|Plenary session, Friday, September 1 2006, 9:00-10:30|
|Chair(s): Jean-Louis Carpentier, Switzerland, Tikki Pang, Switzerland|
|Putting Research Evidence into Practice|
|Nirmal Kumar Ganguly, Director General, Indian Council of Medical Research, New Delhi, India|
|Manuel Dayrit, Human Resources for Health, World Health Organization, Geneva, Switzerland|
|Towards Improving Transparency in Clinical Trials|
|Odette Morin, Director, Regulatory and scientific Affairs, International Federation of Pharmaceutical Manufacturers & Associations (IFPMA), Geneva, Switzerland|
|Can Research Make a Difference in Global Access to Health?|
|Stephen A. Matlin, Executive Director, Global Forum for Health Research, Geneva, Switzerland|
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Submitted by: Anne May (ICVolunteers)
Plenary V addressed the current challenges and conditions for effective capacity building in the health workforce as well as medical research to improve health and give access to health care in developing countries.
Dr. Manuel Dayrit, of Human Resources for Health at World Health Organization (WHO), discussed the current challenges and conditions for effective capacity building in the health workforce. Although Mr. Dayrit's focus was on human resources for health, he insisted throughout his presentation on the fact that capacity building was constantly taking place in a much broader context of socioeconomic and political circumstances, institutions, and involved many actors from different horizons. Hence, it is essential, in order to be effective, that capacity building be systemic. However, failure to address the capacity constraints (political, institutional) limiting the achievement of overall capacity building project objectives has repeatedly been shown.
Mr. Dayrit defined "capacity building" as "a process by which individuals, groups, institutions, organizations and societies enhance their abilities to identify and meet development challenges in a sustainable manner." As set forth by WHO's late Director General, Dr. Lee Jong-wook, the ultimate goal of capacity building is "to ensure access to a motivated, skilled, and supported health worker by every person in every village everywhere."
The health workforce, Mr. Dayrit noted, must be understood as "all people engaged in actions whose primary intent is to enhance health," not only doctors and nurses, but also such diverse professionals as economists, drivers, cooks, etc.
Mr. Dayrit, provided various illustrations of the strong positive correlation observed worldwide between the proportion of health workers in the population and population's health measured by various indicators. The latest WHO World Health Report (2006) provides ample evidence supporting the view that shortages of health workers in certain areas in the world must be addressed as one key step to improve overall health. The causes of such shortages are many and diverse and may be grouped into three tiers: the entry level, including planning, education and retirement; the workforce level, including supervision, adequate compensation, continuing education; and the exit level, limiting emigration, changes in career and ensuring the health of the workforce. Only a strategy tackling these three aspects (a "lifespan strategy") may lead to effective sustainable results. To illustrate this point, Mr. Dayrit described the case of Thailand where multiple strategies have helped to improve the retention of trained health workers in rural areas. With concerted regulatory, economic, educational, managerial and social strategies, the country has indeed managed to shift the ratio of health workers in Bangkok v. those in the northeast of the country from a 22:1 ratio in the eighties to a 10:1 ratio in 1999.
In conclusion, Mr. Dayrit reiterated the view that capacity building efforts will succeed only where they take adequate account of the prevailing local politics, economics and institutions and are country-owned rather than donor-driven. To that effect, he noted that countries have to take the lead in developing capacity building efforts and that donors should harmonize their support around the countries' priorities.
Ms. Odette Morin, Director of Regulatory and Scientific Affairs of the International Federation of Pharmaceutical Manufacturers and Association (IFPMA), presented the newly created IFPMA Clinical Trials Portal, launched in 2005, that is the first portal to provide public, online information about on-going and completed clinical trials sponsored by pharmaceutical companies worldwide.
The portal was developed as a response to various pressures for improved trial transparency. Through their associations, the pharmaceutical companies have taken a joint position on the disclosure of clinical trial information that has led to the creation of the portal. Pursuant to ongoing public pressures, the number of clinical trial postings on the portal has almost doubled during the first months of its launch.
The portal is not a database but is structured as a platform giving access to various sources which centralize information, such as national industry associations, governments or international organizations. It allows multiple-criteria searches in English, French, German, Japanese and Spanish.
The portal is not only useful to doctors and patients, it is also an essential tool, as was discussed after Ms. Morin presentation, to inform health systems management. Of course, the portal may be only as good as the information made available by companies and governments. It was hence emphasized that national registries should be improved in many regions to improve coverage.
Mr. Stephen A. Matlin, Executive Director, Global Forum for Health Research, discussed the crucial role of health research in ensuring that people everywhere have access to health. Mr. Matlin first provided an overview of the changing face of health problems worldwide. Although infectious, communicable diseases (CDs) remain the major health burden in Africa, there is an overall increase in non-communicable diseases (NCDs) among low and medium income countries (LMICs). Health research agenda should adapt to these evolving needs.
Health research, Mr. Matlin highlighted, is not limited to biomedical research and the development of new products. The health research agenda should also focus on systemic aspects such as strengthening health policy and systems, the promotion of health equity, the study of social and other determinants of health including the availability of public transport networks for access to health resources.
It is widely recognized that there is a major lack of spending on health research for the needs of developing countries, both by HICs and by LMICs themselves. Although global health research expenditure is growing at a rapid pace, only a small proportion of it (less than 5% in the 1990s) is devoted to diseases and health problems that are endemic in LMICs. As a result, during the last few decades, very few new products for diseases that are mainly endemic in poor countries were registered for clinical use. In parallel, health systems and health research capacities in LMICs have not been sufficiently developed.
In order to tackle the disease burden in LMICs, concerted approaches should be implemented by both LMICs and HICs. HICs should focus on research that generates leads for LMICs and support country-based research and capacity building in LMICs. LMICs should similarly support their own research capacity and utilization. They should focus on the development of national health research systems, foster innovation and ensure that local research capacity addresses local priority health needs.
There is an emergence of innovating developing countries, such as Brazil, China, India and South Africa. These countries have demonstrated a growing capacity to undertake health innovation and assume an increasing role in the development of new drugs, vaccines and diagnostic tools, as well as of new techniques and new policies in health systems and services. One characteristic of these countries is that they manage to span the spectrum from innovative research to product delivery.
One major source of funding for, in, and by, LMICs is philanthropy. Over the 1993-2003 period, the 50 most generous philanthropists collectively donated over 50 billion USD. Public-Private Partnerships (PPPs) are playing a growing role in the financing of health research for LMICs. PPPs' Research & Development (R&D) expenditure has increased dramatically since 2000 and 75% of all neglected disease R&D projects are currently conducted by PPPs. The public sector should devote an increased share of available R&D resources to the health needs of developing countries, as they have fallen short of meeting the the targets set at the 1990 Commission on Health Research for Development (2% of government health budget on essential health research).
Mr. Matlin concluded by highlighting areas to which government financing of health research for development should focus. In HICs, greater priority should be given to national research programs and more health research should be included in bilateral and multilateral channels. In LMICs, in additional to giving greater priority to national health programs, capacity building for national health research systems and innovation should be emphasized.