05_XXX _MM 1 Department of Reproductive Health and Research (RHR) UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) A. Metin Gülmezoglu July 2009 05_XXX _MM 2 Department of Reproductive Health and Research (RHR) Created in November 1998 Composed of two pre-existing entities – WHO Division of Reproductive Health (Technical Support) (RHT) – UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) RHR = RHT(PDRH)+HRP 05_XXX _MM 3 (ICPD Programme of Action, para. 7.6) “All countries should strive to make accessible through the primary health-care systems, reproductive health to all individuals of appropriate ages as soon as possible and no later than the year 2015.” Overall goal 05_XXX _MM 4 The WHO global reproductive health strategy adopted by WHO's 192 Member States in May 2004 05_XXX _MM 5 Regional and Country Offices, UNFPA, other partners Department of Reproductive Health and Research (RHR) including UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) ANNOTATED ORGANIZATIONAL CHART RHR Department of Reproductive Health and Research including HRP UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) MPH Improving maternal and perinatal health STI Controlling sexually transmitted & reproductive tract infections PFP Promoting family planning PUA Preventing unsafe abortion PMR Programme management TCC Technical cooperation with countries for sexual and reproductive health GRR Gender, reproductive rights, sexual health & adolescence SIS Statistics and informatics services 05_XXX _MM 6 The objectives and mandate of HRP To coordinate, promote, conduct, and evaluate interdisciplinary research on sexual and reproductive health; To collaborate with countries in enhancing national capacities to conduct SRH research; To promote the use of research results in policy- making and planning for SRH care at the national and international levels; To set standards and guidelines, including ethical guidelines, in the field of SRH research. 05_XXX _MM 7 Technical Cooperation with Countries Assist with identification of sexual and reproductive health needs Build capacity for research (national, regional and global) Support countries in dissemination and implementation of research results Provide support to planning, implementation, monitoring and evaluation of programmes aimed at improving access to good-quality sexual and reproductive health care Build partnerships in support of sexual and reproductive health research and programming 05_XXX _MM 8 HRP’s commitment to research capability strengthening US$ 2 US$ 1 Research and development Research capability strengthening 05_XXX _MM 9 Key mechanisms of Research Capacity Strengthening (RCS) by WHO/HRP Long-term Institutional Development grant Resource Maintenance, Service Guidance and Capital grant Research Training & Re-entry Grant Research Mentoring Grant Competitive Intra-regional Research grant Courses, workshops, seminars grant RCS Small Supplies grant Service Guidance Centre grant 05_XXX _MM 10 Institutions receiving RCS Grants in Asia & Pacific Mumbai New Delhi Colombo Yangon Medan Surabaya Ulaanbaatar Ho Chi Minh Hanoi Vientiane Shanghai Beijing Chengdu Chandigarh Tianjin Hangzhou • • • • • • • • • • • • • • • • 05_XXX _MM 11 Technical Co-operation with Countries Research capacity strengthening Support for national research RTI/STI studies in different populations Antenatal syphilis screening Emergency Obstetric care Post-abortion family planning Peer education for adolescents Approaches to improve cervical cancer screening 05_XXX _MM 12 Maternal and Perinatal Health • Improve knowledge on magnitude/burden of leading causes of mortality and morbidity Identify, develop, adapt and evaluate best practices in maternal and perinatal health Conduct research to improve quality of maternal and newborn care and promote implementation of findings Develop, keep up-to-date and promote evidence-based clinical practice guides for maternal and perinatal health 05_XXX _MM 13 Countries Women Status Effects of radiation on reproductive health 1 27 000 data analysis Treatment of postpartum haemorrhage 5 1400 data analysis Prevention of pre-eclampsia 6 2000 in preparation (treatment of hypertension) Screening for pre-eclampsia 7 12 000 ongoing Caesarean section techniques 9 4000 in preparation Fetal growth standards 10 2000 in preparation Genetics of preterm birth 4 2000 ongoing Managing the 3rd stage of labour* 7 20 000 ongoing Multi-country Study* 9 100 000 ongoing Operations research (implementation of an adapted version of the WHO ANC Model integrating antenatal care services with other health-care programmesprogrammes) Ongoing research activities * USAID support 05_XXX _MM 14 WHO Global Survey and WHO Multicountry Study on Maternal and Perinatal Health Global survey (2004-2009) To study the relationship between mode of delivery and pregnancy outcomes worldwide To develop a network of institutions collaborating in research To develop research capacity in new centres Multicountry study (2009-2011) To study the worldwide incidence of major maternal complications, maternal and neonatal near miss, and explore the quality of care through process indicators and the maternal near miss concept 05_XXX _MM 15 WHO Global Survey in Asia (107 950 deliveries in 122 health facilities) 0 5 10 15 20 25 30 35 40 45 50 Cambodia (5565) China (14541) India (24682) Japan (3300) Nepal (8489) Philippines (13295) Sri Lanka (15024) Thailand (9745) Viet Nam (13309) Figure2 Proportions of caesarean deliveries by four classifications and countries P r opor t i on c aesar ean d e l i ver i es ( % ) Intrapartum with indications Intrapartum without indications Antepartum with indications Antepartum without indications 05_XXX _MM 16 Global Africa Americas Asia Countries 24789 Maternal deaths 375 245 26 104 Neonatal death 2,304 950 627 727 Facilities 367 125 120 122 Number of births 290,453 83,364 97,988 109,101 Caesarean sections Caesarean section rate 25.9% 12.5% 35.7% 27.5% 75,362 10,425 34,974 29,963 The WHO Global Survey on Maternal and Perinatal Health Overall conclusions One out of four women delivered by caesarean section CS without a medical indication was associated with higher maternal mortality and severe morbidity CS for breech presentation was associated with improved perinatal outcomes Substantial variations among participating countries in terms of institutional capacity and outcomes were observed Overall descriptive results 05_XXX _MM 17 PPH Treatment Guidelines In press PPH prevention and treatment Knowledge synthesis Knowledge generation Knowledge synthesis Knowledge products WHO GRC South Asian Cochrane Network Thai Cochrane Network 05_XXX _MM 18 05_XXX _MM 19 Thank you for your attention
Thirty-first session of WHO South-East Asia Advisory Committee on Health Research Kathmandu, Nepal, 21-23 July 2009 SEA/ACHR/31/12 18 July 2009 Agenda Item 3.3.3 REVIEW OF GLOBAL WORK OF WHO ON HEALTH RESEARCH: UNDP/UNFPA/WHO/WORLD BANK SPECIAL PROGRAMME OF RESEARCH, DEVELOPMENT & RESEARCH TRAINING IN HUMAN REPRODUCTION (HRP)
UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development & Research Training in Human Reproduction (HRP) Introduction WHO's work in reproductive health is guided by its core principles and values of advancing human rights and gender equality, social justice and equity for the poor, and community participation. The Department of Reproductive Health and Research assumes a leadership role in the global reproductive health community, effectively combining research with support to programme development at country level. The Special Programme of Research, Development and Research Training in Human Reproduction (HRP) was established by WHO in 1972 to coordinate, promote, conduct and evaluate international research in human reproduction. In 1988, the United Nations Development Programme (UNDP), the United Nations Population Fund (UNPFA) and the World Bank joined WHO as cosponsors of HRP. As the main instrument within the United Nations systems for coordination of the global research effort in the field of sexual and reproductive health, HRP brings together health care providers, policy makers, scientists, clinicians and consumer and community representatives to identify and address priorities for research aimed at improving sexual and reproductive health. Since 1998, HRP has functioned within the WHO Department of Reproductive Health and Research (RHR), which has the overall mission of helping people to lead healthy sexual and reproductive lives. The objectives and mandate of HRP The objectives of HRP are: • to coordinate, promote, conduct, and evaluate interdisciplinary research on sexual and reproductive health; • to collaborate with countries in enhancing national capacities to conduct sexual and reproductive health research; 1 • to promote the use of research results in policy-making and planning for sexual and reproductive health care at the national and international levels; • to set standards and guidelines, including ethical guidelines, in the field of sexual and reproductive health research. HRP commits a key building block in the effort to eradicate poverty by contributing to research that ensures that individuals and families living in resource poor countries have equitable and reliable sexual and reproductive healthcare and family planning services. The Programme has for over 30 years worked with countries, nongovernmental organizations (NGOs), national and international organizations, an extensive network of collaborating research institutions and scientists and community groups to coordinate, promote, conduct and evaluate international research in reproductive health. It provides support to countries to improve sexual and reproductive health through research at national, regional and global levels, and the application of research findings in policy and priority setting. The core aspects of the Department's work plan, including HRP's, are based on the WHO Global Reproductive Health Strategy, which were adopted by WHO's 192 Member States in May 2004. These core aspects are: • Gender, reproductive rights, sexual health and adolescence • Promoting family planning • Maternal and perinatal health • Preventing unsafe abortion • Controlling sexually transmitted and reproductive tract infections • Technical cooperation with countries. Since its inception, HRP has been active in fertility regulation and family planning. After the International Conference on Population and Development, the focus of its work expanded to cover the broader agenda of sexual and reproductive health, including prevention and management of sexually transmitted infections and infertility, safe motherhood, men's roles 2 and responsibility and prevention of unsafe abortion. Lately, additional emphasis has been given to advocacy, gender, reproductive rights, the sexual and reproductive health of adolescents, and the interface between SRH and HIV. HRP depends, almost entirely, on voluntary contributions from international organizations, governments, foundations and civil societies which accounts for over 95% of HRP's budget. Despite limited funding, it has generated research which has played, and continues to play, an essential role in improving sexual and reproductive health throughout the world. Collaborating with countries to enhance national research capabilities Assisting developing countries to become self-sufficient in meeting the health needs of their populations is an essential part of health and development support. Research plays a central role in this process by identifying those needs, allowing priorities to be set and supporting the development of health strategies that are appropriate and relevant to a particular country. An integral part of development support is therefore the building-up of national and regional self-reliance through research capacity strengthening. One-third of HRP's operational budget is currently allocated to national reproductive health research and research capacity strengthening. HRP has developed a system of grants, which it uses to build and strengthen the capacity of developing countries to conduct research on reproductive health and to apply the findings of that research to policy and practice. The main instrument is the long-term institutional development grant, which is renewable for up to ten years, and which offers a technical support package including training, equipment, expert advice and other resources to support a research programme in line with the country's need. Other instruments include research training grants, which allow scientists from developing countries to undertake training in an institution other than their own, and grants for resource maintenance, courses, workshops, seminars, and advocacy for best practices through centres of excellence. Examples of HRP work in the region will be presented at the meeting. 3