaluate priority setting exercises that have taken place at country level. Data were gathered from presentations at a meeting held at the World Health Organisation in 2008 and a web-based search. A number of findings emerged. Across the countries surveyed there was a relative lack of genuine stakeholder engagement, while countries varied markedly in the extent to which the priority setting processes were documented. None of the countries surveyed had a systematic or operational appeals process for outlined priorities, and in all countries (except South Africa) the priorities that were outlined described broad disease categories rather than specific research questions. The authors argue that priority setting processes must have in-built mechanisms for publicising results, effective procedures to enforce decisions as well as processes to ensure that the revision of priorities happens in practice.

A scandal of invisibility: making everyone count by counting everyone
Setel PW, Macfarlane SB, Szreter S, Mikkelsen L, Prabhat P, Stout S, AbouZahr C: The Lancet 370(9598): 1569-1577, 29 October 2007

Most people in Africa and Asia are born and die without leaving a trace in any legal record or official statistic. Absence of reliable data for births, deaths, and causes of death are at the root of this scandal of invisibility, which renders most of the world's poor as unseen, uncountable, and hence uncounted. This situation has arisen because, in some countries, civil registration systems that log crucial statistics have stagnated over the past 30 years. Sound recording of vital statistics and cause of death data are public goods that enable progress towards Millennium Development Goals and other development objectives that need to be measured, not only modelled. Vital statistics are most effectively generated by comprehensive civil registration. Now is the time to make the long-term goal of comprehensive civil registration in developing countries the expectation rather than the exception. The international health community can assist by sharing information and methods to ensure both the quality of vital statistics and cause of death data, and the appropriate use of complementary and interim registration systems and sources of such data.

A simple, generalisable method for measuring individual research productivity and its use in the long-term analysis of departmental performance, including between-country comparisons
Wootton R: Health Research Policy and Systems 11(2), 14 January 2013

In this study, researchers developed a simple, generalisable method for measuring research output to support attempts to build research capacity, and in other contexts. They developed an indicator of individual research output, based on grant income, publications and numbers of PhD students supervised. They then used the indicator to measure research output from two similarly-sized research groups in different countries. Research output scores of 41 staff in Research Department A had a wide range, from zero to 8; the distribution of these scores was highly skewed. Only about 20% of the researchers had well-balanced research outputs, with approximately equal contributions from grants, papers and supervision. Over a five-year period, Department A's total research output rose, while the number of research staff decreased slightly, in other words research productivity (output per head) rose. Total research output from Research Department B, of approximately the same size as A, was similar, but slightly higher than Department A. The authors conclude that their proposed indicator can be used for comparisons within and between countries. Modelling can be used to explore the effect on research output of changing the size and composition of a research department.

A spatial national health facility database for public health sector planning in Kenya in 2008
Noor AM, Alegana VA, Gething PW and Snow RW: International Journal of Health Geographics, 6 March 2009

A disparate series of contemporary lists of health service providers were used to update a public health facility database in Kenya, last compiled in 2003. These new lists were derived primarily through the national distribution of antimalarial and antiretroviral commodities since 2006. A combination of methods were used to map service providers and analyse disparity in geographic access to public health care. The update shows that, with concerted effort, a relatively complete inventory of mapped health services is possible, with enormous potential for improving planning. Expansion in public health care in Kenya has resulted in significant increases in geographic access, although several areas of the country need further improvements. This information will be key to future planning for Kenya’s public health sector.

A World That Counts
UN Data Revolution Group, 24 October 2014

This is the draft report of the UN Secretary General’s Expert Advisory group on the data revolution for sustainable development. This report is not about how to create a data revolution – it is argued to be already happening – but how to mobilise it for sustainable development. In the first section the authors describe what the data revolution is, and the opportunities and pitfalls it presents. The second section highlights the current state of data, and the kind of world the authors foresee if the promise of the revolution is realised. Finally, the third section provides a “vision” of a possible world of data in 2030, and some recommendations for how to achieve it. The authors believe that governments, and governments acting together through the UN, have a crucial role to play. This report offers options for using the data revolution not only to monitor progress towards sustainable development goals, but also to accelerate their achievement.

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