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WHO strategy aims for leadership

28 April 2008, 18:00

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The WHO research strategy team has just finished its global consultations, in a democratic approach to setting a new focus and role for WHO in health research: leadership and convening power to help other bodies set agendas, and an internal focus on ‘making a difference’ – getting care to where it’s most needed. RealHealthNews talked to team leader Robert Terry.

Robert Terry: In 2007 in Resolution 60.15, the WHA requested the Director-General to submit to the 62nd WHA in 2009, a strategy for the management of research activities within WHO. That’s the mandate.

So we’ve been doing a lot of regional consultations at WHO offices, talking to a lot of stakeholders, and to summarise, a general feeling is that there’s a lack of coherence in WHO’s work in and around health research.

>RHN: I think what our readers would like to know at this point is how far you’ve got towards building a coherent strategy – and whether you are forming a view already on what impact that strategy might be likely to have, and on whom.

RT: Well we tried to make this process as participatory as possible; and I actually think that’s unusual for WHO. I’m new to the organization – I previously worked at the Wellcome Trust in the UK. The standard approach [at WHO] appeared to be that good people in Geneva work very hard, produce great ideas, analysis and reports and then others comment upon them.

“We tried to make this process as participatory as possible; and I actually think that’s unusual for WHO.”

ROBERT TERRY

But what we’ve done here is to start the other way around. We’ve been organizing meetings in every single regional office, bringing in the country representatives, and talking to the Regional Advisory Committees on Health Research. We’ve just finished that process.

So we’ve had meetings in all six regions. We’ve also spoken to more than 100 stakeholders on a one-to-one basis, drawn from right across the spectrum of the type of people that WHO needs to work with – so that’s ministries of health, funding agencies, and leading researchers and commentators on health research globally.

We’ve also just had a meeting of the global WHO Advisory Committee on Health Research, and the point we’ve got to is that we’re just starting to pull all that together.

>RHN: You must have quite a pot-pourri of ideas!

RT: It’s a lot of ideas. We do have some working documents, but they are not at the stage when it could be circulated widely. I find that once people start talking about drafts they forget clever ideas and focus on details and definitions.

>RHN: What impact do you expect or hope for in the end, when the strategy is finalised and in use?

RT: The strategy will need to have an impact both internally, within the WHO organization, to move us towards leadership in health research rather than that lack of focus that people perceive, so we’ll need a real emphasis on trying to change the internal culture; and externally, positioning WHO in its global leadership role in health research.

Some people say it’s abdicated that leadership in the last maybe ten years, allowing other organizations to enter onto the scene, like the the Global Forum for Health Research and COHRED [the Council for Health Research and Development].

>RHN: Are we talking about bodies like the Gates Foundation?

READ ON: “WHO department of research policy and coordination”:http://www.who.int/rpc/en/

RT: Well there’s a big difference, because what WHO will never have is lots of money for research. It’s constrained – and I think rightly so – in that all of these activities would be considered ‘extra-mural’, so it has to fund-raise to get support for them.

So even this research strategy development process I’ve had to fund-raise for – we’ve got support form Gates in fact, the Wellcome Trust and others.

READ ON: “WHO research strategy programme”:http://www.who.int/rpc/research_strategy/en/

>RHN: On the other hand WHO does have a role in pulling together all the best ideas, at every level and globally about these issues.

RT: Exactly. That’s the leadership. And that’s where the research strategy, I would suggest, has gone a bit further than just moving the tables and chairs around within the organization. It will redefine what WHO does at global scale.

READ ON: “A Position Paper on WHO’s Role and Responsibilities in Health Research [May 2006 – 216k pdf]”:http://www.who.int/rpc/meetings/position_paper.pdf

The WHO research strategy is not the global health research strategy. But it is a strategy which positions the WHO to lead, facilitate, convene, all those things, on a ‘global agenda’. And the reason I say ‘global agenda’ is that it’s easier than saying in all countries at all levels etc. etc.

>RHN: I would say it has a particular role in bringing the voice of the South to bear.

READ ON: “60th World Health Assembly resolutions [pdf file of nearly one megabyte; resolution 60.15 on setting up a WHO research strategy is at page 68]”:http://www.who.int/gb/ebwha/pdf_files/WHASSA_WHA60-Rec1/E/reso-60-en.pdf

RT: Well we hear lots and lots of perspectives, and certainly one of those is that WHO should have a focus on one part of the health research strategy – that it should be promoting research that has the largest amount of impact on public health needs as identified by the countries.

Where we’ve got to at the moment is that we’ve that kind of big vision, and four or five major goals. One will be around how we actually promote health research to address public health needs; another will be towards ensuring strong, transparent and sustainable national health research systems; and another will be promoting best practice in health research.

READ ON: “The Special Programme for Researach and Training in Tropical Diseases [TDR]”:http://www.who.int/tdr/

A fourth might be called ‘lost in translation’, why when we’ve got all this research, all these ideas, that we’re challenged in getting it to make a difference, translating it into policy that has an impact.

A fifth would be ‘making it happen’ – making the changes in WHO so it can deliver those sorts of things.

READ ON: “The Special Programme of Research, Development and Research Training in Human Reproduction [HRP]”:http://www.who.int/reproductive-health/hrp/index.htm

>RHN: What about the independence of existing programmes? Quite a lot of health research is done either within or in close association with WHO already, and it’s run rather independently – for example the Tropical Disease Research Programme (TDR), the Human Reproduction Programme, (HRP), and programmes like the new Alliance for Health Policy and Systems Research; these programmes have their own well-established ways of setting programmes and policies. Is it foreseen that the WHO strategy will either influence or even control the policies of these bodies?

READ ON: “The Alliance for Health Policy and Systems Research”:http://www.who.int/alliance-hpsr/en/

RT: I wouldn’t say control, but yes it will have to influence them. And yes it will have to provide some sort of coherence to what are called the ‘special programmes’. Everyone talks about the high-profile ones, the ones you just mentioned, but there are more than 20 or so departments who have research as a big part of what they do.

READ ON: “The Global Forum for Health Research”:http://www.globalforumhealth.org

Some of it’s the classic research, like TDR – primary research and research generation and those sorts of things; others have to do with normative work and setting standards – finding out what is best practice in a field, like health systems research – it’s changing things incrementally, doing meta-analysis, producing guidelines. Now the research strategy would also encompass that activity. It’s public health research that’s so lacking.

READ ON: “The Council for Health Research and Development [COHRED]”:http://www.cohred.org/main/

A lot of Gates and other funding goes towards looking for the silver bullet, the cure for AIDS or malaria and so on; but much less of the funds go towards what we would call ‘making the difference’ – how do you actually deliver this stuff? Why is it that bednets are used in so many different ways other than stopping mosquitoes biting children? – that kind of social, behavioural, economic and other multi-sectoral stuff.

It’s not sexy; but that’s the sort of stuff that WHO can do.


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