What s the RAP for Bamako Third Expert Consultation

What's the RAP for Bamako? Third Expert Consultation on Positive Synergies between health systems and Global Health Initiatives 2 October, 2008 Tim Evans, Assistant Director General, Information, Evidence and Research Cluster, WHO

Overview Background to the Bamako Ministerial Forum on Research for Health n What's the RAP (research action plan) for synergies? n

The Road to Bamako! n 1990: Commission on Health Research for Development n 1996: Ad Hoc Committee on Health Research Relating to Future Intervention Options n 2000: International Conference on Health Research for Development (Bangkok) n 2004: Ministerial Summit on Health Research (Mexico) n 2008: Bamako Ministerial Forum

Global Ministerial Forum on Research for Health Bamako, Mali November 17 -19, 2008

Themes n. Review & build on achievements since Mexico 2004 Ministerial Summit on Health Research n. Make new commitments drawing on "Research for Health" theme n. AFRICA FOCUS – role of research in alleviating Africa's health problems

Nature of Meeting n High Level research POLICY forum whereby official country delegations (currently 60 including >40 Ministers) commit to Bamako Action Plan…. that will go to WHO and UNESCO governing bodies n. Announcements and LAUNCHES of initiatives n. Scientific FORUM on specific topic areas in health security, health development and innovation for health

Global Context n The n race for results Systems are in fashion!: ¨ GAVI/GFATM – increasing "systems" funding ¨ G 8 focus on finances, workers, information ¨ Intl Health Partnership++++ ¨ Delivery/operations research exploding § Africa Health Initiative - $100 million! ¨ …but research activities are too adhoc and fragmented….

The challenges to scale up services for HIV, TB, malaria, and immun HIV/UA assessment report Global Plan to stop TB • Inadequate financing • Partnership alignment • HR crisis • Inadequate financing • Affordable commodities • Laboratory capacity • Stigma, discrimination… • HR crisis • Accountability • Quality drugs World Malaria report • Drug efficacy • Information system • Inadequate financing • HRH and Community services • M&E GAVI/Norad report • HR crisis • Inadequate financing • Leadership and management • Inter-agency coordination

What's the opportunity for "synergies" research in Bamako? Follow-up from Mexico n Figure prominently in the Bamako Action Plan … n ¨ Research Priorities ¨ Research Capacities ¨ Research Standards ¨ Research Translation

A framework for health research priorities at WHO Un he of t ion of the s luat Eva ivenes n ct tio effe solu Health need Translation and delivery of the solution elop solu ment tion of s de r th stan de e pr d c te ob au rm le se so in m an – f ts Dev he f t is o s nt no me ag re – di u as em Me bl o pr

Patient Safety Research: Establishing global research priorities - use of a Delphi method , expert peer review and a priority framework of harm relative to knowledge gap, likelihood of research delivering a solution, political support. he f t is o s nt no me ag re – di u as em Me bl o pr Un de r th stan de e pr d c te ob au rm le se so in m an – f ts Research elop solu ment tion of s he of t ion of the s luat Eva ivenes n ct tio effe solu Safety Translation and delivery of the solution Evaluation of costeffectiveness of solutions Understanding the main causes & organizational and system failures that lead to patient harm Patient Dev Measuring the burden of unsafe care PSP Adaptation of effective solutions to local contexts ensuring local effectiveness and affordability Identification of locally effective and affordable solutions

Multi-country studies on prevalence of unsafe care Tunisia Morocco Mexico Egypt Jordan Costa Rica Colombia Yemen Kenya Peru Brazil Argentina South Africa Sudan

Alliance HPSR research areas Alliance HPSR works across all areas, given relatively limited (although growing) number of other partners in the field and limited existing research. The Alliance currently focuses on three specific themes – health financing, human resources for health, role of the non-state sector. he f t is o s nt no me ag re – di u as em Me bl o pr Un de r th stan de e pr d c te ob au rm le se so in m an – f ts Dev he of t ion of the s luat Eva ivenes n ct tio effe solu Research on neglected priority systems issues Translation and delivery of the solution Advocating for and supporting evaluations of health system strengthening interventions elop solu ment tion of s Variable quality of metrics Alliance HPSR Supporting the development of solutions e. g. mechanisms to identify the poor Critical need to improve understanding of problems E. g. . factors underlying poor health worker motivation, growth of the private health sector. Key area of focus e. g. . incentives for health workers to locate in underserved areas, strategies to promote universal coverage

Striking synergies: a three level approach to research 1. Community/Clinical the "coal face"; innovative delivery models, transformative technologies 2. Systems/Policy support Financing, workforce, governance 3. Comprehensive assessment monitoring and evaluation

Research Priorities Agenda n Monitoring and Evaluation Research Agenda – n n n Coverage surveys of GHI interventions Cross-country survey on the strength of health systems Essential and non-essential indicators (data reduction!) Convergence – look at ways individual/clinical/facility based records can be linked to population monitoring Evaluate specific efforts at synergy e. g. GAVI-HSS window Real-time or continuous evaluation of scaling up e. g. UNICEF Catalytic Initiative

Research Capacity n Stewardship ¨ ¨ n Clearer "identity" required to facilitate greater strategic collaboration/networking Advocacy for policy and funding priority Financing ¨ Longer term structural change in research funding n ¨ Nearer term opportunities n n e. g. "National Institute for Delivery Research" e. g. tap "research" funds from global sources such as global fund grants Individuals and Institutions ¨ ¨ The research curricula, cadres, cohorts, careers Institutions n n n Academic/training Research – observatories, country learning platforms, public health institutes, Twinning

Standards n Concepts/Frameworks ¨ ¨ ¨ n Measurement/Methods ¨ ¨ n health systems metrics e. g. measures of coverage, governance Attributable fractions to systems, GHIs? Conduct ¨ ¨ n International classification on health systems and GHIs? Systems boundaries, functions, building blocks require greater clarity What constitutes a "synergy"? Ethics – informed consent, Information privacy, access to results Innovative Research Designs ¨ ¨ GFATM-TDR – "operations research" UNICEF - "real-time scaled evaluation"

Standards of Evidence n If gold standard evidence for clinical medicine is the RCT, what is it for scaling up health systems and striking synergies with GHIs? n Retrospective: § case studies of success and failure n Prospective: § Four cell designs § Real time experiments in implementation § Innovative randomization n New Approaches to research: § Complex adaptive systems

An emerging "field" of research n Beyond serendipity ¨ n Towards "savvy" in striking systems synergies A new science needed to: Illuminate the black box of delivery? ¨ Avoid the black hole of systems? ¨ Scale-up services more quickly, safely, equitably and efficiently ¨

Translation to Policy and Public n Cultivating demand for this research by actively engaging key policy constituencies ¨ ¨ n Accelerate translation of research to policy/action ¨ n G 8 – Japan follow-up and lead into Italy…Canada GHI leadership, H 8 Civil society Implementers Facilitating mangers and policy makers to make evidence-informed decisions e. g. EVIPNET Facilitate access to research Health Systems Evidence Libraries e. g. Cochrane, Campbell –like effort for health systems ¨ Innovative IT applications e. g. "Itropica" for synergies ¨