The 10/90 Report on Health Research 1999 Overview of the Global Forum Priorities in Health Research Analytical Work for Priority Setting Poverty and Health Partnership Initiatives in Health Research Capacity Development Communication to Help Bridge the 10/90 Gap Practical Framework for Setting Priorities Fo u n d a tion Council Se c re t a ri a t Adetokunbo O. Lucas Louis J. Curra t H a rv a rd School of Public Health Executive Secret a r y Ch a i r p e r s o n Thomas C. Nchinda Rashidah Abdullah Senior Public Health Specialist Asian-Pacific Resources and An d r es de Francisco Re s e a r ch Center for Wom e n Public Health Specialist Ha r vey Bale Elizabeth Carey - B u m g a rn e r In t e r national Federation of Senior Communication Offi c e r Ph a r maceutical Manufacturer s Diane Keithly As s o c i a t i o n s Administrative Offi c e r Ma r tine Berge r Kirsten Bendixen Swiss Agency for Development and Cooperation Administrative Assistant Rolf Carlman Jane Abel Swedish International Development Administrative Assistant Cooperation Agency Adnan A. Hyder Tim Evans Co n s u l t a n t Rockefeller Foundation Theodor M. Fliedner WHO Advisory Committee on Health Research Julio Fren k Mexican Health Foundation Adrienne Germa i n In t e r national Wom e n ’ s Health Coalition Ma r y Ann Lansang College of Medicine University of the Philippines Ma u r een Law World Bank Si g r un Møgedal No r wegian Agency for Development Cooperation Carlos Morel Oswaldo Cruz Foundation Mi n i s t r y of Health of Brazil Pramilla Senanayake In t e r national Planned Pa r enthood Federation Charas Suwanwela College of Public Health Ch u l a l o n g k o r n University This report was prepared by the Secretariat of the Global Forum for Health Research (GFHR) on the basis of the presentations and discussions at Forum 2 held in June 1998 in Geneva, and on the work of GFHR during 1998. The Secretariat alone is responsible for the views expressed in this Report. The principal authors are: Chapter 1.............. Louis J. Currat Chapter 2.............. Adnan A. Hyder Chapter 3.............. Adnan A. Hyder Chapter 4.............. Adnan A. Hyder Chapter 5.............. Thomas C. Nchinda Chapter 6.............. Thomas C. Nchinda Chapter 7.............. Elizabeth Carey-Bumgarner Chapter 8.............. Louis J. Currat Editor:................... Sheila Davey Design:.................. Raphaël Michaluk Printing:................ AGLfm Production © Global Forum for Health Research, 1999 The reproduction of this document is regulated in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights are reserved by the Global Forum for Health Research. The document may be freely reviewed, abstracted, reproduced or translated, in part or in whole, but not for sale or for use in conjunction with commercial purposes. The designations employed and the presentation of the material in this document do not imply the expression of any opinion whatsoever on the part of the Secretariat of the Global Forum for Health Research concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Additional copies available from: Global Forum for Health Research c/o World Health Organization 20, Avenue Appia 1211 Geneva 27 Switzerland Manufactured in Switzerland First printing: March, 1999 Louis J. Currat Adetokunbo O. Lucas Executive Secretary Chairperson Global Forum for Health Research Global Forum for Health Research Preface Investment in health research and develop- The many institutions that fund health ment by the public and private sectors amounts re s e a rch could help improve both global to about US$ 56 billion a year. Most of this – a health and their own effectiveness if they were staggering 90% – is spent on research into to exchange information, link their efforts, health problems that concern only 10% of the and base their decisions about re s o u rc e world’s population. As a result, only 10% of allocation on explicit analysis of priorities. the limited funds available for health research is currently used to help improve the health The need for global prioritization in health of 90% of the world’s population. This grave research was raised in the 1990 Report of disparity is widely referred to as the 10/90 the Commission on Health Research for Disequilibrium. Development, Health Research: Essential Link to Equity in Development. This led to the creation To make matters worse, there is duplication in 1994 of the Ad Hoc Committee on Health in some areas of health re s e a rch, major R e s e a rch Relating to Future Interv e n t i o n gaps elsewhere, dispersal of efforts, and an Options,1 under the auspices of the World a l a rming lack of information on re so urc e Health Organization (WHO) and with the flows. participation of a wide range of institutions, 1 Report of the Ad Hoc Committee on Health Research, Investing in Health Research and Development, WHO, September 1996 (Referred to henceforth as "Report of the Ad Hoc Committee"). to reflect its broad mandate. The Committee at the Headquarters of the World Health presented its findings in Geneva on 27-29 Organization in Geneva, started its operations June 1996 at a meeting which bro u g h t in January 1998. together re s e a rchers, government off i c i a l s , n o n - g o v e rnmental organizations (NGOs), During the first year, the Global Forum for and funders of research. The Committee’s Health Research concentrated its activities on major conclusions were that, over the coming the following strategies: decades, the world community would continue to be faced by four major challenges:2 • O rganization of the Second Annual Forum: Forum 2 was held in Geneva on • The huge and unnecessary burden of 25-26 June 1998. The agenda is presented infectious diseases among the poor that can in Annex 1. be addressed with existing cost-effective • Analytical Work for Priority Setting interventions (referred to as "the unfinished along the lines of the five-step process agenda"). for resource allocation developed by the • The continually changing nature of Ad Hoc Committee on Health Research: m i c robial threats, such as HIV/AIDS, (i) analysis of the burden of disease; tuberculosis, and malaria. (ii) analysis of the reasons why the disease • The epidemics of noncommunicable persists (analysis of the determ i n a n t s ) ; diseases and injuries in low- and middle- (iii) analysis of the current state of income countries, such as heart disease, knowledge; (iv) estimation of the cost- n e u ro-psychiatric conditions, violence, effectiveness of present and future inter- and road traffic accidents. ventions; and (v) analysis of resource flows • The great disparity in how efficiently and into health research, disease by disease. equitably different health systems provide • Launching new initiatives: the magnitude services. of many health problems is beyond the capacity of any single institution and Participants at the meeting endorsed the main re q u i res a concerted eff o rt involving a findings of the Report and, in particular, the broad partnership. By acting together, the recommendation for the creation of a Global probability of finding solutions adapted to Forum for Health Research to mobilize forces the magnitude of the challenges increases to help correct the 10/90 Disequilibrium. considerably. A number of initiatives were directly supported by the Forum in 1998 The first Annual Forum (June 1997) launched in the areas of health policies, malaria, the Global Forum for Health Research as an tuberculosis, cardiovascular diseases, and independent entity and established a Steering domestic violence. Committee of 16 members re p re s e n t i n g • Communication and information: government policy-makers, multilateral and intensive eff o rts were made to develop bilateral development agencies, foundations, appropriate communication tools for the i n t e rnational NGOs, women's associations, Fo r um, including a website, media contacts, research institutions, and the private sector. and publication of the first 10/90 Report The Secretariat of the Global Forum, located on Health Research. 2 The recommendations of the Ad Hoc Committee to deal with these challenges appear in Chapter 1, Section 2 of the present Report. The objective of this report is to present the people to those benefiting the large majority. results of Forum 2 in the broader context of In view of the magnitude of the problems the 10/90 Disequilibrium. It will attempt to to be solved, there is a need to mobilize put each of the issues in context, summarize thousands of institutions. In this era of the perspectives offered at Forum 2, and globalization, it is necessary to pro p e l outline the plan of action for the coming research on the health problems of the poor years. It is the first such report. The road to onto the global health agenda. It is unrealistic help correct the 10/90 Disequilibrium will to contemplate a future in which the clearly be a long one, but it is also clear that developing world will grow healthier and it will lead to better health for the majority wealthier, while the poor everywhere remain of the world community. This will be made marginalized by ill-health and poverty. The possible by a reallocation, by decision-makers silent spread of drug-resistant microbes is in the South as well as in the North, of health evidence enough that no country can afford research funds from lower to higher priority to ignore international health concern s .