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32nd WHO South-East Asia Advisory Committee on Health Research Bangkok, Thailand, 11-13 October 2011
Review of the 31st WHO SEA-ACHR follow up points of recommendation
Dr. Gunawan Setiadi Regional Advisor, Research Policy and Cooperation WHO Regional Office for South-East Asia
DRAFT
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32nd WHO South-East Asia Advisory Committee on Health Research Bangkok, Thailand, 11-13 October 2011
Recommendations of the 31st SEA-ACHR 12 major areas of recommendations 6 key strategic follow up actions:
Development of regional strategy on research for health Establishment of SEA-ACHR Subcommittee on Vaccine and Drug Development Review of the Regional policy on research aspect of immunization Review of the last five SEA-ACHR meetings (26th – 30th Sessions) and recommendations. Assess the quality of research supported by WHO SEARO and Country Offices implemented in 2008-2009. Strengthening research capacity in Bhutan, Maldives and Timor-Leste through countries visits.
The Thirty-first Session of the WHO SEA-ACHR made the following recommendations: Recommendations pertaining to the follow up actions on the recommendation of the thirtieth session of the SEA-ACHR Recommendations pertaining to the area of avian influenza research Recommendations pertaining to the area of promotion of research and development in areas of drugs and vaccines Recommendations pertaining to research management in countries Recommendations pertaining to research management in WHO/SEARO Recommendations pertaining to review of global work of WHO on health research Recommendation pertaining to UNDP/World Bank/UNICEF/WHO Special Programme for Research and Training in Tropical Diseases Recommendation pertaining to UNDP/UNFPA/WHO/Wolrd Bank/Special Funding of Research Development and Research Training in Human Reproduction Recommendations pertaining to research priorities in communicable diseases Recommendations pertaining to research priorities in non-communicable diseases Recommendations pertaining to review of the Regional Strategy on Health Research The overall recommendations
The first meeting was conducted on 29 July 2009. There were 8 major follow up actions taken after the meeting: Consolidating the recommendations Writing of proceeding and full report of the meeting Formulation of regional and country strategy for research for health Establishment of ACHR Subcommittee on Vaccine and Drug Development to build capacity in South East Asia for public private partnership. Review of the Regional Policy on Vaccine for South East Asia. Review of the last five ACHR meetings and recommendations whether recommendations have been implemented and were possible to be implemented. Only the recommendations that could be implemented should be considered. Assess the quality of research conducted during 2008-2009 in order to ensure the quality of research proposals and reports as well as research capacity. Strengthening research capacity in Bhutan, Maldives and Timor-Leste through countries visits for needs assessment
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32nd WHO South-East Asia Advisory Committee on Health Research Bangkok, Thailand, 11-13 October 2011
Follow up actions on the recommendation of the thirtieth session of SEA-ACHR WHO SEARO has reminded country offices to work closely with Member Countries in developing WHO biennial work-plans on research related activities. WHO has worked with SEA Network of Medical Council Network and medical councils at the national level in further strengthening the institutional mechanisms for improving ethical standards including research. Advocacies on Ethical Review.
Follow-up actions on the recommendation of the thirtieth session of SEA-ACHR (1) WHO SEARO has reminded country offices to work closely with Member Countries in developing WHO biennial work-plans, including work plan to support research and research capacity strengthening activities. (2) WHO has worked with SEA Network of Medical Council Network and medical councils at the national level in further strengthening the institutional mechanisms for improving ethical standards including research, particularly through developing and disseminating learning modules for teaching medical ethics in undergraduate medical education. Several WHO Country Offices have been supporting Ethical Review Committees in implementing ethical review to research involving human subjects. (3) Advocacies on Ethical Review Boards (ERB) have been done by WHO staffs in countries in their respective technical areas. SEA Network of Medical Council has developed and disseminated modules for teaching medical student on ethics.
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32nd WHO South-East Asia Advisory Committee on Health Research Bangkok, Thailand, 11-13 October 2011
Avian influenza research Influenza surveillance, including for AI, in the context of the pandemic was formally reviewed by a joint WHO / MoPH team in Thailand 5-9 October 2009. Regional meeting of National Influenza Centres (NIC) with emphasis on determination of drug resistance in influenza virus was held in Bangkok in August 2010. Influenza Pandemic related meeting in SEA Region was held in Cochin, Kerala (India) in February 2010 which was jointly organized by SEARO and CDC Atlanta. WHO collaborates closely with FAO and OIE and there are regular ‘tripartite’ meetings under the ‘One Health’ banner. WHO SEARO held a regional meeting to discuss a ”Public Health Research Agenda for Influenza” in August 2010, An informal consultation was held in New Delhi from 29-30 October 2009 to assess regional pandemic influenza vaccine production capacity and discuss possibility of public private partnership.
Avian influenza research (1). There has been no systematic review of surveillance for avian influenza in the region by WHO. The only country which continues to be severely affected in the region is Indonesia and surveillance for AI is an ongoing issue under periodic scrutiny. Influenza surveillance, including for AI, but in the context of the pandemic was formally reviewed by a joint WHO / MoPH team in Thailand 5-9 October 2009. (2). A system already exists through the WHO Global Influenza Surveillance and Response System (GISRS- new name for GISN): there are eight National Influenza Centres (NICs), one regional influenza reference laboratory and one global H5 reference lab in SEAR. There is a network of National Influenza Centres in SEAR and WPR and annual meeting is organized to share influenza information since 2007. Regional meeting of National Influenza Centres (NIC) with emphasis on determination of drug resistance in influenza virus was held in Bangkok in August 2010. Influenza Pandemic related meeting in SEA Region was held in Cochin, Kerala (India) in February 2010 which was jointly organized by SEARO and CDC Atlanta. The objectives of the meeting were to review surveillance efforts and progress in the region as well as to discuss challenges and to share and document lessons learned from the current H1N1 influenza pandemic. WHO collaborates closely with FAO and OIE and there are regular ‘tripartite’ meetings under the ‘One Health’ banner – and this is precisely the kind of approach we advocate for and support in SEAR Member States. WHO SEARO held a regional meeting to discuss a ”Public Health Research Agenda for Influenza” in August 2010, which included consideration of all the technical areas mentioned above. An informal consultation was held in New Delhi from 29-30 October 2009 to assess regional pandemic influenza vaccine production capacity and discuss possibility of public private partnership.
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32nd WHO South-East Asia Advisory Committee on Health Research Bangkok, Thailand, 11-13 October 2011
Research priorities in communicable diseases South-East Asia Regional Conference on epidemiology held in New Delhi 8-10 March 2010. Representatives from Member countries participated. Research Methodology workshop was organized and Bangladesh, Bhutan, Maldives, India, Indonesia from the Region Participates. Informal Consultation on Research to assess the impact of climate change on communicable diseases was organised at SEARO from 15 to 17 September 2010. Regional meeting of the WHO Collaborating Centres (WHO CC)on Communicable Diseases was held in New Delhi from 2 to 4 June 2010. Eight small research grants have been funded each amounting to US$ 7500 from SEARO/CDS funds.
Research priorities in communicable diseases Assist Member countries in identifying research priorities in communicable diseases. South-East Asia Regional Conference on epidemiology held in New Delhi 8-10 March 2010. Representatives from Member countries participated. Participants remarked that they all benefited by attending the conference. Research Methodology workshop was organized and Bangladesh, Bhutan, Maldives, India, Indonesia from the Region Participates. Informal Consultation on Research to assess the impact of climate change on communicable diseases was organised at SEARO from 15 to 17 September 2010. Participants from Bangladesh, Bhutan, India, Indonesia, Maldives, Nepal, Sri Lanka and Thailand attended the consultation and learnt develop appropriate research protocol in relation to climate change impact on communicable diseases. They were exposed to retrospective and prospective study protocols. Regional meeting of the WHO Collaborating Centres (WHO CC)on Communicable Diseases was held in New Delhi from 2 to 4 June 2010. During the meeting emphasis was given for formation of a net work amongst WHO CCs for strengthening research capacity. Two institutes in India were identified to initiate the networking
Eight small research grants have been funded each amounting to US$ 7500 from SEARO/CDS funds.
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32nd WHO South-East Asia Advisory Committee on Health Research Bangkok, Thailand, 11-13 October 2011
Non communicable diseases In March 2011, a regional meeting was organised in Jakarta. 9 out of 11 Member states have conducted national level multisecotral advocacy meetings during July-September 2011 Surveillance for NCD risk factors have been carried out in 10 out of 11 countries in the Region. Cost effective interventions for NCD prevention and control have been identified globally; studies will be planned in the next biennium to validate the efficiency and feasibility of these measures. SEARO has conducted several awareness activities in 2011 including regional and country level meetings, updating of website, preparation of FAQs and fact sheet and advocacy dockets as well as development of human interest stories on NCDs.
Follow up actions on the recommendations pertaining to NCD: Intersectoral collaboration among various programmes is being solicited at the regional and country levels. In March 2011, a regional meeting was organised involving multiple stakeholders and partner agenecies to discuss health and social challenges of NCDs and mechanisms to address these. As a follow-up to the Jakarta meeting, 9 out of 11 MS have conducted national level multisecotral advocacy meetings during July-September 2011 to raise the priority of NCDs at the country level as well as to sensitize stakeholders about the importance of different sectors in the prevention and control of NCDs. Surveillance for NCD risk factors have been carried out in 10 out of 11 countries in the REgion. SEARO is providing technical and partial financial support for at the country level for designing protocols and questionnaires, capacity building and dissemination of survey findings. Cost effective interventions for NCD prevention and control have been identified globally; studies will be planned in the next biennium to validate the efficiency and feasibility of these measures. SEARO has conducted several awareness activities in 2011 including regional and country level meetings, updating of website, preparation of FAQs and fact sheet and advocacy dockets as well as development of human interest stories on NCDs.
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32nd WHO South-East Asia Advisory Committee on Health Research Bangkok, Thailand, 11-13 October 2011
Research management in countries Strengthening institutional capacity to report and share good practice, by facilitating regional and global networks, and with the involvement of WHO collaborating centres; Developing portal for digital journals in Thailand and Indonesia. Strengthen its advocacy in support of both research and the development of robust national systems for research for health; continue to promote the development of the comprehensive systems for health information that are necessary in order to support national research priorities; providing technical assistance to support the strengthening of national systems for health research; Message has been conveyed to every unit in SEARO and country offices that funds provided for carrying out a research project should include provisions for publication of good quality papers.
In the last two years, WHO Country Offices have been working with Member countries and partners in: Strengthening institutional capacity to report and share good practice, by facilitating regional and global networks, and with the involvement of WHO collaborating centres; Developing portal for digital journals in Thailand and Indonesia. Strengthen its advocacy in support of both research and the development of robust national systems for research for health; continue to promote the development of the comprehensive systems for health information that are necessary in order to support national research priorities; providing technical assistance to support the strengthening of national systems for health research; Message has been conveyed to every units in SEARO and country offices that funds provided for carrying out a research project should include provisions for publication of good quality papers.
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32nd WHO South-East Asia Advisory Committee on Health Research Bangkok, Thailand, 11-13 October 2011
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32nd WHO South-East Asia Advisory Committee on Health Research Bangkok, Thailand, 11-13 October 2011
Research management in WHO/SEARO All research proposals to be funded by WHO SEARO had been reviewed by Research review Committee. Similar mechanism has been implemented in most of WHO country offices as well. WHO Country Offices have been supporting medical research council/ health research council to strengthen their capacity in research management, including in coordinating all research being carried out in the country . WHO SEARO has developed digital library
Follow up actions on the recommendations pertaining to research management in WHO SEARO: (1) All research proposals to be funded by WHO SEARO had been reviewed by Research review Committee. Similar mechanism has been implemented in most of WHO country offices as well. (2) WHO Country Offices have been supporting medical research council/ health research council to strengthen their capacity in research management, including in coordinating all research being carried out in the country . (3) WHO SEARO has developed digital library.
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32nd WHO South-East Asia Advisory Committee on Health Research Bangkok, Thailand, 11-13 October 2011
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32nd WHO South-East Asia Advisory Committee on Health Research Bangkok, Thailand, 11-13 October 2011
The overall recommendations
Report of the WHO 31st Session SEA-ACHR has been developed and distributed WHO SEARO has instructed WHO Representatives to use of the WHO Regular Budget (Assessed Contribution) and Voluntary Contribution to support research activities in line with national research priorities. WHO SEARO has organized workshops on to technically support Member Countries in developing proposal to GAVI and Global fund, including research in priority areas. WHO Country Offices has provided technical support to Member Countries in the proposal development. Research focal points in WHO Country Offices have been working with national stewardship mechanisms, e.g. National Health Research Council / NIHRD The Regional Office has developed research management modules and conducted workshops on health research management in most of the countries.
Report of the WHO 31st Session SEA-ACHR has been developed and distributed to all WHO Country Offices, all Departments within SEARO, and all relevant units in WHO HQ. WHO SEARO has instructed WHO Representatives to use of the WHO Regular Budget (Assessed Contribution) and Voluntary Contribution to support research activities in line with national research priorities. WHO SEARO has organized workshops on to technically support Member Countries in developing proposal to GAVI and Global fund, including research in priority areas. WHO Country Offices has provided technical support to Member Countries in the proposal development. Research focal points in WHO Country Offices have been working with national stewardship mechanisms, e.g. National Health Research Council / NIHRD The Regional Office has developed research management modules and conducted workshops on health research management in most of the countries.
UNKNOWN-0.ppt
11th Meeting of Health Secretaries (HSM)
of South-East Asia Region
12-13 June 2006
Agenda 3: Beyond DOTS:
The New Stop TB strategy
and its implementation
Presentation outline
Background and progress with DOTS
Lessons learnt and challenges ahead
Beyond DOTS: The new Stop TB strategy
Rationale
Goals and objectives
Strategic elements and interventions
Translating the Strategy into action
DOTS Strategy: A historical background
1950s
NTPs established in most high burden countries
1970s
Short course regimens for the treatment of TB introduced
Elements of the future DOTS strategy developed
1980s
TB control efforts not very successful; ‘Outbreaks’ of TB in some developed countries
1993
WHO declares TB a ‘global emergency’
DOTS strategy adopted for TB control
1994
Expanding DOTS implementation; achieving 70% case detection and 85% treatment success targets set for 2000; later postponed to 2005
Progress towards DOTS case detection and
treatment success targets, 2005
MAV
DPRK
MMR
SRL
THA
NEP
IND
SEAR
INO
TLS
BAN
BHU
50%
60%
70%
80%
90%
100%
0%
20%
40%
60%
80%
100%
DOTS detection rate
Treatment success rate
Treatment success:
Target: 85%
Case Detection: Target: 70%
Lessons learnt so far and challenges ahead
Sustaining current success and progress: ensuring resources and quality implementation
Weak laboratory networks and surveillance mechanisms
Difficulties in establishing interventions for TB/HIV and emerging drug resistance
Low community awareness and utilization of services
National public health care systems overstretched: limited management capacity, infrastructure
Beyond DOTS:
Why the new Stop TB strategy
and what is the added value it brings?
The new Strategy and link with Millennium
Development Goals
MDG ( Goal 6, Target 8):
To have halted and begun to reverse the
incidence of malaria and other major diseases
Indicators for TB:
% cases detected and cured
TB prevalence per 100,000
TB deaths per 100,000
Medium-term target for the SEA Region:
To halve TB prevalence and deaths by 2010
The Context
General Health Services
Policy, planning,
Capacity building
Implementation
Monitoring, evaluation
Surveillance and research
National TB programmes
Broader determinants of health
Poverty
Malnutrition
Low awareness
High risk behaviour
Increased vulnerability
Poor access
Delayed treatment seeking
The new Stop TB Strategy: what’s new?
Sustaining quality DOTS
Addressing newer challenges
Addressing TB/HIV and MDR-TB
Contributing to health system strengthening
Engaging all care providers
Empowering patients and communities
Enabling and promoting operational research
The new Stop TB Strategy: Translating into
action
Member countries are requested to:
Support the full implementation of the Regional Plan 2006-2015 aimed at achieving the TB related MDGs
Develop long and medium-term plans based on the new strategy, adapted to country-specific contexts
Sustain adequate financing through domestic and external funding, in line with WHA 58 resolution: “Sustainable financing for TB prevention and control”
Implementation at country level
Build capacity: adequate skilled personnel and infrastructure including laboratory
Strengthen surveillance and monitoring systems
Scale up public and private partnerships at all levels
Accelerate interventions to prevent drug-resistance and enhance collaboration with AIDS programmes
Augment significantly advocacy, communication and social mobilization approaches
Strengthen delivery of TB services through primary health care systems
Conclusions
Excellent progress has been made with DOTS
Maintaining this progress requires intensified support both to maintain quality and to implement additional interventions
Broader partnerships, inter-sectoral collaboration, community outreach and use of innovative approaches are essential
Sustained and long term financing is critical!