STRATEGIC PLAN FOR HEALTH RESEARCH IN THE WESTERN PACIFIC REGION
1997 - 2001
World Health Organization Regional Office for the Western Pacific Manila 1997
STRATEGIC PlAN FOR HEAlTH RESEARCH IN THE WESTERN PACIFIC RE GION, 1991-2001
WORLD HEALTH ORGANIZATION 1997
STRATEGIC PLAN FOR HEALTH RESEARCH IN THE WESTERN PACIFIC REGION , 1997 - 2001 (Revised version, September 1996)
As revised and confirmed by the Western Pacific Advisory Committee on Health Research (WPACHR) and the Directors of Health Research Councils or Analalogous Bodies (HRC/AB) at their joint meeting held in Manila from 5-9 August 1996
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TABLE OF CONTENTS
Foreword Summary
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1 3 3 4 4 5 6 8 8
1. Introduction Background New horizons in health
Goal Strategy Criteria
2. Research capability and strategic links WHO research activities Links to national health research councils or analogous bodies Links to WHO Global and Regional Advisory Committees on Health Research WHO links to other agencies and organizations
10 14 15 17 17 19 21 23 23 25 41
3. Research planning and implementation Planning for priority research Themes, health issues and researchable areas for New horizons in health Implementation of the strategic plan for health research
4. Review and evaluation of the strategic plan for health research Evaluation of the plan Tables Annex
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I am pleased to endorse this new strategic plan for health research and will do my best to implement its recommendations, as they apply to the various health programmes of the Regional Office.
S.T. Han, MD, Ph.D. Regional Director
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SUMMARY
Ajoint meeting ofthe Western Pacific Advisory Committee on Health Research (WPACHR) and the Directors of Health Research Councils or Analogous Bodies (HRC/AB), held in August 1994, recommended that priority be given to the development of a five-year strategic plan for health research in the Region and that a task force be established to initiate this process. The task force met from 29 August to 1 September 1995. It reviewed the research needs of the major health programmes within the Regional Office of the Western Pacific (WPRO) and recommended various priority fields of research (PFOR) linked to the three themes of New horizons in health. The PFOR were grouped into those concerned with process (i.e. development of tools/resources for research) and those concerned with content (i.e. research directly concerned with the health problem). The Task Force recommended that the PFOR be the focus of active research intervention, including research commissioned by WPRO, over the next five years. The recommendations of the task force were widely distributed for comment and the responses were analysed for presentation to the members of the WPACHR and the HRC/AB at their joint meeting in August 1996. The three subcommittees of the WPACHR on Environmental Health, Health Promotion and Health Systems Research met jointly in October/November 1995 and provided further input to the development of the strategic plan from the perspective of their own health fields. The reports of the task force and the three subcommittees, the inputs arising from the consultation process and the group and plenary discussions during the WPACHR meeting were all used in the development of the strategic plan for health research in the Western Pacific Region. The strategic plan is organized in four sections. The introduction (section 1) gives a background and sets out goals, guidelines and criteria for selection; this is followed by sections dealing with research capability and strategic links (section 2) and research planning and implementation (section 3). The final section (4) deals with review and evaluation of the strategic plan. Section 2 addresses WPRO capability and research activities, links with member countries
STRATEGIC PLAN FOR HEALTH RESEARCH IN THE V\lESTERN PACIFIC REGION. 1997-2001
through national health research councils or analogous bodies, links to the global and other regional ACHRs and links to other agencies and organizations. Section 3 describes the methods to be used in research planning and its implementation, and provides details of the research needed for" New horizons in health." This latter section on "research needed for New horizons in health" represents the heart of the plan and contains lists of priority health issues and researchable areas grouped according to their association with the objectives set out in the New horizons in health document. The lists are presented as a set of tables. Twenty-six groups of researchable areas are identified. There is a variable degree of overlap between the lists of research priorities, since similar research may be needed to achieve more than one objective of the New horizons in health strategy. To some extent, the degree of this overlap gives a measure of the relative importance of the research. However, it is recognized that each country will judge the importance by reference to its own health research priorities: for this reason the lists have not been placed in a rank order. Implementation of the plan will depend on strengthened commitments to health research by WPRO and by Member States, enhanced networking and collaboration in research and development of new funding partnerships with donor agencies. The plan proposes the establishment of a Committee on Strategic Plan Implementation to encourage, expedite and oversee the implementation process. Process evaluations at two-yearly intervals are recommended, together with a full outcome evaluation at the conclusion of the fiveyear period.
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1. INTRODUCTION
Background The Western Pacific Advisory Committee on Health Research (WPACHR) recommended the development of a strategic plan for health research at its meeting in August 1994 and a task force was set up to initiate this process. The task force met from 29 August to 1 September 1995. It reviewed the research needs of the major health programmes within the Regional Office of the Western Pacific (WPRO) and recommended a total of thirty-two priority fields of research (PFOR) linked to the three themes of New horizons in health (see below). The PFOR were grouped into those concerned with process (i.e. development of tools/resources for research) and those concerned with content (i.e. research directly concerned with the health problem). Eight of the PFOR were classified as process-related and 24 as content-related, the highest ranked group in the latter category being healthy lifestyles, healthy cities/islands, environmental health factors and urbanization/urban poverty. The Task Force recommended that these areas be the focus of active research intervention, including research commissioned by WPRO, over the next five years. Sixteen other PFOR were given high priority status and the remaining four were placed in a lesser priority category. The task force recommended that these areas, while still important for the realization of the goal for "Health for All", be less intensively targeted than those in the highest priority group during the next five years, but that research projects within them be supported on merit as they come forward. Following the meeting of the task force a process of consultation was undertaken. The recommendations of the task force were widely distributed for comment and the 46 responses were analysed tor presentation to the members of the WPACHR and the Directors of Health Research Councils or Analogous Bodies (HRC/AB) at their joint meeting in August 1996. The three subcommittees of the WPACHR on Environmental Health, Health Promotion and Health Systems Research were also asked to consider the strategic plan at their jOint meeting in October/November 1995 and they provided further input from the perspective of their own health fields.
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One effect of this process of consultation was a considerable increase in the number of fields proposed for inclusion in the strategic plan. Participants at the jOint meeting in August 1996 were presented with proposals for 34 PFOR, 101 researchable areas within these PFOR and over 200 examples of individual research projects. The focusing of these recommendations into a final version of the strategic plan for health research was the major task of the WPACHR and HRCI AS at their joint meeting.
New horizons in health WPRO has recently adopted a new approach which recognizes that the effects of economic and social development throughout the Region now require a health strategy which is "people-centred" rather than "disease-centred" and which can improve and sustain health in more holistic ways, through the dual approach of health promotion and health protection. This strategy outlined in the WPRO document New horizons in health, gives a vision for the future and sets out a series of key health objectives grouped within the three broad themes of "preparation for life", "protection of life" and "quality of life in later years". The purpose of health research is to facilitate the realization of these objectives. The strategic plan for health research has been developed in a manner that ensures it is consistent with the New horizons in health approach,
Goal The goal of health research in the Western Pacific Region for the next five years should be to promote and conduct research which will support the realization of the objectives of New horizons in health. For this purpose the research should have a strategic and systematic focus, providing the Region with new knowledge and methodologies to apply to the process of building healthy communities and nations. In particular it should: • reflect a holistic, integrated and multidisciplinary approach to problem solving; enhance the integration of health considerations in decisionmaking at the individual, community, national and regional level; be relevant to the different conditions in least developed countries, those countries whose economies are in transition, and rapidly developing countries;
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contribute to the development and implementation of health supportive poliCies in different settings; enhance human resources development processes and the actions necessary to influence values and behaviours in positive ways; • contribute to the integration of health and environmental factors in the context of an overall strategy to achieve sustainable development
Strategy The health research strategies needed to achieve these goals should be developed in accordance with the three themes of the "New horizons in health" concept, Le, preparation for life, protection of life and quality of life in later years. Research which is multidisciplinary, multicentred and/or multisectoral in character should be especially encouraged, The research should generally be problem-solving in nature, appropriate and timely in terms of generation of research results, Appropriate research in this context is defined as research (including research training) which is appropriate to the problem(s) to be solved. Essential national health research, health systems research, health behavioural research, health economics research and epidemiological research would all be considered as highly suitable in this regard. Clinical and biomedical research may also be appropriately used to generate new technologies and approaches for diagnosis/treatment of diseases of continuing high prevalence or diseases of newly emerging significance, It is recognized that more than one type of research may be needed for some problem areas, The development of tools and resources for research (Le. processrelated research) should have high priority, Examples are the development of indicators, collection and analysis of baseline data, encouragement of attitudinal changes and operational research on health service delivery systems. Human resource development for appropriate research should be especially supported. Research which is needed for areas identified as priorities within the strategic plan should be commissioned and actively supported, including commissioning as a component of existing or new health programmes within WPRO. This process may require the deliberate designation and protection of a proportion of the funds allocated to WPRO Technical Units.
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The active cooperation of relevant WHO collaborating centres in the Region is also essential if the research effort in priority areas is to be enhanced. The facilities and expertise of the WHO Regional Centre for Research and Training in Tropical Diseases and Nutrition, in Malaysia, should be fully utilized and if necessary expanded in order to meet research targets during the period of the strategic plan. Investigators working in priority areas should also be encouraged to submit projects for possible support, either by WHO or by other funding agencies. For both commissioned and investigator-initiated research, the project plans should satisfy scientific and ethical requirements and should also specify objectives, activities, timeframe for completion, cost, proposed funding sources and outcome measures for evaluation. General criteria for the selection of suitable projects are suggested in the next paragraph.
Criteria The selection of researchable areas and projects within the priorities identified in the strategic plan should take account of the following factors:
Primary criteria
importance to stakeholders in Least Developed Countries (LDC); degree of emphasis on individual responsibilities in the context of supportive environments; amenability to collaborative research; importance/urgency for solutions and/or planning in the area of concern; extent of promotion of multisectoral and interdisciplinary involvement; level of contribution to sustainable improvement in health in particular and to sustainable development in general; relationship to broader health and development issues; availability of indicators or capability to develop suitable indicators for evaluation.
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Secondal:Y criteria
degree to which the project has been conceptualized from a systems perspective; estimated health impact(s) including number of people to benefit; relevance to other priority fields of research; quality of research methodology; availability of appropriate expertise and technical capabilities; scale of project, including budgetary requirements and timeframe; • extent of existing efforts by other agencies; potential of demonstrating effects; potential for inter-country and inter-regional collaboration; likely cost-effectiveness_
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2. RESEARCH CAPABILITY AND STRATEGIC LINKS
WHO research activities Goal To strengthen research capacity, improve research management and facilitate the conduct of priority research in Member States.
Overview
WHO's research programmes generally have two interrelated purposes: (a) to attain specific research results that are relevant and applicable; and (b) to strengthen the research capacity of the countries themselves. These two purposes are evident in the work of large research programmes, but to one degree or another they should underlie all the research programmes of WHO.
Objective 1
Regional Research Policy and Strategy Coordination Programme (RPS) This programme aims (a) to develop the national capability to carry out health research relevant to the solution of major health or healthrelated problems; and (b) to develop necessary mechanisms to ensure efficient coordination and management of research.
Activities provision of research training activities, e.g. national workshops on research design and methodology in developing countries of the Region and provision of training grants; provision of funding for applied or operational research projects considered by the Regional Office to be vital to Member States; • encourage technical units within WPRO to initiate commissioned research in the priority areas set out by the Regional Office; strengthen the health research information systems; involve the WHO Regional Centre for Research and Training in Tropical Diseases and Nutrition (Malaysia) and the WHO collaborating centres in various research activities;
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encourage Member States to establish necessary mechanisms for ensuring coordination and management of research activities.
Objective 2
Special Programme for Research and Training in Tropical Diseases (TDR) This programme aims (a) to develop, through research and development, new tools and strategies to control tropical diseases; and (b) to train individuals and strengthen institutions to enhance the research capability of developing tropical countries.
Activities • use latest advances in basic science to explore disease and parasite mechanisms in order to achieve the strategic goal of finding ways of improving disease control; select the most promising leads and prototype tools emerging from strategic research and take them through the development process up to and beyond phase III clinical trials; for communities plagued by tropical diseases and of national and local disease control programmes: identify the most important problems and seek solutions to these problems; determine how a health system could best apply these solutions; support for research training within and among the diseaseendemic countries.
•
•
Objective 3
Special Programme of Research, Development and Research Training in Human Reproduction (HRP) One of the goals of the Programme is to respond to the needs of developing countries in reproductive health research and to ensure (a) that the needs of developing countries are reflected in all activities of the Programme; and (b) that the developing countries receive technical and financial support to strengthen their capacity to undertake research in reproductive health.
Activities • • increase the inclusion of women's perspectives into priority setting; support research collaboration between the developed and less developed countries;
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transfer and sharing of technologies; support for research training grants and in particular, regional self-reliance in training; support for workshops and courses and consultant visits; support for research grants of national and global importance;
•
support of infrastructure building-up; dissemination of the activities of the programme.
Objective 4
Division of Child Health and Development (CHD) CHD was officially created in April 1996 as part of a group of programmes called Family and Reproductive Health. It will build on the work of the Division of Diarrhoeal and Acute Respiratory Disease Control, in particular the integrated approach to management of the sick child. The primary objectives will be to reduce morbidity and mortality significantly among children.
Activities • • improve family and community practices; improve activities of health system practices and programme management methods; develop practical guidelines and training materials for both programme management and for specific interventions; provide technical support to countries.
Links to national health research councils or analogous bodies Goal
To utilize HRC/AB in the promotion of intercountry collaboration and in implementation of the regional strategic plan for health research,
Overview
The development of links between HRC/AB and WPRO will be an important factor in the implementation of the strategic plan for health research. WPRO has actively encouraged such links over the past sixteen years, by convening meetings of Directors of HRC/AB. Focal
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points for health research have now been identified in 16 countries of the Region, HRC/AB are responsible for the development and implementation of health research policy at national level. They work closely with, or are part of, the government in their country. This ensures that they have a pivotal role in implementation of the regional health research strategy at a national level. Within the regional HRC/AB are skills and experience which should be mobilized to strengthen the organization and management of research and to help in the building of research capacity and implementation of research projects. This resource is available for WPRO to use as part of its overall strategy to improve health status throughout the Region,
Objective 1
To develop intercountry collaborations to strengthen the organization and management of health research in the countries of the Region. Activities provision of advice by HRC/AB on research organization and management at national level: collaboration in the development and implementation of priority setting; collaboration in the development and implementation of health research policy (e.g. ethical review); facilitation of access and advice on technology and methodologies for health research; provision of access to researchers with needed skills and experience;
•
collaboration in the development of strategies to disseminate and utilize research results for policy development; provision of advice through the medium of the regional resource handbook and use of the regional networks [see objective (2) below); collaboration with countries as in building research capacity [see objective (3) below,
RoZeo/WHO facilitates and coordinates the intercountry collaboration and provides resources.
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Role of HRC/ AB provides the focal point of contact at national level and to identify organizations and/or individuals to provide advice.
Objective 2
To establish an intercountry network to strengthen health research within the Region. Activities participation at Western Pacific Regional Office meetings for Directors of HRC/AB; development and use of a regional resource handbook for health research; use of the Internet (WVVW and E-mail); involvement of WHO collaborating centres to a maximum degree;
promotion of an interchange of individuals with skills and experience; organization of conferences/workshops.
Role of WHO facilitates and coordinates the networking and provision of resources.
Role of HRC/ AB provides the focal point of contact for countries needing support and, in the case of the developed countries, may provide resources.
Objective 3
To build human resource capacity for health research in countries of the Region. Activities provision of research training opportunities, both overseas and in the home country; provision of opportunities to complete academic training relevant to health research (e.g. MPH); conduct of workshops to develop research skills; • use of networking activities to identify and improve access to research training opportunities [see objective (2) above);
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•
establishment of new initiatives providing resources for research training (e.g. Wellcome Trust, UK); use of the WHO Regional Centre for Research and Training in Tropical Diseases and Nutrition in Malaysia for training in research methodologies.
Role of WHO facilitates and coordinates identification of training opportunities in relevant priority areas and where possible provides resources.
Role of HRCI AB • provides resources (e.g. through research training programmes), facilitates identification and access to training opportunities and organizes workshops.
Objective 4
To develop intercountry collaboration on research projects within priority research areas. Activities • collaboration in the establishment of partnerships between research communities in countries of the Region, to facilitate conduct of research projects on priority topics; provision of resources (funding, technology and expertise) for collaborative research partnerships.
Role of WHO • coordinates and facilitates the development of research partnerships and where possible may provide resources.
Role of HRCI AB coordinates and facilitates the development of research partnerships at a national level and may provide resources.
Objective 5
To enhance existing links between countries of the Region and the ACHR network of WHO (global and regional). Activities provision of input into the development of recommendations and policy advice by the WPACHR;
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ensuri~g that national representatives on the Regional Committee for the Western Pacific are aware of the position of their HRC/AB on regional health research issues',
•
facilitation of transfer of information provided by the global and regional ACHRs to appropriate research personnel in Member States.
Role of WHO coordinates the transfer of information to and from global and regional ACHRs to Member States.
Role of HRC/ AB in their capacity as focal pOints for national health research activity, coordinates provision and dissemination of information to and from WPACHR.
Links to WHO Global and Regional Advisory Committees on Health Research Goal To ensure that WPRO and Member States in the Western Pacific Region receive the best available advice relevant to health research.
Overview
Health research is a worldwide activity which requires free communication to achieve its full potential. Wide dissemination of research-based information is a vital component, needing the removal of barriers and active cooperation at national, regional and global levels. It is important that Member States receive the best advice on health research, both to support the development of their health strategies and to use the results of health research in the development and implementation of their national health plan. WPRO, through the global ACHR network, which is the operational arm of WHO, plays an important role in disseminating research advice throughout the Region.
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Objective 1
To ensure that the Regional Director, WPRO, receives the best available advice on health research. Activities • ensure that WPACHR members are actively involved in or are familiar with the health research activities and policies of their country; ensure that advice on research matters is received at regional level from the Global ACHR, other regional ACHRs and Member States; ensure that key papers relevant to the regional health research strategy are disseminated to those providing advice and to the HRC/AB.
Objective 2
To improve the sharing of knowledge, expertise and policy development between countries in the Western Pacific Region and their neighbours in other WHO regions. Activities organize meetings between relevant countries to address specific needs in implementation of the regional health research strategy; develop further the relationship between HRC/AB in the WPRO and the SEARO regions; disseminate strategy and policy documents relevant to health research which have been developed in SEARO countries.
WHO links to other agencies and organizations WHO may provide research support in ways other than by direct funding, e.g. by facilitating intercountry collaboration and through the provision of expertise to support research capability strengthening.
Goal
To access extrabudgetary partners for support of priority research topics in Member States.
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Overview
Resources for health research available from WHO and from the majority of Member States are very limited: demand for them far exceeds the supply. For research to be implemented on priority topics within the New horizons in health approach it will be necessary for funding and other resources to be mobilized, both from global and regional extrabudgetary partners and from other organizations. In its pivotal position as coordinator of the regional health research strategy, WHO will play an important role in facilitating access to external sources offunds for research. The strategic plan will support this process by advising such partners on the areas to which WHO has given greatest priority for the next five years.
Objective 1
To use the influence of WHO, as coordinating agency for health research in the Region, to access resources needed for priority health research to be conducted in Member States. Activities use by WPRO of its established links with extrabudgetary partners and other organizations to mobilize resources for priority health research; mobilization of resources from the developed countries in the Region for research in other countries, using the influence of WPRO in partnership with HRC/AB; development of new initiatives to provide resources for health research, using the influence of WPRO in Member States; provision of information by WPRO, through regional networking, on the agencies which provide resources for health research in the Region.
Role of WHO facilitates the process of linking with extrabudgetary partners and coordinates the implementation of priorities within the strategic plan for health research.
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3. RESEARCH PLANNING AND IMPLEMENTATION
Planning for priority research Goal To identify the priority research projects to be developed and implemented in Member States.
Overview
It is important, particularly for the less developed countries, that health research is closely linked to the health needs of the population. Identification of priority research topics requires knowledge of the health issues of importance to Member States and the use of specific criteria as an aid to the selection and ranking of possible research projects. WHO plays a pivotal role in coordinating with the countries to identify priorities and in facilitating the implementation of research projects.
Objective 1
To explore links between national health plans and objectives of New horizons in health. Activities • • obtain information from Member States on priority health issues identified in their national health plan; WPRO to identify common themes in the Member States which are relevant to health research planning.
Objective 2
To use objectives 1-14 of New horizons in health, related health issues and identified researchable areas as a guide to research planning in Member States (see page 19). Activities WPRO to integrate Member States' priority research needs with researchable areas relevant to New horizons in health objectives.
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Objective 3
To review completed, current and proposed research activities applicable to New horizons in health which are relevant to the less developed countries. Activities collect relevant information on research from Ministries and HRC/AB of Member States; WHO to collect additional information, as required, by use of WHO collaborating centres, other extrabudgetary partners, etc.
Objective 4
To develop and apply appropriate criteria for identification ofpriority research projects. Activities adopt the criteria from the Report of the ACHR subcommittees (October 1995), see page 6; • include the following additional criteria to those on page 6 cost effectiveness results of research should be of benefit to a significant proportion of the population. review periodically the criteria on the basis of information and feedback obtained from Member States.
Objective 5
To determine the priority research projects to be promoted or conducted by WHO in Member States. Activities • • Member States to advise WPRO on priority areas for research (if appropriate); WPRO to assess regional research priorities through RPS unit with advice from ACHR members; WPRO to coordinate with Member States in identifying priority research projects.
Objective 6
To conduct and promote priority research in Member States. Activities WPRO to mobilize resources (funding, technical support, research facilities) for priority research.
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WPRO to encourage training opportunities as part of research projects.
Objective 7
To disseminate the results of research within relevant Member States and include them in WPRO database [see objective (3) above}. Activities • WPRO to use HRC/AB network, publications, conferences, workshops and WHO/ACHR system to disseminate results of research; WPRO to ensure results of research are included in the WPRO database.
Themes, health issues and researchable areas for New horizons in health Goal To identify researchable areas based on the health issues relevant to the themes of New horizons in health.
Overview
As noted in the introduction, the regional document New horizons in health proposes that emphasis be given to three particular groupings of health problems, relating to the major life periods of infancy! childhood, adulthood and old age. Within each grouping a set of realisable health objectives is proposed. These health objectives have formed the basis for selection of the research areas for priority support within the strategic plan for health research during the next five years. They are intended to provide guidance in the setting of research agendas and to help focus resources in areas where effective progress can be achieved.
Objective 1
To link the themes of New horizons in health to health issues and priority researchable areas. Activities l • The first step in this selection process was the identification, within the 14 broadly-based objectives, of specific health issues which would be especially amenable to research during the
'These activities were conducted in 1995/96 by the task force and by consultation with member countries prior to finalization of the Strategic Plan.
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next few years. Many of these health issues were seen as applicable to more than one of the New horizons in health objectives. Altogether 26 such health issues were identified. The next step was to identify priority research areas appropriate to these particular health issues; again, the chosen areas were often applicable to more than one health issue or health objective. Twenty-nine such priority research areas were identified. All the research areas are considered to be important but it is recognized that each country will assess this by reference to its own health research priorities. For this reason the lists have not been placed in a rank order. Countries may still wish to support research in other areas and should be encouraged to do so, especially if the research also addresses the New horizons in health objectives. However, it is important that such research should also measure up to the criteria set out in the strategic plan (see page 6). Regular exchange of information between Member States and WPRO will provide feed-back on the congruence between national health research priorities and the health issues/research areas identified as priorities in the strategic plan (see section 2). Tables 1-16 set out the health issues and research areas selected under each of the major objectives in the New horizons in health strategy. They represent a consensus of expert opinion, developed over a twelve-month period, and together they form the core of the research agenda proposed for implementation in the Western Pacific Region during the next five years. The first table lists the process-related research areas, as originally identified by the task force. To a greater or lesser extent, these types of research are applicable to all the health issues and research areas which follow and all are of high priority, when relevant. The next 14 tables show the health issues and priority research areas identified for each of the 14 health objectives in New horizons in health. The final table clarifies the links between health objectives, health issues within objectives and priority research areas. Specific projects within the recommended researchable areas have not been listed, since the detail of these will vary from country to country. However, it should be noted that examples of suitable research projects are included in the resource documents cited (see Annex).
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Implementation of the strategic plan for health research Goal To ensure that the strategic plan for health research in the Western Pacific Region is implemented by WPRO and Member States.
Overview
The identification of priority areas for research represents only the beginning of the process of implementation of this research. Much practical work remains to be done and necessary detail developed: for this a practical business plan will be needed. The smooth and effective implementation of the strategic plan will depend on the combined efforts of WPRO, the WPACHR members, HRC/AB and Member States to maintain the momentum which the plan has generated.
Objective 1
To facilitate the smooth implementation of the strategic plan for health research to ensure its maximum impact. Activities establishment of a Committee on Strategic Plan Implementation; phased-in implementation of the plan, consistent with the availability of resources.
Ralea/WHO provides a secretariat for the Committee on Strategic Plan Implementation, facilitates the Committee's work by providing necessary resources and materials and disseminates the output as required.
Proposed terms of reference for the Committee on Strategic Plan Implementation • to help WPRO identify key projects for support in the priority areas; • to support the development of necessary detail for such projects, including goals and objectives, proposed activities, proposed time-frame for implementation, proposed funding sources and cost and outcome measures for programme evaluation;
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• to recommend and encourage ways to initiate and fund such projects; • to identify any constraints/barriers to smooth implementation of the strategic plan; • to monitor progress by way of process evaluation on a two-year time-frame; • to ensure that feedback from Member States is appropriately reflected in future revisions of the strategic plan.
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4. REVIEW AND EVALUATION OF THE STRATEGIC PLAN FOR HEALTH RESEARCH Evaluation of the plan Goal To undertake effective review and evaluation of the strategic plan for health research.
Overview
The strategic plan should serve as the guiding document both for WPRO and for Member States in the formulation of health research policies and the effective management of their respective research programmes. The plan will need to be revised periodically, in order to maintain its relevance to the needs ofWPRO and Member States; this revision should be carried out both by regular process evaluation (see page 21) and through a critical outcome-based review and impact evaluation. Mechanisms for these review stages should be accepted as an integral part of the strategic plan for health research.
Objective 1
To ensure that the strategic plan for health research is revised periodically to reflect the ever-changing health needs of the Western Pacific Region. Activities utilization of the occasion of the joint meetings of WPACHR and HRC/AB as an opportunity for review and evaluation of the strategic plan.
Objective 2
To conduct a formal five-year evaluation of the Strategic Plan. Activities • conduct an outcome evaluation of the strategic plan (after five years) according to the following criteria: »
how did implementation of the plan influence the health research policies of WPRO and of Member States? how useful and usable was the strategic plan, from the perspective of decision-makers in health research? 23
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»
did the plan help reduce constraints/barriers to effective management of health research programmes (e.g. by improving availability of information/resources)? were the documented research priorities or the methodology to establish them suited to the diverse circumstances throughout the Western Pacific Region? what were the specific features of successful and of unsuccessful components in the strategic plan and how can these lessons be utilized in its revision?
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RoZeo/WHO functions as the secretariat of the joint meeting of WPACHR and HRC/AB, collects sufficient materials for the review/ evaluation, facilitates the discussions by providing necessary resources and helps the joint meeting ensure that the results of the review/evaluation are reflected in the revision of the strategic plan, while conducting its own formal evaluation.
24
STRATEGIC PlAN FOR HEALTH RESEARCH IN THE WESTERN PACIFIC REGION, 1997-2001
TABLE 1 PRIORITY FIELDS OF RESEARCH - PROCESS RELATED
Approaches to the strengthening of institutional infrastructure at different levels (policy, managerial, technical, communication, support, etc.) with special emphasis on human resource development Development of appropriate interventions· Health policy research with special emphasis on intersectorallinkages and their role (to Improve understanding of the impact of the social and economic sectors on health) Health systems research to support implementation of New horizons in health concepts with empOasis on the maximum use of multidisciplinary/multisectoral approaches Methodological research with special emphasis on measurement and analysis (e.g. development of better data collection and development and field testing of indicators··) Research to promote: • acceptance of individual responsibility for health • the role of the famHy, community and nation in health ntred and humanistic a towards health • a ' Research on development of appropriate interventions is relevant to most health issues in Tables 2-15. "In the case of high priority health problems in the Region which do not have suitable indicators, emphasis should be given to research that will develop and/or field test potential indicators. In developing these indicators, priority must go towards identifying indicators which are simple, realistic, feasible and easy for countries to implement and monitor.
25
STRATEGIC PLAN FOR HEALTH RESEARCH IN THE weSTERN PACIFIC REGION, 1997·2001
TABLE 2 THEME: .MATERNAL AND NEONATAL HEALTH (PREPARATION FOR LIFE)
Objective - To ensure that every mother has the best opportunities for appropriate timing and spacing of pregnancies, safe delivery of a healthy infant in an environment conducive to health, with adequate antenatal care, sufficient nutritional and preparation for breast-feeding her child . Health Issues Breast feeding Researchable Areas
•
Health information/education for correct choices Nutrition and reproductive health Immunization/vaccine development and delivery systems Infectious diseases Health information/education for correct choices Health systems research into access and utilization of health services Immunizationlvaccine development and delivery systems Infectious diseases Multisectoral approaches to maternal and infant health Health systems research into access and utilization of health services Multisectoral approaches to maternal and infant health Immunization/vaccine development and delivery systems Infectious diseases Multisectoral approaches to maternal and infant health Strategies to lower the incidence of kernicterus Health information/education for correct choices Nutrition and reproductive health
Communicable diseases
• • • • •
Fertility management [(including gender ratio) Health care access and utilization Maternal health (including mortality)
• • •
Maternal literacy
•
• Neonatal and infant mortality
• • •
Neonatal jaundice Nutrition
• •
•
26
STRATEGIC PLAN FOR HEAlTH RESEARCH IN THE Wf:STERN PACIFIC REGION, 1997-2001
TABLE 3 THEME: CHILD HEALTH (PREPARATION FOR LIFE)
Objective - To increase child survival and decrease infant morbidity by promoting healthy environments, immunization, and by providing adequate case management for infectious diseases which are the major causes of mortality. H.althlssues Breast feeding Communicable diseases Researchable Areas
• • •
Nutrition Immunjzation/vaccine development and delivery systems Infectious diseases Immunizationlvaccine development and delivery systems Infectious diseases Mental well-being Health systems research into access and utilization of health services Healthy schoolslhealthy cities/healthy islands Multisectoral approaches to matemal and infant health Healthy schoolslhealthy cities/healthy islands Injury prevention Health systems research into access and utilization of health services Multisectoral approaches to matemal and infant health Healthy schools/healthy cities/healthy islands Nutrition Immunizationlvaccine development and delivery systems Infectious diseases
Diarrhoeal disease
• •
Environment (physical, psychosocial and cultural) Health care
•
access and utilization .
• • •
I nfant mortality
Injury (including child abuse and neglect) Matemalliteracy
• •
• .
•
Nutrition .
• • • •
Respiratory disease
27
STRATEGIC PlAN FOR HEAlTH RESEARCH IN THE 'A£STERN PACIFIC REGION, 1997·2001
TABLE 4 THEME: ADOLESCENT HEALTH (PREPARATION FOR LIFE)
Objective - To support the development of healthy lifestyles through promoting education, supportive and safe environments for health and healthy behaviours during childhood and adolescence to establish lifelong healthy practices.
H..Ith ....... Adolescent reproductive health
Researchable Areas
• •
Health information/education for correct choices Health systems research into access and utilization of health services Infectious disease 15TDl Infectious disease (5TO) Mental well-being Health systems research into access and utilization of health services Health information/education for correct choices Healthy citieslhealthy islands Injury prevention Mental well-being Health information/education for correct choices Nutrition Health information/education for correct choices Testing of new deliverv systems Health information/education for correct choices Mental well-beina
• Communicable disease (esp. 5TD) Environment (physical, psycho-social and cultural) Health care access and utilization Injury
•
• •
• • • • • • •
Mental health Nutrition
Oral health
SUbstance abuse (alcohol, tobacco, drugs)
• •
•
28
STRATEGIC PLAN FOR HEAlTH RESEARCH IN THE 'wYESTERN PACIFIC REGION, 1997· 2001
TABLE 5 THE;\IE: HEALTHY LIFESTYLES (PROTECTION OF LIFE)
Objective - To establish comprehensive national policies and programmes which promote healthy lifestyles throughout the lifespan of all individuals. Health Issues Researchable Areas
Environmental health
• •
Assessment of impact of environmental pollution on health Healthy cities/healthy islands Healthy work places Social/cultural/behavioural factors as determinants of health Special health problems of megacities and rapid urbanization Water and solid waste management Health information/education for correct choices Healthy cities/healthy islands Healthy work places Social/cultural/behavioural factors as determinants of health Health information/education for correct choices Healthy cities/healthy islands Healthy work places Injury prevention Mental well-being Social/cultural/behavioural factors as determinants of health Special health problems of megacities and rapid urbanization Health information/education for correct choices Healthy cities/healthy islands Healthy work places Injury prevention Mental well-being Social/cultural/behavioural factors as determinants of health Special health problems of megacities and rapid urbanization Health information/education for correct choices Healthy cities/healthy islands Healthy work places Social/cultural/behavioural factors as determinants of health Health information/education for correct choices Healthy cities/healthy islands Mental well-being Social/culturaUbehavioural factors as determinants of health
• •
• Infectious and parasitic diseases" including STD
• •
• • •
Injury
• • •
• • • • • • • • • • • • • • • • •
Noncommunicable diseases/disorders
Nutrition
Substance abuse
• •
'I nfectious diseases and parasitic diseases are country specific.
29
STRATEGIC PlAN FOR HEALTH RESEARCH IN THE WESTERN PAC IFIC REGION, 1997·2001
TABLE 6 THEME: NUTRITION (PROTECTION OF LIFE)
Objective - To improve the nutritional status of all sectors of the population, especially mothers and other vulnerable groups, and to promote appropriate, balanced diets and safe food preparation .
Healthlssu.. Food safety
Researchable Areas
• • • • • • • •
Healthy cities/healthy islands Social/culturallbehavioural factors as determinants of health Healthy citieslhealthy islands Monitoring of nutritional status of population Healthy cities/healthy islands Matemal nutrition Monitoring of nutritional status of population Social/cultural/behavioural factors as determinants of health
Food security Nutritional disorders (especially matemal)
30
STRATEGIC PLAN FOR HEALTH RESEARCH IN THE 'NESTERN PACIFIC REGION, 1997·2001
TABLE 7 THEME: COMMUNICABLE DISEASES (PROTECTION OF LIFE)
Objective - To decrease the transmission , morbidity and mortality rates of diseases such as tuberculosis , malaria and other diseases of public health importance, including vector-borne diseases. Health Issues Current communicable dlseasss of public health importance· Researchable Areas
• • •
Drug resistance Immunizationlvaccine development and delivery Infectious diseases Non-compliance to drug therapy Testing of new drugs/delivery systems Transmission Monitoring and surveillance (including forecasting) Transmission
New, emerging and re-emerging communicable diseases
• • • • •
' Communicable diseases are country specific.
31
STRATEGIC PlAN FOR HEAlTH RESEARCH IN THE VllESTERN PACIFICREGION, 1997·2Q01
TABLES ,
THEME:
NONCOMMUNICABLE AND OCCUPATIONAL DISEASES (PROTECTION OF LIFE)
Objective - To prevent or delay the onset of the noncommunicable diseases, including reduction in occupational diseases, in order to maximize disability-free and productive lives in older age.
Health Issues Injury .
Researchable Areas
Mental disorders Noncommunicable diseases/disorders
• • • • • • • • • • • •
Injury prevention Mental well-being Epidemiological studies Healthy citiesihealthy islands Healthy workplaces Mental well-being Risk factors Social/cultural/behavioural factors as determinants of health Epidemiological studies Healthy workplaces Mental well-being Social/cultural/behavioural factors as determinants of health
Occupational diseases
32
STRATEGIC PLAN FOR HEALTH RESEARCH IN THE WESTERN PACIFIC REGION, 1997·2001
TABLE 9 THEME: HEALTHY ENVIRONMENT (PROTECTION OF LIFE)
Objective - To promote environmentally sound practices and technologies for the effective prevention and management of environmental health-related disease and disability.
H.althl...... Environmental health
Researchable Areas
• • •
Healthy cities/healthy islands Healthy workplaces Impact of environmental pollution (including nuclear radiation) on health Injury prevention Integration of health and environmental factors in national development
• •
33
STRATEGIC PLAN FOR HEALTH RESEARCH IN THE 'A£5TERN PAC IFIC REGION, 1997-2001
TABLE 10 THEME: PREVENTION OF DISABILITY (PROTECTION OF LIFE)
Objective - To enhance people's quality of life by preventing disability, including blindness and deafness, and by rehabilitating the handicapped, infirm and disabled. Health Issues Health care access and heaHh care utilization Researchable Areas
• •
Health systems research directed at non-institutional care (all ages especially elderly) Sociallculturallbehaviouralleconomic factors affecting quality of life (all ages especially elderly) Healthy citieslhealthy islands Injury prevention Health systems research directed at non-institutional care (all ages especially elderly) Sociallculturallbehaviouralleconomic factors affecting quality of life (all ages especially elderly) Healthy workplace Health information/education for correct choices
Injury Mental disability
•
• •
• Occupational disability Physical disability
• •
34
STRATEGIC PLAN FOR HEALTH RESEARCH IN THE WESTERN PACIFIC REGION, 1997. 2001
TABLE 11 THEME: HEALTHY LIFE FOR THE ELDERLY (QUALITY OF LIFE IN LATER YEARS) Objective - To improve the well-being and quality of life of the elderly.
Health Health care access and health care utilization
Re.earchable Area.
• • •
Epidemiological and intervention studies Health information/education for correct choices Health systems research directed at noninstitutional care of the elderly Injury prevention SociaVculturallbehaviouraVeconomic factors affectina aualitv of life of the elderlv Epidemiological and intervention studies Health systems research directed at noninstitutional care of the elderly Mental well-being SocialiculturallbehaviouraVeconomic factors affecting Quality of life of the elderlv Epidemiological and intervention studies Health information/education for correct choices Sociallculturallbehaviouralleconomic factors affectina aualitv of life of the elderly Epidemiological and intervention studies Health systems research directed at noninstitutional care of the elderly Injury prevention Sociallculturallbehaviouralleconomic factors affeclina aualitv of life of the elderlv
Injury
• • • • •
Mental health
• Nutrition
•
• • Physical disability
• •
• •
35
STRATEGIC PlAN FOR HEAlTH RESEARCH IN THE \'\'ESTERN PACIFIC REGION, 1997·2001
TABLE 12 THEME: HEALTH SYSTEMS REFORM (QUALITY OF LIFE IN LATER YEARS) Objective - To ensure that health systems are organized, managed and sustained so that appropriate, accessible and affordable services, including those that promote the achievement of personal health potentials and a high quality of life, are available to all people.
H..Ith ....... HeaHh care access and heaHh care utilization
Re.earchable Area.
• •
Barriers to health care of the elderly Distribution of health care for the elderly Health systems research directed at noninstitutional care of the elderly Support for carers of the elderly
•
•
36
STRATEGIC PLAN FOR HEALTH RE SEARCH IN THE WESTERN PACIFIC REGION, 1997-2001
TABLE 13 THEME: CARE OF THE ELDERLY (QUALITY OF LIFE IN LATER YEARS) ,
Objective - To develop the potential for healing and health in people who live with chronic illness and disabilities, including their supporters. Health Issues Health care access and health care utilization Researchable Areas .
• •
Barriers to heaHh care of the elderly Distribution of health care for the elderly HeaHh systems research directed at noninstitutional care of the elderly Support for carers of the elderly
• •
37
STRATEGIC PlAN FOR HEALTH RESEARCH IN THE VvESTERN PACIFIC REGION, 1997·2001
TABLE 14 THEME: HEALTH CARE ACCESSIUTILIZATION (QUALITY OF LIFE IN LATER YEARS) Objective - To ensure the rights of everyone to enjoy a good quality of life, and to promote equity in access to resources necessary for optimal health .
HealthlHuea Health care access and health care utilization
Researchable Areas
•
Barriers to health care of the elderly Distribution of health care for the elderly Health systems research directed at noninstitutional care of the elderly Support for carers of the elderly
• • •
38
STRATEGIC PlAN FOR HEALTH RESEARCH IN THE VYESTERN PACIFIC REGION, 1997-2001
TABLE 15 THEME: WELFARE SERVICES (QUALITY OF LIFE IN LATER YEARS) Objective - To provide a physical and social environment that enhances quality of life.
H••lthl8Sues Health care access and health care utilization
Researchable Areas
• • •
Barriers to health care of the elderly Distribution of health care for the elderly Health systems research directed at non· institutional care of the elderly Support for carers of the elderly
•
39
STRATEGIC PLAN FOR HEAlTH RESEARCH IN THE weS TERN PACIFIC REGION, 1997-2001
TABLE 16 PRIORITY AREAS FOR RESEARCH (grouped from Tables 2-15, with table l'eferences) R_rchable Area BanienI to heellh cant of the elderly
Total Number 4
Table References 12113/14/15
a - tranamlsaion Distribution of hesIth csre for the elderly
2 4
7 12113/14/15
ONe I1IMIance EpidemioIogicllllnlelvenlion studies of heIIIIh Jsauea for the elderly
1 4 1
7 11
Epidemiology of occupallonal dIaeaMa
8 5/9 214/5/10/11 2/314 10/11112113/14/15 3/4/5/6/8/9/10 21317 213/417 3/4/5/8/9/10/11
Health Impact of environmental poUution (Including nuclear radiation) HesIIh lnformsIion/educalion for COITIICI c:hoicea
2 16 6 9
HesIth syatema research Into acceaalutifization of hesIth HrVicea HesIIh ayatema research Into non-inslitutlonal cant (especIaUy elderly)
Healthy 1ChooIs, cities, illands, workpIacea
25 7 9
immunization, vaccine development and delivery InfecIIoua (communlceble) dis_es, including STD I~ury
pnwentIon
9 1 11 1
Integndion of hesIth and environmental factors in national development
9 3/4/5/8/11
MenIal wll8ll being MonIIorIng/8UMIiIIance of ~ and re-emergIng communiclble
7 2/3
deel••• MuIIIsecIoraI approeches to maternal and Infant health Non-compIlance to drug therapy 5 1 7 2/3/416
Nutrition (Including metemaI, reproductiOn and .-utoring studies)
8 2 16
RIsk factorsIepidemI of noncommuniceble diseaseatdlaorders . factors as determlnents of heIIIIh end of quality of life SpedeI heIIIIh problems of ln8gacllies and rapid exchange
8 5/6/8/10/11
3 1 4
5 2 12/13/14/15 417 5/9
StreIegIea to lower the incidence of kemlcterus Support for of the elderly
ca_
Testing of ~ drugsldelivefy systems Water end solid waste management
2 2
40
STRATEGIC PLAN FOR HEALTH RESEARCH IN THE WESTERN PACIFIC REGION, 1997-2001
ANNEX
RESOURCE DOCUMENTS
1. 2.
New horizons in health Strategic Plan for Health Research: Report of Task Force Report of 1995 meeting of the WPACHR subcommittees Analysis of submissions on the Strategic Plan for Health Research
WPR/RPS/RPD(1 )/96.9 WPRlRPS/RPD(1)/96.11
3.
WPRlRPS/RPD(1 )/96.12
4.
WPR/RPS/RPD(1 )/96.13
41