SEAlACHR122
TWENTY-SECONDSESSION OFTHESOUTH-EAST ASIAADVISORYCOMMITTEE ON HEALTH RESEARCH
Report to fhe Regional Direcfor
Dharan,
Nepal, 22-26 April 7 996
WHO Project: ICP RPS 001
World Health Organization Regional Office for South-East Asia New Delhi August 1996
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9.
PROGRESS REPORT ON UNDP/WORLD BANK/WHO SPECIAL PROGRAMME FOR RESEARCH AND TRAINING IN TROPICAL DISEASE (TDR) Discussion Recommendations
14 15 15
9.1 9.2
10.
PROGRESS REPORT ON UNDP/UNFPA/WHO/WORLD BANK SPECIAL PROGRAMME OF RESEARCH, DEVELOPMENT AND RESEARCH TRAINING IN HUMAN REPRODUCTION (HRP)
15 16 16
I i
10.1 Discussion 10.2 Recommendations
11.
SUGGESTIONS ON TOPICS FOR TECHNICAL DISCUSSION AT TWENTY-THIRD SESSION OF SEAIACHR
16
12.
DATE AND PLACE OF TWENTY-THIRD SESSION OF SEA/ACHR
17
13.
ANY OTHER BUSINESS
17
14.
ADOPTION OF THE REPORT
17
15. CLOSING SESSION Annexes I. 2. 3. 4. Agenda List of Participants List of Working and Information Documents Full Text of Address by Regional Director, WHO/SEAR
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19 20 22 24
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CONTENTS Page I. INTRODUCTION 1
2. 2.1 2.2 2.3 2.4 2.5
INAUGURAL SESSION Welcome Address by Director, BPKIHS Address by Chairman SEA/ACHR Address by Regional Director, WHO/SEAR Inaugural Address by Secretary of Health, HMG/Nepal Vote of Thanks
3. 3.1 3.2 3.3 3.4
SCIENTIFIC SESSION Introductory Statement by Chairman, SEA/ACHR Opening Remarks by Regional Director, WHO/SEAR Nomination of Vice-Chairperson and Rapporteur Adoption of Agenda 4 5 6
4. 4.1 4.2
PROGRESS REPORT ON SEA REGIONAL RESEARCH PROGRAMME Discussion Recommendations ’
5. 5.1 5.2
PROMOTION OF RESEARCH IN HEALTH SECTOR REFORMS Discussion Recommendations
6 7 9
6. 6.1 6.2
RESEARCH IN OCCUPATIONAL HEALTH Discussion Recommendations
9 9 10 10
7. 7.1 7.2
ETHICAL ISSUES IN HEALTH Discussion Recommendations
11 12
8. 8.1 8.2
MATTERS ARISING OUT OF THE MEETING OF GLOBAL/ACHR Discussion Recommendations
13 14 14
SEAlACHRl22 Page 2 2.3 Address by Regional Director, WHO/SEAR
Dr Uton Muchtar Rafei, Regional Director, WHO/SEAR, thanked the Government of Nepal for hosting the meeting. He said that WHO’s role in helping to achieve progress in research in the countries of this Region had been through promotion, technical support, information exchange and research capability strengthening. WHO had also helped the countries identify their research needs, and formulate their health policies, strategies and programmes. He said that it would be most beneficial if efforts were directed towards developing and undertaking research which was supportive of priority health programmes aimed at satisfying the basic primary health care needs of the Member Countries. Dr Uton pointed out that countries would benefit greatly if their health research policies were reviewed from time to time and reoriented within the context of overall national health and healthrelated policies. As factors affecting the performance of health care systems were changing constantly, health research policies and strategies should also be equally dynamic. He emphasized that an important aspect of research was the need for fusion and interaction between various disciplines comprising health sciences as well as related fields such as social and behavioural sciences and health economics. Another area in which a careful review was needed in the Region was the extent to which research findings were being utilized to improve the performance of health system. In this context, exchange of information, not only among researchers and research institutions but also among researchers and health policy-makers and senior health administrators, was of crucial importance. WHO would continue to facilitate such exchange and play a catalytic role in this regard. The Regional Director drew attention to the fact that the whole area of health research could be streamlined and improved by establishing a proper management system at different levels of the research hierarchy in the countries. He pointed out that research management was not an end in itself but it was one of the means by which the research output could exert its full impact on the community at large. WHO would assist Member Countries in coordinating and improving their national research infrastructures in the coming years. It was important that the WHO-sponsored research projects give due attention to the main policy orientations of the WHO’s Ninth General Programme of Work (9 GPW). Within the framework of 9 GPW, certain priorities for research had been identified. WHO would continue to promote and support health research and technological development in response to priority health problems in the countries; to build up the capacity for research on the determinants of health, behavioural changes and operational research to improve the delivery and performance of integrated services. Dr Uton expressed his confidence in the present mechanism of seeking guidance from the SEA/ACHR in the field of research and said he was looking forward to the Committee’s deliberations and recommendations on the three topics listed for technical discussion. 2.4 Inaugural Address by Secretary of Health, HMGLNepal
Mr Ghana Nath Ojha, Secretary of Health, MOH/HMG Nepal, welcomed the members of ACHR and the Regional Director to the meeting. On behalf of HMG/Nepal, he expressed appreciation of the work of SEA/ACHR. He said that the health situation in developing countries was becoming increasingly complicated. While the problems of communicable diseases were still posing a great challenge, the problems of non-communicable diseases like heart diseases, cancer, etc., were rapidly
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1.
INTRODUCTION
The twenty-second session of the South-East Asia Advisory Committee on Health Research (SEA/ACHR) was held at the B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, Nepal, from 22 to 26 April 1996. Eleven members of the SEA/ACHR, seven special invitees, four staff members each from WHO/HQ and WHO/SEARO, five staff members from the WHO Representative’s office in Nepal and one observer from Nepal attended the meeting. List of participants is given in Annex 1. The objectives of the meeting were, among others, to hold technical discussions on such topics as research in health sector reforms, research in occupational health, and ethical issues in health. Progress reports on the Special Programme for Research and Training in Tropical Diseases (TDR) and the Special Programme for Research Development and Research Training in Human Reproduction were also presented and discussed. The progress report on the Regional Promotion and Development Programme was presented and matters arising out of the Global ACHR and other regional ACHRs were discussed. 2. 2.1 INAUGURAL SESSION Welcome Address by Director, BPKIHS
Dr M.P. Upadhyay, Director, BPKIHS, welcomed the Health Secretary, the Regional Director and the ACHR members. He said that the widening gap between available technology and services actually delivered, exploding population, deteriorating environment, dwindling resources and declining ethical values were all constituents of what some world health leaders had called “a global health care crisis”. Health reforms that had been practised and were being advocated in the health sector at the global level to overcome this crisis were to be discussed at this meeting. At the national level, Nepal had restructured its health system and had formulated a new health policy in the last few years. Also, at the sub-national level, health planners were now working towards a comprehensive health system to ensure access and equity as essential attributes for the quality of care for the people. He stressed the need for a nature-friendly approach instead of making efforts to conquer nature. He said that the goal of science had been reduced to acquiring knowledge to dominate and control nature. It was this anti-ecological thinking, which was the root cause of the peril mankind was now witnessing. He said he looked forward to the deliberation of the ACHR meeting, especially in identifying priority researchable issues in the area of health sector reforms. 2.2 Address by Chairman SEAIACHR
Prof Aree Valyasevi, Chairman SEA/ACHR, welcomed all participants and the WHO secretariat. He hoped to have fruitful discussions on the three technical subjects placed before the ACHR.
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3.4 Adoption of Agenda The provisional agenda and the working schedule presented to the members were adopted.
4.
PROGRESS REPORT ON SEA REGIONAL RESEARCH PROGRAMME
Dr Samlee Plianbangchang, DPM, WHOLSEARO, presented an overview of activities and progress made with regard to regional research promotion and development, highlighting WHO’s regional objectives in health research, SEARO’s role in promotion of health research, health research strategies of the Region, future research agenda, utilization of WHO research funds at the regional and country levels, current role and status of WHO collaborating centres and expert advisory panels. Dr Samlee remarked that WHO’s regional research activities were integral components of the WHO regional collaborative programme. At the. country level, these were under WHO country programmes while the intercountry activities were developed and managed by the Regional Office with the involvement of concerned nationals from Member Countries. During the last biennium, about US$5 million were spent on research activities through country and intercountry programmes. Dr Samlee reiterated the main objectives of health research, namely, strengthening of national research capabilities, promotion and coordination of research, and facilitating the application of existing and emerging scientific knowledge. Referring to WHO/SEARO’s role, he stressed that WHO generally promoted, facilitated, coordinated and played a catalytic role in regional collaborative research efforts. It also helped in strengthening national medical research councils and supported the development and implementation of commissioned research projects. It collaborated with Ministries of Health, and through them with universities, research institutes and potential partners in other sectors. The following were some of the main research strategies adopted: Research should be related to the eight elements of PHC and research areas identified and prioritized. Main emphasis should be on health systems research, including health policy research and health economic research. Health research system should be linked to the health care system. Intersectoral and multidisciplinary research and research beyond the health domain should be promoted.
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Referring to the future research agenda recommended by the twenty-first SEA/ACHR, he assured the Committee that WHO would continue to promote and support behavioural, socioeconomic, cultural and other aspects of the determinants of health and diseases and the development of human resources for health. Health policy research, health promotion research and operational research on identification and analysis of constraints in implementing health programmes were priority areas. The Research Promotion and Development programme of SEA/ACHR included policy and strategy development, strengthening of research management mechanisms, information service, overall coordination of research activities and provision of visiting scientist grants, research training grants
SEA/ACHR/22 Page 3 increasing. In addition, diseases like tuberculosis, malaria and kala-azar were resurging in several countries and new challenges such as HIV/AIDS were threatening to become major health problems in the countries of this Region in the not too distant future. To face these multiple burdens with scarce human and financial resources, research had been recognized as a fundamental tool for improvement in appropriate technologies towards achieving national health goals. WHO’s cooperation in support of institutional strengthening of the Nepal Health Research Council, other centres of excellence and the development of health research capabilities in Nepal had been successful. WHO/SEAR0 accepted a simplified mechanism by which research grants were being awarded to new investigators under the “Young Researchers Programmes”. It promoted the effort to achieve a proper mix in the allocation of research funds between undertaking research and developing research capabilities. HMG looked forward to increased WHO technical and material support for strengthening the research capabilities of Nepal. The topics chosen for discussion at the twenty-second session of SEA/ACHR were most appropriate and inter-related. The Committee’s deliberations on these would certainly help Member States in formulating acceptable strategies to solve their pertinent health problems. 2.5 Vote of Thanks
Dr Shekhar Koirala, Rector, BPKIHS, thanked the Regional Director; for providing the opportunity to host this very important meeting in their institute. He also thanked Mr Ghana Nath Ojha, Secretary-Health, HMG/Nepal, for inaugurating the meeting and also the staff of BPKIHS for their hard work and support in its organization. 3. 3.1 SCIENTIFIC SESSION Introductory Statement by Chairman, SEA/ACHR
Prof Aree Valyasevi, Chairman, SEA/ACHR, welcomed the participants. He said that he was confident that the members would, as in previous years, discuss the technical subjects enthusiastically and that important issues as well as sound recommendations would emerge from the meeting. 3.2 Opening Remarks by Regional Director, WHO/SEAR
While welcoming the participants to the scientific session, the Regional Director stated that the three topics selected for technical discussion were based on the current situation and emerging interests. There had been a growing concern over the issue of occupational health, and the subject was also discussed at the WHO Executive Board which adopted a resolution urging Member States to devise national programmes on occupational health for all, based on the global strategy. Similarly, an in-depth review on issues relating to ethics and health, and quality in health care was made during the 97th session of the Executive Board in January 1996. He felt confident that the ACHR members would not only identify the priority researchable issues, but will also recommend ways and means to promote research in the respective areas. He added that in view of the developments taking place in many countries of the Region, promotion of research in health sector reforms was another area where there was a need to identity issues for research. He informed the Committee that Dr A.Kone-Diabi, ADG/HQ, and Prof Mwaluko would also join the discussions on this topic. 3.3 Nomination of Vice-Chairperson and Rapporteur
Dr G.V. Satyavati (India) and Dr Dulitha Fernando (Sri Lanka) were nominated as ViceChairperson and Rapporteur respectively.
SEAlACHRl22 Page 6 would be economical and the training would be more appropriate within the regional context and also relevant to the countries’ needs. The ACHR felt that the mechanisms and criteria for identification of research priorities for commissioned research needed to be revised to be compatible with the renewed HFA strategy. Partnership between institutions within and among countries should be encouraged and established in order to assist countries in developing research programmes. It was reiterated that commissioned research projects were more productive, dealing as they were with issues common to several countries in the Region, to which preferential support should be given. On the other hand, investigator-initiated research projects of high quality should also be considered for support if found relevant to national/WHO priorities. Research programmes and strategies should also be built up utilizing the human resources of Global and regional ACHRs, WHO collaborating centres, WHO expert committees, members of medical research councils and universities. The need for WHO assistance on supplies and equipment for research varied from country to country. It was agreed that such supplies played a vital role in maintaining quality research output. It was observed that the type of assistance should be flexible according to a country’s requirements. Promotion of health policy research and health systems research should be made a priority as these were crucial for future world health. Since donors normally did not want to support health policy research and health systems research, members were of the view that benefits of health policy research and analysis needed to be highlighted by WHO for due recognition and effective utilization by Ministries of Health, Planning Commission, or any other relevant department. 4.2 Recommendations
The SEA/ACHR recommended that: (1) WHO should support research management .at the country level in order to facilitate and catalyse research promotion activities in Member Countries; (2) WHO should promote dissemination of research findings and their applications; (3) WHO should review the status of collaboration of WHO collaborating centres to make them more effective in WHO programmes and in their own countries, and (4) WHO should promote utilization of WHO collaborating centres and national centres of excellence in the development of human resources for health research in the Region. 5. PROMOTION OF RESEARCH IN HEALTH SECTOR REFORMS
Dr Samlee Plinabangchang, DPMBEARO, while presenting the paper on promotion of research in health sector reforms, touched on the reasons for doing health sector reforms, role of research, framework for research, type of research required, and the role of WHO in health sector reforms. He also mentioned that the subject encompassed a wide range of issues, including those which were of current concern such as renewal of HFA strategy, new public health functions, ethics and quality
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and consultancies. The Collaboration in Research programme supported 25 research projects, most of which were commissioned research projects. Dr Samlee pointed out that because of budgetary constraints, there was need to better manage the intercountry research activities. Research grants would have to be provided under WHO country budget, and the regional/intercountry funds would have to be geared to activities strictly in areas of promotion, coordination, information dissemination and management. Referring to the important role played by the WHO collaborating centres, Dr Samlee remarked that the expertise and facilities of these centres should be utilized to a greater level. In addition to WHO collaborative activities in research, these centres should be involved in other WHO activities as well, especially in training. The Expert Advisory Panel, which included 232 experts from Member Countries, would also need a closer look. Their inventory and profiles needed updating, and their utilization, especially within the Region, should be ensured. There was also a need to promote greater representation of members from countries with only a few experts listed. Summing up his presentation, Dr Samlee remarked that in view of the epidemiological, social, economic and political changes as well as financial crisis, there was a need to have a fresh look at the research promotion activities in the Region. 4.1 Discussion
The SEA/ACHR appreciated the progress made in the promotion of research activities in the Region during the 1994-1995 biennium. Members noted wide variations in the allocation of WHO country Regular budget for research activities in Member Countries. To some extent, these differences were due to the levels of development of research programmes in different countries. It was pointed out that WHO should give more attention and support to countries such as Bhutan and Maldives where research activities were weak. These countries would, in addition, need adequate support for the development of research infrastructure. Members noted with satisfaction that in spite of small budgets, WHO had been able to make significant achievements in health research. Although, WHO’s research budget of US $5 million for the Region was only a fraction of what the Member Countries actually spent in this area, SEARO’s input had a catalytic effect and had significantly helped in the development of research infrastructure and in the improvement of the quality of research in the countries. Even so, the Committee felt that there was need for additional funds and efforts should also be made to mobilize extrabudgetary resources to support research activities in the Region. It was observed that the expertise in the WHO collaborating centres in the Region had the potential to make significant contributions to the health research agenda regionally as well as globally. The existing mechanisms for designation and redesignation of collaborating centres should be reviewed on the basis of their work, and the need to identify and designate centres on the basis of “issues” was highlighted. It was felt that contributions of collaborating centers might be improved by strengthening regional and global networking. Some members agreed that collaborating centres had the capability to provide training facilities for development of human resources for health, and there was indeed considerable scope for some of them to help develop formal regional courses for research training; this
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Since the main reason which prompted reform was budgetary constraints, the possibility of reforms being donor-driven could not be ruled out. Members emphasized that health sector reforms should be undertaken based on the needs of the country and not as a response to requests by funding agencies. It was observed that health sector reforms had major political implications. Sensitization of community, policy-makers and politicians was a priority. The process of change to be involved in health sector reforms should be clearly identified. Implementation and evaluation were important areas for consideration and socio-political research might be required in this context. Some of the areas/tracks to be considered in health sector reform activities included (a) how to liberate the health system to become more holistic in nature; (b) prevent a top-down approach and-establish a bottom-up approach, and (c) to make health a public agenda and conduct research on manpower development in relation to training and performance. It was agreed that a demand for change should come from the people. Uplifting their level of awareness will enhance their capability to make appropriate choices. The focus in health sector reforms so far had been mainly in the area of health financing. A mid-term review of the HFA strategy implementation conducted in 1988 as well as the second evaluation and the third monitoring of HFA strategy implementations had all highlighted increasing inequity and inaccessibility of health care as the main areas of concern. Research in’these areas would help national leaders and policy-makers to develop health sector reforms, which would provide valid data on which decisions could be based. Health sector reforms needed to be considered as an ongoing process and research should provide data to identify “directions” for change. In addition to inequity and inaccessibility, other problems also needed to be tackled. These included ineffective system and lack quality and efficiency in the use of resources. Views were expressed that as reform involved substantial changes, HSR per se may not provide all the required solutions. Even though health sector reforms could be considered as urgent, reforms should be undertaken only after thorough discussion in the national context, with adequate support of data arising out of research. Health sector reforms would depend on national health policies and national level policies in other relevant sectors, e.g. agriculture, nutrition, etc. Reforms have to take into consideration all relevant policies. If a country had decided on health sector reforms, WHO should be ready to provide technical guidance. As this topic was considered important, a small group was formed to draw up the general line of action. The group identified the following steps to be taken as part of the reform process: (1) National advocacy/debate on the health care system of the country and the need for possible change. (2) To determine “what is unsatisfactory” and “what is satisfactory” in the health care system. (3) To undertake required research and to debate results for consideration .of use. (4) To reform health services as required. (5) To develop an in-built evaluation system for continuous development.
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assurance in health care, and health care financing. He pointed out that in its broad categorization, health sector reforms also included structural and functional areas. Structural reforms included restructuring of ministries of health and reorientation of related infrastructure, including training and research institutions. Functional reforms included improvement in the performance of civil service, decentralization, realization of health rights and responsibilities, health security and accountability. Dr Samlee emphasized that in order to operationalize the idea of health sector reform, it was important to have a clear understanding of how to do it in practice. This was the point where research came in. Most important was the political will and commitment as well as multisectoral and multidisciplinary efforts and actions necessary to go through the process successfully which necessitated the promotion and advocacy of health sector reforms. Professor G.M.P. Mwaluko, Joint HSR Project Manager, Harare, Zimbabwe, recounted the experience of the Joint Programme on HSR for Eastern and Southern Africa. He also highlighted the characteristics, importance and role of HSR in health sector reforms and challenges for the future. 5.1 Discussion
The Indonesian and Nepalese experiences in health sector reforms were discussed. The Indonesian experience was shared by Dr Brotowasisto. It was a good example of how and why such reforms should be undertaken. Dr Brotowasisto recounted that the process started in the early eighties when it was realized that improvement in health status was slow; demographic and epidemiological transition brought in new problems which added to the existing ones, health budget was limited; the role of the private sector was increasing, and the government changed its policy of recruiting new doctors. To meet these challenges, several changes were effected at all levels, which collectively qualified for the term “reform”. Health insurance with community health funds was introduced; all hospitals were allowed to utilize their resources, including user fees; health development programmes were decentralized to the district level; health services were standardized at health centre and hospital levels, and Posyandus - that is, village health posts funded by the coverage of households - were established, and concomitantly, there was a steep increase in immunization coverage to almost 100%. The reforms, indeed, were progressive and resulted in considerable improvement of health services at all levels. Members noted that the present-day health sector reforms were part of structural and socioeconomic changes, and were not primarily health sector reforms; they may not necessarily lead to the achievement of the desired goal of health equity for the underprivileged and the underserved. In fact, in many countries, such reforms had widened the gap between the rich and poor segments of the population in terms of health services and health status. Reform must not be undertaken without giving due consideration to issues relating to Health for All. What was required was research to enable countries to make appropriate reforms in the health sector. In this context, several issues were suggested as suitable topics for research. They included, among others, (a) achievability of policy options; (b) opportunity costing; (c) effects of growth in one area on the survival of the others - that is, a possible negative effect on some segments of the population; (d) phasing of the changed process, and (e) gender issues. In tackling these issues, it must be ensured that the contents of health sector reforms are country specific, should have political backing, and should not be undertaken in isolation. Policy-makers should be involved right from the beginning, and should provide assurance that the results of research would be fully utilized. WHO’s role could be to provide technical back-up to countries desirous of applying scientific principles to the process of health sector reforms.
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Discussions centred on the need to include non-formal/unorganized sector with special emphasis on employment of women, children and bonded labour. Disaster management (in relation to industries) was also considered important by the ACHR members. Members observed that acute occupational health hazards like injuries/poisoning were easier to identify and handle, but health hazards due to chronic exposure were most difficult to study, understand, prevent, cure and compensate, taking into account the delayed effects of exposure at work. WHO at the global and regional levels and national agencies had added responsibility in deciding the threshold limit values of certain hazardous substances and also the blood levels, such as pesticide level in water and food, blood levels of trace elements, and levels of toxic elements like arsenic and others in water and soil. Members also noted the fact that when multinational corporations (MNCs) made entry into developing countries, national governments and international agencies could make it obligatory on the part of the MNCs to provide full data on the known and potential hazards being brought into these countries. It was agreed that the scientific, ethical and legal issues involved in occupational health were too complex to be tackled in one meeting. Members noted that WHO’s global strategic principles on occupational health provided a very good framework to achieve most of the other objectives.
6.2
Recommendations
In view of the importance of occupational health as a major health concern in the Region, the SEA/ACHR recommended that: (1) WHO, in collaboration with ILO, should promote national dialogue between all concerned authorities to develop a coordinated and comprehensive programme for the care of workers’ health; (2) Efforts should be commenced to develop a preliminary database to serve as a basis for programme development, in keeping with the global strategic principles and objectives suggested by WHO, and (3) WHO and other international agencies should collaborate with Member Countries in attracting extrabudgetary funds for this programme and for related research.
7.
ETHICAL ISSUES IN HEALTH
The Vice-Chairperson briefly remarked on the ethical dimension in medical practice, medical education and medical research. These considerations were becoming more important in areas such as scientific publications, use of different interventions, use of contracts, etc. In Ayurveda, the Indian system of medicine, ethical aspects had been highlighted long before they were incorporated in the Western system of medicine. Dr B.A. Jayaweera introduced the paper on ‘Ethical issues in health’. Reference was made to the Nuremburg Code on Experimentation on Human Subjects of 1947, the Helsinki Declaration in
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The SEA/ACHR recommended that: (1) WHO should sensitize Member Countries on the need for change through advocacy, and (2) WHO should be in a position to provide technical guidance, if needed, in bringing about health sector reforms. 6. RESEARCH IN OCCUPATIONAL HEALTH
The background paper titled “Research in Occupational Health”, prepared by Dr B.A. Jayaweera, WHO Short-term Consultant, was presented by Dr Myint Htwe. He explained the magnitude of the problem at the global as well as the regional levels, and the current situation in the countries of the South-East Asia, drawing attention to the multi-sectoral responsibility for occupational health care and the need for a concerted effort for collective action for this vulnerable group of the population. He also highlighted the WHO global occupational health strategic principles, the WHO global occupational health objectives and the factors responsible for success in this area in industrialized countries. Research requirements in occupational health in the context of occupation, workforce, health status and care, education and training and applied and basic research were also elaborated. 6.1 Discussion
Members noted a wide range of issues relating to occupational health, including legal, moral and ethical aspects. The linkage between the socioeconomic status of workers in different occupations and their health status was highlighted. It was observed that occupational health could not be isolated from environmental health inasmuch as it was related to environmental pollution and its effects on workers and community. A considerable number of departments/institutions were involved in areas related to occupational health. The need to develop ‘working groups’ with members from different sectors was emphasized. The advocacy programme highlighting the theme ‘Investing in health ofworkers means increase in productivity’ was considered important and should be directed towards both employees and employers. Members noted that research studies aimed at economic analysis as part of the strategy would serve as a backstopping mechanism for improving the occupational health programme. It was mentioned that some of the collaborating centres in occupational health in the Region served mainly as reference centres for standard setting. It was felt necessary that WHO should review the optimal use of research findings from these centres. Development of a database (with emphasis on non-formal/unorganized sector) was considered a priority for most countries of the Region, and this could be done by collation of data by WHO collaborating centres and other institutions. Concern was expressed on the paucity of data in this area. Development of a programme based on a valid database was considered important in view of the emerging importance of occupational health in the general health agenda in the next few decades. At every stage of development and implementation of occupational health programme, research issues needed to be identified to help improve the programme.
SEAlACHW22 Page 12 “Appropriate disposal of wastes, bio-hazardous or hazardous matters in any other way arising out of the activities of research in health; protecting the environment by not engaging in direct or indirect harm or damage to environment/ecology due to research activities”. Members also stressed the importance of safety of data and protection, of individual’s right to confidentiality. Members noted the existence of guidelines relating to the use of laboratory animals or use of animals in research and also expressed the need to review it. Members expressed the view that there should be a distinction between research on ethical issues in health and ethics of health research. The need for looking at ethical issues from the “users’ perspective”, including the rights of patients, was emphasized. They aired the view that an impersonal “case approach” to patients may have a dehumanizing effect, and a suggestion was made to consider a declaration for fundamental rights and responsibilities of patients (Charter for Patients). The need for inclusion of ethics in the medical curriculum was highlighted. Some medical schools had already included ethics in the curriculum and the need to improve such programmes was emphasized. An analysis of the teaching of medical ethics in medical school was recommended. The importance of the teachers of health professionals to be role models of ethical practice was emphasized. The responsibility for providing authentic models for ethical practice should be considered by all institutions. “Mission statements” by health institutions should provide for direction for better institutional ethical codes and conduct. It was suggested that “Health and Ethics” be considered together at a broader level. Ethical aspects of resource allocation, identification of health priorities and research topics also needed emphasis. This was especially so for accessibility and equity in the provision of health care. Quality control in the pharmaceutical industry, provision of information on the HIV/AIDS status of individuals, problems of literacy levels of patients to understand their medications and investigations, and validity of “informed consent” were considered by members as problems which had important ethical implications. The need for continuous advocacy and review of the existing ethical review mechanisms in the cultural context of countries was emphasized. It was agreed that SEAR0 should continue to play the advocacy role. Ethical issues related to epidemiological research and health systems research also needed to be considered. In discussing ethical issues it was important to consider “individual benefit” in relation to “community benefit” and also the “rights” of individuals and groups. It was suggested that the issue be considered at macro level - for example, at community and district level, and at the level of health research and related institutions. At the micro level also advocacy was needed. Medical Research Councils (MRCs) in countries could be expected to discuss issues of ethics in health research. 7.2 Recommendations
The SEA/ACHR
recommended that:
SEAlACHR22 Page 11 1964 by the World Medical Association on ethics for. biomedical research (amended in 1975, 1983 and 1989), and guidelines for biomedical research involving human subjects, provided by the Council of International Organizations of Medical Sciences (CIOMS) in 1982. These guidelines had been distributed widely by the Regional Office. As a result, several institutes in the countries of the Region had developed their own ethical guidelines and criteria for review of research projects and programmes. The 1993 CIOMS publication “International Ethical Guidelines for Biomedical Research Involving Human Subjects”, which was developed in response to additional ethical issues, superseded the earlier one. Taking into consideration the revised CIOMS guidelines of 1993, further promotion of ethics and research was suggested. A proposed action plan for this purpose could include: (a) distribution of the 1993 guidelines to Member Countries; (b) promotion of national meetings; (c) technical support by WHO and participation of the Regional Office at national meetings; (d) regional synthesis of national activities for distribution and sharing information, and (e) presentation of report to ACHR, MRCs meetings, meetings of WHO representatives, and Regional Committee, as appropriate. This should be followed by a periodical review of situation and evaluation of progress. Dr Jayaweera said that with the institutionalization of health care and its development into a complex public and private enterprise oftoday influenced by diverse political commitments and market forces, the question of ethical conduct had taken a wider perspective. In the health care system, there were several levels at which ethical issues could arise. These covered policy development through health care management, the services provided (promotive, preventive, curative and rehabilitative) and their coverage, the service delivery system, the choice of technology and its appropriateness, and human resources and their development. He mentioned that WHO had obligations for promotion of ethics in health care. Periodic evaluation of the HFA strategy had confirmed the existence of inequities in health status and access to health care and services. WHO’s collaboration in the Ninth General Programme of Work for the period 1996-200 1 was expected to focus on support to countries in reducing such inequities by tackling the main problems affecting health and health systems. The 97th session of the Executive Board in January 1996 had discussed the subject of Ethics and Health and Quality in Health Care and made the following recommendations: 7.1
WHO should organize a public debate on the ethical aspects of health policy and international cooperation, and WHO should organize a forum along with NGOs involved in emergency humanitarian assistance and the UN inter-agency working group on “measuring the value of health”.
Discussion
The group noted the international guidelines in this regard and said there was a need to develop national guidelines. It was noted that ethics in health research was a part of the initiative of the global ACHR jointly with CIOMS and constituted an integral part of the terms of reference of the ACHR system. WHO/HQ would support this initiative of SEAR0 and bring it to the attention of the Global ACHR. The experience in Nepal had indicated that some ethical issues had not been covered by the CIOMS’ 1993 guidelines. These included the following:
SEAlACHRf22 Page 14 Professor M. Manciaux, Vice-Chairman of the G/ACHR, reported on a meeting in Ulm (Germany), 8-12 March 1996, held for the preparation of the research component in the renewed HFA strategy to be presented to the World Health Assembly in May 1998. The meeting was attended by ACHR members and prominent scientists from various disciplines who worked in groups on sectoral ,and cross-se&oral topics and produced the table of contents, the outline and the main issues for “A science and technology agenda for global health”, which would constitute the research component of the renewed strategy for HFA. 8.1 Discussion The recommendation made by the G/ACHR on the usefulness and limitation of DALY as a health-related indicator was discussed in detail. It was observed that there were several limitations of this indicator, specially in situations where there was a long time-lag between the commencement of the disease process and the manifestation of disease, e.g. HIV/AIDS, and in situations where there was co-morbidity and multifactorial causation of diseases. The importance of the assessment of the quality of data on which DALY was based was highlighted. Experience from Indonesia had indicated the need for improvement of quality of morbidity and mortality data. It was suggested that countries which had experience of developing DALY or in using them should share their experiences. In view of the limitations of this indicator, modifications were needed to be considered. The recommendation of the Global ACHR, which was made after a detailed study, should be widely publicized, specially to policy-makers, researchers, medical professionals and other related professional groups. The mechanism in which WHO regions and individual countries could contribute to Planet Heres (Planning Network for Health Research) was discussed. It was agreed that the ACHR system, i.e. G/ACHR, Regional/ACHRs and other related organizations could work together towards this activity. Countries could make their contribution through the above mechanism. 8.2 Recommendations The SEA/ACHR recommended that:
(I) Involvement of the scientific community (health and non-health sector) in developing a science and technology agenda for global health was necessary. The Regional Office would contact national scientific academies and initiate discussion; (2) WHO should follow-up on the recommendations of the G/ACHR regarding the use of DALY and to encourage research on development of appropriate health indicators, and (3) The new approaches to health research following the decision to renew the Health-For-All strategy be discussed at the next MRC meeting. 9. PROGRESS REPORT ON UNDPbVORLD BANK/WHO SPECIAL PROGRAMME FOR RESEARCH AND TRAINING IN TROPICAL DISEASE (TDR)
Dr C.P. Ramachandran, TDR, WHO/HQ presented an update of the programme of research and development in the six TDR diseases, with emphasis on malaria, leishmaniasis, leprosy and lymphatic fkiasis. He said that priority for TDR was the development of an effective vaccine against P.
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(1) Member Countries be encouraged to review ethical guidelines and revise them as appropriate, taking into consideration the CIOMS guidelines; (2) The Regional Office should promote the review of the situation related to the use of ethics in medical practice, medical research and medical education in Member Countries; (3) WHO may invite MRCs in Member Countries to report on the situation of ethical issues in health and the existing mechanisms in the forthcoming MRCs’ meeting in October 1996; (4) SEAR0 should promote the application of ethical guidelines in health care in Member Countries with special emphasis on medical education, and (5) Research leading to the development of a “patients’ charter” (rights and responsibilities) was a priority area and should be supported. s 8.
MATTERS ARISING OUT OF THE MEETING OF GLOBAL/ACHR
Dr B. Mansourian, RPS, WHO/HQ, briefed the Committee on the thirty-third session of the Global Advisory Committee on Health Research, which was held in Geneva from 17 to 20 October 1995. The overall orientation of the ACHR was to strengthen the linkages between all components of the ACHR system at the global and regional levels, and to increase the dialogue with WHO’s governing bodies to cooperate more intensely with the scientific community. The Global ACHR (G/ACHR) pursued its deliberations on the basis of reports presented by various auxiliary bodies and other groups. Health policy research, perceived as a priority, had been discussed in the light of a critical review of the literature, while taking cognizance of the pioneering contributions of SEARO. Research activities at the global level were reviewed in the areas of maternal and child health; aging and health; safety promotion and injury control, and neurosciences. New research initiatives at the global level were started and encouraged, particularly in relation to global and integrated environmental health, and to the WHO Kobe Centre for Health Development. The reports by the Chairmen of all regional ACHRs were discussed and the G/ACHR urged EURO to reconsider the downsizing of its research secretariat, and WPRO to participate actively in trans-regional initiatives. Two other subjects of special interest were also discussed. The first was the report of the ACHR “DALY Review Group”, set up in response to concerns expressed at the previous session of the G/ACHR. The Committee, while recognizing the technical achievement of this new indicator, discouraged its use for setting health research priorities. It also considered that its use for resource allocation or prioritization of research could divert attention from the original determinants of disease, which were still relevant and of value. Another issue discussed was a draft report of the “Ad hoc Committee on Research in Future Intervention Qptions”. The substantive areas identified for intensified research were consistent with previous G/ACHR recommendations. The proposed plans for a consortium constituted a risk for the institutional integrity of WHO.
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family planning programmes, and (vii) helping countries to address regional and national research priorities in reproductive health.
10.1 Discussion The Committee noted that evaluation of the impact of technical and financial support provided by HRP on the strengthening of research capabilities of some countries of Asia and the Pacific region during the past six years had commenced and a report would be available by June 1996. It was agreed that research on male infertiiity caused by STDs was important in family planning. Long-term safety of new methods of fertility regulation being developed for men should be ascertained through operational research. This would best be carried out in countries under the guidance of the WHO Regional Offices. Socio-behavioural studies with a view to increasing the participation of men in reproductive health needed to be further pursued. Research findings in areas such as post-marketing surveillance of Norplant, use of emergency method of contraception, and social science research on abortion-related issues were considered important. The results of these studies would be made available to policy-makers and politicians. It was suggested that HRP/HQ should provide information on the percentage of research projects from the South-East Asia Region which were not approved for funding by HRP. This information would help in assessing the need to further strengthen research training in the Region.
10.2 Recommendations (1) Operational research should be the focus of reproductive health research and should be coordinated by the Regional Ofice. SEAR0 may constitute a scientific working group to draw a plan of activities, and (2) Research which can be translated into action over a short period of time should get high priority.
11.
SUGGESTIONS ON TOPICS FOR TECHNICAL DISCUSSION AT TWENTY-THIRD SESSION OF SEA/ACHR
Members suggested that the subject for technical discussion at the 23rd session of SEA/ACHR may be chosen from the following: -
Health futures research in SEAR countries Research on interventions for improvement in quality of care Research relating to new, emerging and re-emerging infectious diseases Impact of environmental degradation on health Review of the role of ACHR Strategies for “getting the results of research into practice”.
-
SEA/ACHR/22 Page 15 falciparum. Dr Ramachandran discussed the possibility of eliminating four of the largest diseases of TDR, namely, leprosy, onchocerciasis, lymphatic filariasis and Chagas disease as public health problems. He said adequate, effective, sustainable and affordable control tools were now available against these diseases. He described the newly-enunciated global control strategies for lymphatic filariasis and how the disease could be “eliminated” as a major public health problem in endemic countries. 9.1 Discussion
In view of the results obtained so far from malaria vaccine trials, the vaccine development programme would continue for approximately another 10 years. It was found that biological methods of vector control, even though shown to be effective, had not been implemented in countries as expected. One reason for their inadequate application was that the “industry” did not show much interest in this area. The mandate of the TDR was to find the tools for disease control and the control programmes needed to apply these tools. Sometimes, problems had been encountered in relation to progression from the development of tools to their introduction and use in control programmes. Special mention was made of the new strategy formulated for the control of filariasis. Other areas of concern relevant to the socioeconomic research component of TDR were identified. These included the study of the importance of environmental changes, socioeconomic development, and health behaviour as areas of concern for the control of these diseases. The Regional Director commended Dr Ramachandran’s contribution to filariasis control in the Region. 9.2 Recommendations
(1) The Regional Office should promote dissemination of information on tropical diseases research at the highest political levels in Member Countries, and (2) The Regional Office should assist Member Countries to promote, advocate and mobilize communities to participate in disease control programmes. 10. PROGRESS REPORT ON UNDP/UNFPA/WHO/WORLD
BANK SPECIAL PROGRAMME OF RESEARCH, DEVELOPMENT AND RESEARCH TRAINING IN HUMAN REPRODUCTION (HRP)
A presentation was made by Dr Chander Puri, HRP, WHO/HQ, on the activities of HRP. He mentioned that at WHO headquarters, a new programme -- Family and Reproductive Health -- had been created which included Reproductive Health programme, Child Health and Development programme, Adolescent Health programme, and Women’s Health programme. The Reproductive Health programme included research (HRP) and technical support programmes. The mandate of HRP had been expanded taking into account the changing concept of reproductive health. The mission goals of HRP reflected the priorities being articulated by people, especially women, and the Programme of Action of International Conference on Population and Development (ICPD). Dr Puri provided a summary of HRP research activities during 1995 which covered the following areas: (i) increasing male responsibility in reproductive health; (ii) developing new methods of fertility regulation; (iii) expanding family planning options; (iv) evaluating the long-term safety and efficacy of family planning methods; (v) responding to gender considerations and people’s needs; (vi) assessing
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possible. In the era of financial constraints, WHO’s main focus would be to ensure productive and complementary linkages between the SEAIACHR and the Global ACHR and with the Research Development Committee in the Regional Office. Therefore, it would be the endeavour of the Regional Office that the recommendations of the ACHR are communicated to the countries for appropriate application and implementation. Dr Samlee added that WHO was now in the process of reform; one important aspect of reform was the significant contribution research could make in ensuring efficient and effective utilization of available resources. He also thanked Dr Myint Lwin (Myanmar), whose term was expiring this year, for his contribution to the ACHR.
i i I / I
SEAlACHRf22 Page 17 12. DATE AND PLACE OF TWENTY-THIRD SESSION OF SEA/ACHR
It was proposed that Thailand host the 23rd meeting of SEA/AHCR in 1997. The Royal Thai Government’s agreement to this proposal would be sought. 13. ANY OTHER BUSINESS
Dr Charas Suwanwela, on behalf of the Chairman of the Council of Health Research for Development (COHRED), made a brief presentation on the concept of Essential National Health Research (ENHR).
I 1
Dr Charas said that research should be of national interest, should be need-based, relevant to the country, and have due consideration for self-reliance. Quality of research was important, and the utilization of results of research was a major activity. All stake-holders should participate in a partnership approach and such action needed a network of centres/institutions. It was felt that this was one of the partnerships that could be built up. Members noted the necessity for WHO to collaborate to avoid overlapping of efforts so that the activities of the two organizations would be complementary. It would be necessary to work out the modalities for building partnerships. 14. ADOPTION OF THE REPORT
The SEA/ACHR members agreed to adopt the report after incorporating appropriate modifications as suggested in the meeting. 15. CLOSING SESSION
Dr M.P. Upadhyay, Director, BPKIHS, congratulated the Chairman, the Vice-Chairman and the members for the successful completion of the ACHR meeting. He said the deliberations of ACHR were very important and would greatly benefit the countries of this Region. The Chairman thanked the members for their contribution in the technical discussions. He also thanked the members for their cooperation which contributed to the successful and smooth conduct of the meeting. He also thanked the Director, the Rector and other staff of BPKIHS for providing their unstinting support and cooperation. Dr Samlee Plianbangchang, DPM/SEARO, speaking on behalf of the Regional Director, thanked the Chairman, the ACHR members, special invitees and other participants for their valuable contributions. He also expressed his gratitude to HMG Nepal for hosting the meeting in the peaceful city of Dharan. He remarked that the ACHR’s role was a normative function to help WHO in the development of guidelines, criteria and framework for regional research activities and, therefore, it was important to keep in mind country situations while formulating country-specific action plans. At the same time the Regional Office action plan should be such as to benefit as many countries of the Region as
SEAlACHRi22 Page 20
Annex 2 LIST OF PARTICIPANTS SEA/ACHR Members Professor Aree Valyasevi Dean Faculty of Medicine Thammasaat University Rangsit, Klong 1 Amphur Klong Luang Prathum-Thanee 12 120 Thailand Dr Brotowasisto Adviser to the Minister of Health Ministry of Health Jakarta, Indonesia Professor U Myint Lwin Former Director-General Department of Medical Research, & Adviser Ministry of Health No.5 Ziwaka Road Yangon, Myanmar Dr (Mrs) G.V. Satyavati Director-General Indian Council of Medical Research Ansari Nagar New Delhi-l 10029 Professor Priyani Soysa Director-General Natural Resources Energy and Science Authority of Sri Lanka Ministry of Science, Technology and Human Resources Development 47/5 Maitland Place Colombo-7, Sri Lanka Dr Thavitong Hongvivatana Centre for Health Policy Studies Faculty of Social Science & Humanities Mahidol University, Salaya Nakorn Phatom 73 170, Thailand Dr M.P. Upadhyay Director B.P. Koirala Institute of Health Sciences P.O. Box 2162 Kathmandu. Nepal Dr V.I. Mathan Professor of Medicine & Gastroenterology & Director Christian Medical College and Hospital Vellore - 632004 Tamil Nadu, India Dr Agus Suwandono Head Health Services Research and Development National Institute of Health Research and Development Jakarta. Indonesia Prof Dulitha N. Fernando Head of the Department of Community Medicine Faculty of Medicine University of Colombo Colombo, Sri Lanka Dr Harun-ar-Rashid Director Bangladesh Medical Research Council Dhaka, Bangladesh Special Invitees Prof M. Manciaux (Vice-Chairman, Global ACHR) 24, rue D’Eulmont 54690 Lay St. Christophe France Dr Charas Suwanwela President, Chulalongkom University Phyathai Road Bangkok 10330, Thailand Professor G. Mwaluko Joint HSR Project Manager Harare, Zimbabwe *H.E. Dr K. Kalumba Deputy Minister of Health Lusaka, Zambia
*Unable to attend
SEAlACHRl22 Page 19 Annex 1 AGENDA
Inaugural Session -
Welcome address by Prof M.P. Upadhyay, Director, BPKIHS Address by Prof Aree Valyasevi, Chairman, SEA/ACHR Address by Dr Uton Muchtar Rafei, Regional Director, WHO South-East Asia Region Inaugural address by Mr Ghana Nath Ojha, Secretary of Health Vote of thanks by Dr Shekhar Koirala, Rector, BPKIHS
-
Scientific Session -
Introductory statement by Chairperson, SEA/ACHR Opening remarks by Dr Uton Muchtar Rafei, Regional Director, WHO Adoption of agenda Progress report on the Regional Research Promotion and Development (RPD) Programme Promotion of research in health sector reforms
-
Research in occupational health Ethical issues in health Matters arising out of the meetings of global/ACHR and ACHRs of other Regions
Progress report on UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) Progress Report on Special Programme of Research, Development and Research Training in Human Reproduction (HRP) Suggestions on topics for technical discussion at twenty-third session of SEA/ACHR Time and place of the twenty-third session of SEA/ACHR Any other business Adoption of the Report
-
-
Closing Session
SEA/ACHR/22 Page 22
Annex 3 LIST OF WORKING AND INFORMATION DOCUMENTS Working Documents (1) Provisional Agenda (2) Suggested Working Schedule (3) List of Participants (4) (5) List of Working and Information Documents Progress Report South-East Asia Regional Research Programme Promotion of Research on Health Sector Reforms SEA/ACHR/22/1 SEAlACHRl2212 SEAlACHRf2213 SEAlACHIU22/4 SEAlACHRf2215 \ \ I
(6)
SEA/ACHRl22/6
(7) Research in Occupational Health (8) Ethical Issues in Health (9) ‘Matters arising out of the meeting of Global ACHR and ACHRs of other Regions
SEAlACHRl22f7 SEA/ACHR/22/8 SEAlACHRl2219
(10) Progress Report on UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR)
SEA/ACHRl22/10
( 11)
Progress Report on Special Programme of Research, Development and Training in Human Reproduction (HRP)
SEA/ACHR/22/11
(12) Topics Suggested for Technical Discussion at the Twenty-Third Session Information Documents (13) Highlights of the 33rd Session of the Global ACHR Meeting (14) .Information Bulletin
SEA/ACHRf22/12
SEA/ACHR/22/13
SEA/ACHRl22/ 14 SEA/ACHR/22/15
(I 5) Health Sector Reform: Key Issues in Less Developed Countries by Dr Andrew Cassels (WHO/SHS/NHP/95.4) (I 6) Experience with Organization and Financing Reform of the Health Sector by Dr Joseph Kutzin (WHO/SHS/CC/94.3)
SEA/ACHRl22/16
SEAlACHRl22 Page 21
Special Invitees (contd.)
WHO Secretariat (WHO Nepal)
Dr B.A. Jayaweera 14, Laxpana Mawatha Jayanthipura, Batharamulla Sri Lanka Dr Brahim Head National Institute of Health Research & Development Ministry of Health Jakarta, Indonesia Dr M.P. Shrestha Chairman Nepal Health Research Council Kathmandu, Nepal Observers
Dr William J. Pigott, WR, Nepal Dr P.T. Jayawickramarajah Mr Lava N. Shrestha Mr Arun K. Pradhan Mr Kedar B. Khadka WHO Headquarters
Dr A. Kone-Diabi, ADG Dr B. Mansourian, RPS Dr C.P. Ramachandran, TDR Dr Chander Puri, HRP Organizing Committee
Dr Shekhar Koirala Rector B.P. Koirala Institute of Health Sciences Dharan, Nepal WHO Secretariat (South-East Asia Regional Office)
Dr Shekhar Koirala, Rector, Chairman Dr Narayan Kumar, Hospital Chief, Member Mr Rameshwar Devkota Assistant Sr. Administrator, Member-Secretary Mr S.R.K. Upadhyay Deputy Finance Manager. Member MS Sakun Singh, Deputy Nursing Chief, Member
Dr Uton Muchtar Rafei, Regional Director Dr Samlee Phanbangchang Director, Programme Management Dr S.P. Tripathy Director, Family Health and Research Dr Myint Htwe Regional Adviser in Medical Research
SEAtACHlU22 Page 24
Annex 4 FULL TEXT OF ADDRESS BY REGIONAL DIRECTOR, WHO/SEAR
Excellencies, distinguished participants and honourable guests, It is my great pleasure to be present here at the inauguration of the 22nd session of the WHO South-East Asia Advisory Committee on Health Research. First of all, I wish to thank His Majesty’s Government of Nepal for hosting this very important meeting. I am most grateful to Health Secretary, Mr Ghana Nath Ojha, for his keen interest in and support to health research, as evinced by his presence here with us today. We most warmly welcome the distinguished members of SEA/ACHR, the special invitees, the Vice-Chairman of Global ACHR, and our colleagues from WHO/HQ. I must express my gratitude to the Assistant Director-General of WHO, Dr A.Kone-Diabi ,who, in spite of her heavy responsibilities related to the preparation for the Forty-ninth World Health Assembly, will be joining us the day after tomorrow at this session. We cordially welcome the distinguished scientists, researchers, high officials from the health profession in Nepal, and honoured guests who are with us here on this occasion, and through them, we extend our warm greetings to all researchers and health scientists in the country. I would also like to extend my warm welcome to the four newly appointed members of ACHR, Dr V.I. Mathan from India, Dr Agus Suwandono from Indonesia, Dr Dulitha N. Fernando from Sri Lanka, and Dr Harun-ar-Rashid from Bangladesh. We now have a total of 11 members, including the Chairman. I would also like to place on record our appreciation of the services rendered by the members whose term concluded last year. They are : Prof. A.P.R. Aluwihare from Sri Lanka, Dr S.G.M. Chowdhury from Bangladesh, Prof. B.N. Dhawan from India, and Dr Tonny Sadjimin from Indonesia. WHO’s role in helping to achieve progress in research in the countries of this Region has been through promotion, technical support, information exchange and research capability strengthening. It has helped the countries identify their research needs, and formulate their health policy, strategies and programme. Most of the countries in the Region have achieved self-reliance in developing and conducting health research in different areas. This is an important part of the achievement related to the regional and country WHO collaborative programmes. But, the absence of uniformity in developmental stages in health research in these countries is a reality that has to be faced. It would be most beneficial if we direct our efforts to developing and undertaking the type of research which would be supportive of priority health programmes aimed at satisfying the basic primary health care needs. The important point which I would like to highlight here is that countries would benefit greatly if, from time to time, their health research policies are reviewed and reoriented within the context of the overall national health and health-related policies. Many of the determinants of people’s health and the factors affecting the performance of health care delivery system are changing constantly. Accordingly, the health research policies and strategies must be equally dynamic to be in line with such changes. This would lead to identification of appropriate, timely and relevant health research priorities as also of the innovative avenues for achieving this end. The established national mechanisms for research promotion and coordination need to take a major role in prioritizing the country research needs for which WHO could give full technical support. It is hoped that during the course of our discussions, we would be able to formulate clear and practical recommendations which the decision-makers could use in devising a sound basis for translating health policies and strategies into research priorities and action.
SEAlACHRf22 Page 23 (17) Alternative Financing of Health Care Report and Documentation of the Technical Discussions - Forty-eighth Session of the WHO Regional Committee for South-East Asia, Colombo, Sri Lanka, 12-l 8 September 1995 (18) Equitable Access to Basic Health Services: Towards a Regional Agenda for Health Sector Reform, Special Meeting on Health Sector Reform, 29-30 September 1995, Washington, D.C. (19) Health Care Financing Reforms - Report of an Intercountry Consultation, 2-6 October 1995, Bangkok, Thailand (WHO Project: ICP MPN 001) (20) Health Sector Reform and Health Systems Research: Can the Reform Process be evidencedbased? - A Background Paper for the WHO Conference “Achieving evidenced-based health sector reforms in Sub-Saharan Africa”, Arusha, Tanzania, 20-23 November 1995 (21) New epidemics - the challenge for international health work by Dr M. Mikheev, WHO/Geneva (22) New epidemics - questions to be addressed by Dr J. Rantanen (23) From sentinel observations to practical actions by Dr C. Hogstedt (24) Health at Work - Global Analysis by Dr MI. Mikheev, WHO/Geneva (25) WHO global strategy for occupational health for all (the way to health at work) - EB 97.6 (26) Equity and Ethics in Health Regional Committee for Europe, Forty-fourth Session, Copenhagen, 12-16 September 1994 (EUR/RC44/Tech.Disc./l) (27) Summary of WHO’s Informal Consultation on Ethics and Health at Global Level, Geneva 30 August - 1 September 1995 SEA/ACHR/22/17
SEA/ACHR/22/18
SEA/ACHR/22/19
SEA/ACHR/22/20
SEAlACHRf2212 1 SEA/ACHRl22/22 SEAlACHRl22123 SEAlACHRl22124 SEAfACHRl22125 SEA/ACHR/22/26
SEA/ACHRl22/27
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WHO will cooperate with countries and give them support as appropriate to also undertake health systems research on problems of implementation; to stimulate increased development, dissemination of and access to the results of research, and to provide relevant health information and appropriate learning and reference materials. Further, WHO will cooperate with countries and give them support as appropriate to build up capacity for research on the determinants of health and changes in behaviour, as well as for assessment and evaluation of measures for health protection and promotion. It will also cooperate with countries by giving them support to encourage operational research so as to improve the delivery and performance of integrated services. In conclusion, I once again wish to thank His Majesty’s Government of Nepal, on behalf of WHO and the regional ACHR, for hosting this session and especially to His Excellency, the Minister of Health, the Chairman of Nepal Health Research Council, the Director of Koirala Institute and all those who have contributed and worked hard in arranging this session. I trust that the members of SEA/ACHR will have an opportunity to exchange views and establish contacts with fellow scientists which may help them in their future work. 1 am convinced that WHO’s present mechanism for seeking guidance from the Advisory Committee on Health Research is comprehensive and flexible enough to respond to the changing needs of the countries. As a global intergovernmental body dealing with health, WHO will continue to provide international leadership in health research. There will he three topics for technical discussions during this session namely, Promotion of Research on Health Sector Reforms, Research in Occupational Health and Ethical Issues in Health. I hope that the recommendations emanating from your deliberations will be extremely useful for the Region. As before, I can assure you that we shall take your advice seriously, and I look forward to your recommendations. I wish the meeting every success in its deliberations. Thank you.
ACHR221WP5 1 lKKB
SEAlACHRl22 Page 25
One important aspect of research is the need for fusion and interaction between various disciplines comprising the health sciences as well as their related fields, such as social and behavioural sciences, and health economics as it is now recognized to be crucial for understanding fully the health problems and their determinants, and for helping to provide solutions to these problems. Another area which we may need to review carefully in this Region is the extent of utilization of research findings for improving the performance of health delivery system. In this context, the exchange of information not only among researchers and research institutions but also among researchers and health policy-makers and senior health administrators is of crucial importance. WHO will try to facilitate and play a catalytic role with regard to this aspect to the utmost extent.possible in the coming years. The whole area of health research can be streamlined and improved by means of establishing a proper management system at different levels of the research hierarchy in the countries. Research management is not an end in itself but it is one of the means by which the output of research can exert its full beneficial impact on the community at large. As a natural phenomenon, new, young and energetic researchers are constantly entering the research community. It is the duty of the senior research scientists to ensure that the newcomers are briefed properly on the promising avenues in the conduct of research, and especially on the importance of research management at different levels of the health care system. This area encompasses a whole gamut ranging from the legislation of research coupled with ethical issues, all aspects of peer review, granting of research funds, implementation, and monitoring and evaluation of research projects, to the utilization of research findings and including the research information system. The whole idea of this regional endeavour is to introduce and establish research management practices systematically in the research institutions in the Member Countries. To achieve this, the Regional Office will assist in coordinating and improving the national research infrastructure in the coming years. In order to have a full impact of the results of WHO sponsored research projects in the Region, it is important that the research areas must not only be in line with the priority areas identified by the countries, but should also give due attention to the following four main policy orientations of WHO’s Ninth General Programme of Work: -
integrating health and human development in public policies; ensuring equitable access to health services; promoting and protecting health, and preventing and controlling specific health problems
-
Under its directing and coordinating function in international health, WHO will continue to promote and support health research and technological development in response to priority health problems in countries. It will identify important bioethical issues in certain areas of health research and of their clinical applications, and will stimulate the exchange of experience and the sharing of information in this regard. It will stimulate and support the strengthening of health research capacity in countries, with emphasis on self-reliance and sustainability, in order to catalyze research to meet known and emerging needs. Within the framework of its Ninth General Programme of Work, WHO has identified priorities for its work in support of action relating to research. It will cooperate with countries and give them support as appropriate in policy research in order to assess the relationship, among the various factors influencing health and development as also to evaluate the effect of development action in other sectors.