Organising Research for Better Health

1
Organising Research for Better Health

• Harmonising, alignment and coherence

Prof. Hannah Akuffo Team Director Team Research
Policy and Method Development Secretariat for
Research Cooperation Swedish International
Development Agency
2
Conclusions (1)

• Research by and in low income countries requires
  the presence of robust in-country research
  capacity
• Sustainable research capacity strengthening for
  health is more than research project support
  involving individual training it requires
  support to the basis for performing research as
  defined by funded institutions
• For alignment of efforts of funders to happen,
  there need to be strategies and implementation
  plans defined by institutions performing research
  for health

3
Conclusions (2)

• We should move from the statements about what the
  donors are imposing, to the development of clear
  strategies that allow donors and funders to align
• Harmonisation does not necessarily mean funders
  funding the same thing, but agreeing to
  simplify where possible such as through joint
  reporting systems
• Coherence in research funding suggests working in
  concert to reduce fragmentation and above all to
  do no harm

4
Not all countries should have national airlines,
some must use the expertise of those with
resources. So why should all low-income countries
have institutions of health research?

• A provocative statement made by one of the
  Northern proponents of research for health
• Perhaps not all need an airline, but low-income
  countries definitely need a cadre of people who
  can ask their own questions and have the tools to
  address getting the answers
• Otherwise, who will ask the pertinent questions
  deemed relevant and of importance to the low
  income countries?
• Unreasonable to think it will be those with other
  agendas, however well meaning

5
Diversity in capacity for research for health in
low income countries

• Continued research capacity strengthening is an
  ongoing endeavour in all countries
• Research capacity issues are under control in
  some countries but in others the challenges
  remain acute
• In our discussions let us not mix the needs of
  countries (even those on the same continent) who
  have attained their targets for research capacity
  with those who are struggling to attain such
  targets
• My emphasis in this presentation is on low income
  countries with weak research capacity for
  research for health

6
So why should low-income countries have
institutions of research?

• And what do we mean with research capacity?

7
National Research capacity entails
National commitment to research
National research policy strategy
Budget line for National research
Skills for carrying out research
Asking nationally relevant questions
National research capacity
Research University as a hub
Capacity to generate own knowledge
Capacity for analysis
Capacity for evaluation
Capacity to utilise external research/knowledge
Innovation systems
Culture of inquiry
Agents of Change Using evidence to question
Capacity to be part of international research
community
8
University Research capacity entails
Well trained Researchers
University policies and strategies
Mechanisms to encourage reward research
Dedicated university budget for research
Research University
Mechanisms of research communication
An Enabling Environment for research
Capacity for local PhD examination
University mechanisms for innovation
Culture of inquiry
Improved teaching- less didactic
Skills for research management
Research Leadership skills
Access to scientific literature
Access to Information Communication Technology
9
The paris Agenda

• Strategies for
• Harmonising, alignment and coherence in support
  for research

10
Paris Agenda

• Emphasises
• Ownership, Alignment, Harmonisation, Managing for
  Results and Mutual Accountability
• For research it is relevant to note
• The Paris Declaration highlights the need for
  research in relation to development for providing
  the knowledge foundation and the expertise that
  make it possible for partner countries to
  analyse, formulate, negotiate, implement and
  evaluate their own development agenda.
• Today these functions are often performed by
  external consultants and technical assistance,
  provided by the donors

11
Paris Agenda

• To change the situation the Paris Declaration
  states that partner countries should undertake
  to
• Integrate specific capacity strengthening
  objectives in national development strategies and
  pursue their implementation through country-led
  capacity development strategies where needed.

12
Paris Agenda

• Operational strategies to strengthen capacity in
  the partner countries implies that donors must
  change their commitments and
• Align their analytic and financial support with
  partners capacity development objectives and
  strategies, make effective use of existing
  capacities and harmonise support for capacity
  development accordingly (Indicator 4).

13
Paris Agenda - Ownership

• Partner countries exercise effective leadership
  over their development policies and strategies
  and coordinate development actions

14
Paris Agenda - Alignment

• Donors base their overall support on partner
  countries national development strategies,
  institutions and procedures
• Currently support to research (for health) is
  mainly focused on
• research on issues of relevance to low-income
  countries (theme-based research), organised as
  projects, with a short- to medium-term
  perspective and closely connected to the agenda
  of the funding organisation
• Less funding goes to
• The long-term commitment aimed at all levels of
  production and utilisation of research in a
  national or regional setting

15
Paris Agenda - Alignment

• Development of partner countries capacity to
  negotiate collaborative research activities and
  to apply for research grants in line with their
  strategic orientation should be advocated
• Donors involved in research cooperation with a
  country or regional/ international organisation
  ought to respect the rules and regulations for
  research, including research permits, research
  ethics, staff remuneration and institutional
  contracts

16
Paris Agenda - Harmonisation

• Donors actions are more harmonised, transparent
  and collectively effective
• This requires support for
• establishment of efficient mechanisms for
  management of external research funds making it
  possible to channel funds through partner
  countries systems
• production of uniform reporting formats at the
  supported institutions to be used by all donors.

17
Paris Agenda - Mutual Accountability

• Donors and partners are accountable for
  development results
• partner countries and regional organisations
  should be encouraged to invite all research
  donors/funders to joint review meetings

18
Coherence

• Funders should endeavour to adhere to the Paris
  agenda
• We should
• Be mindful that in an attempt to assist, we
  should not undermine and fragment the efforts of
  fragile institutions
• At the least our actions should do no harm to
  partner country institutions

19
Basis for research for health

• The basis for capacity for research for health
  also requires capacity in areas/disciplines of
  research of a broad nature.
• These include fundamental science (Biology,
  Statistics, Bio-Physics, molecular biology etc.)
  as well clinical research and health systems
  research
• Time to stop polarizing this debate

20
A concerted approach to research funding

• Support for the conditions/foundation for
  research
• Support for individual researchers
• Support for research projects
• Finding opportunities to work with other donors
  and funders in the spirit of the Paris
  Declaration for Aid effectiveness

Individual researchers
Foundation and Basis
21
Financing of Research for Health
22
In times of financial constraints, can low income
countries prioritise research for health as
opposed to immediate action?

• The real question is
• Can low income countries afford not to make
  decisions based on evidence relevant to their
  specific environments?
• Considering the dynamic circumstances the World
  is in, including climate change, can countries be
  content with old research results from other
  situations?

23
Who should pay the researchers?

• The Governments or institutions!
• The role of funding agencies should be to
  negotiate support based on the strategies of
  countries and institutions
• This could consist of supporting countries human
  resource plans for researchers (research for
  health) and career plans
• This requires clear country budgeting plans by
  Governments and institutions for human resource
  for health research
• Funders/development partners can then also
  contribute to such plans in a coherent fashion

24
Capturing research funding flows by external
funders

• Can different modalities of financial
  contribution be captured in the kind of surveys
  performed to date?
• If the Paris Agenda and closer collaboration by
  funders and harmonisation is approached, can
  sources of external financial flows be followed
  adequately?
• How does one capture the important contribution
  to the basis/foundation for research for health
  while questionnaires ask for project based
  research alone?

25
Channelling of financial resources for research
for health in low income countries
26
Are low-income countries ready in 2008 for
funding to research for health through General
Budget Support?

• Are countries ready to prioritise research for
  health?
• Where is the evidence for this? Are governments
  using their general budget support for research
  for health?
• What are the prerequisites for this?
• Will research for health be able to compete with
  the many pressing needs of the country?
• Are there clear government budget lines for
  research, that would allow monitoring of the flow
  of Government funds to research in general and
  research for health in particular?

27
Are low-income countries ready in 2008 for
funding to health research to be primarily
through Sector-Wide Approach (SWAP) funding?

• Are countries ready to prioritise research in the
  wake of many health needs?
• Where is the evidence for this?
• Will research and research training be sidelined
  for shorter term emergencies and current health
  needs?
• Are there clear government and institutional
  budget lines for research?
• Will SWAPs improve the link between health
  research and policy makers
• Where is the evidence for this?

28
The response of funders

• A strategy of funders to work together to support
  research capacity strengthening for health in
  low-income African Countries

29
ESSENCE on Health Research

• Enhancing Support for Strengthening
• the Effectiveness of National Capacity Efforts

30
ESSENCE

• Is a collaborative framework between funding
  agencies providing synergism to address research
  capacity needs.
• It aims to improve the impact of investment in
  institutions and enabling mechanisms that address
  the identified needs and priorities within
  national strategies on research for health.

31
ESSENCE

• Was established after a meeting of funders in
  April 2008 in Stockholm
• Is open for all funders, bilateral development
  agencies, philanthropists, charities etc. who
  support or are interested in supporting research
  capacity in low income countries in Africa
• The initial executive group includes development
  cooperation agencies the United Kingdom
  Department for International Development (DFID ),
  International Development Research Centre (IDRC
  ), the Ministry of Foreign Affairs of the
  Netherlands, Norwegian, Agency for Development
  Cooperation (Norad), the Swedish International
  Development Cooperation Agency (Sida) plus the
  Bill Melinda Gates Foundation and the Wellcome
  Trust.
• The ESSENCE secretariat is hosted in TDR (Special
  Programme for Research and Training in Tropical
  Diseases).

32
ESSENCE

• We have started the process between the
  funders/development partners/donors through
  ESSENCE for health Research in the spirit of the
  Paris Agenda
• We need to more clearly define our goals and
  approach in the next few weeks
• We will of course engage partner countries and
  institutions, but ESSENCE is focused on how the
  funders can best align and harmonise and be
  coherent and learn from each other in the quest
  for supporting research capacity in Africa

33
Thank you