Category Archives: COHRED Fairness Index

COHRED Fairness Index: Where there is need for best practices in health research collaborations

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– The field of international health research partnerships is vast and mostly unstructured with gaps that often leave the expectations of actors in international collaborative partnerships unattended. Every year significant amount of global expenditure is drawn towards improving global health through partnerships and yet there are prominent North-South discrepencies in health related benefit sharing around the globe. Evidence has increasingly shown that North-South research partnerships have been plagued by inequity and unfair practices, including the use of Southern research resources to serve Northern priorities. As a result, decades of global support for health research in low and middle-income countries (LIMCs) have not substantially improved the systems that countries need to prioritize, conduct, commission, partner or finance research and to translate results into effective policy, practice and products.

– Availability of global health funds and resources is not adequate to resolve the issue. This is becoming an increasingly accepted vision of many researchers in LMICs who now have a focus on ‘ownership’ and demand for a ‘change in approach’. Indeed, increased involvement of LMICs in their national research and innovation agenda is a pre-requisite for making country-led strategies in health happen and for addressing local priority problems especially those that are not funded by global health funds. Such increased involvement has been an enabling factor for many emerging markets such as India, China as well as Thailand and now the Philippines and South Africa to poise for on-going growth, leveraging this capacity to become globally competitive and to support their own economies through research and innovation.

– It is often challenging for a single institution especially in a LMIC to rise and expand without support from global research and partnerships. To learn from China where according to the World Bank, all Millennium Development Goals are within reach, the country has made promising progress in this direction by holding majority of partnership stakes at all times for amelioration of its national business, research, drug and vaccine production.

– In spite of these efforts, several LMICs lag behind in their ability to sufficiently reap the benefits from research and innovation partnerships for system building and enhancing their economic activity. A crucial bottleneck is that bulk of these benefits finds its way into high-income countries and institutions. In 2005, the economic impact of global health activity in Washington State was such that it bolstered its taxes, jobs and social development. This clearly illustrates how global health research is not merely about global health but also about reinforcement of economic activity, employment and growth – sadly a benefit package streaming into high-income countries.

– The COHRED Fairness Index seeks to change this by proposing a certification mechanism that will encourage a fairer distribution of all benefits of research and innovation – not just products, but also measurable impacts on the economy and system building in LMICs. And ultimately, it intends to increase research and innovation capacity for global health by building up research and innovation systems everywhere – especially in LMICs.

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North-South research partnerships: building on equitable foundations

Years of global support for health in LMICs, has made it clear that international aid from governments, research institutions, for-profit enterprises, non-profit organisations, research sponsors and donors in high-income countries have helped LMICs achieve access to improved health care services and even products. And yet these countries are still seeking to achieve autonomy in priority setting and in aligning their research results and outcomes with their regional policies.

One of the major setbacks of continued donor dependency of LMICs is that they have not been able to address building the relevant capacity required to deal with their own health needs. Indeed, if the guiding principle that health is a public good and that all partners should share the burden and benefits of doing research for health equally, then the choice of identified priorities as areas of work and the investment in local research capacity must become equally important.

Building an environment where equitable research partnerships can flourish is possible. Human Heredity and Health in Africa (H3Africa) research, for example, is a framework aimed at fostering the study of the complex interplay between environmental and genetic factors by investigating   disease susceptibility and drug responses in African populations. Founded by the Wellcome Trust and the National Institutes of Health, H3Africa research initiative spurred from concerns over inequality and exploitation, and strives to place “a firm focus on African leadership and capacity building as guiding principles for African genomics research,” with grants awarded to, and managed by, African scientists and institutions.


Shaping a useful tool…

In line with this, the Council on Health Research for Development (COHRED) has embarked on the development of a standard: the COHRED Fairness Index (CFI) that would serve as a certification mechanism by providing guidelines for best practices in international collaborative partnerships in research for health. The CFI will not be about ‘naming and shaming’ but rather a mechanism that would encourage improvement of practices in international collaborative research partnerships for health. The CFI will thus include indicators, a measurement process, and a reporting system that is independent, transparent and that can address the key problems, potentials and challenges of collaborative research partnerships. Increased capacity of LMICs to perform research, enhanced ownership of data and results, reduction of harm of research to people, and reduction of reputational risk to all partners in the research process are a few examples of the ultimate impact of the implementation and use of the CFI.

Using a rigorous methodology, the development of the CFI started in early 2014 and its design is the result of a multi-sector consultation approach involving a Technical Working Group (TWG) with 30 representative key stakeholders from NGOs, international organizations, philanthropies, donors, the public and private sector as well as academic institutions. The input received from these key stakeholders in global research and innovation has been consolidated into a report, The COHRED Fairness Index Global Consultation Document. It formulates the outcomes of the consultation and is structured to give an overview of the scope of the CFI, its operational model as well its potential application and uptake by end users. The report is open for comments and contributions from the public until 27 March 2015. The purpose of this global consultation phase is to give every stakeholder outside of the CFI Technical Working Group an opportunity to steer certain aspects of the CFI according to their relevant expertise and needs.

Fair Not Unfair Sticky Note


…and making research and innovation work for everyone!

All such input will be invaluable for helping us revise the report, improving the alignment of the principles and scope of the CFI with the real needs of all stakeholders, and making it certain that the new version of the CFI receives broad approval. In April 2015, the Fourth COHRED Colloquium will bring together 80-100 key representatives of different stakeholder groups during a 2-day meeting at the Wellcome Trust in London. The results of the first global consultation will be presented at this meeting. Over the next 6 months, COHRED’s core writing group and Technical Working Group will then prepare an update of this document. Because COHRED seeks to institutionalise fair and equitable practices in international partnerships in research for health, we have decided to prioritize a part of our efforts on developing opportunities for meaningful endorsements or sponsorships to collaboratively sustain and strengthen an inclusive framework where all stakeholders of the CFI feel engaged and own the CFI experience (more information on endorsement or sponsorship for the CFI can be obtained by contacting

Finally, it is expected that the CFI will be inaugurated before the end of 2015. The pre-launch of the CFI is scheduled this year in August at the Global Forum on Research and Innovation for Health 2015 in Manila, Philippines. With its implementation in January 2016, we hope the CFI will serve its stakeholders to add value to specific areas of operation in research for health allowing to improve the alignment of interests of all partners in global health research in the first instance, and in the long run to increase the capacity of LMICs, to optimize the use of research to improve health, reduce inequity and finally stimulate socio-economic development.

Najia Musolino and Janis K. Lazdins-Helds

Universal Health Coverage: the right path towards equity and development

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– A large global coalition of more than 500 organizations from over 100 countries, has marked 12 December 2014 as the first-ever Universal Health Coverage Day, to reaffirm that health is a right, not a privilege, and that access to quality health care should never depend on where you live, how much money you have or your race, gender or age.

– Investing in health is a wise choice. Indeed, making universal health coverage a priority for all nations could be the cornerstone of the post-2015 sustainable development agenda and a powerful driver of economic growth in low- and middle-income countries.

– The Council on Health Research for Development (COHRED) proudly supports UHC Day and actively works on a number of activities at the global scale, all aimed at contributing to UHC through making the most out of the impact of research and innovation on the health and development problems of people in developing countries.

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Health is a right, not a privilege

“Health for all, everywhere”. Simple and linear as it may sound, attaining this is indeed a formidable challenge. Each year 1 billion people can’t afford a doctor, pay for medicines or access other essential care, and another 100 million fall into poverty trying to access it. In Africa and Southeast Asia, for example, nearly a third of households have to borrow money or sell assets to pay for health care.

Taking action to rapidly change this grim reality, on 12 December 2012, the United Nations unanimously endorsed Universal Health Coverage (UHC), declaring that everyone, everywhere, has the right to access the quality health services they need without facing financial hardship. Shortly after, Margaret Chan, Director General of the World Health Organization stated that, “Universal health coverage (is) the single most powerful concept that public health has to offer. It is inclusive. It unifies services and delivers them in a comprehensive and integrated way, based on primary health care.”

Responding to that historic call, a global coalition of more than 500 organizations from over 100 countries is now marking 12 December 2014 as the first-ever UHC Day. Spearheaded by The Rockefeller Foundation and WHO, this coalition is stepping up to reaffirm that health is a right, not a privilege, and that access to quality health care should never depend on where you live, how much money you have or your race, gender or age.


Looking ahead, wisely: invest in health!

Making UHC a priority for all nations is not only a matter of justice and human rights. Rather, it could be the cornerstone of the post-2015 sustainable development agenda and a powerful driver of economic growth in low- and middle-income countries (LMICs). Health improvements drove a quarter of full income growth in developing countries between 2000 and 2011. At this rate of return, every US$1 invested in health would produce US$9-US$20 of growth in full income over the next 20 years.

To revisit the case for health investment, an independent commission of 25 renowned economists and global health experts from around the world came together from December 2012 to July 2013. The commission’s report, “Global Health 2035: A World Converging within a Generation”, was published in The Lancet on December 3, 2013 and launched on the same day at events in London, Tunis, and Johannesburg. The report clearly states that there is an enormous payoff from investing in health, and specifically makes the case that:

– the returns on investing in health are even greater than previously estimated;

– within a generation—by 2035—the world could achieve a “grand convergence,” bringing preventable infectious, maternal and child deaths down to universally low levels;

– taxes and subsidies are a powerful and underused lever for curbing non-communicable diseases and injuries;

– progressive universalism, a pathway to UHC that targets the poor from the outset, is an efficient way to achieve health and financial protection. Although some might believe that UHC is costly, studies consistently show that, when well-managed to provide quality care, it delivers better health outcomes at lower costs.

Thus, there is now widespread agreement that health may transform communities, economies and nations. But to tap into such a potential for development, the way that health care is financed and delivered must change, to be more equitable and more effective. Costs must be shared among the entire population through pre-payment and risk-pooling, rather than shouldered by the sick, and access must be based on need and unrelated to ability to pay.

Benefits can be almost immediate. If out-of-pocket spending for health services is eliminated or even reduced, money that families have to spend on health can now be spent on sending a child to school, starting a business or coping with an emergency. More broadly, UHC policies create resilient health systems: in times of distress, they mitigate shocks to people’s lives and livelihoods; in times of calm, they improve a community’s social cohesion and economic productivity.


Adding the COHRED touch

COHRED proudly supports UHC Day. Delivering sustainable solutions to the health and development problems of people living in LMICs will require more than tackling health financing. If the medicines, health workers and health facilities do not exist, for example, it will be impossible to move toward UHC. In other words, strengthening health systems will be the key to ensure health for everyone and everywhere.

COHRED’s strong belief is that research and innovation play a crucial role in speeding up progress towards sustainable solutions to the health and development problems of people in LMICs. Either through enabling developing countries to identify their own national research priorities, or by providing leadership and effective solutions to support countries to build their own research and innovation systems for health and development, COHRED works actively to deliver UHC.

Last year, the WHO’s annual World Health Report was focused on “Research for universal health coverage”, remarking that UHC, with full access to high-quality services for prevention, treatment and financial risk protection, “cannot be achieved without the evidence provided by scientific research”. In the report, several examples of COHRED’s work are cited. These include Health Research Web, a global platform for information and interaction on health research for development, and RHInnO Ethics, a platform for research ethics review management.

Reaffirming its own commitment to contributing to UHC through research and innovation, COHRED is currently seeding the future, by shaping novel groundbreaking initiatives. In April 2015, the COHRED Fairness Index (CFI) will be officially presented in London. CFI is designed to provide an assessment tool to stakeholders to measure and report vital information that reflects their performance with respect to transparency, level of engagement, accountability and equity in their collaborations. The aim is to encourage good practices in North-South health research collaborations, for the benefit of health development and innovation in LMICs. Furthermore, COHRED and its partners are gearing up for the Global Forum on Research and Innovation for Health 2015, “People at the Center of Health Research and Innovation”. Planned for August 2015 in Manila, Philippines, Forum 2015 will bring together all stakeholders who have a part in making research and innovation benefit health, equity and development. Finally on stage as leading role actors of their own future, LMICs will take prime position in defining the global health research agenda that better suits their needs, in presenting solutions and in creating effective partnerships for action.

Universal health coverage is the final destination of a journey the World cannot afford to delay. Many paths lead to that destination. COHRED is making its way with determination and optimism about the impact of its global action.

Anthony Nguyen and Carel IJsselmuiden