problems.However, after thefive exercises all which of – the to solutions effective finding to contribute to likely most were that questions research identifying to view a ing an impact on the cause of death. They were chosenfollowed with the path from generating new knowledge to hav Thefive criteria used by the scorers were intuitive as they reduce disease burden; and (v) effect on equity [3–7]. (withityaffordability sustainability);and (iv)potential to effectiveness of the resulting intervention; (iii) deliverabil swerabilityresearchtheof question; likelihood(ii)the of exercisesfive “standard” the were criteria: CHNRI an (i) income countries by the year 2015. The criteria used in all middletalityandchildrenlowinin age years ofunder 5 defined: identify to research could that help reduce mor weightcontextthose[3–7].exercisesThefor clearly was asphyxia,neonatal infections andpreterm birth/low birth lected causes were childhood , diarrhoea, birth which was just being introduced at the time [1,2]. The se (ChildHealthNutritionand Research Initiative) method, CHNRI the on based were exercises The 2015. year the thefive major causes childof deaths for the period to up large five exercises define research to priorities related to commissioned Health) Adolescent and Child Newborn, I I. Involving funders Rajiv Bahl www.jogh.org Igor Rudan using the CHNRI method Setting health research priorities 3 2 1 London School of Hygiene and Tropical Medicine, London, UK Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland Scotland, UK Centre for Global Health Research, The Usher Institute for Population Health Sciences and Informatics, The University of , opment (later renamed as WHO MNCAH – Maternal, partment for Child and Adolescent Health and Devel n 2007 and 2008, the World Health Organization's De • doi:10.7189/jogh.06.010301 2 , Jose Martines 1 , Sachiyo Yoshida 2 2 , Kit Yee Chan ------1 1 ful addition to the standard CHNRI framework. funding support”, or simply “fundability” – would be a use another criterion to the exercise – “likelihood of obtaining adding then funders, identified research to priorities the However, if there were large differences in prioritization. attractivenessof process of the for sufficient were criteria “standard”CHNRI the that indicate would this support, attractequallyfundingattractivelikelytofundersand to were priorities leading the all If funding. being of hood and asked to discuss any potential variation in their likeli research priorities identified through the CHNRI exercises search.Thefunders wouldpresentedbe withtheleading explorefunders' perspective inprioritization ofhealth re to processaimed The WHO. the consultationprocessat a in parttake researchhealth childtointerested tions in numberrepresentativesaof fromlarge funding organiza ercises at the WHO agreed that it would be useful to invite To answer these questions, coordinators of the CHNRI ex support for specific research questions? which would evaluate the likelihood of obtaining funding should another criterion be added to the CHNRI exercises, specifically,researchMorefunders?to they were tractive “fundable”howidentified werethe priorities, at how ie, – the WHO officers were left with an additional question: respectedpublishedwereinternationalin [3–7]journals , Simon Cousens 3 : , Devi Sridhar June 2016 •Vol. 6No. 1•010301

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VIEWPOINTS VIEWPOINTS ideas submittedexercises.ideasCHNRIscoringduringthefor priorities represented roughly the top 5% of all the research termbirth/low birth weight [3–7]. This set of 50 research nia,, birth asphyxia, neonatal infections and pre for each of the five major causes of child deaths: pneumo were presented with a list of the top 10 research priorities the representatives of funding agencies, the 16 participants Havingexplained the aims ofthe consultation meeting to ligation. ingagencies, nor would itcreate any form offunding ob necessarily be the official position of their respective fund not would input their that understood was Moreover,it anonymity. of condition the under exercise the in part tually, 16 representatives of funding agencies agreed to take ka Research Institute for Maternal and Child Health. Even Foundation, Children's Investment Fund Foundation, Osa Global Forum for Health Research, Trinity Global Support Brazil, and PakistanZambia, of Health ofMinistries dia, USAID,PATH, Ministry Scienceof andTechnology Inof Children,EPICENTRE,INCLEN,theUNICEF, Save UK, of Health USA, Department for International Development Gates Foundation, the Wellcome Melinda Trust, and National Bill Institutes the including organizations, funding MarchIn2009, MNCAHinvited representatives 40 from (GENEVA, 27–29 MARCH 2009) THE MEETING WITH THE FUNDERS June 2016 •Vol. 6No. 1•010301 attractive were they to research funders? how i.e. priorities,identified the were able” “fundquestion:anotherhowwith left were officers WHO the exercises, the completed Having equity. on effect the and reduction deliverability,mortalityburden potentialfor effectiveness,answerability, criteria: CHNRI exercises“standard”fivetheallwere in tion prioritizaforcriteria usedTheweight. birth birth/low preterm and infections neonatal asphyxia,pneumonia,diarrhoea,birthhood the year 2015. The selected causes were child jor causes of child deaths for the period up to fine research priorities related to the five ma search Initiative) method. The aim was to de Re Nutrition and Health (Child CHNRI the large research priority setting exercises using HealthandDevelopment commissioned five Adolescent and Child for Departmenttion's In 2007 and 2008, the World Health Organiza

------2 ranks and the US$ assigned to research priorities. generalconsistencyTherewas2.5. US$ between to20.1 US$ fromranged research priorities to assigned amount searchpriorities ranged from 3.7 to 7.2. The average US$ 10 ed; ranks across the 16 participants (1 tiesaccording thetoinstructions ( Sixteenparticipants scoredidentifiedthe research priori funding support that they may obtain. likely the to concordance in priorities researchdifferent umn1),andalsodistributeto hypotheticala US$100to priorities identified for each of the five causes of death (col researchtenassigntheweretheyaskedranks toto1–10 providetoneedorganization,not didtheirtheyorname given to meeting participants is shown in attractive) for funding support. The scoring sheet that was sionon what makes aresearch question attractive (or un seem most fundable. Results were used to facilitate discus ute a theoretical US$ 100 among the research priorities thatwas measured by asking funder representatives to distrib ment policies and practices. Second, funding attractiveness organization’sinvest an current under support funding researchpriorities according theirto likelihood receiveto identified the rank to asked representativeswere funder attractiveness Funding support from their respective organizations. ally identify those that were most likely to receive funding researchofindividulist prioritiesthetoaskedwith and representativesprovideddonorwere 16 the Then, tives. 50leading research priorities tothe16 donor representa The WHO coordinators (RB and JM) explained each of the Figure 1. standing funding attractiveness of different research priorities. tatives at the meeting to obtain information useful to under

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most likely to be fund Figure 1 ). The).average . While ------the horizontal axis at the US$ 10.0 line. between 50 research priorities. No substantial differences in funding attractiveness would be indicated by equality of the scores on www.jogh.org Figure 2. Table 1 in shown are prioritiesresearch 4 These efforts. its trate ing point from which MNCAH Department could concen therest [8]. Itwas agreed that they might provide starta thermore, 4 research priorities (8%) clearly stood out from to the line that represents an investment of US$ 10.0. Fur from the funders, then all the bars would be supportextending obtain to likely onlyequally were priorities research ofthe assigned funds from that expected atrandom: ifall clearly shows that there was a rather substantial departure the 2nd column (ie, assigned US$), presented in Importantly,collectivetheanalysisonbasedinput theof

. The results of the collective input from 16 funder representatives, showing large differences in funding attractiveness • doi:10.7189/jogh.06.010301 RANK OF RESEARCH PRIORITIES ACCORDING TO THEIR ATTRACTIVENESS TO DONORS 50 49 48 47 46 45 44 43 42 41 40 39 38 37 36 35 34 33 32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

0,0 AV ER AG E AMOU 5,0 NT OFUS$ASSIGNED (OUT OF POSSIBLEUS$100) Figure 2 T 10,0 O THERESE 1 - - - , 3 ARCH Table 1. support positive outliers in terms of their likelihood to obtain funding newborn survival? home visits for initiation of supportive practices, detection feasibility,theare routineWhat of scheme a effectivenessof cost and care seeking, handwashing)? practices(breastfeedcarefollowinghomepromote the What are the feasibility, effectiveness and cost of different approaches to What are the barriers against appropriate use of oral differentrehydration contexts and settings. therapy? dangernizesigns,treatreferacuterespiratoryand infec Evaluate the quality of community workers to adequately assess, recog P RIORITY The 4 research priorities (8%) that were identified as 5,0 June 2016 •Vol. 6No. 1•010301 20,0 2 ing, cord/skin,ing, tions(ARI)in of illness and 5,0 -

VIEWPOINTS VIEWPOINTS edge may not be were identified as most likely to generate useful new knowl it implies that the CHNRI exercises' research priorities that stoodterms.particularlypointThisis important because readilymoreundercommunicateinand these are goals ferent languages. Researchers need to be clear on what theirpecially privatethethosesector,in oftenspeakquitedif discussionresearchersthatwas researchand funders,es mentsthat were already made. Animportant point inthe invest strategic long–term other with complementarity posing the research, linkages to broader societal issues, and novelty,internationalcompetitivenessgroups prothe of money, for researchspecificity value ideas, of andclarity the burden and equity. Funders were also interested in the value answerability, effectiveness, deliverability, impact on to tendedResearchers funders. researchersand between mostimportant criteria for research prioritisation differed sultstheirofcollective input. Participants agreed thatthe held with participants to understand and interpret the re was discussion open An meeting. the of day second the and presented to donor representatives at the beginning of The results were analysed after the first day of the meeting FUNDER REPRESENTATIVES AN ANALYSIS OF THE EXERCISE WITH June 2016 •Vol. 6No. 1•010301 their application tryimproveto thetranslation findingsof and partnershipsbetween researchers and indus formingpotentialfor the interestedinularly they have already made. Some may be partic that investments strategic long–term other societaler issues, complementarityand with groups proposing the research, links to broad novelty,international competitiveness theof specificity of research ideas, value for money, funders.Funders areinterested clarityin and oritisationdiffered betweenresearchers and agreedthatmosttherelevant criteria prifor under the condition of anonymity. Participants sentativesagreed taketopartthe exercisein health research. Eventually, 16 funders' repre plorefunder's perspective inprioritization of process at the WHO. The process aimed to ex healthresearch consultationtaketopartain child global for support funding substantial provide that organizations from sentatives In March 2009, WHO officers invited 40 repre considered equally relevant by the funders.

------4 views on what represents an attractive funding option. option. funding attractive an represents what on views ful in understanding that funders certainly have their own MNCAH department in March 2009 was exceptionally use The meeting with research funders organized by the WHO CONCLUSIONS are made on very long–term, strategic investments. of great urgency to tackle a problem, or whether decisions Priorities can differ substantially if the overall context is one overall importantcontext. definingthe ancomponent of of interest, the time frame in which returns are expected is styles, the population, geographic area and disease burden Apart from funders’ perceived returns and their investment for–profit organizations). research (which may be typical for some industry and not– and biased towards high risk – high profit avenues of healthpreferred among some industrial partners) or risk–seeking those investing public funds), for risk–averting (suggested (whichresponsible may and be balanced be may styles by defined primarily expected thus returns is of the funders. place Moreover, takes their investment oritization tion for their agenda. The context in which investment pri tions may be primarily interested in increased media atten productstheirpreferredas returns. Non–profit organiza patentable see may industries from Investors invested. duction in disease burden wherever public money is being at the beginning of the process. They may be defined as re on investments in health research should be clearly stated therefore,beginwiththose invest.who Perceived returns Transparencyresearchofpriority settingprocesses must, economic gaps.. tationof research results would widen the existing socio– sues of safety and equity issues and ask whether implemen Finally, society as a whole may be more concerned with is products.commercial into resultsresearch translate and trial donors may be primarily motivated to generate patents going public debate or an important societal issue. Indus ideas, and whether a research question is linked to an on tional research capacities to carry out the proposed researchsustainabilityresultingtheof interventions, localnaand pearedinterestedmoredeliverability,in affordability and application. Ministries and international organizations ap their and findings oftranslation theincrease to industry potential for forming partnerships between researchers and money.particularlyHowever,interestedbe in may some way,ethicalfor an value inand feasibilityresearch ideas research are concerned with answerability of the proposed cide on research priorities. Generally, all investors in health the categories of funders in the criteria that they use to de Moreover, there seem to be important differences between ing and discussing the results of the CHNRI exercises. This should certainly be taken into account when present www.jogh.org • doi:10.7189/jogh.06.010301 ------www.jogh.org an attempt on the part of researchers to communicate their search community. Results of the CHNRI process re broadrepresent the of knowledge collective on drawing ideas, efits associated with investing in many competing research ability to transparently lay out the potential risks and ben Thekey value of the CHNRI method to funders lies in its funders' decision making. on impactlimited very prioritizationhaveexercises may stakeholders.wider researchOtherwise,outcomestheof count, in addition to those preferred by the ac researchersinto taken be must andcriteria Funder–supported sults. re the ofownership theirencourage process,to CHNRI theinlyprocess settingof research priorities, suchtheas stakeholder groups. It is important to involve funders ear wider or researchers, of those fromdifferent quite often categoriesfunders.of Moreover, funders' perspectives are Those views are not generalizable and may differ between • doi:10.7189/jogh.06.010301

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Bahl doi:10.1371/journal.pmed.1000041 Fontaine journal.pmed.1001099 ue lbl otlt fo cidod irhe b 2015. by diarrhoea childhood from mortality global duce newborn infections by 2015. by infections newborn al mortality from childhood pneumonia by 2015. INF.0b013e31819588d7 Rudan line:19090596 research investments: guidelines for implementation of the CHNRIRudan Method. line:18581609 research investments: universal challenges and conceptual framework. Croat Med J. 2008;49:307-17.J. researchconceptualframework.MedCroatinvestments: challengesuniversaland Rudan I, Chopra M, Kapiriri L, Gibson J, Lansang MA, Carneiro I, et al. Setting priorities in global child health

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conflict of interest. icmje.org/coi_disclosure.pdf(available on request from the corresponding author) and declare no Competinginterests: the article and made useful comments. andmoderatedIR theconsultation process. IR,andSYKYC wrote thearticle. andSCrevisedDS Authorship declaration: Funding: necessarily represent the views of the Organization. RB and JM are the employees of the World Health Organization. Their views expressed inhere thedo notconsultation process and providing useful information under the conditionAcknowledgements: of anonymity. SY, Gibson El Arifeen O , Kosek

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, Ali

M S Ameratunga , ,

Bhutta N Bhatnagar , Bhan

ZA

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S Black , JM and RB organized the consultation at the World Health Organization , , El Arifeen Boschi–Pinto Carlo

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Chan S a target that CHNRI exercises should serve quite well. be improving public health in the most cost–effective way – about investing public funds, whose primary agenda should should be particularly relevant to those who make decisions ingpriorities directasa result ofthe CHNRI process. This ercises on funder decision making and any change in fund tools that can detect and evaluate the impact of CHNRI ex develop to be will yearsfuture in challengegreater even of the CHNRI process remain considerable challenges. An and securing their commitment to acknowledge the results clearly, outcomes the communicating exercises, CHNRI propriate and effective ways of involving funders in future ap finding perspective,methodological a From agenda. research own their on deciding when account into take useful additional information that funders may, or may not derstood, transparent, replicable and intuitive. It provides easilyunisthatway opinionsviewsand funders a to in , Bhutta

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