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Structure, Function and Five Basic Needs of the Global Health Research journal of global health Structure, function and five basic needs of the global health research system PAPERS VIEWPOINTS Igor Rudan, Devi Sridhar Background Two major initiatives that were set up to support and Centre for Global Health Research and WHO co–ordinate global health research efforts have been largely discon- Collaborating Centre for Population Health tinued in recent years: the Global Forum for Health Research and Research and Training, The Usher Institute for World Health Organization's Department for Research Policy and Co- Population Health Sciences and Informatics, operation. These developments provide an interesting case study into University of Edinburgh, Scotland, UK the factors that contribute to the sustainability of initiatives to sup- port and co–ordinate global health research in the 21st century. Methods We reviewed the history of attempts to govern, support or co–ordinate research in global health. Moreover, we studied the changes and shifts in funding flows attributed to global health re- search. This allowed us to map the structure of the global health re- search system, as it has evolved under the increased funding contri- butions of the past decade. Bearing in mind its structure, core functions and dynamic nature, we proposed a framework on how to effectively support the system to increase its efficiency. Results Based on our framework, which charted the structure and function of the global health research system and exposed places and roles for many stakeholders within the system, five basic needs emerged: (i) to co–ordinate funding among donors more effectively; (ii) to prioritize among many research ideas; (iii) to quickly recognize results of successful research; (iv) to ensure broad and rapid dissem- ination of results and their accessibility; and (v) to evaluate return on investments in health research. Conclusion The global health research system has evolved rapidly and spontaneously. It has not been optimally efficient, but it is pos- sible to identify solutions that could improve this. There are already examples of effective responses for the need of prioritization of re- search questions (eg, the CHNRI method), quick recognition of im- Correspondence to: portant research (eg, systems used by editors of the leading journals) Professor Igor Rudan, MD, DSc, PhD, MPH, and rapid and broadly accessible publication of the new knowledge HonMFPH (eg, PLoS One journal as an example). It is still necessary to develop Chair in International Health and Molecular tools that could assist donors to co–ordinate funding and ensure more Medicine equity between areas in the provided support, and to evaluate the Joint Director, Centre for Global Health Research and WHO Collaborating Centre for value for money invested in health research. Population Health Research and Training Director of Research, The Usher Institute for Population Health Sciences and Informatics In the past four years, two major initiatives that were set up with the aim University of Edinburgh to support and co–ordinate global health research efforts have been large- Teviot Place, Edinburgh EH8 9AG Scotland, UK ly discontinued. The first is the Global Forum for Health Research, which [email protected] was established in Geneva in 1998 to support WHO’s focus on health re- www.jogh.org • doi: 10.7189/jogh.06.010505 1 June 2016 • Vol. 6 No. 1 • 010505 Rudan and Sridhar search [1]. The second is WHO's Department for Research challenges that may be relevant to low and middle–income Policy and Cooperation (WHO RPC), which ceased its op- countries should also be included. Still, under any assump- erations in 2012 during the WHO's internal reform. Almost tion, the interest in funding global health research is grow- ironically, the annual WHO World Health Report for 2012 ing, and the structure of this system is rapidly evolving. announced its theme as: “No health without research” and In Figure 2, we show the simplified representation of the was to be coordinated by the WHO RPC [2]. The journal key stakeholders and processes, based on how the funds PLoS Medicine agreed to publish a special series on health flow through the system. At the beginning of the system is research in parallel to the release of the World Health Re- the source of the funding – with donors being either pub- port, as discussed in the journal's editorial to the series, lic, private, or the emerging “class” of donors – the large entitled: “The World Health Report 2012 that Wasn’t” [3]. philanthropies, such as the Bill and Melinda Gates Foun- APERS Eventually, the report was retitled “Research for Universal VIEWPOINTS P dation (BMGF), the Carlos Slim Foundation, and the Rock- Health Coverage” and published in 2013 [4]. efeller Foundation. They all provide financial support for These developments provide an interesting case study into the projects of researchers employed in universities, re- the factors that contribute to the sustainability of initiatives search institutes, international organizations, biotech com- to govern, support and co–ordinate global health research panies and small and medium enterprises (SME are a grow- in the 21st century. A timeline of key events that set the ing “class” of recipients). They also fund stakeholders with current context is shown Figure 1. In this viewpoint, we research capacity in low and middle–income countries that will map the structure of the global health research system can help carry out the research projects as equal partners. as it has evolved under the funding increases of the past Eventually, the responsibility for spending the funds is decade. Bearing in mind its structure, core functions and passed down to research teams and their international con- dynamic nature, we will propose a framework on how to sortia, which conduct research to generate new knowledge effectively support the system to increase its efficiency. in several generic areas: measuring a problem; understand- ing its cause(s); elaborating solutions; translating the solu- tions or evidence into policy, practice and products; and/ THE EVOLVING STRUCTURE OF THE or evaluating the effectiveness of solutions [10]. GLOBAL HEALTH RESEARCH SYSTEM The decision over the channel of dissemination of this knowl- Over the past two decades, the funding available for health edge is made by a new set of stakeholders (Figure 2), which research has increased rather dramatically from US$ 50 bil- may involve research committees of public institutions, jour- lion in 1993 to US$ 240 billion in 2009 [5], but this did nal editors, reviewers, donor representatives, company man- not happen in any planned or coordinated way. Those who agers or owners. The bulk of work will end up published by tried tracking this funding – such as the Global Forum for research journals, where editors and reviewers, and some- Health Research in its annual reports, G–FINDER, the In- times even private publishers, influence decisions on the stitute for Health Metrics and Evaluation and other aca- shape and form of publication. The funders increasingly re- demics, provided rather different figures [5–9]. This dis- quire researchers to publish in open–access journals. Some crepancy is largely due to the difficulty in distinguishing of the findings do not get published because placing the research funding from broader development assistance for knowledge in the public domain would invalidate patent ap- health. There is also lack of consensus on whether the plications and subsequent financial profits. This new knowl- funding invested in high–income countries to study health edge can also be presented at conferences, published as a re- COMMISSION GLOBAL WHO, THE GLOBAL WORLD MORE THAN WORLD ON HEALTH WHO SETS UP FORUM FOR WORLD BANK, THE "CHNRI" FORUM FOR HEALTH 50 RESEARCH ECONOMIC RESEARCH COUNCIL ON "AD HOC HEALTH GFHR AND METHOD FOR HEALTH REPORT 2012 PRIORITY FORUM FOR DEVELOP- HEALTH COMMITTEE" RESEARCH COHRED SETTING RESEARCH DELAYED, SETTING (DAVOS, SWI): MENT: THE RESEARCH ON HEALTH (GFHR) REVIEW PRIORITIES IN DISCON- WHO's EXERCISES THE GRAND "10/90 GAP" AND DEVELOP- RESEARCH ESTABLISHED "ESSENTIAL HEALTH TINUED ITS DEPARTMENT BASED ON CHALLENGES AND MENT RELATED TO AND "BEST NATIONAL RESEARCH OPERATIONS, FOR RESEARCH THE "CHNRI" INITIATIVE "ESSENTIAL (COHRED) FUTURE INTER- BUYS" IN HEALTH DEVELOPED THE CEO POLICY AND METHOD SPONSORED NATIONAL ESTABLISHED VENTION HEALTH RESEARCH" IN AND RESIGNED, COOPERATION CONDUCTED BY THE BMGF HEALTH OPTIONS RESEARCH BANGKOK, PRESENTED STAFF DISCON- AND AND NIH RESEARCH" PROPOSED THAILAND DISMISSED TINUED PUBLISHED 1990 1995 2000 2005 2010 Figure 1. A timeline of several important events relevant to governance, support and co–ordination of global health research that determined the current context. June 2016 • Vol. 6 No. 1 • 010505 2 www.jogh.org • doi: 10.7189/jogh.06.010505 Structure, function and needs of the global health research system PAPERS VIEWPOINTS Figure 2. The structure of the global health research system and the five basic needs to ensure its efficient performance. port to the funder, as “grey literature”, or simply posted on being generated. This knowledge is then translated into the internet. Finally, in many cases, new knowledge does not both clinical and public health practice in order to reduce get published in any way – perhaps due to insufficient rele- the burden of disease in the population and improve vance or novelty, concerns over its quality, or simply a lack of health–related outcomes. a positive result. In the end, the published knowledge can be The effectiveness of the global health research system to professionally evaluated and replicated, with a growing in- perform its main function will depend on the efficiency of dustry of companies offering those services. Moreover, uni- several of its sub–components (Figure 2). First, donors versities have set up structures to help researchers to com- need to be motivated to continue investing; informed to un- mercialize their work and set up spin–out companies. derstand the targets; and coordinated to avoid over– and under–funding certain areas.
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