Health Research Priority Setting

Health Research

Priority Setting

in the Cooperation Council States

Prepared & Revised by

Dr. Tawfik A. M. Khoja

Dr. Mohamed S. Hussein

© Excutive Board of the Health Ministers’ Council, 2009

King Fahd National Library Cataloging-in-Publication Data

Khoja, Tawfik

Health Research Priority Setting. / Tawfik Khoja 2.. - Riyadh, 2009.

150 p. ; 24 cm.

ISBN: 978-603-90062-4-4

1 Medicine Research Arabian Gulf States 2 Medical care Arabian Gulf States 3- Medical policy - Arabian Gulf States I- Title 610.72053001 dc 1430 / 1372 L.D. no. 1430 / 1372 ISBN: 978-603-90062-4-4 Executive Board Of the

Health Ministers’ Council For GCC States P.O.box 7431 Riyadh 11462

E-mail: [email protected] www.sgh.org.sa

Contents

- Preface……….……...………... 9 - About the Health Research Priority Setting Gulf Workshop ... 15 - Scientific Programme Health Research Priority Setting

Workshop Riyadh 29-30 Dhual-Qa’dah 1428H /

9-10 December 2007... 17 - Address of Dr. Tawfik A. M Khoja, Director General

Executive Board, Health Ministers Council for

Cooperation Council States…... 21 - Health Research Priority Setting in the GCC

Dr. Tawfik A. M Khoja, Dr.Mohamed S. Hussein... 27 - Application of Combined Matrix Approach :

Experiences and Way Forward Dr. Abdul Ghaffar

Health Policy and Systems Specialist , GFHR,Geneva... 45 - Role and contribution of research (evidence) in

improved decision making Dr. Abdul Ghaffar

Health Policy and Systems Specialist , GFHR,Geneva... 55 - Prioritizing health research and development needs:

Eastern Mediterranean Experience Dr. Mohammad Afzal Regional advisor, Research Policy and Cooperation,

- Research Priorities Setting: King Abdulaziz City for Science and Technology Experience

Prof. Abdulrahman Alabdulalaaly... 91

- The Mechanism of Selection of Health Research Priorities in King Abdulaziz City of Science and Technology Prof. Othman A. Al-Shabanah, Ph.D. ... 99

- Country Presentations: 1- UAE: Dr. Saeed Abdu... 105

2- Kingdom of Bahrian: Dr. Jamal Alsayyad... 113

3- Kingdom of Saudi Arabia: Dr. Faisal Abu-Dhuhier... 119

4- Sultanate of Oman: Mr. Hilal Al-Kharusi... 125

5- Qatar: Dr. Hassan AlHail, Dr. Sink and Dr. Ahmad AlMulla, Medical Research Centre... 139

6- Kuwait: Health Research Agencies... 143

7- Yemen: Mr. Tarek Salah Asad Al-Aghbary, Dr.Nour Addin Al-Jaber, Dr. Yahia Raj’a... 149

Preface

Praise be to Allah and Peace and Blessings on the most honorable of the Messengers and the last of the prophets Mohammad, Peace be Upon Him.

The Health Ministers’ Council for the Cooperation Council States gives a special priority to health research and positions it on the top of its agenda.

This is in realization that health research is an investment for health which should be given the due care at all levels, notably decision – makers and takers. Appropriate and enough budgets should be allocated and effective coordination with all health bodies, whether regional or international, should be done.

The impact of scientific research in various aspects of life became the main drive for the process of development. There is no doubt that health research, with the increase in the science and health technologies coupled with the importance of provision of high quality, evidence-based health care, has become a principal requirement. This led to study of the current situation from the perspective of scientific research and the world trends in this respect.

Many studies and reports (national, regional and international) showed that there is a gap in knowledge, data and research to make well-considered health information on which constructive health concepts, activities and policies can be adopted.

Hence the Global Forum for Health Research in Geneva affirmed the presence of an extremely important and serious gap, called the 10/90 gap. This gap illustrated that the amount of expenditure and allocations to face 90% of the real health problems especially in the developing world is no more 10% only and vice versa.

At the Gulf level, the process of coordination and integration in the field of scientific research and technical development in health research in the Council States has become a necessity which is mandated by the nature of the current circumstances, due to the common positive elements owned by these countries, which made it a principal pivotal issue for improving health care services.

In this respect, a Fund for Health Research at the Executive Board, Health Ministers’ Council for the Cooperation Council States has been established through which research projects (which are agreed upon according to certain criteria set for the priorities of these researches) are funded and supported in the member states.

This fund is supported from the annual contribution of each country after endorsement of those granted capacity at the MOH of the country.

On the other hand, the accumulation of previous research experiences, namely the Child Health Study, The Gulf Family Health Survey, in addition to conduction of a lot of research and studies in the member states such as the Global Tobacco Youth Survey, Burden of Diseases, STEP wise approach for non-communicable diseases as well as the World Health Survey which is currently underway.

To affirm this concept, The Health Ministers’ Council for the Cooperation Council States in collaboration with the Eastern Mediterranean Region (EMRO) and the Global Forum of Health Research organized the regional joint Health Research Priorities workshop which was held in Riyadh (29-30 Dhual-Qa’dah 1428 H / 9-10 December 2007).

This workshop also emphasized the continuous role of the Executive Board in promotion of health research, and support of information technology and making this a basis for taking health decisions based on documented data and credible evidence as well as support of Gulf national caders in this respect.

Based on the preliminary national health research mopping that was done in the Gulf countries and some EMR countries which revealed that there is a gap in health research priority setting in the Gulf countries And, realizing the importance of bridging this gap and to give effect to the recommendation made by the Executive Body in ITS 65th meeting (held in Riyadh 4-6 Dhul Qaeda 1427 H corresponding to 25-27 November 2006 G) about holding a joint workshop on health priority setting in the Kingdom of Saudi Arabia, the Executive Board with collaboration with MOH, KSA with undertake this mission.

The objectives of this regional workshop were as follows: 1. Orienting the participants with the importance / objectives

of setting priorities for health research.

2. Presentation of various methodologies and tools for priority setting in health research with comparison.

3. Presentation of some international/regional experiences. 4. Lessons learnt from presented experiences.

5. Practical applications and group work.

I found it useful to collect the proceedings of this important scientific workshop in a book which will give an expressive glimpse on health research in the Cooperation Council States.

This highlights how health research, priorities are set, what are these priorities and what are the constraints and fading facing this process, as well as the achievements and proposals for improvement of health research priorities setting and the future challenges.

I do ask the Almighty Allah to make this effort useful as required to support the Gulf research march and to depict the future directions and visions in this respect for more improvement of quality.

I do also ask the almighty Allah to grant us rightness and success.

Wishing you all the best……

Dr. Tawfik A M Khoja

MBBS, DPHC, FRCGP, FFPH, FRCP Director General, Executive Board

For Health Ministers’ Council For GCC States

About the Health Research Priority Setting Gulf Workshop

Gulf Health Research Priority Setting Workshop

Based on the preliminary national health research mapping that was done in the Gulf countries and some EMR countries which revealed that there is a gap in health research priority setting in the Gulf countries And, realizing the importance of bridging this gap and to give effect to the recommendation made by the Executive Body in its 65th meeting (held

in Riyadh – 4-6 Dhul Qaeda 1427 H corresponding to 25-27 November 2006 G) about holding a joint workshop on health priority setting in the Kingdom of Saudi Arabia, the Executive Board with collaboration with MOH, KSA with undertake this mission.

Objectives

1. Orienting the participants with the importance / objectives of setting priorities for health research.

2. Presentation of various methodologies and tools for priority setting in health research with comparison.

3. Presentation of some international / regional experiences. 4. Lessons learnt from presented experiences.

5. Practical applications and group work .

Organization It is a joint organization between:

1. Executive Board, Health Ministers’ Council for Cooperation Council States.

2. Ministry of Health, Kingdom of Saudi Arabia .

3. KACST (King Abdul-Aziz City for Science and Technology). 4. EMRO (Eastren Meditenanean Regional Office).

Scientific Programme

Health Research Priority Setting Workshop

Riyadh 29-30 Dhual-Qa’dah 1428H / 9-10 December 2007 .

Day I 29 Dhual-Qa’dah 1428H (9 December 2007G)

08:30 - 08:40 Welcoming and Opening Address Dr.Tawfik A. Khoja

Director General , Executive Board , HMC/CCS 08:40 - 09:00 Application of Combined

Matrix Approach : Experiences and Way Forward Dr. Abdul Ghaffar

Health Policy and Systems Specialist , GFHR,Geneva 09:00 - 09:20 WHO/EMRO

Dr. Mohammed Afzal , WHO/EMRO / RPC 09:40- 10:00 Role and contribution of research (evidence)

in improved decision making Dr. Abdul Ghaffar

Health Policy and Systems Specialist , GFHR,Geneva 10:00 - 10:30 Discussion

10:30-10:45 Tea Break

10:45 - 11:10 Research Priorities Setting: King Abdulaziz City for Science and Technology Experience

11:10 - 11:30 The Mechanism of Selection of Health Research Priorities in King Abdulaziz City of Science and Technology

Prof. Othman A. Al-Shabanah, Ph.D. KACST 11:30 - 11:50 Health Research priorities in GCC

Dr. Tawfik A. Khoja ,

Director General , Executive Board , HMC/CCS 11:50 - 12:10 Discussion

12:10 - 01:15 Prayer and Lunch Break 01:15 - 01:30 Country Presentation (UAE) 01:30 - 01:45 Country Presentation (Bahrain) 01:45 - 02:00 Country Presentation (KSA) 02:00 - 02:15 Country Presentation (Oman) 02:15 - 02:30 Country Presentation (Qatar) 02:30 - 02:45 Country Presentation (Kuwait) 02:45 - 03:00 Country Presentation (Yemen) 03:00 - 03:30 Discussion

Day II 30 Dhual-Qa’dah 1428H (10 December 2007G)

08:30 - 09:30 Introduction to Group Work Dr. Tawfik Khoja

( Participants will be divided into 2 Groups to deal with various tools of priority setting, based on early

presentations made by GFHR , and EMRO experts ..) Group A (EMRO)

Group B ( GFHR)

09:30 - 10.00 Group Presentations (A & B) 10:00-10:30 Discussion

10:30 - 10:45 Tea Break 10:45 - 12:00 Work and action plan 10:45 - 11:30 Group Work (A & B) 11:30 - 12:00 Presentation of workplan 12:00 - 01:30 Prayer and Lunch

1:30 - 02:15 Consensus on the workplan

Address of

Dr. Tawfik A. M. Khoja,

Director General, Executive Board,

Health Ministers’ Council for Cooperation Council States, Riyadh – Saudi Arabia

In the Opening Ceremony of the Gulf Workshop on Health Research Priority Setting

Riyadh, 29-30 Dhul Qa’da, 1428 H 9-10 December, 2007

It gives me great pleasure in this blessed day in this nice evening to welcome you all surrounded by the care of Allah. We convene on the land of your second country, in Riyadh, - Riyadh of good and growth - Riyadh of affection and giving, in the Kingdom of Saudi Arabia in one of the important Gulf Scientific gathering. This is the Gulf Workshop on Setting Health Research Priorities which is held under the kind patronage of HE the Minister of Health – Dr. Hamad Al-Mana. I raise my deep thanks and gratitude for the great support and care of HE to hold this important Gulf workshop. It also gives me great pleasure to have with us and among us the representative of HE the Minister, my dear brother Dr. Obaid Bin Sulaiman Al-Obaid, Deputy Minister for Planning and Development to open this ceremony. Dr. Obaid spares no effort in supporting all research activities, health systems improvement and development in general and primary health care and family medicine in particular.

This is no strange for Dr. Obaid, he is reputed for full and continuous support of all programmes and activities of the Health Ministers’ Council for the Cooperation Council States and its Executive Office.

This workshop represents an important turning point in the field. Thanks are due to Your goodselves and to the Ministry of Health, Kingdom of

Saudi Arabia for this strong response and support. Before this workshop, a regional workshop about partnership in Health Research in the Eastern Mediterranean Region was held in Riyadh (12-13 Shawal, 1426 H/ 14-15 November, 2005).

This was followed by a workshop for Health Research Current Situation Analysis, in Muscat, Oman (2-3 Jumada I, 1427 H / 29-30 May 2006), the outcome of which was presented in the 10th Global Forum for Health Research in Cairo (29 October – 1 November, 2006) and in this forum, it was agreed to hold a Gulf workshop about setting health research priorities.

Hence, we are here today to witness the opening ceremony of this said workshop which was prepared for with active participation from the WHO/Eastern Mediterranean Regional Office (represented by my Brother Dr. Mohamed Afzal, and with the Global Forum for Health Research (represented by my Brother Dr. Abdul Ghaffar). I do express my great thanks and appreciation for both of them for coming to share us this gathering and enrich our experience and knowledge.

- I do also express my deep thanks and gratitude to my brother Professor Dr. Abdulrahman Al-abdulalaaly – Supervisor of the Research Fellowships General Directorate in King Abdul Aziz Medical City for Sciences and Technology and my brother Professor Dr. Othman A. Al-Shabanah – Chairman of the Health Sciences Group, in KAMCST, who both insisted on taking part in the activities of such workshop to enrich it with their rich experiences and knowledge and to present the experience of KAMCST, this great scientific castle in the field of setting and implanting health research priorities.

- Many thanks are extended to my brother Dr. Khalid Al-Hussain, Executive Body member, Kingdom of Saudi Arabia, for his outstanding efforts exerted in overcoming all constraints faced to hold this workshop as well as for supporting the Executive Board to realize its

ambitious mission and securing material and logistic support for the workshop.

I do also thank my brother Dr. Faisal Abu Zaheer, Director General of Medical Research Department and his working staff for the efforts exerted in coordination of this workshop.

I highly appreciate the outstanding and effective support and contribution of Astra Zeniza for this Gulf Workshop which indicates the effective partnership of the private sector and the dedication to develop manpower and disseminate knowledge and promote research.

The executive board is highly interested in and focuses on the issue of health research. This is in realization on the part of the Health Ministers’ Council for the Cooperation Council States that health research is an investment for health which should be given utmost care at all levels especially that of decision makers and takers. Appropriate budgets should be allocated in addition to effective coordination with all international and regional research bodies and institutes.

Let me in my person and in your name appraise the blessed launching of King Abdul Aziz University for Sciences and Technology which the Custodian of the Two Holy Mosques – King Abdullah Bin Abdul Aziz Al-Saud (Allah may protect him) has laid its foundation lately will- Insha Allah – support our efforts in upgrading research. This university together with its sister Saudi and Gulf universities will contribute in producing leading scientific research leap towards preparing qualified manpower in the fields required by the developmental plans, conduction of research and postgraduate studies, as well as contribution – in general – in raising the cultural, social and scientific standards of the Arabic and Muslim citizens, and producing a national, regional and international partnership in the field of global health research in an integrative and coordinative relation together with removal of constraints faced and improving management.

I would also alike to refer to and appreciate the kind gesture and initiative by the Custodian of the Two Holy Mosques whereby 3000 million US$ has been allocated for the basis of program that funds scientific research related to energy, environment and climatic change.

Both initiatives clearly reflect the wise vision and the human scientific approach on the part of our leaders – Allah protect them – In this setting, I do urge the participants in this workshop to make full use of these two initiatives and take actions towards coordination with concerned people in this respect and finding a joint channel for cooperation within the frame of a Gulf partnership at the scientific and research level. This is due to the fact that, building national capacities in the field of research is an objective which is sought by the Health Ministers’ Council for the Cooperation Council States and its Executive Office. It strives hard to realize this in an effective way in belief that human power development is an important if not the most important elements of health research promotion.

That was the subject of the World Health Organization Report in 2006. In the same context, I did admire what was published in Al-Iqtisadia Newspaper, issue number 5160 issued on Tuesday 17/11/1428 H in the name of Dr. Abdul Rahman Sulaiman Al-Tariri saying : If we closely examined our universities, we will find all specializations and a lot of experts. We just need to have confidence in these expertise people and give them a chance to prove themselves and extract their knowledge store. In the Kingdom, there are universities that include all specialties, in addition to other bodies outside universities which have research interest. He proposed, that I quote “research should not be restricted to the material aspects only in energy, environment or climatic changes, but should include the human aspect (behavior, values, culture) which has a very prominent role and is closely related to the above mentioned fields. Marketing, administration, negotiation and communication with

the environment are basically knowledge, values, practices, skills and behaviors”.

I am not going to elaborate more, you have a very comprehensive program. I do pray to Allah the Almighty to grant you success and rightness to come up with useful results that are reflected on the current situation of health research in the Gulf and contribute effectively in promotion and development of health research, support of its priorities and depicting a more clear and luminant picture to this side at the present and in the future utilizing all facilities and capacities provided by our wise governments in the Gulf countries to consolidate efforts in a very clear and outstanding manner with research and studies that enable us to review and restore the glory of our leading Islamic and Arabic nation in development of all sciences.

Once again, I welcome you all and I raise my thanks and acknowledgement to HE Dr. Hamad Al-Mana, Minister of Health for his kind patronage of this workshop. Thanks are also extended to my brother Dr. Obaid Bin Sulaiman Al-Obaid, Deputy Minister for Planning and Development and to all concerned brothers in the Ministry of Health and in particular Dr. Khalid Al-Hussain – Executive Body Member and to all MOH workers, also to all participants in this important Gulf workshop.

Your presence is the real support to such eminent initiative with the support of Allah.

I do pray to Allah the almighty to make our work pure for the sake of Allah, and see you in other meetings – Insha Allah.

Peace be upon you and the mercy and blessings of Allah

Health research Priorities In the Gulf Cooperation Council States Health Research Priority Setting Workshop

Dr. Tawfik A. M. Khoja

Riyadh, 29-30 Dhual Qa’dah, 1428 H / 9-10 December 2007

Functions of the Health Ministers’ Council.

The Council, for realization of its objectives, undertakes the

following:-(1) Setting and developing health strategies, policies and systems development in the Council states.

(2) Realizing coordination and integration as well as strengthening aspects of cooperation in the various health fields.

(3) Control and elimination of infectious diseases in the Council States.

(4) Protection of the member states from imported diseases and unifying related systems .

(5) Unifying joint situation in the international circles and strengthening common relations with all related regional and international organizations.

(6) Depicting a unified drug policy that assures full control of the imported drugs, and prepare for establishment OF self sufficiency for the Council States.

(7) Realizing coordination and integration in the field of Group purchasing of drugs, Sundries and Central Drug Registration . (8) Encouraging joint studies and research in such a way that serves

the sets objectives.

(9) Approval on the plans and executive programmes for conduction of studies and research in the field of health problems, control of endemic and chronic diseases, health education, protection and safety of the environment, in the Council States.

(10) Organizing exchange of experiences in the field of health learning and education, for the objective of developing and unifying education systems in the health colleges and institutions among the Council States.

RESEARCH

The main objectives of the HMC/GCC research programme may be summarized as follows:

• To develop the capacity to undertake research in the core areas of health.

• To develop the capacity to undertake in-depth research in a specified set of critical population and health issues in the region.

Functions of the Studies and Research Division

1. Proposing studies and researches related to raising the health standard and development of health services in the Council states. 2. Setting a plan for studies and research , taking part in its preparation

and follow up of implementation after being approved by the Director General.

3. Studying the technical reports, health statistics about diseases, mortalities, health problems in the Council States. Necessary proposals and recommendations are made in this regard.

4. Cooperation with specialized scientific and technological agencies inside and outside the Gulf States to help in preparing studies and research proposals.

FIELD RESEARCH

In collaboration with health ministries of the member states throughout the period from 1992 to 1997, the Executive Board completed a study on “The child health in the Gulf States” which involved data of over 277,000

citizens, 38,000 mothers and 56,000 children. (The study achieved its objective of providing an extremely important database).

Another study had been carried out since 1994 “The Gulf Family Health Survey”, its objective being to delineate the biological, environmental, demographic and economic factors that affect the health of the family (children-youth — husbands — aged people) in the Gulf region; in addition to studying the patterns of morbidity and mortality in the different age groups among the citizens of the region.

These two projects had been implemented by HMC/GCC under the auspices of H.R.H. Prince Talal Bin Abdul Aziz, President of AGFUND and with the collaboration of GCC, WHO, UNICEF, UNFPA. Both projects helped to formulate the base-line data for health and health determinants. These data help in planning, setting priorities evaluation of health programmes and projects in the member states.

The main objectives of the (Gulf Family Health Survey) are:

ֺ To provide policy-makers, programme planners and researchers with a timely and integrated flow of reliable information suitable for formulating, implementing, monitoring and evaluating the family health and related development polices and programmes in a cost-effective manner,

ֺ To expand the health and demographic information systems at both the national and regional levels.

ֺ To advance research methodology for the collection, processing and analysis of data on the health problems of families and their determinants; and

ֺ To strengthen the technical skills required for handling interlinkages and connections between family health, bio-demographic, socio-economic and cultural parameters which influence national and regional development policies and programmes.

GFHS Background (Continued)

Community and tools of the study

The project has been implemented in each of the UAE, BAHRAIN, KINGDOM OF SAUDI ARABIA, OMAN, QATAR and KUWAIT throughout the period 1995-1998.

Study included samples of resident families selected randomly through probability designs that ensures representativeness of the community. The total number of Gulf households included in the study was 34481.

Burden of diseases Studies in the Gulf Countries.

Rationale - there is a very strong need for comprehensive evaluation of the burden of diseases in the Council States due to lack of full population-based data about morality, morbidity, disability and the underlying causes, in most of the Council States , AND Calculating the DALY, (Disability Adjusted Life Years) and DALE (Disability Adjusted Life Expectancy) .

Objectives

A. Consistent estimation of mortalities and its causes.

B. Consistent estimation of incidence, prevalence and case fatality rates for the main causes of disability.

C. Utilization of the results of burden of diseases in conduction of cost effectiveness analysis.

D. Utilization of information in health planning and decision making processes.

E. Promotion of national capacities and analytical skills in the field of epidemiology of population health and health information..

World Health Survey (WHS)

The Cooperation Council states are in the process of implementing the WHS.

Objectives of the WHS:

• Develop a means of providing low-cost, valid, reliable and comparable information.

• Build the evidence base to monitor whether health systems are achieving the desired goals.

• Provide policy-makers with the evidence they need to adjust their policies, strategies and programmes as necessary.

WHO CONTRIBUTION

• $ 50,000 for each Gulf Country except Yemen ($ 150,000) • WHO provides technical assistance + training and experts.

• HQ and regional office of the WHO provide technical training to the WHS teams, experts, quality assurance and assistance in data analysis and extracting results.

• Focal point in the EMRO. Has been assigned

• Workshop has been conducted in Muscat – Oman (June 2005). • Countries will be provided with the agreement with WHO (from the HQ

in Geneva).

• An agreement between the WHO/HQ & The Executive Board has been signed lately (it outlines the terms of reference and the technical assistance given by the WHO to implement the WHS project in the Gulf countries ( UAE- Bahrain- KSA – Oman – Kuwait and Yemen). Qatar has implemented the survey.

Role of the Executive Board

• Facilitation to the meetings, agreements and training • Assistance in mobilization of resources

Responsibilities of GCC States Logistic preparation

• Assigning the body which will implement the survey (General directorate of Statistics, Ministry of Planning or Ministers Cabinet). • Deciding on the sample (representative to the community)

• Defining the requirements for training the surveyors • Estimated cost of the survey

Current Situation

• UAE conducted this survey 2003, planning to implement another round on a larger sample.

• Qatar has finished the field work and data analysis of the survey is underway.

• Saudi Arabia has finished the field work and the data entry will be finished soon.

• Cs Pro training is being conducted in Muscat, Sultanate of Oman. (1-5 December, 2007).

• The rest of the Gulf countries will start the field work in the beginning of 2008.

Global Youth Tobacco Survey (GYTs)

This survey focuses on the age group 13-15 years and it defines the knowledge, attitudes and practices of those children and adolescents as related to tobacco consumption.

It also emphasizes on the effectiveness of the preventive programmes and the activities directed to this age group through the school curricula, the social programmes and the media with the objective of reduction of tobacco consumption among them.

The research provides accurate information about how children and adolescents obtain tobacco products, and how to use it, and it evaluates the actions taken in this regard.

Emphasis has been made on the following in this survey:

• Defining the % of consumption of tobacco and its products.

• Estimation of the age of the child / adolescent at the start of consumption of tobacco and its products for the first time.

• Estimation of the readiness of the child / adolescent to become a smoker in the future.

• Estimation of the extent the child/adolescent is exposed to involuntary smoking.

• Estimation of how much is the child / adolescent is exposed to smoking advertisements.

• Defining the basic factors such as attitudes beliefs and behaviours about tobacco consumption which may contribute in preparing future preventive programmes.

• Defining the extent of success of the preventive programs about tobacco consumption as well as the views of children / adolescents.

The WHO STEPwise approach to Surveillance of

Non-Communicable Diseases (STEPS)

The approach is based on the concept that surveillance systems require data collection in a standardized way to ensure comparability across time and place and allow development of an increasingly comprehensive surveillance system which is based on local needs and resources.

General Aim

• Development of manuals and infrastructure related to monitoring of risk factors for non-communicable diseases with emphasis on developing countries.

• Work towards provision of global informatics resources about the burden of risk factors, its trends and distribution.

Expected Outcomes

1- Increasing awareness about the value of monitoring risk factors for non-communicable diseases and its control.

2- Production of manuals for monitoring risk factors of non-communicable diseases and / or its development in half of the WHO member states. 3- A global database about the burden of risk factors of non-communicable

disease, its patterns, and trends for decision makers in the field of public health.

Collaborators

• Various departments and units in the WHO • WHO Regional offices

• Others United Nations Agencies • WHO collaborating centers • Governments and donor agencies

• Ministries of health and leading scientific establishments • Related Non-governmental organizations.

• Current initiatives and networks about monitoring risk factors of non-communicable diseases.

Joint Risk factors in most non-communicable diseases

Risk factor Disease _{CVD* Diabetes Cancer Respiratory} Diseases**

Smoking    

Alcohol  

Nutrition    

Decreased physical Activity    

Obesity    

Hypertension  

Increased Glucose in blood   

Hyperlipidemia   

* includes heart diseases, stroke and hypertension

COHRED

is an international organisation established in 1993, based in Switzerland with a strong global network.

Vision

COHRED works for a world in which health research is recognised as essential to optimising health and reducing inequity and poverty.

To achieve this vision, we support countries to optimise their health research potential to:

• Improve health and reduce health inequities. • Improve health sector performance.

• Link health research with science, technology and innovation. • Promote health sector accountability.

• Encourage donor alignment and harmonisation. • Generate economic and social prosperity.

In its work, COHRED prioritises the poorest countries, regions and populations.

Why health research?

COHRED helps countries address the health needs of the poor Health research is necessary for countries to achieve better health, equity and development. COHRED’s business is to enable countries to set and meet health research objectives, especially those aimed at improving equity in health.

Mission

COHRED is passionate about enabling countries to put in place and use health research to foster health, health equity and development. They work globally - prioritising the poorest countries.

COHRED values and working principles to ensure that health research is used to achieve better health, equity and development as well as

strengthen health research systems, COHRED operates according to certain fundamental values and working principles.

COHRED values and working principles

COHRED value social justice, good governance, sustainability, human rights, excellence and relevance, evidence-based action and south-south alliances in health research.

Working principles are:

Country focus long-term commitment to work within countries enables them to strengthen their health research system and institutions.

Partners & Collaborations

COHRED works in an inclusive and participatory way, with a broad range of partners at national, regional and international level.

COHRED’s partners traditionally include members of the following constituencies:

• Government decision-makers. • Research councils and institutions. • Universities.

• Development agencies. • Multilateral agencies. • International organisations. • National and international.

• Non governmental organisations as well as community organisations.

• Foundations. • Networks.

COHRED Interim Executive Committee

COHRED’s Executive Committee facilitates the rapid response of COHRED to challenges of health research for development. It meets several times a year. The Interim Executive Committee consists of Marian Jacobs, Somsak Chunharas, Ernesto Medina, Carel IJsselmuiden and Sylvia de Haan.

The Global Forum for Health Research was established as an independent international foundation in Switzerland in 1998.

Its origins lay in the recognition of three key facts:

ֺ Improving health is not only an outcome of development but also a prerequisite for development. Consequently, investment in health yields one of the highest rates of return that a country can achieve. ֺ Improving health requires the effective application of existing research.

It also, crucially, requires research aimed at creating new knowledge and new technologies. This includes the whole spectrum of research: - biomedical sciences (creating affordable and accessible new

drugs, vaccines, diagnostics and appliances). - health systems and policy research.

- social sciences. - political sciences. - health economics.

- behavioural and operational research.

- research into the relationship between health and the cultural, physical, political and social environments.

- Few of the world’s resources for health research are directed to solving the health problems of developing countries.

Mission

COHRED believe that more health research needs to be devoted to improving the health of people in developing countries.

The Global Forum is working to:

• change the priorities governing how existing resources for health research are used.

• encourage new resources that will be directed to research in the neglected areas.

• foster research in the neglected areas to reduce the burdens of disease and disability.

Recommendations of the Consultative Meeting About the Priorities of Health Research Executive Board,

Health Ministers Council for GCC & the Global Forum for Health Research,

23-24 Rajab 1424 H / 20-21 September 2003, Abu – Dhabi – UAE

I- At the level of the member states

1- Establishing a council or national body for health research (or its equivalent) in each country that involves representatives from the Ministry of Health, and various sectors of health services, governmental and private, as well as the universities, health colleges and institutions and health research centers.

The council should aim at setting priorities of health research at the national level and bridging the gaps in supporting the priorities of health research and follow up and utilization of its results.

2- Increasing financial allocations for health research in the Ministry of Health, and supporting the infrastructure of the health research centers and departments, as well as calling upon raising the % expenditure on health research from Gross Domestic Product. 3- Calling upon the member states to:-

- establish units or departments for research in the organizational structure in the Ministries of Health and granting the required capacities to supervise health research in the Ministry.

- work towards finding mechanism for documenting research conducted in each country and its production in a printed form to be disseminated locally and regionally.

- Gulf participation in the annual meeting of the Global Forum for Health Research.

- the countries should continue holding training workshops to raise the standard of the workers in the health research field. 4- Preparation of a Gulf joint media plan to raise the attention and

awareness towards the importance of defining priorities of health research in the member states in the decision makers of the Gulf health committees and the entire research community.

II- At the level of the Executive Board, HMC-GCC

1- Call to establish the GCC Regional Health Research Forum, involving representatives from national health research committees, various sectors of health services, research centers and institutes, related national societies and organizations, supportive economic organizations, associations and centers, to define and depict health research priorities in the Council States to be implemented in a collective way.

2- Encouraging joint Gulf research and studies and provision of technical advice and recommendations together with finding mechanisms for strengthening relation between scientific research centers in the ministries health in the Council states.

3- Promotion and support of constructive integration and collaboration in the field of health research through :

-- encouraging visits and meetings with exchange of experiences among specialists in the research and academic establishments in the Council States.

- Raising the attention and awareness about the importance of scientific research in the community.

- Continue holding educational workshops about methods and tools of defining priorities of health research, and giving effect to the role of the Council in this field.

4- work toward unification of common Gulf situations in the international gatherings and strengthening common relations with national regional and international organizations related to health research

Health Research Priorities KSA Experiences Health Sciences

Group in KAMCST

Prelude

The process of supporting health research started since the very early stage of establishment of KAMCST in 18/12/1397 H, which consequently required the importance of setting priorities.

The General directorate of fellowships programmes in the KAMCST has undertaken support of health research through the following actions.

1. Exploring the views of governmental agencies and the production sectors concerning problems faced.

2. Defining priorities : This mission was originally done by a team form the fellowships general directorate, then it was assigned to the “Health Sciences Group”.

3. Announcing the priorities : This is done annually through issuance of booklets and posters about the health research program, which are disseminated to the universities, research centers, ministries, production sectors and agencies.

4. Draft research projects are received from the researchers.

5. Exploring the views of the ministries, governmental agencies and other concerned bodies in the submitted research projects.

6. Scientific evaluation of the research projects, these are sent to 4 specialized peer reviewers.

7. Overall review of research projects : Specialized personnel in the general directorate with the help of consultants in the various fields included in the research projects conduct a very comprehensive review for each project.

8. approval of the research project which fulfills the priorities requirement and which can be supported from the program.

9. A scientific discussion with researchers whose research projects have been accepted is made.

10. Follow up of supported research projects.

EMRO / COHRED / GCC Collaboration in Health Research Workshop to Develop a Strategic Partnership to promote

Research for Health in the EMR Countries

Riyadh, Saudi Arabia, 14-15 November, 2005

Purpose of the meeting

The purpose of this meeting was to initiate a dialogue for an active collaboration between WHO/EMRO, COHRED, and GCC and other partners to support and strengthen national health research systems in EM Region countries. The ultimate aim is that these systems begin to address national health research priorities and start providing evidence for policy development and for changes in health practice, driven by the principles of fairness and equity. The objective is to draw together the strengths and capacities of both WHO/EMRO, COHRED, and GCC, to build on the work already carried out by EMRO and COHRED in the Region, to involve other interested parties, and to suggest possible mechanisms for future collaboration in Health Systems Research.

This meeting is being organized as a first step in the establishment of the joint WHO/EMRO – COHRED – GCC partnership in health research. The meeting will attempt to reach an agreement on the potential areas of collaboration, on identifying partners for collaboration and on some key areas for undertaking research.

Objectives of the Workshop:

ֺ To review the national health research systems (NHRS) analysis that was undertaken in selected countries of the EM region in 2003 and 2004 – specifically from the point of view of assessing the ability of these national health research systems to help in achieving the Millennium Development Goals and to reduce poverty and increase health equity.

ֺ To identify the priority areas that require (urgent) health systems research inputs.

ֺ To discuss and agree on the outline of a proposal focusing on priority areas and develop a joint plan for research for the 2006-2007 biennium, at least.

ֺ To define the role and responsibilities of partners in the project.

Expected Outcomes:

ֺ Establishment of priority areas for collaboration

ֺ A plan of action for joint WHO/EMRO – COHRED – GCC partnership in health research, including identification of potential sources of funding and outline of research activities

ֺ Key partners (institutes, lead persons and deputies) are identified, their roles in the partnership defined, and their commitment obtained ֺ EM Regional health research systems strengthened

ֺ Possibly, an EM Regional Forum for health research is established.

RECOMMENDATIONS

1. Holding a one or 2 day meeting before the 10th Global Forum of Health, Cairo (29 October – 2 November 2006). The Executive Board will undertake the arrangements of this said meeting by establishing committees for preparation in the proper way and securing the effective participation of the countries in the forum.

2. Preparation of the questionnaires and health research situation analysis tools by the WHO/EMRO and the COHRED, including issues of equity.

3. Conduction of the situation analysis study in the Gulf countries and some of the EMR countries in which health research situation analysis has not been yet made. The Executive Board will bear the cost in the Gulf countries from the Research Fund, and the EMRO will bear costs of the non Gulf countries.

How do decision makers make use of Health Systems

Research in the field of Primary Health Care.?

There are a lot of difficulties that prevent the utilization of the results of health research, where the applicability of any research is dependent on a number of items and requirements linked to many options that are associated with the various stages of the research process.

1. focus on the priority problems at all health service levels ( central – middle – peripheral – community level) in order not to waste the research efforts in problems which are of low or unimportant priority. 2. Primary focus on the priority and the most stressing problems at all

levels with the importance of using modern tools and mechanisms to set health research priorities

3. Research should be practically oriented, i.e. it seeks finding simple and practical solutions for problems.

4. In-depth research in particular (dealing with various aspects of health system) should involve various partners in evaluation of health care starting with decision makers, the middle level (provinces and directorates) and service providers at the health centers, and the beneficent community.

5. The Research should be timely conducted, in order to provide results that enable decision makers to take appropriate and significant decisions at the proper time.

6. Limited publicization . The way the results of research is published may lead to its non-utilization. Mostly peer-reviewed journals and periodicals, where the results are presented in a highly technical and difficult language which is not comprehended by the policy makers and directors of health systems, therefore, they cannot take necessary decisions to improve the quality of health services.

Recommendations & Future Perspectives

1- The importance of research lies in how much of its results can be utilized, and therefore, it is important to establish national mechanism to promote the utilization of research results and to efficiently and effectively publicize it.

2- Based on the recent global trends, the Global Forum for Health Research (GFHR) – collaborating with the World Health Organization – proved the presence of an extremely important and serious phenomenon which is 90/10 gap. This showed that the size of allocations and costs spent on 90% of real health problems especially in the developing world does not exceed 10% and vice versa.

3- As the Gulf level, the process of coordination and integration in the field of scientific research, and technical development in health research in the Cooperation Council states, has become a necessity imposed by the current situation due to the many common positive elements they posses. It has become a pivotal case to better health services. 4- Based on this, scientific research in general, and research directly

related to health care quality – with all its specialties and sub-specialties in particular, became the cornerstone for continuous improvement of performance level in all aspects.

5- The relation of scientific research to the activates of quality is an integrated close relation towards betterment and safety of health care and its promotion at various levels.

Global Forum for Health Research HELPING CORRECT THE 10/90 GAP Workshop on Health Research Priority Setting Saudi Arabia

Riyadh 9-10 December 2007

Application of Combined Approach Matrix (CAM): Experiences and Way forward

Dr Abdul Ghaffar

MBBS, MHA, MPH, PhD Health Policy and Systems Specialist Global Forum for Health Research, Geneva • Why research and why priorities?

• What is CAM and how to use it? • CAM Experiences

• Way Forward

Priority setting for research in developing countries

• Health plays a vital role in development

- not only as an outcome, but also as a co-determinant

- investment in health yields exceptionally high rates of return • Not enough is spent on health and health research by many developing

countries

• Not enough is spent on health research for the needs of developing countries

Research

• Research is the systematic application of tools and procedures, whose results are expected to lead to improvements in health, social and economic development of a population.

• Purpose

– Identification of gaps and of solutions – Development of Programmes

Kinds of Health Research

Research = new knowledge and technologies

• Biomedical

Drugs, vaccines, diagnostics, appliances • Health policy and systems research Scaling up, burden, demand, evaluation • Social sciences and behavioural research Equity, social determinants of health • Operational research

Human resources, effectiveness, access

Why research……..

• Difficulty in translating promising product – cultural sensitivities

– affordability

– application to the local environment

• Synthesis of available information/sharing good practices • Search for new knowledge

Knowing is not enough, we must apply. Willing is not enough; we must do.

(Goethe)

1990 Commission on Health Research for Development

About 5% of resources for health research spent on 90% of world’s health problems

Measurement issues

How do we measure health? Selected examples

• Human development indexes

• Measures of Social Determinants on Health • Healthy life years

• Life expectancy

• Levels of mortality, morbidity, disability • Gap measures: DALYs, HEALYs, QUALYs • Gross National Happiness (?)

• Lack of consensus on methods to measure health. • Indicators:

– ‘Standard’ (coverage, morbidity, mortality)

– Equity ‘Sensitive’ indicators (equity disaggregated analysis, transparency, accountability, personal experiences and real life stories).

Combined Approach Matrix

• Objective is to incorporate both the public health and the institutional dimensions

• Helps to classify, organize and present the large body of information • Identifies gaps in health research

• Identifies health research priorities

Three elements in priority setting

1. Values – Equity considerations – Cost of interventions 2. Process – Diversity of stakeholders – Participatory (COHRED) 3. Tools

– Markers of health and disease

– Sectors ‘other than MOH’ (Global Forum).

Actors and Factors involved in priority setting

1. Individual, family and community determinants 4. Level of the

central government

2. Level of health ministry, health research institutions, health systems and services 3.Sectors other

than the MOH

      HEALTH

Examples of Application of CAM

ֺ Institutions and national governments - IMRC and MOH Pakistan

ֺ Programs

- TDR, NCD Action Plan in Pakistan ֺ Diseases

- Malaria, TB, Schizophrenia ֺ Risk factors

- Indorr Air Pollution

CAM

Dimensions

Steps National, regional or global level Individual, household and community Health ministry and other health institutions Sectors other than health Macro-economic policies Disease burden Determinants Present level of knowledge Cost and effectiveness Resource flows

Challenges and Way Forward

• Availability of required data • Competencies and capacities • Political will

• Involvement of Stakeholders • Working together

• Public interest shall take a priority over the organizational interests • Development of a tool, which is comprehensive, takes into account

the needs and voices of all concerned and is easy to use

Two relevant quotes

• All diseases have two causes, one pathological, the other political

(Rudolf Virchow)

• It isn’t the strongest of the species that survive, nor the most intelligent, but the ones most responsive to change

(Charles Darwin)

* * *

Role and promise of research in

decision making

Dr Abdul Ghaffar

MBBS, MHA, MPH, PhD Health Policy and Systems Specialist Global Forum for Health Research, Geneva

Why health research?

Research is not a luxury, but is

• An indispensable way to create solutions, learn how to apply them and evaluate their impact

• A way to develop local ownership

• scope for considerable progress towards improving health status if existing knowledge was used optimally

BUT:

• complex and urgent context of health sector development in LMICs: not possible to research all issues and use scientific analysis to solve all problems

• political processes are not deeply influenced by scientific evidence nor by researchers Health research or “research for health” – a paradigm shift

• Health research is not principally responsibility of Health Ministry • Health research depends and need to involve other sectors • What do we mean by other sectors?

Why health systems research?

• Limited application of available knowledge and technological interventions

• There are no clear answers for many issues commonly confronted by the policy planners

• There is an absolute lack of knowledge of which health system strengthening strategies are effective, and under which conditions • Non-functional and fragile health care systems

• “It has been estimated that full use of existing health interventions could reduce child deaths by at least 63% and maternal mortality by as much as 74%”.

Chronic diseases: the new epidemic

• Becoming the dominant source of ill health and death in the Middle East driven by

- poor diet

- lack of physical activity - tobacco use

Death statistics

Estimated 57 million deaths (approx.) occurred in 2003:

• 33 million are attributed to chronic diseases, and of these: - 17 million are attributed to cardiovascular disease - One third of these occurred in mid-aged people - One third occurred in China and India

Urbanization

• Tipping point:

2007 marks a turning point in human history: the world’s urban population for the first time equals the world’s rural population

Changing demographics

• In 68 countries:

over 40% of population is below age 15 • But populations also ageing

Changing demographics

Opening and closing demographic windows of opportunity

Bars show the range of years for which the dependency ratio—the number of dependents relative to people of working age—is falling.

‘Neglected health systems’

Health systems that are:

• weak/failing

• inadequately funded and staffed • poorly managed

• lacking investment in health policy and systems research • lacking in utilization of the evidence/research base

- systematic, sustainable data collection and use for health policy/planning

- use of the data for national and international policy- making to ensure more equitable direction of funds for research on health • Stressed by epidemics AND by demands of ‘vertical’ programmes:

1990 Commission on Health Research for Development

• Not enough is spent on health research for the needs of developing countries

• Not enough is spent on health and health research by many developing countries

‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.’

WHO Constitution 1948

The carrying power of a bridge is not the average strength of the pillars, but the strength of the weakest pillar. I have always believed that you do not measure the health of a society by GNP but by the condition of its worst off.’

Zygmunt Bauman

The spectrum of health research for development

Biomedical

research systems research Health policy and behavioural research Social sciences and Operational research Basic research: physical and biological sciences including chemistry, pharmacology, toxicology, genetics, etc Research on policy formulation, relationship to evidence, prioritization, etc Research on social and behavioural

factors influencing health and their relation to equity,

access, lifestyle and health-seeking behaviours, etc Research on factors affecting functioning of programmes, effectiveness of targeting, impact on behaviour, disease burdens and public

health, etc R&D for drugs,

vaccines, diagnostics, appliances, etc Research on health systems management, functions, efficiency, effectiveness, system factors affecting access

scale-up, monitoring and evaluation, etc Understanding the biological

nature of diseases; creating products to prevent or treat

disease states

Understanding how to test, scale-up and follow through the introduction of interventions and optimise their benefits Biological, economic, environmental, political and social determinants of health

Prioritizing health research and development needs: Eastern Mediterranean Experience

Dr. Mohammad Afzal

A/Regional advisor Research Policy and Cooperation

WHO-EMRO, Cairo, Egypt.

- In recent years the world has seen a rapid increase in technological and economic potential, implying an enhanced ability to overcome problems related to poverty and poor health.

- But there has also been an actual deterioration in health status in many developing countries, largely as a result of HIV/AIDS but also because of a resurgence in other infectious diseases and a growing burden of non-communicable diseases.

How could we know?

- Am I going the right way? - How fast am I going?

- Who else should I ask for directions? - Am I doing the “right things right”?

- How will I know when I arrive in my destination?

The participatory nature of public health research

ֺ To ensure that the research is relevant and appropriate, everyone directly concerned with a particular health or health care problem should be involved in the research project(s) focused on it.

- If decision-makers are only involved after completion of the study, the report may just be shelved.

- If staff of health and other public services are only involved in data collection and not in the development of the proposal or in data analysis, they may not be motivated to collect accurate data or

-carry out the recommendations.

- If the community is only requested to respond to a questionnaire, the recommendations from the study may not be acceptable. - If professional researchers are not involved in the implementation

of recommendations, they may have little concern for the feasibility of the recommendations.

Basic questions which health policy makers need be answered

ֺ What are the health needs of (different groups of) people, not only according to health professionals but also according to the people themselves? Can shared priorities be agreed upon?

ֺ To what extent do the present health interventions cover these priority needs? Are the interventions acceptable to the people in terms of culture and cost, especially to the poor? Are they provided as cost-effectively as possible?

ֺ Given the resources we have, could we cover more needs, or more people, in a more cost-effective way? Is it possible to introduce or expand cost-sharing through insurance, to reduce the risk of unexpected high costs, in particular for the economically vulnerable? Could co-operation with the private/NGO sector be improved? Could donor agencies help solve well-defined bottlenecks in the system? ֺ Is it possible to better control the environmental factors which influence

health and health care? Can other sectors help (education, agriculture, public works/roads, etc.)? (See Figure.)

Specific questions for specific levels of service

ֺ HR is not only of use to policy makers; at each level managers may have questions that require further research, e.g.,

- Health policy makers: What are the prospects for voluntary community-based insurance?

certain districts more fatal than in other districts?

- Hospital directors: Why do we have such a high rate of complications due to Diphtheria? Are malarial patients coming late for treatment and, if so, why? Are the first-line services available and adequate? Are our own services adequate?

- Managers at village level (village health committees: How can we assist women with little or no education so that they can effectively recognize the symptoms of pneumonia and go in time to the health centre with their children?

Three Types of Diseases

Type I Type II Type III

- Incident in both rich and poor countries.

- The strategy will focus on the following Type I diseases, increasingly prevalent in developing countries: diabetes, cardiovascular disease and cancer. - Incident in developing countries. For the purposes of the strategy, the focus is on the 9 neglected infectious diseases populations prioritized by the TDR: Chagas disease, dengue and dengue haemorrhagic fever, leishmaniasis, leprosy, lymphatic filariasis, malaria, onchocerciasis, schistosomiasisand human African trypanosomiasis. - Incident in both rich

and poor countries, but with a substantial proportion of the cases in poor countries. For the purposes of the strategy, the focus is on HIV/AIDS and tuberculosis.

Prioritizing research and development needs

ֺ Health research and development policies in developed countries need to reflect adequately the health needs of developing countries. ֺ Gaps in research on Type II and Type III diseases and on the needs

of developing countries in relation to Type I diseases need to be identified urgently.

ֺ A better understanding of disease determinants is essential to drive sustainable research and development on new and existing products.

The actions needed to prioritize research and development

needs :

1. Identifying gaps in research on diseases that disproportionately affect developing countries:

a. develop methodologies to identify gaps in research on Type II and Type III diseases and on developing countries’ needs in relation to Type I diseases

b. provide an assessment of identified gaps

2. facilitating upstream research on new and existing products for diseases that disproportionately affect developing countries

a. improve accessibility to compound libraries for identification of compounds with potential activity against the above-mentioned diseases, by means including public– private collaboration

b. provide technical support to developing countries in order to create libraries of new compounds at both national and regional levels. 3. coordinating research activities between developed and developing

countries:

a. coordinate international efforts in research and development in order to optimize resources

b. support developing countries in building technological capacity c. promote the active participation of developing countries in the

innovation process

4. formulating explicit prioritized strategies for research and development at country level:

a. developing countries to set research priorities so as to address public health needs and implement public health policy based on appropriate and regular needs assessments

b. conduct research appropriate for resource-poor settings and research on technologically appropriate products to combat diseases in developing countries (including Type I diseases) c. include research and development needs for traditional medicines