Review of recommendations of the 26th – 30th sessions of the Advisory Committee on Health Research, WHO-South-East Asia Region.


Thirty-second Session of WHO South-East Asia Advisory Committee on Health Research Bangkok, Thailand 11-13 October 2011 SEA/ACHR/32/2.2 8 September 2011 Agenda Item 2.2  By Dr. Dulitha N. Fernando  Table of Contents Table of Contents i List of Tables iii List of Abbreviations iv Executive Summary vi 1. Terms of Reference of the APW 1 2. Methodology 1 3. Introduction 2 4. Sessions of WHO SEA-ACHR included under this review: 3 5. An overview of the ACHR sessions 3 6. Process adopted in making the recommendations 4 7. Assessment of the recommendations 4 7.1. Summary of recommendations 4 7.2 Review of recommendations by broad groups 7 7.2.1 Review of recommendations related to research 7 7.2.2 Recommendations made in technical areas 8 8. Information on implementation of recommendation 11 8.1. Sources of information on implementation of recommendation 11 8.2. Status of implementation 11 8.2.1. 26th ACHR: Thimphu, Bhutan, 17 – 20 April 2001. 11 8.2.2 27th ACHR: Dhaka, Bangladesh, 15-18 April, 2002 16 8.2.3. 28th ACHR : Male, Maldives,Male, 12-13 August 2003 20 8.2.4 29th ACHR: SEA-ACHR, Yangon, Myanmar,14-16 June 2004. 26 8.2.5 30th ACHR: SEA-ACHR, Jakarta, Indonesia,14-16 March 2007. 29 9. 31st ACHR session – an overview 33 10. Conclusions 35 11. Recommendations 38 12. List of documents 40 13. Acknowledgments 40 14. Annexes 1 - 4 41 List of Tables Table 1 - Summary of the recommendations- ACHR sessions, 26,27,28, 29 and 30 5 Table 2 - Summary of the status of implementation of the recommendation s. 37  Abbreviations ACHR Advisory Committee on Health Research APW Agreed Programme of Work CD Communicable diseases CDC Centre for Disease Control CIDA Canadian International Development Agency CSR Communicable Disease Surveillance and Response CVD Cardiovascular diseases EH Environmental Health EID Emerging Infectious Diseases ERB Ethical review Board ERC Ethical Review Committee FETP Field Epidemiology Training Programme FERCAP Forum for Ethical Review Committees in the Asian and Western Pacific Regions HIA Health impact assessment HR Human resources HRP UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development & Research Training in Human Reproduction ICMR Indian Council of Medical Research MDGs Millennium Development Goals MOH Ministry of Health MRC Medical research Council NCD Non communicable diseases NHRS National Health Research System NICD National Institute for Communicable diseases RA Regional Adviser RPC Research promotion and Cooperation RD Regional Director SEAR South East Asian Region SEARO South East Asia regional Office TAG Technical Advisory Group TB Tuberculosis TDR UNDP/WORLD BANK/WHO Special Programme for Research and Training in Tropical Diseases TU Technical Unit WHO World Health Organization WHO – CC World Health Organization – Collaborating Centres WHO – HQ World Health Organization - Headquarters WHO – WPRO World Health Organization – Western Pacific Regional Office Executive Summary The Advisory Committee for Health Research (ACHR) of the World Health Organization (WHO) is an advisory body with the mandate to support the WHO in carrying out the role of promoting and coordinating health research. ACHR at WHO South East Asian Region (WHO – SEARO) was established in keeping with the above and includes eminent scientists from the countries of the region as its members. At each of the 31 ACHR sessions held since its inception, recommendations have been made focusing on health research policies, promoting regional health research priorities, strengthening research capacity, dissemination of evidence based information on health science and technology and maintenance of a regional health research information system. This report is based on the findings of a review of the recommendations made during the five sessions of the SEA-ACHR , 26th to 30th. A total of 55 recommendations were made of which 27 (49%) were focused on actions to be taken to promote health research. Other focused on specific problems relevant to the countries of the region. Many of the recommendations are ‘general’ and include several follow up actions by different agencies within and outside SEARO, with some recommendations being clear, specific statements. There were some recommendations within the broad area of research which were repetitive. . Of the 55 recommendations, 35 were to be followed up at SEARO, 5 at SEARO in collaboration with relevant units at WHO/HQ and others (15) at country level.. A total of 35 (64%) have been implemented, some of them, with on going follow up activities. Four (4) recommendations i.e.7% have not been implemented with no information available on 4 others (7%). In respect of 12 others (22% ) available information was not adequate to make an assessment of the status of implementation Follow up action required varied, some requiring immediate “one time action” whereas others require initiation of implementation early with follow up to be ‘on going’ over a period of time. The extent, to which information of the follow up action taken is documented in the ACHR report to follow was limited, and information had to be obtained from the Technical Units(TU), using a format developed for the purpose. Thus, the introduction of a session under an agenda item titled ‘Follow up of recommendations’ from 29th ACHR session onwards, is of importance. The status of implementation should be clearly given and discussed, in order to assess the progress. A mechanism to disseminate the recommendations made at ACHR meetings, at SEARO and at the country level within the shortest possible time has to be streamlined. It is necessary to develop a formal system for follow up on the recommendations at SEARO, through sharing of information among all relevant technical units, obtaining their views on the priority areas ‘within’ the recommendations and the feasibility of implementation both at SEARO and at country level. A forum ( based at SEARO) that meets on a regular basis to discuss the implementation of the recommendations will be a useful input. Specific areas/topics which are priorities may need to be followed up through special sub committees. It is useful to consider developing a time frame indicating a schedule for implementing the recommendations. As ACHR sessions are held biannually, financial planning which is also done on a biannual basis need to take cognizance of the recommendations of ACHR in making allocations. There is a need for SEARO to implement a mechanism to follow up on activities linked with the recommendations at country level through a focal point for research at the country office. The responsibilities of such an officer need tobe reviewed and need to include, dissemination of ACHR recommendations among all the relevant institutions/departments within the country, develop and implement a plan for follow up, liaising with the national focal point for research at the country level and other relevant research institutions as well as with the RPC unit and relevant technical units in SEARO. Terms of Reference of the APW 1.1. To develop a tool to assess the quality of the ACHR recommendations 1.2. To develop a tool to assess the implementation of the recommendation 1.3 To conduct an assessment of 5 past ACHR recommendations under both tools 1.4 To prepare a report on the findings to be presented at the 32nd ACHR Methodology The following steps were adopted in the preparation of this report: 1. Perusal of all available ACHR reports, 26th, 27th, 28th, 29th, 30th and 31st and the Consultant’s report 2. Review of the agenda followed during the different sessions and the process adopted in making the recommendations 3. Developed a tool to be used to assess the quality of the recommendations (Annex 1) 4. Identified the level at which each recommendation has to be followed up, at country level, at SEARO, at both or at another level e.g. TDR. Those that have to be followed up at WHO – SEARO were further identified by the technical areas and a request made to the TIP, RCP to obtain relevant information from the TUs using tool given in Annex 2. 5. Developed a tool to obtain information from countries on follow up action taken as given in Annex 3(discussion with the TIP indicated that this may not be feasible, hence was not carried out, after developing the tool). 6. Developed a tool to obtain views regarding the recommendations from recent ACHR members who attended the 28th, 29th and 30th sessions, to obtain their suggestions on how recommendations should be made more effective. A copy of the tool so developed is given in Annex 4. 7. Preparation of the report Introduction The Advisory Committee for Health Research of the World Health Organization (WHO) is an advisory body with the mandate to support the WHO in carrying out the role of promoting and coordinating research relating to international health work, acting in close collaboration with external institutions pursuing common goals and with the scientific community at large .Each of the Regional Offices of the WHO have set up their own ACHR. ACHR at WHO SEARO was established in keeping with the above and includes eminent scientists from the countries of the region as its members. SEA – ACHR has held 31 sessions since its inception and one Bi regional meeting with the Eastern Mediterranean Region. During each Session , the ACHR makes recommendations focusing on health research policies, promoting regional health research priorities, strengthening research capacity, dissemination of evidence based information on health science and technology and maintenance of a regional health research information system. To make an assessment of the recommendations made and the status of their implementation was considered timely, to provide useful background information to the ACHR. Thus, in this report an attempt has been made to review recommendations made by the previous five sessions of the SEA-ACHR (26th – 30th). The Terms of reference of the WHO SEA-ACHR, adopted at the 25th session of the SEA-ACHR held in Bali, Indonesia in April 2000 are given below: To advise the Regional Director on: Formulation and implementation of health research policies and health research agenda in the Region in line with the resolutions and policy guidance of the World Health Assembly, Executive Board and the Regional Committee, and also within the overall framework of the global WHO research policy Coordination and harmonization of health research activities of various national health research bodies/councils/departments, institutions with those of WHO, with the purpose of strengthening of national research capability and research management for health development Development, management and improvement of the health research information system, including research monitoring and evaluation, for evidence based decision making. Collection, analysis, and dissemination of existing health research findings on emerging scientific knowledge and technology, with a view to promote and foster research application and practices at the national and institutional levels. Sessions of WHO SEA-ACHR included under this review: Recommendations of following five (5) Sessions of SEA-ACHR are included in this review: 1. Twenty-sixth Session: Thimpu, Bhutan, 17-20 April, 2001 2. Twenty-seventh Session: Dhaka, Bangladesh, 15-18 April, 2002 3. Twenty-eighth Session: Male’, Maldives, 12-13 August, 2003 4. Twenty-ninth Session: Yangon, Myanmar,1 4-16 June,2004 5. Thirtieth Session: Jakarta, Indonesia, 14-16 March, 2007 In addition to the above, available information on the recommendations of the 31st Session held from 21-23 July 2009 in Kathmandu, Nepal are also included in this report as section 9 of this report, as an overview of the 31st ACHR.. An overview of the ACHR sessions The agenda of the ACHR follows a pattern with minor variations from session to session.. After the inaugural session, the business session commences. Once the formalities of electing Chairpersons, appointment of a reporting group etc. are completed, the work on the business session commences. This session includes several key presentations common to all ACHR sessions with minor changes in the titles by which the session is identified in the agenda. They are: i.. Presentations/updates on Regional Programme in Research Policy and Promotion, ii. .Global and regional coordination in health research iii. Technical presentations on selected topics, varying from session to session. iv. Adoption of the report and recommendations. The business session is followed by the closing session. From the 27th session onwards, a scientific debate on a topic of major public health concern especially to the host country was taken up as a topic for scientific debate. Such sessions were aimed at involving the local scientific community on a topic of interest to the host country. During the 30th and 31st sessions, an agenda item titled ‘Follow up actions on the recommendations of the previous ACHR sessions’ has been included. Process adopted in making the recommendations During the 26th , 27th and 28th ACHR sessions, recommendation were made in relation to agenda items, on issues relevant to those discussed during the presentations under the agenda item. The report contains recommendations following each agenda item. . In the 29th ACHR session, the recommendations were made at the session where the conclusions and recommendations were finalized, prior to the closing session. At the 30th session, a number of recommendations are mentioned in relation to presentations and at the session on conclusions and recommendations, 9 recommendations have been adopted which were considered as the recommendations of the 30th session of ACHR. . Assessment of the recommendations In the section to follow, the recommendations are analyzed under 4 headings. Those made at each session are considered separately. 7.1 Summary of the recommendations made during the ACHR sessions 26,27,28,29 and 30. This section includes information on the: total number of recommendation per session to whom were the recommendations made to, WHO –SEARO, to the countries, to both WHO –SEARO and the country or WHO- SEARO with HQ recommendations by broad subject areas 7.2 Review of recommendations by broad groups, with a view to making observations on relevance to countries of the region, clarity of the statements, repetition of any and any other relevant comments. 7.3 Follow up actions on the recommendations of the ACHR: based on information available from the following ACHR sessions and information from other sources. 7.4 Observations from the above analysis. 7.I : Summary of the recommendations Table 1 presents a summary of the recommendations made during the five ACHR sessions 26 to 30. A total of 55 recommendations have been made with the number per session ranging from 8 to 14. Of the 55 recommendations made, 27 (49%) were on topics related to development of health research and the others were in technical areas, which included the following: human genetics, health impact assessment , Arsenic poisoning, cardiovascular diseases, Thalassaemia, emerging infectious diseases and avian influenza. Table I : Summary of the recommendations made during the ACHR sessions, 26,27,28, 29 and 30 ACHR session and yearNo. of recommendationsFollowed up at : Subject areasTechnical Units in SEAROCountrySEAROJointly26th, 200112391(with countries)Health research promotion and development (3) Research grant application(1) Human genetics(5) Collaborating centres((3)RPD (7) NCD (5)27th ,200212661(with countries)Health research policy and promotion(1) Ethical guidelines (3) Arsenic poisoning (2) Health impact assessment (2) CVD (2)RPD(1 + 3) NCD(4) EH(2)28th,200314 262 (with countries) 4 (with HQ)Health research management(1) Collaborating centres(1) Situation studies on knowledge utilization(1) Health research promotion (1) Capacity building on health research (1) with TDR Improving utilization of research findings in HRP (1) with HRP Regional/ national vaccine policy and regulatory authorities(3) Strengthening epidemiological surveillance and health research capabilities for TB(1) Thalassaemia (4)RPC NCD CD29th 20048161(SEARO +HQ)More as a guideline and not for implementation per se.(1) Improving efficiency of the HRS thro new instruments(1) Promote, support development and dissemination of tools and methodologies for extending health research systems(WHO & HQ) (1) EID (5) RPC30th 20079151(with countries)1 (with TDR)Technology development on vaccines, medicines etc (1) Resource allocation in HR(1) Research management (1) Avian influenza(TAC) (1) Recom. to TDR to strengthen the links between researchers and MOHs.(1) Facilitate linkages between MRCs / research institutions(1) Promote ethical standards (1) Health research development (repeat) Establish and interactive forum for ACHR members and RAs (1)RPC CDTotal 53123011Research related topics Technical topics Recommendations made at the 31st session, 200931st 2009Overall recom..WR’s 4 +! Countries 1SEARO 3 44 specific recommendations were made, during the technical sessions. However, at a follow up meeting held in SEARO, a decision has been made to follow up 8 of them. SEE SECTION 9 for DETAILS 7.2 Review of recommendations – by broad groups 7.2.1 Review of recommendations related to research A total of 27 recommendations out of a total of 55 (i.e. 49%) were in the areas related to health research. Varying number of such recommendations were made an every ACHR session reviewed. The follow up actions were to be done by the RPC – SEARO, RPC and countries, RPC and HQ units and by countries. The recommendations were reviewed taking into consideration: Specific topics within the broad area of health research in which the recommendations were made Relevance to the countries in the region Clarity and ease of interpretation Follow up required As all recommendations have been made in the broad area of research promotion, there is some degree of repetition, even though in each recommendation, a new input has been focused on. The recommendations under the broad area of research promotion could be divided into the following broad categories. Activities supporting national health systems. These recommendations include a wide range of follow up activities from updating profiles of national health research systems, identifying their strengths and weaknesses to knowledge dissemination.( similar topics have been repeated with minor differences) - Strengthening country capacity for health research Strengthening research management capabilities Resources for research Links with the HQ research programmes - TDR and HRP. Research ethics Collaborating centres There are a total of 4 (15%) recommendations related to research on Collaborating centres and 4 (15%) on ethics in research. Some recommendations include more than one set of follow up actions, by more than one group (country/SEARO /HQ units). Several recommendations are stated in general terms, making the follow up activities less clear. Relevance to countries of the region All research related recommendations are relevant to all countries of the region to varying extents. In some countries where there are well organized health research organizations e.g. India, only some aspects may be relevant. On the other hand, in countries such as Bhutan, Maldives and Timor Leste, where support is required for setting up a national health research programme, others may be relevant. Clarity and ease of interpretation These aspects vary with each recommendation and the writing style of the recommendation differs between different reports. Some are clearly stated and are ‘focused’ statements while others are more ‘generic’. Some of the recommendations include more that one follow up action. Follow up required Almost all of them clearly indicate the responsibility for taking action to implement the recommendation, whether it is the country or SEARO or SEARO in collaboration with the relevant units at HQ. There are a few that have to be implemented by SEARO in collaboration with the countries. 7.2.2 Recommendations made in technical areas (The number of recommendations per topic is given within brackets) The recommendations made on technical areas varied both on the topic and in numbers. They are as follows: 26th session Human genetics (5) 27th Arsenic poisoning (2), Health impact assessment (2) CVD (2) 28th TB (1) Thalassaemia (5) 29th EID (5) 30th Avian influenza (1) Vaccine development (1) As mentioned, a scientific debate on a selected topic usually of relevance to the host country in which the local scientists can take part has been included in the ACHR session since the session of 27th ACHR. . In the section to follow, relevance of the recommendations to countries of the region, clarity and required follow up are given by ACHR session. 26th ACHR Five recommendations on human genetics were identified during the technical sessions. Relevance to the countries of the region Human genetics is a topic of importance that is likely to contribute to new and emerging fields related to health research. Even though the availability of human and other resources for research in this area within the region vary widely between countries, there is a need to be aware of the scope of such research , availability of such facilities in the region. The 5 recommendation in this area are all targetted at achieving such objectives. Clarity of recommendations and follow up All five recommendations are clearly stated with no overlap among them nor with recommendations made at the other four sessions reviewed. The follow up required with SEARO as the implementing agency is clearly indicated. The required follow up activities seem feasible.. 27th session Recommendations were made in three areas- Arsenic poisoning, health impact assessment and cardiovascular diseases. Arsenic poisoning Relevance to the countries of the region: This is an important public health problem in several countries of the region and the importance lies in the fact that it can cause debilitating disease, has a high burden of disease and is preventable. Clarity of recommendations and follow up Two recommendations have been made to be implemented at the country level and the areas of research proposed are grouped as immediate, medium term and long term which makes it clear and facilitates implementation. Follow up has to be at the country level with support from national and international bodies to strengthen the national Centres of Excellence. Need for the WHO to collaborate with these national centres with a view to further development is an area that has to be considered in relation to implementation. There is no information as to the extent to which such collaboration has taken place. Health impact assessment Relevance to the countries of the region: A survey was conducted in nine countries of the region on information relevant to HIA, which is s subject of relevance to all countries, specially in the present “development” scenario. This study identified the need to strengthen the infrastructure and expand the human resources required for HIA, focusing on the inter sectoral nature of inputs required. Two key recommendations aimed at such improvement were made at this session Clarity of recommendations and follow up Both recommendations are clearly stated and identified SEARO to be the responsible organization to undertake follow up activities, which were to deal with technical inputs. Cardiovascular diseases (CVD) Relevance to the countries of the region : In view of the increasing importance of CVD as a cause of morbidity and mortality in all countries of the region, there is a continuing need for research on prevention and management of pre transitional and post transitional CVDs. Clarity of recommendations and follow up : The recommendations indicate the need for the WHO to work in partnership with other institutions to promote CVD research and for the need to promote an integrated approach for prevention of CVD along with other NCDs. 28th ACHR During this session, one recommendation on TB and 5 recommendations on Thalassaemia which was the topic for the scientific debate were adopted. Tuberculosis : Relevance to the countries of the region :Tuberculosis is a public health problem in almost all countries of the region, hence research in this area that will facilitate prevention of TB is of importance. Clarity of recommendations and follow up : One recommendation has been made related to TB. However, this includes two components – one of providing technical and financial support to countries by WHO to strengthen research capabilities and the other is linked to the national TB control programme to measure epidemiological impact of TB control. Both these are written in one paragraph hence causes some confusion. Thalassaemia: Relevance to the countries of the region: Importance of Thalassaemia as a public heath problem was identified by several presentations and the key aspects of the Thalssaemia programmes (including research) in India, Maldives and Thailand were presented and discussed. As the burden of genetic diseases were increasing in the countries of the region and treatment was expensive, alternative approaches to prevent the problem must be considered. Need for collaborative action was emphasized. Clarity of recommendations and follow up: Five (5) recommendations were made, 3 of them to be followed up by WHO-SEARO, one of them to be implemented through collaborating centres. 29th ACHR At this ACHR session, 8 recommendations were made at the concluding session of which five recommendations were on research related to Emerging Infectious Diseases -EID. Relevance to the countries of the region: There were a number of presentations followed by group discussions, on health research priorities on Emerging Infectious Diseases (EID). EIDs are priority health problems in all countries of the region with several EIDS such as SARS, Avian influenza, DHF and Nipah infection emerging as important issues in recent years. Clarity of recommendations and follow up: One recommendation on EID refers to strengthening of an effective disease surveillance system and this recommendation has to have several ‘inputs’ by the country and/or by the WHO. This needs some clarification. Two others focus on the SEARO supporting the countries in public policy analysis which are clearly stated. Other two are targeted towards SEARO to take follow up action. 30th ACHR In this session, 22 recommendations have been suggested during the technical sessions. However, at the concluding session only 9 recommendations were adopted, which included one, focusing on Avian influenza and the other on vaccine development. Relevance to the countries of the region: Avian influenza as a public health problems is of high significance in the region and so is the technology development for vaccines. Clarity of recommendations and follow up: There is some degree of inadequate clarity in all recommendations made during this session, with less focus on the direction for follow up. Each recommendation has several components, which are inter related and covers a wide scope. Information on implementation of recommendation 8.1. Sources of information on implementation of recommendation The report of the ACHR following the session in which the recommendation is made is the main source of information on its implementation. The presentations by SEARO staff and other documented information in these reports can be used to assess the follow up. From the 30th ACHR session onwards, an agenda item titled ‘Follow up actions on the recommendations of the previous session’ has been introduced, which was a key source of information. In addition to the above, a tool was developed by the reviewer to obtain information from the relevant technical unit /s in WHO-SEARO on information available on the follow up (Annex 2). This was especially in relation to the recommendation for which no information was available in the ACHR reports. In addition to the above, a tool was developed to follow up the recommendation at the country level (Appendix 3). However, the reviewer was informed that it may not be feasible to obtain country level information, hence was not attempted. 8.2. Status of implementation Status of implementation of each recommendation based on available information from all sources, are presented in the sections to follow, by each ACHR session. Each recommendation is given a number which includes the ACHR session in which the recommendation was made. 8.2.1. 26th ACHR: Thimphu, Bhutan, 17 – 20 April 2001. Recommendations were made by agenda item. Agenda item 3.1. : The Work of the Regional Research Policy and Cooperation Programme of the WHO South-East Asia Region, 2000-2001 Recommendation 26.1 WHO, in collaboration with national health research councils or analogous bodies, should update the profiles of the national health research systems, using a common framework, and also undertake a regional analysis to identify the strengths and weaknesses of each system. Implementation Presentation by the RA-RPC, WHO,SEARO at the 27thACHR session, has stated that ‘using a common framework developed and endorsed by the Regional Committee in September 2001, all member countries had provided profiles of their health research systems’ indicating that the recommendation has been implemented.. Agenda item 3.2. Strategies for Health Research Development in the WHO South-East Asia Region (Agenda Item 3.2): Recommendations 26.2. The committee endorsed the actions taken by WHO-SEARO to finalize the paper on Strategies for strengthening the national health research systems in the WHO South-East Asia Region. It also requested SEARO to further improve the document, taking into account the suggestions and modifications proposed at the meeting as well as contribution received at later consultations. 26.3. The Committee endorsed further promotion of the systems approach on the strengthening of national health research system in the countries of the Region as well as in other Regions. The latter would need to be undertaken by submitting a special report to the Global ACHR. Implementation Report of the Twenty-seventh Session of ACHR, Dhaka, Bangladesh, April, 2002 states that ‘the critical area for WHO in promoting health research had been to develop a strategy to address and influence specific country needs. With this in mind, an expert group comprising of ACHR members and other senior scientists developed regional strategies for strengthening health research systems and they were endorsed by the Regional Committee in September 2001. Based on these strategies and the common framework, all Member countries had provided profiles for their health research systems’. Additional information available from RPC indicate that papers were prepared and presented at the 2002 session as working documents. These were considered to be useful at the country level. The above indicates that the recommendations have been implemented. Agenda item 3.3: Regional Perspectives in Human Genetics: Scientific Debate Recommendation 26.4 WHO-SEARO should map and compile the profiles of national centres of expertise in the area of human genetics. After a thorough analysis, WHO-SEARO should identify potential institutes and utilize them as a network of regional resource centres on human genetics. Implementation Information from NCD unit: As a follow-up of the recommendations made by ACHR 2001, the Inter country Consultation “Identifying Regional Priorities in the Area of Human Genetics in SEAR” was held from 23rd to 25th September 2003. The Consultation finalized the proforma on ‘Standardized Profile of Centres of Excellence in Human Genetics’ as a useful instrument for collecting information required for planning of a regional genetic research programme. Countries such as Thailand, Sri Lanka, Maldives, Indonesia, India and Bangladesh provided information on national centers. Recommendation 26.5. WHO-SEARO should conduct a situational analysis on the availability of clinical genetics services in the Region. WHO should identify the strengths and deficiencies in clinical services, education and training in this field, encourage the exchange of information and personnel and advocate improvements. Implementation Information from NCD unit: At the above mentioned Consultation, countries presented the availability of clinical genetic services at the country level and the presentations were disseminated in the Report. A proforma on “Availability of Clinical Genetic Services in the Member Countries” was also finalized. It was agreed to distribute the Country Profile on Availability of Clinical Genetic Services questionnaires to member countries. The countries were requested to conduct situational analysis on the availability of clinical genetic services and identify and support national centres of excellence in the area of human genetics. The selected institutions represented in the Consultation agreed to fill the Standardized Profile of Centres of Excellence in Human Genetics and contribute to strengthening regional collaboration through networking. Recommendation 26.6 WHO-SEARO should establish an expert group or scientific working group on human genetics, comprising of expertise from various disciplines, in order to update the development of knowledge and technology related to human genetics as well as to provide necessary advice and guidance to Member Countries. Implementation The expert group has not been established, hence the recommendation was not implemented. Recommendation 26.7 WHO-SEARO should also facilitate regional technical consultations, seminars and debates on ELSI of human genomics and health and also provide support to countries (especially least developed ones) in responding to ELSI issues. Implementation Information from NCD unit: ELSI related research on human genomics was identified during the Consultation as one of the research priorities and the areas of ELSI, such as privacy and confidentiality, gender issues, autonomy including informed consent, genetic testing and pretest counselling, legal issues, social issues and consanguinity and its implications were identified as the areas for special considerations in the countries. Countries were requested to assess and address ethical, legal and social issues of genetics and genomics. Recommendation 26.8 WHO-SEARO should prepare a paper on “Regional perspectives on human genomics and health”, taking into consideration the contributions made during presentations and debates at the 26th session of SEA-ACHR. The final paper should be submitted to WHO/HQ for its appropriate use. Implementation The regional input to the global document “Genomics and World Health” was provided through a consultation organized by the Thai Health Research Forum. In addition to the above inputs from NCD unit, the report of the Twenty-seventh Session of ACHR, Dhaka, Bangladesh in 2002, indicated that the scientific debates on Genomics and Health, held in the last ACHR meeting, had provided substantial input for WHO Policy Paper on Genomics and Health. Agenda item 3.4. Proposed Criteria for Health Research Activities Supported by WHO in the South-East Asia Region Recommendation 26.9 WHO-SEARO should update and make widely available, the “Information Booklet for Health Research Grant Application” taking into consideration the observations and suggestions made by SEA-ACHR. Implementation Information from the RPC unit indicated that the document was developed in 2001 and is still valid and available at the country offices. Those who wish to get funding from WHO have to submit their proposal using the template in the booklet. This booklet has not been updated so far. However, no information on the implementation was available in the Report of the 27th Session of SEA-ACHR. Agenda item 3.7: Promoting the Use of WHO Collaborating Centres and other Networks in SEAR Recommendation 26.10 Member Countries and WHO should identify appropriate national institutions and networks, which have been collaborating closely with WHO for health development ,in order to designate new WHO Collaborating centres (WHOCC).The revised WHO guidelines for WHO collaborating centres should be made available widely. Information on distribution of WHOCC by region and by different technical subject areas should also be widely accessible. Implementation Information from RPC - Institutions with potential to be WHO CC is identified by the relevant RAs including RPC. Guidelines for WHO CCs were prepared by the focal point of WHO CCs in HQ and has been shared with countries and are now available on-line. Follow up actions are on going, being taken care by the RAs. Information on WHO CC by region and by different technical subjects is accessible at the global database and is shared with all technical units. Recommendation 26.11 Periodic joint meetings and systematic evaluation of collaborative activities between WHO and the centres have to be undertaken by responsible technical units of WHO, including the WHO Representative concerned. An annual meeting of WHO CC at national level, especially for countries with a sizable number of centres (such as India, Indonesia and Thailand) would help stakeholders to promote the effective use of these countries. Implementation Information from RPC - Whenever RAs visit countries, they make an attempt to visit the WHO CC and discuss progress of collaboration. When nearing the end of designation, an evaluation sheet has to be filled by RA, ideally through a visit to the WHO CC and if satisfied, WHO CC can propose for re-designation with the support of the RA. The evaluation on WHO CC is done at the institutional level not at regional level, on a one to one basis. Evaluation of collaborative activities between CC and WHO was done in 2007 by the WHO HQ. Annual meetings of WHO CCs are held at national level, in some countries. Recommendation 26.12 WHO-SEARO should strengthen the networks of WHO CC as important instruments for capacity building and promoting health research. WHO should work closely with development partners to facilitate the mobilization of appropriate resources for the network to undertake effective research and development activities. Implementation Information from RPC -When an institution is designated as WHOCC, this means that they will carry out collaborative work with WHO on proposed plans of action. At the global level, there are networks of WHO CCs under the same areas, e.g. Network of WHO CCs that deal with genetics, with health systems etc.. SEARO made an attempt to strengthen the networks by inviting all WHO CCs in the region to a meeting in Jaipur in 2003 and identified a list of technical areas for networking. Recently the Reproductive Health unit in SEARO conducted a meeting with all WHO CC in India under the network of ‘Making pregnancy safer’ and a similar activity was undertaken , by CDS unit for networking in areas related to communicable diseases. WHOCC are often requested by WHO to conduct training. RPC/FHR has encouraged all technical units to include the network meeting/s in the work plans of 2010-2013. However, in the Report of the 27th session of the SEA-ACHR, there was no mention made of implementation of these recommendations. Summary A total of 12 recommendations were made by the 26th Session of SEA-ACHR. Of them, the Report of the 27th ACHR indicated that 4 have been implemented. However, with the information available from the RPC and other technical units, it was observed that some follow up action has been taken in respect of all recommendations, except one (26.6). 8.2.2 27th ACHR: Dhaka, Bangladesh, 15-18 April, 2002 Recommendations were made by agenda item Agenda item 2.1. The regional programme on research policy and promotion Recommendation 27.1. WHO SEARO should establish an expert group to develop a strategic framework for member countries to better organize, manage and disseminate existing knowledge in order to provide evidence base for health policy and also promote research network strengthening as a tool for promoting research Implementation There is no information available in the 28th ACHR report on the implementation of this recommendation. However, it is mentioned that two countries in the region (Thailand and Indonesia) participated in the pilot phase of the global study in development of health research systems using a generic framework and the modules. Information from RPC has indicated that there was no such expert group and that the countries that the checklist developed by RPC/HQ is available to be used by the research institutes in the countries. Agenda item 2.2. Ethics in health research Three (3) recommendations related to ethical review mechanisms were made following the presentation and discussion on ‘Ethics in health research: an update on ethical review mechanisms’. Recommendations 27.2. Member countries with support of ACHR members should update/ develop their national ethical guidelines in collaboration with WHO/SEARO, FERCAP and other partners. Special attention should be paid to ethical, legal and social implications related to emerging health research issues such as material used for genetics research etc. 27.3 Member countries, under the guidance of national Ethical Review Boards (ERB) and with the support of ACHR members and WHO, should thoroughly assess their own ethical review mechanisms, through national forums for information sharing and through discussion of complex issues such as acquisition and use of genetically modified food and other materials, including research in those areas 27.4 Member countries in collaboration with WHO, other development partners and international health research bodies should continue their efforts to strengthen the capacity of national and institutional ERB members, PIs and related stakeholders through forums, seminars and training workshops. Implementation The three recommendations are linked to one another and focus on three aspects relevant of ethical review process i.) updating ethical guidelines ii) possible mechanisms of information sharing and iii). importance of collaboration with other relevant bodies. As there is no established mechanism through which recommendation are to be followed up at country level, the implementation of these recommendations is not clear. However, according to the Report of the Twenty-eighth Session of ACHR, Male’, Maldives, 2003), WHO-SEARO works closely with the national experts in the development of a compendium of cases for teaching research ethics. Seven medical training institutions in Bangladesh, India, Indonesia, Myanmar and Thailand were field-testing the modules on health ethics and is expected to complete the work by October 2003. However, this information does not indicate the status of implementation of the above three recommendations per se. Agenda item 2.1.4.. Review of National Health Research Systems Development Recommendation 27.5 Member countries, with the support of ACHR members, should update their national HRS profiles. The final versions should be ready within three months Implementation The report of the 28th session of ACHR does not mention the implementation status of this recommendation, which is a close repetition of recommendation no.26.1. However an Agenda titled Review of National Health Research Systems Development, including Progress of the Global Project on Health Research Systems Assessment in Thailand and Indonesia (Agenda Item 2.1.2) was included in the Session but the discussion does not suggest implementation of the above recommendation. Recommendation 27.6 WHO-SEARO should establish an expert group to make an in-depth analysis and review NHRS and produce a regional analytical report and recommendations for action by Member countries and WHO, within six months. Implementation Information from RPC indicted that this expert group was not established. However, RPC Headquarters has developed a checklist and are available to be used by research institutes in countries to conduct analysis. Agenda item 2.2. : Health Research in Arsenic Poisoning: There were two recommendations made under this topic, one indicating the direction for research on arsenic poisoning in the short term, medium term and in the long term, and the other referring to the mechanisms that may be adopted to enhance the research capabilities in this area.. Recommendations 27.7 Member countries, in collaboration with WHO, other development partners and international health research institutions, should promote the following health research related to arsenic poisoning (focusing on intervention oriented research), in Member countries where Arsenic poisoning is a major public health problem. Immediate health research on arsenic poisoning should focus on the harmonization and validation of a “system for detection of cases”, for regional case-detection, reporting and management. The testing of arsenic should also be standardized and validated and a policy for the import and testing of kits should be supported in the affected countries. Medium-term health research should focus on establishing the natural history of arsenicosis including bioavailability studies from food chain and the role of cofactors and use of biomarkers in exposure and outcome measurement. Risk communication and IEC should also be addressed. Long-term health research on arsenic poisoning should address the issue of low-dose exposure. 27.8 Member countries, with the support of both national and international resources, should strengthen their national centres of excellence which have been involved in health research in arsenic poisoning. WHO should collaborate with these national centres and develop them as Regional Reference Centres as well as WHO collaborating centres. Implementation Report of the 28th ACHR does not provide and information regarding the implementation of these recommendations. However, the report of the Second follow up meeting on implementation of the 31st ACHR recommendations, following on a discussion on the follow up on previous five ACHRs, mention was made of the need for attention of mitigation of health problems related to arsenic and to undertake follow up. No further information is available. Agenda Item 2.3: Ecology and Health: Health Impact Assessment (HIA)) Two recommendations were made under the above in view of the need to strengthen the infrastructure for HIA. Recommendations 27.9 SEARO should organize a Regional Consultative meeting on Health Impact Assessment with a view to providing a strategic framework for strengthening health impact assessment activities. 27.10: WHO, in collaboration with scientific experts and respective national centres of excellence should share information on the available methods and tools for conducting HIA in the Region. Implementation In the Report of the ACHR there is no mentioning of implementation of these recommendations nor was any information available from the technical unit. Agenda item 2.4. : Health Research in Cardiovascular Diseases: Following the two technical presentations, two recommendations were adopted on this topic. Recommendations 27.11 WHO, in partnership with the regional and national networks of institutions, should promote operational and community-based health research on prevention and control of CVDs, especially addressing the problems of early childhood. Research should the feasibility of implementation of such interventions at the country level. 27.12. WHO should promote an integrated approach for the prevention and control of CVDs along with other non-communicable diseases that share common, modifiable risk factors. Implementation There was no evidence of implementation of above recommendations in the Report of 28th Session of SEA-ACHR. However, information form Technical Unit NCD has provided some information on the follow up. WHO Collaborating Centre on “Epidemiology and Prevention of Cardiovascular Diseases” was designated in 2005 at the Cardiothoracic Centre, All India Institute of Medical Sciences (AIIMS), New Delhi. Its work-plan is focused on designing, implementing and evaluating community-based demonstration projects for cardiovascular diseases risk reduction, for promoting healthy behaviours and increasing capacity of health professionals in providing community based services for health promotion and prevention of CVDs. The integrated approach to prevention and control of NCDs has been emphasized in the Regional Framework for Prevention and Control of NCDs, in the WHO documents submitted to the recent WHO SEAR Regional Committee Meetings and in the regional 2011. Summary Of the total of 12 recommendations made during this session, there is no information on the status of implementation of 5 of them, including the two on Arsenic poisoning, from any of the sources. However, at the Second Follow Up meeting of the Report of the 31st ACHR, the issue of research on Arsenic poisoning has been brought up. Of the other 7, two recommendations on CVDs have been implemented and on 5 others, some information is available which are not adequate to assess the status of implementation. 8.2.3 28th ACHR: Male, Maldives, 12-13 August, 2003 Recommendations were made agenda wise, which are given below: Agenda item 2.1.1. The Work of the Regional Programme on Research Policy and Promotion, including follow-up of Recommendations of 27th ACHR Recommendations 28.1. WHO-SEARO should promote the use of the Health Research Management Modules in countries of the Region, and make flexible arrangements to select different target audiences, so as to provide wider variation on the usage and applicability of the modules. Implementation There is no reference to the status of recommendation even though there is information on the completion of Health Research Management modules in some of the reports of ACHR. Recommendation 28.2 WHO-SEARO should constantly review, update and share information on the status of WHO CCs in the Region and at the global level as a whole. It should proactively involve more national centres of excellence, in collaboration with ACHR members and national health research councils. Implementation With reference to the above recommendation (28.2), the report of the 29th ACHR mentions that ‘the ACHR members could further assist in better use of national expertise and WHO CCs. The WHO country office in Thailand had initiated creation of database of national expertise to enable them to share their experience on international work. It had also established the Secretariat and the Charter for networking of national centres of expertise and WHO CCs. These initiatives were to be expanded to other Member States’. Information from RCP refer to the ongoing practice of the technical units working closely with the WHO CC and RPC units for all activities related to WHOCC – WHO collaborative work. This information indicates that the implementation of the recommendation is on-going. Recommendation 28.3 WHO-SEARO, in collaboration with RPC/EIP-HQ, should organize national and regional situation studies on “Knowledge utilization”, using the tools and methodologies already developed as part of the global exercise on the “Health research systems performance assessment”, and further disseminate the results to all SEAR Countries. Implementation Status of implementation was not reflected in the Report of the 29th ACHR. Information from the RPD unit indicates that the RA-RPC and the officer for information and management of data/librarian SEARO attended a workshop on knowledge management at WHO/HQ. In SEARO, this knowledge was shared with all RAs. The RAs were to use this information in their programmes and activities. This information could be considered as providing some indirect evidence of implementation if this recommendation. Agenda item 2.1.2 Review of National Health Research Systems Development, including Progress of the Global Project on Health Research Systems Assessment in Thailand and Indonesia . Recommendation 28.4 WHO/SEARO, in collaboration with RPC/EIP-HQ, should promote and disseminate the basic concept, framework, the simplified tools and methodologies on the assessment of national health research systems as widely as possible to all Member States. They should be supported to use them for developing their own health research systems Implementation At the 29th session of the ACHR, the members congratulated RPC/HQ for assisting countries with the framework for health research systems, and providing analytical tools and instruments for assessing the performance of national health research systems. The tools on health research system's performance had been pilot-tested in 13 countries globally including two countries in the region, Thailand and Indonesia. It has been planned to conduct workshops and training for study teams to enable them to conduct analysis based on country needs. Data on individual and institutional survey had been submitted to WHO/HQ. The ACHR members proposed that WHO-RPC/HQ should strengthen capacity-building for country teams to enable them to analyse their data (Report of the 29th Session of ACHR, 2007 ). Agenda item 2.1.3.a Selected Global Health Research Activities -UNDP/WORLD BANK/WHO Special Programme for Research and Training in Tropical Diseases (TDR) Recommendation 28.5. WHO-SEARO should expedite the implementation of capacity strengthening in health research, through funding small-grant research activities supported by TDR/HQ, TDR and RPC/SEARO jointly, especially to institutions and individuals in countries with limited capacity for health research Implementation The report of the 29th ACHR does not provide any information on the implementation of this recommendation. Information from RPC: TDR HQs supported small research grants through provision of funding, limited to US Dollars 7500 per proposal. The support was directly from HQs or channeled through SEARO, through the TDR -RA in SEARO. Staff from TDR HQ used to go direct to the institutions in the countries who forwarded the research protocol, and assist them in refining the proposal. Proposal is submitted direct to the HQs if HQs funding is wished, with a copy to Who country office. If SEARO TDR funds are requested, the proposal will go to the concerned TAs at SEARO, then be reviewed at the regional review committee . SEARO does not provide funds for conduct of research. . Since 2010, TDR has not been able to continue this process due to shortage of funds. This indicated that the recommendation has been implemented, until recently. Agenda item 2.1.3.b UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development & Research Training in Human Reproduction (HRP) Recommendation 28.6 WHO-SEARO should work closely with HRP/HQ in improving the utilization of research findings and in supporting research capacity strengthening in human reproduction and related areas, with the focus on selected SEAR countries with limited research capacity, such as Timor-Leste, DPR Korea, Bhutan and Maldives. Implementation No evidence was available in the Report of the 29th ACHR showing support in research capacity strengthening and utilization of research findings focusing countries, Timor-Leste, DPR Korea, Bhutan and Maldives. Information from RPC explains the mechanisms used by HRP/HQ in provision of funds and describes the role played by RPC. HRP has their own mechanism and system. The HRP HQ does many publications on research which contribute to policy decisions. Through resource mobilization efforts, SEARO HRP sets aside funds for research at country level though not on a routine basis , but on an ad hoc basis. Some countries got funding for HRP research from donors at the country level, and SEARO RA is involved in providing technical advice. Some studies were conducted in the three small countries referred to. This information indicates that the recommendation has been implemented. Agenda item 2.2. Regional Vaccine Policy as a Follow up to the SEA-ACHR Work related to a regional vaccine policy commenced in 1999 with the primary purpose of providing a policy and strategic framework for decision making on a range of issues related to production, availability and distribution of vaccines in the countries of the region. Following a presentation and the discussion, three recommendations were made. Recommendations 28.7 WHO-SEARO should widely advocate and disseminate the Regional Vaccine Policy, conduct in-depth country case studies on specific key issue areas and make appropriate plans for implementation of this policy. 28.8 All countries should develop their own National Immunization Policies and also establish Technical Advisory Groups to continuously advise the Ministry of Health on specific national immunization and vaccine issues. 28.9 All countries should establish National Regulatory Authorities, with fully supported National Control Laboratories, capable of carrying out the regulatory functions appropriate for their vaccine procurement practices. Implementation The 29th ACHR report did not provide any information on the implementation of the above recommendations. The Report of the Second Follow up meeting on implementation of the Thirty First ACHR recommendations held in September 2009, included the establishment of a sub committee of SEA -ACHR on vaccines and drug development, as one of the agenda items. The composition of the sub committee, the terms of reference and modus operandi were agreed upon at this meeting indicating that taking follow up action on these recommendations has commenced. Agenda item 2.3. Epidemiological Research in Tuberculosis Control: Updating TB Prevalence Following a presentation on the overview of the Tuberculosis situation in the region and a discussion, the following recommendation was made. Recommendation 28.10 WHO should provide and facilitate technical and financial support to Member countries in order to strengthen their epidemiological surveillance and health research capabilities, both in the basic and operational aspects, for effective control of TB. This would enable the national TB control programmes to measure the epidemiological impact of TB control efforts in terms of reduction of disease burden. Implementation Report of the 29th ACHR does not provide any information on the implementation of this recommendation. Information from the Technical Unit has provided the information given below. WHO provided technical support most of the time and assisted the countries to find funding from donors to conduct surveillances. One example is Myanmar, where the proposal development on TB was done by the Ministry of Health team and WHO sent experts to assist. WR then forwarded the proposal to donors to obtain funding. When funding was available and surveillance was to be performed, WHO staff were involved in the implementation of the surveillance and in providing technical advice to the researchers. Measuring the impact of TB control was discussed in a seminar. This indicates that the recommendation has been followed up in some countries, but does not provide information relevant to all countries of the region. Agenda item 2.5. Health Research on Prevention and Control of Thalassaemia (Scientific Debate) The scientific debate during this ACHR session was on Thalassaemia. Following several presentations and discussions, four recommendations were made. Report of the 29th ACHR session did not have any information on the implementation of these recommendations. However, it was possible to obtain information related to each of these recommendations from the technical unit (NCD). The information from the Technical Unit is presented, by each recommendation. Recommendation 28.11 WHO-SEARO should identify national and regional centres of excellence for conducting basic and operational research on Thalassaemia. Implementation Information from the NCD unit: India, Indonesia, Sri Lanka and Thailand strengthened national capacity to control Thalassaemia and each country has a comprehensive national Thalassaemia programme. Recommendation 28.12 In collaboration with WHO CCs and national centres of excellence, WHO-SEARO, should conduct a situation analysis on the availability of services for prevention and control of Thalassaemia in Member Countries. Implementation Information from NCD Unit: Thalassaemia prevention programmes have been introduced in India, Indonesia, Maldives and Thailand, with WHO technical support. This statement does not clearly indicate whether the proposed recommendation has been implemented. Recommendation 28.13 WHO-SEARO should establish a regional technical expert group on Thalassaemia, consisting of various disciplines to update and disseminate the information on the development of knowledge and technology related to prevention and control of Thalassaemia and provide necessary advice and guidance to Member Countries. Implementation Information form NCD unit: WHO technical support for the thalassaemia programmes is to ensure the provision of basic facilities, skills and knowledge for prevention and management. Such programmes should be integrated into existing health-care systems and take into account social and cultural needs of the community. The expert group on Thalassaemia has not been established yet. Recommendation 28.14 Countries should be facilitated and supported in capacity building, conducting technical consultations, seminars and operational research on the ethical–legal issues of thalassaemia. Implementation Information form NCD unit: Technical support has been provided to the countries in the form of technical updates and sharing of country experiences. Even though this indicates some degree of follow up, detailed information is not available. Summary Fourteen (14) recommendations were made by the 28th Session of SEA-ACHR. The Report of the 29th Session of the ACHR indicates that only two (2) recommendations have been implemented. Additional information available from the technical units in SEARO indicate that in respect of recommendation 28.4, follow up action has been taken, for recommendations, (28.2 and 28.5) implementation activities have commenced and are on going. In relation to the recommendation on vaccine policy, some concrete follow up actions have commenced in 2009 with the establishment of the Sub Committee of SEA-ACHR on vaccines and drug development. However, the available information on three recommendations on Thalssaemia and one on Tuberculosis, is not adequate to make a clear assessment of the status of implementation. 8.2.4 29th ACHR: SEA-ACHR, Yangon, Myanmar,14-16 June 2004. Nine recommendations were made at the session on conclusions and recommendations. Of them, three (29.1 – 29.3) were on health research and the others, were on EID. The report of the 30th ACHR does not provide information on the implementation of the recommendations 29.1, 29.2 and 29.3 given below. However, information available from RPC provides some relevant information. Recommendations 29.1. Strongly endorses the view that health research is an indispensable means to effective development of health systems, and urges Member States to develop and strengthen the capacity for health systems research, in order to address the challenges in reaching the MDGs. (These two recommendations is is to some extent overlaps with several previous recommendations. 29.2 Recommends that the Regional Office for the SEA Region facilitates the use of the new framework and cutting-edge instruments in implementing effective and efficient health research systems Implementation Report of the 30th ACHR does not provide any information on the implementation of this recommendation. However, information from RPC indicates that the document is available electronically and any institute in any country can use it. WHO SEARO provides technical advice when in demand but not financial support for this exercise. Recommendation 29.3 Recommends that WHO, especially WHO-RPC/HQ, promotes and supports the development and dissemination of tools and methodologies (both qualitative and quantitative) that are crucial for extending health research systems beyond conventional approaches. Implementation Report of the 30th ACHR does not provide any information on the implementation of this recommendation. However, information from RPC provide the following information. In 2005, COHRED published guidelines for research priority setting which is widely used now, there are many other tools and guidelines published and countries are at liberty to select and use the ones according to the country capacity, at country level. Recently a checklist for reviewing ethics in research proposal adapted by SEARO, from HQs checklist was distributed to all countries for use. This information indicates that follow up action is being taken on this recommendation. Recommendations on EID There were 5 recommendations made on the subject of Emerging Infectious diseases (EID) which is a high priority area for countries of the region. 29.4 Recommends that health research on EID should lead to strengthening and development of effective integrated disease surveillance systems, which would include strengthening of human resources; networking of public health and biomedical laboratories; capacity-building and budgetary and financial support 29.5 Recommends that the Regional Office facilitates and supports the public policy analysis including economic analysis, in relation to the prevention and control of EID; 29.6 Recommends that the Regional Office facilitates health research focusing on public and media perception on the prevention and control of EID, as well as public responses EID; 29.7 Recommends the Regional Office to establish a coordinating centre (within WHO) to coordinate the work of the existing disease surveillance network, facilitate capacity building, and to conduct situation analysis (risk and vulnerable assessment), as well as to provide necessary support for strengthening the capacity for disease surveillance and health research, including epidemic alert and response by Member States, and 29.8 Requests the Regional Director to develop the work plan comprising health research priorities for the prevention and control of EID in the Region as proposed by this ACHR session, within the framework of Asia-wide disease surveillance strengthening. WHO should also follow up on resource mobilization and immediate implementation, in collaboration with country offices, regional offices and headquarters, as well as with other development partners. Implementation (29.4 – 29.8) The report of the Thirtieth Session of ACHR, Jakarta, Indonesia, 2007 provides the following information indicating the implementation of the above recommendations. In line with the ACHR recommendations, a document entitled ‘Combating Emerging Infectious Diseases’ was prepared by a Technical Working Group and published in 2005. A working paper on EID vis-à-vis economic development was also prepared and presented at the Regional Conference of Parliamentarians on “Healthy public policies and emerging diseases” held in October 2005. Comprehensiveassessment of the national disease surveillance system and response (including the laboratory aspects) was carried out in Indonesia, the Maldives, Myanmar and Sri Lanka. Actions have been taken to develop a plan of action for the integrated surveillance of diseases for these countries. In SEARO, an Operations Room for Outbreak Alert and Response System was set up in February 2006. Support was provided to medical officers from Bhutan, Myanmar, Nepal and Sri Lanka for participation in a 12-week Field Epidemiology Training Programme (FETP). In July 2006, SEARO published literature and non-peer reviewed reports and documents on Avian influenza in the past five years. In addition, ‘Avian influenza in the South-East Asia Region: priority areas for research’ was published in October 2006. A bi-regional meeting on EID was organized by SEARO and Western Pacific Region;a Office(WPRO) during 18–20 July 2006. Another meeting was organized by SEARO on 30–31 March 2006 to assess the drug manufacturing capacity in the Region for pandemic influenza preparedness. A manual on the diagnosis of avian influenza was published in collaboration with the WHO Country Office, India and distributed to all Member countries. To facilitate research on organisms that require laboratory bio safety level 3 (BSL3) facility, technical support to establish the requisite laboratory infrastructure was provided to Thailand and India. WHO SEARO and the WHO -WPRO work in close collaboration to combat emerging diseases using the bi-regional approach under the “Asia–Pacific strategy on emerging diseases”, which provides a framework for strengthening national capacities for preparedness, and prompt detection and rapid response to EID in order to protect national and global health security in the Asia–Pacific. A bi-regional technical advisory group (TAG) has been established to guide the implementation of this strategy by the two Regional Offices. The WHO vision for communicable disease prevention, control and elimination/eradication was articulated in the Regional Office publication entitled CDS profile and vision as well as a regional strategy Combating emerging diseases in SEAR WHO missions were fielded to assist Member countries in the investigation/management of outbreaks of Avian influenza in Indonesia and Thailand; Nipah virus disease in Bangladesh; Japanese encephalitis (JE) in India; Myocarditis in Sri Lanka; Dengue in Indonesia, the Maldives, India, Nepal; Botulism in Thailand and other communicable diseases in the other countries. The Regional Office continued to support Member countries in the control and containment of communicable diseases through a surveillance and response programme, with major assistance from donor agencies such as the Asian Development Bank (ADB), World Bank, AusAID, United States Agency for International Development (USAID), US Centers for Disease Control (CDC) and Canadian International Development Agency (CIDA). The Communicable Disease Surveillance and Response (CSR) unit at SEARO coordinates the overall work of WHO relating to emerging infectious diseases including surveillance, response and capacity building, and works in close collaboration with Country Offices, WPRO and WHO Headquarters. Support for training has been given to medical officers from Bhutan, Myanmar, Nepal and Sri Lanka in the 12-week FETP course at the National Institute of Communicable Diseases (NICD), India. Paramedical staff has also been trained for four weeks in epidemiology, and prevention and control of communicable diseases. In order to bring WHO operations closer to countries, WHO SEARO has established two CSR subunits – one in Bangkok and the other at NICD, New Delhi in 2006. Formal agreements to make these two subunits fully functional were signed between the Health Ministers of the two countries and the WHO Regional Director for each of the subunits. The agreement for Bangkok was signed on 27 October 2006 and the agreement for New Delhi on 7 April 2007. Summary Of the 8 recommendations made during the 29th session, 5 were in relation to EIDS and detailed information related to their implementation is available. In respect of the other 3, information from RPC unit indicate their implementation even though the Report of the 30th ACHR sessions does nor provide such information. 8.2.5 30th ACHR: SEA-ACHR, Jakarta, Indonesia,14-16 March 2007. The Committee adopted 9 recommendations at the concluding session. Recommendation 30.1. Recommends that WHO SEARO should coordinate and facilitate technology development, innovation and transfer of new vaccines, medicines and other interventions among SEAR countries, enabling the Region to be self-reliant. It is necessary to strengthen the public health system through research for development including the research information system, research laboratory system, clinical research system and ethical evaluation system for utilization of new products and technologies.( This recommendation focuses on several of the recommendations done in previous ACHR sessions and is very broad ). Implementation The Report of the 31st ACHR session reports on the progress made in the area of promotion of research and development in areas of drugs and vaccines. The need for clinical trials was highlighted, indication follow up on this recommendation. Recommendation 30.2. Strongly endorses the view that resource allocation in health research remains a critical issue in countries of the Region and that more investment in health research is necessary for health development in Member States. WHO SEARO should advocate for national governments to allocate the necessary funds for health research. SEARO should increase the allocation for health research under the WHO budget, ensuring equitable distribution of funds among the Member countries, with due attention to individual and institutional capacity strengthening. Implementation Report of the Thirty-first Session of ACHR, Nepal, 2009 provides information on the follow up of this recommendation. At this meeting, it was stressed that more investment in health research was required. The biennial work plan was presented. A research pool fund for USD 500,000 was established in 2008. The Indian Council of Medical Research (ICMR) and WHO were collaborating in carrying out a study on funds investment for health research. Recommendation 30.3 Recommends strengthening of research management in Member countries. Utilization of research findings should be promoted through development of a mechanism of effective communication between research producers and users, as well as promotion of evidence-seeking behavior of policy-makers, planners and managers. Implementation By way of strengthening of the research in Member countries, the first meeting of the Task Force was held in New Delhi on 6-7 March 2008. An Inter-country Workshop on Research Management was conducted in Bali, Indonesia from 3-6 June 2008. Country-level workshops on research management have also been held subsequently in various countries of the region. (Ref. Thirty-first Session of ACHR,Nepal,2009) Recommendation 30.4. Recommends the setting up of a Technical Advisory Group on Avian Influenza in SEARO. WHO SEARO should disseminate the results of the Pilot Avian Influenza Prevention and Control Project to Member countries for use as appropriate, and assist in identifying data analysis experts to analyse the existing data collected in Indonesia. Implementation A Regional Technical Advisory Group (TAG) on Avian Influenza was established in April 2007. The Expert Group made five recommendations from strengthening surveillance, detecting cases early on, elucidating environmental factors in disease transmission to recording human AI cases. A Regional Task Force Meeting on Avian Influenza was held in Bali to identify and address the priorities in AI research in the region (Report of the Thirty-first Session of ACHR, Nepal, 2009) Recommendation 30.5. Endorses the view that DECs should play a pivotal role in setting priorities for research activities of the TDR to be funded by development partners. The Committee recommends that TDR should consider reducing the gap between institutions/universities/ researchers and research users – the Ministries of Health. The investment pattern for research funding should be considered in the context of the impact to be achieved by conducting the research. The Committee requests the TDR to increase the resource allocation of small-scale research grants to expand research activities in SEAR countries. Implementation There was no information on the status of implementation of this recommendation in the Report of the 31st ACHR, even though mention was made of the actual diseases that require attention in SEAR region. Recommendation 30.6 Requests WHO SEARO to play a catalytic role in facilitating linkages between MRCs/research institutions in the Region. SEARO should commission research studies in Member countries to evaluate the infrastructure and research environment of research institutions. Networking of research institutions in Member countries should be promoted to develop a critical mass of researchers. ACHR recommends strengthening of MRCs or analogous bodies to provide stewardship to the national health research system of each country. In countries where MRCs do not exist (Bhutan, the Maldives, Timor-Leste) SEARO should work with them using priority research programme(s) as a starting point and move towards establishing research coordinating units/centres. Implementation Evaluation of the research infrastructure in the region and networking between various research organizations in the region was addressed. In this regard, the ICMR has prepared a directory of all health research institutions in India to facilitate collaboration in the Region.(Report of the . Thirty-first Session of ACHR, Nepal, 2009). However, this information is limited to one country and information from other countries have not been provided indicating that implementation of the recommendation has been limited. Recommendation 30.7. Recommends that WHO SEARO promote ethical standards in conducting research in Member States through various mechanisms. Implementation SEARO has had a fruitful collaboration with the Forum for Ethical Review Committees in Asia and the Western Pacific (FERCAP) and Strategic Initiative for Developing Capacity for Ethical Review (SIDCER) under TDR HQ. Five members from Bangladesh, Bhutan, India and Nepal were certified as Regional Surveyors in July 2008. Six Ethics Review Committees (ERCs) / Institute Review Boards (IRBs) were accredited by FERCAP and SIDCER. A training course was held in Indonesia from 18-22 March 2008, and an orientation programme on Ethical Review was organized by WHO in Bhutan in July 2008. (Ref. Thirty-first Session of ACHR, Nepal, 2009). This information indicates that implementation of the recommendation is on going. Recommendation 30.8 WHO –SEARO should establish a Technical Working Group(TWG) to develop a strategic framework for Member countries to better organize, manage and disseminate existing knowledge in order to facilitate utilization of research findings through promotion of evidence based decision making. 30.9 Recommends an interactive forum for ACHR members as well as other regional advisers be established in SEARO so that they can exchange views on health research in SEARO in between ACHR sessions. This will help to sustain interest and generate ideas as well as actions in health research more energetically and regularly through ACHR members. Implementation There is no evidence that this recommendation has been implemented. It is important to note that a similar recommendation was made by previous ACHR sessions including the 27th Session of ACHR in 2002. Summary There were total nine (9) recommendations adopted by the 30th Session of the SEA-ACHR. Of them follow up action has been undertaken in respect of 6 recommendations. Of them, follow up related to 4 recommendations are on going with the need to involve more countries. The two recommendations (30.8 and 30.9) focus on broad based activities which are important for promoting health research in the regions. However, there is no information available to assess the implementation of these recommendations. 31st ACHR session – an overview The Thirty first session of the ACHR – WHO, SEAR was held in Kathmandu, Nepal from 21-23 July 2009 . The business session included a presentation on the follow up actions on the recommendations of the 30th session of WHO –ACHR. This session was very informative and made it possible to obtain information of the status of follow up of the recommendations made at the 30th ACHR session. After several presentations on relevant topics, a number of recommendations were made at the session on adoption of recommendations, under the following headings: 1. Follow up actions on the recommendations of the thirtieth session of SEA-ACHR (6) 2. Area of avian influenza research (4) 3. Promotion of research and development in areas of drugs and vaccines (7) 4. Research management in countries (4) 5. Research management in WHO/SEARO (5) 6. Review of global work of WHO on health research (3) 7. UNDP/World Bank/UNICEF/WHO special programme for research and training in tropical diseases (1) 8. UNDP/UNFPA/WHO/World Bank special funding of research development and research training in human reproduction (1) 9. Research priorities in communicable diseases (3) 10. Research priorities in non communicable diseases (5) 11. Review of the regional strategy on health research ( 12. Overall recommendation: 12.1. WHO Representatives should play a pivotal role in supporting health research system in countries by: - making use of the WHO Regular Budget (Assessed contribution and voluntary contribution) to support research activities in line with national research priorities - coordinating with other key actors in health research, e.g. the Global Fund to provide funding for research in priority areas -assisting the development of good review mechanisms for project evaluation and for assessing the utilization of research results 12.2. Countries should develop national health research strategies that fit into their national health systems 12.3 Regional Office should develop at least the following three strategies to supplement national health research strategies 12.3.1. Support research management in countries 12.3.2. Create a platform for knowledge management and for sharing knowledge 12.3.3. Support the establishment of mechanisms to ensure ethical review of projects. The Regional Office should strengthen the infrastructure for ethical review and for supporting quality research. 12.4 At least 5% of the WHO Regular Country Budget should be made available to support all types of research activities. The regional office should also try and mobilize additional resources from international donors and non governmental organizations Information available on the follow up actions taken after the 31st ACHR session A series of meetings were held to follow up n these recommendations at SEARO The first follow up meeting was held on the 29th July 2009 at which 8 recommendations (including improvement of recommendations and the preparation of the report of the meeting) were identified for immediate action. These were: Formulation of regional and country strategies on research for health Establishment of ACHR Sub Committee on Vaccines and Drugs development to build capacity in South East Asia for public private partnership Review the last 5 AVHR meetings and recommendations as to whether those recommendations have been implemented and were possibke to be implemented. Review the regional policy for vaccine development. This issue was discussed in Myanmar in 2005 and it needs to be re oriented as the regional policy Assess the quality of research conducted during 2008 – 20009 in order to ensure the quality of research proposals and re[ports as well as research capacity Strengthen research capacity in Bhutan, Maldives and Timor Leste through country visits for a needs assessment Available information as per mid July 2011. 1. The recommendations have been revised and are included in pages 10 – 16 of the report of the 31st ACHR. 2. The report of the 31st ACHR has been finalized and disseminated. 3. Regional Strategy for research for health: At the second follow up meeting, held in September 2009, Dr. Mahesh Maskey (Nepal) presented a review of the regional strategy. Dr.Somsak (Thailand) presented the guidelines for developing a national health research strategy. The two presentations were to be incorporated and a document was to be produced by July 2011. The work commenced in February 2011 and a draft paper was prepared in consultation with relevant staff. FHR requested the RD to consider holding a national consultation for strategy for health. The Regional Consultation was held in Kathmandu from 6-8 July with 30 participants, from HQ, nominees from 10 member countries, except DPRK, research experts from health and non health sectors, NGO and INGO. Final draft of the regional strategy is ready. 4. Sub committee on drugs and vaccine development At the 2nd F.U. meeting in September 2009, a sub committee consisting of 5 members was established, TOR decided on. Since then, two meetings of the sub committee have been held in March 2011 and July 2011. 5. Review of the regional policy on vaccine for SEA (now changed to regional policy on immunization) is being undertaken. Conclusions (on review of recommendations of the 5 ACHR sessions 20 - 30 ) 1. In keeping with the ToR , nearly half of the recommendations made are related to aspects relevant to health research. As such there is some degree of overlap between recommendations, even though some ’new’ areas have been highlighted in each recommendation. 2. As would be expected from the ACHR as a body whose main function is to provide advise to the RD, many of the recommendations are focused on strengthening health research in the countries of the region. Many of the statements given as recommendations are ‘general’ and include several follow up actions by different implementing agencies within and outside SEARO. On the other hand, such generic statements enables the follow up to include different approaches and activities as required by SEARO, the technical unit and/or the country. There were some recommendations which are very specific clear statements. 3. In general, all recommendations made related to research are relevant to all countries of the region, the degree of relevance and the topics of importance varied between different countries. However, this does not have any negative influence on the importance of recommendations 4. Of the technical subjects on which recommendations are made, some are relevant to all countries of the region with others being less so. However, the emphasis of all recommendations is related to research capacity strengthening which is relevant to all countries irrespective f the topic of research. 5. A total of 55 recommendations have been made among which 35 were to be followed up at SEARO, 5 at SEARO in collaboration with relevant units at WHO/HQ and others (15) at country level. However, even those to be implemented at the country level, WHO-SEARO have an important role to play in the follow up. 6. The follow up action required varied in many ways. Some require immediate “one time action” whereas others require initiation of implementation of follow up actions within a period of time and the implementation to be an on going process. Many of the recommendations seem to belong to the latter category. Implementation of the recommendation need not be completed during the year following the ACHR session, even though it is important to commence the activities relevant to implementation during that period. However, it is necessary to assess the status on implementation on an annual basis, if the recommendations are to have an impact. 7. Information of the follow up action taken in respect of each recommendation is an important issue. Such information has been documented in the subsequent ACHR report only in respect of some recommendations. Additional information was obtained from the technical units wherever feasible, during this review. 8. Introduction of a session under an agenda item titles ‘Follow up of recommendations ‘ from 29th ACHR session is of crucial importance even though in the previous sessions too, some discussions on the follow up is available. This practice needs to be strengthened and continued. The status of implementation should be clearly given and discussed , in order to assess the progress. 9. Of the total of 55 recommendations, 35 have been implemented and some are on going. Four (4) recommendations have not been implemented with no information available on 4 others. Information available on 12 recommendations are not adequate to make an assessment of the status of implementation. Information of the status of implementation based on all sources of information (reports, technical units) by ACHR session are presented in table 2. Table 1 - Summary of the status of implementation of the recommendation of ACHR sessions 26, 127, 28, 29 and 30. ACHR sessionNo. of recommendationsStatus of implementation26th 12Report of the 27th ACHR indicated that 4 have been implemented. However, with information from RPC and other technical units, follow up action has been taken in respect of all recommendations, except one ( 26.6)27th 12Of the12 recommendations made during this session, there is no information on the status of implementation of 5 of them, including the two on Arsenic poisoning, from any of the sources. However, at the Second Follow Up meeting of the Report of the 31st ACHR, the issue of research on Arsenic poisoning has been brought up. Of the others, two recommendations on CVDs have been implemented and on 4 others, some information is available which are not adequate to assess the status of implementation.28th 14The Report of the 29th Session of the ACHR indicates that only two (2) recommendations have been implemented. Additional information available from the technical units in SEARO indicate that in respect of recommendation 28.4, follow up action has been taken and for recommendations, (28.2 and 28.5) implementation have commenced and are on going. In relation to the recommendation on vaccine policy, some concrete follow up actions have commenced in 2009 with the establishment of the Sub Committee of SEA-ACHR on vaccines and drug development. However, the available information on three recommendations on Thalssaemia and one on Tuberculosis, is not adequate to make a clear assessment of the status of implementation.29th 8Of the 8 recommendations made during the 29th session, 5 were in relation to EIDS and detailed information related to their implementation is available. In respect of the other 3, information from RPC unit indicate their implementation even though the Report of the 30th ACHR sessions does nor provide such information. 30th 9Follow up action has been undertaken in respect of 6 recommendations among which follow up related to 4 are on going with the need to going with the need to involve more countries (30.1).  Recommendations 1. It is commendable that in recent years, an agenda item titled ‘follow up of recommendations of the previous ACHR’ has been included from the 30th ACHR session onwards. However, in keeping with the inputs required for implementation, it may be necessary to include the follow up not only for the following ACHR session, but also for later sessions. The practice of including this agenda item in the ACHR session has to be continued with appropriate modifications to obtain information on the recommendations that have to be implemented on an ‘on going’ basis 2. A mechanism to disseminate the recommendations made at ACHR meetings, at SEARO and at the country level within the shortest possible time has to be streamlined. 3. It is necessary to develop a formal system for follow up on the recommendations at SEARO, through sharing of information among all relevant technical units, obtaining their views on the priority areas ‘within’ those recommendations and the feasibility of implementation both at SEARO and at country level. A forum (based at SEARO) that meets on a regular basis to discuss the implementation of the recommendations will be a useful input. Such a forum has to be developed where the relevant technical Unit/s could provide information on the follow up on a periodic basis, may be after 6 months initially. Issues related to implementation need to be discussed. It is suggested that the RPD Unit has a major role to play in the follow up of the recommendation which has to be undertaken in collaboration with all technical units and relevant units at HQ. 4. it is suggested that specific areas which are priorities within the recommendation of an ACHR session to be followed up through special cub committees. 5. Financial support for implementation need to be made available. This is specially relevant as the ACHR sessions are held biannually and the biannual financial planning to take cognizance of the recommendations of ACHR. 6. The benefit from all recommendations has to be finally at the country level. There is a need for SEARO to implement a mechanism to follow up at country level in countries where such a system is not available. It is suggested that the focal point for research at the country office be provided with a ‘terms of reference’ clearly identifying the expected role that he has to play. It is necessary for the focal point at the country office has strong links with the national focal point for research at the country level as well as other relevant research institutions. (For example, there are programme officers for MCH, Communicable diseases etc. in many country offices). Once such a system if formalised, there has to be a strong link between such an officer and the technical unit responsible for research (RPC) in SEARO. It is necessary to develop a mechanism at the country level, to provide access to such recommendation to a broader group, within a given country in order to sensitise the relevant personnel on issues related o health research. This should be an important function of the focal point at the country office level. (It must be noted that it was not possible to obtain any information on the status of implementation of recommendations at country level during this review due to inaccessibility to such a mechanism, even though a tool was developed for this purpose- Appendix 1 B ). List of documents 1. Report of the Twenty-sixth Session of WHO South-East Asia Advisory Committee for Health Research organized in Thimpu, Bhutan from 17-20 April, 2001.World Health Organization, Regional Office for South-East Asia, New Delhi,India,2001. 2. Report of the Twenty-seventh Session of WHO South-East Asia Advisory Committee for Health Research held in Dhaka, Bangladesh from15-18 April.2002. World Health Organization, Regional Office for South-East Asia, New Delhi, India, 2002. 3. Report of the Twenty-eighth Session of WHO South-East Asia Advisory Committee for Health Research organized in Male’, Maldives from 12-13 August, 2003. World Health Organization, Regional Office for South-East Asia, New Delhi, India, 2003. 4. Report of the Twenty-ninth Session WHO South-East Asia Advisory Committee for Health Research held in Yangon, Myanmar from 1 4-16 June, 2004. World Health Organization, Regional Office for South-East Asia, Indonesia from 14-16 March, 2007. 5.Report of the Thirtieth Session of WHO South-East Asia Advisory Committee for Health Research organized in Jakarta, Indonesia from 14-16 March,2007. World Health Organization, Regional Office for South-East Asia, New Delhi, India, 2007. 6. Report of the Thirty-first session of WHO South-East Asia Advisory Committee for Health Research held in Kathmandu, Nepal from 21-23 July,2009.World Health Organization, Regional Office for South-East Asia, New Delhi,India,2009. 7. Report of the Second Follow up Meting on implementation of the Thirty First ACHR Recommendations – September 2009. WHO, Regional Office for South East Asia. Acknowledgments I wish to thank Dr. Samlee Pliangbanchang , Regional Director, WHO – SEAR for giving me the opportunity of undertaking this review. I am grateful for the assistance given by Dr.Adik Wibowo, TIP, RPC, WHO – SEARO, Mr. Ravinder Kumar Senior Administrative Secretary, RPC and other staff of the RPC unit in the preparation of this report. Staff of relevant technical units provided useful information which was incorporated into this report and I wish to thank them all. Several of the ACHR members responded to my invitation to make a contribution to this report. To all of them, I am very grateful. Annexes Annex 1 Format to review individual recommendations ACHR No: Year Recommendation Clarity Relevance to countries of the region Is it repetitive? Does the recommendation clearly identify follow up action/s? Has the recommendation been implemented? If Yes – current status Stage of implementation By whom What were the facilitating factors? Has any use being made of the results of the study, if available/ If not, why? Any other relevant information Annex 2 INFORMATION FROM TECHNICAL UNITS Technical Unit: ------------- ACHR No. YearRecommendationInformation required on Follow up ( Please indicate briefly on this same document) 1. 2. 3. 4.Continued – one row for each recommendation Annex 3 INFORMATION TO BE COLLECTED FROM COUNTRIES It will be useful to collect information from all the following sources; 1. Focal point for research at the national level 2. ACHR members and others who participated in ACHR meetings. This will be in two parts. PART I General information: 1.1. ACHR report – received regularly/ no Who receives the report now? Main stakeholders in conducting research within the country Suggestions as to whom the ACHR report should be sent on a regular basis 1.2. Sharing of information at country level Methods used ( e.g Dissemination meetings, Workshops Conducting health research at country level Facilitating factors Hindering factors Brief description of financial / human resources available for research? Continued ….. 1.3. Suggestions as to how ACHR recommendations could be made more useful: At the stage of development of the recommendation Dissemination of the recommendation Possible mechanisms tp influence implementing agencies Follow up Support that could be extended from SEARO 1.4. Brief overview of the linkages between the main research organizations within and outside the national health system INFORMATION TO BE OBTAINED FROM COUNTRIES PART II ACHR No: Year: Recommendation Implemented If implementedIf not implemented, any reasonsYesNoCurrent statusBy whomFacilitating factorsIf completed, follow up   Annex 4 INFORMATION FROM ACHR MEMBERS (delete what is not applicable) ACHR REPORT Received the recent ACHR reportYes / No NOWho receives the report at present (in your country)Suggestions as to whom the ACHR report should be sent(additional persons)Any methods used to share information at country levelSuggestions to improve sharing of information at country levelSHARING OF INFORMATION AT COUNTRY LEVEL Is there a mechanism Yes/NO If yes, briefly indicate such mechanismsAny suggestions for methods of dissemination CONDUCTING HEALTH RESEARCH AT COUNTRY LEVELFacilitating factors Hindering factors Financial resources, adequate (general observation) Yes/No If no, any suggestions for improvement Human resources, adequate (general observations) If no, any suggestions for improvements  SUGGESTIONS AS TO HOW ACHR RECOMMENDATION COULD BE MADE USEFULAt the stage of development of the recommendation  In dissemination of the recommendations Possible mechanisms to influence implementing agencies Role of SEARO  Brief overview of the linkages between the main research organizations within and outside he national health system, in your country   Of the 36 e mails sent to ACHR members and some special invitees, 21 were returned indicating their non availability at those addresses. The number of responses from ACHR members were limited.     6 Review of Recommendations of the 26th – 30th Sessions of the Advisory Committee on Health Research, WHO-South-East Asia Region