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

Research resourcesThe threat of pandemics from new and emerging diseasessuch as the severe acute respiratory syndrome (SARS) andavian influenza (AI), as well as widespread natural disastershas demanded the rapid development of global alert andresponse systems as well as basic and clinical research rightat the core of these affected countries. Bioterrorism also hasthe potential to modify a country’s research priorities andresources. Situations such as milk supplies and botulinumtoxin, smallpox and self-infected terrorists, and release ofaerosolized microbes in closed environments are newproblems that need previously untaught tools and skills.The growing burden of disease from injuries and violenceas well as mental and neurological diseases must also berecognized. Likewise, cross-cutting issues of equity,particularly gender-related issues, and intersectoral concernslike environmental health and global warming, have grown inimportance through the years.All of the above developments require RCS, wherescientists and public health officers will be asked to leadneeds assessments, develop new tools and interventions andwork with policy-makers. Without coordinated research andprogrammatic action, health systems and the health of thepeople in many LMICs are bound to deteriorate even further.Brain drainIn 2005, the Joint Learning Initiative, a group of more than100 scientists, called the world’s attention to the dire crisis inthe health workforce, especially in LMICs. The World HealthReport 2006: Working together for Health also focused onthe global human resources for health and proposed a 10-year action plan for addressing this challenge, both in thepublic and private sectors. Far less aired but also a significantproblem is the chronic lack of skilled health researchers inmany LMICs due to intra- and international migration.Many of the root causes are similar to those of the generalhealth workforce, such as the quest for state-of-the-arttechnologies, better socio-political conditions, and improvedrevenue and quality of life. Among researchers, the situationis compounded by the lack of a nationally coordinated careerpath for researchers and an enabling research environment.It is critical for LMICs to achieve and sustain the minimumknowledge-based mass needed for creativity, credibility andinnovation in health and development. The vigorous call toaction for building and retaining the health workforce inLMICs must also include strategic action for RCS.Recent research developmentsNew research streams and technologies require constantsharpening of research skills or developing new cadres ofscientists, refining old methods or developing new researchapproaches, and arranging innovative partnerships. There aretremendous research challenges related to the attainment ofthe MDGs, the reduction of poverty, inequities and othersocial determinants of ill health, but insufficient numbers oftrained professionals to carry out health policy and systemsas well as health social science research. The attention to the“know – do” gap in recent years underscores the importanceof considering other stakeholders as essential players inWithout coordinated research and programmaticaction, health systems and the health of the people inmany LMICs are bound to deteriorate even furtherresearch formulation, implementation and translation topolicy and action.The revolutions in science and technology – frominformation and communication technology, to genomics,proteomics and nanotechnology – present new opportunitiesfor North–South and South–South research partnerships forimproving access to much-needed drugs and tools. On theother hand, they pose dilemmas in the realm of researchethics, intellectual property and equity – all of which nationalhealth research systems must be prepared to confront.The growing emphasis on performance-based funding, theneed to track progress towards the MDGs and thecomplexities of decentralized reporting in devolved healthsystems agencies have necessitated a fresh look at healthinformation systems and strengthened competencies atcountry levels to generate reliable and accurate healthstatistics. The explosion of information and knowledge hasalso generated global interest in knowledge management andthe synthesis, dissemination and translation of the bestavailable evidence for health policy and practice.GlobalizationThis phenomenon is not new, but the rapid changes inscience, communication and technology frontiers, newinternational trade and market regulations, macroeconomicsand the environment have heightened the impact ofglobalization more than ever before. Overall, it has had adeleterious effect on health care systems in developingcountries, affecting not only the migration of health humanresources, but also the capacity to deal with emergingdiseases, bioterrorism and biased health sector markets.LMICs need to build their capacity to define and pursueglobalization-related research that can reduce inequities inhealth and knowledge capacities and that can strengthenregulatory policies. Only then can national health researchsystems derive maximum gain from the opportunities andthreats from globalization 19,20 .Recent trends in RCSThe urgent and enormous need for research capacity toaddress the problems of LMICs and the poor has not goneunheeded. In addition to a number of existing and recentlyestablished initiatives that have RCS as a major strategicobjective, there are numerous research initiatives that haveRCS streams integrated into their respective activities. Apanoramic view of capacity strengthening efforts and issueswas recently published by the Global Forum for HealthResearch according to the following parameters:✜ RCS levels: individual training, institutional development,organizational development, national health researchsystems, supranational health research bodies;124 ✜ Global Forum Update on Research for Health Volume 4