Council on Health Research Working Paper 2 for Development (COHRED)

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Strengthening Health Research Systems in Central Asia

A system mapping and consultative process

Country experiences: - Kazakhstan - Kyrgyzstan - Tajikistan - Uzbekistan

Mohir Ahmedov, Sylvia de Haan, Bakhyt Sarymsakova

www.healthresearchfordevelopment.org Author credits on inside cover Authors Mohir Ahmedov, Tashkent Medical Academy, Keywords Uzbekistan Central Asia, health research systems, Sylvia de Haan, Council on Health Research Kazakhstan, Kyrgyzstan, Tajikistan, for Development (COHRED) Uzbekistan, Council on Health Research for Bakhyt Sarymsakova, Kazakhstan School of Development, COHRED, research for health, Public Health health research mapping, national health research, health research priorities, health The COHRED Working Paper Series publishes research policy. authored and collaborative papers. Authored papers are attributed to the people leading the © Copyright and Fair Use analysis, concept development and writing. The Council on Health Research for Collaborative papers are the result of interactions Development (COHRED) holds the copyright between groups of professionals that have to its publications and web pages but been convened by COHRED to improve encourages duplication and dissemination of understanding on a specific area of research these materials for non-commercial purposes. for health, where all participants have made an Proper citation is requested and modification equal contribution and lessons to emerge from of these materials is prohibited. Permission to this experience. Working Papers are one point make digital or hard copies of part or all of this in this ongoing learning process. work for personal or classroom use is granted without fee and without a formal request COHRED Working Paper Series provided that copies are not made or COHRED Working Papers capture lessons and distributed for profit or commercial purposes synthesise new thinking on improving health and that copies bear this notice and full research and health research systems in citation on the first page. Copyright for developing countries. The series reflects the components of publications that are not owned work in progress of the COHRED programme by COHRED must be honoured and with developing country partners and others permission pursued with the owner of the involved in research for health. Each COHRED information. To copy otherwise, to republish, Working Paper is externally peer reviewed. to post on servers, or to redistribute to lists, requires prior specific permission from Learning Spiral COHRED. The COHRED Learning Spiral is COHRED’s process of dialogue and critical review by COHRED is interested in tracking the use and groups of health research experts of effectiveness of its published information, and approaches to how developing countries can receiving feedback from readers. Readers improve their health research systems. Specific interesting in providing input or interacting learning points in the Spiral are opportunities with COHRED on its published materials for publications. please contact [email protected]

ISBN ©Council on Health Research for Development 92-9226-015-4 (COHRED) 2007

1 CONTENTS

Executive Summary 3

1. Introduction 4

1.1 Central Asia 4

1.2 Health Research and Health Research Systems mapping in Central Asia 5

2. Methods and processes 5

2.1 National Health Research System maps 5

2.2 Regional Consultation 6

3. National health research systems in Central Asia 7

3.1. NHRSs in Central Asia - a three-country perspective 7

3.2. Kazakh Health Research System Map 10

3.3. Kyrgyz Health Research System Map 15

3.4. Uzbek Health Research System Map 22

4. Regional Consultation on Health Research and Health Research Systems 27

5. Conclusion 29

Annex 1: Participants list: regional consultation 32

Annex 2: Agenda COHRED regional consultation, Almaty, 21/10/2006 34

2 Executive Summary National health research systems that are research agendas. It is not clear from the effective, efficient, innovative – and in step information collected what process is used to with practices around the world – are a critical set the agenda, who is involved, and how component of modern health systems. frequently the agendas are revised.

Rather than consisting of isolated actions, 3) Health research policy framework: none system strengthening efforts should be an of the countries has a health research policy inclusive process that builds on existing framework. Country teams highlighted this infrastructure, available resources, accepted gap during the consultation. They consider a practices and local culture. To assist Central policy framework essential to help outline Asian countries in their efforts to strengthen the organisational structure and financing their health research systems, COHRED has mechanisms for health research. It also initiated a series of initiatives. This paper supports creation of the conditions for reports on two of these. quality research and innovation to flourish.

The first initiative mapped the national health 4) National research management: the research systems in Kazakhstan, Kyrgyzstan countries in the region have similar health and Uzbekistan (a Tajik health research map research systems. Central government was done in another COHRED project). This agencies play a key role in setting paper provides a comparative description of regulations for the system, and providing the health research systems of these three funds for research. In addition to the central countries, and a detailed description of each government agency on research and the national health research system. Published Ministry of Health sub-unit on health here for the first time, this information helps research, national attestation commissions facilitate decision making to strengthen the and leading medical education institutions of health research systems in the region. each country are key players in Central Asia’s health research systems. Precisely The second initiative is a regional consultation how the different mechanisms relate to each on health research between health research other and coordinate the various activities is actors from four Central Asian countries not clear. (Kazakhstan, Kyrgyzstan, Tajikistan and Uzbekistan). System maps were used to The countries have all the basic requirements discuss challenges and opportunities for health of a national health research system. There research in the region. Participants shared appears to be general interest in research and experiences and discussed common needs and basic governance structures exist. At the proposed solutions. same time, each country needs to develop a clear health research policy framework and The basic requirements of a national health collect further information on human and research system are listed below. The maps financial resources to inform strategic plans provide detailed information on these on staffing, training and research financing requirements. mechanisms.

1) Political commitment to health research: There is great potential for regional research is considered fundamental to health cooperation and networking. The similarities care in the region. All the countries have a in the national health research systems mean history of research (established and that initiatives in one country can be easily developed during the Soviet era), structures adapted for use in others. Despite in place to manage their research, and have considerable disparities in economic made some financial commitments to development, the Central Asian countries research. are very similar in terms of the development of their national health research systems. 2) Health research priorities: Kazakhstan, Kyrgyzstan and Uzbekistan have health

3 1. Introduction

1.1 Central Asia Short profile of Central Asian region Central Asia is a landlocked region of Asia. Although different definitions of Central Asia Health care and research systems in exist, the most common definition includes Kazakhstan, Kyrgyzstan, Tajikistan, and five countries that formerly formed part of the Uzbekistan previously formed part of the Soviet Union—Kazakhstan, Kyrgyzstan, Soviet medical and research frameworks. Each Tajikistan, Turkmenistan and Uzbekistan. of the Soviet republics had an identical health They have a combined population of research system at republic level that was approximately 60 million. supervised by a single national framework operating at the Union level in Moscow. In Geographically, Central Asia expands over 1991, after the rupture of the Soviet Union, all almost four million square kilometres south of Central Asian countries became independent Russia, west of China, north of Afghanistan and Moscow’s supervision of their economies, and Iran and east of the Caucasus and Caspian including health care and health research Sea. frameworks, ceased. The region lies at the crossroads of the ancient This has led to transformations of the health Silk Road that connected east and west for systems in the Central Asian countries, and has many centuries. The local culture is an included the streamlining of the health care amalgam of Turkish and Persian cultures. infrastructure and changes in financing and Conquests of the region by Arabs in the 8th governance. For example, by 2004 the number century and Mongols in the 13th century had a of hospital beds halved (to 600 beds per 100, significant impact on the local culture both 000 population) making them comparable to through the introduction of Islam as the EU figures (591 beds per 100, 000 population). dominant religion and assimilation of local The physician to population ratio has also and invading ethnicities. Starting in the late decreased over this period from 35 per 10, 000 19th century, the region was gradually population in 1990 to 29 in 20041. incorporated into the Russian empire. Following the October Revolution, it became All Central Asian countries have young part of the Soviet Union. This defined another populations, with 32.5% of the population turning point in the history of the region. under the age of 14, and only 5.2% of the population aged over 65 (2004). Literacy rates Since then until the early 1990’s the regional are very high in all of the countries of the politics, economics and social infrastructure region, with the regional average standing at was shaped in line with the transformations 99% (2003) 2. throughout the Soviet Union, and led to the similar development of all of the countries of With regard to health outcomes, the countries the region. are experiencing a double burden of disease specific to countries in transition. In addition to infectious diseases such as tuberculosis and HIV/AIDS, non-communicable diseases (cardiovascular, respiratory and cancer conditions) represent major public health challenges (2004)3.

1 European health for all database www.euro.who.int/hfadb , WHO/Europe, June 2006 update 2 European health for all database www.euro.who.int/hfadb , WHO/Europe, June 2006 update 3 European health for all database www.euro.who.int/hfadb , WHO/Europe, June 2006 update

4 1.2. Health Research and Very little information is available on health Health Research Systems research systems in Central Asian countries, so that informed decision- and policy-making mapping in Central Asia about how best to strengthen the systems is difficult. Furthermore, most of the available Advances in science and technology, combined resources are not specific to health research with political stability and transparency, have systems, but cover more general health-related helped shape the developed countries into fields. To “catch up” with international trends what they are today. Research and access to in health research, specific efforts are needed information on health issues are vital to the to facilitate review of the countries’ health well-being of nations and contribute to research frameworks. economic and human development. Many transition economies are well placed to reap To start filling in this information gap, and to the broader benefits of these initiatives. initiate a discussion on how best to strengthen the health research systems in the region, Although former Soviet countries have made COHRED facilitated a health research significant progress to align their economic mapping project in three countries of the framework with internationally acceptable region (Kazakhstan, Kyrgyzstan and benchmarks, they have failed to do so in fields Uzbekistan), followed by a regional that do not yield immediate economic benefits. consultation with participants from four Health research is one such field; it has drawn countries (Kazakhstan, Kyrgyzstan, Tajikistan insufficient attention over the years despite its and Uzbekistan). The project aimed to place as an important factor for development. strengthen the health research systems in Advanced economies continuously enhance Central Asian countries by building local their health research systems to encourage and interest and capacity in health research diffuse innovation, but the countries of Central systems evaluation and change. Asian have not kept pace with this process. This working paper presents a comparative analysis of the health research systems in the region, and provides detailed national health research maps of three countries.

2. Methods and processes

national, regional and international partners The project was divided into three parts. (1) on strengthening national health research National Health Research System (NHRS) systems in Central Asia. maps were prepared for Kazakhstan, Kyrgyzstan and Uzbekistan4; (2) a regional 2.1. National Health Research consultation involving participants from four Central Asian countries (Kazakhstan, System maps Kyrgyzstan, Tajikistan and Uzbekistan) was The NHRS maps form the basis of this held in October, 2006 in Almaty; and (3) this working paper. An NHRS map template, working paper was developed. developed by COHRED and used in other Based on the maps produced and the countries and regions, was used as guidance 5 consultation meeting, this working paper is for the mapping processes . meant to facilitate further discussion between

4 The national health research map for Tajikstan was developed earlier and is available on the COHRED 5 See for more information on the tools used: Building and website (See: Research for Health in Tajikistan: strengthening national health research systems. A Strengthening the National Health Research System. manager’s guide to developing and managing effective COHRED Record Paper 4, 2006). health research systems. COHRED, 2007. (in preparation)

5 The objectives were:

- The maps would bring together key 2.2. Regional Consultation country level health research system The outcomes of the regional consultation, information into a single, publicly held in Almaty in October 2006, form the accessible document; second part of this working paper. The round - Mapping would facilitate discussion table was organised jointly by the Kazakhstan among national stakeholders on gaps, School of Public Health and COHRED, and challenges and opportunities for facilitated by the project team. The objectives strengthening their health research pursued by the consultation were three-fold: systems; - To discuss the status of health research - Mapping would facilitate learning in countries of the region and discuss among countries within the region. needs, opportunities and mechanisms Such regional exchange of information for strengthening national health has lessened since the countries research systems; became independent. - To explore opportunities for A two-member team from Kazakhstan and partnerships and collaboration Uzbekistan conducted the work. The team between countries in the region with worked closely with a researcher from the international agencies; Health Policy Analysis Project (Kyrgyzstan) - To define possible roles COHRED can and a COHRED project officer from Tajikistan. play in supporting and strengthening COHRED staff based in Geneva (Switzerland) national health research systems and provided technical support for the entire research initiatives in the countries of project. the region.

The project started with a briefing of the team The mapping process, and discussions held in Geneva which allowed for a detailed review with national stakeholders, facilitated the and discussion of the NHRS map template, identification of key people to be invited to the assessment of its applicability to the Central consultation. Participants included policy Asian context, and discussion of experiences makers from the ministries of health and from other countries/regions where the map representatives from medical and public health has been used. institutions (see Annex 1 for a list of The map development process was different participants). The consultative meeting was for each of the three countries and primarily scheduled at the time the COHRED board held consisted of a review of available data its annual meeting in Almaty, facilitating (legislative documents, reports) and open international networking and exchange of interviews with relevant officials. experiences beyond the region. Annex 2 provides the agenda of the consultation. On completion of the country maps, the first draft of the working paper was produced and translated into Russian to facilitate feedback from the regional consultation participants. These comments are included in this working paper.

6 3. National health research systems in Central Asia

This section of the paper provides a Uzbekistan, the science committee under the comparative description of the national health Cabinet of Ministers has two health officials research systems (NHRSs) in three Central representing the health sector. Asian countries (Kazakhstan, Kyrgyzstan and Uzbekistan) based on NHRS maps produced Research is considered fundamental to health for these countries. It is followed by detailed care in the region. All Ministries of Health maps of each of these countries6. have special health research departments and a health research degree is required for most policy and decision-making positions. The Medical Science Council of the Ministry of 3.1. NHRSs in Central Asia – Health in Kyrgyzstan has a primarily technical a three-country perspective function since financial matters are dealt with by the State Committee on Science. In The content of this section is based on Uzbekistan, the day-to-day management of information from the maps (which are health research is the responsibility of the Unit presented in full in sections 3.2. – 3.4) and of Health Research Coordination within the provides a comparison of the NHRSs with Ministry of Health. The Kazakh Ministry of regard to key research system elements Health has a Department of Medical including governance of health research Education, Research and International systems; health and health research policies Collaboration, which is responsible for and priorities; communication/dissemination defining priorities in research, conducting and utilisation of research; and routine health applied research and financing research information systems. programs.

3.1.1 NHRS Governance Ministries of Finance in the region tend not to have a special department for health research. The central government is a major stakeholder Health research funding is dealt with by in the NHRS in each of the countries. The state departments on social issues. In Uzbekistan, it provides research funding through a centrally is handled by a Department for Financing earmarked budget. Each of the countries has a Social Affairs and Sciences, while in central government organisation that performs Kyrgyzstan it falls under the Social a governing function. In Kazakhstan, this Expenditures Policies Division. function is performed by the Higher Science Commission (led by the Prime Minister) and In addition, in all three countries, national the Scientific Committee of the Ministry of attestation commissions set standards and Education and Science; in Kyrgyzstan, it is benchmarks for the quality of research performed by the State Committee on Science conducted for scientific degrees and they are of the Ministry of Education and Science; and becoming important entities in the governance in Uzbekistan by the Committee on Science of national research systems. and Technology Development within the Research funded outside the state budget does Cabinet of Ministers. In Kazakhstan and not have unified standards or governance Kyrgyzstan the science committees within the structures because these are set up by the Ministry of Education have a dedicated person funding agencies and institutions themselves. working on health research related issues. In Although there are some developments towards incorporating an ethical framework 6 The NHRS map of Tajikistan is provided in a separate into health research regionally, and there is document (see footnote 1) – the analysis in this paper is some international interest in supporting based on three countries only, as the Tajik mapping followed a slightly different approach and was therefore not ethics initiatives, overall ethics in health entirely comparable with the data collected for Kazakhstan, research is still in its early stages in the three Kyrgyzstan and Uzbekistan. Input from Tajikistan was received during the regional consultation and is included in countries. section 4 (regional consultation).

7 Table 1 Overview of main structures for health research governance

Kazakhstan Kyrgyzstan Uzbekistan Central Higher Science Commission State Committee on Committee on Science and government (headed by Prime Minister) Science (Ministry of Technology Development level Education and (within Cabinet of Science) Ministers) Ministry of Scientific Council and Medical Science Unit of Health Research health level Department of Medical Council Coordination Education, Research and International Collaboration

Although only two of the three countries have 3.1.2 Health and Health Research Policies and Priorities an agenda for health, all three countries do have an agenda for health research. Again, the Currently, none of the countries has legislation process followed to define these priorities is dealing specifically with health research. not clear. In addition, the priority areas tend to Although specific health research policy be wide in scope, covering whole medical documents are not available for Kyrgyzstan fields (eg. paediatrics, social conditions) and Uzbekistan, issues related to health without attempting to define more narrow research are covered in other documents on areas for priority research. science or health care. In Kyrgyzstan and Uzbekistan, general research-related documents7 indicate that the research system should aim to facilitate scientific-technological progress; align scientific potential with government priorities; contribute to the nation’s economic-social development; and raise research efficiency, effectiveness, quality and utilisation of research outputs in the country. Kazakhstan has developed a draft concept (still to be approved and adopted) for reforming medical sciences. One of the main aims of the suggested reform is to modernise medical science through the implementation of innovative management that raises the quality of national research to come more in line with international research standards. While this aspiration to raise locally conducted research to international standards is shared by all three countries, Kazakhstan states it most explicitly.

Health priorities are formulated in Kyrgyzstan and Kazakhstan. In Kyrgyzstan the National Health Sector Reform program has defined five health sector reform aims, as well as five priority health conditions. In Kazakhstan the State Program on Health Care Reform defined thirteen conditions and disease groupings as health priorities. For both Kyrgyzstan and Kazakhstan the process that was used to define the priorities is not clear. No active list of health priorities was available for Uzbekistan.

7 For details of references see sections 3.3. and 3.4 8 Table 2 Existence of (health) research legislation and priorities

Kazakhstan Kyrgyzstan Uzbekistan research Scientific Act (2001) Law on Science (in not available legislation development) health draft Concept of not available, general not available, general research Reforming Medical research strategy documents research strategy documents legislation Sciences (to be address also health research address also health research adopted) health Defined in State Defined in National Health Defined in National Public priorities Program on Health Sector Reform Program Health Strategy (in Care Reform development) health Defined by Scientific Defined in report of State Defined by Ministry of research Council, Ministry of Agency on Science and Health priorities Health (2006) Intellectual Property (2005)

3.1.3 Communication, Dissemination and Utilisation of Research involves frameworks that make local and Regionally, there are no planned mechanisms international research findings accessible to the to regularly disseminate research findings to public and health professionals. These the relevant stakeholders. However, isolated frameworks comprise a network of medical attempts to disseminate information are libraries that maintain updated registries of occurring in each of the three countries, locally produced research and provide access exemplified by the launch of evidence-based to internationally produced research through medicine centres and schools of public health. medical periodicals. The local journals in Central Asia usually depend for their financing In Kyrgyzstan and Uzbekistan there are no on the authors of the articles. This constitutes a specific mechanisms or frameworks to ensure conflict of interest, resulting in poor quality that policymakers are regularly informed of articles being published. While rapidly advances in health services and medical increasing internet access makes international research. Whether and how policymakers research outcomes more and more accessible keep up to date with recent advances in health to the public, language and search skills services and medicine depends upon their remain major barriers both for the public and personal decisions and opportunities. health professionals. Participation in professional meetings (seminars, conferences) and self-learning are There is no apparent framework in the region the approaches most commonly adopted by that actively disseminates research findings policymakers who wish to stay informed. In (both local and international) to the public. Kazakhstan, the recently re-organized Institute Generally, in Central Asian countries, the of Health Care Development aims to regularly media does not play a major role in shaping inform policy makers of health services and the research agenda or in disseminating medical advances. This institute also conducts research outputs to the public. Health related impact evaluations of health policies that focus media is mostly oriented towards expert primarily on health status. The reports of the opinions rather than presenting and evaluations are delivered to relevant interpreting research outputs directly to the departments of the Ministry of Health. public. However, how this influences the policy/decision-making loop is not clear. 3.1.4 Routine Health Information Systems

Challenges to effective dissemination of Health-related data collection systems in the research findings occur with both passive and three Central Asian countries are built around active approaches. Passive dissemination data collection schemes used during the Soviet Union period. Currently, three major data

9 collection systems are observed in all three 3.2. Kazakh Health Research countries: System Map 1) The state statistical agency in each country pools selected health related information such as mortality and morbidity related data 3.2.1. Governance of the Health Research System through its regional and district branches.

2) The second system involves the Ministries of The governance of health research in Health and is divided into two data collection Kazakhstan takes place at several levels (see components. The information centre at the also figure 1): national level collects data through its regional and district branches. The responsible agencies Governmental (national) are the Institute of Health in Uzbekistan, The Higher Scientific Technical Commission MedInform in Kazakhstan, and the Republican (HSTC) acts directly under the Government of Medical Information Centre in Kyrgyzstan. All the Republic of Kazakhstan. Since 2006, the three institutions perform similar functions. Prime Minister has been head of the The second component is the state sanitary Commission. The HSTC is an advisory body, epidemiology (SES) system, where data related which defines state priorities for development to infectious conditions is pooled. Although of fundamental and applied research, and both data collection functions are performed develops recommendations for forming and through the Ministry of Health, these two improving governmental scientific policies. components tend to be independent from each The Commission reports to the President about other and the information they gather is all developments in science and technology generally pooled only at the national level. once every three years. An International With regard to the private health sector, in Council of Experts (ICE) will be created in 2007 Kyrgyzstan the data is collected by regional at the HSTC. The mission of ICE will be to information centres and passed on to national analyse world trends in science and capacity level, but in Uzbekistan the private sector is for research. left out of the Ministry of Health data collection mechanisms. There was no available Intra-sectoral information on Kazakhstan at the time of In July 2006, a Scientific Committee was writing. created at the Ministry of Education and Science. The Scientific Committee (SC) should 3) The third data collection system is the become the administrator for all studies, program-specific mechanism, where major including fundamental sciences programs at health programs and projects (for example on the state level. The SC is an executive part of HIV/AIDS or tuberculosis) develop their own the HSTC. A step-by-step transition is data collection systems. The extent to which foreseen, moving financing of all studies program-specific mechanisms merge with conducted by different ministries through the official collection mechanisms varies among SC by 2010. The Ministry of Education and countries and programs. Science also plays a role in the provision of scientific and technical expertise to scientific In addition to the above, Uzbekistan and programs, and in the accreditation and Kyrgyzstan seem to have separate data attestation of research organisations. The collection systems in place for parallel health Committee on Attestation and Supervision of systems employed by the National Security Human Resources in Science plays an active Services, the military and some other large role in the process of research quality state agencies and enterprises. assurance and has defined requirements for All of the mechanisms described above tend to thesis and dissertations in scientific degrees. be independent from each other. Actual data These roles are defined in the Scientific Act (9 collected varies among countries and is July 2001, № 225-II, www.zakon.kz). defined by the respective agencies. Sectoral The Ministry of Health provides scientific and medical expertise to programs, defines

10 priorities for research, conducts applied Medical University, a department of the studies, and finances research programs. The university in Ust-Kamenogorsk city, the Ministry of Health is the main administrator of Kazakhstan School of Public Health, and the the program “Applied Health Research”. The Almaty Institution of postgraduate medical Ministry of Health has a Department of education. Medical Education, Research, and International Collaboration. The Ministry of Health monitors and evaluates its programs on the basis of quarterly and Twenty research organisations (14 centres and annual reports submitted by contractors. After 6 institutes) function under the Ministry of completing a program, the contracted Health. Fifteen of these organisations are organisation is supposed to present a final situated in Almaty. They provide highly report to the Ministry of Health. The report is specialised medical care for the population and sent to the Scientific Committee of the Ministry are leading specialised medical organisations. of Education and Science. In addition, all They coordinate scientific, technical, diagnostic governmental programs must be registered at and treatment, preventive, and advisory work the Kazakh State Centre of Scientific and in specific areas. Substantial scientific capacity Technical Information (KSCSTI). Submission is concentrated at the five State medical of interim and final reports to this centre is also academies: the Kazakh National Medical required. University, a non-governmental Kazakh

Figure 1: Overview of the health research governance structure in Kazakhstan

Higher Scientific Commission (Headed by Prime Minister)

Ministry of Education and Science: • Scientific Committee • Committee on Attestation and Supervision of Human Resources in Science

Ministry of Health: • Scientific Council • Department of Medical Education, Research and International Collaboration • 20 research centres and institutions

11 3.2.2. Health and Health Research Policies The State Program on Health Care Reform and Priorities defines the following health priorities: - Respiratory diseases In 2001, Kazakhstan adopted a Scientific Act. - Injuries and poisonings Building on this Act, the State Program of - Urinary diseases Science Development (2007-2012), developed - Skin diseases by the Ministry of Education and Science, was - Gastro-intestinal diseases presented to the Government. This Program - Eye diseases has yet to be adopted. In addition to the State - Infectious diseases Program of Science Development, a State - Psychological and narcological Program on Health Care Reform in the diseases Republic of Kazakhstan for 2005-2010, was - Diabetes developed and approved by the President of - Pulmonary, cardio-vascular diseases the Republic of Kazakhstan on September 13, - Tuberculosis 2004 (Order # 1438). The latter includes a - STI, including HIV/AIDS section on medical science and education. - Cancer

Besides the above acts and programs, At its meeting of 25 January 2006, The Kazakhstan developed the draft Concept of Scientific Council of the Ministry of Health, Reforming of Medical Science till 2010. One of approved the following list of health research the main objectives in this Concept is priorities: enhancing the competitive ability and quality - Essentials to improve management in of national research to international standards. health care; To implement this aim, the following strategies - Development and improvement of are defined: diagnostics, treatment and preventive - Creating a supportive environment for technologies to protect mother-and- the development of medical science child health; through improvement of co-ordination - Development and improvement of and research management; prevention, diagnostics, treatment, - Increasing research effectiveness and rehabilitation of lifestyle diseases; through introduction of modern - Evidence-based improvement of management in medical organisations; hygienic, epidemiological monitoring, - Integration of science, practical health surveillance, and prevention of care, and professional education; incidence in the Republic of - Assessing whether the quality of Kazakhstan; national research adheres to - Development of innovative international standards. technologies in health care.

In 2004, the Pharmaceutical Act (from 13.02.2004) and Additional Instructions, 3.2.3. Communication, Dissemination and particularly instructions for the work of ethical Utilisation of Research commissions and ethical reviews of clinical trials, were approved in Kazakhstan. This At the moment the phase of research facilitated the creation of an environment for utilisation is insufficiently financed, and developing networks of local ethics research often has no orientation towards the commissions, which should provide safety for economic needs of the society. In the Concept patients and protection of patients’ rights, of Reforming of Medical Science several freedom, dignity, and health during clinical strategies and objectives are defined that trials. An Ethics Commission was established address this issue: under the Government alongside with local - Facilitate interaction between research committees within research institutes, entities (health research institutes and universities, and research centres. health research centres) and the health care system to facilitate implementation of research based

12 program designs and newest (SES). General statistical data include health achievements in medical sciences; data on morbidity and mortality, and are - Provide software and informational published yearly. maintenance to support the research process; - Make financial provision for the implementation of achievements and results; - Involve practitioners in research work; - Introduce technologies and methods that are based on principles of evidence-based medicine.

The Institute of Health Care Development directly informs the Ministry of Health about the latest achievements of science in the world. In 2006, the Scientific Centre of Economical and Medical Problems was re-organised and re-named in Institute of Health Care Development (IHCD). One of the aims of the Institute is to conduct relevant studies and closely collaborate with the Ministry of Health to keep it informed of new developments.

The following organisations evaluate the impact of health care policy on health status of the population: IHCD, the Kazakhstan School of Public Health, and the National Centre on Healthy Lifestyle Development. Derived data are analysed by the relevant departments of the Ministry of Health (Department of Education, Science, and International Collaboration, Department of Curative and Preventive Work) and reported to the Vice- minister.

Two newspapers (“News in Public Health”, “Pharmaceutical Herald) are used for reporting on health and health research issues.

3.2.4. Routine Health Information Systems

Official health and health care statistical data are collected and analysed by the Governmental Statistical Committee and “Medinform” which works under the Ministry of Health. Health care departments in each oblast8 have informational and analytical centres where all statistical forms about the health status of the population are sent by medical organisations. For infectious diseases, reports are sent to the governmental agency for sanitarian and epidemiological surveillance

8 Subdivision of a republic of the former Soviet Union

13 3.2.5 List of Institutions Engaged in Health Research Institution Commission Conduct (a) Government departments and agencies Ministry of Finance Yes No Ministry of Education and Science Yes Yes Ministry of Health Yes Yes Ministry of Industry Yes Ministry of Defence Yes (b) Health care system Republic Research and Clinical Center “Stomatology” Yes Republic Research and Practical Center on Psychiatry, Psychotherapy and Narcology Yes National Medical Research Centre Yes Research and Practical Center of Medical and Social Problems of Narcomania (drug Yes abuse) National Centre of Hygiene of Work and Occupational Diseases Yes National Center of Healthy Lifestyle Development Yes Republic Research Centre of Child and Mother’ Health Protection Yes Republic Research Centre of Quarantinic and Zoonotic Infections (named after Masgut Yes Aikimbayev) Republic Research Centre of Pediatrics and Children’s Surgery Yes National Center of Tuberculosis Problem Yes Research Institute of Cardiology and Internal Diseases Yes Kazakh Research Institute of Eye Diseases Yes Research Institute of Dermatovenerologic Diseases Yes Republic Research Centre for Surgery (named after Sizganov) Yes Republic Research Centre of Hygiene and Epidemiology Yes Institute of Health Care Development Yes Republic Research Centre of Urology (named after Acad. B. O. Jarbusynov) Yes Research Institute of Traumatology and Orthopedics Yes Research Institute of Radiology’ Medicine and Ecology Yes (Semipalatinsk city) Kazakh Research Institute of Oncology and Radiology Yes Kazakhstan School of Public Health Yes Almaty Postgraduate Medical Institution Yes (c) Higher education and (national) research institutes / laboratories Kazakh National Medical University named after S.D. Asfendiyarov Yes Western Kazakh State Medical Academy Yes Karaganda State Medical Academy Yes Kazakh State Medical Academy in Astana Yes Semipalatinsk State Medical Academy Yes South Kazakh State Medical Academy Yes (d) Private non-profit organisations involved in research for health Central Asian Centre on Health Research for Development Yes Medical Consulting Group Yes (e) Business enterprise or industry (Private for-profit) Biotechnology companies (no detailed information available) Yes (f) International research and development sponsors or partners involved in research for health CDC Regional office for Central Asia Yes Yes UNICEF Regional office for Central Asia Yes UNESCO Cluster office for Central Asia Yes World Bank Yes (g) Any other institutions / commissions / structures / councils / networks / fora National Association of Young Researchers Yes of PK, National Academy if Science of USA. Audit Further Readings: Akanov A. Approaches and Principles materials. 2006 www.naukakaz.kz of Reforming and Development of Medical Science in Kazakhstan. Astana-Almaty, 2005; Akanov A. Medical Science in current conditions. Astana-Almaty, 2005; Status and perspectives of science and technologies development in Kazakhstan. Report prepared by National Centre of Scientific Information, Ministry of Science and Education

14 3.3. Kyrgyz Health Research System Map application process for the state research 3.3.1. Governance of the Health Research funding; coordinates the institutional research System in the public health sector, and conducts The NHRS in Kyrgyzstan constitutes part of technical review of new research proposals. the overall national research framework and The Council’s involvement is primarily follows general regulations pertaining to the technical, as all financial elements are in the national research system. The health research realm of either the State Committee on Science system consists of three major components or other funding agencies/institutions. The that, for the most part, act independently of Council coordinates its functions with the State one another. These components are: Committee on Science and with public medical - Research framework linked to state institutions. research funding, including the State Committee on Science within the Ministry Although there is no designated official on of Education and Science; and the Medical health research at the Ministry of Finance, a Science Council within the Ministry of special department —the Social Expenditures Health; Policies Division— is responsible for the social - The National Attestation Commission sector that includes both public health sector (NAK); and overall research. The division consists of - Independent researchers and institutions. two sub-divisions: Health Sector and Social Protection, and Education, Science and For state funded research, there is a clear Culture. The Department is directly governance structure that involves the State accountable to the Deputy Minister of Finance. Committee on Science of the Ministry of Education and Science and the Medical Science There are no specific regulations with regard Council of the Ministry of Health. The to research financed outside state government Ministry of Education and Science is the funding. Irrespective of the financing source, primary implementing state agency however, research used to obtain a degree responsible for the management of earmarked must meet special rules and regulations set by state research funding. The State Committee a special governmental agency—the National on Science is the fund holder and the final Attestation Commission. decision maker in grant allocation. The The National Attestation Commission Committee9 reviews applications, and, jointly (NAK)12,13: with the Ministry of Finance, makes decisions - Develops frameworks to improve and on funding of research initiatives (based upon implement the unified state policies on the conclusions/recommendations of an expert attestation of research and academic panel)10. cadre, and controls implementation of the policies; The Medical Science Council at the Ministry of - Forms and regulates the specialty Health11 is the agency involved in day-to-day dissertation commissions; management of the health research conducted - Initiates and coordinates draft laws within the public medical institutions. The and regulatory acts related to Medical Science Council facilitates the attestation and training of scientists and academic cadre; - Sets requirements for dissertations 9 Framework for the financing of research, technology and seeking research degrees; sets innovative initiatives from the national budget, approved by the Government of Kyrgyzstan on August 6, 1999 # 429 10 A detailed description of other responsibilities and roles were not available for this study, due to pending changes in the national research funding framework. Personal 12 Framework for the National Attestation Commission of correspondence with Ms. Nagaeva, State Committee on the Kyrgyz Republic, approved by the President of Kyrgyz Science, Ministry of Education Republic March 14, 2006 #115 11 Contact details: Head of Council, 1 T. Moldo str., 13 Bulletin #1, National Attestation Committee, Kyrgyz Bishkek, Kyrgyz Republic 720045, tel: 996 612 901690 Republic, January 2006

15 requirements for assigning research bulletins by the State Agency on Science and degrees and academic titles; Intellectual Property and the NAK represent - Reviews the defended dissertations; the evaluation format generally used by the - Sets the list of acceptable academic agencies. For detailed examples see the periodicals for the publications of “Report on activities in the area of science, doctoral research results; techniques and new technologies, 2004” or the - Sets the requirements for the annual Bulletin series by the National accreditation of academic and research Attestation Committee of Kyrgyz Republic14,15. institutions that grant doctoral degrees; - Grants research degrees and academic titles to researchers and academic staff; - Improves the training and attestation frameworks for researchers and academic staff; - Controls the quality of the activities of the special dissertation commissions and dissertations; - Initiates and guides the process for acceptance of foreign research degrees.

NAK is accountable to the President and is represented by the leading experts in the areas of science, technology, education and culture. The composition of the Commission needs to be approved by the President upon nomination by the Presidential Apparatus and must be renewed every three years by at least one third. Meetings of the NAK should be conducted at least two times a year. The board of the NAK is headed by the chairman and consists of 16 members. A number of expert commissions function under the NAK. The expert commissions review the dissertations submitted in their respective fields and grant degrees.

Responsibilities and roles of institutions and independent researchers outside the state funded and degree seeking research frameworks vary significantly depending upon institutional and individual arrangements. One organisation that can potentially play a major role in health research is the Mandatory Health Insurance Fund. This organisation commissions a number of studies for its own use. This research could easily be expanded, giving the organisation the potential to become a major health research funder in the Kyrgyz health context.

Although independent, together the three 14 Bulletin series, National Attestation Committee, Kyrgyz components of the Kyrgyz health research Republic system comprise the core of the system as a 15 Report on activities in the area of science, techniques whole. Regular reports on science by the and new technologies, 2004. State Agency on Science and Intellectual Property, Government of Kyrgyz Republic, Ministry of Education and Science, and Bishkek 2005

16 Figure 2: Overview of the health research governance structure in Kyrgyzstan

M inistry of Education and Science: N ational Attestation Committee State Comm ittee on Science

For research leading M inistry of Health: to a degree Medical Science Council

Organisations: For state funded • Medical research institutes research • Medical schools • National research centres

- Respiratory conditions; 3.3.2. Health and Health Research Policies - Cardiovascular conditions and their and Priorities complications; - HIV/AIDS. National Health Priorities in Kyrgyzstan are reflected in the National Health Sector Reform No specific document dedicated to national Programme “Manas Taalimi 2006-2010”16. health research priorities could be found at the Health priorities were formulated in the form time of preparation of this working paper. The of reform aims/objectives and priority health annual report on science by the State Agency conditions. on Science and Intellectual Property, however, lists ten priority areas and directions for health The following reform aims and objectives are research17: stated: - Development and implementation into - Raising equity and accessibility of clinical practice of effective methods of health services; diagnostics, treatment and prevention - Reducing the financial burden to the of socially significant cardiovascular population (for accessing/using the conditions in Kyrgyz Republic; health services); - Study of mechanisms (inclusive of - Raising the efficiency of the health molecular level) of adaptation of delivery system; healthy and ill individuals to - Improving the quality of care; conditions of hypoxia; - Improving the responsiveness and - Improvement of the methods of early transparency of the system. diagnostics, treatment and prevention of internal diseases; The following priority health conditions are - Improvement of the quality of surgical stated: care delivered to the population of - Maternal and child health; Kyrgyz Republic. Implementation of - Tuberculosis;

17 Report on activities in the area of science, techniques 16 Manas Taalimi National Health Care Reform Program of and new technologies, 2004. State Agency on Science and the Kyrgyz Republic 2006-2010 - Executive Brief Intellectual Property, Government of Kyrgyz Republic, Bishkek 2005

17 endoscopic and less invasive surgical scientific potential with government priorities, procedures in regions; and raise research efficiency, effectiveness, - Safe motherhood and childhood; quality and utilisation of research outputs in - Epidemiology, prevention and early the country. diagnosis of malignant tumors; - Social-hygienic monitoring; In recent years, there has been an increased - Recreational resources in Kyrgyz focus on ethics, ethics codes and ethical Republic: current state, development standards in research in Kyrgyzstan. Ethical prospects; committees are in place at the Ministry of - Holistic rehabilitation of patients and Health and the Kyrgyz State Medical disabled with socially significant Academy. The Ministry of Health established a conditions; Committee on Ethics of Clinical Investigations - Current clinical and epidemiological and Clinical Pharmacology in 1998. The features of tuberculosis and committee has 13 members representing improvement of tuberculosis related various stakeholders including health activities. practitioners, researchers, workers union, and lawyers. A similar committee has been This priority list is used as one of the criteria in established in 2004 within the Kyrgyz Medical the selection process for the state research Academy with the support of American grants. Through its Medical Science Council, International Health Alliance. There are also the Ministry of Health gets involved in the some efforts to incorporate courses on processes of state research grant allocation. All bioethics into the medical curriculum. research proposals are initially submitted to and reviewed by the Medical Science Council. Applicants are required to address the 3.3.3. Health Research Financing comments made by the Medical Science Council prior to final submission to the State In 2004, the equivalent of $600,000 was Committee on Science. allocated for research and technology projects of which 39.9% were allocated for medical Priority setting is a practice in some sciences19. Funds allocated for science organisations that do not seek state funding for represent 0.12% of GDP20. studies. The Health Policy Analysis Unit is a good example of such an organisation. The In 2004, 15 medical research institutions Unit defines its priority studies for the year in conducted 84 projects totalling approximately close collaboration with the Ministry of Health. $280,000. In 2005, 17 medical research In 2007, 13 studies were included in the work institutions were involved in 97 projects. In plan. Information regarding the process 2005, earmarked medical research funding followed to define these priorities and how the accounted for 38.6% of total national research national health priorities influence the Unit’s funding21. health research priorities was not available. Overall research funding has been decreasing The Kyrgyz Republic lacks legislation that since the end of the Soviet Union. Total deals with health research specifically. research funding in 2004 constituted almost However, there are some efforts underway to 25% of allocated research funding in 1990. In develop a new Law on Science. In addition, the 1990, allocations into research accounted for State Program on Science18, provides guidance 0.7% of a national budget, while over the last for the national research system in Kyrgyzstan, which should become one of the key 19 resources/tools for the economic and moral Report on activities in the area of science, techniques and new technologies, 2004. State Agency on Science and development of the country. In addition, the Intellectual Property, Government of Kyrgyz Republic, research system should aim to facilitate Bishkek 2005 20 scientific-technological progress, align Meeting with Ms. Nagaeva, State Committee on Science, Ministry of Education and Science 21 Report on activities in the area of science, techniques and new technologies, 2004. State Agency on Science and 18 State Program on Reforming Science in Kyrgyz Republic Intellectual Property, Government of Kyrgyz Republic, in 2003-2005, approved by Kyrgyz Government March 19, Bishkek 2005 2003 #144

18 decade this percentage has steadily decreased produce information for practitioners and to reach 0.17% in 2004. Moreover, almost 95% policy/decision makers. These events do not, of research funding tends to go for salary however, specifically target policy makers, aim related items (salary, social fund payments and at producing decision support information, or stipends). evaluate effects upon practice or policy/decision making.

3.3.4. Communication, Dissemination and A number of television shows and newspaper Utilisation of Research columns are dedicated to health issues; however, they rarely if ever use research Attempts to increase the utilisation of research outputs as guidance or core information, and by different stakeholders, particularly by most of the content is based on expert opinion policy makers and practitioners may be (interviews with clinical specialists) or divided into a) structured and regular; and b) references to other popular media. isolated unstructured efforts with no specific aim to increase the utilisation of the research results. 3.3.5. Routine Health Information Systems

Currently, there is no framework/mechanism Kyrgyzstan inherited, from the Soviet Union, a within the public sector designed to regularly comprehensive data collection system built for inform health policy and decision makers with central planning and control purposes. The quality evidence and decision support. The use system has undergone a number of changes of international medical advances and the since the end of the Soviet Union. Currently, extent and mechanisms for utilisation of such the system used by the Ministry of Health can information vary widely among policy makers, be divided into three hierarchical levels22: and depend upon individual personality rather than on the frameworks in place. - National level: at the National level Nonetheless, efforts to develop sustainable data is pooled by the Republican public sector frameworks that would serve to Medical Information Center (RMIC). address policy makers’ and practitioners’ The RMIC pools data from its regional needs for evidence and decision support do branches, Ministry of Health exist. departments, Republican level health care organisations and health care The Center for Health System Development is organisations of two major cities a good example. The Center incorporates (Bishkek and Osh). A total of 37 departments that are well placed to serve statistical forms are pooled by the practitioners and policy/decision making RMIC. community. It has a modern information - Regional level: at the regional level resource unit with a medical library and two entities are responsible for the facilities for accessing international electronic pooling of health data: regional databases. Units of Evidence Based Medicine medical information centres and and Health Policy Analysis produce reports regional Sanitary Epidemiology and clinical guidelines. Control (SES) departments. A regional medical information centre pools data No specific position or department is set to from regional united hospitals, evaluate the impact of new government health regional level health care policies or interventions. However, elements of organisations, sanatoria, private health impact evaluations are incorporated into the care providers and regional family products of the Health Policy Analysis Project medicine centres. The regional SES and of international agencies active in the department pools the data from the health sector. city and district SES departments.

In addition, there are many national and regional conferences on various topics that, in 22 addition to providing opportunities for Alisher Ibraimov, Health Policy Analysis Project: Information flows in health sector. 2005 networking and exchange of ideas, often

19 Information from the regional level is covers indicators on mortality, births passed on to the national level. and logistics; - Local level: Territorial hospitals and - Parallel health systems: The National family medicine centres collect data at Security Service maintains a parallel the local level. Data related to health system; the Ministry of Internal infectious conditions, immunisations Affairs and other ministries or etc. are collected by city and district companies use a separate reporting SES departments. All entities involved system for their facilities. in local data pooling pass data on to relevant regional level entities. All these mechanisms are independent from each other. The extent of coordination among In addition to the system of the Ministry of the mechanisms is not clear. Institutions/units Health, the following data collection paths are responsible for the data collection in each of also characteristic of Kyrgyzstan: the mechanisms produce regular reports, most of which are not readily available to the public. - Program specific: major vertical These data and reports tend to be heavily national/international programs quantitative in nature. develop their own data collection system that may or may not be pooled A number of internationally funded surveys into the Ministry of Health system; that aimed to capture the gaps in existing data - State Statistics System: the National collection systems were carried out. The Statistics Committee requires separate Demographic and Health Survey of 1997 is a reporting on selected health data good example of such large-scale surveys. through its regional and district branches. This data collection system

20 3.3.6. List of Institutions Engaged in Health Research Institution Commission Conduct (a) Government departments and agencies Ministry of Health Yes No Mandatory Health Insurance Fund Yes Yes Ministry of Education, Committee on science Yes Yes State Agency on Science and Intellectual Ownership Yes Yes (b) Health care system Center for Health System Development Yes Yes National Centre of Tuberculosis Yes Yes Scientific Research Institute of Balneology and Rehabilitation Yes Yes National Centre of Surgery Yes Yes National Centre of Oncology Yes Yes Kyrgyz Scientific Centre of Human Reproduction Yes Yes National of Cardiology and Therapy Yes Yes Kyrgyz Scientific Center of Hematology Yes Yes Scientific research institute of heart surgery and organ transplantation at Yes Yes National Centre of Cardiology and Therapy Republican Blood Centre Yes Yes National Centre of Pediatric and Child Surgery Yes Yes (c)Higher education and (national) research institutes / laboratories Kyrgyz State Medical Academy Yes Yes Kyrgyz State Medical Institute on Continuing Medical Education Yes Yes (d) Private non-profit organisations involved in research for health NGO “Preventive Medicine” Yes Yes NGO Hospital Association Yes Yes NGO Family Group Practitioners Association Yes Yes NGO Socium Econic Yes Yes (e) Business enterprise or industry (Private for-profit) “Socium Consult” Yes Yes “Avanco” Yes Yes (f) International research and development sponsors or partners involved in research for health Health Policy Analysis Project WHO/DFID Yes Yes Zdrav Plus USAID Yes Yes Kyrgyz-Swiss Health Reform Support Project Yes Yes World Bank Institute Yes Yes City Hope Project Yes Yes

Further Reading: Ministry of Health www.med.kg Center for Health System Development http://chsd.med.kg Health in Transition series www.euro.who.int/observatory/CtryInfo/CtryInfoRes?C OUNTRY=KGZ&CtryInputSubmit Demographic and Health Survey, 1997 UNDP reports www.undp.kg/

21 3.4. Uzbek Health Research - Ensure effective monitoring of the implementation of research projects, as System Map well as applying local research outcomes in practice; - Develop mutually beneficial 3.4.1. Governance of the Health Research international cooperation in research; System - Attract international investments into The NHRS in Uzbekistan constitutes part of an the national research sector; overarching national research framework. It - Facilitate involvement of research follows general regulations that cover all areas institutions and researchers in of national research. The aims of the research international research projects and system in Uzbekistan include facilitating programs. scientific-technological progress; aligning scientific potential with government priorities; The day-to-day management of state-funded and raising research efficiency, effectiveness, research is done by the research coordination quality and the application of research outputs units of various government agencies; these in the country23,24. are ministries and state agencies. In the health sector, day-to-day management is done by the Since the end of the Soviet Union, the Unit of Health Research Coordination under governance structure of the research system the Ministry of Health28. The Unit closely has undergone a number of changes, the most coordinates its functions with the Committee recent of which was initiated in August 2006. on Science and Technology Development

within the Cabinet of Ministers. The Ministry A clear governance structure is in place for of Health grant centrally earmarked state state-funded research. It is headed by the funding and coordinates state funded research Committee on Science and Technology within the sector. It also determines the Development (Coordination Committee), number of training slots for aspirantura (PhD which is based within the central government training) and doktorantura (Doctor of Science (Cabinet of Ministers). This body coordinates training). research, including health research, funded through the central government. The Although there is no designated official for Committee established an advisory group that health research at the Ministry of Finance, the includes representation from different Department for Financing Social Affairs and sectors25. Two representatives represent the Sciences exists as a special department health sector26. Committee tasks include:27 responsible for the social sector, including both - Identify priority directions for research the public health sector and overall research. (in coordination with relevant This Department is directly accountable to the Ministries and agencies); Deputy Minister of Finance. - Ensure coordination of the Academy

of Science, research institutes and While specific regulations with regard to higher education institutions in research financed outside state funding are not implementing research priorities; in place, research that is used to obtain degrees- irrespective of the source of financing- must meet special rules and 23 Presidential decree on “Measures to improve the regulations set by the Highest Attestation coordination and management of science and technology Commission or VAK—a special governmental development”, August 8, 2006 agency. The VAK includes a number of 24 Presidential Decree on the Improvement of Research departments29, such as Departments of Activities, 20 February 2002 Chemistry, Biology, Agriculture and Medicine. 25 Presidential decree on “Measures to improve the coordination and management of science and technology development”, August 8, 2006 26 Deputy Minister of Health (tel: 998 71 139 4410; 28 Following the government decree dated August 8, 2006, http://mzr.uz/index.php?id=structure&lang=ru) ; Director, a sub-unit on research at the Ministry of Health has been Research Institute of Paediatrics (tel: 998 712 29 38 74 – transformed into a Unit of Health Research Coordination. http://mzr.uz/index.php?id=nii_pediatrii&lang=ru ) Contacts: Head of the Unit, 12 Navoi str., Tashkent, 27 Presidential decree on “Measures to improve the Uzbekistan 100011; tel: 998 71 139 4808 coordination and management of science and technology 29 http://vak.uz/index.php?go=Vak&in=view&id=6 accessed development”, August 8, 2006 February 3, 2007

22 The Departments review the dissertations 3.4.3. Health and Health Research Policies submitted in their respective fields and grant and Priorities degrees. In addition the VAK:30 - Grants research degrees and academic Efforts are underway to develop a health plan, titles to researchers and academic staff; which includes health priorities. The National - Improves the training and attestation Public Health Strategy (2008-2015) is expected frameworks for researchers and to build a list of national health priorities and academic staff; specific goals to be achieved. Currently, there - Ensures a unified approach to granting is no specifically adopted set of priorities. At a science and academic degrees; practical level, policy makers prioritize health - Ensures quality control of the activities issues based upon the political visibility of the of the special dissertation problem, interest from international commissions; investors/agencies and past prevalence/ - Initiates and guides the process for incidence. acceptance of foreign research degrees; and No specific health research policy document or - Regularly updates the respective legislation that specifically deals with health agencies and ministries on locally research is available. Prior to August 8, 2006, conducted research and results. the State Committee on Science and Technology Development was responsible for Roles and responsibilities of institutions and all research, including health research. This independent researchers outside the state- Committee was solely responsible for funded and degree-linked research decisions with no direct involvement from the frameworks vary significantly depending Ministry of Health. Under the new upon institutional and individual arrangement, decision-making will be arrangements. delegated to the Ministry of Health.

Although independent, these major players The Ministry of Health has developed a list of comprise the core of the NHRS framework in research priorities for state funded research. Uzbekistan. The Unit of Health Research Priority areas include reproductive health, Coordination at the Ministry of Health and the neonatology, paediatrics, adolescent medicine VAK have specific evaluation and monitoring and development of new technologies32. The systems in place. These systems have a mostly priority list is used as one criterion in the quantitative focus, and are carried out by selection process for state research grants. regular staff. Explicit descriptions of Information on how the priorities have been monitoring and evaluation processes and defined and how they are being used in the selection criteria for indicators were not selection process is not available. available for this mapping study. In recent years, ethical issues in health research 3.4.2. Health Research Financing have been highlighted and given more importance. This is due in part to international State research funding is complex in interest and emphasis on ethics but still, to Uzbekistan. The state budget has a separate date, there is no clear legislation for ethical line item for science totalling some $19 million review of research. US dollars in 200631. There is no information available on the allocation of this budget to personnel, administration and actual research costs.

30 http://vak.uz/index.php?go=About accessed January 26, 2007 31 http://www.mf.uz/eng/?gb_3r=1&n=51 accessed January 32 European Observatory on Health Systems and Policies - 26, 2007 Health in Transition, Uzbekistan 2007, draft

23 Figure 3: Overview of the health research governance system in Uzbekistan

Cabinet of Ministers: Committee on Science and Cabinet of Ministers: Technology Development Highest Attestation Committee Coordination Committee Department of Chemistry, Biology, Agriculture and Medicine

For research leading Ministry of Health: to a degree Unit of Health Research Coordination

Organisations: For state funded • Medical research institutes research • Medical schools • National research centres

supported by international agencies in Uzbekistan, targets clinicians through the 3.4.4. Communication, Dissemination and recently launched Center for Evidence Based Utilisation of Research Medicine which aims to provide clinical protocols for primary care physicians. There are two types of activities that aim to communicate the results of research by There is no specific position or department to different stakeholders, mostly by policy evaluate the impact of new government health makers and practitioners: structured and policies or interventions. However, impact regular activities; and isolated, unstructured evaluation is often used by international efforts that have no specific aim to increase the agencies active in the health sector and is use of research results. regular practice for major international agencies. Two projects funded by the World A framework/mechanism designed to Bank and the Asian Development Bank regularly inform health policy and decision (Health 2 and Woman and Child Health makers with quality evidence does not exist. Development), for example, include significant The use of international medical advances, and project components that specifically focus on the extent and mechanisms for utilisation of monitoring and evaluation of project activities such information vary widely among and their impact. policymakers. For the most part, they are determined by individual choice rather than In addition to offering opportunities for by the frameworks in place. There are, networking and exchanging ideas, national however, some efforts to develop this area. The and regional conferences on various topics School of Public Health at Tashkent Medical often produce information for policy and Academy is currently advocating for the decision makers. But they do not specifically launch of a health policy unit that would work target policy makers, produce decision support in close collaboration with national policy information, or evaluate the effects upon makers and provide needs-based quality policy/decision making. decision support. Another similar effort,

24 No specific body is responsible for the requires separate reporting of health dissemination of research findings to the data through its regional and district public. The Institute of Health (under the branches. This data collection system Ministry of Health) focuses on health covers indicators on mortality, births promotion. The Institute carries out a number and logistics. of health promotion campaigns through media - Parallel health systems: the parallel and other channels. These activities are not, health systems maintained by the however, primarily focused on the National Security Service, the Ministry communication/dissemination of research of Internal Affairs, Uzbek Airlines and findings. other ministries or companies use a separate reporting system for their A number of television shows and newspaper facilities. columns are dedicated to health issues; however, they rarely- if ever- use research All these mechanisms are independent from outputs; most of the content is based on expert each other and their level of coordination is not opinion (interviews with clinical specialists) or clear. Institutions/units responsible for data references to other popular media. collection in each of the mechanisms produce regular reports, most of which are publicly unavailable. Generally, these data and reports 3.4.5. Routine Health Information Systems tend to be quantitative and extensive35.

Uzbekistan inherited from the Soviet Union a It is worth noting that most of the data comprehensive data collection system built for collection mechanisms capture information the purposes of central planning and control. pertaining to the public health sector, while leaving out the rapidly expanding private The Data collection system in Uzbekistan is health sector. divided into five mechanisms33,34: A number of internationally-funded surveys - Ministry of Health: data is collected that aimed to fill the gaps in existing data through district organisational and collection systems have been carried out. Good methodology units (based within examples of such large-scale surveys are the district health authorities), pooled at Demographic Health Surveys of 1996 and the regional branches of the Institute 2002. of Health, then transferred to the headquarters of the Institute of Health in Tashkent. - Sanitary and Epidemiology System: data is collected from all public health care facilities. It is first pooled at the sanitary and epidemiological units at district level, and then at the regional and national Sanitary-Epidemiology System departments/centres. For the most part, the data focuses on infectious conditions. - Program specific: major vertical national/international programs (i.e. HIV/AIDS, Tuberculosis) develop their own data collection systems. - State Statistics System: the Ministry of Macroeconomics and Statistics

33 Theo Lippeveld, Trip Report: Health Information 35 Systems and M&E for Primary Health Care in Uzbekistan, Dennis Streveler, Consultancy Report: Strategic 27 July 2002, Tashkent Evaluation of Health Management Information Systems in 34 Clifford D. Olson, HMIS Draft Technical Report, ADB Uzbekistan, May 2004, Tashkent Working Group, 25 November 2003

25 3.4.6. List of Institutions Engaged in Health Research Institution Commission Conduct (a) Government departments and agencies Republican Institute of Obstetrics and Gynecology Yes Yes Republican Institute of Haematology and Blood Transfusion Yes Yes Republican Institute of Dermatology and Sexually Transmitted Diseases Yes Yes Republican Institute of Medical Parasitology Yes Yes Republican Institute of Tuberculosis and Pulmonology Yes Yes Republican Institute of Paediatrics Yes Yes Republican Institute of Endocrinology Yes Yes Republican Institute of Sanitary, Hygiene and Occupational Conditions Yes Yes Republican Institute of Medical Rehabilitation and Physical Therapy Yes Yes Republican Institute of Traumatology and Orthopaedics Yes Yes Republican Institute of Virology Yes Yes Republican Institute of Epidemiology, Microbiology and Infectious Conditions Yes Yes Republican Institute of Clinical and Experimental Medicine Yes Yes Regional Health Authorities Yes No Ministry of Health Yes No (b) Health care system National Specialized Center of Urology Yes Yes National Specialized Center of Surgery Yes Yes National Specialized Center of Cardiology Yes Yes National Specialized Center of Microsurgery of the eye Yes Yes National Research Center of Emergency care Yes Yes National Research Center of Neurosurgery Yes Yes National Research Center of Oncology Yes Yes National Research Center of Mycology and protozoy conditions Yes Yes National Research Center of Gastroenterology Yes Yes National Research Center of Allergology Yes Yes Research Center of Surgery of Liver and Biliary passages Yes Yes National Center of Narcology Yes Yes National Screening Center of Mother and child Yes Yes National Center of Child orthopaedics Yes Yes National Center of Pathology Yes Yes National Center of Perinatal Care Yes Yes (c)Higher education and (national) research institutes / laboratories Tashkent Medical Academy Yes Yes Tashkent Paediatrics Institute Yes Yes Tashkent Institute of Pharmacy Yes Yes Andijan Medical Institute Yes Yes Bukhara Medical Institute Yes Yes Samarkand Medical Institute Yes Yes Tashkent Institute of Advanced Medical Education Yes Yes (d) Business enterprise or industry (Private for-profit) Pharmaceutical companies: commission mostly small scale clinical studies for local Yes No product licensing purposes (see the requirements for the licensing of the (contract pharmaceuticals in Uzbekistan) out) (f) International research and development sponsors or partners involved in research for health World Bank Yes Yes Asian Development Bank Yes Yes USAID (through its contracted agencies such as Project Hope, Abt Associates etc.) Yes Yes UN agencies: UNFPA, UNDP, UNICEF, WHO, UNODC Yes Yes CDC Yes Yes Japanese International Cooperation Agency Yes Yes Red Cross Yes Yes Further Reading: Analytical and Information Center, Ministry State Department of Statistics 2. Health in of Health of the Republic of Uzbekistan [Uzbekistan], State Transition series Department of Statistics, Ministry of Macroeconomics and www.euro.who.int/observatory/CtryInfo/CtryInfoR Statistics [Uzbekistan], and ORC Macro. 2004. es?COUNTRY=UZB&CtryInputSubmit= ; Uzbekistan Health Examination Survey 2002. Calverton, 3. UNDP reports www.undp.uz/ Maryland, USA: Analytical and Information Center,

26 4. Regional Consultation on Health Research and Health Research Systems

in medicine, and to develop technical The regional consultation on health research recommendations based on research results. and health research systems was jointly The primary constraint is the lack of financing, organised by the Kazakhstan School of Public including financing for re-equipment of Health (KSPH) and COHRED. The research institutions. Medical scientific consultation brought together a group of institutions conduct research in close policy makers and researchers from four collaboration with research institutions and countries of the region – Kazakhstan, academic organisations within Tajikistan (such Kyrgyzstan, Tajikistan and Uzbekistan. See as the Tajik State Medical University and the annexes 2 and 3 for the list of participants and Tajik Institute of Postgraduate Education) as the agenda of the meeting. well as with institutions from other countries. Concurrent scheduling of the COHRED Board A School of Public Health was established in meeting and the consultation provided a 2005, and training of Masters of Public Health unique opportunity for sharing experiences – started in 2006. Within this training, attention not only regionally – but also internationally, is given to research. through involvement of COHRED Board members in the round table proceedings. Kyrgyzstan: In 1996 the "Manas" program, which is the The consultation had three key objectives: locomotive of all Health Care reform including medical research, was approved in - To discuss the status of health research Kyrgyzstan. The following problems in in countries of the region and discuss medical science development were identified: needs, opportunities and mechanisms - Discrepancies between the regulatory for the strengthening of national and legal base and the modern health research systems; conditions and requirements of research; - To explore opportunities for - Inadequate financing for research; partnerships and collaboration - Outflow and ageing of the staff; and between countries in the region and - Insufficient level of research staff international agencies; training. - To define possible roles COHRED can The following approaches to solving these play in supporting and strengthening priority issues were defined: national health research systems and - Improve governmental policy and research initiatives in the countries of legislation in the field of health care the region. and medical research; - Increase financing; The meeting involved country presentations - Improve coordination of the activities and presentations on draft national health of various institutions; and research maps, followed by group work. - Develop international communication Country representatives presented the current and adopt available international status and recent developments in national expertise. health research systems as well as problems and obstacles to system strengthening and In 2005 the Center of Health System gave their views on possible solutions. The Development, which also carries out research presentations are outlined below: in health care systems, was established. The Center has departments on evidence-based Tajikistan: medicine, health care policy analysis and The main objectives of research at the Ministry health care information technologies; and it of Health in Tajikistan are to enhance training, provides courses on health care policy and to conduct research on the most relevant issues

27 management. Financing of medical research Group work happens through the Ministry of Health, Group work followed the country although only 0.19 % of gross national product presentations. Two groups, each of which is allocated to research. Additional financing included representatives from all four for research comes from international grants. countries, were formed. The groups were expected to formulate five priority needs for strengthening NHRS. These needs had to be common to all four countries. The groups then Uzbekistan: formulated potential solutions acceptable to all In 2006, a Committee on Science and four parties. Technology Development was created under the Cabinet of Ministers. This occurred in The working groups formulated the following response to a number of identified weaknesses common needs: including an irrational use of resources (narrow group of experts, narrow topics, - A comprehensive holistic strategic duplication of research projects), failure to policy framework on health research at apply results, and inefficient coordination. The a national level; Committee should work closely with various - Refined financing mechanisms; ministries and corresponding departments, who should also become the main customers - Capacity strengthening among of research projects financed by the researchers and academics involved in Committee. research training programs;

The following challenges for medical sciences - Strengthening of research training in Uzbekistan remain: training of research staff programs (curricula: methods and including training in foreign languages; content); introduction of international research - An effective national evaluative standards (modern methodology, software for framework; statistical data processing); networking and experience exchange at the regional and - Increased international cooperation in international levels; and increasing financing research. of research from national as well as international sources. The groups formulated the following as possible solutions to these needs: Kazakhstan: The president of Kazakhstan has given major - Detailed situational analysis that leads attention to science and wants Kazakhstan to to a state policy document which enter into the world’s top 50 countries in the includes an effective and efficient area of research. A concept paper on reforming organisational structure and financing medical science has been developed. The mechanisms that facilitate quality, document aims for changes in important areas efficiency, effectiveness, and of the health research system such as innovation as well as creative financing, human resources management, competition; governance/ management and - Assessment and revision of research efficiency/effectiveness. Priority is on training programs with strong modernizing domestic medical research emphasis on research methodologies through innovative management and and learning and assessment methods facilitating the integration of medical scientists (benchmarking against international into the international research community. The standards); reform can build on the current potential of medical science in the country, which is - Development and implementation of powerful as there are 20 research institutes and systems for the monitoring and centres, six medical schools, a school of public evaluation of health research and health and an institute of postgraduate health research systems; medical education. As personnel potential grows financing tends to increase steadily. - Joint international research programs.

28 The group presentations were followed by Most participants noted that there was little discussions of how international organisations, exchange within the region, as researchers and specifically COHRED, might assist in policy makers actually visit Europe and addressing the need for NHRS strengthening elsewhere more often than neighbouring in the region. countries in the region. Opportunities for regional networking were suggested as The main discussion revolved around the idea another area for cooperation with international of international organisations becoming agencies. Regular regional health research enablers and facilitators that provide tools and forums could facilitate regional exchange of assist in developing mechanisms and ideas and help countries align directions for frameworks. Expert support and facilitative development in NHRS within the region. environments/frameworks for developing Notably, health research systems in all health research policy documents, countries of the region evolved from the same strengthening research training programs model. This provides significant opportunities and/or strengthening evaluation /monitoring for countries from within the region to learn frameworks were formulated as possible from each other. pathways for cooperation. 5. Conclusion

This paper provides national health research The health research maps from the three system (NHRS) mapping information from countries provide detailed information Kazakhstan, Kyrgyzstan and Uzbekistan. regarding these basic requirements: NHRS mapping provides the information necessary to describe the governance 1) Political commitment to health framework of the system, the health research research: research is considered policies and priorities in place, and the actors fundamental to health care in the playing key roles in the system. It is a basic region. All the countries have a history description needed to effectively plan the of research (established and developed system’s development. during the Soviet era), structures in place to manage their research, and COHRED defines two other levels for health made some financial commitments to research system assessment: health research research. system profiling and health research system analysis. Profiling provides an analysis of the 2) Health research priorities: all three financial and human capacities of the system. countries have health research Analysis provides information on how well the agendas. However, it is not clear from system performs in addressing the defined the information collected which priority health research needs, the quality of process is followed to set the agenda, the research produced and how the research is who is involved in this process, and used. how frequent the agendas are revised.

The focus of this work with Central Asian 3) Health research policy framework: countries is on NHRS mapping. However, none of the countries currently has a some conclusions will refer to the capacities comprehensive health research policy and performance of the systems, noting that framework. The country teams further information needs to be collected to highlighted this gap during the make firmer conclusions or recommendations. regional consultation. Consultation participants consider a policy The basic requirements of a national health research framework essential as it can help system are: political commitment to health research; outline the organisational structure credibly set and regularly updated health research and financing mechanisms for health priorities; a health research policy framework that is research, and can support creation of in place; and a mechanism to manage the national the necessary conditions for quality health research effort. research, innovation and creativity.

29 4) National research management: all 2) Predictable health research funding: three countries have very similar there is limited information available health research systems. Central on the financing of research and health government agencies play a key role in research. The Kyrgyz health research setting the regulations for the health map illustrates an overall decrease in research system, and in providing research funding since independence – funding for research. In addition to the from 0.7% of the national budget central government agency on allocated to research in 1990 to 0.17% research and the Ministry of Health in 2004. Almost 95% of this budget sub-unit on health research, the goes to salary related costs. national attestation commissions and the leading medical education Further information on human and financial institutions of each country are key resources needs to be collected to inform players in the health research systems strategic plans for human resources for health in Central Asia. How the different research, and develop health research mechanisms exactly relate to each financing mechanisms. However, further data other and coordinate the various gathering need not precede system activities is not entirely clear. development work. A better research policy framework and well-defined research agendas Kazakhstan, Kyrgyzstan and Uzbekistan have in these countries will support discussion with the basic requirements of a national health internal and external partners around human research system in place. It appears that there and financial resource investment and is general interest in research and that basic alignment towards priority research needs. governance structures exist. At the same time, each country needs to develop a clear health A third level of system development focuses on research policy framework. This will clarify the optimising the system. This includes research coordination of research, and the process for ethics, research communication, peer review agenda setting. It is also a priority for mechanisms, monitoring and evaluation, and health strengthening health research systems in the information systems. If a country considers some of countries of the region, and key to creating an these issues very important, they can be addressed environment that is conducive to research at an earlier stage of system development. generation and utilisation. In the countries involved in this study, ethics A second level of system development focuses on and monitoring and evaluation are considered research implementation and the human and key areas for system development: financial resources needed to achieve this.

The mapping and consultation provided some 1) Ethics review of health research: in information on human and financial resources recent years, ethical issues in health in the Central Asian region: research are given more importance. In Kyrgyzstan this has resulted in the 1) Human Resources for Health establishment of committees on ethics Research plan: participants raised the in the Ministry of Health and in the importance of revisiting and Kyrgyz Medical Academy. In strengthening health research training Kazakhstan, legislation facilitated the programmes. Training and capacity creation of ethics committees. In building can be achieved directly, by Uzbekistan, legislation does not yet revising the research training curricula exist and information on ethical in the countries and, indirectly, committees was not readily available. through joint research initiatives. The 2) Monitoring and evaluation systems. countries in the region tend to use the Good evaluation and monitoring same curricula for all training systems can become the drivers of programs in the country. A focus on change and improvement in the health research training is timely in the light and health research system. In the of initiatives in these countries to study countries these practices are not redesign their medical curricula. yet well developed. Participants in the consultation summarised in this report

30 strongly supported developing and agencies, ministries of health, and implementing such monitoring and vertical disease-oriented programs. evaluation systems in the countries of These systems operate independently the region—a process that may require from each other and collect different international cooperation. types of information. The focus is on the public sector, leaving out the Other system optimising areas are not yet rapidly growing private sector. The addressed. Consideration should be given to reports produced are often not how important these areas are in the early publicly available, and the quality of stages of health research system strengthening the data collected is not clear. in the countries of the region. 6) Great potential exists for regional cooperation, networking and This includes peer review mechanisms, exchange. Given the similarities in the research dissemination, and the work of health research systems of the region, routine health information systems: any initiatives developed could, with 3) National attestation committees may minor adaptation, be easily applicable need to be supplemented by peer to all other countries. Despite review mechanisms to ensure quality considerable disparities in economic and independence of research review. development, the Central Asian 4) There are no mechanisms in place to countries are very similar in terms of ensure regular dissemination of the development of their national information to key stakeholders. health research systems. Local journals in Central Asia usually depend on authors for the financing of Consultation participants expressed their articles. This may create a conflict of appreciation for the networking and exchange interest. Increased Internet access opportunity provided through this regional does not yet benefit many researchers meeting, and indicated that regular regional due to a low knowledge of English in forums on health research would greatly the countries and a lack of local benefit research on health in the region. language information. 5) Routine health information is fragmented: it is collected by statistical

31 Annex 1: Participants list: regional consultation

Name Place of work, position Address, Contact details Mohir Ahmedov Senior Lecturer Farobiy, 2 School of Public Health Tashkent Tashkent Medical Academy Uzbekistan 700 109 Uzbekistan Tel: 998 90 188 68 43 Email: [email protected] Nurin Akunov Policy Analyst 1, Togolok Moldo str. WHO/DfID Health Policy Bishkek Analysis Project, Kyrgyz Republic Kyrgyzstan, 720040 Tel: +996 (612) 901693 Email: [email protected] Abdumalik Vice Rector on Science Parkentskaya 51 Nigmatovich Aripov Professor Tashkent Tashkent Institute of Advanced Uzbekistan 700 007 Medical Education Tel: 998 712 68 17 44 Uzbekistan Email: [email protected] Ravshan Azimov Deputy-Director Farobiy, 2 Associate Professor Tashkent School of Public Health Uzbekistan 700 109 Tashkent Medical Academy Tel: 998 90 188 68 43 Uzbekistan Email:[email protected] Yelzhan Birtanov Director 19A, Utepov street Institute of Health Care 050060, Almaty Development Kazakhstan Kazakhstan Tel +7-3272 498463, fax 498463 Email: [email protected] Somsak Chunharas COHRED Board member National Health Foundation Bangkok Thailand Sylvia de Haan Head, Projects and Programmes, 1-5 Route des Morillons COHRED PO Box 2100 1211 Geneva 2 Switzerland Email: [email protected] Zarina Ishakova COHRED coordinator Tajikistan c/o COHRED 1-5 Route des Morillons PO Box 2100 1211 Geneva 2 Switzerland Carel IJsselmuiden Director COHRED 1-5 Route des Morillons PO Box 2100 1211 Geneva 2 Switzerland Email: [email protected]

Marian Jacobs Chair University of Cape Town COHRED Board Cape Town South Africa

32 Maksut Kulzhanov Rector 19 A Utepov Street Kazakhstan School of Public 480060 Almaty Health Kazakhstan Tel: + 7 3272 491819 Email: [email protected] Daniel Mäusezahl COHRED Board member Swiss Agency for Development and Cooperation Bern Switzerland Madamin Musaevich Deputy-Minister of Health 1, Togolok Moldo str. Karataev Kyrgyz Republic Bishkek Kyrgyzstan, 720040 Tel: +996 (312) 626522 E-mail: [email protected]

Zumrat Maksudova Associate professor Dushanbe Department of General Hygiene Tajikistan and Ecology Email: [email protected] Tajik State Medical University Dilbar К. Vice Rector on Science and Farobiy, 2 Najmutdinova Postgraduate Education Tashkent Professor Uzbekistan 700 109 Tashkent Medical Academy Tel: 998 90 186 09 42 Uzbekistan Email: [email protected] Bakhyt Sarymsakova Professor 19A, Utepov str. Department of Pharmaceutical 050060, Almaty Management Kazakhstan Kazakhstan School of Public Tel.(+7-3272) 491819, fax 498101 Health Kazakhstan Email: [email protected] Altynay N. Smailova Chief specialist 66, Moskovskaya str. Department of Postgraduate Astana Medical Education Kazakhstan Ministry of Health Tel.(+7-3172) 316746, 318336 Kazakhstan Email: [email protected] Muhiddin Safarovich Head of Unit of Science Ministry of Health Tabarov Department on Science and 69 Shevchenko Human Resources Dushanbe Ministry of Health Republic of Tajikistan Fax: + 992 372 217525 Jyldyz Satarovna Deputy-Director 1, Togolok Moldo str. Uzbekova Center for Health System Bishkek Development Kyrgyz Republic Kyrgyzstan, 720040 Tel: +996 (312) 662575 Email: [email protected]

33 Annex 2: Agenda COHRED regional consultation, Almaty, 21/10/2006

Morning session (9.00 – 12.30): Afternoon session (13.30 – 18.00) (Chaired by Prof A.N. Aripov and Prof M.S. Tabarov): Welcome and introductions (Chaired by: Prof Maksut Kulzhanov): - Report on prelimanary results NHRS - Prof. Kulzhanov M.K., Rector, mapping (Dr M. Ahmedov) Kazakhstan School of Public Health, - Introduction to working groups (Dr Kazakhstan: Welcome Bakhyt Sarymsakova) - Ms Sylvia de Haan, Head, Projects and o discussion on general needs Programmes, COHRED: Introduction for strengthening health Meeting Objectives research systems in the region; - All: Introduction and meeting o discussion on potential roles expectations of COHRED and other - Prof. Carel IJsselmuiden, Director, international organizations in COHRED: Welcome and introduction supporting development of to COHRED the health research systems in the region. Country presentations (Chaired by: Dr A.N.Smailova and Prof M.M.Karataev): - NHRS in Thailand (Dr Somsak - Tajikistan (Prof M.S. Tabarov) Chunharas) - Kyrgyzstan (Prof M.M. Karataev) - Uzbekistan (Prof Dilbar - Reporting back by two working Nadzhmutdinova) groups - Kazakhstan (Dr. Altynai Smailova) - Questions and discussion Closure of the meeting by Prof Marian Jacobs (chair of COHRED Board) and Prof Carel IJsselmuiden (Director COHRED) 12.30 -13.30 Lunch After the consultation a reception will be held for the participants in the regional consultation and COHRED Board members

34