Alliance for Health Policy and Systems Research (In collaboration with the World Health Organization, an initiative fostered by the Global Forum for Health Research) Strategic Research Grants Effects of Global Health Initiatives on Health Systems Development Call for Proposals Third Round 2005 Deadline: 15 June 2005 An Initiative of Alliance for Health Policy and Systems Research in Collaboration with Systemwide Effects of the Fund (SWEF) Research Network CALL FOR PROPOSALS STRATEGIC RESEARCH ON THE EFFECTS OF GLOBAL HEALTH INITIATIVES ON HEALTH SYSTEMS DEVELOPMENT Background The Alliance for Health Policy and Systems Research was established in November 1999 as an initiative sponsored by the Global Forum for Health Research in collaboration with the World Health Organization. The Alliance aims to promote the generation, dissemination and use of knowledge for enhancing health system performance. One of its objectives is to stimulate the generation and synthesis of knowledge, encompassing evidence, tools and methods. To achieve this objective the Alliance has been undertaking strategic research to develop international knowledge in high priority but neglected or innovative areas, encouraging new policy thinking. The Systemwide Effects of the Fund (SWEF) Research Network, a collaborative research network composed of research organization in the South and the North, that seeks to understand how monies being disbursed by the Global Fund, as well as other significant sources of funding for AIDS, TB and malaria affect the broader health care systems of recipient countries. The overall objective of the SWEF research is to document the effects of the processes involved in applying for and receiving a Global Fund grant, and in implementing Global Fund-supported activities, on the health care systems of recipient countries. A conceptual framework on this topic was developed by the Partners for Health Reformplus Project in 2003. SWEF researchers in Benin, Ethiopia, Georgia, Malawi and Nicaragua are currently actively involved in the SWEF network. SWEF also has links, via the London School of Hygiene and Tropical Medicine, to researchers in Mozambique, Tanzania, Uganda, and Zambia. The SWEF Research Network has developed a Common Research Protocol , which has since been adapted to meet the specific needs of the study countries. The use of a common core protocol helps to ensure the technical quality and comparability of findings across countries. The SWEF research focuses on four thematic areas, including: • Effects upon the policy environment • Effects upon the public-private mix • Effects upon human resources • Effects upon pharmaceuticals and commodities. The Alliance for Health Policy and Systems Research is collaborating with the Systemwide Effects of the Fund (SWEF) Research Network in a process based on a competitive Call for Proposals to support research to assess the effects of global health initiatives on the health systems in recipient countries. This collaboration aims to support research to measure the systemwide effects of global health initiatives – such as the Global Fund to Fight AIDS, Tuberculosis and Malaria (GF), the President’s Emergency Plan for AIDS Relief (PEPFAR), the World Bank Multi-Country AIDS Program (MAP), and others – on broader health systems in low-income countries in Africa, Latin America and the Caribbean, Asia, and Eastern Europe. New and expansive global health initiatives – especially those aiming to scale-up efforts to fight HIV/AIDS and other diseases – are likely to have a variety of direct and indirect effects upon health care systems that could be positive or negative in nature. To be effective and sustainable in the long run, these global health initiatives and the interventions they support will depend upon well-functioning health systems. This is true for the Global Fund to Fight AIDS, Tuberculosis and Malaria, the World Bank’s Multi-country AIDS Program (MAP), the President’s Emergency Plan for AIDS Relief, and others that aim to substantially increase the scale of response to specific diseases, particularly HIV/AIDS. The results of this research will be used to derive lessons for: 1) Stakeholders in countries receiving support from global health initiatives, to inform policies and implementation strategies for supported activities; 2) the global health initiatives directly, to help improve processes and guidelines in order to ensure that supported activities at the country level enhance broader health care systems; and 3) the broader donor and global community regarding how best to channel efforts to scale up substantially efforts to improve health – especially for HIV/AIDS and other diseases of poverty – in low- and middle-income countries. The Alliance-SWEF collaboration is a process to support relevant research to further address such issues at the country level. This will include the funding of 2 or more strategic research projects with approximately 2 years duration. This call for proposals is to be filled out by any research team interested in competing for these funds. Preference will be given to research teams in low-income countries. 1. Strategic Research Objective The Alliance has decided to invest in strategic country level research on the impact of global health initiatives on health systems development. This is a topic of significant current interest, in the light of the very large amounts of new resources that target specific diseases now being disbursed by financing mechanisms such as The Global Fund to Fight AIDS, Tuberculosis and Malaria (GF), and the President’s Emergency Plan for AIDS Relief (PEPFAR), among others. Such global health programs, especially those targeting HIV/AIDS, have acknowledged that bottlenecks in the health system are a primary constraint upon their effectiveness. Such disease-focused programs may have a variety of direct and indirect effects upon health care systems that could be positive or negative in nature. The proposed strategic research will evaluate the effects of global health initiatives on health systems development and produce evidence useful both for national and global level decision-making. 2. Funding limits Funding will be provided for selected research efforts, ranging from approximately $50,000 to $150,000, and for a maximum of two years. Smaller research efforts that consider specific questions will also be considered favorably. 3. Who can apply for funding? Research institutions, government agencies, health service providers and civil society organizations are eligible for funding. Applicants should ideally have a well-established collaboration with stakeholders within the health sector at the country level (including policy/decision-makers). Research teams should integrate professionals with complementary disciplines and skills in health and social sciences (such as health policy, public health, economics, sociology, political science or anthropology). The bidding institution(s) should possess: • Extensive experience of conducting health research including qualitative and quantitative surveys and analysis; • A reputation for conducting high quality, credible and unbiased research; • Experience working with Government counterparts and other key stakeholders in the targeted country; and, • Strong management and accounting systems. Proposals will only be accepted from institutions that are based in, and intend to conduct the research in, a country that meets the following criteria: • A country already involved in SWEF (or related) research OR • A low-income country that is a recipient of significant amounts of resources from at least one global health initiative (such as the Global Fund, PEPFAR, or MAP). Significance is defined as follows: annual resources received from the global health initiative(s) should exceed 10 percent of annual current national public health expenditure. • A province or a state in a country with a federal system of government, that is a recipient of significant amounts of resources from at least one global health initiative (such as the Global Fund, PEPFAR, or MAP). Significance is defined as follows: annual resources received from the global health initiative(s) should exceed 10 percent of annual current province/state public health expenditure. Researchers from higher-income countries may be named as collaborators but are not eligible to act as the lead institution. Researcher institutions and individuals currently participating in the SWEF Research Network are eligible to apply for funding. 4. Research topics and questions The purpose of this call for proposals is to expand and deepen existing research initiatives within this broad research area. Institutions are invited to consider and address at least one (but possibly more than one) of the following research issues in their proposals: - Effects of the global health initiatives on the broader health system, within the four thematic areas currently included in the current SWEF protocol, including: o Policy processes – Country level processes for many global health initiatives (such as proposal preparation, planning and implementation) are often designed to enhance the range of actors involved in informing policy and implementing activities. To what extent does this occur? In addition, global health initiatives – namely the development and implementation of supported activities – interfaces with other planning and aid frameworks such as sector wide approaches (SWAps) and poverty reduction strategy papers (PRSPs), as well as other financing mechanisms. What is the effect of global health initiatives (such as the Global Fund) upon the broader pattern of health system funding, and to what extent are the policy and operations of global health initiatives in alignment with existing country level structures and policies? o Human resources – how has the enhanced availability of funding from global health initiatives affected the overall distribution, retention and motivation of health staff? o Role of the private sector -- several of the new global disease initiatives encourage collaboration between public and private sectors, and contracting with private sector providers for service delivery. What effect has this had upon the nature of the market for private sector services, and the relationship between public and private sectors? Have there been real shifts in the role of the private sector? o Pharmaceuticals and commodities – the influx of new resources from global health initiatives in support of pharmaceuticals and commodities may affect procurement, supply and distribution systems, and the quality and prices of other drugs and commodities. What are the effects of such resources on these systems, as well as the implications on the availability, equitable access, and affordability of drugs and commodities? - Funding additionality, absorption and sustainability – have the funds made available by the global health initiatives – especially for HIV/AIDS – been truly additional to other sources of funding, or have there been drops in donor or government funding for health? To what extent have recipient governments and other agencies been able to absorb the funding made available? To what extent is the increased funding being applied to strategies that will be sustainable? This topic might also include research studies that examine the implications of global disease funding for macroeconomic frameworks; for example, what are the effects of such large influx of resources earmarked for the health sector on broader macroeconomic policies at the country level (such as financial ceilings set by multilateral agencies and ministries of finance). - Equity and financial protection – how have the new sources of financing affected the overall equity of who pays for care? How has new money affected household financial protection – in particular have governments used user fees to complement global sources of funding for services such as ART, or alternatively decided to offer universal free access to services, and how has this affected household economics? How do such approaches affect equity, access (especially for the poor), and overall sustainability of supported programs? - Vertical versus integrated delivery services – to what extent is the new global disease control funding being channeled through vertical, stand alone systems, versus being integrated into existing delivery channels? What are the implications of this for the overall development of the health system? In countries with decentralized health systems, how effectively have the global disease control funding mechanisms worked at the decentralized level? Across the above research topics, the studies should aim to assess how the changes observed have affected overall health system performance. Particularly the equity, sustainability, accessibility, quality and efficiency of health care services. Research proposals that can demonstrate synergies with ongoing research initiatives on relevant topics will be viewed favorably. In the Call for Proposal instructions, institutions are asked to explain how they would focus/adapt the existing SWEF common core protocol to address the specific research questions selected, and how the protocol would be adapted to fit the conditions and health system context in the particular country. 5. Evaluation of Proposals An independent review panel will review each submitted proposal to determine acceptability, and to select the proposals that provides the best combination of understanding of the research, proposed study objectives and design, institutional/personnel qualifications and experience, and total cost. The following factors will be considered during the evaluation: (a) Technical Understanding of Research, (b) Analysis of Country Level Issues, Development of Hypotheses, and Proposed Research Approach (c) Institutional Experience (d) Proposed Staff (e) Overall Quality of the Proposal (f) Total Cost The evaluation panel will make a final determination of acceptability in meeting the conditions described in the Call for Proposals. The panel will choose the best combination of price and performance from those proposals that have adequately responded to the requests of the Call. 6. How to apply • Proposals should be submitted in the format annexed below. This format is also available in the Alliance Web site. Proposals exceeding the word limit will not be considered. • Proposals must be written in English. • Curriculum Vitae of the principal investigator and co-investigators should be attached as an annex to the proposal response. • Proposals should be sent to the Alliance preferably by email as attachments to a cover letter. Proposals may also be posted if email is difficult. Fax copies will not be accepted. Emailed or posted proposals should reach the Alliance not later than close of business on June 15, 2005.. Send proposals by email to: alliance-hpsr@who.int Please state in the subject heading "Strategic Research". If mailed by post, send proposals to Alliance for Health Policy and Systems Research Office No. 4123 EIP/RPC World Health Organization CH 1211 Geneva 27 Switzerland