Health Research Policy and Systems - Latest Comments

Strong national research for health systems are key to new directions for research

Francisco Becerra-Posada — 2011-03-27T11:33:51Z

The authors reflect on one of the very few commemoration conferences on the 20th anniversary of the Commission for Health Research for Development. The other we are aware of, is the COHRED Colloquium held last October in Geneva, Switzerland. As the authors say, much has changed in a positive way since the report was issued and thus, creating awareness and giving research for heath relevance and bringing it to be openly discussed and on finding ways on how to support countries to achieve the recommended investment to advance their ‘essential national health research’. The analysis both authors present on the advances and the gaps are accurate and there have been more advances after two key conferences on research for health, the one held in Mexico in 2004 (Dr Frenk was then Minster of Health), and the one in Bamako in 2008.
On strengthening research for health systems, they fail to mention that the system, in order to support and facilitate all the needed capacity building, infrastructure, prioritised agenda for research for health, financing and support for researchers, needs to be integrated, coordinated, with a clear set of goals and objectives, with a sustainable and ongoing financing system and under good management in order to fulfil a defined Research for Health Policy or National Programme. Without all these elements, research in low and middle income countries will continue to face all the problems they have been facing all along.
COHRED is not only, as the authors refer to, “a Geneva based initiative, to strengthen essential national research in the world’s poorest countries” (page 3). COHRED was born right after the Conference where the Commission presented its results, becoming the first and still existing organisation working in supporting and providing technical support to low and middle income countries to develop and/or strengthen their research for health systems. COHRED has been playing an advocacy and promotional role of national research for health systems and many countries have benefited from it. Just as an example, the 1st Latin American Conference on Research and Innovation for Health (Report of the 1st Latin American Conference on Research and Innovation for Health, available at http://www.cohred.org/sites/default/files/Rio_report_EN_low_res.pdf, accessed March 25th, 2010), 2008, Rio de Janeiro, and the support given to Paraguay in achieving a dedicated Policy on Research for Health. ( Política Nacional de Investigación, Desarrollo Tecnológico e Innovación para la Salud, Available at http://www.healthresearchweb.org/files/Politica_Nac__Inv__Salud_Paraguay_20101206_pr.pdf, , accessed March 25th, 2010 )
The Global Forum for Health Research –wrongly addressed by the authors as the “Global Health Research Forum” (page 4), is currently being integrated to COHRED, who is preparing the next Global Forum (on health research) where it is expected participants can discuss on the future for research for health as a global good and with equal gains and responsibilities from both rich and poor countries.

Francisco Becerra-Posada, COHRED, Head of Projects&Programmes. Becerra@cohred.org
Carel IJsselmuiden, COHRED, Director; Global Forum for Health Research, Interim Executive Director. carel@cohred.org

Review Misses Seminal & Prize-Winning Studies

Ted Miller — 2010-09-29T19:19:45Z

1. (be sure to read 2 also) This review misses the seminal work in the US starting with the work of David Cutler estimating the value of the US National Institutes of Health. A few citations to this work are
Cutler, D. M., & Richardson, E. (1997). Measuring the health of the U.S. population. In Brookings Papers on Economic Activity, Microeconomics. (pp. 217–271). Washington, DC: Brookings Institute.
Cutler, D. M., & Richardson, E. (1998). The value of health: 1970–1990. American Economic Review, 88(2), 97–100.
D.M.Cutler and M. McClellan, “Is TechnologicalChange inMedicineWorth It?” HealthAffairs 20, no. 5
(2001): 11–29
D.M. Cutler, Your Money or Your Life: Strong Medicine for America’s Health Care System (New
York: Oxford University Press, 2004).
D.M. Cutler et al., “Are Medical Prices Declining?
Evidence from Heart Attack Treatments,” Quarterly Journal of Economics 113, no. 4 (1998): 991–1024.

2. Also missing are the papers that won the annual Eugene Garfield Economic Impact of Health and Medical Research Prize.
2009 - Darius N. Lakdawalla, PhD; Dana Goldman, PhD; Pierre-Carl Michaud, PhD; Neeraj Sood, PhD; Robert Lempert, PhD; Ze Cong; Han de Vries; and Italo Gutierrez
2008 - Amitabh Chandra, PhD and Douglas O. Staiger, PhD
2007 - Tomas J. Philipson, PhD and Anupam B. Jena, PhD
2006 - Amy Finkelstein, PhD, MPhil
2005 - Kevin M. Murphy, PhD and Robert H. Topel, PhD
2004 - Sherry A.M. Glied, PhD
2003 - David Cutler, PhD
2002 - David Meltzer, MD, PhD

Murphy, Kevin M., and Robert Topel. 2002. "The Economic Value of Medical Research." in Exceptional Returns, eds. Kevin M. Murphy and Robert H. Topel. Chicago: University of Chicago Press.
Murphy, Kevin M., and Robert Topel.“The Value of Health and Longevity”, NBER Working Paper #11405, June, 2005. Journal of Political Economy, 2006

Consistent effort rather than just effort

NAEEM SALEEM — 2010-06-21T07:06:40Z

Abstract:-
Pakistan has well established HIV epidemic among IDUs which is still evolving among Transgender. Political institutions in the country have not evolved due to frequent interruptions in the political process. Recent fragmented effort to mobilize the parliamentarians has not been effective due to lack of consistency. There is need to address all the political and power structure within the country for effective HIV response.
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In response to recent article published in Health Research Policy and Systems 2009, 7; 20 titled “Educating the Power: HIV/AIDS and Parliamentarians of Pakistan” I shall like to extend the discussion further and clarify few points.

1- Islamic Republic of Pakistan has unique geographic location and is situated in South East Asia. She has borders with Afghanistan, India, Iran, and China on west, east, north and south west. (1) It is very frequently compared with neighboring country on the western border which has only partial social resemblance and is discordant in terms of religion and geographical size. HIV epidemic in neighbouring country is clearly two fold i.e., IDUs driven in north and through sexual routes in south as compared to IDUs driven in Pakistan. (2)
2- The history of HIV response in Pakistan is not very old. It started with the beginning of new millennium when National AIDS Control Program (NACP) with its stakeholders like government departments, non-governmental organization, community based organizations, researchers, donors and people living with HIV/AIDS (PLWHA) formulated National HIV/AIDS Strategic Framework for the period of 2001-06 (revised in 2006 and new framework for 2007 – 2011 has been developed) in order to guide the activities to curtail HIV epidemic. This framework was operationalized over the next five years with financial assistance of US Dollar 37.1 million from International Development Association (IDA), the World Bank’s concessionary lending arm. Out of this total value ten million were provided as grant and fifteen percent equity was injected from public source.
3- In order to have clear epidemic picture Pakistan has well established HIV surveillance system. Sentinel surveillance system collects data regularly from surveillance centers, blood banks, STI clinics and Voluntary Counseling and Testing Centers (VCTs) spread throughout the country. More effective Second Generation Surveillance has also been established in the light of international guidelines. (3) Present HIV prevalence at the end of current HIV response among various High Risk Groups is; Injecting Drug User’s (IDUs) 20.8% (95% CI: 19.4%, 22.3%), Transgender Sex Workers (TSWs) 6.4% (95% CI: 5.0%, 7.7%). (4) This is very alarming situation and demands enhanced response.
4- Democratic republic of Pakistan has political system which has not fully evolved due to frequent interruptions by military dictators. Frequent experimentation with the political system by politicians themselves is also not uncommon. The recent announcement of the rollback of eight years old district devolution system is clear example of this experimentation.
5- Recent combined effort by Parliamentarians for Global Action (PGA), United Nations Joint Programme on HIV/AIDS (UNAIDS) and AIDS Control Programs to educate members of National/ Provincial assemblies has not been fully effective. It was aimed to sensitize, educate and built capacities as advocates of policy makers through series of seminars. (5) This initiative led to the formation of parliamentary fora at national and provincial levels. The reflection of this effort has resulted in limited response perhaps due to recent elections in 2007 leading to new parties in the parliament which has not been reached by PGA. Due to lack of this sensitization the HIV/AIDS Prevention and Treatment Act, 2007 in order to prevent the HIV from becoming established amongst general population, vulnerable population and to provide care, support and treatment of person with HIV and AIDS exists but awaits constitutional endorsement by the parliament.
6- Political commitment as shown in hard hit Africa is exemplary and much can be learned from it as well. During April 2001 Organization of African Unity (OAU) met in Abuja, Nigeria, to address the exceptional challenges of HIV/AIDS. (6) During this summit the current African response was critically evaluated with recognition of various existing factors like poverty, biological vulnerability of women, and injecting drug abuse. It was emphasized that continuity of sustainable source of income to fund HIV/AIDS program was essential with more contribution from internal resources. The role of political leadership was emphasized and this role was exercised by everyone in his/her area of responsibility against HIV/AIDS. This led to commitment of massive participation of Head of State and Government at the United Nations General Assembly Special Session (UNGASS) on HIV/ADIS held in June 2001. Subsequently convention of heads of African States at Maputo, Mozambique, during July 2003 led to commitment of 15% of national budget to health sector. (7)

Way Forward:-

Remnants of colonial structure still exist in Pakistan in the form of beurocracy and they are the key players of power. They are the most powerful stakeholders to influence the planning and funding process. Their active involvement in the process cannot be overlooked and they also need to be sensitized in order to curtail current HIV epidemic in Pakistan.

Other key players who can influence the political system must also be sensitized. This sensitization in Africa has resulted in the formation of a body of African first ladies. This organization in Africa constitutes of forty African first ladies who are currently combating against HIV/AIDS threat effectively and has produced very impressive results.

In order to mobilize the politicians effectively continuity of effort is more important as compared to one time activity as exhibited earlier by the PGA.

Not only the parliamentarian but also all political parties in the country must be part of such initiatives.

Refrences:-

(1) Outline of Pakistan, Wikipedia, the free encyclopedia [Online].
Available from: URL: [http://en.wikipedia.org/wiki/Pakistan]
(2) Naeem Saleem, poster discussion # A-072-0129-03284 entitled "Next wave of HIV epidemic in Punjab, Pakistan", at the XVII International AIDS Conference in Mexico City 3-8 August 2008.
(3) Second Generation Surveillance for HIV: the next decade. Geneva: World, Health Organization and Joint United Nations Programme on HIV/AIDS 2000.
(4) National AIDS Control Program & Canada-Pakistan HIV/AIDS Surveillance Project (HASP). HIV Second Generation Surveillance in Pakistan, National Report Round III. 2008. p 28.
(5) Report on a joint initiative: “Empowering Parliamentarians to address HIV & AIDS in Pakistan”. A joint publication by PGA and UNAIDS, Pakistan. [Online].
Available from: URL: [http://www.aplfaids.com/download/Empowering_Parliamentarian.pdf]
(6) African Summit on HIV/AIDS, Tuberculosis, and other related infectious diseases. [Online]. 2001, 24-27 April. Abuja, Nigeria.
Available from: URL: [http://www.un.org/ga/aids/pdf/abuja_declaration.pdf.]
(7) Maputo Declaration on HIV/AIDS, Tuberculosis, Malaria and other related infectious diseases. [Online].
Available from: URL: [http://www.rollbackmalaria.org/docs/maputo_declaration]

Acknowledgments:-

I am grateful to AIDS Control Program for sharing the information and for providing insight.

Key Words:- HIV, Parliamentarians, Pakistan

Comments and Feedback

Anthony Zwi — 2010-06-21T07:05:45Z

As authors, we would be very interested in feedback on any aspect of this article - theory, methods and approach, specific content area covered. Additional dimensions to this work are being taken forward actively, so learning from others exploring related matters would be of value.