Copyright: Knowledge Utilization Research Center1 Chapter 2 Building and Sustaining Strong National Health Research Systems World health report 2012

Copyright: Knowledge Utilization Research Center 1

Chapter 2Building and Sustaining Strong National Health

Research Systems

World health report 2012


Kazem Heidari

PhD student of epidemiologyKnowledge Utilization Research

Center;Tehran University of Medical

Sciences


Introduction-An Overall Framework

Research improves health through three primary paths Better products and services Evidence-informed policies and practice Empowering people towards healthy behaviors

The mechanisms through which these goals are achieved are a set of activities which occurs within an entity called a national health research system (NHRS)



NHRS requirements to achieve the desired goals A sound conceptual framework and a

pragmatic strategy An ability to monitor and evaluate its

own progress An appreciation of the forces beyond

research which needs to be in place for success.





The movement towards a stronger NHRS is driven by its three primary constituencies(and beneficiaries) or stakeholders:1. Researchers (in the public and private

sectors); health professionals; 2. People: patients and the general

public; 3. Decision- and policymakers(including

health system managers).


What is a National Health Research System? Who Are Its Key

Stakeholders? Responsibility of countries to promote activities

to strengthen NHRS Improvement of the knowledge base for making

decisions Setting priorities Managing research Monitoring performance Adopting standards and regulations for high quality

research and its ethical oversight Ensure participation in such activities of the

community, nongovernmental organizations and patients.

The research system should be seen as the 'brains' of the health system - a means to analyze, understand and improve the health system.


An integrated and holistic 'systems' approach to health research is arguably a rational approach to maximize its value and impact.

The health system, in turn, must also inform the health research system. For example, reliable, accurate and accessible

health information, is critical for informing priority research agendas and as a means of tracking the impact of research.


Stakeholders?


How the three stakeholder groups can effectively contribute to the overall system (UK experience) The diverse needs of the various groups

must be addressed A facilitating mechanism at the

interface between the health research system and its various stakeholders should be developed

Additional resources should be allocated to expand the scope of the health research system while maintaining support for basic science


Stakeholders?


Four principal functions of NHRS


Stewardship can be seen as the 'umbrella' function of a NHRS The overall organization and governance of a

NHRS needs to be established in order to deliver to coordinate and monitor the system so that it delivers the expected results and benefits.

The effective implementation of the functions of the NHRS can, in turn, be considered in by identifying the building blocks or key capacities for such a system.


Stakeholders?


1. Setting relevant research priorities -allocation of resources

2. Building and strengthening research capacity - people and institutions

3. Defining norms and standards - rules of the game

4. Translating knowledge into actions which can improve health outcomes.

Key capacities needed for NHRS


Combined Approach Matrix (CAM): by Global Forum for Health Research, public health and institutional dimension

COHRED: by using ENHR (Essential National Health Research) strategy which takes into account four criteria: appropriateness, relevance, chance of success and impact of the research outcome.

CHNRI group (Child Health and Nutrition Research Initiative): Applied successfully in developing country settings

and with different childhood diseases. Focuses on the principles of legitimacy, fairness

and inclusiveness Provide scores to individual questions against pre-

defined criteria with technical experts independently scoring each research option.

The process identified twenty 'universal challenges' in setting priorities in health research

Tools for priority setting



The COHRED approach to research priority setting seems to be the most appropriate for health systems and policy issues for which it is important to consult policymakers, managers and other stakeholders

Setting National Health Research Priorities


Another approach uses a cost-effectiveness analyses of medical research as a means to set research priorities, using a 'value of information' perspective. These kinds of objective approach to

priority setting are not desirable, but could be improved by including a subjective component (e.g. stakeholder consultation).

Priority setting in health research is a dynamic process and strongly influenced by local context and capacities.



It is unrealistic to try and decide which of the various methods developed is 'the best' one, and it is most likely that no one size fits all

Instead, it is suggested that a checklist approach be considered where the use of a particular priority setting tool is only part of the armamentarium.



Commonly, criteria can be categorized into one of three dimensions: Public health benefit (should

we do it?) feasibility (can we do it?) Cost

Participants in the priority setting exercise should decide by consensus on appropriate criteria at the beginning of the exercise



Key lessons learnt and recommendations The need to have broad and inclusive consultation. The National Agenda of Priorities in Health Research

needs to be updated periodically to accommodate new technological advances and new scientific knowledge, as well as the changing epidemiologic profile of the Brazilian population,

The Ministry of Health played a key role in setting up and implementing the Agenda.

Many barriers were encountered and partially overcome.

The financing mechanisms available at the MoH aren’t adequate to sponsor research projects and the bureaucracy involved hinders the flow of resources in a timely fashion.

How Brazil set their priorities for health research


Challenge of finding the appropriate balance between investing in biomedical, clinical, educational, public health and health systems and policy research where resources are limited.

The ratio of biomedical research to the rest Probably 9 to 1 in developed countries Ought to be the converse in low income

countries as applied research is more likely to provide a good return on investment where resources are very limited.



Importance of incorporating rigorous evaluation alongside major policy innovations and programmes Such an evaluation needs to be planned in

advance not added as an afterthought - which makes adequate evaluation impossible.

At a higher level of governance, the setting of appropriate priorities should be guided by a robust national health research policy.

In many countries, the development and implementation of such a policy is entrusted to a national health research (or medical research) council or other similar body



1. Setting relevant research priorities -allocation of resources

2. Building and strengthening research capacity - people and institutions

3. Defining norms and standards - rules of the game; and

4. Translating knowledge into actions which can improve health outcomes.

Key capacities needed for NHRS


Building and Strengthening Research Capacity

Capacity is not solely an individual attribute but it implies effectiveness, ability and, most importantly, sustainability.

Capacity strengthening refers to improvement in individual or institutional capabilities within a broader system - and implies purposeful investments and efforts directed at achieving practical results and outcomes.

Several levels and dimensions. Individual researchers Research organizations/institutions There is also receptor capacity which refers to the

ability of policy makers and health professionals to use, and even demand, research findings


Three additional elements Research networks serve to link organizations

and/or researchers within countries for conducting research and relating it to implementation and policy;

These inner levels are further embedded within a national institutional framework defined by the intersection of government policies, funding priorities and administrative systems

The capacity within NHRS to link national to international research networks are critical, especially in developing countries and in the face of the rapid advances in knowledge.



Capacity strengthening should be seen in the context of a system, i.e. capacities are needed across the entire spectrum of the NHRS.

Several key areas for capacity Generation of knowledge - researchers and others who

perform primary research in a range of disciplines from biomedical to health systems research;

Synthesis of research through systematic reviews- often described as 'secondary' research, and a critical tool for decision making;

Knowledge translation-turning knowledge into evidence-informed policy and practice, as well as for effective public communication of research – the need for a cadre of 'knowledge brokers';

Manage and monitor the research system itself



The core skills and capacities needed for individual

researchers


Areas often neglected in both developed and developing countries.

The skills needed here include Accessing scientific publications (including those in the

'grey' literature) Capabilities to do systematic reviews and meta analysis Development of guidelines, research summaries and

policy briefs. NHRS should address the roles of all actors and

participants in the research process, not just the academic researchers in universities or research institutions. The participation of nurses, community health workers,

policy makers, NGO's and consumers/patients and communities in both the planning and performance of research.

Capacity for research synthesis and translation


Many NHRS in developing countries face the problem attracting and retaining staff in the public research sector Brain drain of their best scientific talent, mostly to the

developed world or to the private sector. Better incentives (e.g. good career structure,

appropriate rewards, respect, grant schemes for young scientists, etc) as well as innovative schemes to attract back the scientific diaspora working outside the country

A meritocratic career structure, mentoring and regular appraisal together with transparent promotion criteria is vital to sustain a high quality research workforce.



At the institutional level, infrastructural capacity is needed to support the individual researchers to pursue their research

Beyond individual institutions, effective networking and a coherent national framework between institutions within countries is important.

Networking also extends to international networks

The all important capacity to monitor and evaluate the performance of the NHRS itself needs to be developed within the NHRS

Another key dimension :the capability to disseminate research findings



Ten recommendations for building, strengthening and retaining research capacity


Framework for Designing and Evaluating a Health Research Capacity-Building

Programme


Thank You!

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Copyright: Knowledge Utilization Research Center1 Chapter 2 Building and Sustaining Strong National Health Research Systems World health report 2012