ALLIANCE EDITORIAL The Alliance … FOR up and running

ALLIANCE
FOR
HEALTH
POLICY
AND
SYSTEMS
RESEARCH

N E W S L E T T E R

No. 1 • September 2000

CONTENTS

Health policy and systems research
networks in the developing world
3
Health research capacity-
strengthening in developing countries
4
Towards HPSR priority-setting
5
Utilization of research in
Latin America and the Caribbean
6
Interview: Louis J. Currat
7
State of the Alliance
8

EDITORIAL

The Alliance …
up and running
The Alliance for Health Policy

and Systems Research, an
initiative of the Global Forum for
Health Research was officially
launched at WHO headquarters,
Geneva, Switzerland on 27 March
2000. The launch was the culmina-
tion of a long planning process
involving country researchers and
health authorities, international
experts, donors and other inter-
ested parties. Over 200 institutions
have become Alliance partners and
regular contacts have been estab-
lished with 11 health policy and
systems research (HPSR) networks.
The Alliance is now poised, as a
global network, ready to make a
difference in the research-to-policy
cycle.

WHO backing
Speaking at the launch, Dr Gro
Harlem Brundtland, Director-
General of WHO welcomed
the initiative and wished it every
success.

She pointed out that health

systems in rich and poor countries
alike have undergone dramatic
changes during the last decade.
Ministries of health are now trying
to ensure the effective participa-
tion of a wide variety of public and
private institutions in meeting
health needs, and national health
systems have become more
complex. Tools for analysis and
decision-making are needed to
steer the various players towards
their common goals. WHO is
supporting this effort by designing
a comprehensive framework for
assessing the performance of
health systems, which will provide
policy-makers with a way to judge
the performance of their own
systems and compare them with
those of other countries, keeping
track of change over time. The
Alliance can play a useful role in
this work by supporting informed
debate on national policy with
input from international experi-
ence.

Dr Brundtland emphasized that

research is pivotal not only to ➤

Dr Gro Harlem Brundtland, Director-General, WHO and Dr Julio Frenk, Executive
Director, Evidence and Information for Policy, WHO

2

NEWSLETTER OF THE ALLIANCE FOR HEALTH POLICY AND SYSTEMS RESEARCH

ABOUT THE ALLIANCE
The aim of the Alliance is to contribute to health development and the
efficiency and equity of health systems through research on and for health
policy. Its objectives are to:

promote capacity for health policy and systems research (HPSR) on
national and international issues

help develop the information for policy decisions in the health sector
and other sectors that influence health

stimulate the generation of knowledge that facilitates policy analysis
and improves understanding of health systems and the policy process

strengthen international research collaboration, information exchange
and shared learning among countries

identify influences on health systems that operate at the global level
and promote appropriate research.

The Alliance promotes the widest possible participation of institutions
using, producing and supporting HPSR with a view to ensuring a “bottom-
up” source of direction and advice for its activities. The Alliance is sup-
ported by an 18-member Board representative of developing countries,
experts, networks and donors; its management is based in WHO’s Global
Programme for Evidence.

The Alliance seeks the partnership of national institutions and international
programmes and networks involved in the production, use and support of
HPSR in the developing world. Interested institutions can apply for partner-
ship through our Website or by mailing a brief letter of intent stating their
HPSR aims and interests, and the benefit expected from the Alliance.

Financial support from the International Development and Research Coun-
cil of Canada, the Governments of Norway and Sweden, and the World Bank
is gratefully acknowledged.

ing top-down authority. Together
with other partnerships such as
Roll Back Malaria and Stop TB, the
Alliance can contribute in creative
ways to the establishment of more
effective foundations for leader-
ship in meeting health needs.

WHO is collaborating with the
Global Forum for Health Research
in the implementation of Alliance
activities relating to HPSR map-
ping and monitoring, supporting
capacity for and the undertaking of
research, developing methodolo-
gies and tools, and facilitating
information and partnership
development.

Alliance small grants
programme
The first call for letters of intent for
the Alliance small grants pro-
gramme has been launched and
we are now in the process of
selecting suitable candidates of
letters of intent. Two types of
grants will be offered. Young
researcher grants will support the
growth and potential of HPSR in
the medium term by supporting
projects undertaken by young
researchers and postgraduate
students. Research-to-evidence
grants will strengthen capacity to
undertake the production and
application of HPSR and apply it in
the policy process. (cid:3)

discovering new drugs and
developing new technologies but
also to building the health systems
of tomorrow. They need innovative
forms of social participation,
policy-making, financing and
service management. WHO is
giving high priority to strengthen-
ing health research and is rede-
signing the Organization’s own
research policy. The Alliance will
be in a position to implement
coordinating activities to build up
research capacity, focusing par-
ticularly on the interface between
global and country issues.

Lastly, the Director-General

drew attention to the need for
partnership. Today’s powerful
competing interests require new
forms of leadership, which are
likely to depend more on recogniz-
ing common aims than on enforc-

FUTURE ALLIANCE EVENTS

Consultation with partners on HPSR capacity-strengthening strategies

Discussion of the international research architecture supporting HPSR

These events will take place in the context of the Bangkok 2000 Interna-
tional Conference on Health Research for Development starting on Monday
9 October 2000.

Visit our Website http://www.who.int/evidence/alliance

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NEWSLETTER OF THE ALLIANCE FOR HEALTH POLICY AND SYSTEMS RESEARCH

3

HPSR NETWORKS

First meeting of health policy and systems
research networks in the developing world

Seven of the 11 networks so far

identified in the field of HPSR
in the developing world took part
in a session organized by the
Alliance during the Annecy
meeting on research capacity-
strengthening sponsored by WHO
(reviewed in this issue). Five of
these networks are of very recent
creation, signalling increasing
interest in this modality for
capacity-strengthening.

HPSR networks are undertaking

capacity-strengthening and
research activities with the support

of small grants, as well as training
of trainers, workshops, communi-
cations and conferences. Their
successes point to their role as a
means of communication, their
high visibility, and their ability to
channel research demand. Among
the limitations mentioned, meagre
finances are a significant problem,
particularly as donors move away
from core support after a few
years. Many network functions
cannot be self-financed and
secretariats soon become over-
loaded. This implies that technical

Health policy and systems research networks
in the developing world

Network

Name of
co-ordinator

Telephone/
fax

E-mail

Eastern & Southern Africa Health
Systems Research Network

ALETA, Isabel,
+263-4 253.724
Harare, Zimbabwe +263-4 252.683

aletai@who.co.zw

Health Economics and Health Policy McINTYRE, Diane, +27-21-4066.537
+27-21-4488.152
Network in Sub-Saharan Africa

dimac@anat.uct.

ac.za

West Africa Network for Health
Research for Development

+223- 21-6045

inrsp@spider.toolnet.

org

Maghreb Economics and Health
Systems Network

+213-641-93.12/26 kbessaoud@
+213-641-9808

netcourrier.com

Asia Pacific Health Economics
Network

kbessaoud@

netcourrier.com

kaemthong.I@
Chula.ac.th

Cape Town,
South Africa

SOUMARE,
N’Diaye Absatou,
Bamako, Mali.

BESSAOUD,
Khaled
Oran, Algeria

KAEMTHONG,
Indaratna,
Bangkok, Thailand

The China Health Economics
Network

YU, Dr Dezhi
Beijng, China

+86-10-6879-2176 wanyan@jcs.cnhei.
+86-10-6879-2175

edu.cn

Jose Luis Bobadilla Interamerican
Network for Health Policy Analysis

GOMEZ DANTES,
Octavio, Cuerna-
vaca, Mexico

+52-73-293.005

ogomezd@insp.mx

Health System and Services
Research in the Southern Cone of
Latin America

ALMEIDA, Celia
Maria, Rio de
Janeiro, Brazil

+5521-290-0993
+5521-2260 8243
+5521-2285 0352

redsalud@malaria.
procc.fiocruz.br

Network for Health System and
Policy Research in Central America Managua,
Nicaragua

OROZCO, Miguel, +505-278-3688/

morozco@catholic.

4383/3700
+505-278-6775

org

reisscac@ibw.com.ni

Inter-American Network for Health
Economics and Financing

JUAREZ, Claudia,
Mexico City,
Mexico

+525- 595-0011
ext. 1131
+525- 595-0644

ciess@servidor.
unam. mx

Private Public Mix Network

GOUDGE, Jane
Johannesburg,
South Africa

+27-11.489.9940
+27-11.489.9900

ppmnet@icon.co.za

support to network partners is also
weak. Moreover, networks have
difficulties in bridging the gap
between research and research
use.

Prerequisites for the success of

HPSR networks include: the
availability and effective manage-
ment of small-grants programmes,
the existence of receptive policy-
makers, and the capacity of
secretariats to act as core adminis-
trators.

While personal leadership is

important, greater efforts are
needed to ensure national com-
mitment and more diversified
support, including private sector
contributions. Networks must
strive to improve the specification
of services and products in order
to increase demand and enhance
cost recovery. Possible key func-
tions include:

— standardization of country

— undertaking of comparative

evidence

analyses

— organization of workshops

and training activities aimed
at exchanging national
experiences and bridging
research and policy-making.

Such activities could provide
support for research that is ear-
marked as part of development
projects but that is heavily under-
used or diverted to international
consultancies owing to the lack of
adequate communication and
capacity. However, networks need
to remain flexible in their partner-
ships and activities in order to
complement their institutional
foundations and develop bridges
to policy-makers. (cid:3)

4

NEWSLETTER OF THE ALLIANCE FOR HEALTH POLICY AND SYSTEMS RESEARCH

MEETING REPORT

Health research capacity-strengthening
in developing countries

Annecy, France, 28–28 April 2000

Opening the recent WHO

meeting on health research
capacity-strengthening in develop-
ing countries, Charas Suwanwela
(Thailand) said that equity and
ethics constitute the paradigm
shift for health research in the year
2000. Research agendas should
focus on the demand side by
involving all stakeholders and
ensuring adequate research
dissemination and use. Research
should benefit those in most need
and should empower researchers
in developing countries.

Professor Adetokumbo Lucas
gave the keynote address, focusing
on the need to strengthen research
capacity by improving knowledge,
skill and expertise. Research

should lead to improved health
system performance through
science and knowledge-based
decision-making at all levels.
Medical practice is only ethical
when it is based on sound science,
so the onus for research use should
be on professionals, while national
governments should be committed
to strengthening research capacity.
Countries and institutions should
be self-reliant in research, in that
they should have the ability to
identify problems, make an initial
approach and cooperate with
others to find solutions. National
and international agencies should
give more opportunities to na-
tional researchers and consultants.
The following key strategies and

Comparing International Health and
Agricultural RCS Initiatives
Dr Stein Bie, Director General of the International Service for National Agri-
cultural Research, presented RCS lessons from the research institutions that
participate in the Consultative Group of International Agricultural Research
(CGIAR). These institutions have been supported thanks to their high cost–
benefit ratio (1:60), considered to be a highly profitable donor investment.
CGIAR has promoted high-profile public awareness of the role of research,
provided environments conducive to research activities, and allowed scien-
tists to get on with the job. Research has not yet ensured global food secu-
rity and sustainable agriculture, however, and the informal nature of CGIAR
funding can lead to sudden fluctuations in financing.

Health research initiatives lag 20 years behind their agricultural counter-
parts. While there are enormous health problems at the global level, pro-
posed research activities are still on a relatively minor scale. Developing
country institutions could well be in a position to launch a major interna-
tional initiative, yet proposals lack boldness in selling solutions and show
an undue fear of donor fatigue and interagency collaboration. There is an
urgent need to demonstrate the cost–benefit of health research and institu-
tion-building.

principles for research capacity-
strengthening (RCS) were pro-
posed at Annecy.

1. National research agendas
(including an RCS plan) are
primarily the responsibility of
countries themselves.

2. More attention must be given to
strengthening the “demand” for
research by governments
(decision-makers), the public
(community), nongovernmental
organizations, the media, the
private sector, and academic
institutions (where future
research producers and users
are being prepared).

3. All aspects of the research
process (not just technical
competence) must be strength-
ened including: advocacy and
promotion, priority-setting,
partnership development,
facilitating research use, net-
working and leadership.

4. A “systems view” of RCS is

needed, to include national
health research networks and
forums, the enabling environ-
ment, and the research “cul-
ture”.

5. There is a critical need for more
effective collaboration and
partnership—the new informa-
tion and communication
technologies can be an impor-
tant tool for this.

6. RCS must be more targeted on

equity-oriented health research.

The full report of the meeting is
available at . (cid:3)

NEWSLETTER OF THE ALLIANCE FOR HEALTH POLICY AND SYSTEMS RESEARCH

5

COMMENTARY

Towards HPSR priority-setting
Health systems the world over

are undergoing reforms to

meet demands for transparency
and accountability. There is a
growing consensus that this
process should include the separa-
tion, or at least the distinction
between, the three main functions
of such systems—the steering,
funding and provision of health
services. Is such a separation also
desirable in our knowledge system,
to improve its capacity to provide
effective evidence on and for
health system reforms? What do we
know about this evidence process?
The two meetings reviewed
elsewhere in this issue revealed
that, at both the national and
international level, the functions of
priority-setting, funding, investiga-
tion, dissemination and the
promotion of research use are
often attempted in various combi-
nations within the same agencies,
which perform these various
functions rather unevenly and
disjointedly. What role do institu-
tions play in priority-setting, and
what relationship should there be
between national and interna-
tional priorities? Should research
institutions focus on the produc-
tion of sound knowledge without
being distracted by its use?

Research transparency
and accountability
Transparency and accountability
may be as important in knowledge
as they are in health. While in the
latter the main issue is the fair and
efficient distribution of scarce
resources, in the former it is the no
less important distribution of
influence on the policy process.
Arguably, research will not find its
rightful place in policy-making
until its influence is made more

transparent and accountable. One
way of achieving this would be by
increasing the competitive pur-
chasing of research by policy-
makers and providers. However,
research funding should strike a
balance between short-term
contracts to stimulate research use
and long-term, discretionary
institutional investment to encour-
age creativity, peer review and
training.

Priority coordination
Given the need for long-term
investment by multiple agencies
and the complex nature of re-
search funding, coordination of
priorities must be improved. HPSR
coordination is also required
because of the complex interface
between health and the social
sciences. As Gerry Rosenthal from
Partners for Health Reform stated
at the Salvador meeting, research-
ers are trained to ask questions in
the right way, but not to ask the
right questions. In contrast, policy-
makers, service providers and
population advocates excel at the
latter, yet they are often not in a
position to do the former. Asking
the right questions in the right way
is what priority-setting is all

BASIC HPSR
REQUIREMENTS

Transparency and account-
ability in the influence of
HPSR on policy-making
Balance between competi-
tive purchasing of research
and long-term investment
Careful coordination of
priorities—asking the right
questions in the right way
(cid:4) National priorities with an
international and global
perspective
Sharing of country experi-
ences

about—this clearly requires
bringing together diverse actors to
agree on a subject matter that
pertains to all and, because of this,
to no one in particular. Further-
more, it is recognized that what
happens in other countries can be
important for one’s own, and that
there are regional and global level
influences that should also be the
subject of research. National
priority-setting should therefore
include international and global
perspectives. (cid:3)

HPSR coordination is essential. West Africa Network for Health Research for
Development meeting, Bamako, June 2000.

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