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Priority Setting for Health Research

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									Priority Setting for Health
         Research

Adnan A. Hyder, MD MPH PhD
 Department of International
 Health Bloomberg School of
        Public Health
Johns Hopkins University, USA
    (ahyder@jhsph.edu)
   Health Research & Development:
   A Global Imperative
1. Population: the most valuable Asset of a country.
2. Value of the Asset is measured by its Health Status.
3. Health Status depends on many Determinants.
4. With unlimited resources, we could act on all
  determinants.

5. Resources being limited, we have to select the
  determinants which have the greatest impact on health.

6. Only through research can a country identify the key
  determinants for the health of the country.

7. Conditions of success: keep research out of isolation.
     Population and BOD by
   Country Income Level in 1998
                  Low-Middle    High



 Population in    4.976.748    907.828
  thousands         (85%)       (15%)
     (%)
Total DALYS (in   1.274.259    108.305
  thousands)        (92%)       (8%)
      (%)
 The Burden of Disease by Income
      (DALYs/100,000 pop)
                   Low-and         High-income
                   middle-income

Comm. Dis (incl.       11,206         863
Mat, perin, &
Nutr)
Non-                   10,200         9,664
communicable
diseases
Injuries                4,198         1,403
The 10 90 Disequilibrium

      $56 Billion spent every year on
       health research.

      Only 10% used for health
      problems of 90% of the world ‟s
      people.
Can We Do Something About
 The 10 90 Disequilibrium?


Priortity Setting in Health Research at
the National & Global Levels.
    Why Prioritise a Research
            Agenda
• Limited resources
• Balance interest of constituencies
• Coordination amongst players
• Local requirements
• Tool development vs.
  implementation
• Levels of intervention
Priority Setting Tools

– Systematic method
– Applicable at various levels
– Evidence based
– Provide linkages between tool
  development , application and policies
– Comparisons amongst (within) diseases
– Assists in the identification of gaps
    Priority Setting Process
•   Problem definition
•   Identification of stakeholders
•   Description of an „ideal‟ control situation
•   Identification of literature of research
•   Description of information gaps
•   Review of national activities
•   Review of institutional comparative advantage
•   Matching requirements of other programmes
  The « Five Steps » in Priority
  Setting: Ad Hoc Committee,
  WHO 1996
What is the burden
of disease?
  The « Five Steps » in
  Priority Setting
                     Why does the
What is the burden
                     burden persist?
of disease?
  The « Five Steps » in
  Priority Setting
                     Why does the
What is the burden
                     burden persist?
of disease?


                      How cost-effective
                      are present
                      interventions?
  The « Five Steps » in
  Priority Setting
                              Why does the
What is the burden
                              burden persist?
of disease?


                                How cost-effective
                                are present
                                interventions?

                How cost-effective
                could future
                interventions be?
  The « Five Steps » in
  Priority Setting
                               Why does the
What is the burden
                               burden persist?
of disease?


                                 How cost-effective
What is the present
                                 are present
resource flow for that
                                 interventions?
disease/risk?

                 How cost-effective
                 could future
                 interventions be?
An Institutional Overview of the
Determinants of Health: Global
Forum for Health Research, 1999


                      HEALTH
An Institutional Overview of
the Determinants of Health
                 1. Individual, Family &
                       Community
                      Determinants



                        HEALTH
An Institutional Overview of
the Determinants of Health
                 1. Individual, Family &
                       Community
                      Determinants



                          HEALTH


                2. Level of Health Ministry,
                Health Research
                Institutions, Health
                Systems & Services
An Institutional Overview of
the Determinants of Health
                       1. Individual, Family &
                             Community
                            Determinants

        3.Level of
        other                   HEALTH
        Sectors
        than Health

                      2. Level of Health Ministry,
                      Health Research
                      Institutions, Health
                      Systems & Services
  An Institutional Overview of
  the Determinants of Health
                             1. Individual, Family &
                                   Community
                                  Determinants

              3.Level of
4. Level of
              other                   HEALTH
the Central
              Sectors
Government
              than Health

                            2. Level of Health Ministry,
                            Health Research
                            Institutions, Health
                            Systems & Services
  FIVE STEPS IN           Actors/Factors Determinig The Health Status of a
PRIORITY SETTING                  Population (Intervention Levels)
                                        (b) Level of Health
                     (a) Individual,
                                         Ministry, Health         (c)Level of   (d) Level of
                       Family &
                                       Research Institutions,   Sectors Other     Central
                      Community
                                        Health Systems &         Than Health    Government
                          Level
                                             Services

I. DISEASE BURDEN        I(a)                  I(b)                 I(c)           I(d)



II. DETERMINANTS
                         II ( a )             II ( b )             II ( c )       II ( d )
FOR PERSISTENCE


III. PRESENT LEVEL
                        III ( a )             III ( b )            III ( c )      III ( d )
OF KNOWLEDGE

IV. COST-
EFFECTIVENESS OF
                        IV ( a )              IV ( b )             IV ( c )       IV ( d )
FUTURE
INTERVENTIONS
V. RESOURCE
                         V(a)                 V(b)                 V(c)            V(d)
FLOWS
      Common Framework

•   Consolidates information
•   Promotes communication
•   Identifies linkages (basic - applied)
•   Places research into context
•   Assists identification of research areas
    (competitive advantages)
Factors Necessary for Capacity
Strengthening:
•   Defined national research priorities
•   Systematic effort involving all actors
•   Multi-disciplinary approach
•   Sustained effort with a long-term perspective
•   Balance between human and physical capacities
•   Defined policy to limit brain drain
•   Measurable indicators of success
•   Systematic analysis of factors of success/failure
•   Regular consultations at regional/international
    levels
Points for Discussion: Diversity
• Overall health research governance:
  – diversity of actors
  – define roles and collaboration principles.
• Fields of health research:
  – (1) biomedical issues
  – (2) behavioural and community issues
  – (3) sectors outside health with profound
    influence on health
  – (4) good governance issues affecting health
    research.
    Points for Discussion: The
         Research Loop
• The research “loop”:
  – (1) creation of knowledge
  – (2) validation of knowledge
  – (3) transformation into best practices
  – (4) dissemination
  – (5) identification of gaps and development
    of initiatives to fill the gaps
  – (6) development of indicators to measure
    impact on health status
  – (7) feedback on orientation and design of
    future research - focus on the weakest link/s.
      Points for Discussion:
      Remember the Goal of
            Research

• How to increase the
  efficiency/effectiveness of the research
  “loop”:
   – research (process, tool)
   – knowledge (research outcome)
   – change in health status of populations
     (global objective).
Communication
& Information
Special
                 Communica
Reports
                 tion with
  Web            Decision
  Site           Makers

                 Strategic
 Work with the   Papers
 Media (North&
 South)
              Conclusions
• Identifying priorities is as important as
  conducting research itself.
• The process is a critical part.
• The methods presented here are tools.
• Review information available and
  research conducted elsewhere.
• Consider a wide variety of areas
  including conditions and risk factors.
              References
• Global Forum for Health Research. The
  10/90 Reports on Health Research. Geneva:
  GFHR, 2000 and 1999
  (www.globalforumhealth.org)
• WHO. Ad Hoc Committee on Research.
  Geneva: WHO, 1996 (www.who.int)
• Essential National Health Research. Council
  on Health Research for Development.
  Geneva: COHRED, 2000 (www.cohred.ch)

								
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