Combining health and social protection measures to reach the ultra ...

Research resourcesThe need to developresearch capacityArticle by Mary Ann D Lansang (pictured) and Rodolfo J DennisThe need for health research capacity strengthening(RCS) is widely recognized as a major unmet need,particularly in low- and middle-income countries(LMICs) 1,2,3,4 . Despite revolutionary advances in healthresearch, science and technology, health gains among thepoor continue to lag far behind the pace of healthimprovement among the wealthy. RCS efforts, which havebeen largely uncoordinated and inadequately funded, haveyet to make a significant impact on addressing the wideninginequities in health and health human resources.Recent global, regional and national developments havemade the agenda of RCS all the more important and urgent.Moreover, new challenges for RCS have emerged as a resultof these developments. In response, three internationalbodies – the Council on Health Research for Development(COHRED), the Global Forum for Health Research, and theSpecial Programme for Research and Training in TropicalDiseases (TDR) – agreed to collaborate, in order to supportand to improve the performance of national health researchsystems, particularly in LMICs 5 . In this paper, we reviewrecent developments and discuss the implications andopportunities for strategic action for strengthening researchcapacity.Recent trends influencing health RCSTo determine the opportunities and strategies for RCS in thefuture, it is necessary to track new developments that arelikely to affect RCS initiatives. Key developments have beenselected from the following spheres of influence: the policyenvironment, the different research actors, major healthproblems, and the tools and competencies for healthresearch.Global health policy environmentThere is strong convergence in the international communityon the importance of strong health systems in achieving thegoals of improved health and alleviating poverty. Likewise,the WHO Commission on Macroeconomics and Health, thecountries resolving to achieve the UN MillenniumDevelopment Goals (MDGs), and the Global Fund to fightAIDS, Tuberculosis and Malaria have underscored the needfor health research to support the goals of health anddevelopment. This was reiterated in November 2004 bydelegates at the Ministerial Summit on Health Research andForum 8 in Mexico City, even as they recognized the limitedcapacity in LMICs to tackle the research agenda fordevelopment 3,4 .Funds for health researchResource flows for health research significantly increasedfrom US$ 84.9 billion in 1998 to US$ 125.8 in 2003.However, it has been difficult to track how much of the globalhealth research funds go to RCS. International healthresearch (IHR) has been used as a proxy for RCS. Thisconsists largely of official development assistance (ODA) tobuild and strengthen “health research for development” andhas seen a moderate increase in funding from 1998 to 2001,with further increases projected until 2006, notably from theUSA, UK, France, Italy and Germany 6 .In 2003, a notable research programme with a sizeableRCS component was launched by the European Commission:the European & Developing Countries Clinical TrialsPartnership (EDCTP). This long-term programme has initiallyobligated a total of €600 million for 2003–2007 to developnew interventions against HIV/AIDS, malaria and TB, withthe collaboration of European and African scientists. In recentyears, the private not-for-profit sector, led by the Bill &Melinda Gates Foundation, has also increasingly caught theattention and imagination of health researchers with itstargeted and high-stakes approach to selected IHR initiativessuch as the Grand Challenges in Global Health and the GlobalHIV/AIDS Vaccine Enterprise.The steady increases in funds for IHR are potentialopportunities for RCS. However, since the bulk of the hugeIHR grants are coursed through scientists and institutionsfrom High-income countries (HICs), national health researchsystems and researchers in LMICs need to be strengthened tonegotiate fairly and squarely throughout the research process.Emerging public health problemsInfectious diseases, nutrition and child and maternal healthcontinue to be major public health concerns in LMICs andamong the poor in HICs. But epidemiological trends in LMICswarn against equally disastrous consequences in morbidityand mortality from cardiovascular diseases, diabetes mellitusand other chronic diseases.Global Forum Update on Research for Health Volume 4 ✜ 123