Category Archives: Research for Health

A healthy society is a disaster resilient society

Disasters are usually measured by the number of deaths, injuries and damage to property that they cause. But, do these measures truly express the magnitude of damage to people’s health and quality of life?

In 2011, the earthquake that struck the Pacific coast of Tōhoku, with a magnitude of 9.0 (Mw), was the largest to ever hit Japan and the fourth most powerful in recorded history. Strong national building codes protected most of the buildings in Japan from this devastating earthquake and saved many lives as a result, but the people affected by that disaster still suffer from chronic illnesses, mental problems, loss of family and exposure to nuclear power plant accidents—most notably Fukushima, which continues to pose contamination risks due to the severe infrastructure damage it incurred during the earthquake. The public health situation of a community is a key factor in measuring their resilience against disasters, and accordingly, the strengthening of mental and physical health must be made a priority when looking to curb the risks posed such disasters in the future.

On the other side, the process of rebuilding after a disaster is just as important as the capacity and resilience building processes that happen prior to a disaster. Health professionals have an important role to play in facilitating mutual, cooperative relationships with non-health professionals as they work together to help rebuild communities. Specialists, such as those involved in disaster medicine, need to forge partnerships with general health providers to create a unified approach to community resilience and rebuilding programs. The role the health professional plays is not only important in the acute response to injuries caused by disasters, but also in preparedness work, which is crucial to later making an efficient response to any disaster.

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In Japan, for example, nation-wide disaster medical response systems have saved many lives.  With the Tōhoku earthquake in 2011, systems such as disaster-base hospitals, disaster medical assistant teams (DMAT), staging care units (SCU), wide-area transportation systems, emergency medical information systems (EMIS) and disaster medical-public health coordinators worked efficiently in the immediate aftermath of the earthquake, saving countless lives and limiting the impact of the disaster.

Despite these efforts, however, the medical and public health needs of the affected people exceeded the relief capacities in place at the time and, indeed, for several months after the event. Mental health problems including post-traumatic stress disorder (PTSD), depression and alcoholism are still huge problems in those affected, and it will take years to find solutions to these issues. Medical and public health preparedness should be emphasized and prioritized in order to build resilience to disasters in the form of long-running, systematized global health programs.

During the International Symposium for Disaster Medicine and Public Health Management that took place last May, scientists and experts in disaster medicine and public health reached a consensus that health concerns should be imperative in the formulation of disaster risk reduction interventions. Prioritization of the people’s mental and physical health in the process of disaster risk reduction should be in included in frameworks and policy at all levels. Preparation for people who need special assistance, such as those with disabilities, children and women, elderly people, people with chronic illnesses, foreigners and travelers, cannot be made without their own participation in the process of disaster risk reduction planning. 

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To achieve the above, education and training of general health-care providers and the continued development of the field of disaster medicine and public health are the only methods that will lead to long-lasting implementation.

All of this has been in the spotlight at the 3rd World Conference for Disaster Risk Reduction taking place in Sendai, Japan earlier this month. The Hyogo Framework for Action (HFA), endorsed by the UN General Assembly in 2005 to make the world more disaster resilient, will be revised in Sendai to reflect the post-2015 development agenda and give greater emphasis to the health of those vulnerable to the risk of natural disasters. The original HFA did not do enough to influence the design of existing national social protection mechanisms, particularly with regard to health programs and education schemes, which are crucial to building resilience to disasters. The new framework HFA framework under discussion in Sendai is meant to cover the next 20-30 years and will be expanded to include such important areas of social protection, like heath and education, effectively leading to the scaling-up of disaster resilience before disasters hit.

We, as health professionals, are striving to strengthen community resilience to disasters through the improvement of physical and mental health services. To do this, health professionals must be regarded as a key stakeholder working in concert with other professionals in the field of disaster risk reduction.

Shinichi Egawa (Tohoku University)

 

COHRED’s take on Prof. Egawa’s excellent contribution

In this guest post, Shinichi Egawa—Division of International Cooperation for Disaster Medicine, International Research Institute of Disaster Science (IRIDeS), Tohoku University—writes about disaster resilience as a necessary trait of ‘healthy’ societies. Governments across the globe are scaling up their combined efforts to reduce the risk of natural disasters. What role can evidenced-based health research, innovations and findings play in shaping local, regional and global Disaster Risk Reduction (DRR) responses? How can we change from ‘disaster preparedness’ to ‘increasing community resilience’? How can public, private and non-profit interactions be streamlined to increase efficiency and impact and reduce duplication? How can we optimize technology and human resource development in early warning, mitigation and post-disaster response? These and other key issues will be under the spotlight at the forthcoming Forum 2015 in Manila, Philippines, for which Prof. Egawa is part of the DRR scientific committee. COHRED firmly believes research and innovation are key to make societies healthy and thus, as Prof. Egawa maintains in his post, disaster-resilient. We therefore aim to stimulate widespread discussion on specific recommendations to strengthen national (health) research and innovation systems to make societies in low- and middle-income countries (LMICs) more resilient after natural hazards/disasters and adaptable to climate changes. Everyone interested in helping to develop the research and innovation systems of LMICs to become more disaster resilient – should be in Manila in August!

Carel IJsselmuiden (COHRED)

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

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SPEED READ

– 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.

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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 musolino@cohred.org).

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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SPEED READ

– 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.

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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.

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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

Fostering sustainable investment in research for health

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SPEED READ

– The Council on Health Research for Development (COHRED) and its partners have recently held an international meeting aimed at identifying opportunities, possible solutions and strategies for moving towards sustainable investment in research for health in low- and middle-income countries.

– The final meeting report offers an overview of innovative financing mechanisms for health research and development, also commenting on the relevance and feasibility of applying such mechanisms in low resource contexts. Recommendations for taking steps towards developing integrated innovation systems, shifting from funding to investment, and engaging in advocacy for research for health financing have also been issued.

– The creation of an ‘African research space’ was recognised as a major driver for optimising African research development while maximising local and global investments. To support this, COHRED has recently launched COHRED Africa in Gaborone, Botswana. COHRED Africa expects to make its technical, advocacy and think tank contributions to science and innovation for health in Africa – and, where appropriate, globally as well.

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Financing health research in a changing landscape

“Healthcare demands in Africa are changing. Ensuring access to clean water and sanitation, battling ongoing communicable diseases and stemming the tide of preventable deaths still dominate the healthcare agenda in many countries. However, the incidence of chronic disease is rising fast, creating a new matrix of challenges for Africa’s healthcare workers, policy makers and donors.” These words, from a recent Economist Intelligence Unit’s report on the future of healthcare in Africa, give a precise idea of the challenges African countries, and more in general low- and middle-income countries (LMICs), will have to face in order to tackle the public health needs of an ever-growing population.

As most stakeholders agree, for health systems in LMICs to be able to cope with existing and future challenges, it is of absolute importance to increase investments in research and development (R&D). But who should pay for health-related R&D in Africa and LMICs? How to mobilise research funding? Can innovative financing mechanisms be identified to help meeting the growing health burden through investing in R&D?

To address these crucial issues, last June, in the framework of the seventh EDCTP Forum in Berlin, Germany, COHRED, in partnership with the West African Health Organisation (WAHO) and the New Partnership for Africa’s Development (NEPAD) Agency, held a meeting on “Sustainable Investment in Research for Health”. Attended by 35 participants from both the public and private sectors and representing European and African institutions, the meeting aimed at identifying opportunities, possible solutions and strategies for moving towards sustainable investment in research for health.

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Integrated innovation systems must be in place

“To help reduce the burden of disease, meet constitutional obligations and spur economic growth, African countries need to increase their investments in health research and innovation”, recently remarked John Ouma-Mugabe, Professor of Science and Innovation Policy at the University of Pretoria, South Africa, in a policy brief.

However, most African countries still rely heavily on external donors and partnerships to fund local research, with the result that research activities do not necessarily respond to development needs of local population but rather of those inhabiting developed countries. In addition, the volume of R&D is significantly insufficient. To break this dependence-poor R&D budget loop and to focus efforts and resources on domestic health demands and priorities, African countries will need to promote innovation, attract investments, and raise funds. Tapping into the possibilities offered by innovative financing mechanisms to either mobilise new revenue or improve the use of existing funds, will certainly play a pivotal role in addressing such complex problems.

Besides overviewing innovative financing mechanisms and assessing the relevance and feasibility of applying such mechanisms in low resource contexts, meeting participants discussed in depth aspects seen as essential for creating the environment in which research financing can happen and the funds eventually raised be spent in a productive way. Accordingly, the issuing meeting report carries recommendations for taking steps towards developing integrated innovation systems, shifting from funding to investment, and engaging in advocacy for research for health financing.

Highlighted actions that should be taken around these issues include, but are not limited to, foster political will and interest through understanding what priorities governments have and showing how research can respond to these; show the actual investments made in research to demonstrate tangible return on investment; create integrated research and innovation platforms to make efficient use of existing resources and thereby incentivise investment; strengthen accountability and transparency to attract potential investors through strong financial and administrative systems; engage the media as an advocate by maximising opportunities to communicate research findings through research-savvy journalists and media-savvy researchers; widen the scope of the audience to include, for example, a range of stakeholders and sectors, such as finance, business, information technology and so on, showing return on investment and thus making health research attractive to all.

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Jacintha Toohey (above), Policy Project Adviser COHRED, and Carel IJsselmuiden (down), Executive Director, The COHRED Group, at the launch of COHRED Africa in Gaborone, Botswana,6 November 2014

Towards an ‘African research space’

Another key point discussed at length during the Berlin meeting was centered on the recognition that moving towards a shared research space would have the benefit of optimising African research development while maximising local and global investments. Although it is still a matter of discussion whether creation of this space – either in the form of a network, an organisation, or a virtual space – should be first implemented at a regional level or immediately be continent-wide, a number of steps were identified as critical in its creation:

– Map the landscape to understand what is already in place and how it can be utilised or improved.

– Harmonise stewardship through tapping into regional leadership bodies and establishing common regulation processes and research agendas.

– Engage all stakeholders through open dialogue and continuous feedback, both during the creation of this space and its operation.

– Secure consistent funding by identifying a range of funding mechanisms to ensure sustainability of the research space.

– Leverage Africa’s potential by creating a strong cohesive whole to stimulate innovation and give it an equal place at the global table.

To support this, COHRED itself has formally launched COHRED Africa in Gaborone, Botswana, three years after appointing the first staff. COHRED Africa is the basis for all our work done in Africa – but – also it will have its own expertise to contribute to COHRED’s global clients and activities. In the company of high level representatives of Botswana, Swaziland, Malawi, Kenya and the African Development Bank, many colleagues with whom COHRED has worked over the years and continues to do so, key partners such as the EDCTP and Pfizer, COHRED Africa expects to make its technical, advocacy and think tank contributions to science and innovation for health in Africa – and, where appropriate, globally as well.

Sylvia de Haan and Carel IJsselmuiden

Note: find below a few examples of the press coverage on the launch of COHRED Africa and relevant discussion

Invest in research to attract funding, African governments told

Scientists contest the value of research

COHRED Africa office prioritises research ethics