Health Research for All: the role of innovation in Global Health in the post-2015 development framework

*   *   *   *   *

SPEED READ

– The Council on Health Research for Development (COHRED), along with the Global Health Council (GHC), the Drugs for Neglected Diseases initiative (DNDi), the International AIDS Vaccine Initiative (IAVI), and the Global Health Technologies Coalition (GHTC) hosted an official nongovernmental organization (NGO) side session at the 67th annual World Health Assembly (WHA) to explore the role of R&D in the post-2015 development agenda.

– The event organizers developed a statement urging MemberStates and delegates to support health research and related policies and capacity building as a core component of a post-2015 agenda for equitable health and sustainable development.

–  WHA Member States approved a resolution on health in the post-2015 development agenda that called for completing the unfinished work of the health Millennium Development Goals (MDGs) and noted the importance of universal health coverage and stronger health systems.

*   *   *   *   *

The eight MDGs have been a milestone in global health and national development efforts, focusing concerted action on crucial themes such as halting the spread of HIV/AIDS, reducing child mortality and improving maternal health. However, as the final deadline of 2015 is rapidly approaching, it is evident that progress on the selected goals has been uneven within and across countries. Thus, further efforts and a renovated, stronger-than-ever global partnership is needed to arrive at a global development agenda beyond 2015.

COHRED, GHC, DNDi, IAVI, and the GHTC organized a side event focused on the critical role of global health research, development and innovation (R,D&I) in accelerating and sustaining progress in global health within the post-2015 development framework at the 67th annual WHA held May 18-24th 2014 in Geneva, Switzerland.

dsc_9068

Panelists included representatives from Kenya and Senegal member states as well as high-, low-, and middle-income country stakeholders from both public and private sectors: Dr. Seth Berkely, CEO of the GAVI alliance, Dr. Christine Sow, Executive Director of the GHC, Mr. Jon Pender, VP government affairs of GlaxoSmithKline, Prof. Osman Sankoh, CEO of the INDEPTH Network, Mr. Rob Terry, Manager of Knowledge Management at TDR and Prof. Carel IJsselmuiden, CEO of COHRED.

All the panelists stressed the importance of R,D&I for health and sustainable development. Rob Terry began his talk with a quote from Mary Lasker: “If you think research is expensive, try disease.” He then explained how the Global Health Observatory shall contribute in covering the current gaps in information on research activities in low- and middle-income countries (LMIC). Prof. Osman Sankoh, as spokesman of the INDEPTH network of 42 health and demographic surveillance systems in 20 LMICs, underscored the need for robust data on individual level to guide policymaking. Mr. Jon Pender said that the public private partnerships approach had delivered for global health and that health should remain a priority in the post-2015 agenda.  “Advocates have a job to do to ensure health is a priority in the post-MDG agenda where there will be 16 goals,” remarked IAVI in a tweet.

Both Kenya and Senegal representatives insisted on the need for new innovative health tools, higher national and international funding for R,D&I, as well as partnerships with the private sector. Principal Secretary of Health, Prof. Fred Segor said in Kenya the new 2013 S,T&I (Science, Technology and Innovation) Act pledged 2% of GDP to the national research fund. Seth Berkley said that equal health across the world cannot be achieved without new health tools and called for a truly global scientific movement to tackle effectively the challenges of R&D financing and capacity building.

Untitled

“GHC and its membership are collectively tasked with moving the needle in the direction we see for the future of global health. This means supporting evidence-based policy change and the operational elements that will mean its success. The World Health Assembly is a unique venue providing a platform for multi-sectoral, multi-issue engagement; the strength and profile of GHC’s membership means that our role can only increase over time. Going forward, we will be sure to optimize the collective impact of our actions and voices,” stated Christine Sow, Executive Director of the GHC, in a related blog post.

Reporting and commenting on the news on research and innovation as emerged from the WHA, GHTC’s coalition director Kaitlin Christenson wrote: “Early in the week, Member States also passed a resolution calling for new tuberculosis (TB) targets, which should be reflected in the post-2015 development agenda. The resolution specifically calls for a 95 percent reduction in deaths from TB by 2035 and notes research and innovation as one of three key pillars that will help achieve this goal.”

Prof. Carel IJsselmuiden, COHRED CEO and chairman of the session, ended the meeting with the following statement developed by the organizing NGOs, urging MemberStates and Delegates to support health research and innovation policies as a core component of the post-2015 agenda to achieve health and sustainable development for all:

 Statement on the role of Research and Innovation to Achieve Health for All and Sustainable Development

 67th World Health Assembly, Geneva, 22 May 2014

 Commitments to the Millennium Development Goals have made a major contribution to the success of global health efforts over the past decade, helping to sustain focus on some of the greatest global health challenges. The post-2015 development agenda must build on these achievements, to ensure that Healthy lives and access to health services for all can be achieved in an equitable and sustainable way.

Achieving equitable and sustainable Health for all requires continued support for Research and Development for new or improved medicines, vaccines, diagnostics, devices and other health tools that work for and are accessible to those most in need. Continuous investment of human and financial resources in science, technology and innovation to improve health and equity is essential to achieve economic and social development.

Strong political leadership, as well as international and multi-sectoral collaboration will be needed for achieving innovations in health care and delivery. In particular, we need policies, incentives and sustainable financing to fully support research and development of affordable and accessible vaccines, medicines, diagnostics, devices and other health tools for diseases that mostly affect low- and middle-income countries and/or marginalized populations. And we need a commitment to the development and implementation of policies that facilitate capacity building, collaboration and knowledge and technology sharing.

We urge Member States and Delegates at the World Health Assembly to explicitly support health research and related policies and capacity building as a core component of a new Agenda for equitable health and sustainable development.

By the end of the week, WHA Member States had approved a resolution on health in the post-2015 development agenda that called for completing the unfinished work of the health MDGs and noted the importance of universal health coverage and stronger health systems.

Golbahar Pahlavan (COHRED)

Tackling health inequalities: the MASCOT vision

*   *   *   *   *

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.

*   *   *   *   *

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.

brochure_cover

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.

mascot_banner_201204021

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)

Forum 2015: People at the center of research and innovation for health

*   *   *   *   *

SPEED READ

– The Global Forum for Research and Innovation for Health is the successor of the Global Forum for Health Research that merged with the Council on Health Research for Development (COHRED) in 2011. Forum 2015, as it will be abbreviated, will provide an opportunity for everyone interested in pursuing global health, equity and development to meet, exchange information, find partners, design solutions and set research and innovation agendas – nationally, regionally and globally.

– Forum 2015 will be jointly hosted by the Department of Science & Technology and the Department of Health of the Philippines and COHRED in Manila, Philippines, 25-27 August 2015.

– Investment in health and in research and innovation for health is a key element for sustainable economic development. Strengthening national health research and innovation capacity and optimizing research and innovation systems will increasingly enable low and middle income countries, institutions and business to participate in setting a shared global health agenda and solve shared problems.

*   *   *   *   *

Towards a new Forum

Secretary Mario G. Montejo of the Department of Science and Technology (DOST) and COHRED signed the agreement for the Philippines to host the Global Forum for Research and Innovation for Health 2015 in Manila last 14 March 2014 during the 32nd Anniversary of the Philippine Council for Health Research and Development at Makati City, Philippines. [1]

The 2015 edition of the Global Forum will see the completion of a major transformation: from a platform focused on redistributing research resources from ‘North’ to ‘South’ as in ‘closing the 10/90 Gap’ towards a new Forum, that will emphasize the new global reality of the greatly increased capacity, funding and potential of low- and middle-income countries themselves in terms of research and innovation for health. Instead of being an advocacy platform for high-income countries to spend more on the problems of low- and middle-income countries, the new Forum will speak to the growing ability and assertiveness of low- and middle-income countries to be active partners in setting local, regional and global research agendas for health – and to their rapidly increasing ability and willingness to contribute to solving problems of both global and local relevance and reap the scientific, health and developmental benefits from doing so. An example of this is that the new Forum is no longer ‘donor-funded’ – but host countries contribute up to a third or more of all costs.

The new Forum will remain a place like no others, where governments, industry, non-profits, health sector organisations, science bodies, researchers and development experts – and you – can think, talk, meet, focus, design on improving health, equity and development, sustainably, through research and innovation.

“The strong participation of institutions from the North will signal a shift in the North-South relationship from donor to partner, made possible by the growing and maturing R&D capacity in the region and in the Philippines, blurring the borders that previously existed between North and South research institutions,” said Gerald Keusch, at the Schools of Medicine and Public Health, Boston University (MA, USA), and member of the COHRED Board. “I anticipate an exceptional meeting and many new scientific relationships developing as a result, both North-South and South-South, in support of their common goals to improve health, equity and development in low and middle income countries through the creation of strong national research and innovation systems.”

Secretary Mario G. Montejo of the Department of Science and Technology (left) and Prof. Carel IJsselmuiden of the Council on Health Research for Development (COHRED) (right) during the signing of  the Agreement for hosting the Global Forum for Health Research 2015 in Manila. Credit: Philippine Council for Health Research and Development
Secretary Mario G. Montejo of the Department of Science and Technology (left) and Prof. Carel IJsselmuiden of the Council on Health Research for Development (COHRED) (right) during the signing of the Agreement for hosting the Global Forum for Health Research 2015 in Manila. Credit: Philippine Council for Health Research and Development

“The Philippine National Health Research System (PNHRS) is a community-in-progress. In the first decade of its existence, the different stakeholders across all sectors of Philippine society interacted and worked together to develop a unified research agenda, implemented this agenda based on available resources, and built human capacity and support systems,” said Jaime C. Montoya, Executive Director of the Philippine Council on Health Research and Development. “Our country is investing more and more in health research. With increasing investments in health research, the need for a bigger pool of health research human resource, research facilities and support systems cannot be overemphasized. Research resources are important, not only for projects, but for people who will do the research, and translate the findings into health benefits that people can enjoy and confidently attribute to research.”

A strong regional flavor

“The agreement to host the Global Forum in Manila represents a landmark for the two partners, to look forward to expanding and developing health for research and innovation capacity in the Asian region in general, and in the Philippines in particular. The opportunities for regional networking this meeting will present are exceptional,” said Keusch.

Indeed, one of the declared objectives of Forum 2015 is to encourage diplomacy to create a regional approach to research and innovation for health as key factors of development. In 2015, Manila will also be host to the APEC meeting, and this year will be historic for the 10 ASEAN countries and beyond, as another major step on the road to ASEAN harmonization will be signed.  The ASEAN region has witnessed one of the strongest economic growth rates in the world in recent times, but this has not yet translated in a comparable development of science, technology and innovations for health. The explicit purpose, therefore, is to tap into the strong regional network of universities, research institutions, business, NGOs, media and more to let health research and innovation start serving everyone, both in the Philippines and other countries in the region.

Credit: Philippine Council for Health Research and Development
Credit: Philippine Council for Health Research and Development

“Global Forum 2015 in Manila will bring in a new level of recognition for Manila and the Philippines as an event venue for health research. In the process, the Philippine health research and innovation community will benefit through the exchange of expertise and information between and among international partners,” said Montoya. “Global Forum 2015 is an umbrella of many events, converging in August 2015, and spilling beyond the conference dates. We hope to bring a distinctly Philippine flavor to this global event, introducing new ways of engaging peoples of the world to the theme: People at the center of research and innovation for health.”

Watch this space for more information – but only after you have booked the dates : 25-27 August 2015! See you there.

Carel IJsselmuiden

[1] (see also: http://www.pchrd.dost.gov.ph/index.php/2012-05-23-07-46-36/2012-05-24-00-01-11/6656-dost-cohred-sign-agreement-for-philippine-hosting-of-global-forum-2015-in-manila)

Science for health diplomacy: complex problems need complex solutions

*   *   *   *   *

SPEED READ

– Almost any major problem in global health – from discovering new drugs to developing vaccines, to finding solutions to environmental changes that can affect health in vulnerable countries – requires research and innovation solutions that are beyond the scope of individual countries, organisation, or companies

– In the case of research and innovation for health, there are few, if any, functional platforms where multiple players can negotiate towards creating constructive solutions, or share global resources better. That is where COHRED wants to play a role

– Following the merger with the Global Forum for Health Research, COHRED will develop its ‘Global Action’ or ‘Science for Health Diplomacy’ arm to generate national, regional or global agreements or agreements involving a complex array of partners, enabling sustainable and usually complex solutions for complex global health problems

*   *   *   *   *

An interdependent world

Global health diplomacy is a relatively new concept, that can be loosely defined as “the processes by which government, multilateral and civil society actors attempt to position health in foreign policy negotiations and to create new forms of global health governance”. Or, to go with the words of the World Health Organization, “[g]lobal health diplomacy brings together the disciplines of public health, international affairs, management, law and economics and focuses on negotiations that shape and manage the global policy environment for health. The relationship between health, foreign policy and trade is at the cutting edge of global health diplomacy”.

Besides the ‘foreign policy and trade’ nuances, the reality is that almost anything that is relevant to major problems in global health – from discovering new drugs to developing vaccines, to finding solutions to environmental changes that can affect health in vulnerable countries – requires resources that are beyond the scope of individual countries, organisation, or companies.

Yet, there are currently very few platforms that can bring the many actors together in ways that lead to rapid and comprehensive research and innovation to the increasingly complex problems in global health. While there are successful examples, such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, the GAVI Alliance, or IAVI, these represent mostly once-off efforts that can not be easily replicated to deal with the research and innovation needs in global health. In fact, we see no such platforms anywhere. Just think about the research and innovation challenges raised by drugs for neglected diseases, new vaccine development, genomic research to improve health in low-income countries, innovation required to deal with food security in Africa before climate change causes a permanent disaster, and more. Where can we combine the experts in ‘big data’ collation and analysis together with governments of low-income countries? How can the research capacity in private health care industry be made available to improve public health services? To name just a few examples.

Credit: European Business Review
Credit: The European Business Review

A role for COHRED?

That is where COHRED is aiming to locate its ‘Global Action’ work that follows our merger with the previous Global Forum for Health Research. We aim to play a role, driving the development of a much-needed platform for low- and middle-income countries to help set more strongly the global health and health research agenda and start featuring what they can contribute to it, as opposed to the past, with the agenda being mostly set by donors from the north.

Think about Africa for a moment. If Africa, politically speaking, would be able to portray itself as a continent of a billion consumers instead of “54 problem countries with a one or two stars” – and if COHRED can contribute to this in the field of research and innovation for health, we can literally turn another page in dealing with global health. If this platform would enable African players to find practical solutions, for example in pharmaceutical production, we can support this new look of Africa. Let us say that we can do a rational ‘division’ of research and innovation – South Africa to focus on HIV/AIDS research and pharmaceutical production, Kenya could take on tuberculosis, Tunisia could take on to high-tech drugs for non-communicable diseases, and so on.

The same can of course apply to other parts of the world. A major middle-income country, like the Philippines, could for example bring together ASEAN countries to think about how research and innovation can support the regional efforts and how it can help set and contribute to the global agenda for research and innovation for health. But in the absence of a reliable platform in which these countries can negotiate, even at the sub-regional level, it is going to be complex to talk about a shared research health agenda or a specific disease to tackle.

Recently, COHRED was officially invited to attend the 32nd anniversary celebration of the Philippine Council for Health Research and Development (PCHRD) in Manila, in March. PCHRD is a forward-looking, partnership-based national body responsible for coordinating and monitoring research activities in the Philippines. Given the number and severity of the natural disasters that struck the archipelago in the past years – including typhoons, floods, earthquakes, the latest one being typhoon Haiyan, that last November exacted a deadly toll of over 6000 people in the country – this year’s anniversary theme will be “The Filipino Resilience in Crises: Connecting Health R&D and Emergency Health Management”. Needless to say, apart from economic, social and environmental implications, these events also have important impact on the well-being and health status of large sectors of society. The celebration will also offer the opportunity to sign the agreement on delivery of the next Global Forum for Health Research meeting – in its new outlook – with the Ministry of Science & Technology of the Philippines. The previous Forum was held in 2012 in Cape Town, South Africa.

Philippine Council for Health Research and Development
Credit: Philippine Council for Health Research and Development

Forum meetings, Colloquia meetings. Although different in size, targeted topics, and audience, both are instrumental to the attempt to help build bridges, so that we can use the capabilities of countries, financiers and institutions to bring them together around solutions. At the inter-regional and continental level there are many issues that can be sorted out, in term of science and technology, and require a place where people can meet and talk and come up with solutions. “Meetings, and the successful execution of them, have become unfairly undervalued in my view. Important progress can be made on difficult global health issues, both in front and behind the scenes at well designed gatherings. Well structured, planned events  give people who don’t usually interact the chance to meet,” said Danny Edwards, Manager at COHRED Think, a Unit within COHRED that combines ideas, insights and intelligence to find innovative solutions to challenges and answers to opportunities that make research and innovation work even better. “The meetings we have held at COHRED strive to make these sort of productive interactions possible. We’ve emphasised an informal atmosphere, more interactive sessions, Chatham House rules where necessary, and work hard to bring in a broad mix of public and private players. Through all this we create an environment where understanding can be reached, decisions made, and partnerships formed. All aimed towards greater research for health and development.”

Carel IJsselmuiden

Aid in the third millennium: marrying relief with development

*   *   *   *   *

SPEED READ

– the international community should marry emergency relief interventions with solid system building capabilities. Complementarity is the real answer

 – research and innovation for health should be seen as key drivers for development – also in lower income countries

 – countries can begin and further optimize their research and innovation systems by defining research and innovation priorities; creating a policy framework to act on these priorities; and develop a national research and innovation management office – so, decisions can be taken and communication can be done. COHRED’s core competence is supporting countries in achieving these – and more

*   *   *   *   *

Africa calls

Armauer Hansen Research Institute (AHRI) is a government biomedical research institution in Addis Ababa, Ethiopia. Founded in 1969 through the initiative of the Norwegian and Swedish Save the Children organizations, AHRI was erected next to a large hospital for leprosy patients, with the specific mission of developing tools for the prevention, control and treatment of mycobacterial infections. Current research activities focus on tuberculosis, HIV, malaria, leishmaniasis, and other diseases of public health importance in Ethiopia.

Notwithstanding these apparently clearly defined goals, AHRI is admittedly in a transitional phase, “undergoing reform to transform itself to be an institute embracing research agenda which will have direct impact in development and transformation of population in Ethiopia and Africa” (sites/ahreaccr.org/i/).

Africa calls, COHRED answers

COHRED, the Council on Health Research for Development, is a global, non-profit organisation with a unique approach to development problems of people living in low- and middle-income countries. COHRED strongly believes research and innovation are potent drivers of sustainable development, for everyone and everywhere, and strives to provide leadership and effective solutions to support low- and middle-income countries to build their own research and innovation systems for health, equity and development.

Very recently, the Ministry of Health of Ethiopia has requested COHRED to define a strategy for the positioning of AHRI in the Ethiopian research system for health, following a detailed analysis of the national situation and after profiling AHRI and its competencies.

Unaligned aid, fragmented landscapes

The AHRI case is by no means an isolated one. Developing countries host a multitude of research institutions that have been set up in the past thanks to the financial, scientific and managerial guidance provided by donors. Needless to say, in most cases activities within these research centres reflected donors’ priorities rather than those of national health research systems, that in many instances were simply non-existent. In other words, the classic stand-alone, vertical programme approach. But as the years went by, and the global research agenda shifted towards different diseases or health-related issues, so did donors’ interest and attention. As a result, many research centres in developing countries – some of which of very good level and with well educated workforce– ended up being disconnected by national health systems. These, one their side, have not been able in many cases to integrate health research into a systems approach, with research continuing to be fragmented, uncoordinated, and based on small-scale activities.

Bobo-Dioulasso, Burkina Faso. Credit: Gabriela Montorzi, COHREDBodo-Dioulasso, Burkina Faso. Credit: Gabriela Montorzi, COHRED

Burkina Faso, were a number of health research structures are present, is a paradigmatic example of this widespread situation. A few years back, COHRED performed a so-called ‘Alignment and Harmonization Study’ for the country . Alignment refers to the donor commitment to base development assistance on partner countries’ strategies, institutions and processes, while harmonization is the commitment by donors to rationalize their multiple activities in ways that maximize the collective efficacy of aid under country ownership. The study acknowledged the positive initiatives undergone in recent years to strengthen the country’s national health research system, but also highlighted the standing poor coordination among health research actors. “There is health research in Burkina Faso but there is no health research system,” the study reports quoting an interviewee, and what you have on the ground is “A fragmentation of health research with each research institution undertaking research activities according to its own priorities, donor’s priorities and/or researchers’ field of interest without any coordination with the Ministries and other research institutions.” On the other hand, the study stressed, in the absence of a well-defined agenda for health research at the country level, it is currently difficult for donors to effectively align their interventions with countries’ policies and strategies.

What you find in the African context in particular, is that research is really driven by vertical programmes. This way you create a fragmented health system of institutions that, when donors’ enthusiasm wanes off or the money stops, find themselves left-behind and isolated.

Beyond relief

The gist of the matter is the need to move beyond the aid model of knights coming from the rich north in their shining armours and shields, bringing expertise and money to solve the problems of the poor south. That time is over, is gone forever. Countries need to come into control, building and managing their own systems. And research and science must be a key part of the development agenda. Thus, strengthening innovation systems – including all those ‘leftover’ research institutes, that must be aligned with countries’ health priorities and could be transformed to attract partnerships with northern institutions and grants from abroad – becomes the key to achieve equity and national development.

Think about the GAVI Alliance for a moment. This partnership is committed to increasing access to immunisation in poor countries, and has done a magnificent work in the field, saving an incalculable number of lives. But, after more than a decade working in Africa, which consumes most of the resources GAVI has recruited and mobilized so far, there is still not a single WHO-prequalified vaccine laboratory in the continent, except for a small yellow-fever outfit attached to the Institut Pasteur in Dakar, Senegal. So, ten years later we are exactly in the same dependency situation for Africa as we were at the beginning of GAVI. Now, for me this is not development. This is relief.

Of course, relief is important, and this is therefore the dilemma: were do we go with aid? It must be relief or development? Clearly, COHRED is on the side of development, but complementarity is the real answer. The international community should marry the emergency relief stuff with solid system building capabilities. And strengthening research systems could really help countries.

The way forward

How is then possible to stimulate science and technology as drivers of development? When people speak about capacity building they mean we train PhD students in London and then we send them back. In reality, if you really want to be able to start taking charge of research and innovation as strategies for development in your country, you need three things in place: credibly set and regularly updated health research priorities; a policy framework to activate the country on these priorities; and some research management capability, such as a medical council or alike. We call these the ‘Holy Trinity’. COHRED can then support country partners, following a comprehensive approach that integrates fundamental national principles into an ‘ideal national research and innovation’ system (www.cohred.org/approaches/).

Bobo-Dioulasso, Burkina Faso. Credit: Gabriela Montorzi, COHRED
Bodo-Dioulasso, Burkina Faso. Credit: Gabriela Montorzi, COHRED

But, above all, there must be readiness to engage in all this. If there is no political commitment to R&D or to making funding available to improve health for everyone, nothing is going to happen. “It really depends on what countries are interested in doing. We don’t go there to work for them. We work in partnership. We don’t impose. They need to ask for it. They need to drive it. We cannot write a policy for them, for instance. It has to come from them. There has to be a leadership,” said Gabriela Montorzi, Manager of Country Support at COHRED.

Although many stories can be mentioned that point to the effectiveness of this approach, the process can be very long, and success is difficult to measure on the short term, Montorzi remarked. However, this is not always the case. “A project COHRED helped to draft along these lines in the recent past, has allowed Liberia to set up a research unit within the Ministry of Health that did not exist before. So it’s already giving a specific place to research. And it’s likely that the unit will continue. So, that’s a short-term result that is quite tangible,” Montorzi said.

Carel IJsselmuiden