What's the RAP for Bamako?

Tim Evans, Assistant Director General, Information, Evidence and Research Cluster,

WHO

Third Expert Consultation on Positive Synergies between health systems and

Global Health Initiatives 2 October, 2008

Overview

Background to the Bamako Ministerial Forum on Research for Health

What's the RAP (research action plan) for synergies?

1990: Commission on Health Research for Development

1996: Ad Hoc Committee on Health Research Relating to Future Intervention Options

2000: International Conference on Health Research for Development (Bangkok)

2004: Ministerial Summit on Health Research (Mexico)

2008: Bamako Ministerial Forum

The Road to Bamako!

Bamako, MaliNovember 17-19, 2008

Global Ministerial Forumon Research for Health

Themes Review & build on achievements

since Mexico 2004 Ministerial Summit on Health Research

Make new commitments drawing on "Research for Health" theme

AFRICA FOCUS – role of research in alleviating Africa's health problems

Nature of Meeting High Level research POLICY forum

whereby official country delegations (currently 60 including >40 Ministers) commit to Bamako Action Plan….that will go to WHO and UNESCO governing bodies

Announcements and LAUNCHES of initiatives

Scientific FORUM on specific topic areas in health security, health development and innovation for health

Global Context

The race for results Systems are in fashion!:

GAVI/GFATM – increasing "systems" fundingG8 focus on finances, workers, information Intl Health Partnership++++Delivery/operations research exploding

Africa Health Initiative - $100 million! …but research activities are too adhoc and

fragmented….

The challenges to scale up services for HIV, TB, malaria, and immunization

HIV/UA assessment report

Global Plan to stop TB

World Malaria report

GAVI/Norad report

• Inadequate financing• HR crisis • Affordable commodities • Stigma, discrimination…• Accountability

• Partnership alignment • Inadequate financing • Laboratory capacity • HR crisis • Quality drugs

• Drug efficacy • Information system • Inadequate financing

• HRH and Community

services • M&E

• HR crisis • Inadequate financing • Leadership and

management • Inter-agency

coordination

What's the opportunity for "synergies" research in Bamako? Follow-up from Mexico Figure prominently in the Bamako

Action Plan …Research PrioritiesResearch CapacitiesResearch StandardsResearch Translation

Health need

Measurement of th

e

problem – diagnosis

Understand causes of

the problem –

determinants

Dev

elo

pm

ent

of

solu

tio

ns

Translation and delivery of the solution

Evalu

ation

of th

e

effectiveness o

f the

solu

tion

A framework for health research priorities at WHO

Patient

Safety

Research

Measurement of th

e

problem – diagnosis

Understand causes of

the problem –

determinants

Dev

elo

pm

ent

of

solu

tio

ns

Translation and delivery of the solution

Evalu

ation

of th

e

effectiveness o

f the

solu

tion

Patient Safety Research: Establishing global research priorities - use of a Delphi method , expert peer review and a priority framework of harm relative to knowledge gap, likelihood of research delivering a solution, political support.

Measuring the burden of unsafe

care

Understanding the main causes & organizational and system failures that

lead to patient harm

Identification of locally effective and affordable

solutions

Adaptation of effective solutions to local contexts ensuring local

effectiveness and affordability

Evaluation of cost-effectiveness of solutions

PSP

Jordan

Morocco Egypt

South Africa

Tunisia

Kenya

Yemen

Sudan

Multi-country studies on prevalence of unsafe care

Argentina

Peru

Mexico

Colombia

Costa Rica

Brazil

Research on neglected

priority systems issues

Measurement of th

e

problem – diagnosis

Understand causes of

the problem –

determinants

Dev

elo

pm

ent

of

solu

tio

ns

Translation and delivery of the solution

Evalu

ation

of th

e

effectiveness o

f the

solu

tion

Alliance HPSR research areas Alliance HPSR works across all areas, given relatively limited (although growing) number of other partners in the field and limited existing research. The Alliance currently focuses on three specific themes – health financing, human resources for health, role of the non-state sector.

Variable quality of metrics

Critical need to improve understanding of

problemsE.g.. factors underlying

poor health worker motivation,

growth of the private health sector.

Key area of focus e.g.. incentives for health workers to locate in underserved areas,

strategies to promote universal coverage

Supporting the development of solutions e.g. mechanisms to identify

the poor

Advocating for andsupporting evaluationsof health systemstrengthening interventions

Alliance HPSR

Striking synergies: a three level approach to research

1. Community/Clinical the "coal face"; innovative delivery models,

transformative technologies

2. Systems/Policy supportFinancing, workforce, governance

3. Comprehensive assessmentmonitoring and evaluation

Research Priorities Agenda

Monitoring and Evaluation Research Agenda –

Coverage surveys of GHI interventions Cross-country survey on the strength of health systems Essential and non-essential indicators (data reduction!) Convergence – look at ways individual/clinical/facility based

records can be linked to population monitoring Evaluate specific efforts at synergy e.g. GAVI-HSS window Real-time or continuous evaluation of scaling up e.g.

UNICEF Catalytic Initiative

Research Capacity Stewardship

Clearer "identity" required to facilitate greater strategic collaboration/networking

Advocacy for policy and funding priority Financing

Longer term structural change in research funding e.g. "National Institute for Delivery Research"

Nearer term opportunities e.g. tap "research" funds from global sources such as global fund grants

Individuals and Institutions The research curricula, cadres, cohorts, careers Institutions

Academic/training Research – observatories, country learning platforms, public health institutes, Twinning

Standards Concepts/Frameworks

International classification on health systems and GHIs? Systems boundaries, functions, building blocks require greater

clarity What constitutes a "synergy"?

Measurement/Methods health systems metrics e.g. measures of coverage, governance Attributable fractions to systems, GHIs?

Conduct Ethics – informed consent, Information privacy, access to results

Innovative Research Designs GFATM-TDR – "operations research" UNICEF - "real-time scaled evaluation"

Standards of Evidence

If gold standard evidence for clinical medicine is the RCT, what is it for scaling up health systems and striking synergies with GHIs?

Retrospective: case studies of success and failure

Prospective: Four cell designs Real time experiments in implementation Innovative randomization

New Approaches to research: Complex adaptive systems

An emerging "field" of research

Beyond serendipity Towards "savvy" in striking systems synergies

A new science needed to: Illuminate the black box of delivery? Avoid the black hole of systems? Scale-up services more quickly, safely, equitably

and efficiently

Translation to Policy and Public Cultivating demand for this research by actively engaging

key policy constituencies G8 – Japan follow-up and lead into Italy…Canada GHI leadership, H8 Civil society Implementers

Accelerate translation of research to policy/action Facilitating mangers and policy makers to make evidence-

informed decisions e.g. EVIPNET Facilitate access to research

Health Systems Evidence Libraries e.g. Cochrane, Campbell –like effort for health systems

Innovative IT applications e.g. "Itropica" for synergies