Category Archives: Maternal and child health

Making the case for research and innovation for health in the post-2015 development agenda

In this guest post, Claire Wingfield—product development policy officer at PATH—writes about a new paper exploring why research and development (R&D) of high-priority health tools for diseases and conditions affecting low- and middle-income countries (LMICs) should be a critical component of the post-2015 development agenda.

A dearth of adequate health technologies and interventions targeting poverty-related diseases—like HIV/AIDS, malaria, tuberculosis, and neglected tropical diseases—means that millions of people in LMICs continue to die each year from preventable and treatable diseases and conditions. Progress on developing new interventions targeting the health priorities of LMICs has faltered because these diseases occur almost exclusively among the world’s poorest and most marginalized populations. Thus, there is little or no perceived commercial market encouraging companies to develop products targeting LMICs. Because the health burden imposed by poverty and social vulnerability remains far too high, achieving health for all is one major goal of the post-2015 development agenda.

In a new paper—developed by the Council on Health Research for Development, the Global Health Technologies Coalition, the International AIDS Vaccine Initiative, and PATH—the authors make the case for the inclusion of research and innovation for health as a central component of the post-2015 development agenda. The paper describes the impact that increased investments in R&D and innovation for health—particularly for the world’s poorest—have had in contributing to progress toward achieving the Millennium Development Goals (MDGs)—particularly for MDGs 4 (reduce child mortality), 5 (improve maternal health), and 6 (combat HIV/AIDS, malaria, and other diseases).

Credit: PATH/Gabe Bienczycki
Credit: PATH/Gabe Bienczycki

These investments have helped to create an enabling environment for research in and for the benefit of LMICs by increasing demand for new health technologies, expanding coverage of proven interventions, and strengthening the innovation infrastructure in these countries. Building on the work of The Lancet Commission on Investing in Health—a group of renowned economists and global health experts—the paper discusses the need for increased R&D investments by all countries to achieve the dramatic health gains envisioned in the post-2015 agenda.

Adequate levels of investment, as suggested by The Lancet Commission, are critical for spurring the development of new health tools, provided they align with financing needs in R&D—notably predictability and flexibility. But even that sort of investment alone does not guarantee more products, and it does not drive innovation toward the right type of products—those that are suitable, acceptable, affordable, and accessible to populations most in need. It is essential, therefore, that indicators for R&D for health tools that primarily affect LMICs address a comprehensive set of outcomes including financing needs, infrastructure and human resources needs, enabling policies, necessary partnerships, capacity strengthening, and access requirements.

Because poor health and disability contribute substantially to poverty, research and innovation for health is linked to improving economic prosperity and is critical to eradicating poverty. Therefore, it must be continuously prioritized within the post-2015 development agenda. Ultimately, the success or failure of the post-2015 agenda relies just as much on how the goals and targets are implemented as it does on how progress will be measured. Thus any research and innovation indicators measuring progress against the goals and targets outlined in the post-2015 agenda must also increase accountability of researchers, governments, and funders, and inform research processes. Inclusion of research and innovation for health must facilitate an enabling environment for research and innovation in LMICs and encourage endemic countries to set and pursue a domestically-driven health research agenda.

Credit: PATH/Evelyn Hockstein
Credit: PATH/Evelyn Hockstein

The post-2015 development agenda is an opportunity for LMICs to set their own health agendas and research priorities and to assert their leadership in strengthening the R&D landscape focused on the needs of the poorest and most marginalized populations. Therefore, it is essential that there is broad agreement among all of the relevant stakeholders that research and innovation for health—which includes the scaling up of proven health interventions as well as the development of new and improved high-priority health technologies—is critical to meeting the ambitious goals of eradicating poverty and ensuring sustainable development for all within a generation.

In support of the inclusion of research and innovation for health in the post-2015 agenda, over 150 organizations and individuals recently signed a petition to United Nations (UN) Secretary General Ban Ki-moon and Member States urging the UN to keep the research, development, and delivery of new and improved health tools for diseases and conditions impacting LMICs at the heart of the post-2015 development agenda. It is our hope that the Members States and other UN officials shaping the agenda will head this call.

Claire Wingfield (PATH)

 

Note: From the September issue of TDR news: “We are making good progress in a number of key initiatives with partners. For example, we’ve worked with COHRED, the Council on Health Research for Development, to develop a new internet platform that lists training opportunities and other important research management information in West Africa. West Africa Health Research Web (WAHRWeb) is a database and an announcement platform for research capacity training opportunities like ethics, grant writing, and clinical trials management for the 15 countries of the West African Health Organization (WAHO).”

Tackling health inequalities: the MASCOT vision

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SPEED READ

– Health inequalities are still affecting women and children in many areas of the word. The MASCOT project aimed at enhancing understanding and dissemination of strategies for addressing these inequalities through international co-operation.

– MASCOT brought together 11 partners and 3 world regions (Europe, Africa, and Latin America) to work towards selected targets. These included mapping the current status of maternal and child health inequalities in selected countries, identifying the best practices that should be implemented for tackling inequalities, and fostering multilateral collaboration and knowledge transfer.

– Among the many results/outcomes produced, an open source, freely searchable webDatabase has been developed that covers research on maternal health in low- middle- and high-income countries.

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Health equity for the vulnerable ones

Building a better future for women and children is a universal must. Yet, in many countries, notably low- and middle-income countries (LMIC), inequalities in maternal, newborn, and child health interventions are a persistent reality, and progress towards the achievement of Millennium Development Goals (MDGs) 4 (reduce child mortality) and 5 (improve maternal health) remarkably slow. While some countries have made advances, these advances remain unknown to other countries which could still benefit from their experience.

The firm belief that international collaboration can help addressing health inequalities was the starting point for MASCOT (“Multilateral Association for Studying Health Inequalities and Enhancing North-South and South-South Cooperation”), a project that took place between October 2011 and March 2014 and was supported by the European Union’s Seventh Framework Programme. Co-ordinated by COHRED (Council on Health Research for Development), MASCOT gathered 11 partners and a number of experts from Africa, Latin America and Europe, to identify research being conducted on maternal and child health, and adequate and efficient strategies for tackling health inequalities affecting children, adolescents and mothers. This was in perfect line with COHRED’s focus on supporting research and innovation systems for health, equity and development.

In a nutshell, MASCOT aimed to create links between North-South and South-South efforts in addressing maternal and child health (MCH) and health inequalities, and to provide research-based evidence on best practice and policy advice for the development of future public health and health systems interventions.

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MASCOT at work

Reduce health inequalities, enhance efficiency of national health research systems (NHRS), enhance collaboration. This was the pole star of MASCOT action. Around these guiding objectives, the work was organized as work-packages intending to reach 6 specific targets:

• To select relevant countries for the studies and to standardise the procedures.

• To describe inequalities concerning MCH as well as strategies and activities currently put into practice to reduce these inequalities at national scale.

• To describe NHRS and detect dedicated projects and research teams working on MCH inequalities.

• To identify the best practices and evaluate their roles in the development of measures (policies or recommendations) that are and/or that should be implemented for tackling MCH inequalities.

• To develop and suggest country-specific strategies derived from best practices and best policy advice for strengthening NHRS, the use of research results for decision-making and the capacity to address MCH inequalities.

• To implement specific activities to stimulate the multi-lateral collaboration between countries and institutions in Africa, Latin America and Europe, enabling countries to make better use of research in addressing health inequalities in maternal and child health.

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Seeding the future now

MASCOT has developed a variety of results/outcomes that will be extremely useful for health professionals and other stakeholders working in the maternal and child health area. Much of the value of these results will become manifest in the future, as the guidelines and recommendations developed under the MASCOT vision will be applied and implemented.

Both national and regional reports were drafted, presenting the results of investigation on health inequality status, national research for health systems and their role in MCH research, and the impact of health research on development of policies and programmes.

An online platform to access MCH data collected from different sources and gathered, selected and analyzed through the MASCOT project has been put in place. This decision-support tool includes analyses of MCH inequalities gaps by country according to selected health indicators and PROGRESS categories (indicators of the social determinants of health), qualitative data on health research systems and MCH research by country, and qualitative data on research use strategies for tackling MCH inequalities by country. The following countries are included in the platform: Ghana, Guinea Bissau, Malawi, Mozambique, Tunisia, Bolivia, Chile, Costa Rica, Mexico.

Promoting the contact and knowledge transfer regarding MCH strategies between countries was one of the declared MASCOT objectives. Collaboration activities between Ghana and Mozambique and Costa Rica and Guatemala were supported and fostered under this framework. Ghana learned from Mozambique’s policy and experience with Maternity Waiting Homes as an effective approach to provide women the same access to quality and in-time basic and emergency obstetric care services. Costa Rica drew out key elements from ‘Hospitals without Walls’, an integrated health care strategy based on the provision of prevention, promotion and care with a community access and empowerment component, to assist Guatemala in their efforts to combat infant malnutrition.

 Another tangible result of MASCOT is the webDatabase on maternal health in low- middle- and high-income countries. The product of a systematic mapping of the maternal health primary research and systematic reviews published in the period 2000-2012, the database stems from a collaboration between partners in the MASCOT and WOTRO projects, from more than a dozen countries. The database includes research that examines maternal health interventional research in LMIC, dealing with health systems interventions, interventions in community settings, health promotion interventions, and interventions on five tracer clinical conditions (antepartum and postpartum haemorrhage, HIV and other sexually transmitted infections, hypertension and malaria). Also, research on maternal health interventions in high-income countries that occurred outside the health facility is included.

The webDatabase is open source and supports a variety of functions. Users can run searches and make reports. Searches can be carried out using key words and free-text terms. Reports enable visual mapping and analysis of the search results. Reports on the database work as “question” reports, whereby one can select a ‘parent’ code, such as HIV codes, and the results will give all the studies included on that topic.

COHRED was proud to co-ordinate this project, serving as it did as a clear reminder that the desire to address the gaps in maternal and child health outcomes between groups in society cuts across borders. This is a fantastic opportunity to give a heartfelt thanks to not only the European Commission for supporting this initiative, but also to all of our partners in this effort. The collaborative effort in the project was strong, and we believe that the outputs will continue serve as useful tools for researchers and policy makers in the future as they seek to identify and implement strategies to address the maternal and child health inequalities in their countries. 

Danny Edwards (Mascot Project Coordinator)