Health research for development conference, Bangkok, 8-13 October 2000.INTRODUCTION
This conference, attended by more than 700 delegates from more than 100 countries, proved to stimulate thoughts about enhanced collaboration in the health research fields, among numerous stakeholders Stakeholders
All parties that have an interest, financial or otherwise, in a firm-stockholders, creditors, bondholders, employees, customers, management, the community, and the government. and among many countries with similar health care problems.
This conference was organised by the Council on Health Research for Development (COHRED COHRED Council On Health Research for Development ), which is an international non-governmental organisation, operating within the United Nations Development Programme (UNDP UNDP United Nations Development Programme
UNDP Unión Nacional para la Democracia y el Progreso (National Union for Democracy and Progress) ). COHRED supports countries implementing the Essential National Health Research (ENHR ENHR Essential National Health Research
ENHR Essential National Health Research - African Network ) strategy and publishes countries' experiences with this programme (Webpage: www.cohred.ch). COHRED was established in 1993 and hosted this international conference mainly to evaluate the health research done by different stakeholders in different parts of the world since 1990, and to set research priorities for the next decade. Another purpose of the conference was to bring together different stakeholders concerned with health research, including the World Health Organisation (WHO), UNAIDS UNAIDS Joint United Nations Programme on HIV/AIDS , the World Bank, private sponsors, ministries of health, academic researchers and non-government organisations (NGOs). Judged by the hundreds of posters and presentations exhibited in the Market Place of the Shangri-La Hotel, this aspect of the conference was indeed most successful.
Due to the vast amount of knowledge acquired during this week, this report is divided into subsections focussing on the
* posters and exhibitions displayed with contact details, which might prove to be useful in obtaining further information or in establishing specific communication contacts
* conference delegates' suggestions for identifying and meeting the challenges inherent in health research, produced by the different work groups.
POSTER DISPLAYS AND EXHIBITIONS: MARKETPLACE: SHANGRI-LA HOTEL, BANGKOK: 8-13 OCTOBER 2000
These poster sessions and exhibitions provided unique opportunities to talk to many health care researchers from many parts of the world within one large venue. Lively debates carried on in this venue throughout the entire conference, which proved to be a melting pot melting pot
America as the home of many races and cultures. [Am. Pop. Culture: Misc.]
See : America for divergent ideas about health care and the ethics thereof.
Some of the exhibitions with particular reference to health care research, included the:
* Electronic Publishing An umbrella term for non-paper publishing, which includes publishing online or on media such as CDs and DVDs. Development Program Open Society Institute, Budapest: providing electronic access to quality controlled and evidence based research from all parts of the globe, which can be accessed at http://search.global.epret.com
* Global Forum for Health Research: promoting research to improve the health of the poor as an independent international foundation, which promotes public-private partnerships for health and can be accessed at www.ippph.org or at www.globalforumhealth.org.
* Soma-Net, which is a regional health research network, promoting and advocating for the application of social sciences in improving human health and development, including establishing long-term holistic and sustainable solutions to health in Africa. Their mission, primary goals, challenges and strategies as well as contact persons and numbers can be obtained at http://www.somanet.org or by sending an e-mail to email@example.com.
* Centre for Health Economics, Faculty of Economics, Chulalongkorn University Chulalongkorn University is the oldest university in Thailand  and has long been considered one of the country's most prestigious universities. It now has eighteen faculties and a number of schools and institutes. , Thailand (A World Bank Institute) offering courses in and research about health sector reform and sustainable financing (e-mail: firstname.lastname@example.org).
* Alliance for Health Policy and Systems Research, established during 2000, as an initiative of the Global Forum for Health Research, is a global network striving to make a difference in the research-to-policy cycle, enhancing the implementation of research findings in the formulation of health related policies (Website: http://www.alliance-hpsr.org).
* International Clinical Epidemiology Network (INCLEN INCLEN International Clinical Epidemiology Network ), proclaiming its mission as: "We are dedicated to improving the health of the people by promoting clinical practice based on the best evidence of effectiveness and the efficient use of resources. We achieve this through a network of physicians, statisticians Statisticians or people who made notable contributions to the theories of statistics, or related aspects of probability, or machine learning: A to E
1. situated toward the median plane or midline of the body or a structure.
2. pertaining to the middle layer of structures.
adj. education." More information can be obtained at http://www.inclen.org globally or from the African office's e-mail address See Internet address.
e-mail address - electronic mail address : email@example.com
* Liverpool School of Tropical Medicine The Liverpool School of Tropical Medicine (LSTM), England, was founded on 12 November 1898, by a donation from Sir Alfred Lewis Jones, a Liverpool Shipowner. The donation of £350 created the first school of its kind. exhibited copies of their latest publications, including The Annals of Tropical Medicine tropical medicine, study, diagnosis, treatment, and prevention of certain diseases prevalent in the tropics. The warmth and humidity of the tropics and the often unsanitary conditions under which so many people in those areas live contribute to the development and and Parasitology Parasitology
The scientific study of parasites and of parasitism. Parasitism is a subdivision of symbiosis and is defined as an intimate association between an organism (parasite) and another, larger species of organism (host) upon which the parasite is and The Annals of Tropical Paediatrics; more information can be obtained at www.tandf.co.uk/journals.
* International Center for Diarrhoeal Disease Research, Bangladesh dealing with health and population issues popularly associated with developing countries by providing simple and cost effective solutions to complex health and population problems (Website: www.icddrb.org).
* UNAIDS exhibited the research results of global research projects (Website: http://unaids.org).
* University of Melbourne
In 2006, Times Higher Education Supplement ranked the University of Melbourne 22nd in the world. Because of the drop in ranking, University of Melbourne is currently behind four Asian universities - Beijing University, , Faculty of Medicine, Dentistry dentistry, treatment and care of the teeth and associated oral structures. Dentistry is mainly concerned with tooth decay, disease of the supporting structures, such as the gums, and faulty positioning of the teeth. & Allied Health Sciences (a WHO Collaborating Centre for Women's Health Women's Health Definition
Women's health is the effect of gender on disease and health that encompasses a broad range of biological and psychosocial issues. ) exhibited information about the short courses offered in Women's Health (it can be accessed at http://www.kcwh.unimelb.edu.au).
* Wellcome Trust The Wellcome Trust is a United Kingdom-based charity established in 1936 to administer the fortune of the American-born pharmaceutical magnate Sir Henry Wellcome. Its income was derived from what was originally called Burroughs Wellcome & Co, later renamed in the UK as the exhibited the results of their global malaria surveys and treatment regimes (www.wellcome.ac.uk/publications).
* Collaborative research project under the Ministry of Public Health, Thailand and the Research Institute of Tuberculosis, Japan exhibited research results about the increasing incidence of TB, especially in the Chiang Rai Province Chiang Rai (Thai: เชียงราย) is the most northern province (changwat) of Thailand. Neighbouring provinces are (from east clockwise) Phayao, Lampang and Chiang Mai. of Thailand, concomitant with the incidence of HIV/ AIDS in this area (http://www.jata.or.jp/ EINDEXHTM or e-mail: firstname.lastname@example.org or email@example.com)
The exhibitions and posters provided a wealth of information and proved the necessity for better collaboration among health care researchers worldwide to the ultimate benefit of the world's people.
THE COUNCIL ON HEALTH RESEARCH FOR DEVELOPMENT (COHRED): CONFERENCE: 10-13 OCTOBER 2000
COHRED is an international non-government organisation, based in Geneva Geneva, canton and city, Switzerland
Geneva (jənē`və), Fr. Genève, canton (1990 pop. 373,019), 109 sq mi (282 sq km), SW Switzerland, surrounding the southwest tip of the Lake of Geneva. , Switzerland, and affiliated to the United Nations (UN). It works closely with a large number of developing countries, international research programmes, UN agencies and other organisations to promote and advocate for effective health research systems based on the strategy of essential national health research (ENHR). COHRED identified eight key challenges, or priority focus points, for this international conference on health care for development. Each delegate was assigned to a specific working group concentrating on a specific issue at local, regional and global levels. Each working group had a specific chairperson and a rapporteur rap·por·teur
One who is designated to give a report, as at a meeting.
[Middle English raportour, judge, from Old French raporteur, from raporter, to bring back who had to distil dis·till also dis·til
v. dis·tilled also dis·tilled, dis·till·ing also dis·til·ling, dis·tills also dis·tils
1. To subject (a substance) to distillation.
2. their group's decisions for each day to be presented at early morning plenary sessions, followed by concurrent workshops every morning on these eight issues, with optional alternative workshops during the afternoons and evenings.
This part of the report presents a summary of the keynote address keynote address
An opening address, as at a political convention, that outlines the issues to be considered. Also called keynote speech.
Noun 1. delivered by Dr Gro Harlem Brundtland /gru hɑɭɛm brʉntlɑn/ , director-General, WHO, followed by COHRED's standpoints about each of the eight issues, distributed to the delegates prior to the conference, followed by the major proposals of each working group, and some proposals from a selected number of optional (additional) workshops as well. (IPA:
Keynote address: Dr Gro Harlem Brundtland, Director-general, WHO
Dr Brundtland, specified that the WHO will strive to support research and development for international health by:
* Continuing to monitor emerging trends in knowledge generation and tracking resource flows for research.
* Helping to promote and advocate for resources to support relevant high quality research.
* Offering norms and standards for the conduct of research, including ethical frameworks.
* Supporting better dissemination of knowledge within all its programmes.
* Strengthening research capacity in developing countries.
* Supporting key research in key areas where gaps continue to exist.
Dr Brundtland also emphasised that good health is the key to development and to human well-being. Technology as well as lifestyle changes could help to reduce global morbidities and mortalities, especially those concerning AIDS, malaria and reproductive ill health. Knowledge and understanding can only be enhanced through universal access to and application of research results. The World Health Organisation's websites are among the most often visited websites in the whole world. Thus the WHO is willing and able to continue to support the collaboration of global health research efforts and to optimise the dissemination of relevant, evidence based research results, including basic and applied, as well as biomedical bi·o·med·i·cal
1. Of or relating to biomedicine.
2. Of, relating to, or involving biological, medical, and physical sciences. and social research.
WORK GROUPS' PROPOSALS ABOUT COHRED'S EIGHT PRIORITY AREAS
The benefits of health knowledge must be made available to the poor and marginalized people of the world, who continue to bear a disproportionately large--and in many cases increasing share of the global burden of disease. They must have choices and hope for the future. This is the fundamental challenge of all health research for development.
Regarding the health research system itself, there are continuing inequities between developed and developing countries. The challenge here is to ensure that research systems in low-income countries have access to the resources they need to address their priority problems and contribute to the global agenda.
The working group on equity concluded that inequities continue to exist among academic and non-academic, male and female, central and peripheral researchers and research projects. Communities should not only be the recipients of research findings but should be partners in the research process. Research funding Research funding is a term generally covering any funding for scientific research, in the areas of both "hard" science and technology and social science. The term often connotes funding obtained through a competitive process, in which potential research projects are evaluated and should be redirected to traditionally neglected researchers to ensure that research efforts embrace the health care needs of the world's marginalized peoples, including the Pacific Region, and indigenous peoples The term indigenous peoples has no universal, standard or fixed definition, but can be used about any ethnic group who inhabit the geographic region with which they have the earliest historical connection. . Funding of research projects should not be determined solely by the scientific quality of submitted research proposals, but should move toward greater inclusiveness and empowerment of the researched, especially of disadvantaged groups.
Health research at both national and international levels should be guided by clear ethical principles, based on respect for the dignity of the individual and for sociocultural so·ci·o·cul·tur·al
Of or involving both social and cultural factors.
soci·o·cul norms, and recognition of the importance of the engagement of the communities involved and the right of everyone to enjoy the benefits of research. Sound ethical principles should also form the basis for partnerships in health research.
The working group on ethics suggested that specific training should be available on research ethics Research ethics involves the application of fundamental ethical principles to a variety of topics involving scientific research. These include the design and implementation of research involving human participants (human experimentation); animal experimentation; various aspects of ; monitoring of ongoing research projects should be maintained; and the existing international guidelines on research ethics should be coordinated. The setting up and maintaining of ethics review committees face numerous challenges, especially in developing countries where capacity in this field needs to be further developed. Regional linkages need to be established, and possibly even a global alliance.
Governance is the process through which those responsible for organisations involved in health research exercise the function of stewardship. The challenge is to create an arrangement that facilitates effective co-ordination among all organisations, institutions and groups involved at various levels in national, regional as well as international health research systems.
The working group on governance identified the underutilisation of research results as a key challenge in the field of governance of health research. A national research coordinating mechanism should coordinate the setting of health research priorities and the dissemination of health research findings. The role of each country's Minister of Health should be specified in governing health research.
Thematic networks might provide effective ways of regional governance. It is essential to conduct research within existing structures, but these regional structures' functions and interactions need to be specified, possibly by COHRED. Regional mechanisms should facilitate and monitor the mobilisation and allocation of resource flows, but need to remain responsive, flexible and proactive.
The disequilibrium disequilibrium /dis·equi·lib·ri·um/ (dis-e?kwi-lib´re-um) dysequilibrium.
linkage disequilibrium in allocation of health research funds identified ten years ago by the Commission on Health Research for Development, remains a key challenge for the coming years. Despite the recent injection of funds from philanthropic foundations and public-private partnerships, both the absolute amounts available for research and alleviation to that of wealth creation. This focus should assist in formulating priorities for capacity development and action plans to develop a stable number of health researchers in each country.
Regional capacity development for health research should focus on inter-activities guided by common problems. International organisations should coordinate such efforts, and should advocate the importance of health research internationally. Research capacity development should incorporate marginalized communities, and should strive to prevent and/or contain the south-north brain drain brain drain
The loss of skilled intellectual and technical labor through the movement of such labor to more favorable geographic, economic, or professional environments. of researchers.
A critical mass of researchers should be established and maintained by developing:
* research skills and expertise of individuals and institutions at national and international levels
* skills in writing proposals and managing funds for specific research projects
* decentralised Adj. 1. decentralised - withdrawn from a center or place of concentration; especially having power or function dispersed from a central to local authorities; "a decentralized school administration"
decentralized research activities whilst maintaining networking amongst institutions, with communities and with journalists, multinational sponsors and policy makers
* short and medium and long term national health care priority settings.
The major recommendations which emanated from the Research Capacity Development sessions addressed the 10%-90% gap in research funding with the North getting 90% of the funds and the South 10%; the perceived health researchers' brain drain to the North; and the need that Principal Investigators of research projects sponsored by the WHO, should be renumerated. Effective research can accelerate the provision of effective health care services and can help to overcome health inequities. However global health care researchers would need to address the challenge of spending 15% of the health research budget in the South where 77% of the people live. Community members should be co-producers of health care services, not merely passive receivers of such care. Communities, including Primary Health Care (PHC PHC Primary health care, see there ) workers, should identify, initiate and maintain meaningful and relevant research projects, ensuring meaningful evidence based health research results enhancing the quality of life and the quality of health of specific communities and persons. Postgraduate students could be a useful source for making contributions to the health of communities, countries and regions. Comparative research between various countries could be conducted by postgraduate students. Meaningful and relevant research agendas should focus on:
* safe motherhood
* enhanced family planning family planning
Use of measures designed to regulate the number and spacing of children within a family, largely to curb population growth and ensure each family’s access to limited resources. services
* evidence based practice The introduction to this article provides insufficient context for those unfamiliar with the subject matter.
Please help [ improve the introduction] to meet Wikipedia's layout standards. You can discuss the issue on the talk page. , including nursing and midwifery midwifery (mĭd`wī'fərē), art of assisting at childbirth. The term midwife for centuries referred to a woman who was an overseer during the process of delivery. In ancient Greece and Rome, these women had some formal training. services
* HIV/AIDS HIV/AIDS Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome
Three elements of this challenge are presented:
* Intersectorality: the health research community needs to be more closely linked to the development community. The challenge is to create purpose-specific, equity-oriented research and action coalitions, and to manage them in an effective way.
* Globalisation: the challenge is to find ways of enabling all countries to identify and use the opportunities offered by globalisation, and at the same time limit the harmful effects.
* Research culture: the challenge is for each country to develop a culture that recognises the value of research and of researchers, creates a sense of "ownership" of research by the community, and facilitates the emergence of a supportive research environment.
The working group, which focussed on the research environment, concluded that the lack of stability and continuity, at national policy making levels as well as within research institutions, hampered the development and/or maintenance of a supportive research environment in any country. Researchers should not operate in vacuums but should establish national forums for exchanging ideas, use existing networks but ensure "inclusiveness" of all groups, publish the research results in journals and on the Internet. Furthermore researchers need to involve all stakeholders in their research projects, including community members. The research environment in the South could be enhanced by:
* Encouraging South-South collaboration, possibly by using centres of excellence.
* Lobbying multinationals to leave a fraction of their profits in the Southern countries for research.
* Specifying that donor support should have a research component.
* Creating a voice for the South by developing negotiation and communication skills.
* Involving researchers and decision-makers from the South in developing policies for research funding for the South.
* Training researchers from the South in the South to reduce the brain drain.
* Establishing a forum of researchers from the South to inform global donors about South specific research priorities.
RECOMMENDATIONS THAT AROSE FROM SELECTED CONCURRENT (OPTIONAL) SESSIONS
Public-private partnerships (PPPs) endeavour to combine resources from both public and private sectors to discover new technologies and to address the TB control needs, not addressed by other mechanisms.
Sexual violence against women
This remains a public health problem, warranting research efforts to be better coordinated and to concentrate on sexual abuse and coercion of adult and adolescent women, child sexual abuse Child sexual abuse is an umbrella term describing criminal and civil offenses in which an adult engages in sexual activity with a minor or exploits a minor for the purpose of sexual gratification. , and sexual violence in war situations.
Community involvement in health research
The formal health care system should demonstrate the benefits of research to the communities. Researchers need to be sensitive to the needs of communities and to ethical issues including legitimacy and accountability.
The intellectual property rights pertaining per·tain
intr.v. per·tained, per·tain·ing, per·tains
1. To have reference; relate: evidence that pertains to the accident.
2. to traditional medicine should be established globally. Research into traditional medicine remains underfunded un·der·fund
tr.v. un·der·fund·ed, un·der·fund·ing, un·der·funds
To provide insufficient funding for.
underfunded adj → infradotado (económicamente) . Therefore a traditional medicine component should be built into all large research projects.
Universities and health research
Universities are in a good position to initiate and maintain research projects, which could improve the performance of health systems. Universities could create coalitions with civil society to improve the health of the disadvantaged. The WHO should find more productive ways of working directly with universities as knowledge producers. The WHO was regarded as a global "clearinghouse" mechanism for knowledge dissemination among members.
Effective HIV/AIDS prevention will require upscaling of available interventions and developing new prevention tools, especially vaccines and new drugs to prevent mother-to-child transmissions. HIV/AIDS related research must meet the highest scientific and ethical standards, especially in developing countries. Research grants should include specific allocations for capacity building of researchers in developing countries.
Poverty and health
Research into these aspects should become more democratic and promote the participation of the poor people. The impact of globalisation on the health of the world's poor people should be recognised.
War and health
Wars impact on health in terms of injuries and diseases, often resulting in more casualties among civilians than among the soldiers. War results in disabilities, emergence of communicable diseases communicable diseases, illnesses caused by microorganisms and transmitted from an infected person or animal to another person or animal. Some diseases are passed on by direct or indirect contact with infected persons or with their excretions. , and psychological trauma Psychological trauma is a type of damage to the psyche that occurs as a result of a traumatic event. When that trauma leads to Post Traumatic Stress Disorder, damage can be measured in physical changes inside the brain and to brain chemistry, which affect the person's to war victims (women, children, soldiers).
Information Technology (IT) and health research
Capacity for health research will only be built if high-quality electronic health information is readily accessible. This requires global coordination, focused advocacy, garnering of resources, attention to inequity of access, sustainable support in obtaining and using information. Capacity building involves raising people's awareness, training local researchers in using search strategies and their critical evaluation abilities. This will only be feasible if stable technical support is maintained.
The assessment indicators of antenatal an·te·na·tal
before parturition. Called also prenatal, antepartal. care (ANC ANC
African National Congress
ANC African National Congress: South African political movement instrumental in bringing an end to apartheid
ANC n abbr (= ) should be expanded beyond mere medical indicators and should include health education outcomes and behavioural changes. ANC should be studied in low-income communities and effective referral systems should be established. Maternal health Maternal health care is a concept that encompasses preconception, prenatal, and postnatal care. Goals of preconception care can include providing health promotion, screening and interventions for women of reproductive age to reduce risk factors that might affect future pregnancies. should be made a health research priority, focussing on appropriate community based interventions, which could improve the quality of maternal care. Human rights approaches should be employed to advance maternal health.
Reproductive health Within the framework of WHO's definition of health as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, reproductive health, or sexual health/hygiene and health sector Reform
Reforms in reproductive health need to be evaluated as they impact on the health of the most vulnerable groups, women and adolescents. The combination of sexually transmitted diseases Sexually transmitted diseases
Infections that are acquired and transmitted by sexual contact. Although virtually any infection may be transmitted during intimate contact, the term sexually transmitted disease is restricted to conditions that are largely (STDs) and family planning (FP) services worldwide needs to be assessed prior to accepting that this integration of services promoted measurable positive public health outcomes.
The conference ended with the Bangkok Declaration ASEAN Declaration or Bangkok Declaration is the founding document of Association of Southeast Asian Nations (ASEAN). It was signed in Bangkok on August 8 1967 by the five ASEAN founding members - Indonesia, Singapore, Philippines, Malaysia and Thailand as a display of on Health Research for Development, affirming:
* a strong ethical basis for health research
* the inclusion of a gender perspective
* knowledge generated through research should be accessible to all
* research is an investment in human development
* research should be inclusive, involving civil society partnerships at local, national and international levels.
I wish to thank UNISA UNISA University of South Australia
UNISA University of South Africa
UNISA Universiteit van Suid-Afrika (University of South Africa) for making this financially possible.
Dr VJ Ehlers
Department of Advanced Nursing Sciences