Meeting on Health Research Management in the South Pacific, Suva, Fiji, 8-12 July 1991 : report

(WP)RPD/ICP/RPD/001 Report series number: RS/91/GE/12/(FIJ)

19 November 1991 ENGLISH ONLY

REPORT

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MEETING ON HEALTH RESEARCH MANAGEMENT IN THE SOUTH PACIFIC Suva, Fiji 8-12 July 1991

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Not for Sale Printed and distributed by the Regional Office for the Western Pacific of the World Health Organization Manila, Philippines •I

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NOTE

The views expressed in this report are those of the members attending the meeting and do not necessarily reflect the policy of the World Health Organization.

This report was prepared by the World Health Organization Regional Office for the Western Pacific for governments of Member States in the Region and for the members attending the Meeting on Health Research Management in the South Pacific, held in Suva, Fiji from 8 to 12 July 1991.

CONTENfS ~

SUMMARY ........................................................................................................................... 1 1. INTRODUCTION ............................................................................................................... 2

1.1 1.2 1.3 1.4 2.

Objectives ...................................................................................................................... Mem~rs,_observers and resource persons ............................................................. OrganJZat1on ................................................................................................................. Opening ceremony.......................................................................................................

2 2 2 2

PROCEEDINGS .................................................................................................................. 3 2.1 Country reports ............................................................................................................ 3 2.2 Summary of discussions/activities ............................................................................ 7

3.

RECOMMENDATIONS ................................................................................................... 20 ANNEXES:

ANNEX 1 - LIST OF TEMPORARY ADVISERS, OBSERVERS, CONSULTANT, RESOURCE PERSONS AND SECRETARIAT ............................................................................ 25 ANNEX 2 - PROGRAMME ........................................................................................ 29 ANNEX 3 - OPENING REMARKS OF lHE REGIONAL DIRECTOR ........ 31

Keywords Health services research - organization and administration I Pacific Islands I Fiji

SUMMARY

The objectives of the meeting were as follows: (1) to review the current status of national systems for the organization, development, management and coordination of health research; (2) to encourage countries with appropriate capabilities to identify priority areas for research in the South Pacific and methodologies for carrying it out; (3) to develop guidelines for the establishment of a health research council and to outline ways to conduct research activities using resources from other countries and organizations. The meeting on health research management in the South Pacific was held in Suva, Fiji, from 8 to 12 July 1991. It was attended by eight temporary advisers from seven countries in the Region, observers from the United States Agency for International Development, Japan International Cooperation Agency, Fiji School of Medicine and the British Development Division in the Pacific, and one consultant, Dr J.V. Hodge. The group made overall and specific recommendations covering the following areas: (1) Policy. Pacific countries should provide incentives for research by local health personnel. (2) Focal points. Each country should identify a focal point for health research management. (3) Coordination. WHO with the collaboration of the South Pacific Commission and other international/national agencies should initiate the formation of a regional health research and information centre. (4) Criteria. Each country in the South Pacific region should identify the particular problems facing its health system and should establish research criteria. (5) Research trainin~. Mechanisms for the training of researchers in the South Pacific region should be developed and implemented. (6) Support. Pacific countries should establish seeding funds to encourage research among health workers. (7) Evaluation. WHO should convene another meeting on health research management in the South Pacific in one to two year's time, at which the progress of health research development in countries of the region could be discussed.

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1. INTRODUCTION

The Meeting on Health Research Management in the South Pacific was held in Suva from 8 to 12 July 1991. Dr Peni Rika, Director of Hospital Services, Ministry of Health, Fiji, was elected Chairman; Dr Eti Enosa, Chief of Surgery in the Health Department, Samoa, Deputy Chairman; and Dr Nathan Kere, Director of the Medical Training and Research Institute, Solomon Islands, Rapporteur. 1.1

Objectives The objectives of the meeting were: to review the current status of national systems for the organization, ( 1) development, management and coordination of health research; (2) to encourage countries with appropriate capabilities to identify priority areas for research in the South Pacific and methodologies for carrying it out; (3) to develop guidelines for the establishment of a health research council and to outline ways to conduct research activities using resources from other countries and organizations.

1.2

Members, observers and resource persons

Those attending the meeting consisted of eight temporary advisers, five observers, four resource persons, and one consultant from WHO. The complete list of participants is given in Annex 1. 1.3 Organization The programme of the meeting is given in Annex 2. 1.4 Opening ceremony

The opening ceremony was held at 9 a.m. on 8 July. Dr A. Rafai, Director, Primary and Preventive Health Care in the Ministry of Health, Fiji, welcoming the participants, said that he was pleased and honoured that Fiji was the host country for the meeting. He told members that the National Health Research Council of Fiji was being revived. Research was considered to be important in the elucidation of health problems; indeed, it was regarded as the torch which lit the way ahead. It was necessary for countries to do their own research, as well as to receive the results from other countries. The WHO Regional Representative, Dr S.K. Ahn, gave the opening address on behalf of the Regional Director, Dr S.T. Han. He drew attention to the background to the planning of the meeting, starting with the discussions at a meeting of Directors of Health Research Councils in December 1989 and meetings of the Western Pacific Advisory Committee on Health Research in July 1990. At that time, it was considered that the practical experience of other countries in the Region might be of assistance to Fiji in its plans for revitalizing a national health research council. This had led to the proposal to hold a sub-regional meeting of countries in the South Pacific area. The full text of the Regional Director's address is attached as Annex 3 to this report.

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2. PROCEEDINGS

2.1 2.1.1

Country reports Federated States of Micronesia (FSM)

The representative from the Federated States of Micronesia, Dr G. Dever, was unable to attend the meeting and his brief report was read out on his behalf. A Research Review Board (RRB) had been convened in 1987 to regulate and monitor research activities in the Federated States of Micronesia, comprising the FSM Epidemiologist, the Secretary of Human Resources and three members of the Office of Health Services staff. The Board had met regularly and reviewed and monitored four research projects. However, this activity had lapsed since the departure of the FSM epidemiologist and no RRB meetings had occurred in over a year. Dr Dever was attempting to re-activate this mechanism for research review and management. A new epidemiologist would be coming later in 1991 and would take over the duties of the Board at that time. In the absence of Dr Dever, there was no discussion of the report. 2.1.2 Fiji

This report was presented by Dr J.I. Samisoni on behalf of the Chairman, Dr Rika. He pointed out that the National Health Research Council had now been re-activated, with a composition and objectives similar to those of the previous council. The aim was to stimulate research activities and locate funds for research support. A disease profile for Fiji had now been finalized and work was progressing on similar studies in other countries of the Region, as needed for developing the new curriculum of the Fiji School of Medicine. Research was being introduced as a substantial component of the curriculum, both at preclinical and at clinical levels. A large project on respiratory disease had been carried out, with help from the New Zealand South Pacific Health Research Committee and from Australia. The School had links with the University of the South Pacific. The recent health research methodology course conducted by WHO in Fiji had stimulated new interest in research. The orientation of research projects carried out by students at the Fiji School of Medicine was questioned during the discussion of the report. For cost reasons, such student projects must focus on problems in Fiji during the training period. It was noted that there was no specific allocation by the Government for health research. On the other hand, there was considerable indirect government support for research, for example through salary payments and other infrastructure support. Although research might be initiated by either the Fijian health staff or by outside agencies, the research itself was done mainly by Fijian people. 2.1.3 Kiribati

The country report was presented by Dr T. Taitai, who stated that the Kiribati Ministry of Health had a commitment to help research, although not much had yet been achieved in this area. A Research and Development Unit had been established within the primary health care programme. Five-year plans had included monitoring and evaluation; a third of these plans was now about to start. The objectives of the Research and Development Unit were to identify, screen and coordinate suitable studies; to stimulate and train staff in the conduct of research; to collect and disseminate research results; and to apply these for planning, monitoring and evaluation purposes. Problems experienced in

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the development of research had been lack of resources, insufficient human resources, and lack of other research facilities and infrastructure, especially library facilities. However, various studies had been carried out or were in progress. The rationale for these had been the need to uncover the causes of various health problems; to identify relevant strategies to achieve health objectives; to monitor and evaluate programmes; to follow up health trends; and to test the suitability of a particular course of action to the local situation. Projects had included the assessment of nutritional status of children in rural and urban areas; primary health care studies; maternal and child health studies; factors responsible for the high fertility rate in Kiribati; common causes of morbidity and mortality; financing of health care; and traditional medicine. There was a brief discussion on Dr Taitai's presentation, especially in relation to the size of the health services in Kiribati and to the project on high fertility rates. This led to a more general discussion on ways of dealing with possible inaccuracies in data recording and a need to distinguish data collected for routine purposes from those needed for research projects. The need for a clear review of research and for quality control, even in small countries, was endorsed. Some help might be available from other countries for this purpose, if needed. Support might also be needed in the interpretation of data from research for use by workers at a grassroot level. Overcommitted staff might not have sufficient time to conduct research and additional help might need to be provided for the costing of research projects. 2.1.4 Papua New Guinea

The report was presented by Dr T. Pyakalyia, who drew attention to the long history of medical research in Papua New Guinea and to the work of the Medical Research Advisory Committee (MRAC), established in 1962 and reconstituted ten years later. This committee was advisory to the Minister of Health and acted as a resource and coordinating committee for all health-related research in the country. It also approved research proposals from an ethical and scientific point of view and monitored ongoing research projects. It met four times each year; lists of approved projects were published annually in the Papua New Guinea Medical Journal. Most research was carried out by the Institute of Medical Research (IMR). Recent research activities of the Institute were described. The main topics were pneumonia, malaria, malnutrition and diarrhoeal diseases. The Institute was also involved in research on a wide range of other national health problems. Health systems research was a priority for the Department of Health, which had established a new committee to develop this field. Other health-related research was carried out by staff of the University Faculty of Medicine, which had its own Research Committee as part of the administrative structure of the National Institute of Research. However, this Committee related to MRAC for technical and ethical clearance of all projects which it supported. The Melanesian Christian Institute supported work in the humanities, also overlapping into the health area. The ethical committee was half lay and half professional in its composition. There were also provincial research committees to give local clearance before research could be undertaken. Substantial support was provided by the Government, mostly in the form of salaries and core costs for support of the IMR. Funds for the actual projects must be raised mainly from outside sources. The Department of Health required particular research projects to be carried out from time to time and might then find some funds for these projects. An annual medical research symposium had been held since 1955, the results of which were published in the Papua New Guinea Medical Journal. Prizes were offered for

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the best research projects. The research methodology workshop in 1989 gave considerable stimulus to medical research, as shown by the quality of the student presentations at the next symposium. Constraints experienced by health research in Papua New Guinea had been the difficulty in coordinating the many projects throughout the country, the lack of local professionals with suitable research training and experience, and insufficient teaching of research methodology in training curricula. Members were most impressed by the strength of health research in Papua New Guinea. The extent of the Government's contribution to research was impressive and was perhaps an outcome of the presence and reputation of the Institute for Medical Research. There was some discussion of the details of research approval, of the outcomes from specific research projects and of the utilization of research results. It was noted that standard treatment manuals were produced in Papua New Guinea for primary health care workers in rural areas and new research findings were introduced into these manuals, as appropriate. 2.1.5. Samoa

The report was presented by Dr E. Enosa, who pointed out that there was no central body for management of health research in his country. The Ministry of Health did have a Health Planning and Research Unit, although this had no research person in it as yet and there was no provision in the current budget for research work. Dr Enosa himself was interested in doing some research and at the request of the Minister had set up a loose committee to begin some surveys, e.g. on smoking habits, alcohol use and weight consciousness in a sample population. Previously there had been a survey on factors relevant to the spread of HIV infection. This committee meet on an ad hoc basis only. Approval had recently been given to staff of the Brown University, Rhode Island, to undertake a study over a four-year period, relating to risk factors for cardiovascular disease and hypertension. This was a well-designed study on diet and electrolyte (particularly sodium) intake, with food analysis and 24 hour urine sampling. A comparison would be made with a similar population sample in American Samoa. Professor Paul Zimmet (Australia) was also reviewing the prevalence of diabetes in Samoa. As yet there were no plans to develop a research training programme, although it was hoped that these new projects would stimulate a revival of research interest among health professionals. This report indicated the difficulty for small countries in generating the critical mass needed to start a national health research programme. Discussions ranged over general issues, including the difficulty of raising funds before research was fully planned and the need to have a registration requirement for the members of outside research teams. It was noted that help could be given in research workforce training by other countries in the region. This included the Masters of Public Health and of Tropical Medicine programmes in Australia. The problem of persuading nationals to return home after such training was noted. 2.1.6 Solomon Islands

The report was presented by Dr N. Kere, who pointed out that health research in the Solomon Islands was centred on the Medical Training and Research Institute, which had been established in 1988 as a result of the failure of previous malaria eradication programmes and an awareness of the need for a greater research effort. The Institute was

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a division of the Ministry of Health and Medical Services, although all research projects must be approved also by the Minister for Education under legislation passed in 1983. The major emphasis of the Institute was on malaria research, although it had a wider responsibility for public health research generally, including health systems research and appropriate human resources development. Projects included both preventive and clinical research on malaria, a nutrition survey in collaboration with the maternal and child health unit, EPI coverage surveys and a diarrhoeal diseases survey. The core funding of the Institute was provided by the Government but most research funds came from external sources. There was now an active awareness of the ethical aspects of conducting research and this was one of the reasons for the Government's legislation on research matters, leading to the establishment of the Institute. Methods for the better coordination of health research at national level were currently under development. Members were interested in the ability of the Institute to generate revenue {from dormitory accommodation), which helped to fund research projects. The need for quality control of all projects was accepted. The Institute staff consisted mainly of field technicians and there were three professionals. There was a discussion on the importance of sharing of research results and expertise between the countries mainly affected by malaria. There is a two-yearly intercountry meeting, which currently dealt mainly with surveillance. It was agreed that this could be expanded to include a greater research component in the future. 2.1.7 Tonga

The report was given by DrS. Foliaki, who pointed out that research was in its infancy in his country. There was no formal infrastructure or national focus for health research and no funds were designated for this purpose by the Government. All research must be coordinated and approved by the Minister of Education and very few projects had been initiated so far by the Ministry of Health. Health workers were given no active encouragement to engage in research and even those with suitable training and postgraduate qualifications were too busy with service work and lacked incentive to carry out research. Research management was carried out on an ad hoc basis, proposals being coordinated by the Health Planning and Information Division of the Ministry of Health as they arose and then forwarded for approval by the National Health Development Committee, chaired by the Minister of Health. This committee determined the suitability, scientific quality and ethics of proposed research projects. There were no training programmes in research, although some staff had participated in workshops on health services research. It was hoped that the constraints on conducting health research, especially shortage of funds and human resources, would lessen in the future. It was noted in discussions that having a research qualification was no guarantee that the person would be able to conduct research in the home environment. The Federated States of Micronesia had produced over 30 Masters of Public Health, most of whom had returned to routine service work rather than research. Additional incentives and an encouraging environment were needed to generate research activities. Insufficient workforce was a related factor, leading to overload problems.

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2.1.8

Vanuatu The report was presented by Dr G.F. Bule, who noted that the focal point for

resear~h was the Health Information and Research Committee, which was an advisory

commtttee of the Department of Health. Its goals were to provide a discussion forum for r~search.an_d_ data collecti~n, develo~ guide~es, plan monitoring_a~d evaluation, develop a list of pnontles for gathermg health mformatton and plan the trammg of health workers in data collection. A number of major priorities had been identified, which would be addressed as funds became available. An early priority was to encourage and train staff in the conducting of research, with emphasis on skills in epidemiology, statistics, survey techniques and computing. Despite the difficulties, a number of research programmes were in progress or had recently been completed. These included surveys of malaria, thalassemia, hepatitis B and some noncommunicable diseases. A pilot study of impregnated netting for malaria control had been carried out. This report had again indicated the familiar problems of funding shortage and lack of people with suitable training and expertise in research. However, it was noted that extra funds were not always required, since some research could be conducted as part of routine duties if there was sufficient motivation. The new training course of the Fiji School of Medicine would help to generate enthusiasm for research in future graduates. Again, a critical mass was needed before a national health research programme could be sustained. 2.2 2.2.1 Summary of discussions/activities Special problems for research in South Pacific countries/areas

This paper was presented by Dr S.A. Finau. He pointed out the need to define research and suggested that in its simplest terms, research was fact-finding, which could be done by anyone. A need was seen to 'demystify' research, to remove reluctance among health workers and to make research a routine tool. The need for further fact-finding surveys was questioned. It was pointed out that there had been many studies of non-communicable diseases in the region since 1961, most of which had come to the same conclusion in regard to the risk factors of obesity, wrong diet and urbanization. Over 250 studies were reviewed by the South Pacific Commission in 1963, while in 1984 there were 450 nutritional surveys studied, of which only 13% included Pacific island authorship. The need now was for suitable interventions based on the results of these many surveys. Attention was drawn to the need to pose specific research questions, which must also be relevant to national needs. General questions might be asked by health managers but these might need to be refmed into a specific question capable of producing a specific answer: this was where the research process began. Other problems experienced in South Pacific countries were noted and it was pointed out that there was an urgent need for research directories and reference archives and for the development of greater research capabilities in those countries. Community participation was essential in all phases of research. Results must be widely disseminated and the approach used in research should take note of cultural factors. The importance of WHO-sponsored research methodology workshops was again referred to during the discussion on this paper. These had shown selected people that they

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themselves could do research. The new training programme at the Fiji School of Medicine would develop this capability in its trainees to a greater extent in the future. One clear message was the need to make research relevant to local problems and the results accessible; they were of no use unless translated into suitable action. The example of the Maori population in New Zealand was cited, since their health problems had been intensively studied for years, without much change in health status. Another problem, however, was the use of information by countries, even when made available. As an example, it was pointed out that the Tokelau Islands authorities had recently requested a study of base-line health information, even though a great deal of such information was already available to them through the Tokelau Island Migrant Study. This showed the need for results published in scientific papers to be rewritten in ways which could be better used in a local and community context. A repeated theme in the discussion was the need for research to be relevant to the needs of the countries themselves. Foreign researchers could ask foreign questions, which might not be helpful to Pacific island countries. The questions must be generated by the countries themselves and must be simple and relevant. The availability of a health research management mechanism might assist in the process of building up research, making research results available and stimulating the process of implementation. The problems identified in the discussions were summarized as being as follows: (1) Research was often imposed and was not necessarily relevant to the country's need. (2) The right questions were not always asked by research planners.

(3) There might be insufficient interest locally, either as a function of the content of previous training programmes or from work overload. (4) Research results were not always available or implemented (a problem which might be helped by a national management system for health research). There might be poor communication and dissemination of research (5) information. WHO /WPRO research programmes in the South Pacific, including special 2.2.2 programmes Dr Shirai's paper was presented on his behalf by Dr R. Sarda, AIDS Epidemiologist from the WHO Office, Suva. He noted the two purposes of the research programmes of WHO, which were interrelated: these were to obtain relevant and applicable research results and to strengthen research capabilities in the countries themselves. These purposes were evident in the work of the major special programmes of WHO as well as in the regional bas~d.-progr_amm~ of Research Promotion and Development (RPD). In the Western Pacific Region, smce 1978, the RPD programme had offered 14 national workshops on research design and methodology, 156 individual research training grants (10 for South Pacific countries) and over 400 research grants, of which almost 16% {66) were for researchers from the South Pacific. The activities of the four special programmes, as applied particularly to South Pacific countries, were then summarized. The purpose of each programme was first outlined and projects supported in the South Pacific region then listed. The most recently developed programme was the Global Programme on AIDS {GPA), which had been in operation

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sine~ 1987. ~Ieven research projects had so far been supported in the Western Pacific Reg~.on by this programme, seven of which had been undertaken in Australia. Discussion revealed that a number of participants were not aware of the full extent of WH~ researc~ support programmes. This was seen to be a further justification for developmg a natiOnal focus for health research, which would ensure that such information was made available as needed. There was a discussion on the details of training programmes, through both the Regional Office for the Western Pacific and the IDR programme, and of the research methodology workshops. The function and activities of the Western Pacific Advisory Committee on Health Research were described and expla_ined. It was pointed out that WHO could make expertise available as needed, but only m response to requests by countries themselves. It was seen to be important that trainees from research training programmes should be supported to undertake projects after their return to their home country. 2.2.3 Health research programmes of the South Pacific Commission

Dr S.A. Finau presented a brief summary of the programmes of the South Pacific Commission (SPC), pointing out that SPC was not a research organization but needed to engage in research to discover answers to essential questions and so fulfil its mandate. It did not have a large budget for research purposes and approximately 85% of the expenditure in this category came from extrabudgetary sources. Health was only one of the areas of responsibility of SPC, the others being agriculture, marine resources, environment management, rural development and technology, community education training, media training, education, information services, awards and grants and cultural considerations. Health-related activities of SPC came under the headings of community health services, rural health, sanitation and water supply, health education, nutrition and food composition, epidemiological/disease surveillance and control, dental health and AIDS/SID information and communication project, the latter being carried out in cooperation with WHO, AIDAB and USAID. The programmes had shown a shift over the years from an emphasis on communicable diseases to the noncommunicable diseases, which might reflect the changing interests of professional staff as much as those of the countries themselves. It was perhaps not surprising that research activities should centre on areas where funding was most readily available. · The discussion dealt mostly with general issues raised by this paper. A distinction was drawn between the needs of large and of small research projects, which needed to be considered separately. It might be possible to fund small projects locally, examples being the budget used for research by students in the Fiji School of Medicine and the University teaching budgets in Papua New Guinea, which allowed the funding of projects by academic staff. It was again emphasized that there was a responsibility for training institutions to engender a research interest among their students, to be used later in their professional work. One task of the focal points for health research was noted to be that of discovering sources of research funds. The need was seen for policy-makers to be made more aware of the importance of research. This might be achieved by involving them more in the research process, perhaps by membership of research committees. A proposal was made that research should be built into the job specifications for health service workers, to be seen as a component of their employment contracts. This might increase the incentive to engage in research, especially if training and other incentives were made available. Although further research training workshops could be arranged on request, this process could not alone provide for

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all research needs, which must be developed within the countries themselves. Ideallr, research-related activities, including training, must be home-grown rather than obtamed overseas. 2.2.4. Selection of research priorities

This paper was presented by Dr M.Jegathesan, who po~ted ou.t that re~earch 'Yas becoming increasingly expensive. Both Government and fundm~ bod!es were mcreasmgly asking questions about the justification for research. Such quest10ns mcluded the usefulness and relevance of the research to major problems facing the country, whether the results of the research were utilizable by planners and managers and what was the quality of the research proposed. These were questions to be raised when selecting priority areas for research. Significant factors in the selection process were noted to be the importance of the topic as a health problem, the identification of areas within the topic which required research to solve the problem, the matching of research with available resources, the time scale needed (with higher priority for projects of shorter duration), previous research on the topic, the human resources available, and the applied nature of projects, which should be problem-solving in nature. Ways to identify priority areas at national level were discussed. These might include the convening of national conferences or workshops, obtaining input from health planners and health services managers, using the guidelines of WHO and other bodies, and obtaining opinions from clinicians and providers of health care. Experience in developing health research priorities in Malaysia was given as an example of this process. The National Council for Scientific Research and Development had established a panel for developing and monitoring research priorities, known as the IRPA (intensification of research in priority areas) medical panel. Seven major areas needing research had been identified by the panel and these were described. The list of priorities was not intended to be static and would evolve with changing national needs. It became apparent during the discussion that a similar process of priority development had been carried out in the Philippines. In both cases, there was the flexibility to support projects which lay outside the priority list, if sufficient need could be demonstrated. It was considered important that such flexibility should be retained in the priority selection process. Priority development was noted to be the key to the effective use of research results. The means of ensuring the quality of priority-driven research were discussed. This was seen as another reason for the establishment of mechanisms for health research management at national level. 2.2.5 Technology transfer relevant to South Pacific countries

This paper was presented by Dr P. Gray, who noted that the purpose of undertaking health research was to obtain information which could ultimately improve health status. The transfer of such information was a major component of the process of technology transfer, which must go beyond the provision of technical assistance only. Some possible ways of ensuring the transfer of research results to South Pacific countries had already been discussed during the meeting, including the use of the South Pacific Commission as a coordinating body or the development of a separate coordinating focus for health research information in the South Pacific. With regard to the accessing of relevant publications, countries might wish to consider linking with the Australian Medlars System, for which some help and sponsorship

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could be avail.able. ~ternatively, the MEDLINE system from the USA was now available on compact d1sc: 11u~ could~ read and analysed with CD/ROM hardware, which was robust and relat~vely. mexpensiVe. Regular information updates were available with the syste~. ~ustralia m1ght be able to provide help with the initial setup costs and annual subscnphons. A list of publications by the National Health and Medical Research Council (NHMRC) of Australia had been tabled and copies of documents of interest would be made available on request. s~m~~rsjworkshops. In most instances these wer~ directed towards particular topics or

Another method of transferring results of research was through conferences/

d1sc1plines and were attended by the people most likely to be in a position to make use of new information to effect change. Information exchange through meetings of professional bodies was a further method, as were education and publicity campaigns, which were needed when research results were widely applicable throughout the population. Examples of such campaigns in Australia were those relating to smoking, drug use and abuse, better nutrition and AIDS. The design of such campaigns must recognize cultural and other factors which might otherwise compromise their effectiveness. Some types of technological development, most particularly new drugs/vaccines or improved instrumentation, could only be made available to the health services through a process of commercial development and distribution. Other methods for effecting technology transfer were noted, particularly exchanges of scientists and practitioners between countries. In Australia, exchange was facilitated through the award of training and travelling fellowships, overseas study programmes for academic and NHMRC research fellows and bilateral or multilateral exchange programmes for more senior scientists or practitioners. It was noted that information on grants awarded by NHMRC was also available on request from Australia. Information distribution was also available from WHO collaborating centres in Australia and elsewhere.

The difficulty of interesting the commercial sector in developing technology was noted in discussion, especially when there was little prospect of financial gain. Some tax incentives were offered for such commercial development in Australia, but the costs were still inhibitory. The activities of the Product Development Unit set up by the WHO Special Programme for Research and Training in Tropical Diseases were noted. This Unit attempted to persuade manufacturers in developed countries to reduce the costs of their products to consumers or to transfer the technology to enable products to be manufactured more cheaply elsewhere. Finally, the possibility was mentioned that a regional association or forum could be promoted to assist in the wider distribution of information to countries of the South Pacific. 2.2.6 Development of human resources

This paper was presented by Dr P. Zara. The paper examined aspects of human resources development in research from the perspective of programmes used in the Philippines. The Philippine Council for Health Research and Development (PCHRD) was a component council of the Department of Science and Technology. All of the sectors within this Department came together through representation on the Science and Technology Council, which determined overall policy within the current five-year plan.

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The guiding principles for human resources development in health research in the Philippines were:

(1)

It should be closely tied up with priority research programmes.

(2) There should be an equitable distribution of capabilitie~ in healt~ ;es~arch (an early survey having shown that 90% of all ~ealt~ research m. ~he _Phihppmes was carried out in Metro Manila, mostly by the Umvers1ty of the Philippmes ). (3) The Department of Health should be maximally involved in planning human resources development programmes for research. ( 4) Involvement of the private sector should be encouraged.

The paper also considered human resources development as a component of the development programme for research institutions and criteria were noted ~or the. selection of such institutions for further development. Other strategies were noted, mcludmg various types of postgraduate study grants such as scholarships for graduates working towards a Master's or Doctor's degree. A series of eight fields had been designated for such scholarships, although these were not exclusive. Thesis/dissertation grants were also available, and research fellowships enabled the researchers to develop project proposals and implement projects under the supervision of a recognized scientist. Development of human resources was also aided by research training grants, short-term courses on research methodology and the provision of various incentives to career research workers, e.g. scientific career appointments, award of personal chairs or other types of award. The situation in the Philippines was seen as enviable by the participants from some other countries and there was discussion of the possibility for trainees from such countries to enter the Philippines programmes. It was noted that this could be a possibility if certain criteria were fulfilled. Dis-incentives to involvement in research were noted to be a problem in some countries, especially where there were bureaucratic blocks to research activities. The constraints on researchers in developing countries had been summarized in a recent WHO paper as occurring at the macro level, in the work environment, and at the personal level. 2.2.7 Interaction with other sectors

This paper was presented by Dr P. Gray. It recognized that health and health research could not be viewed in isolation from other sectors. Links were needed with these at policy level, administrative level and scientific/institutional level. At a policy level, planning in the health sector must take account of other instances, e.g. those relating to housing, nutrition, environment/climate, work practices and services such as water supplies and sanitation. Different countries had different systems for health research management. In the Philippines, the National Health Research Council was a component of the Department of Science and Technology, but the National Health and Medical Research Council in Australia was part of the Department of Health. Both had wider links with other sectors, however. Whatever the structure, there were a number of features which were desirable if intersectoralliaison was to be facilitated. These include a commitment by the Government about its role in science and technology, clarification of how the Government should receive its advice on science and technology, sufficient information to enable decisions to be made between competing priorities from different sectors, and the development of suitable cross-links with other research funding agencies. Focused health research management systems facilitated the development of these and other cross-links.

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At the administrative level, organizational links were clearly needed with health department~, with. healt~ servi':e agenci~s independent of the health departments, and with other agenc1es whtch might be mvolved m health research. These interactions must provide for the development of appropriate coordination between R&D institutions and uses of health research. ~oli~ies on the criteria for supporting and evaluating research must be stat~~ ~learly; wtde mput should be available in the research priority setting process; acttvtttes at sectoral boundaries must be coordinated, with jointly developed pro~ammes where appropriate; and training programmes for researd1ers should be available. The latter programmes accounted for 8% of total expenditure by the NHMRC in Australia. Coordination and interaction were even more important at the scientific/ institutional level, since health research nowadays was very much a multidisciplinary endeavour. Such links should be fostered by health research councils, which should have an ongoing commitment to training programmes at both undergraduate and postgraduate levels. Students might need to travel to foreign laboratories and schemes to facilitate such travel would be advantageous. Scientific links were also enhanced by collaboration between scientists of different institutions, both at home and in other countries. The extent to which governments themselves needed to be involved in decisions between the competing priorities of different science sectors was discussed. It was noted that it would be better if these could be resolved through debate between the sectors at an administrative level. As far as the health sector was concerned, it was seen to be essential to have a clearly stated health and health research policy, which should preferably be developed by health professionals through a process of consultation and then adopted by the government. This was seen to be another reason for a national focus for health research management, which should coordinate the development of a national health research policy. Politicians needed to be persuaded about the importance of research, which was often an unpopular word even though the results of research were essential in the policymaking process. Australian health and health research policies had been influenced some years ago when the Government established a "Better Health Commission", which selected several areas of health for priority development, including cardiovascular disease, nutrition, accidents, etc. Consultation was seen to be the key to such activities, since health goals concerned the community as a whole and all sectors should be involved in their selection. The possibilities of research trainees from South Pacific countries receiving their training in Australia were discussed. It was noted that, while this was certainly possible in some circumstances, it was important that most of the research training should be conducted in the home environment. In this connection, it was suggested that both Australia and New Zealand could assist with hands-on training by making it mandatory for projects in the Pacific area which they supported to include a training component for local research workers. Dr Gray noted that Australia was considering ways in which it might more actively assist health research in Pacific countries. If so, it would want to do this in ways which were seen to be the most appropriate by the countries themselves. 2.2.8 Networking/information exchange between research agencies

This paper, presented by Dr P. Zara, described a sophisticated networking system for information exchange now being developed and tested in the Philippines. It was built around a tripartite structure linking research, services and academic sectors, each with its own subnetwork. The Philippine Council for Health Research and Development was the focus of the network, which was income-generating through subsidized subscriptions and

- 14-

was expected to be eventually self-supporting. The network was ca~ed the Health Research and Development Information Network (HE~IN) and tts tasks were to develop computerized data bases for local health matenals, to enhance access to . international data bases and to disseminate the use of these resources. Comprehensive literature search services were available and these could now be conducted on-line between . . computers in different centres. Mini-Micro CDS/ISIS w~s .a textual data base management software in wide use; HERDIN offered trammg and consultancy servtces m the use of this software. Regular publications were produced for users of the network. Since the system was experimental and was still evolving, feedback from users was seen to be important. The HERD IN model was noted in discussion to be an excellent approach to information exchange, applicable to larger countries but not possible within individual small countries in the South Pacific. However, such a network might be possible on a regional basis in the South Pacific, to be accessed by individual countries as needed. Parts of the model were already in existence through the South Pacific Commission. The problem of feeding information into such a network at a draft stage was discussed. Although data were often only useful if they were timely, there was a problem for some countries that local health information could not be released until officially approved, which might be only once a year. It was agreed that the first priority for such a network should be distribution of essential information, followed by other information which would be "nice to have" but less essential in nature. WHO Regional Centre for Research and Training in Tropical Diseases 2.2.9 and Nutrition Dr M. Jegathesan presented information on the WHO Regional Centre, which had now been in existence for thirteen years. Short, medium and long-term objectives were described, the principal long-term objective being to develop improved control methods for major communicable diseases (especially parasitic diseases) in Malaysia and in the wider Pacific region. However, the scope of work in the Centre had been expanded to include a new emphasis on clinical nutrition and on health behaviour research. During the stage of establishment of the Centre, research training grants had been non-competitive in nature. However, scientists were encouraged from the outset to apply for normal grants in competition and these had now taken over as the sole funding mechanism for research within the Centre. Graduate courses and ad hoc training were available, both through WHO support and through the Malaysian Government, which provided some scholarships which might occasionally be made available to trainees from other countries. Training was provided for non-graduates as well as for graduates. Detailed information on the activities of the Regional Centre was available from the agenda paper and from other reports. Participants said in discussion that they were impressed by the work of the Regional Centre and by the major contribution being provided by the Malaysian Government to its support. Ways to translate research results into health policy were questioned; it was noted that the successful formula in Malaysia was to involve relevant officials and policymakers in the research planning from the outset, making them feel as if it were their project. It was seen to be important also to list expected outcomes from the research at the beginning, so that these could then be more easily incorporated into policy at a later stage. The value of re-entry grants for trainees from research programmes was again emphasized.

- 15-

The addition of a behavioural element to the work programme of the Regional Centre was commended. It was agreed that this was an important component in view of the key place of behavioural practices and lifestyle modification in health improvement. It was finally noted again that trainees from courses at the Regional Centre and elsewhere must be encouraged to do research on return to their own countries. Some support for this was needed. 2.2.10 Functions of national health research councils or analogous bodies

This paper was presented by Dr J. V. Hodge as an introduction to the study of health management systems in countries which had already established national health research councils. The history of development of these councils in the Western Pacific Region was briefly recalled and it was noted that WHO, for some years, had been encouraging the establishment of national focal points for health research. National health research councils or their equivalent now existed in Australia, New Zealand, the Philippines, Malaysia and Viet Nam. A number of other countries in the Region had identifiable focal points at a committee level. Fiji, as host country for the meeting, was in the process of reactivating its national health research council. It was noted that, while the details of the administrative structures and linkages of such councils/committees might vary widely, there were a number of functions which were needed to give stability and coherence to a national programme of health research. These were grouped under the headings of facilitatory functions and quality control. Facilitatory functions included the encouragement and promotion of health research, identification of health problems needing research, advice to government on a health research programme appropriate to national needs, determination of research priorities within this overall programme, identification of resources for research support, maintaining a database on health research methods, encouraging use of research results, assisting with workforce development, and strengthening and maintaining liaison with other sectors. In some cases, the facilitatory functions included the direct provision of funds from the government for research support.

Under the heading of quality control, national health research councils were the appropriate bodies to set research standards and monitor their implementation. Examples of such functions included the development of suitable application and reporting formats, provision of mechanisms for scientific and ethical assessment of research, setting of guidelines and monitoring of standards, monitoring the progress of ongoing research and ensuring that research, when completed, was implemented whenever appropriate. The demonstration of satisfactory procedures for maintenance of quality control in research would reassure health administrators that the results of research were reliable and deserved to be implemented. In conclusion, it was pointed out that national health research councils served as an important bridge between policy-makers, consumers of health services and the research community. Practical questions were asked in the discussion on this paper about the possibilities of using New Zealand and Australian assessment systems for the refereeing of local research in member countries. Whether applications for research grants should be refereed at the beginning or at the end, before implementation of the results, was also discussed. While an examination of quality was essential before implementation, it was considered that the most important time for refereeing of projects was at the outset, before funds were committed. Reservations were expressed over the fact that most research until now had been externally initiated and funded and also externally refereed. More involvement of experts from the South Pacific countries themselves was clearly needed.

- 16-

The availability of small funds for the seeding of projects, such as those carried out by the students at the Fiji School of M~dicine was discussed. While it wa~ agreed that funds were available from donor agencies, for large and well-planned proJects, there was often difficulty in obtaining very small sums needed for seeding and training purposes. Dr Hodge drew attention to the system of dean's funds used in New Zealand fo~ t~e seeding of projects within the medical and dental schools an~. ~uggested that a. s~ilar arrangement might be explored for use by the Dean of the FIJI School of Med1cme. The importance of ethical assistance was underlined. It was pointed out that research in the Pacific would be of a clinical and epidemiological nature for the foreseeable future, which meant that bad research would be exploiting people in the community. Ethics committees therefore had a particular responsibility to review research proposals carefully. Similarly, final reports from research workers needed to be carefully assessed, before implementation. A final comment related to the establishment of a council for health research management rather than a committee, which implied less permanence. In the Philippines, a committee structure had preceded the development of PCHRD and subsequent comparison showed that health research was much better served by a more permanent council structure. 2.2.11 ( 1) Health research councils/ country reports Australia

The report was presented by Dr P. Gray, who presented further factual information about the focal point for health research, the National Health and Medical Research Council (NHMRC) of Australia. A strength of the Council was the link which it provided between health research and other public health activities which came within its overall mandate. The objective of NHMRC was to advise the Australian community on the achievement and maintenance of the highest practicable standards of individual and public health, and to foster research in the interests of improving these standards. The various committees of the Council were described, most attention being given to the Medical Research Committee, of which Dr Gray was the secretary. This committee itself had a number of subcommittees, including those of the ethics of animal experimentation, project and programme grants, career awards, training awards, grants coordination and strategic research. There were also individual committees linking the Council with the various institutes and units which it supported. The complex linkages between the Council and other sectors/agencies in the public and private sectors were briefly described. Categories of expenditure from the Medical Research Endowment Fund included priming grants, full project grants, programme grants, equipment grants, awards for career and training purposes, and grants to support institutes and units. Ethical clearance was essential for all research supported by the Council. The general research programmes of the Council were summarized. Priority areas for research included cardiovascular disease, diabetes, mental health, arthritis and rheumatism, substance abuse, kidney disease, respiratory disease and asthma, osteoporosis and accidents. Cancer research was also strongly supported by NHMRC. Some further information on NHMRC activities was requested during the discussion. An explanation was provided on the linkages between NHMRC and the National Heart Foundation of Australia. The Council was prepared to assist with

• 17.

assessment of research for other agencies if requested also. There were from 80 to 100 research funding agencies in Australia, many being quite small, and coordination was a function of the Council from time to time. Members of NHMRC committees were part time and busy people with other jobs. The secretariat numbered 18 people and provided the continuity needed for all the Council's activities. A possibility was raised that NHMRC might be prepared to allocate some funds for research in the South Pacific and Dr Gray undertook to explore this possibility on his return to Australia. (2) Malaysia

This report was presented by Dr M. Jegathesan, who described the history of medical research support in Malaysia since the turn of the century, especially since the establishment in 1975 of the National Council for Scientific Research and Development. Science and technology had gained a special place in the fifth five-year plan for Malaysia (1986 • 1990), when a sum ofUS$160 M was designated for science and technology in all areas. Some of this money was set aside for strengthening research capabilities; from this arose the management system known as IRPA (intensification of research in priority areas). There were six IRPA panels, which in the current five-year plan would receive a total of MAU600 M over five years. These were for agriculture, industry, health, strategic, social and defense. The health sector would receive some 10% of this total funding (MAU60 M) over the five-year period. The Ministry of Health also had a standing committee for medical research, for which the secretariat was based within the Institute for Medical Research (IMR). This committee had established separate mechanisms for reviewing, processing and approving all research projects conducted within the Ministry's institutions, irrespective of the nature and sources of funding. The committee was also served by a research review committee, an ethical committee and an animal use committee. Other sources of research funding were available, including the regular operating budget of the IMR, grants from international agencies, and sometimes grants from industry or the private sector. The mechanisms for processing grant applications through the IRPA mechanism were described, as well as the steps needed for clearance of research for both local and foreign scientists. While such controls were needed, it was stressed that foreign researchers were encouraged and that a number of bilateral arrangements were in place (such as with Canada) to allow foreign graduates to come to Malaysia. The system of allocating priorities to research was explained and it was noted that 10% of research funds were kept aside for the support of non-priority ('curiosity driven') research. Finally, a summary was given on the types of training award and other career support pathways for researchers and the methods used for the dissemination of research results. The timing of decisions on research funding was discussed and it was stated that the turn-around time for small projects was between two and four months, major programmes being dealt with once a year. Despite the different sources of funding within IMR, all applications for research grants were submitted to the same level of peer review and ethical assessment. The system of regulating research on drugs in Malaysia was questioned and explained. All types of therapeutic drug research, from basic to applied, could be accommodated within the overall programme and nearly all such research must go through the relevant IRPA panel.

- 18-

It was generally considered that the Malaysian example offered an excellent model, although beyond the scale needed for most small countries. The philosophical points of ensuring relevance while maintaining quality and setting research standards were seen to be important, regardless of the size of the country or the amount of research being conducted. The success of Malaysia in getting a clear commitment regarding the support of research from its Government was especially noteworthy.

(3)

New Zealand

Dr Hodge described the changes in health research management which had occurred recently in New Zealand, as a result of the appreciation of a need for greater emphasis on research in public health areas. A new statutory body, the Health Research Council of New Zealand (HRCNZ}, had come into being in October 1990. This council had many similarities to its predecessor, the Medical Research Council of New Zealand, and had assumed all its responsibilities under the new legislation. The functions of the new Council, as stated in the Health Research Council Act 1990, were described and it was noted that the funding cycle in New Zealand was a triennial one, with negotiation of the government research grant every three years. Currently, the annual grant for the Council's activities was about NEZ$17 M, an additional NEZ$1 M having been allocated at the time of transition in recognition of the additional costs of supporting research in public health areas. The Council has four statutory committees, these being a biomedical research committee, a public health research committee, a Maori health committee and an ethics committee. Linkages between the council and other bodies and sectors were described, especially those which were developing with the new body for general science support in New Zealand, the Foundation for Research, Scie11ce and Technology. The Council was also required to advise the Government on a national health research policy, for which wide consultation would be required. Health research had previously been predominantly biomedical in nature and the Council saw it as important that strong support in this area should continue, with scientific excellence as the major criterion for support. On the other hand, there was a clear need for the promotion of public health research, to improve the efficiency of health services and to reduce the burden on these services through research on health protection and disease prevention. Some areas in which research was particularly needed were described. Particular mention was made of the Council's South Pacific Health Research Committee, which had a long history and for many years had provided modest support for health research projects in the Pacific region. Although its funds had been less than NEZ$100 000 per year, the Committee had not always been able to spend its allocation, owing to a lack of suitable grant applications. The new Council was aware of the importance of continuing this form of research assistance to neighbouring countries in the Pacific and would continue to do so for the foreseeable future, based on its knowledge of the need and of the justification provided in grant applications from these countries. (4) Philippines

This report was presented by Dr P. Zara, who pointed out structural similarities between the Philippine Council for Health Research and Development (PCHRD) and the councils already described in other countries. However, the resources available to PCHRD were considerably less than in other countries. The organizational structure of the Council was described. The decision-making and policy-making body of PCHRD was its Governing Council, which had four divisions and a number of technical committees together with a

- 19-

national ethics review committee. The four divisions were a research management and development division, a human resource and development division, a research information, communication, and utilization division and a finance and administrative division. The Council was responsible for setting the national health research and development plan, for which the goals were the generation of new knowledge and appropriate technologies to solve and identify new health problems, the maximizing of the use of research results by policy-makers and others, and the enhancement of research capabilities to meet present and future scientific needs for health research development. Strategies used by PCHRD for the encouragement of research, and the training of research workers, were described. The information network (HERD IN) had already been described in an earlier paper. Problems in research management were noted to be the limitation of public sector funds for health research, the complexity and slowness of development in coordination of research activities, the continuing brain drain from the Philippines, a concentration of human research resources in Metro Manila, and the lack of fully developed strategies for enhancement of research utilization and technology transfer. Over the next two to three years, PCHRD would be stressing these priorities in the current science and technology master plan, particularly those contributing to pharmaceutical and biotechnology research and development. Additionally, research on epidemiology, diagnosis, management/treatment of diseases, social/cultural factors, policy and health economics would be supported. (5) Papua New Guinea

The country report for Papua New Guinea had been presented previously by Dr Pyakalyia, in the context of the discussion on health research councils. He gave some further details of the structures for health research support in his country and noted that it might be necessary in the future to develop a general science and technology council to draw together the different science sectors at a later stage. (6) Solomon Islands

Dr Kere added some further details to his earlier country report. Some current research priorities were family planning, EPI target disease, nutrition and health financing. There was no permanent committee structure for ethical evaluation of research and ad hoc arrangements were made as needed. A collaborative research scheme was described, in which individual research workers were encouraged to work with a known institution which could form links with the Solomon Islands Medical Training and Research Institute through the mechanism of coordinating committees. Examples of successful research were described, particularly those relating to permethrin treatment of mosquito nets, evaluation of the new anti-malarial drug, halofantrine, and projects comparing the costs of new versus recycled glass slides and disposable syringes. The country reports from New Zealand, Philippines, Papua New Guinea and the Solomon Islands were then briefly discussed. Focal points for technology transfer were again noted to be separate in most cases from focal points in health research management in the countries represented. The focal points identified by some countries for technology transfer, e.g., Australia and the Philippines, indicated that countries saw these as relating mainly to the provision of major equipment rather than the broader area of information transfer, which should be a function of a health research council.

-20-

2.2.12 Guidelines for the development of a health research council or analogous body (NHRC) This fmal paper was presented by Dr J.V. Hodge. It was noted that the title assumed that there was an identifiable process and regular pattern in the development of a NHRC, but that this was not the case. In countries with an established NHRC, there had been various factors which had ensured that each case had been unique, and only limited generalization was possible. These factors had included the state of academic and research development, the way in which research was funded, the relationship between public and private sectors, pre-existing arrangements for research administration at national level, and previous experience with peer review, research protocol development and the monitoring of research. The paper approached the topic through a series of theoretical questions, to which some answers had been attempted. Firstly, there were questions as to whether the NHRC was needed at all, whether sufficient local experience was available, and whether there was an adequate research base to support a management structure at national level. If so, there was a question of whether existing bodies could undertake a national coordinating/ managerial function. Only after these questions had been answered was it necessary to proceed to the detail of how the NHRC should be structured and should function, and what should be the timetable for its development and initial work programme. This paper was noted in discussion to be theoretical in nature and not yet of great relevance to most countries in the South Pacific region. The need for a simple focal point committee for health research was accepted, however, and participants would be returning to their own countries with a new commitment to ensure that such a structure was in place and able to operate effectively.

3. RECOMMENDATIONS

The Meeting on Health Research Management in the South Pacific, Recognizing the limited resources, both human and financial, available for research in the South Pacific, and the necessity to ensure that any research is directed to the development of viable solutions of significant health problems and to the development of indigenous expertise; Recognizing that research is best conducted by people who are aware of and understand local conditions and problems, and that such people require training to enable them and encourage them to undertake research; Noting that most research to be undertaken in the South Pacific region will have to be funded from external sources, while accepting that it is important for countries to demonstrate a commitment to this activity; Recognizing and endorsing the continuation of the activities of the New Zealand Health Research Council, through its South Pacific Health Research Committee, in supporting research in the region;

- 21 -

. . ~w~re ?f the difficulties experienced in the incorporation of research or evaluation actiVities m a1d programmes; Noting the benefits of exchange of experts in the process of information and technology transfer; Makes the following recommendations: 3.1

Policy

3.1.1 Pacific countries should provide incentives for research by local health personnel

through the following: (1)

creation of a national research policy;

(2) incorporation of research in job descriptions and contracts of appropriate health workers; (3) including research performance and publications as one of the criteria for consideration in salary increases and promotion; (4) encouraging and supporting attendance at conferences and meetings in order to participate therein or present research results; (5) promoting the use of research as a management tool at all administrative levels; (6) (7) (8) 3.2

strengthening of research capabilities within the country; establishing easily accessible seeding funds for research projects; identifying and prioritizing areas for health research.

Focal Points

3.2.1 Each country in the South Pacific region should identify a focal point for health

research management appropriate for its level of activity. 3.2.2 Each focal point for health research management should set up an ethics committee at the national level. 3.2.3. WHO should encourage and support the establishment and early stages of operation of national focal points for health research management. 3.3 Coordination

3.3.1 WHO, with the collaboration of the South Pacific Commission and other

international/national agencies, should initiate the formation of a regional health research and information centre with the following responsibilities: ( 1)

to encourage and coordinate research activities in the Pacific;

(2) to provide and disseminate research information and technical advice to individuals and institutions in the Pacific;

-22-

(3) to develop and maintain a regist~r. of researchers and research projects undertaken and of relevance to the Pac1f1c; (4) to facilitate the availability of literature search facilities;

(5) to encourage the publication of research results in an existing journal and, if necessary, establish a multidisciplinary health journal; (6) to encourage scientific meetings of health research workers.

3.3.2 The WHO Special Programme for Re~earch a~d Traini~g in Tropical Diseases .. (IDR) should be asked to consider ways to mcrease 1ts commitment to research capability strengthening in South Pacific island countries, with emphasis on training and follow-up support of suitable research projects. 3.3.3 The Regional Director of WHO /WPRO may wish to consider appointing a member from the South Pacific Region to the Western Pacific Advisory Committee on Health Research. The Advisory Committee should establish a sub-committee for the South Pacific. 3.4 Criteria

3.4.1 Each country in the South Pacific region should identify the particular problems facing its health system and should establish research criteria which: (1) (2) should focus on these problems; should seek solutions that are appropriate socially, culturally and financially;

(3) should at least include a strong local involvement, should preferably be partially or fully initiated locally, and should include an element of research training; should give preference to the use of appropriate Pacific islanders as advisers ( 4) to the research. 3.5 Research training

3.5.1 The following mechanisms for training of researchers in the South Pacific region should continue to be used or should be implemented:

(1) the conducting by WHO of further health research methodology workshops in the South Pacific, consideration being given by donor countries to making funds available to undertake projects developed at workshops; undergraduate training in research methodology through programmes (2) conducted by the Fiji School of Medicine, Pacific Basin Medical Officer Training Programme and similar institutions, with resources to be made available by National Health and Medical Research Council (NHMRC), Health Research Council of New Zealand (HRCNZ), WHO, South Pacific Commission (SPC) and other donors; (3) fellowships for further experience and training through the WHO IDR programme; ( 4) practical experience and training as participants in projects conducted in the country concerned or within the South Pacific region.

- 23-

3.6

Sum>ort

3.6.1 Pacific countries should establish seeding funds to encourage research among health workers. 3.6.2 Potential health research funders (such as Australia, New Zealand and WHO), through their research capability strengthening programmes, should consider providing special research grants to those who have been trained in health research training programmes. 3.6.3 Organizations such as WHO and countries such as Australia and New Zealand should provide financial support to promote the effective exchange of regional experts in the South Pacific in support of recent development within the region. 3.6.4 Consideration should be given by donor agencies to including a research and evaluation component in projects supported by bilateral and multilateral aid programmes. 3.7 Evaluation

3.7.1 WHO should convene another meeting on health research management in the South Pacific in one to two years' time, at which the progress of health research development in countries of the region could be discussed.

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ANNEX1

LIST OF TEMPORARY ADVISERS, OBSERVERS, CONSULTANT, RESOURCE PERSONS AND SECRETARIAT

TEMPORARY ADVISERS Dr George Bule Director of Health Services Ministry of Health Private Mail Bag Vila Vanuatu

* Dr Gregory Dever Director Pacific Basin Medical Officers Training Programme P.O. Box 1298 Kolonia Pohnpei ECI 96941 Federated States of Micronesia Dr EtiEnosa Chief of Surgery Health Department Apia Samoa Dr Supileo Foliaki Director of Health Ministry of Health Nuku'alofa Tonga

*unable to attend

-26-

Annex 1 Dr Nathan Kere Director Solomon Islands Medical Training and Research Institute Ministry of Health and Medical Services P.O. Box349 Honiara Solomon Islands Dr Timothy Pyakalyia Acting First Assistant Secretary Primary Health Service Department of Health P.O. Box 3991 Boroko. N.C.D. Papua New Guinea Dr Peni Rika Director of Hospital services Ministry of Health Tamavua Fiji Dr J .1. Samisoni Head of School Fiji School of Medicine Private Mail Bag Suva Fiji Dr Tetaua Taitai Secretary for Health and Family Planning Ministry of Health and Family Planning P.O. Box268 Bikenibeu Tarawa Kiribati OBSERVERS UNTIED STAlES AGENCY FOR IN'IERNATIONAL DEVELOPMENT Dr David H. Calder Chief Office of Health, Population and Nutrition Agency for International Development Regional Development Office/South Pacific American Embassy P.O. Box218 Suva Fiji

-27-

Annex 1 JAPAN IN1ERNATIONAL COOPERATION AGENCY Mr Hideaki Ito Resident Representative Japan International Cooperation Agency Third Floor Dominion House Private Mail Bag Suva Fiji Dr I. Lewis Deputy Head Fiji School of Medicine Private Mail Bag Suva Fiji Dr Annette Robertson Clinical Tutor Community Health Fiji School of Medicine Private Mail Bag Suva Fiji BRITISH DEVELOPMENT DIVISION IN THE PACIFIC Dr David Philips Regional Health Adviser British Development Division in the Pacific British Embassy P.O. Box 1355 Suva Fiji CONSULTANT Dr J.V. Hodge Director Health Research Council of New Zealand P.O. Box 5541 Wellesley Street Auckland New Zealand

FIJI SCHOOL OF MEDICINE

-28-

Annex 1 RESOURCE PERSONS Dr Sitaleki Finau Health Coordinator South Pacific Commission B.P.DS Noumea-CEDEX New Caledonia Dr Peter Gray Secretary Medical Research Committee National Health and Medical Research Council G.P.O. Box 9848 Canberra ACf 2606 Australia Dr M. Jegathesan Director Institute for Medical Research J alan Pahang 50588 Kuala Lumpur Malaysia Dr Pacita C. Zara Executive Director Philippine Council for Health Research and Development General Santos Avenue, Bicutan Taguic Philippines SECRETARIAT Dr Sung-kyu Ahn WHO Representative WHO Regional Office for the Western Pacific Suva Fiji

* Dr A. Shirai Responsible Officer Research Promotion and Development WHO Regional Office for the Western Pacific Manila Philippines *unable to attend

. 29.

ANNEX2

PROGRAMME

1. 2.

Opening session Adoption of the agenda Country reports (a) (b) (c) . (d) (e) Federated States of Micronesia Fiji Kiribati Papua New Guinea Samoa Solomon Islands Tonga Vanuatu

3.

(t) (g) (h) 4. 5. 6. 7. 8. 9. 10. 11. 12.

Special problems for research in South Pacific countries/area WHO/WPRO research programmes in South Pacific, including Special Programmes Health research programmes of South Pacific Commission Selection of research priorities Technology transfer relevant to South Pacific countries/area D_evelopment of human resourc~s

Interaction with other sectors Networking/information exchange between research agencies Regional Centre for Research and Training in Tropical Diseases and Nutrition: collaboration in South Pacific

-30-

Annex2 13. Functions of a national health research councils or analogous bodies (a) (b) (c) (d) (e) (f) 14. 15. 16. Australia Malaysia New Zealand Papua New Guinea Philippines Solomon Islands

Guidelines for development of health research council Discussion/confirmation of recommendations Closing

-31-

ANNEX3

BRIEF MESSAGE FROM DR S.T. HAN, REGIONAL DIRECTOR, WHO REGIONAL OFFICE FOR THE WESTERN PACIFIC, AT THE OPENING CEREMONY OF THE MEETING ON HEALTH RESEARCH MANAGEMENT IN THE SOUTH PACIFIC, SUVA, FIJI, 8-12 JULY 1991

Distinguished participants, ladies and gentlemen, On behalf of Dr S.T. Han, Regional Director of the WHO Regional Office for the Western Pacific, allow me to extend a warm welcome to all of you participating in this Meeting on Health Research Management in the South Pacific. I would like to thank the Government of Fiji for agreeing to host this meeting. You are gathered here because of your common interest in using research to overcome the health problems in your countries, which is a major challenge of the 1990s. The importance of research was reemphasized during the technical discussions at the 1990 World Health Assembly. However, the ability to develop effective health research programmes depends on many factors and varies greatly from country to country. In the Western Pacific Region, there is great diversity among the Member States in terms of socioeconomic development, health problems and population size. This makes it difficult to develop options that can be applied throughout the Region. However, the difficulties can be reduced through collaboration, which is one of the topics for discussions during your meeting. The need for collaboration was discussed at a meeting of directors of health research councils or analogous bodies in December 1989 and at the meeting of the Western Pacific Advisory Committee on Health Research last July. They referred in particular to the situation in your host country, Fiji, where an increase in research and changes within the School of Medicine have led to the decision to revitalize the National Health Research Council. It was felt that these plans might benefit from the practical experience of other countries in the Region. This led to the proposal to hold this subregional meeting of countries in the South Pacific area. Its objectives are set out in your information bulletin and include a review of national health research systems and programmes, identification of priority areas for research in the South Pacific, and development of guidelines for national health research management. Much research has already been conducted in the South Pacific, and some has been very beneficial. However, most of it has been planned and funded by other countries, sometimes with little or no coordination or

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Annex 3

feed-back of the results to the communities concerned. So in this meeting, you will be discussing ways to achieve greater control over the research process, to ensure the maximum benefit of your own people and your own health programmes. For some countries, this may require the establishment of a council to coordinate health research activities at national level and provide links with other countries and external funding agencies. Countries with smaller health research programmes may wish to consider forming a small committee rather than a large council as a focal point for health research management. In addition, there are concerns that a multiplicity of organizations within a country to cover technology transfer, health systems research and other such areas could be counter-productive. Clearly, adequate coordinating mechanisms are needed at the national level. I note that you will also be discussing the progress of particular health research initiatives in each of your countries, as well as the selection of research priorities, technology transfer, development of human resources, interaction with other sectors, and information exchange. These are all very important issues for WHO. I hope that smaller countries which can do priority research will receive encouragement and support from the highly developed and rapidly developing countries of the Region. I will look forward to seeing your recommendations and hope these will include practical ways in which you can assist each other in the strengthening of research capabilities and the management of health research at a national level. I wish you all a successful meeting and an enjoyable stay in Suva.