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

Research resources✜ Health research system functions: stewardship, financing,resource generation, production and utilization ofresearch;✜ Research process: managing the research agenda,producing evidence, promoting the use of evidence,utilizing evidence in policy, practice and action.More recently, Nuyens made a review of useful andaccessible resources on RCS, ranging from analyticaldocuments, RCS tools, programmes and grants 22 .Of the above efforts, we highlight some recent RCSexamples that specifically address developments described inthe previous section. In line with developments in the globalhealth policy environment, there have been three notabledevelopments:✜ The Global Forum for Health Research and TDR initiatedcollaboration in 2005 on RCS efforts that would improvethe performance of national health research systems,especially in LMICs 5 .✜ The 60th World Health Assembly adopted a resolution on23 May 2007 – WHO’s roles and responsibilities inhealth research, including a major role in RCS 23 .✜ Strengthening of national health research systems:national efforts to consolidate research within countriesand develop and implement strategic plans for NHRS.Some developing country efforts have been described inForums 6–9, www.globalforumhealth.org and also at theCOHRED website, www.cohred.org.New RCS activities have been associated with recentmega-infusions of funds for health and health research. Forexample, the EDCTP has a substantial portfolio for capacitybuilding in the areas of project management, clinical trialsmethodology, research ethics, and support for libraries,laboratories and information technology. These RCS activities,however, are focused on Africa in partnership with Europeaninstitutions. Also worth mentioning is the Systemwide Effectsof the Fund Research Network (SWEF). This is a collaborativeresearch network of research organizations in the South andin the North that conducts country case studies to understandhow the Global Fund grants and similarly large funds affectthe broader health care systems of recipient countries 24 .Although the RCS thrust is not explicit, the implications of theSWEF studies are important for health systems strengtheningof recipient countries, while harnessing skills for healthsystems research through learning in the context of theselarge and complex public health interventions.Spurred by the unprecedented scale of philanthropies aswell as the huge unmet needs for new drugs and tools andtheir cost-effective delivery to the poor, 80 or so public-privatepartnerships (PPPs) for health and health research haveemerged over the years. With this changing landscape, theRCS response has also become increasingly collaborative andmore focused on networks and partnerships, bothNorth–South and South–South. The approach to RCS withinthese networks and PPPs has been largely pragmatic, i.e.,on-the-job training, short courses and workshops, orfellowship and graduate degree programmes built into theresearch programmes. Many of these have focused oncapacity for specific fields of interest like demographic healthsurveillance, health information systems, knowledgerepositories, clinical trials of interventions for neglecteddiseases, basic and applied research on emerging infections,research ethics, research synthesis, health policy andsystems research, equity research, product development andinnovation, and leadership and management.The vast opportunities for strengthening capacity throughICT have certainly been recognized in the health researchfield, although there is much room for growth. Internetcommunications and open access to research and evidencehave been a big boon to researchers in LMICs despite thepersistent digital divide. The Health InterNetwork Access toResearch (HINARI), launched in 2000 by the United Nationsand coordinated by WHO, has been a landmark undertakingnow serving more than 1800 institutions in 113 eligibledeveloping countries. There are other free or highlydiscounted initiatives for journal access such as theProgramme for Enhancement of Research Information,Electronic Information for Libraries and the Ptolemy Project 25 .A related innovation for increased access to the scientificliterature is Biomed Central, where original, peer-reviewedresearch articles are published online and are freely,immediately and permanently accessible 26 . The “nextgeneration” Internet is seeing a growing number of middleincomecountries joining Internet2, a consortium of academicpartners, the technology industry and government, whichenables high speed applications in various fields includingthe health sciences 27 .South-based virtual campuses for health education andresearch, such as the Virtual Campus for Public Healthlaunched by PAHO/WHO and the University of Zimbabwemaster’s degree programme in clinical epidemiology offeredto the African region, may be one answer to the rising needfor expanding the health research human resources in LMICs.But large challenges remain. In addition to the digital divide,there are issues to resolve regarding adaptations tothe virtual environment, language of instruction, culturalappropriateness, student motivation, faculty resources, andquality assessment and evaluation 28,29 .In terms of the long-haul process of institution building,much can be learned from the more systemic approaches tocapacity building for science and technology. The Academy ofSciences for the Developing World (TWAS), the MillenniumScience Initiative (MSI) and the InterAcademy Council (IAC)have all emphasized the role of universities and institutions inbuilding scientific capacity for sustainable development 30,31,32 .Centres of excellence, as well as virtual networks ofexcellence, which are aligned to nationally determined S&Tpriorities, have been proposed and are being established inseveral LMICs. Interestingly, the MSI projects planned inUganda, Cameroon, Botswana and Namibia include abiotechnology component for drugs and vaccines, while that inTanzania focuses on instrumentation and ICT for its scientists.Challenges for RCSRCS needs have been laid out and discussed in previousGlobal Forum Update on Research for Health Volume 4 ✜ 125