World Health Report 2012No Health Without Research

Chapter 4Effective Governance

Knowing That We Are on the Right Track

Bahareh Yazdizadeh

Introduction: Key Roles for Governance

• Governance of a health research system: the formal and informal institutions, norms and processes which govern or directly influence health research policy and outcomes.

• Role of Governance:1. managing and coordinating the NHRS2. to monitoring and evaluating its performance3. monitoring future trends in research of relevance to the

NHRS and its activities

• A starting point for good governance is a robust national health research policy.

• e.g: national health research (or medical research) council

COHRED survey

Example: Paraguay

• In an encouraging development, in January 2011 Paraguay adopted a National Policy on Research, Technological Development and Innovation for Health. The policy, backed by a Presidential Decree, places Paraguay in the group of countries that have moved beyond health research – that develops medicines and interventions – to a broader country research strategy that mobilizes science and technology to improve health and prevent illness.

First role:Coordination and Management of NHRS

• Example: Philippines & Malaysia

Second role:Monitoring and Evaluation

• If research has really had an impact on improving health outcomes

• If the NHRS is thus performing optimally

Importance of M&E of NHRS

• The CHRD in 1990 : "the establishment of an international mechanism to monitor progress in health research“.

• the Bamako Global Ministerial Forum on Research for Health in 2008 identified an immediate need "to establish a monitoring mechanism that can track progress against stated intentions, so that next time it will be possible to assess what has been achieved and by whom".

• WHO's Advisory Committee on Health Research (ACHR) highlighted this issue previously when they stated that "perhaps the most effective way for WHO to gain 142 support among Member States, funders, potential partners, and the public for its mandate in health research would be to ensure the implementation of methodologies, to ensure good returns on investments in the research endeavour".

• International Development Research Centre's project titled Accountability Principles for Research Organizations.

• WHO's IMCI (Integrated Management of Childhood Illness)initiative was subjected to a rigorous evaluation process.

• Importantly, there is a second dimension which also needs to be addressed:

• The use of scientifically rigorous research methods to evaluate public health programmes, policies and institutions more generally.

"Our hope is that if governments and development practitioners can make policy decisions based on evidence—including evidence generated through impact evaluation—development resources will be spent more effectively to reduce poverty and improve people’s lives“.

• At the institutional level:The recent 5 year evaluation of the Global

Fund to Combat HIV/AIDS, TB and Malaria.Evaluations of GAVI's Health Systems

Strengthening Initiative and the World Bank's Health, Nutrition and Population programme.

a key question is :What scientifically rigorous methods are suitable for evaluations of these very complex 'interventions'?

Evaluation of a NHRS Approaches and Indicators

• An effective M&E process has three main objectives/goals:

1.To provide information to manage existing research

2.To enable improved allocation of resources between competing research activities

3.To justify the overall level of research expenditure

• It has also been suggested that a monitoring system should not attempt to set uniform targets in advance but, instead, strive to meet an alternative set of five criteria:

1. Relevance to funder's objectives2. Be decision-relevant3. Encourage truthful compliance4. Minimize unintended consequences5. Have acceptable net costs

Impact evaluation: example

• scientific quality:o Times Higher Education World University Rankingso the Shanghai Jiao Tong World University Rankings

• The Council for Medical Sciences of the Royal Netherlands Academy of Arts and Sciences, The Societal Impact of Applied Health Research, 2002:

o scientific quality + societal impacto Tool

www.societalimpact.info

• The tool evaluates factors : The aim of the published paper; The extent to which authors try to translate their

findings into actions which benefit society; The level, status and target group of this

translation To assess the level of translation(provincial, national, regional, global) The target group for translation(individuals, population subgroups, public).

• Research impact framework:1.Research related impacts;2.Policy impacts; 3.Service impacts (health and intersectoral); 4.Societal impacts

Kuruvilla S, Mays N, Pleasant A, et al. 2006. Describing the impact of health research: a research impact framework. BMC Health Services Research 6, 134. doi:10.1186/1472-6963-6-134.

• Making an Impact – A Preferred Framework and Indicators to Measure Returns on Investment in Health Research,2009:

1. advancing knowledge2. capacity building3. informing decision making4. health impacts5. broad economic and social impacts• sets of indicators, rather than single ones, provide a

more accurate assessment of impact.

Although some of these methodologies have been applied in developed countries, its value, usefulness and feasibility in resource-limited

settings are unknown.

comparative (cost) effectiveness research

• the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition, or to improve the delivery of care.

• compare drugs, medical devices, tests, surgeries, or ways to deliver health care.

• the Patient-Centered Outcome Research Institute and NICE.

• The basic tenet of making decisions based on scientific evidence can also be extended more broadly beyond the health sector as illustrated by the well-known Foresight programmes in Japan and the UK designed to develop visions of the future.

• These programmes aim to bring about a culture change in the way business and the science base relate to each other based on the predicate that all organizations need knowledge of what the future might hold to inform current decision making.

Evaluation at the Global Level?

• Evaluating the impact of various global programmes and initiatives which provide support for strengthening health research in countries, especially in the developing world.

• Going a step further, a similar approach should be applied in future to evaluating the various modes and mechanisms for improved harmonization and coordination of global health research which can be referred to as 'evidence-informed' governance of global health research.

• Effective evaluation and monitoring of untested interventions and strategies: population screening programmes for genetic risk to chronic diseases, personalized medicine

Third Role:Monitoring research trends

what will research look like in the future?

• Governance has 'scoping' and intelligence function in identifying new and breaking trends and challenges in research.

• How research for health will be done in the future.

Monitoring research trends - what will research look like in the future?

• Biomedical and Epigenomics• Ggenomics to public health• malERA (Malaria Eradication Research Agenda)• Clinical research: stem cell therapy• Vaccines• Non-communicable diseases• Health systems and health services research• Traditional medicine• Do research on research• Information and communication technologies• how to promote better inter-sectoral and inter-disciplinary

approaches

Health systems and health services research:1. More definitional clarity as to what constitutes health systems research2. A move towards more robust methodological approaches, e.g. the use of

a gold standard, randomized control design of a study to implement a universal health insurance scheme in Mexico

3. Better guidance and clarity on the type and quality of evidence needed for health systems strengthening

4. Implementation and evaluation of the 'systems thinking' framework

Do research on research:1.The challenge of coming up with a universal

standard for research classification(a Babel fish for research)

1.Global health research governance (GHRG)2.How to develop better research networks?

World Bank: Open Data, Open Knowledge, Open Solutions“elite retail” model of economic research

Four levels of cross-disciplinary interactions

Key Messages

• Effective coordination of a NHRS• Evaluation of the impact of research• Exciting new trends and developments

Links to Chapter 5

• The focus of the present Chapter is on the role of effective governance in ensuring coordination and evaluation of the NHRS and monitoring scientific trends. But effective governance should be translated into an effective blueprint or plan of action based on a 'roadmap' which describes the final destination.

• Such a road map will be described in the next chapter which will serve as a guide to Member States for implementing the key recommendations contained in the Report.