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An overview on health research in the Eastern Mediterranean Region

An overview on health research in the Eastern Mediterranean Region. June 10 th , 2014 . 34 slides. Main message. The status of health research in the key priority areas across the region is not satisfactory. There are critical deficits in: stewardship;

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An overview on health research in the Eastern Mediterranean Region

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  1. An overview on health research in the Eastern Mediterranean Region June 10th, 2014 34 slides

  2. Main message • The status of health research in the key priority areas across the region is not satisfactory. • There are critical deficits in: • stewardship; • translation of research into policy and practice; and • often research agenda. • These problems are mainly attributable to the weak political and subsequently financial support available to health research systems. 1/23

  3. Publication in selected key priority areas from 2007-2012 Quantity of research, by means of number of publications, in each priority area is not satisfactory to fill the knowledge gap. 2/23

  4. Composition of Systematic Review, Health Service Research and Clinical Trialsin the region, 2007-2012. 4/23

  5. H-index of publications (1996 -2012) by countries group Source: The SCImago Journal & Country Rank, the Scopus® database (Elsevier B.V.), (http://www.scimagojr.com/index.php), Nov, 2013. 5/23

  6. Share of the region in the on-going clinical trials EMRO is even lagging behind AFRO in number of registered clinical trials. 6/23 Source: RøttingenJA, et al. Lancet. 2013 Oct 12;382(9900):1286-307.

  7. Number of patent applications registered in medical technology, biotechnology and pharmaceuticals, 1997 - 2011 Total of 5753 for 15 years 383.5 per year Source: The World Intellectual Property Organization (WIPO) (http://www.wipo.int/about-wipo/en/), Nov, 2013. 7/23

  8. But contradictory to this discouraging state of affairs, there are some opportunities still remain. • The published papers seem to lack the answers to the very needs of the health priority areas by means of: • Quantity; • Relevance; and • Type. • A large proportion of the region’s research do not result in tangible outputs (product manufacture and/or decision-making). 8/23

  9. Publication in Medicine by WHO regions In 2002, the region’s share was 6111articles. Source: The SCImago Journal & Country Rank, the Scopus® database (Elsevier B.V.), (http://www.scimagojr.com/index.php), Nov, 2013. 9/23

  10. Publication in Medicine by WHO regions More than 2 times • This was doubled and reached 12421 after 5 years in 2007 Source: The SCImago Journal & Country Rank, the Scopus® database (Elsevier B.V.), (http://www.scimagojr.com/index.php), Nov, 2013. 9/23

  11. Publication in Medicine by WHO regions In 2012 the number of articles has grown by almost 6 times compared to 2002. Almost 6 times Source: The SCImago Journal & Country Rank, the Scopus® database (Elsevier B.V.), (http://www.scimagojr.com/index.php), Nov, 2013. 9/23

  12. Trendof publication in medicine by the EMR countries All the countries have had considerable Rises in their publications. More than 1000 publications/year 200 -1000 publications/year

  13. Mission statement • To support health care programs through sustainable health research systems and develop necessary capacities for generation ofappropriate knowledge and its utilization towards improved health. 11/23

  14. Financing • Production and utilization of research • To support health care programs through sustainable health research systems anddeveloping necessary capacitiesforgenerationofappropriate knowledge and its utilizationtowards improved health. • Resources Stewardship Source: Pang T, Sadana R, Hanney S, Bhutta ZA, Hyder AA, Simon J. Knowledge for better health: a conceptual frame- work and foundation for health research systems. Bulletin of the World Health Organization, 2003, 81(11):815–820. 12/23

  15. provision of leadership to direct, coordinate, manage and review research Source: Pang T, Sadana R, Hanney S, Bhutta ZA, Hyder AA, Simon J. Knowledge for better health: a conceptual frame- work and foundation for health research systems. Bulletin of the World Health Organization, 2003, 81(11):815–820. 13/23

  16. Financial investment in R&D and health research 4.6% of the world’s financial resources are produced in this region. Source: World Health Organization, Global Health Observatory Data Repository. http://apps.who.int/gho/data/view.main.GNI2020?lang=en (Nov 24, 2013).

  17. Financial investment in R&D and health research Data for 15 countries are based on modeling 25%of the proportionality The share of research resources in the region is 1.1%. Source: World Health Organization, Global Health Observatory Data Repository. http://apps.who.int/gho/data/view.main.GNI2020?lang=en (Nov 24, 2013). Røttingen JA, et al. Lancet. 2013 Oct 12;382(9900):1286-307. Source: World Health Organization, Global Health Observatory Data Repository. http://apps.who.int/gho/data/view.main.GNI2020?lang=en (Nov 24, 2013). Røttingen JA, et al. Lancet. 2013 Oct 12;382(9900):1286-307.

  18. Financial investment in R&D and health research The budget share of health research is 0.6% . 14% of the proportionality Data for all countries are based on modeling Source: World Health Organization, Global Health Observatory Data Repository. http://apps.who.int/gho/data/view.main.GNI2020?lang=en (Nov 24, 2013). Røttingen JA, et al. Lancet. 2013 Oct 12;382(9900):1286-307. Source: World Health Organization, Global Health Observatory Data Repository. http://apps.who.int/gho/data/view.main.GNI2020?lang=en (Nov 24, 2013). Røttingen JA, et al. Lancet. 2013 Oct 12;382(9900):1286-307.

  19. The countries’ plan in R&D investment in all areas –not specific to health Trend of investment on GERD/GDP 1996 2009 0.03 1.25 R&D investment was 0.03% in Tunisia in 1996, but had crossed 1% in 2000. Expenditure on research does not exceed 0.3% of GDP, 97% of which comes from government sources. 15/23 Source: UNESCO Science Report, 2010. http://unesdoc.unesco.org/images/0018/001898/189883E.pdf.

  20. The countries’ plan in R&D investment in all areas –not specific to health 2016 3.0 Expenditure on research does not exceed 0.3% of GDP, 97% of which comes from government sources. Iranhas a Five-Year Plan to reach 3% 15/23 Source: UNESCO Science Report, 2010. http://unesdoc.unesco.org/images/0018/001898/189883E.pdf.

  21. The countries’ plan in R&D investment in all areas –not specific to health Trend of investment on GERD/GDP Expenditure on research does not exceed 0.3% of GDP, 97% of which comes from government sources. 2011 Qatarhad a plan in which this figure was to reach 2.8% in 2011 2.8 15/23 Source: UNESCO Science Report, 2010. http://unesdoc.unesco.org/images/0018/001898/189883E.pdf.

  22. The countries’ plan in R&D investment in all areas –not specific to health Expenditure on research does not exceed 0.3% of GDP, 97% of which comes from government sources. 2012 1.0 Egypthad targeted 1% by 2012 15/23 Source: UNESCO Science Report, 2010. http://unesdoc.unesco.org/images/0018/001898/189883E.pdf.

  23. The countries’ plan in R&D investment in all areas –not specific to health Expenditure on research does not exceed 0.3% of GDP, 97% of which comes from government sources. Many countries have shown their interest in greater investments in R&D. 15/23 Source: UNESCO Science Report, 2010. http://unesdoc.unesco.org/images/0018/001898/189883E.pdf.

  24. Number of academic institutions in health by countries group Pakistan, Iran, Sudan, Egypt and Saudi Arabia have the highest numbers of institutes. 16/23

  25. Number of academic institutions in health vspublication in 2012 Pakistan and Sudan academic institutions haven’t had as many publications as expected. Publication in 2012 Pakistan Sudan Number of academic institutions 17/23

  26. Human capital: skilled migration among countries of the region(2006 estimate by World Bank) The emigration rate is high in group 2 and 3 countries. 18/23

  27. Human capital: skilled migration among countries of the region(2006 estimate by World Bank) A report by the International Monetary Fund in 2009 indicated that Iran tops the list of countries losing their academic elite, with an annual loss of 150,000 to 180,000 specialists. It's equivalent to a capital loss of $50 billion. 19/23

  28. Result of National Health Research Systems (NHRS) assessment in the countries of the region 6 did not havestructure 9 were not functional 10 did not have all components • Sources: A study of national health research systems in selected countries of the WHO EMR. • Cairo World Health Organization’s Regional Office for the Eastern Mediterranean, 2004. Kennedy A, et al. East Mediterr Health J. 2008 May-Jun;14(3):502-17. • Ghannem H., et al. East Mediterr Health J. 2011 Mar;17(3):260-1. 20/23

  29. Conclusions • Based on the numbers of registered clinical trials and patents it can be induced that studies that lead to the manufacture of tangible products are not well-grounded in the region. • The few studies that have been conducted across the region indicate that research evidence does not influence decision-makings much. • Absence of data on health-specific research financial investment. • Investment in health research has remained low. However, there is a political will in several countries to increase their GERD. • More effective stewardship is required for the region’s health research systems. 22/23

  30. We need better research and research done for the right reasons 23/23

  31. Global Monitoring Framework 9 global voluntary targets for 2025 29/34

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  33. Five areas: • Epidemiology and burden • Governance for NCD • Prevention and reduction of risk factors • Health system response • Implementing priority interventions • Improving access • Surveillance, monitoring and evaluation 31/34

  34. NCD research priorities • What are the barriers, and potential solutions of inter-sectoral collaboration on NCD? • What is the situation of political economy of healthy vs.unhealthy nutrition? What measures can be considered for improving situation of access and utilization of healthy foods? • What are the actual impacts of priority interventions on risk factor levels and global risk profile distribution? • What are the impacts of community health workers on NCD prevention and control? • What is the impact of patient education on improving adherence and strengthening the self-care? 32/34

  35. Country specific • Which social groups are most adversely affected by NCD and its risk factors and determinants?(upgrading STEPS with appropriate questions and methods of analysis in this regard) • Are people at high risk of cardiovascular disease receiving recommended drug therapy and counseling? • What are the health system-related barriers to access NCD services in primary health care? • What are the practices of delivery of evidence-based NCD interventions at primary health care level? • Are evidence-based guidelines being applied to guide utilization of high-tech approaches (for example coronary revascularization)? 33/34

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