Word Health Organization (2000) This document is not a formal publication of the World Health Organization (WHO), and all rights are reserved by the Organization. The document may, however, be freely reviewed, abstracted, reproduced or translated, in part or in whole, but not for sale or for use in conjunction with commercial purposes. The views expressed in documents by named authors are solely the responsibility of those authors. Page iii CONTENTS Page 1. INAUGURAL SESSION .....................................................................................1 2. BUSINESS SESSION ........................................................................................4 2.1 The Work of the WHO Regional Research Policy and Cooperation (RPC) Programme .................................................................................. 6 2.2 South-East Asia Advisory Committee on Health Research – Terms of Reference, Membership and Methods of Work .............................9 2.3 Work of Scientific Working Groups on “Management and Coordination of Health Research Activities in the Countries” and “Management of Health Research Information” ................................... 11 2.4 Work of Scientific Working Groups on “Criteria for Setting Health Research Priorities” and “Formulation of National Health Research Policies and Strategies” ........................................................ 14 2.5 Work of Scientific Working Group on “Operational Research on Reproductive Health” and presentation on UNDP-UNFPA-WHO- World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) ................................ 19 2.6 Regional Priorities in HIV-AIDS Research ............................................ 22 2.7 Regional Vaccine Research and Development Policy ........................... 26 2.8 Operational Guidelines for Ethics Committees Reviewing Biomedical Research ........................................................................... 28 2.9 Global and Regional Coordination in Health Research ........................ 31 3. CLOSING SESSION .......................................................................................38 Annexes 1. Address by Dr Uton Muchtar Rafei Regional Director, WHO South-East Asia Region ......................................................................41 2. List of Participants.......................................................................................44 3. Terms of Reference of the WHO South-East Asia Advisory Committee on Health Research (SEA-ACHR) .................................................................50 Page iv 4. Agenda and Working Schedule ....................................................................51 5. List of Working Documents .........................................................................55 6. List of Information Documents....................................................................57 Page 1 1. INAUGURAL SESSION The twenty-fifth session of the WHO South-East Asia Advisory Committee on Health Research (SEA-ACHR) was held at Hotel Natour Kuta, Bali, Indonesia, from 17 to 20 April 2000. In his opening address, Dr Uton Muchtar Rafei (Regional Director, WHO South-East Asia Region) thanked the Ministry of Health of the Government of the Republic of Indonesia for hosting this meeting and welcomed the participants. He said that in view of the pace of globalization and its impact on international health development, WHO, as part of overall reform efforts, had recently developed a new strategic framework for its secretariat. This WHO Corporate Strategy had provided four main strategic directions: (a) to reduce the burden of disease, especially among the poor and marginalized populations; (b) to promote healthy life styles and reduce factors of risk to human health; (c) to develop health systems for the equitable improvement of health outcomes; and (d) to develop an enabling policy and institutional environment in the health sector and promote an effective health dimension to social, economic, environmental and development policy. Dr Uton added that these strategic directions were complemented by the six core functions of the WHO Secretariat. One of these core functions was related to “ managing information, assessing trends and comparing performance of the health systems, setting the agenda for, and stimulating research and development .” He urged the SEA-ACHR members to deliberate on how the new ACHR mechanism would fit in with this corporate strategy, especially in setting the health research agenda and stimulating research and development. The main priority of WHO was to reduce the burden of disease among the poor and disadvantaged. WHO WHO South-East Asia Advisory Committee on Health Research Page 2 would continue to facilitate health research and provide evidence-based information to policy makers. It was, therefore, important to strengthen the links between research outputs and health outcome. Dr Uton said that the barriers to applying scientific and other advances in health development efforts were not necessarily confined to technological issues. Even simple and affordable technologies had not always been widely applied due to lack of human capacity, organizational support or financial resources. While much was known about the determinants of maternal mortality, more operational research was needed to help reduce the persistent burden of maternal mortality in the South-East Asia Region. Dr Uton said that based on the recommendations of the last SEA- ACHR session, he had established a regional core group for the development of a vaccine policy in October 1999. This core group covered major issues ranging from vaccine selection policy to vaccine delivery. What was needed was in-depth research to develop a viable regional vaccine policy. Another scientific expert group had also looked into research related to prevention and control of HIV-AIDS and the practical application of research findings for effective interventions. Dr Uton urged the ACHR and the research community at large to consider maximizing cooperation with development partners, which included WHO collaborating centres, national centres of expertise and international research networks. He stressed that while new knowledge was always needed, existing knowledge should not be ignored. He requested the ACHR to ask themselves as to why – all too often - proven, affordable and available technologies or approaches were still not applied for the benefit of peoples’ health. More experience was required in order to learn from successful research institutions and efforts. Finally, he said that there was a need for effective utilization of research findings in the development of health programmes. This was critical if the ultimate benefits of research were to reach those in need, which were the main goals. For this, it was necessary for research findings to be clearly understood and Report of the Twenty-fifth Session Page 3 implemented by managers at all levels of the health system (see Annex 1 for full text of the Regional Director’s address). HE Dr Achmad Sujudi, Minister for Health, Republic of Indonesia, in his inaugural address expressed deep appreciation for the responsibility given to the National Institute of Health Research and Development (NIHRD), one of the leading national institutes of the Ministry of Health, to host this pertinent and prestigious meeting. The Hon Minister said that the impact of recent global and regional changes, including the economic crisis and reforms carried out among developing countries, especially those within Asia and particularly Indonesia, should be carefully considered when making policy decisions for health development. There were still many gaps in health status, both between developed and developing countries, as well as between and within developing countries, especially in a country as diverse as Indonesia. Five major factors affecting health development could be considered: (1) basic changes in population dynamics causing demographic and epidemiological differences; (2) substantial findings in medical sciences and tech nology leading to a new concept of health, illness and death; (3) global challenges caused by a free trade policy, drastic revolution in information technologies, telecommunications and transportations; (4) environmental changes influencing health status and health services; and (5) democratization of aspects requiring empowerment and partnership in health development management. Considering the above, Indonesia had now established a new initiative for national health development, based on a vision known as “Healthy Indonesia 2010”. It would be implemented through a new concept of “ Indonesian Healthy Paradigm ”, giving more attention to promotion and prevention rather than curative and rehabilitative measures. The Hon Minister believed that this paradigm shift was a model of health development, which encouraged people to be independent and WHO South-East Asia Advisory Committee on Health Research Page 4 to have awareness in making themselves healthy. Four basic strategies would be adopted, viz., decentralization; “ JPKM” or Managed Community Health Care; professionalism of health providers; and keeping health at the centre of all development efforts. The Hon Minister reiterated that health research and development had become very important for assessing and maintaining the performance of health systems. Health research, by generating and applying evidence-based information, was also the guiding force for national and local health development. The Ministry of Health placed much emphasis on increasing, coordinating and facilitating the roles and responsibilities of the NIHRD within the framework of the process of decentralization. NIHRD should work with partners from both within and outside the country. The SEA-ACHR was an important forum for all SEAR countries to share their experience in health research and development, particularly in improving health research management. The Hon Minister expressed the hope that the deliberations of the ACHR and its recommendations would also cover capacity strengthening and resource mobilization. 2. BUSINESS SESSION (Agenda items 2 and 3) In addition to 18 members of the SEA-ACHR, 13 WHO special invitees as well as members of the WHO secretariat headed by the Regional Director attended the Silver Jubilee session (see Annex 2 for full list of participants). Professor N K Ganguly, Director-General of the Indian Council of Medical Research, as Chairperson of the SEA-ACHR, opened the business session. He warmly welcomed all participants and expressed his appreciation to the WHO Regional Director for giving him the opportunity to chair this regional scientific body on health. He added that he would carry out his duties in accordance with the terms of reference. Report of the Twenty-fifth Session Page 5 The WHO Regional Director in his introductory remarks, highlighted the reforms made within the Organization, and in particular the reshaping of the SEA-ACHR. Based on the discussions and recommendations relating to reform of the ACHR, he had drawn up its new terms of reference, keeping it as a scientific advisory body, with both upstream and downstream activities (see Annex 3). He had also revised the composition of members and the method of work of the SEA-ACHR, as reflected in the present membership and the working schedule of the current session. A series of meetings of scientific working groups and expert groups had been organized by WHO during the past year on subjects related to health research management, reproductive health, research priorities for HIV-AIDS and the development of a regional vaccine research policy. The results of these expert groups would be presented at this ACHR for review and guidance. He also said that the ACHR should enhance and strengthen its involvement in the arena of international health research. The regional ACHR needed to be well informed about the global research developments and also be fully aware of the WHO global policy on health research. For this reason, senior representatives from WHO HQ, Global Forum for Health Research, Council on Health Research for Development (COHRED) and WHO Kobe Centre were joining this session. Good linkages between the global and regional ACHRs were important for better understanding, coordination and cooperation – and also to strengthen the ACHR system as a whole. The Regional Director then nominated Professor Umar Fachmi Achmadi, Director-General, Department of Communicable Diseases Control and Environmental Health, Ministry of Health, Indonesia, as Co- Chairperson of the 25 th session amidst acclamation. Professor Umar Fachmi expressed his gratitude for the nomination as well as for the trust placed in him. WHO South-East Asia Advisory Committee on Health Research Page 6 The Chairperson, requesting the cooperation of members in the proceedings of the ACHR, proposed establishment of a report-drafting group consisting of Professor Dulitha Fernando (Sri Lanka), Professor Porapan Punyarathbandhu (Thailand) and Dr Agus Suwandono (Indonesia). The Committee agreed to the proposal. At the Chairperson’s request, it also unanimously adopted the agenda and the working schedule. The Chairperson drew attention to the changes introduced in the working schedule, such as small group discussions, which had been created in order to enable wider and deeper deliberations (see Annex 4). He also welcomed HE Dr Achmad Sujudi, Minister of Health, Republic of Indonesia, who joined the business session as an observer. 2.1 The Work of the WHO Regional Research Policy and Cooperation (RPC) Programme (Agenda item 3.1) The progress of work of the WHO regional RPC programme for the past two years was reported. The work had placed much emphasis on the formulation of research agenda and policy, on strengthening national and regional capability for health research management, and on promotion and utilization of health research in selected priority health problems. With the full involvement of the WHO collaborating centres, national centres of expertise and national research institutions, a series of training courses on health research management and health research methodology had been carried out to enhance and strengthen research capability. Seminars and other relevant activities had also been conducted to promote health research and to sensitize policy makers and planners to the use of research results. To face the challenges in health research and development, WHO had taken initiatives by improving the methods of work, coordinating and implementing mechanisms and processes of WHO headquarters and regional offices supported by WHO country offices and Member Report of the Twenty-fifth Session Page 7 Countries. One major challenge at the country level was to obtain the full involvement of policy makers in health research, from the very beginning, in implementing health research. The ACHR welcomed the implementation of the WHO RPC programme both in range and content. The initiatives taken during the reporting period were relevant to the recommendations of the 24 th session of the SEA-ACHR, held in Myanmar in 1999, and they also responded to the other strategic needs of the Region. In particular, the ACHR commended the efforts related to the establishment of scientific working groups, expert and core groups, capability strengthening for health research management, promoting the utilization of research results, and collaborative activities for research promotion and development. The ACHR meeting also underlined the fact that there were wide variations among the countries of the Region with regard to disease burden as well as the development of health systems. Research was not only about knowledge, but required dedication and commitment. Countries with a stronger capability in terms of human, institutional and financial resources needed to collaborate with the weaker ones in a spirit of regional solidarity. WHO was very much in line with this notion of promoting inter-country cooperation, which was on its agenda both regionally and globally . Members furthermore remarked that health was a complex issue, and was increasingly being recognized as such. Many variables determined health status – and not merely the medical aspect. The social, anthropological, economic, ecological, and technological and other relevant sciences had to be properly considered and applied in health research. Health policy research for identifying reform alternatives was a good example of an activity that requires multidisciplinary support. Much work had been done but the challenge was how to translate these findings into action. The capacity to conduct and manage health research on the part of the countries was very important. WHO South-East Asia Advisory Committee on Health Research Page 8 The meeting concluded that the health situation in the Region was dynamic, and that health research in support of health development was also a dynamic process. Networking for improving and building linkages was a very important means of doing this. The Committee felt that there was a need to strengthen the networking of health research institutions and individuals for the better management of health research. This would facilitate the transformation of health research results into policy planning and implementation. The future agenda of the research programme in the Region would aim at addressing health problems, which could provide evidence-based information in closing the gaps and inequities in health, especially for the poor population. The research should also help create conditions which promote health, which ensure access to basic health services to all, which help to uphold and enforce health ethics, and which place health at the centre of development. The Regional Director informed the meeting of the recent establishment of an operations room at the Regional Office. This was also a part of reform measures reflecting the need for appropriate information management and for providing quick responses, especially in cases of health emergencies. The Regional Office was planning to strengthen its clearing-house functions through the creation of interactive WEB sites and enhancement of networking. The Regional Director requested all Member Countries to send to WHO relevant information on health development and health research, especially observations which may not have been published. Recommendation Countries, with the support of WHO and other development partners, should collaborate in the establishment of regional networking of health Report of the Twenty-fifth Session Page 9 research institutions and individuals on health research, with the aim of translating health research into policy planning and implementation. 2.2 South-East Asia Advisory Committee on Health Research – Terms of Reference, Membership and Methods of Work (Agenda item 3.2) The SEA-ACHR reviewed its new terms of reference, membership and methods of work, including its historical evolution. It was noted that it was in Bali, Indonesia, that the seed of the ACHR had been sown, during the session of the WHO SEA Regional Committee in 1974. The first ACHR session had been held in 1976 and since then, the ACHR had held its annual meetings at various venues in the Region. Also, on several occasions eminent scientists and special invitees as well as representatives from the global ACHR and other WHO regional and headquarters staff had attended its sessions. Since 1979, the heads of national medical and health research councils (MRC) had also held their meetings every two years. In 1998, WHO SEARO bad organized the joint session of the regional ACHR and MRC in order to review the progress of work of both bodies and also to review their roles in the light of globalization and WHO reform. The 24 th session of the ACHR in Myanmar in 1999 had further deliberated these issues and recommended to the Regional Director that the ACHR mechanism should be renewed with appropriate reforms. The Regional Director, thus, had reconstituted the SEA-ACHR with new membership and fresh terms of reference. The method of work of the Committee had also been revised in consonance with those changes. The ACHR system had taken a new form, whereby the new WHO Corporate Strategy set the overall direction. Members recommended that WHO South-East Asia Advisory Committee on Health Research Page 10 the ACHR should remain as an advisory body to the Regional Director with the main aim of promoting health research in the Region. The renewed functioning of the ACHR should be linked to the work of the Global ACHR. It should also have links with the establishment and working of scientific working groups, task forces and core or experts groups which might be associated with the mainstream of WHO programmes as need arose. The ACHR could identify and propose strategic areas for the development and formulation of health research policies and programmes. The regional ACHR, as part of the global ACHR system, had a continuing role to play as a major functional linkage of health research initiatives at national, regional and global levels. The Committee felt that in the light of renewed directions within the framework of the WHO Corporate Strategy and the reconstituted Global ACHR with its new terms of reference, the Regional Director might need to revise the terms of reference, membership and the method of work of the SEA-ACHR in late 2000. While expressing satisfaction with the work of the regional RPC programme, the Committee raised concerns about the need for expanding health research in the area of traditional medicine. The ACHR was informed that WHO SEARO had organized a regional consultation on the development of traditional medicine in late 1999, with the objective of promoting national programmes and district health systems. The issue of health research in traditional medicine, including clinical studies and ethics, had been discussed at this consultation, but further in-depth technical review and discussion might be required. Some members also expressed the need to enhance research work on major health problems which were unique to many countries of the Region, e.g. snakebites and anaemia among pregnant women. The reason was evident from the fact that the interventions and technical tools being used for these health Report of the Twenty-fifth Session Page 11 problems would not appear to have advanced very much during the last few decades. Recommendation The WHO Regional Director should review and update the Terms of Reference, membership and methods of work of the newly reconstituted SEA-ACHR, in the light of implementation of the WHO Corporate Strategy and also of any changes introduced in the global ACHR system. 2.3 Work of Scient ific Working Groups on “ Management and Coordination of Health Research Activities in the Countries ” and “Management of Health Research Information ” (Agenda items 3.3a and 3.3c) The Committee noted that major issues on health research management and coordination, identified by the Scientific Working Group on “Management and coordination of health research activities in the countries ” were very relevant. However, in view of the different stages of development of health research in Member Countries, the respective national health or medical research councils or analogous bodies (HRC/MRC) should review these issues and prioritize them for implementation according to local needs. Members noted the importance of documenting the profiles of available resources for health research. National HRC/MRCs, in collaboration with WHO and other partners, should conduct resource availability studies in the area of human resources for health research, both at institutional and national levels. They also recognized the need for better coordination among various agencies involved in health WHO South-East Asia Advisory Committee on Health Research Page 12 research in order to avoid duplication of activities. As health research information was the key to better health research management and coordination practices, it should be promoted as a priority. Members also felt that there was a need for the development of a system of quality assurance for public and private research institutions. They were of the opinion that concerted efforts must be made to create a research environment conducive to conducting quality health research. This included improved information management and technical support, establishment of a system of reward, and an appropriate staff development and deployment policy. The Committee reviewed and endorsed, one of the recommendations made by the Scientific Working Group that national HRC/ NRCs or analogous bodies, with support from WHO and development partners, should prepare position papers on the role of health research in current and future health development, in order to sensitize different target groups (parliamentarians, decision makers, industrialists, the general public, the scientific community). National HRC/MRCs should also monitor and analyse the research resource flows, in the context of national health policy, including health research policy. This would help in the rational allocation of health research resources. WHO, in collaboration with national HRC/MRCs, should develop an appropriate guide on good research management practice. After reviewing the outcome of the work of the Scientific Working Group on “ Management of health research information ” (MHRI), the Members endorsed the recommendations contained in their report. The ACHR also highlighted the need to undertake the following at appropriate levels. Countries – Health or Medical Research Councils or analogous bodies Report of the Twenty-fifth Session Page 13 (1) Situation analyses of MHRI using the framework suggested by the Scientific Working Group. (2) Development of human resources for MHRI. (3) Appropriate application of advances in communication and information technologies, to strengthen networking and resource centres. (4) Registration of research studies and creation of database(s). (5) Creation of a forum for dissemination and communication. Research institutions (1) Development of competence and s kill in the area of data collection, analysis, presentation and dissemination. (2) Ensuring high quality of research information through better management of data collection and analysis. (3) Development of databases for effective research management. (4) Strengthening of national research institutions for enhancing access to essential information. (5) Registration of research studies and creation of database(s). WHO (1) Promotion of MHRI for policy and decision making. (2) Provision of technical and manage ment support for information management. (3) Coordination with other agencies for financial and technical support. (4) Establishment of electronic database(s) and promotion of their use. WHO South-East Asia Advisory Committee on Health Research Page 14 (5) Assistance to national research and other scientific journals to improve quality and visibility. Recommendation The conclusions and recommendations of the two scientific working groups, with additional inputs from the ACHR, should be implemented within the context of national and regional programmes for health research development. 2.4 Work of Scientific Working Groups on “ Criteria for Setting Health Research Priorities ” and “ Formulation of National Health Research Policies and Strategies ” (Agenda items 3.3b and 3.3d) The ACHR members were informed of the deliberations of the Scientific Working Group on “ Criteria for setting health research priorities ”. They considered, among others, the development of the health research agenda within the framework of national health development, the selection and application of criteria and methods for priority setting, the information needs, the participatory and ethical dimensions of priority setting. The linkages between national and sub-national settings were explored, as was the context of a national health policy in developing an agenda for priority health research. The tools used in priority setting processes, and the lessons learnt, were considered. The experience of priority setting in essential national health research exercises was drawn upon. The discussion highlighted the fact that due to considerable variations and diversity among SEAR countries, guidelines for priority setting should be considered as a flexible framework. They could be adopted and adapted as appropriate to the relevant national and sub- Report of the Twenty-fifth Session Page 15 national setting(s) chosen. In a sub-national context, priority setting should be attuned to local needs or requirements which could facilitate a decentralized approach. The value of a two-stage process of priority setting was emphasized. During the first stage, appealing especially to planners, broad areas or health problems were prioritized. During the second stage, appealing especially to researchers, research problems within those major areas identified would be prioritized. The methods and tools chosen should be attuned to each stage. Periodic review of priorities was considered essential. This would allow for correction of research on health problems that might have been neglected earlier. A balance between different types of research and the importance of feed-back was emphasized. Priority setting in itself did not favour one type of health research over another. Identification and involvement of multiple stakeholders was underlined to be of particular importance for success and sustainability. Members emphasized that the twin objectives of equity and efficiency of the system should be pursued in priority setting. The concept of disparity reduction had been proposed as a crucial yardstick to measure progress towards equity. An efficient process and system should complement this. Members observed that the value of priority setting extended to other dimensions also, especially as it could lead to strengthening research capacity, and to bringing researchers and policy makers together. A plea was made to allow for creativity and not to stifle it. This could in turn enhance the value of priority setting. The Committee noted that the draft document prepared by the scientific working group – “Priority setting in health research. A guideline containing strategies, criteria, tools and processes used for priority setting of health problems and health research” - would be a useful guide for national health planners and researchers. They proposed that this document should be finalized in generic form. WHO South-East Asia Advisory Committee on Health Research Page 16 Members further considered the report of the Scientific Working Group on “ Formulation of national health research policies and strategies ”. Most of the discussion focused on the steps required to formulate a national health research policy (see Figure 1), and on selecting priority actions proposed for countries and for WHO. As outlined diagrammatically in Figure 1, the importance of identifying an appropriate body for developing a national health research policy was underlined. There was the advantage of doing this as part of the national health policy. Just as the national health research plan should relate to the national health plan, a national health research policy should be laid out in the national health policy. Sub-national components or modalities could help to calibrate overall national policy to local needs and circumstances. This in turn could help in attaining of wider policy objectives, for example decentralization. Report of the Twenty-fifth Session Page 17 Figure 1 . Steps in the formulation of a national research policy Formulation or revision of a national health research policy could begin with the national authorities identifying an appropriate body to initiate the process. Following this, an advisory group and a functional core group or task force should be formed. Importantly, attention should be paid to identifying key stakeholders and involving them fully. A situation analysis should be undertaken and the findings, as well as the policy options , discussed. The prioritization process could then be usefully carried out, leading to – and contributing towards – policy Identification of an appropriate body Situation analysis Prioritization process Policy development Researc Formulation of advisory group, functional core group of key Policy options WHO South-East Asia Advisory Committee on Health Research Page 18 development. Significantly, health research was an important ingredient in every step of the health planning and health policy development process. Health policy development was thus not the end. It was linked to research on one hand and was (or should be) the foundation for implementation on the other. The scientific working groups on priority setting and on research policies and strategies differed in content but were at the same time linked together. The framework developed as part of the proposed guideline on ‘setting priorities in health research’ could serve as a useful conceptual model linking the processes of planning and policy formulation with those of priority setting and evidence generation. The Committee critically reviewed the series of follow-up actions contained in the report of the Scientific Working Group on “ Formulation of National Research Policies and Strategies ”. From amongst these, members proposed the following priority actions: Countries (1) To develop or update health research policies, through situation analysis and research, in close interaction with decision-makers. (2) To initiate and sustain a mechanism for implementation, monitoring and evaluation, and use the information generated by monitoring as a feedback for the review of policy and priorities. Sub-national components or modalities could help to fine-tune policy to local needs, thus assisting with broader policy objectives as may exist. WHO (1) To assist in the formulation of a national health research policy as appropriate ; and to share the status of implementation of formulating, or reformulating, health research policies and priorities as appropriate. Report of the Twenty-fifth Session Page 19 (2) To promote methods on evidence-based policy development through the process of linking resources and decision makers. WHO Representatives should play an advocacy role with policy- making bodies and responsible personalities. Recommendations (1) WHO SEARO should finalize the draft document “Priority setting in health research: A guideline containing strategies, criteria, tools and processes used for priority setting of health problems and health research”. This should be field-tested before wider application . (2) The conclusions and recommendations contained in the reports of the two scientific working groups, with additional inputs from SEA-ACHR, should be considered for formulating health research policies, including priority setting in health research, within the context of national and regional situations. 2.5 Work of Scientific Working Group on “ Operational Research on Reproductive Health” and presentation on UNDP-UNFPA-WHO- World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) (Agenda items 3.3e and 3.8) The Committee discussed the work of the Scientific Working Group on ”Operational research in reproductive health ”. Members took note of the progress made since the first meeting of the Scientific Working Group in 1996, as well as the work done during their second meeting in 1999. It was observed that reproductive health involved physical, social and behavioural issues, dealing with intimate aspects of human lives. Reproductive health should be viewed in the broader context of multisectoral and multidisciplinary involvement. They also noted the WHO South-East Asia Advisory Committee on Health Research Page 20 importance of mechanisms such as intersectoral coordination committees in improving coordination in all aspects of reproductive health, including research. The Committee emphasized the need to conduct operational research to address priority problems on reproductive health prevailing in the Region. These problems were: high maternal mortality, high peri- natal and neonatal deaths, unwanted pregnancies especially among young adolescents, unsafe abortion, high incidence of reproductive tract infections (RTI) and sexually transmitted diseases including HIV-AIDS, mother-to-child transmission of HIV-AIDS, a higher number of anaemia cases and babies of low-birth-weight. The Committee also noted the organizational changes in the UNDP-UNFPA-WHO-World Bank Special Programme on Research, Development and Research Training in Human Reproducton (HRP) as part of WHO organizational reform. They also appreciated the joint planning effort at all levels of WHO, including the HRP programme. It was felt that further concerted support should be provided to developing countries, in identifying research needs, adoption and application of tools, capacity building, planning, monitoring and evaluation of reproductive health programmes. As indicated below a number of areas on reproductive health research were considered which would promote operational research in the countries. The aim of doing so would be to address priority reproductive health issues, particularly high maternal mortality. The approaches to be used in such operational research could be developing community-based models, to provide a continuum of care linking the community, male members of the family and improving health systems. Unwanted pregnancy was the main cause of abortion, which contributed up to 40% of maternal mortality in some countries. Therefore, it was felt by the group that research on new approaches, such as emergency contraception and safe abortion technologies that could prevent unwanted pregnancy and contribute to reduction of maternal mortality, should also be given higher priority. To avoid possible Report of the Twenty-fifth Session Page 21 duplication of efforts, countries should establish a repository of various research studies related to reproductive health and disseminate these. WHO should strengthen regional information networking between institutions. Capacity building for conducting reproductive health research should include components of priority setting, research coordination, monitoring and management. Several mechanisms for capacity strengthening were envisaged such as (a) application of existing health systems research modules to suit the operational research needs on reproductive health; and (b) conduct of training of trainers to enable district-level health managers to undertake appropriate implementation of operational health research, within the decentralized systems. Maternal deaths were unacceptably high in some countries of the Region despite available technologies to prevent them. The Committee felt that there were factors outside health systems that could affect health outcomes. Such factors included the socioeconomic determinants, for example poverty, social status of women, literacy, male involvement. The possibility was discussed of organizing, or commissioning several studies to identify the determinants affecting maternal health. The result of these studies could be used for advocacy for better maternal health. As initiatives on health systems reform were ongoing at various stages in many countries, maternal health could be positively or negatively affected. Examples of such reforms were the decentralization process in the Indonesian health sector, or the integration of health infrastructure and health centre functions in Bangladesh. It was felt that studies should be conducted to evaluate possible effects of health sector reforms on maternal health. The studies would identify various intervention approaches, with a balance between centralized coordination and decentralized decision making, which would be helpful in promoting reproductive health. Countries should document their research results on reproductive health, especially unpublished ones. Such information could WHO South-East Asia Advisory Committee on Health Research Page 22 be valuable, potentially useful for programming as well as for sharing with Member Countries and WHO through available mechanisms. In addition, WHO should advocate wider use of its research databases on reproductive health, especially in support of policy formulation. Recommendations (1) Countries should conduct operational research which is aimed at reducing maternal mortality. The approaches should include developing community-based health care models, in order to provide a continuum of care linking the community as well as male members of the family. (2) Studies on determinants affecting maternal health should be commissioned, and the results used for advocacy in countries where maternal mortality remains unacceptably high. (3) Countries, with the support of WHO, other UN agencies and development partners, should conduct health research on appropriate public health interventions and approaches, which could prevent unwanted pregnancies and contribute to the reduction of maternal mortality. (4) Countries and WHO should promote documentation of unpublished research results in reproductive health. (5) WHO should promote networking among institutions within the Region through supporting multi-centre studies in priority areas of reproductive health, including those related to HIV-AIDS, women’s health and nutrition. 2.6 Regional Priorities in HIV-AIDS Research (Agenda item 3.4) Report of the Twenty-fifth Session Page 23 The Committee discussed the conclusions and recommendations, including the regional research priorities in HIV-AIDS, as identified by the Expert Group on HIV-AIDS research, which had met in New Delhi from 15 to 17 December 1999. The Committee also noted the structure and priorities of the HIV-STI initiative of WHO HQ as well as WHO SEARO. The meeting acknowledged with concern the rapid spread of HIV-AIDS in the Region. The epidemic continued to evolve and was highly dynamic in nature. While it was fairly advanced in some countries, HIV prevalence remained low in others at present. The risk behaviours that promoted HIV transmission were prevalent in the region. Therefore, the potential for rapid spread exists in all countries. In view of this, it was recognized that multi-disciplinary research could play a crucial role in formulating and implementing HIV prevention and care policies and interventions. The meeting also endorsed the priority health research topics on HIV-AIDS as proposed by the Expert Group, and selected important areas of research, as stated below, for urgent implementation: � Evaluating/reviewing existing HIV-STI surveillance programmes. � Carrying out intervention–linked knowledge, attitude and behaviour surveys among populations at high risk for HIV to assist in designing interventions and evaluating their impact. � Assessing knowledge, attitude, practices, needs and skills of care providers at various health settings, as relevant to each country situation. � Studies to determine the availability, accessibility, acceptability, and correct use of condoms. � Promoting the development of rapid diagnostic kits for sexually transmitted infections (STI). � Studying STI treatment-seeking behaviour, particularly in women. WHO South-East Asia Advisory Committee on Health Research Page 24 � Studies on the mother-to-child transmission of HIV, including care and support needed by children born to HIV-infected mothers. � Assessing cost-effective management options for HIV prevention and care, including access to drugs for preventing mother-to- child transmission and for provision of care for people living with HIV-AIDS. � Evaluating the use of alternative systems of medicine as part of a comprehensive care package for people living with HIV-AIDS. � Studies relating to AIDS clinical care, including counselling and prevention of HIV at the health care setting. � Immunological and virological studies with a view to promoting vaccine development relevant to the Region. The SEA-ACHR also considered important issues relevant to research management in the area of HIV-AIDS. It was recognized that given the different stages of the HIV-AIDS epidemic, as well as cultural and behavioural aspects, research priorities should be specific to each country and local situation. Strengthening capacity and health infrastructure were crucial prerequisites for carrying out relevant research activities. Members arrived at the following conclusions and recommendations. Countries (1) Countries should develop their own country-specific HIV-AIDS- STI research priorities and a framework for implementing research in these priority areas. (2) Ministries of Health should allocate a part of the national HIV- AIDS programme budget for operational research. Report of the Twenty-fifth Session Page 25 (3) Countries and WHO should promote utilization of research findings for programme purposes through regular dialogue between researchers and national HIV-AIDS programmes. (4) Countries, in collaboration with WHO and development partners, should strengthen national capacity for research through training and institutional strengthening. (5) Countries should establish information centres at national level for dissemination of research findings and other technical information; develop an inventory of research institutions capable of research in multidisciplinary areas, of research expertise and of research studies already carried out locally. Research institutions (1) Accord importance to research on priority areas identified at national level, using the framework already agreed to. (2) Establish regular dialogue and linkage with national HIV-AIDS programmes and policy makers to make them aware of the research carried out and its implications. (3) Share available technical and financial resources among institutions. (4) Establish a network to share multi-disciplinary information among researchers within and outside the countries. (5) Medical and other relevant research councils should establish mechanisms for research capacity building, besides providing financial support to HIV-AIDS research proposals. (6) Every attempt should be made to strengthen research management, including quality of data collection, analysis, dissemination and use. WHO South-East Asia Advisory Committee on Health Research Page 26 WHO (1) Promote HIV/AIDS research and allocate resources. (2) Provide technical support by developing guidelines, generic protocols and assist in capacity building. (3) Mobilize resources from UNAIDS, multilateral and bilateral agencies. (4) Facilitate inter-country, south-to-south collaboration and exchange of country experiences within as well as outside the region (such as with countries of the Western Pacific and African regions). (5) Consider establishing an Asia Repository of HIV Strains and also an immunological reagent bank. (6) Develop guidelines on the ethical dimensions relating to HIV/AIDS research. (7) Strengthen capacity at the regional level to assist countries more effectively. Recommendation The conclusions and recommendations of the Expert Group, with additional inputs from the ACHR, should be implemented within the context of national and regional HIV-AIDS control programmes. 2.7 Regional Vaccine Research and Development Policy (Agenda item 3.5) The Committee reviewed and discussed the report of the Core Group Meeting on “ Regional vaccine research and development policy” held in October 1999, including the activities to be conducted at regional and national levels. The consensus was that the field of vaccine research and Report of the Twenty-fifth Session Page 27 development was complex and contained many related areas, each with its own complexity. It was, therefore, necessary to focus on areas that were particularly important for the Region and where WHO could play a leading role. The Committee briefly reviewed the important ongoing activities of WHO on vaccine research and development at the regional level: � Capacity building of national regulatory/control authority for vaccine testing and use. � Technology transfer in the areas of vaccine production (including new technologies). � Inter-country and institutional cooperation for sharing information, providing training and quality control services, conducting multi-centre studies and trials. � Regional information systems on vaccine use, clinical trials, vaccine research and development, disease burden of vaccine preventable diseases. � Ethics in vaccine research and development. The Committee noted the importance of collaborating with the global initiatives on promoting vaccine development and increasing access to vaccines, such as the Global Alliance for Vaccines and Immunization (GAVI), International Vaccine Institute (IVI), United Nations Foundation, Bill and Melinda Gates Foundation. These, as well as other international institutions and initiatives, were welcome. Regional solidarity should be fostered within the context of these global initiatives. In order to address these issues, members agreed that a regional vaccine policy was necessary, to help ensure a degree of self-reliance in vaccine research and development in the Region and, ultimately, in vaccine security. Such a policy would be based on the development of a national vaccine policy in Member Countries. The countries should organize national level meetings, with the full involvement of stakeholders, to arrive at a consensus on national vaccine policy, including vaccine selection and use, quality assurance, vaccine production and delivery. WHO South-East Asia Advisory Committee on Health Research Page 28 Recommendations (1) A second meeting of the Core Group on "Regional vaccine research and development policy" should be held in June 2000 to refine the plan for regional vaccine research and development, leading to the development of a regional vaccine policy. The Core Group should be expanded to include health systems experts and additional experts from WHO HQ, WHO SEARO, Member Countries, other technical agencies and others. (2) A regional conference should be held by the end of October 2000 with the Core Group and representatives from relevant national programmes and institutions, together with the development partners, to endorse a regional action plan, as well as national action plans, for the development of regional and national vaccine policies. 2.8 Operational Guidelines for Ethics Committees Reviewing Biomedical Research (Agenda item 3.6) The Committee reviewed the situation of national and institutional ethical review committees or similar bodies existing in countries of the Region. They noted the different stages of development in terms of activities as well as functioning. Based on the international ethical guidelines, many countries have their own national guidelines for ethical clearance of health research activities. Some were even updating these through wide consultation. As part of capacity building, a series of national workshops on ethical issues in health research had been held in a few countries. In some countries, for example India, in addition to the general national guidelines on ethics in biomedical research, specific ethical guidelines are being developed on human tissue transplantation, research publications, Report of the Twenty-fifth Session Page 29 epidemiological studies, reproductive technologies, animal experimentation, genetic research and organ transplantation. National health research councils played a major role in upholding ethics in health research. The composition of ethical review committees varied, but most of them consisted of multidisciplinary members. The Committee also noted that there was some deficiency in the teaching of ethics in many countries. There was a need to integrate the teaching of ethics in various segments of educational curricula of all medical and public health education institutions. Based on its experience in many parts of the world, the WHO-UNDP- World Bank Special Programme for Research and Training in Tropical Diseases (TDR) embarked in 1999 on developing operational guidelines for ethics committees reviewing biomedical research. A series of workshops, meetings and discussion groups were held in order to draft a standard manual consisting of operational guidelines. The final draft was reviewed, completed and made available in 2000. In order to facilitate wider use of the operational guidelines and to share experience on their adaptation and application, an informal regional network, called Forum for Ethical Review Committees in the Asian and Western Pacific Region (FERCAP), has been formed with scientists possessing experience on ethics. FERCAP strives to help improve communication among national ethical review committees in the countries of Asia and the Pacific, facilitate training opportunities, and assist in the adaptation and modification of WHO generic guidelines for ethical review. In future, FERCAP will be involved in developing appropriate quality assurance mechanisms for effective functioning of national and institutional ethical review committees. WHO South-East Asia Advisory Committee on Health Research Page 30 SEA-ACHR reviewed the WHO operational guidelines, developed under the initiative of the TDR programme, for ethics committees reviewing biomedical research. The guidelines would be useful as generic operational guidelines for each country to adapt. It could guide ethical review committees to evaluate and strengthen their work within the context of the prevailing national framework. Members considered that a future revision of the guidelines could differentiate between national, institutional and granting agencies involved in ethical review. Furthermore, the term “ biomedical ”, which was used in the title of the operational guidelines, might not indicate the full range of meaning intended. It would be better if the term “ Health Research ” or the elaboration “ Research involving Human Subjects ” was used. The procedures for follow-up consequent to the review, such as protection of research subjects, accountability of ethical review committees, reconsideration of rejected proposals, possible consequences for researchers not following the ethical procedures, needed to be further elaborated. In future revisions there was also a need to highlight some important ethical issues in research as may be involved in inducement, compensation, confidentiality, group clinical practices, research design, analysis, report writing. The Committee noted that national codes of ethics would be within the legal domain of each country. WHO should facilitate and support the capability of the countries in formulating their framework on national codes of ethics. Ethics was a comprehensive area: it was felt that one should not apply only one type of ethics universally. It was suggested to conduct country case studies on ethical review processes and mechanisms. Recommendations Report of the Twenty-fifth Session Page 31 (1) Countries should undertake situation analyses on their ethical review processes and mechanisms for reviewing health research, in particular research involving human subjects. WHO could facilitate this process through the support and involvement of the regional FERCAP network . (2) Countries should review their curricula on biomedical and health ethics, including ethics in health research, in medical, paramedical and health training institutions. WHO could facilitate the training of trainers on ethics in health research . 2.9 Global and Regional Coordination in Health Research (Agenda item 3.7) Council on Health Research for Development (COHRED), Geneva Professor Charas Suwanwela shared with members the latest information on the International Conference on Health Research (ICHR), which would be held in Bangkok, Thailand, in October 2000. WHO, COHRED, the World Bank and some 30 agencies were organizing this conference, COHRED being the secretariat. The first announcement has been disseminated. Explaining the programme of the conference, Professor Charas said that on the first day, comprehensive review and analysis of the past 10 years’ work on health research at national, regional and global levels would be carried out. The results would give ideas on the future of health research, especially in the areas of joint collaboration and cooperation at various levels. The second day would be used for analysis of the current situation and the expectations for the next decade. On the third day, an action plan for the coming years would be developed. The fourth and final day was dedicated to plenary discussion, during which a future action WHO South-East Asia Advisory Committee on Health Research Page 32 plan for international cooperation for health research would be adopted. Conference would consist of a mix of parallel and plenary sessions, including group activities and market places. Many small group discussions would be arranged to deal with cross cutting as well as specialized issues. Conference would arrange a considerable number of market places, exhibition stalls and electronic exhibits, where researchers could interact, display their products, promote proposals and exchange ideas. Professor Charas also explained the consultative process in preparation for the International Conference on Health Research. In particular, he reported briefly the outcome of the Asia Health Research Forum, organized in Manila, The Philippines, from 17 to 19 March 2000, involving 300 researchers. This forum was jointly organized by the Council on Health Research for Development (COHRED), Essential National Health Research networks, WHO SEARO, International Clinical Epidemiology Network (INCLEN), South-East Asia Clinical Epidemiology Network (SEACLEN) and other partners. It drafted Asia’s Voice on Health Research to be used at the forthcoming ICHR. This draft dealt with three levels of ‘voice’: The first level was the philosophical one, dealing with equity, ethics and a new paradigm of health research. The paradigm was about the changing face of health research, signifying a shift from biomedical to social and behavioural sciences, and from supply side to demand- driven research. It also included the involvement of other sectors. In addition to generating knowledge, conducting and utilizing health research should contribute to the empowerment of developing countries. Report of the Twenty-fifth Session Page 33 The second level was the architectural one, which meant ways and means to deal with heath research at the national, regional and global levels. The third level was the action one, dealing with leadership, tools and methodologies and the use of communications in health research. The Committee considered that in view of the importance of the International Conference on Health Research, countries should consider sending senior scientists and policy makers to attend. WHO RPC Programme (HQ) and Global Advisory Committee on Health Research, Geneva Dr Tikki Pang, Director, Research Policy and Cooperation, WHO HQ, explained the new role of WHO in health research within the context of WHO reform. The role and functioning of the Global ACHR had undergone a thorough review. The first meeting of the reconstituted Global ACHR would be held in Bangkok, Thailand, in October 2000. Dr Pang shared with members the functions of the Global ACHR as an advisory body, which provided guidance on WHO research policy and strategies. This role included commissioning reviews on thematic areas of research, playing an ‘intelligence’ role in responding to emergency health research issues, and conducting high-level advocacy for global health research. Dr Mahmoud Fathalla of Egypt will chair the new Global ACHR consisting of 12 members of multidisciplinary background. The meeting appreciated the reform of the Global ACHR and hoped to further strengthen the linkages within the ACHR system. Several modalities were suggested to achieve this objective. These included cross-representation at respective ACHR meetings, and more frequent interactions and WHO South-East Asia Advisory Committee on Health Research Page 34 consultations among members of global and regional ACHRs. A “summit” of all ACHRs was proposed to share experience as well as respective roles and functions. The WHO Director-General had stated on several occasions that research was one of the core functions of WHO and that stimulating health research in the developing world was of key importance. It was realized that health research in developing countries was usually top- down, or frequently driven by external donors, or restricted to specific areas, thus not following a balanced approach. On the positive side, there were an appreciable number of initiatives to support health research, strengthen research capacity, organize training programmes, or strengthen institutional capacity. It is felt that the development of a research culture should be further promoted in the countries. Dr Tikki Pang further explained the new REACH initiative – Research empowerment accelerates complete health . REACH was mainly an award scheme based on the participation of, and owned by, researchers of developing countries. The REACH awards ceremony is scheduled to coincide with the International Conference on Health Research to be held in Bangkok, Thailand, in October 2000. Members emphasized the diversity inherent in the regional and global ACHR system. Cross-representation of members and sharing experience of thematic issues on international health research was likely to result in success. The present practice of the ACHR chairpersons reporting directly to the respective WHO governing bodies (World Health Assembly, Executive Board or the regional committees) should be continued. In addition, to promote exchange of ideas, the possibility of members of WHO governing bodies attending ACHR meetings could be explored. Report of the Twenty-fifth Session Page 35 Global Forum for Health Research, Geneva Mr Louis Currat, Executive Secretary, Global Forum for Health Research, Geneva, briefed the ACHR members on the work of the Forum. Summarizing the Forum’s 10/90 Report on Health Research 2000, due to be released in mid-2000, Mr Currat stated that global spending on health research – by both public and private sectors – amounted to approximately US$ 56 billion per year (1992 estimate). However, less than 10% of this considerable sum was devoted to 90% of the world’s health problems. The human and economic cost of such misallocation of resources was enormous. The central objective of the Global Forum was therefore to help correct this 10/90 gap The Ad Hoc Committee on Health Research had recommended in 1996 the creation of the Global Forum for Health Research. The Forum commenced operations in January 1998 and became a foundation on 24 June 1998. It attempts to address the 10/90 gap by a variety of means, such as focusing research efforts on diseases representing the heaviest burden on the world’s health, or assisting to improve the allocation of research funds, or facilitating collaboration among the Forum’s partners. These partners included government policy makers, multilateral and bilateral aid agencies, international foundations, national and international NGOs, women's organizations, research insitutions and universities , private sector companies the media. The Forum believed that solutions to the present health challenges would depend on the strength of partnerships created between these constituencies over the years to come. The Forum’s efforts centred around five strategies: WHO South-East Asia Advisory Committee on Health Research Page 36 � Organization of an Annual Forum: Global Forum 2 and 3 had been held in June 1998 and June 1999, respectively. The next Forum 4 would be held in conjunction with the International Conference on Health Research for Development, scheduled for October 2000 in Bangkok, Thailand. � Analytical work in priority setting: The analytical activities focused on burden of disease, cost-effectiveness, resource flows and the development of a practical framework for priority setting. � Initiatives in key areas of health research: Progress had been made under a number of initiatives, such as the Alliance for Health Policy and Systems Research, Medicines for Malaria Venture, Global Tuberculosis Research Initiative, Cardiovascular Health in Developing Countries, Initiative on Violence against Women and Initiative on Child Health and Nutrition. � Communication and information: Activities had been initiated in the development of networks of partners in the constituencies of the Global Forum, the development of the website, and work with the media. � Indicators of performance: An external evaluation of the Forum’s work was being planned for 2001. Progress would be measured in terms of the Forum’s contribution to a more widespread knowledge of the gaps in health research, priority setting efforts, and development of initiatives with a purpose of bringing together partners in key areas of health research. Mr Currat also elaborated on the possible role of the Global Forum within the framework for overall health research governance. The characteristics of the Forum were summarized as a network linking the efforts of many partners, as a potential catalyst and promoter of equality. Members appreciated the initiatives and the support extended by the Global Forum in health research, especially for developing countries. As many initiatives of the Forum were falling within the purview of global Report of the Twenty-fifth Session Page 37 health development initiatives by WHO, for example Roll Back Malaria and Stop TB, the work supported by the Global Forum at the country and regional levels needed to be coordinated. WHO Centre for Health Development, Kobe, Japan Dr Ataollah Amini, Public Health Consultant and Senior Adviser to the Director, WHO Centre for Health Development, Kobe, Japan, briefed members about the history of the Centre (since its inception in 1996) and its future plans. The WHO Kobe Centre had been established with the support of WHO and the Kobe Group, through a Memorandum of Understanding signed in August 1995. Its main mission was to undertake multisectoral research in health development and its determinants with a view to improving scientific knowledge on the interrelationship among social, cultural, economic, demographic, epidemiological and environmental variables. The WHO Kobe Centre, an inter-disciplinary and inter-sectoral centre for research and symposia, intends to provide evidence-based information required by decision-makers. The Centre plans to bring together decision-makers and researchers to explore common health and welfare problems, to define relevant research agendas, and to organize internally commissioned research. It was utilizing international and national networks of academic, research and development institutions, ranging from governments, universities, foundations, the private sector, national and international NGOs, multilateral and bilateral agencies. It also organized a series of international meetings and symposia on topical health development issues, such as urbanization, women's health, ageing, traditional medicine and social security systems. The Centre used its information technology resources to strengthen information networks. WHO SEARO and some countries of the Region were involved in the activities of the WHO Kobe Centre. Members noted the progress of this work and WHO South-East Asia Advisory Committee on Health Research Page 38 expressed their desire to continue collaboration, especially in international health research and information technologies. 3. CLOSING SESSION (Agenda items 3.9 and 4) The Chairperson, Professor N K Ganguly, summarized the discussion, conclusions and recommendations of the meeting. The draft report was reviewed by plenary, which members endorsed with minor modifications. Professor Ganguly, in his closing remarks, reiterated that the speeches by the Hon Minister of Health of the Republic of Indonesia and by the WHO Regional Director had set a new tone for the new SEA-ACHR. He emphasized that the regional ACHR mechanism should support the policy-making processes of national health administrations, as well as help in strengthening national health research capabilities. This year’s session had covered major themes on health research management, such as ethical review, development of research culture, priority setting, research policy formulation, health research information management. Decentralization and enhancement of linkages had been emphasized. The Chairperson urged members to bring the needs of health research to centre stage of health policy development, so as to facilitate availability of simple health interventions for widespread use. Within the context of the new WHO Corporate Strategy, Professor Ganguly requested members to identify an appropriate niche in the new international health research environment. After the International Conference on Health Research in October 2000, new directions for health research should become much clearer. To this end, the Chairperson urged members to participate fully in that Conference and to plead for a stronger regional voice. In conclusion, Professor Ganguly pointed out that the Committee had thoroughly Report of the Twenty-fifth Session Page 39 reviewed and debated the outcome of the various working groups and was very satisfied with the conclusions and recommendations. He hoped that these would be acceptable to the WHO Regional Director. While South-to-South cooperation needed to be strengthened, there was also a need to expand and enhance the partnership and networking mechanisms. The Chairperson urged SEA-ACHR members, who were attending the meeting not only in their personal capacity as eminent scientists, but were also representing their respective national health research authorities, to take prompt action to implement the recommendations of the meeting. The Chairperson expressed high appreciation for the longstanding and valuable contributions to the Committee’s deliberations rendered by Dr Samlee Plianbangchang, Deputy Regional Director and Director, Programme Management, WHO SEARO. Professor Ganguly also commended the Secretariat for their thorough, comprehensive documentation and technical support, and the national organizers for the excellent local arrangements. Dr Uton Muchtar Rafei, WHO Regional Director, in his closing remarks, congratulated members and special invitees for their valuable contribution, especially on the fruitful outcome of the meeting. As WHO was emphasizing the product approach, Dr Uton was pleased to note the concrete results coming out of this meeting. WHO would implement these recommendations with the assistance of all SEA-ACHR members and also with the support of the national and international health research community . Dr Uton further emphasized the importance of appropriate marketing of health research results and also the need for communicating health research information to relevant users. The Regional Director hoped that next year, the Committee would be able to share such communication and marketing experience. He urged participants to continue to make WHO South-East Asia Advisory Committee on Health Research Page 40 maximum use of communication technologies and to foster linkages of health research networks, which were already becoming stronger in the Region. Following appreciation expressed by members for the conduct of the meeting, the twenty-fifth session of the WHO South-East Asia Advisory Committee on Health Research was declared duly closed. Report of the Twenty-fifth Session Page 41 Annex 1 ADDRESS BY DR UTON MUCHTAR RAFEI REGIONAL DIRECTOR, WHO SOUTH-EAST ASIA REGION I am deeply honoured to address this august gathering at the inauguration of the Twenty-fifth session of the WHO South-East Asia Regional Advisory Committee on Health Research (SEA-ACHR). I extend my sincere thanks to the Ministry of Health of Indonesia for hosting this session in the enchanting island of Bali. I warmly welcome the distinguished members of ACHR, special invitees, dignitaries from the Government of Indonesia, and our colleagues from WHO headquarters. I am especially pleased to welcome our eminent new members of ACHR. In view of the pace of globalization and its impact on international health development, WHO has recently developed a new strategic framework for its secretariat . This WHO Corporate Strategy will guide in improving the Organization’s effectiveness and efficiency. As a guiding framework, the Corporate Strategy has identified four main strategic directions, and these are: (a) to reduce the burden of disease especially among the poor and marginalized populations; (b) to promote a healthy lifestyle and to reduce factors of risk to human health; (c) to develop health systems to equitably improve health outcomes; and (d) to develop an enabling policy and institutional environment in the health sector to promote an effective health dimension to social, economic and development policy. These strategic directions are complemented by the six core functions of the WHO Secretariat. Among these core functions is: “Managing information, assessing trends and comparing performance of the health systems, setting the agenda for, and stimulating, research and development.” WHO South-East Asia Advisory Committee on Health Research Page 42 How will the new ACHR mechanism fit in with this Corporate Strategy? At the global level, linkages will be created through global health research development. As you may be aware, the global ACHR is also being reconstituted with new terms of reference. As you are aware, WHO’s priority is to reduce the burden of disease among the poor and disadvantaged. WHO will continue to facilitate health research and provide evidence based information to policy makers. It is, therefore, important to strengthen the links between health outcome and research outputs. While old health problems like malnutrition, malaria, tuberculosis, diarrhoeal diseases and acute respiratory infections are still major killers in our Region, diseases like HIV/AIDS, cardiovascular diseases and cancer have emerged as major problems. The Regional Health Declaration, adopted by the Health Ministers of the Region in 1997, had identified the double burden of communicable and non- communicable diseases and the opportunities to address them, which require health research. We have learnt from experience that the barriers to applying scientific and other advances in our development efforts are not necessarily confined to technological issues. Even simple and affordable technologies have not been widely applied due to lack of human capacity, organizational support or financial resources. While much is known about the determinants of maternal mortality, more operational research is needed to help reduce the persistent burden of maternal mortality in our Region. As part of the development of a regional vaccine policy, WHO/SEARO established a Regional Core Group for Vaccine Policy Development in October 1999. The core group covered major issues ranging from vaccine selection policy to vaccine delivery. What we need now is in-depth research to develop a viable regional vaccine policy. HIV/AIDS has emerged as a major epidemic in our Region and considerable research from operational to clinical areas has been conducted. What is needed is practical application of the findings for effective interventions. Report of the Twenty-fifth Session Page 43 To ensure a greater impact on health development in the countries, the work of WHO will have to complement the work of development partners, both at the national and international levels. I would urge the ACHR members and the research community at large to consider maximizing cooperation with our development partners. These include WHO collaborating centres and national centres of expertise and the international research networks. We always need new knowledge but let us not ignore existing knowledge. We also have to ask ourselves why – all too often – proven, affordable and available technologies or approaches are still not applied to benefit peoples’ health. We should learn from successful research institutions and efforts. We should use all experience of successes and failures, to reduce the disease burden and promote health. Finally, there is a need for effective utilization of research findings in the development of health programmes. This is critical if the ultimate benefits of research are to reach those in need, which is our main goal. For this, research findings need to be clearly understood and implemented by managers at all levels of the health system. In conclusion, I wish you success in your deliberations and keenly look forward to the outcome of this important meeting. I wish you all a pleasant and enjoyable stay in Bali. Thank you. WHO South-East Asia Advisory Committee on Health Research Page 44 Annex 2 LIST OF PARTICIPANTS SEA-ACHR Members Dr Harun-ar-Rashid Director, Bangladesh Medical Research Council Mohakhali Dhaka, Bangladesh Tel. 00-880-2-8828396 & 880-2- 8811395 (O) Fax. 00-880-2-8828820 E-mails: bmrc@bd.drik.net bmrc@citechco.net Professor Shahjada Chowdhury Director, National Institute of Preventive and Social Medicine Mohakhali Dhaka, Bangladesh Telefax: 00-880-2-8821236 E-mail: director@nipsom.medinet.agni.com Dr Sangay Thinlay Secretary, Ministry of Health & Education Royal Government of Bhutan Thimphu, Bhutan Tel. 00-975-2-326627 Fax: 00-975-2-324649 E-mail: Sangay@Druknet.net.bt Professor N K Ganguly Director-General Indian Council of Medical Research New Delhi, India Tel. 00-91-11-6517204 (O) and 00-91-11-6493145 Res. E-mail: icmrhqds@sansad.nic.in Dr Indrani Gupta Reader, Institute of Economic Growth, Health Policy Research Centre University Enclave Delhi, India Tel. 00-91-11-7257288 and 91-11- 7257101 Fax: 00-91-11-7257410 E-mail: indrani@ieg.ernet.in Professor Umar Fahmi Achmadi Director-General Communicable Diseases and Environmental Health Ministry of Health Jakarta, Indonesia Tel. 00-62-21-4209930 E-mail: umar@indosat.net.id Report of the Twenty-fifth Session Page 45 Professor Ramdan Panigoro Director, Health Research Unit Padjadjaran University School of Medicine Hasan Sadikin Hospital Bandung 40161 West Java, Indonesia Tel. 00-62-22-203 8218 Fax: 00-62-22-203 0776 E-mail: ramdan@fk.unpad.ac.id Dr Agus Suwandono Secretary National Institute for Health Research and Development Ministry of Health Jakarta, Indonesia Tel. 00-62-21-4243122 Fax: 00-62-21-4243933 E-mail: dragus@indosat.net.id Dr Soeharsono Soemantri Senior Researcher, Health Ecology Research and Development Centre National Institute for Health Research and Development Ministry of Health Jakarta, Indonesia Tel. 00-62-21-4261088 Fax: 00-62-21-4244226 E-mails: ssoem@dprin.go.id soeharsono@litbang.depkes.go.id Professor Eddy Pranowo Chairperson Department of Public Health and Preventive Medicine Medical Faculty University of Airlangga Surabaya 60131, Indonesia Tel. 00-62-31-502 7830 or 502 0251 (Ext. 134) Fax: 00-62-31-502 2680 or 502 2472 E-mail: msdfkua@rad.net.id Dr Than Swe Retired Director-General Department of Medical Research Ministry of Health Yangon, Myanmar Tel: 00-95-1-290900 Fax: 00-95-1-251514 Professor Paing Soe Director-General Department of Medical Research (Lower Myanmar) Yangon, Myanmar Tel: 00-95-1-284419 Fax: 00-95-1-251514 Professor Gopal Prasad Acharya Chairperson Nepal Health Research Council Kathmandu, Nepal Tel: 00-977-1-254220 Fax: 00-977-1-262469 E-mail: gacharya@healthnet.org.np WHO South-East Asia Advisory Committee on Health Research Page 46 Dr K C S Dalpatadu Deputy Director-General (Planning) Ministry of Health and Indigenous Medicine Colombo, Sri Lanka Tel: 00-94-1-692694 Fax: 00-94-1-679997 E-mail: ddgp@sri.lanka.net Professor Dulitha N Fernando Professor ,Community Medicine and Head, Department of Community Medicine Faculty of Medicine University of Colombo Colombo, Sri Lanka Tel: 00-94-1-695300, 00-94-1- 696243 Fax: 00-94-1-691581 E-mail: cmcol@slt.lk Dr Mongkol Na Songkhla Director-General Department of Medical Sciences, Ministry of Public Health Nonthaburi, Thailand Tel: 00-66-2-5906001 Fax: 00-66-2-5918233 E-mail: mongkol@health.moph.go.th Professor Porapan Punyaratabandhu Associate Professor, Faculty of Public Health Mahidol University Bangkok, Thailand Tel: 00-66-2-2459673 Fax: 00-66-2-2483299 E-mail: phppy@mucc.mahidol.ac.th Professor Chantapong Wasi Associate Professor Department of Microbiology Faculty of Medicine Siriraj Hospital Mahidol University Bangkok, Thailand Tel: 00-66-2-4113111 or 00-66-2- 4197068 Fax: 00-66-2-4184148 or 00-66-2- 4110263 E-mail: sicws@mahidol.ac.th Special Invitees Professor Charas Suwanwela College of Public Health Chulalongkorn University Bangkok 10330, Thailand (Also responsible for Council on Health Research for Development (COHRED) Geneva) Tel: 00-66-2-2188187 Fax: 00-66-2-2556046 E-mail: charas@cph.chula.ac.th Professor Natth Bhamarapravati Professor of Pathology Director, Dengue Vaccine Development Project Institute of Sciences and Technology for Development Mahidol University Bangkok, Thailand Telefax: 00-66-2-4419744 E-mail: stnbm@mucc.mahidol.ac.th . Report of the Twenty-fifth Session Page 47 Professor Sudarto Ronoatinodjo Dean, Faculty of Public Health University of Indonesia Kampus UT West Java, Indonesia Tel: 00-62-21-7863471 Fax: 00-62-21-7863472 Dr Ataollah Amini Senior Adviser to the Director WHO Centre for Health Development Kobe, Japan Tel: 00-81-78-2303178 E-mail: dramini@aol.com Professor S Modasser Ali National Institute of Opthalmology Sher-e-Bangla Nagar Dhaka, Bangladesh Tel: 00-880-2-8114807 Fax: 00-880-2-9118336 E-mail: sadia@citechno.net Mr Louis J Currat Executive Secretary Global Forum for Health Research c/o WHO/HQ, Geneva Tel: 00-41-22 7913418 fax: 00-41-22 7914394 E-mail: curratl@who.ch Professor Chandravati Head Department of Obstetrics and Gynecology KGM Medical College Lucknow, India Tel: 00-91-522-266007 or 266839 Fax: 00-91-522-266007 Dr Astuti Soedarto Suparmanto Director-General National Institute for Health Research and Development Ministry of Health, Jakarta, Indonesia Tel: 00-62-21-4245214 Fax: 00-62-21-4243933 Dr Muharso Senior Adviser to the Minister of Health on Health Technology Ministry of Health Jakarta, Indonesia Professor Sangkot Marzuki Head, Eijkman Molecular Biology Institute Jakarta, Indonesia Tel: 00-62-21-3148694 and 00-62-21-3147982 E-mail: smarzuki@eiikman.go.id Dr Triono Sundoro Head Bureau of Science and Technology National Development Planning Board Jakarta, Indonesia Dr Ingerani Director of Diseases Control Research and Development Centre Jakarta, Indonesia Dr Nyoman Adiputra Head of Research Institute, University of Udayana Bali, Indonesia WHO South-East Asia Advisory Committee on Health Research Page 48 WHO Secretariat WHO HQ Dr Tikki Pang Director, Research Policy and Cooperation E-mail: pangt@who.ch Dr Wang Yi-fei Area Manager, Asia and the Pacific UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction Department of Reproductive Health and Research (RHR) E-mail: wangy@who.ch WHO SEARO Dr Uton Muchtar Rafei Regional Director WHO South-East Asia Region E-mail: rafeiu@whosea.org Dr Samlee Plianbangchang Deputy Regional Director/ Director, Programme Management E-mail: samleep@whosea.org Dr U Than Sein Director Department of Evidence and Information for Policy E-mail: thansein@whosea.org Dr Adik Wibowo Regional Adviser Research Policy and Cooperation E-mail: wibowoa@whosea.org Mr Abdul Muhid Meliala Scientist Research Policy and Cooperation E-mail: melialaa@whosea.org Dr Stephan P Jost Technical Officer Health Systems Research E-mail: josts@whosea.org Dr Arun B Thapa Medical Officer EPI, Vaccines and other Biologicals E-mail: thapaa@whosea.org Dr Jai Prakash Narain Regional Adviser HIV/STI Initiative and Stop Tuberculosis E-mail: narainj@whosea.org Dr Suniti Acharya Regional Adviser Reproductive Health and Research E-mail: acharyas@whosea.org Dr U Myint Htwe Regional Adviser Evidence for Health Policy E-mail: htwem@whosea.org WHO Country Office Dr Georg Petersen WHO Representative to Indonesia E-mail: petersen@who.or.id Dr Stephanus Indradjaya Senior National WHO Consultant on Health Financing E-mail: stevei@indosat.net.id Report of the Twenty-fifth Session Page 49 WHO South-East Asia Advisory Committee on Health Research Page 50 Annex 3 TERMS OF REFERENCE OF THE WHO SOUTH-EAST ASIA ADVISORY COMMITTEE ON HEALTH RESEARCH (SEA-ACHR) (as revised in April 2000) To advise the WHO South-East Asia Regional Director in the following areas: � Formulation and implementation of health research policies and health research agenda in the Region in line with the resolutions and policy guidance of the World Health Assembly, Executive Board and the Regional Committee, and also within the overall framework of the global WHO health research policy. � Coordination and harmonization of health research activities of various national health research bodies/councils/departments, institutions with those of WHO, with the purpose of strengthening national research capability and research management for health development. � Development, management and improvement of health research information system , including research monitoring and evaluation , for evidence-based decision making. � Collection, analysis and dissemination of existing health research findings on emerging scientific knowledge and technology, with a view to promoting and fostering research application and practices at the national and institutional level. Report of the Twenty-fifth Session Page 51 Annex 4 AGENDA 1. Inaugural Session 2. Introductory Session 2.1 Introductory remarks by Chairperson, Professor N K Ganguly 2.2 Introductory remarks by Dr Uton Muchtar Rafei, Regional Director, WHO South-East Asia Region 2.3 Introduction of participants 2.4 Adoption of agenda and working schedule 3. Business Session 3.1 The work of WHO Regional Research Policy and Cooperation (RPC) programme 3.2 South-East Asia Advisory Committee on Health Research – Terms of reference, memberships and method of work 3.3 The work of WHO Scientific Working Groups on: (a) Management and coordination of health research activities in the countries (b) Criteria for setting health research priorities (c) Management of heal th research information (d) Formulation of national health research policies and strategies (e) Operational research on reproductive health 3.4 Regional priorities in HIV/AIDS research (Expert group meeting on HIV/AIDS research) 3.5 Regional vaccine research and development policy 3.6 Operational guidelines for ethics committees reviewing biomedical research 3.7 Global and regional coordination in health research WHO South-East Asia Advisory Committee on Health Research Page 52 (a) Council on Health Research for Development (COHRED), Geneva (b) WHO RPC and Global Advisory Committee on Health Research, Geneva (c) Global Forum for Health Research, Geneva (d) WHO Centre for Health Development, Kobe, Japan 3.8 Selected global health research activities: (a) UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) 3.9 Adoption of conclusions and recommendations 4. Closing Session Annex 4 (contd.) Working Schedule Date Morning Session(8:30 – 12:30) Afternoon Session(14:00 – 17:00) 17 April 2000 (Monday) 1 . 2 . 3 . 3 . 1 3 . 2 Inaugural session Introductory session Business session The work of WHO Regional Research Policy and Cooperation (RPC) programme South-East Asia Advisory Committee on Health Research – Terms of reference, memberships and method of work Introduction to Group work I {Agenda items 3.3 (a) to (e)} Group Work I Report of the Twenty-fifth Session Page 53 Date Morning Session(8:30 – 12:30) Afternoon Session(14:00 – 17:00) Grou p 1 Grou p 2 Grou p 3 Work of Scientific Working Groups on: Management and Co-ordination of health research activities (Agenda item 3.3a) and Management of health research information (Agenda item 3.3c) Work of Scientific Working Groups on: Criteria for setting health research priorities (Agenda item 3.3b) and Formulation of national health research policies and strategies (Agenda item 3.3d) Work of Scientific Working Group on Operational research in reproductive health (Agenda item 3.3e) & Selected global health research activities: UNDP- UNFPA-WHO-World Bank Special programme of research, development and research training in human reproduction (HRP) (Agenda item 3.8a) Group Work II18 April 2000 (Tuesday) Presentations on Group work I Introduction to Group work II {Agenda items 3.4, 3.5 & 3.6} Grou p a Grou p b Grou p c Regional priorities in HIV/AIDS research (Agenda item 3.4) Regional vaccine research and development policy (Agenda item 3.5) Operational guidelines for ethics committees reviewing biomedical research (Agenda item 3.6) WHO South-East Asia Advisory Committee on Health Research Page 54 Date Morning Session(8:30 – 12:30) Afternoon Session(14:00 – 17:00) 19 April 2000 (Wednesday) Presentations on Group work II Discussion 3.7 Global and regional coordination in health research (a) COHRED (b) WHO RPC and Global ACHR (c) Global Forum for Health Research (d) WHO Kobe Centre 20 April 2000 (Thursday) 3.9 Discussion and adoption of conclusions and recommendations 4. Closing session Report of the Twenty-fifth Session Page 55 Annex 5 LIST OF WORKING DOCUMENTS Document Name Terms of reference List of participants SEA/ACHR/25/ A Agenda SEA/ACHR/24/ B Working schedule SEA/ACHR/25/ C The work of WHO Regional Research Policy and Cooperation (RPC) programme SEA/ACHR/25/ D (Agenda item 3.1) South-East Asia Advisory Committee on Health Research – Terms of Reference, membership and method of work SEA/ACHR/25/ E (Agenda item 3.2) Work of WHO Scientific Working Groups (a) Management and coordination of health research activities in the countries SEA/ACHR/25/ F (Agenda item 3.3a) (b) Criteria for setting health research priorities SEA/ACHR/25/ G (Agenda item 3.3b) (c) Management of health research information SEA/ACHR/25/ H (Agenda item 3.3c) (d) Formulation of national health research policies and strategies SEA/ACHR/25 /I (Agenda item 3.3d) WHO South-East Asia Advisory Committee on Health Research Page 56 (e) Operational research on reproductive health SEA/ACHR/25/ J (Agenda item 3.3e) Regional priorities in HIV/AIDS research SEA/ACHR/25/ K (Agenda item 3.4) Regional vaccine research and development policy SEA/ACHR/25/ L (Agenda item 3.5) Operational guidelines for ethics committees reviewing biomedical research SEA/ACHR/25/ M (Agenda item 3.6) Global and regional coordination in health research (a) Global Advisory Committee on Health Research, Geneva SEA/ACHR/25/ N (Agenda item 3.7a) (b) Global Forum for Health Research, Geneva SEA/ACHR/25/ O (Agenda item 3.7b) (c) WHO Centre for Health Development, Kobe, Japan SEA/ACHR/25/ P (Agenda item 3.7c) (d) Council on Health Research for Development (COHRED), Geneva SEA/ACHR/25/ Q (Agenda item 3.7d) Selected global health research activities UNDP/UNFPA/WHO/World Bank Special Programme of Research Development & Research Training in Human Reproduction (HRP) SEA/ACHR/25/ R (Agenda item 3.8a) Report of the Twenty-fifth Session Page 57 Annex 6 LIST OF INFORMATION DOCUMENTS 1. Recommendations of the WHO South-East Asia Advisory Committee on Health Research, 1976-1999 (SEA-ACHR-25), WHO SEARO, 2000 Related to Agenda item 3.3a 2. Management and coordination of health research activities in the countries, Report of the meeting of the Scientific Working Group, Bangkok, Thailand, 6-8 October 1999 3. Development of research culture in the country – India (SEA/SWG- RCO/D) 4. Mobilization and management of resources, including resource flows for health research – Thailand (SEA/SWG-RCO/E) 5. Ethical review, peer review and technical review of research proposals – Myanmar (SEA/SWG-RCO/F) 6. Development of human resources for health research including research capacity building – Sri Lanka (SEA/SWG-RCO/G) 7. Role of Health (Medical) research councils in research promotion, development and coordination - Nepal (SEA/SWG-RCO/I) 8. Monitoring and evaluation of progress in national health research system – Indonesia (SEA/SWG-RCO/J) 9. Issues on management and coordination of health research (SEA/SWG/RCO/L) Related to Agenda item 3.3b WHO South-East Asia Advisory Committee on Health Research Page 58 10. Criteria for setting health research priorities, Report of the meeting of the Scientific Working Group, New Delhi, 1-3 November 1999 11. Priority setting in health research. – A guideline containing strategies, criteria, tools and processes used for priority setting of health problems and health research (April 2000) 12. Research Prioritization (SEA/SWG-PRIOR/P) Related to Agenda item 3.3c 13. Management of health research information, Report of the meeting of the Scientific Working Group, New Delhi, 15-17 December 1999 14. Procedure and mechanism to identify health research information need in relation to available resource allocation for health research at country level (SEA/SWG/HRI/H) 15. Health research information flow and its potential networking - India (SEA/SWG/HRI/I) 16. Approaches and methods for validation of the health research data and information – Bhutan (SEA/SWG/HRI/J) 17. The role of research council in monitoring and evaluation of research information at country level – Bangladesh (SEA/SWG/HRI/K) 18. Monitoring and evaluation of health research information system at country level (SEA/SWG/HRI/L) Related to Agenda item 3.3d 19. Formulation of national health research policies and strategies, Report of the meeting of the Scientific Working Group, Jakarta, Indonesia, 6-8 December 1999 20. Experience in translation of national health research policy into action (SEA/SWG-FPS/F) Report of the Twenty-fifth Session Page 59 21. Role of research institutions in formulation and translation of national health research policy into action (SEA/SWG-FPS/H) 22. Monitoring and evaluation of the implementation of national health research (SEA/SWG-FPS/I) 23. Epidemiological methods used in policy analysis (SEA/SWG-FPS/J) 24. Health research policy formulation implementation and evaluation (SEA/SWG-FPS/K) 25. Issues in health policy research (SEA/SWG-FPS/L) Related to Agenda item 3.3e 26. Operational research on reproductive health, Report of the second meeting of the Scientific Working Group, New Delhi, 17-19 November 1999
Word Health Organization (2000) This document is not a formal publication of the World Health Organization (WHO), and all rights are reserved by the Organization. The document may, however, be freely reviewed, abstracted, reproduced or translated, in part or in whole, but not for sale or for use in conjunction with commercial purposes. The views expressed in documents by named authors are solely the responsibility of those authors. Page iii CONTENTS Page 1. INAUGURAL SESSION .....................................................................................1 2. BUSINESS SESSION ........................................................................................4 2.1 The Work of the WHO Regional Research Policy and Cooperation (RPC) Programme .................................................................................. 6 2.2 South-East Asia Advisory Committee on Health Research – Terms of Reference, Membership and Methods of Work .............................9 2.3 Work of Scientific Working Groups on “Management and Coordination of Health Research Activities in the Countries” and “Management of Health Research Information” ................................... 11 2.4 Work of Scientific Working Groups on “Criteria for Setting Health Research Priorities” and “Formulation of National Health Research Policies and Strategies” ........................................................ 14 2.5 Work of Scientific Working Group on “Operational Research on Reproductive Health” and presentation on UNDP-UNFPA-WHO- World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) ................................ 19 2.6 Regional Priorities in HIV-AIDS Research ............................................ 22 2.7 Regional Vaccine Research and Development Policy ........................... 26 2.8 Operational Guidelines for Ethics Committees Reviewing Biomedical Research ........................................................................... 28 2.9 Global and Regional Coordination in Health Research ........................ 31 3. CLOSING SESSION .......................................................................................38 Annexes 1. Address by Dr Uton Muchtar Rafei Regional Director, WHO South-East Asia Region ......................................................................41 2. List of Participants.......................................................................................44 3. Terms of Reference of the WHO South-East Asia Advisory Committee on Health Research (SEA-ACHR) .................................................................50 Page iv 4. Agenda and Working Schedule ....................................................................51 5. List of Working Documents .........................................................................55 6. List of Information Documents....................................................................57 Page 1 1. INAUGURAL SESSION The twenty-fifth session of the WHO South-East Asia Advisory Committee on Health Research (SEA-ACHR) was held at Hotel Natour Kuta, Bali, Indonesia, from 17 to 20 April 2000. In his opening address, Dr Uton Muchtar Rafei (Regional Director, WHO South-East Asia Region) thanked the Ministry of Health of the Government of the Republic of Indonesia for hosting this meeting and welcomed the participants. He said that in view of the pace of globalization and its impact on international health development, WHO, as part of overall reform efforts, had recently developed a new strategic framework for its secretariat. This WHO Corporate Strategy had provided four main strategic directions: (a) to reduce the burden of disease, especially among the poor and marginalized populations; (b) to promote healthy life styles and reduce factors of risk to human health; (c) to develop health systems for the equitable improvement of health outcomes; and (d) to develop an enabling policy and institutional environment in the health sector and promote an effective health dimension to social, economic, environmental and development policy. Dr Uton added that these strategic directions were complemented by the six core functions of the WHO Secretariat. One of these core functions was related to “ managing information, assessing trends and comparing performance of the health systems, setting the agenda for, and stimulating research and development .” He urged the SEA-ACHR members to deliberate on how the new ACHR mechanism would fit in with this corporate strategy, especially in setting the health research agenda and stimulating research and development. The main priority of WHO was to reduce the burden of disease among the poor and disadvantaged. WHO WHO South-East Asia Advisory Committee on Health Research Page 2 would continue to facilitate health research and provide evidence-based information to policy makers. It was, therefore, important to strengthen the links between research outputs and health outcome. Dr Uton said that the barriers to applying scientific and other advances in health development efforts were not necessarily confined to technological issues. Even simple and affordable technologies had not always been widely applied due to lack of human capacity, organizational support or financial resources. While much was known about the determinants of maternal mortality, more operational research was needed to help reduce the persistent burden of maternal mortality in the South-East Asia Region. Dr Uton said that based on the recommendations of the last SEA- ACHR session, he had established a regional core group for the development of a vaccine policy in October 1999. This core group covered major issues ranging from vaccine selection policy to vaccine delivery. What was needed was in-depth research to develop a viable regional vaccine policy. Another scientific expert group had also looked into research related to prevention and control of HIV-AIDS and the practical application of research findings for effective interventions. Dr Uton urged the ACHR and the research community at large to consider maximizing cooperation with development partners, which included WHO collaborating centres, national centres of expertise and international research networks. He stressed that while new knowledge was always needed, existing knowledge should not be ignored. He requested the ACHR to ask themselves as to why – all too often - proven, affordable and available technologies or approaches were still not applied for the benefit of peoples’ health. More experience was required in order to learn from successful research institutions and efforts. Finally, he said that there was a need for effective utilization of research findings in the development of health programmes. This was critical if the ultimate benefits of research were to reach those in need, which were the main goals. For this, it was necessary for research findings to be clearly understood and Report of the Twenty-fifth Session Page 3 implemented by managers at all levels of the health system (see Annex 1 for full text of the Regional Director’s address). HE Dr Achmad Sujudi, Minister for Health, Republic of Indonesia, in his inaugural address expressed deep appreciation for the responsibility given to the National Institute of Health Research and Development (NIHRD), one of the leading national institutes of the Ministry of Health, to host this pertinent and prestigious meeting. The Hon Minister said that the impact of recent global and regional changes, including the economic crisis and reforms carried out among developing countries, especially those within Asia and particularly Indonesia, should be carefully considered when making policy decisions for health development. There were still many gaps in health status, both between developed and developing countries, as well as between and within developing countries, especially in a country as diverse as Indonesia. Five major factors affecting health development could be considered: (1) basic changes in population dynamics causing demographic and epidemiological differences; (2) substantial findings in medical sciences and tech nology leading to a new concept of health, illness and death; (3) global challenges caused by a free trade policy, drastic revolution in information technologies, telecommunications and transportations; (4) environmental changes influencing health status and health services; and (5) democratization of aspects requiring empowerment and partnership in health development management. Considering the above, Indonesia had now established a new initiative for national health development, based on a vision known as “Healthy Indonesia 2010”. It would be implemented through a new concept of “ Indonesian Healthy Paradigm ”, giving more attention to promotion and prevention rather than curative and rehabilitative measures. The Hon Minister believed that this paradigm shift was a model of health development, which encouraged people to be independent and WHO South-East Asia Advisory Committee on Health Research Page 4 to have awareness in making themselves healthy. Four basic strategies would be adopted, viz., decentralization; “ JPKM” or Managed Community Health Care; professionalism of health providers; and keeping health at the centre of all development efforts. The Hon Minister reiterated that health research and development had become very important for assessing and maintaining the performance of health systems. Health research, by generating and applying evidence-based information, was also the guiding force for national and local health development. The Ministry of Health placed much emphasis on increasing, coordinating and facilitating the roles and responsibilities of the NIHRD within the framework of the process of decentralization. NIHRD should work with partners from both within and outside the country. The SEA-ACHR was an important forum for all SEAR countries to share their experience in health research and development, particularly in improving health research management. The Hon Minister expressed the hope that the deliberations of the ACHR and its recommendations would also cover capacity strengthening and resource mobilization. 2. BUSINESS SESSION (Agenda items 2 and 3) In addition to 18 members of the SEA-ACHR, 13 WHO special invitees as well as members of the WHO secretariat headed by the Regional Director attended the Silver Jubilee session (see Annex 2 for full list of participants). Professor N K Ganguly, Director-General of the Indian Council of Medical Research, as Chairperson of the SEA-ACHR, opened the business session. He warmly welcomed all participants and expressed his appreciation to the WHO Regional Director for giving him the opportunity to chair this regional scientific body on health. He added that he would carry out his duties in accordance with the terms of reference. Report of the Twenty-fifth Session Page 5 The WHO Regional Director in his introductory remarks, highlighted the reforms made within the Organization, and in particular the reshaping of the SEA-ACHR. Based on the discussions and recommendations relating to reform of the ACHR, he had drawn up its new terms of reference, keeping it as a scientific advisory body, with both upstream and downstream activities (see Annex 3). He had also revised the composition of members and the method of work of the SEA-ACHR, as reflected in the present membership and the working schedule of the current session. A series of meetings of scientific working groups and expert groups had been organized by WHO during the past year on subjects related to health research management, reproductive health, research priorities for HIV-AIDS and the development of a regional vaccine research policy. The results of these expert groups would be presented at this ACHR for review and guidance. He also said that the ACHR should enhance and strengthen its involvement in the arena of international health research. The regional ACHR needed to be well informed about the global research developments and also be fully aware of the WHO global policy on health research. For this reason, senior representatives from WHO HQ, Global Forum for Health Research, Council on Health Research for Development (COHRED) and WHO Kobe Centre were joining this session. Good linkages between the global and regional ACHRs were important for better understanding, coordination and cooperation – and also to strengthen the ACHR system as a whole. The Regional Director then nominated Professor Umar Fachmi Achmadi, Director-General, Department of Communicable Diseases Control and Environmental Health, Ministry of Health, Indonesia, as Co- Chairperson of the 25 th session amidst acclamation. Professor Umar Fachmi expressed his gratitude for the nomination as well as for the trust placed in him. WHO South-East Asia Advisory Committee on Health Research Page 6 The Chairperson, requesting the cooperation of members in the proceedings of the ACHR, proposed establishment of a report-drafting group consisting of Professor Dulitha Fernando (Sri Lanka), Professor Porapan Punyarathbandhu (Thailand) and Dr Agus Suwandono (Indonesia). The Committee agreed to the proposal. At the Chairperson’s request, it also unanimously adopted the agenda and the working schedule. The Chairperson drew attention to the changes introduced in the working schedule, such as small group discussions, which had been created in order to enable wider and deeper deliberations (see Annex 4). He also welcomed HE Dr Achmad Sujudi, Minister of Health, Republic of Indonesia, who joined the business session as an observer. 2.1 The Work of the WHO Regional Research Policy and Cooperation (RPC) Programme (Agenda item 3.1) The progress of work of the WHO regional RPC programme for the past two years was reported. The work had placed much emphasis on the formulation of research agenda and policy, on strengthening national and regional capability for health research management, and on promotion and utilization of health research in selected priority health problems. With the full involvement of the WHO collaborating centres, national centres of expertise and national research institutions, a series of training courses on health research management and health research methodology had been carried out to enhance and strengthen research capability. Seminars and other relevant activities had also been conducted to promote health research and to sensitize policy makers and planners to the use of research results. To face the challenges in health research and development, WHO had taken initiatives by improving the methods of work, coordinating and implementing mechanisms and processes of WHO headquarters and regional offices supported by WHO country offices and Member Report of the Twenty-fifth Session Page 7 Countries. One major challenge at the country level was to obtain the full involvement of policy makers in health research, from the very beginning, in implementing health research. The ACHR welcomed the implementation of the WHO RPC programme both in range and content. The initiatives taken during the reporting period were relevant to the recommendations of the 24 th session of the SEA-ACHR, held in Myanmar in 1999, and they also responded to the other strategic needs of the Region. In particular, the ACHR commended the efforts related to the establishment of scientific working groups, expert and core groups, capability strengthening for health research management, promoting the utilization of research results, and collaborative activities for research promotion and development. The ACHR meeting also underlined the fact that there were wide variations among the countries of the Region with regard to disease burden as well as the development of health systems. Research was not only about knowledge, but required dedication and commitment. Countries with a stronger capability in terms of human, institutional and financial resources needed to collaborate with the weaker ones in a spirit of regional solidarity. WHO was very much in line with this notion of promoting inter-country cooperation, which was on its agenda both regionally and globally . Members furthermore remarked that health was a complex issue, and was increasingly being recognized as such. Many variables determined health status – and not merely the medical aspect. The social, anthropological, economic, ecological, and technological and other relevant sciences had to be properly considered and applied in health research. Health policy research for identifying reform alternatives was a good example of an activity that requires multidisciplinary support. Much work had been done but the challenge was how to translate these findings into action. The capacity to conduct and manage health research on the part of the countries was very important. WHO South-East Asia Advisory Committee on Health Research Page 8 The meeting concluded that the health situation in the Region was dynamic, and that health research in support of health development was also a dynamic process. Networking for improving and building linkages was a very important means of doing this. The Committee felt that there was a need to strengthen the networking of health research institutions and individuals for the better management of health research. This would facilitate the transformation of health research results into policy planning and implementation. The future agenda of the research programme in the Region would aim at addressing health problems, which could provide evidence-based information in closing the gaps and inequities in health, especially for the poor population. The research should also help create conditions which promote health, which ensure access to basic health services to all, which help to uphold and enforce health ethics, and which place health at the centre of development. The Regional Director informed the meeting of the recent establishment of an operations room at the Regional Office. This was also a part of reform measures reflecting the need for appropriate information management and for providing quick responses, especially in cases of health emergencies. The Regional Office was planning to strengthen its clearing-house functions through the creation of interactive WEB sites and enhancement of networking. The Regional Director requested all Member Countries to send to WHO relevant information on health development and health research, especially observations which may not have been published. Recommendation Countries, with the support of WHO and other development partners, should collaborate in the establishment of regional networking of health Report of the Twenty-fifth Session Page 9 research institutions and individuals on health research, with the aim of translating health research into policy planning and implementation. 2.2 South-East Asia Advisory Committee on Health Research – Terms of Reference, Membership and Methods of Work (Agenda item 3.2) The SEA-ACHR reviewed its new terms of reference, membership and methods of work, including its historical evolution. It was noted that it was in Bali, Indonesia, that the seed of the ACHR had been sown, during the session of the WHO SEA Regional Committee in 1974. The first ACHR session had been held in 1976 and since then, the ACHR had held its annual meetings at various venues in the Region. Also, on several occasions eminent scientists and special invitees as well as representatives from the global ACHR and other WHO regional and headquarters staff had attended its sessions. Since 1979, the heads of national medical and health research councils (MRC) had also held their meetings every two years. In 1998, WHO SEARO bad organized the joint session of the regional ACHR and MRC in order to review the progress of work of both bodies and also to review their roles in the light of globalization and WHO reform. The 24 th session of the ACHR in Myanmar in 1999 had further deliberated these issues and recommended to the Regional Director that the ACHR mechanism should be renewed with appropriate reforms. The Regional Director, thus, had reconstituted the SEA-ACHR with new membership and fresh terms of reference. The method of work of the Committee had also been revised in consonance with those changes. The ACHR system had taken a new form, whereby the new WHO Corporate Strategy set the overall direction. Members recommended that WHO South-East Asia Advisory Committee on Health Research Page 10 the ACHR should remain as an advisory body to the Regional Director with the main aim of promoting health research in the Region. The renewed functioning of the ACHR should be linked to the work of the Global ACHR. It should also have links with the establishment and working of scientific working groups, task forces and core or experts groups which might be associated with the mainstream of WHO programmes as need arose. The ACHR could identify and propose strategic areas for the development and formulation of health research policies and programmes. The regional ACHR, as part of the global ACHR system, had a continuing role to play as a major functional linkage of health research initiatives at national, regional and global levels. The Committee felt that in the light of renewed directions within the framework of the WHO Corporate Strategy and the reconstituted Global ACHR with its new terms of reference, the Regional Director might need to revise the terms of reference, membership and the method of work of the SEA-ACHR in late 2000. While expressing satisfaction with the work of the regional RPC programme, the Committee raised concerns about the need for expanding health research in the area of traditional medicine. The ACHR was informed that WHO SEARO had organized a regional consultation on the development of traditional medicine in late 1999, with the objective of promoting national programmes and district health systems. The issue of health research in traditional medicine, including clinical studies and ethics, had been discussed at this consultation, but further in-depth technical review and discussion might be required. Some members also expressed the need to enhance research work on major health problems which were unique to many countries of the Region, e.g. snakebites and anaemia among pregnant women. The reason was evident from the fact that the interventions and technical tools being used for these health Report of the Twenty-fifth Session Page 11 problems would not appear to have advanced very much during the last few decades. Recommendation The WHO Regional Director should review and update the Terms of Reference, membership and methods of work of the newly reconstituted SEA-ACHR, in the light of implementation of the WHO Corporate Strategy and also of any changes introduced in the global ACHR system. 2.3 Work of Scient ific Working Groups on “ Management and Coordination of Health Research Activities in the Countries ” and “Management of Health Research Information ” (Agenda items 3.3a and 3.3c) The Committee noted that major issues on health research management and coordination, identified by the Scientific Working Group on “Management and coordination of health research activities in the countries ” were very relevant. However, in view of the different stages of development of health research in Member Countries, the respective national health or medical research councils or analogous bodies (HRC/MRC) should review these issues and prioritize them for implementation according to local needs. Members noted the importance of documenting the profiles of available resources for health research. National HRC/MRCs, in collaboration with WHO and other partners, should conduct resource availability studies in the area of human resources for health research, both at institutional and national levels. They also recognized the need for better coordination among various agencies involved in health WHO South-East Asia Advisory Committee on Health Research Page 12 research in order to avoid duplication of activities. As health research information was the key to better health research management and coordination practices, it should be promoted as a priority. Members also felt that there was a need for the development of a system of quality assurance for public and private research institutions. They were of the opinion that concerted efforts must be made to create a research environment conducive to conducting quality health research. This included improved information management and technical support, establishment of a system of reward, and an appropriate staff development and deployment policy. The Committee reviewed and endorsed, one of the recommendations made by the Scientific Working Group that national HRC/ NRCs or analogous bodies, with support from WHO and development partners, should prepare position papers on the role of health research in current and future health development, in order to sensitize different target groups (parliamentarians, decision makers, industrialists, the general public, the scientific community). National HRC/MRCs should also monitor and analyse the research resource flows, in the context of national health policy, including health research policy. This would help in the rational allocation of health research resources. WHO, in collaboration with national HRC/MRCs, should develop an appropriate guide on good research management practice. After reviewing the outcome of the work of the Scientific Working Group on “ Management of health research information ” (MHRI), the Members endorsed the recommendations contained in their report. The ACHR also highlighted the need to undertake the following at appropriate levels. Countries – Health or Medical Research Councils or analogous bodies Report of the Twenty-fifth Session Page 13 (1) Situation analyses of MHRI using the framework suggested by the Scientific Working Group. (2) Development of human resources for MHRI. (3) Appropriate application of advances in communication and information technologies, to strengthen networking and resource centres. (4) Registration of research studies and creation of database(s). (5) Creation of a forum for dissemination and communication. Research institutions (1) Development of competence and s kill in the area of data collection, analysis, presentation and dissemination. (2) Ensuring high quality of research information through better management of data collection and analysis. (3) Development of databases for effective research management. (4) Strengthening of national research institutions for enhancing access to essential information. (5) Registration of research studies and creation of database(s). WHO (1) Promotion of MHRI for policy and decision making. (2) Provision of technical and manage ment support for information management. (3) Coordination with other agencies for financial and technical support. (4) Establishment of electronic database(s) and promotion of their use. WHO South-East Asia Advisory Committee on Health Research Page 14 (5) Assistance to national research and other scientific journals to improve quality and visibility. Recommendation The conclusions and recommendations of the two scientific working groups, with additional inputs from the ACHR, should be implemented within the context of national and regional programmes for health research development. 2.4 Work of Scientific Working Groups on “ Criteria for Setting Health Research Priorities ” and “ Formulation of National Health Research Policies and Strategies ” (Agenda items 3.3b and 3.3d) The ACHR members were informed of the deliberations of the Scientific Working Group on “ Criteria for setting health research priorities ”. They considered, among others, the development of the health research agenda within the framework of national health development, the selection and application of criteria and methods for priority setting, the information needs, the participatory and ethical dimensions of priority setting. The linkages between national and sub-national settings were explored, as was the context of a national health policy in developing an agenda for priority health research. The tools used in priority setting processes, and the lessons learnt, were considered. The experience of priority setting in essential national health research exercises was drawn upon. The discussion highlighted the fact that due to considerable variations and diversity among SEAR countries, guidelines for priority setting should be considered as a flexible framework. They could be adopted and adapted as appropriate to the relevant national and sub- Report of the Twenty-fifth Session Page 15 national setting(s) chosen. In a sub-national context, priority setting should be attuned to local needs or requirements which could facilitate a decentralized approach. The value of a two-stage process of priority setting was emphasized. During the first stage, appealing especially to planners, broad areas or health problems were prioritized. During the second stage, appealing especially to researchers, research problems within those major areas identified would be prioritized. The methods and tools chosen should be attuned to each stage. Periodic review of priorities was considered essential. This would allow for correction of research on health problems that might have been neglected earlier. A balance between different types of research and the importance of feed-back was emphasized. Priority setting in itself did not favour one type of health research over another. Identification and involvement of multiple stakeholders was underlined to be of particular importance for success and sustainability. Members emphasized that the twin objectives of equity and efficiency of the system should be pursued in priority setting. The concept of disparity reduction had been proposed as a crucial yardstick to measure progress towards equity. An efficient process and system should complement this. Members observed that the value of priority setting extended to other dimensions also, especially as it could lead to strengthening research capacity, and to bringing researchers and policy makers together. A plea was made to allow for creativity and not to stifle it. This could in turn enhance the value of priority setting. The Committee noted that the draft document prepared by the scientific working group – “Priority setting in health research. A guideline containing strategies, criteria, tools and processes used for priority setting of health problems and health research” - would be a useful guide for national health planners and researchers. They proposed that this document should be finalized in generic form. WHO South-East Asia Advisory Committee on Health Research Page 16 Members further considered the report of the Scientific Working Group on “ Formulation of national health research policies and strategies ”. Most of the discussion focused on the steps required to formulate a national health research policy (see Figure 1), and on selecting priority actions proposed for countries and for WHO. As outlined diagrammatically in Figure 1, the importance of identifying an appropriate body for developing a national health research policy was underlined. There was the advantage of doing this as part of the national health policy. Just as the national health research plan should relate to the national health plan, a national health research policy should be laid out in the national health policy. Sub-national components or modalities could help to calibrate overall national policy to local needs and circumstances. This in turn could help in attaining of wider policy objectives, for example decentralization. Report of the Twenty-fifth Session Page 17 Figure 1 . Steps in the formulation of a national research policy Formulation or revision of a national health research policy could begin with the national authorities identifying an appropriate body to initiate the process. Following this, an advisory group and a functional core group or task force should be formed. Importantly, attention should be paid to identifying key stakeholders and involving them fully. A situation analysis should be undertaken and the findings, as well as the policy options , discussed. The prioritization process could then be usefully carried out, leading to – and contributing towards – policy Identification of an appropriate body Situation analysis Prioritization process Policy development Researc Formulation of advisory group, functional core group of key Policy options WHO South-East Asia Advisory Committee on Health Research Page 18 development. Significantly, health research was an important ingredient in every step of the health planning and health policy development process. Health policy development was thus not the end. It was linked to research on one hand and was (or should be) the foundation for implementation on the other. The scientific working groups on priority setting and on research policies and strategies differed in content but were at the same time linked together. The framework developed as part of the proposed guideline on ‘setting priorities in health research’ could serve as a useful conceptual model linking the processes of planning and policy formulation with those of priority setting and evidence generation. The Committee critically reviewed the series of follow-up actions contained in the report of the Scientific Working Group on “ Formulation of National Research Policies and Strategies ”. From amongst these, members proposed the following priority actions: Countries (1) To develop or update health research policies, through situation analysis and research, in close interaction with decision-makers. (2) To initiate and sustain a mechanism for implementation, monitoring and evaluation, and use the information generated by monitoring as a feedback for the review of policy and priorities. Sub-national components or modalities could help to fine-tune policy to local needs, thus assisting with broader policy objectives as may exist. WHO (1) To assist in the formulation of a national health research policy as appropriate ; and to share the status of implementation of formulating, or reformulating, health research policies and priorities as appropriate. Report of the Twenty-fifth Session Page 19 (2) To promote methods on evidence-based policy development through the process of linking resources and decision makers. WHO Representatives should play an advocacy role with policy- making bodies and responsible personalities. Recommendations (1) WHO SEARO should finalize the draft document “Priority setting in health research: A guideline containing strategies, criteria, tools and processes used for priority setting of health problems and health research”. This should be field-tested before wider application . (2) The conclusions and recommendations contained in the reports of the two scientific working groups, with additional inputs from SEA-ACHR, should be considered for formulating health research policies, including priority setting in health research, within the context of national and regional situations. 2.5 Work of Scientific Working Group on “ Operational Research on Reproductive Health” and presentation on UNDP-UNFPA-WHO- World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) (Agenda items 3.3e and 3.8) The Committee discussed the work of the Scientific Working Group on ”Operational research in reproductive health ”. Members took note of the progress made since the first meeting of the Scientific Working Group in 1996, as well as the work done during their second meeting in 1999. It was observed that reproductive health involved physical, social and behavioural issues, dealing with intimate aspects of human lives. Reproductive health should be viewed in the broader context of multisectoral and multidisciplinary involvement. They also noted the WHO South-East Asia Advisory Committee on Health Research Page 20 importance of mechanisms such as intersectoral coordination committees in improving coordination in all aspects of reproductive health, including research. The Committee emphasized the need to conduct operational research to address priority problems on reproductive health prevailing in the Region. These problems were: high maternal mortality, high peri- natal and neonatal deaths, unwanted pregnancies especially among young adolescents, unsafe abortion, high incidence of reproductive tract infections (RTI) and sexually transmitted diseases including HIV-AIDS, mother-to-child transmission of HIV-AIDS, a higher number of anaemia cases and babies of low-birth-weight. The Committee also noted the organizational changes in the UNDP-UNFPA-WHO-World Bank Special Programme on Research, Development and Research Training in Human Reproducton (HRP) as part of WHO organizational reform. They also appreciated the joint planning effort at all levels of WHO, including the HRP programme. It was felt that further concerted support should be provided to developing countries, in identifying research needs, adoption and application of tools, capacity building, planning, monitoring and evaluation of reproductive health programmes. As indicated below a number of areas on reproductive health research were considered which would promote operational research in the countries. The aim of doing so would be to address priority reproductive health issues, particularly high maternal mortality. The approaches to be used in such operational research could be developing community-based models, to provide a continuum of care linking the community, male members of the family and improving health systems. Unwanted pregnancy was the main cause of abortion, which contributed up to 40% of maternal mortality in some countries. Therefore, it was felt by the group that research on new approaches, such as emergency contraception and safe abortion technologies that could prevent unwanted pregnancy and contribute to reduction of maternal mortality, should also be given higher priority. To avoid possible Report of the Twenty-fifth Session Page 21 duplication of efforts, countries should establish a repository of various research studies related to reproductive health and disseminate these. WHO should strengthen regional information networking between institutions. Capacity building for conducting reproductive health research should include components of priority setting, research coordination, monitoring and management. Several mechanisms for capacity strengthening were envisaged such as (a) application of existing health systems research modules to suit the operational research needs on reproductive health; and (b) conduct of training of trainers to enable district-level health managers to undertake appropriate implementation of operational health research, within the decentralized systems. Maternal deaths were unacceptably high in some countries of the Region despite available technologies to prevent them. The Committee felt that there were factors outside health systems that could affect health outcomes. Such factors included the socioeconomic determinants, for example poverty, social status of women, literacy, male involvement. The possibility was discussed of organizing, or commissioning several studies to identify the determinants affecting maternal health. The result of these studies could be used for advocacy for better maternal health. As initiatives on health systems reform were ongoing at various stages in many countries, maternal health could be positively or negatively affected. Examples of such reforms were the decentralization process in the Indonesian health sector, or the integration of health infrastructure and health centre functions in Bangladesh. It was felt that studies should be conducted to evaluate possible effects of health sector reforms on maternal health. The studies would identify various intervention approaches, with a balance between centralized coordination and decentralized decision making, which would be helpful in promoting reproductive health. Countries should document their research results on reproductive health, especially unpublished ones. Such information could WHO South-East Asia Advisory Committee on Health Research Page 22 be valuable, potentially useful for programming as well as for sharing with Member Countries and WHO through available mechanisms. In addition, WHO should advocate wider use of its research databases on reproductive health, especially in support of policy formulation. Recommendations (1) Countries should conduct operational research which is aimed at reducing maternal mortality. The approaches should include developing community-based health care models, in order to provide a continuum of care linking the community as well as male members of the family. (2) Studies on determinants affecting maternal health should be commissioned, and the results used for advocacy in countries where maternal mortality remains unacceptably high. (3) Countries, with the support of WHO, other UN agencies and development partners, should conduct health research on appropriate public health interventions and approaches, which could prevent unwanted pregnancies and contribute to the reduction of maternal mortality. (4) Countries and WHO should promote documentation of unpublished research results in reproductive health. (5) WHO should promote networking among institutions within the Region through supporting multi-centre studies in priority areas of reproductive health, including those related to HIV-AIDS, women’s health and nutrition. 2.6 Regional Priorities in HIV-AIDS Research (Agenda item 3.4) Report of the Twenty-fifth Session Page 23 The Committee discussed the conclusions and recommendations, including the regional research priorities in HIV-AIDS, as identified by the Expert Group on HIV-AIDS research, which had met in New Delhi from 15 to 17 December 1999. The Committee also noted the structure and priorities of the HIV-STI initiative of WHO HQ as well as WHO SEARO. The meeting acknowledged with concern the rapid spread of HIV-AIDS in the Region. The epidemic continued to evolve and was highly dynamic in nature. While it was fairly advanced in some countries, HIV prevalence remained low in others at present. The risk behaviours that promoted HIV transmission were prevalent in the region. Therefore, the potential for rapid spread exists in all countries. In view of this, it was recognized that multi-disciplinary research could play a crucial role in formulating and implementing HIV prevention and care policies and interventions. The meeting also endorsed the priority health research topics on HIV-AIDS as proposed by the Expert Group, and selected important areas of research, as stated below, for urgent implementation: � Evaluating/reviewing existing HIV-STI surveillance programmes. � Carrying out intervention–linked knowledge, attitude and behaviour surveys among populations at high risk for HIV to assist in designing interventions and evaluating their impact. � Assessing knowledge, attitude, practices, needs and skills of care providers at various health settings, as relevant to each country situation. � Studies to determine the availability, accessibility, acceptability, and correct use of condoms. � Promoting the development of rapid diagnostic kits for sexually transmitted infections (STI). � Studying STI treatment-seeking behaviour, particularly in women. WHO South-East Asia Advisory Committee on Health Research Page 24 � Studies on the mother-to-child transmission of HIV, including care and support needed by children born to HIV-infected mothers. � Assessing cost-effective management options for HIV prevention and care, including access to drugs for preventing mother-to- child transmission and for provision of care for people living with HIV-AIDS. � Evaluating the use of alternative systems of medicine as part of a comprehensive care package for people living with HIV-AIDS. � Studies relating to AIDS clinical care, including counselling and prevention of HIV at the health care setting. � Immunological and virological studies with a view to promoting vaccine development relevant to the Region. The SEA-ACHR also considered important issues relevant to research management in the area of HIV-AIDS. It was recognized that given the different stages of the HIV-AIDS epidemic, as well as cultural and behavioural aspects, research priorities should be specific to each country and local situation. Strengthening capacity and health infrastructure were crucial prerequisites for carrying out relevant research activities. Members arrived at the following conclusions and recommendations. Countries (1) Countries should develop their own country-specific HIV-AIDS- STI research priorities and a framework for implementing research in these priority areas. (2) Ministries of Health should allocate a part of the national HIV- AIDS programme budget for operational research. Report of the Twenty-fifth Session Page 25 (3) Countries and WHO should promote utilization of research findings for programme purposes through regular dialogue between researchers and national HIV-AIDS programmes. (4) Countries, in collaboration with WHO and development partners, should strengthen national capacity for research through training and institutional strengthening. (5) Countries should establish information centres at national level for dissemination of research findings and other technical information; develop an inventory of research institutions capable of research in multidisciplinary areas, of research expertise and of research studies already carried out locally. Research institutions (1) Accord importance to research on priority areas identified at national level, using the framework already agreed to. (2) Establish regular dialogue and linkage with national HIV-AIDS programmes and policy makers to make them aware of the research carried out and its implications. (3) Share available technical and financial resources among institutions. (4) Establish a network to share multi-disciplinary information among researchers within and outside the countries. (5) Medical and other relevant research councils should establish mechanisms for research capacity building, besides providing financial support to HIV-AIDS research proposals. (6) Every attempt should be made to strengthen research management, including quality of data collection, analysis, dissemination and use. WHO South-East Asia Advisory Committee on Health Research Page 26 WHO (1) Promote HIV/AIDS research and allocate resources. (2) Provide technical support by developing guidelines, generic protocols and assist in capacity building. (3) Mobilize resources from UNAIDS, multilateral and bilateral agencies. (4) Facilitate inter-country, south-to-south collaboration and exchange of country experiences within as well as outside the region (such as with countries of the Western Pacific and African regions). (5) Consider establishing an Asia Repository of HIV Strains and also an immunological reagent bank. (6) Develop guidelines on the ethical dimensions relating to HIV/AIDS research. (7) Strengthen capacity at the regional level to assist countries more effectively. Recommendation The conclusions and recommendations of the Expert Group, with additional inputs from the ACHR, should be implemented within the context of national and regional HIV-AIDS control programmes. 2.7 Regional Vaccine Research and Development Policy (Agenda item 3.5) The Committee reviewed and discussed the report of the Core Group Meeting on “ Regional vaccine research and development policy” held in October 1999, including the activities to be conducted at regional and national levels. The consensus was that the field of vaccine research and Report of the Twenty-fifth Session Page 27 development was complex and contained many related areas, each with its own complexity. It was, therefore, necessary to focus on areas that were particularly important for the Region and where WHO could play a leading role. The Committee briefly reviewed the important ongoing activities of WHO on vaccine research and development at the regional level: � Capacity building of national regulatory/control authority for vaccine testing and use. � Technology transfer in the areas of vaccine production (including new technologies). � Inter-country and institutional cooperation for sharing information, providing training and quality control services, conducting multi-centre studies and trials. � Regional information systems on vaccine use, clinical trials, vaccine research and development, disease burden of vaccine preventable diseases. � Ethics in vaccine research and development. The Committee noted the importance of collaborating with the global initiatives on promoting vaccine development and increasing access to vaccines, such as the Global Alliance for Vaccines and Immunization (GAVI), International Vaccine Institute (IVI), United Nations Foundation, Bill and Melinda Gates Foundation. These, as well as other international institutions and initiatives, were welcome. Regional solidarity should be fostered within the context of these global initiatives. In order to address these issues, members agreed that a regional vaccine policy was necessary, to help ensure a degree of self-reliance in vaccine research and development in the Region and, ultimately, in vaccine security. Such a policy would be based on the development of a national vaccine policy in Member Countries. The countries should organize national level meetings, with the full involvement of stakeholders, to arrive at a consensus on national vaccine policy, including vaccine selection and use, quality assurance, vaccine production and delivery. WHO South-East Asia Advisory Committee on Health Research Page 28 Recommendations (1) A second meeting of the Core Group on "Regional vaccine research and development policy" should be held in June 2000 to refine the plan for regional vaccine research and development, leading to the development of a regional vaccine policy. The Core Group should be expanded to include health systems experts and additional experts from WHO HQ, WHO SEARO, Member Countries, other technical agencies and others. (2) A regional conference should be held by the end of October 2000 with the Core Group and representatives from relevant national programmes and institutions, together with the development partners, to endorse a regional action plan, as well as national action plans, for the development of regional and national vaccine policies. 2.8 Operational Guidelines for Ethics Committees Reviewing Biomedical Research (Agenda item 3.6) The Committee reviewed the situation of national and institutional ethical review committees or similar bodies existing in countries of the Region. They noted the different stages of development in terms of activities as well as functioning. Based on the international ethical guidelines, many countries have their own national guidelines for ethical clearance of health research activities. Some were even updating these through wide consultation. As part of capacity building, a series of national workshops on ethical issues in health research had been held in a few countries. In some countries, for example India, in addition to the general national guidelines on ethics in biomedical research, specific ethical guidelines are being developed on human tissue transplantation, research publications, Report of the Twenty-fifth Session Page 29 epidemiological studies, reproductive technologies, animal experimentation, genetic research and organ transplantation. National health research councils played a major role in upholding ethics in health research. The composition of ethical review committees varied, but most of them consisted of multidisciplinary members. The Committee also noted that there was some deficiency in the teaching of ethics in many countries. There was a need to integrate the teaching of ethics in various segments of educational curricula of all medical and public health education institutions. Based on its experience in many parts of the world, the WHO-UNDP- World Bank Special Programme for Research and Training in Tropical Diseases (TDR) embarked in 1999 on developing operational guidelines for ethics committees reviewing biomedical research. A series of workshops, meetings and discussion groups were held in order to draft a standard manual consisting of operational guidelines. The final draft was reviewed, completed and made available in 2000. In order to facilitate wider use of the operational guidelines and to share experience on their adaptation and application, an informal regional network, called Forum for Ethical Review Committees in the Asian and Western Pacific Region (FERCAP), has been formed with scientists possessing experience on ethics. FERCAP strives to help improve communication among national ethical review committees in the countries of Asia and the Pacific, facilitate training opportunities, and assist in the adaptation and modification of WHO generic guidelines for ethical review. In future, FERCAP will be involved in developing appropriate quality assurance mechanisms for effective functioning of national and institutional ethical review committees. WHO South-East Asia Advisory Committee on Health Research Page 30 SEA-ACHR reviewed the WHO operational guidelines, developed under the initiative of the TDR programme, for ethics committees reviewing biomedical research. The guidelines would be useful as generic operational guidelines for each country to adapt. It could guide ethical review committees to evaluate and strengthen their work within the context of the prevailing national framework. Members considered that a future revision of the guidelines could differentiate between national, institutional and granting agencies involved in ethical review. Furthermore, the term “ biomedical ”, which was used in the title of the operational guidelines, might not indicate the full range of meaning intended. It would be better if the term “ Health Research ” or the elaboration “ Research involving Human Subjects ” was used. The procedures for follow-up consequent to the review, such as protection of research subjects, accountability of ethical review committees, reconsideration of rejected proposals, possible consequences for researchers not following the ethical procedures, needed to be further elaborated. In future revisions there was also a need to highlight some important ethical issues in research as may be involved in inducement, compensation, confidentiality, group clinical practices, research design, analysis, report writing. The Committee noted that national codes of ethics would be within the legal domain of each country. WHO should facilitate and support the capability of the countries in formulating their framework on national codes of ethics. Ethics was a comprehensive area: it was felt that one should not apply only one type of ethics universally. It was suggested to conduct country case studies on ethical review processes and mechanisms. Recommendations Report of the Twenty-fifth Session Page 31 (1) Countries should undertake situation analyses on their ethical review processes and mechanisms for reviewing health research, in particular research involving human subjects. WHO could facilitate this process through the support and involvement of the regional FERCAP network . (2) Countries should review their curricula on biomedical and health ethics, including ethics in health research, in medical, paramedical and health training institutions. WHO could facilitate the training of trainers on ethics in health research . 2.9 Global and Regional Coordination in Health Research (Agenda item 3.7) Council on Health Research for Development (COHRED), Geneva Professor Charas Suwanwela shared with members the latest information on the International Conference on Health Research (ICHR), which would be held in Bangkok, Thailand, in October 2000. WHO, COHRED, the World Bank and some 30 agencies were organizing this conference, COHRED being the secretariat. The first announcement has been disseminated. Explaining the programme of the conference, Professor Charas said that on the first day, comprehensive review and analysis of the past 10 years’ work on health research at national, regional and global levels would be carried out. The results would give ideas on the future of health research, especially in the areas of joint collaboration and cooperation at various levels. The second day would be used for analysis of the current situation and the expectations for the next decade. On the third day, an action plan for the coming years would be developed. The fourth and final day was dedicated to plenary discussion, during which a future action WHO South-East Asia Advisory Committee on Health Research Page 32 plan for international cooperation for health research would be adopted. Conference would consist of a mix of parallel and plenary sessions, including group activities and market places. Many small group discussions would be arranged to deal with cross cutting as well as specialized issues. Conference would arrange a considerable number of market places, exhibition stalls and electronic exhibits, where researchers could interact, display their products, promote proposals and exchange ideas. Professor Charas also explained the consultative process in preparation for the International Conference on Health Research. In particular, he reported briefly the outcome of the Asia Health Research Forum, organized in Manila, The Philippines, from 17 to 19 March 2000, involving 300 researchers. This forum was jointly organized by the Council on Health Research for Development (COHRED), Essential National Health Research networks, WHO SEARO, International Clinical Epidemiology Network (INCLEN), South-East Asia Clinical Epidemiology Network (SEACLEN) and other partners. It drafted Asia’s Voice on Health Research to be used at the forthcoming ICHR. This draft dealt with three levels of ‘voice’: The first level was the philosophical one, dealing with equity, ethics and a new paradigm of health research. The paradigm was about the changing face of health research, signifying a shift from biomedical to social and behavioural sciences, and from supply side to demand- driven research. It also included the involvement of other sectors. In addition to generating knowledge, conducting and utilizing health research should contribute to the empowerment of developing countries. Report of the Twenty-fifth Session Page 33 The second level was the architectural one, which meant ways and means to deal with heath research at the national, regional and global levels. The third level was the action one, dealing with leadership, tools and methodologies and the use of communications in health research. The Committee considered that in view of the importance of the International Conference on Health Research, countries should consider sending senior scientists and policy makers to attend. WHO RPC Programme (HQ) and Global Advisory Committee on Health Research, Geneva Dr Tikki Pang, Director, Research Policy and Cooperation, WHO HQ, explained the new role of WHO in health research within the context of WHO reform. The role and functioning of the Global ACHR had undergone a thorough review. The first meeting of the reconstituted Global ACHR would be held in Bangkok, Thailand, in October 2000. Dr Pang shared with members the functions of the Global ACHR as an advisory body, which provided guidance on WHO research policy and strategies. This role included commissioning reviews on thematic areas of research, playing an ‘intelligence’ role in responding to emergency health research issues, and conducting high-level advocacy for global health research. Dr Mahmoud Fathalla of Egypt will chair the new Global ACHR consisting of 12 members of multidisciplinary background. The meeting appreciated the reform of the Global ACHR and hoped to further strengthen the linkages within the ACHR system. Several modalities were suggested to achieve this objective. These included cross-representation at respective ACHR meetings, and more frequent interactions and WHO South-East Asia Advisory Committee on Health Research Page 34 consultations among members of global and regional ACHRs. A “summit” of all ACHRs was proposed to share experience as well as respective roles and functions. The WHO Director-General had stated on several occasions that research was one of the core functions of WHO and that stimulating health research in the developing world was of key importance. It was realized that health research in developing countries was usually top- down, or frequently driven by external donors, or restricted to specific areas, thus not following a balanced approach. On the positive side, there were an appreciable number of initiatives to support health research, strengthen research capacity, organize training programmes, or strengthen institutional capacity. It is felt that the development of a research culture should be further promoted in the countries. Dr Tikki Pang further explained the new REACH initiative – Research empowerment accelerates complete health . REACH was mainly an award scheme based on the participation of, and owned by, researchers of developing countries. The REACH awards ceremony is scheduled to coincide with the International Conference on Health Research to be held in Bangkok, Thailand, in October 2000. Members emphasized the diversity inherent in the regional and global ACHR system. Cross-representation of members and sharing experience of thematic issues on international health research was likely to result in success. The present practice of the ACHR chairpersons reporting directly to the respective WHO governing bodies (World Health Assembly, Executive Board or the regional committees) should be continued. In addition, to promote exchange of ideas, the possibility of members of WHO governing bodies attending ACHR meetings could be explored. Report of the Twenty-fifth Session Page 35 Global Forum for Health Research, Geneva Mr Louis Currat, Executive Secretary, Global Forum for Health Research, Geneva, briefed the ACHR members on the work of the Forum. Summarizing the Forum’s 10/90 Report on Health Research 2000, due to be released in mid-2000, Mr Currat stated that global spending on health research – by both public and private sectors – amounted to approximately US$ 56 billion per year (1992 estimate). However, less than 10% of this considerable sum was devoted to 90% of the world’s health problems. The human and economic cost of such misallocation of resources was enormous. The central objective of the Global Forum was therefore to help correct this 10/90 gap The Ad Hoc Committee on Health Research had recommended in 1996 the creation of the Global Forum for Health Research. The Forum commenced operations in January 1998 and became a foundation on 24 June 1998. It attempts to address the 10/90 gap by a variety of means, such as focusing research efforts on diseases representing the heaviest burden on the world’s health, or assisting to improve the allocation of research funds, or facilitating collaboration among the Forum’s partners. These partners included government policy makers, multilateral and bilateral aid agencies, international foundations, national and international NGOs, women's organizations, research insitutions and universities , private sector companies the media. The Forum believed that solutions to the present health challenges would depend on the strength of partnerships created between these constituencies over the years to come. The Forum’s efforts centred around five strategies: WHO South-East Asia Advisory Committee on Health Research Page 36 � Organization of an Annual Forum: Global Forum 2 and 3 had been held in June 1998 and June 1999, respectively. The next Forum 4 would be held in conjunction with the International Conference on Health Research for Development, scheduled for October 2000 in Bangkok, Thailand. � Analytical work in priority setting: The analytical activities focused on burden of disease, cost-effectiveness, resource flows and the development of a practical framework for priority setting. � Initiatives in key areas of health research: Progress had been made under a number of initiatives, such as the Alliance for Health Policy and Systems Research, Medicines for Malaria Venture, Global Tuberculosis Research Initiative, Cardiovascular Health in Developing Countries, Initiative on Violence against Women and Initiative on Child Health and Nutrition. � Communication and information: Activities had been initiated in the development of networks of partners in the constituencies of the Global Forum, the development of the website, and work with the media. � Indicators of performance: An external evaluation of the Forum’s work was being planned for 2001. Progress would be measured in terms of the Forum’s contribution to a more widespread knowledge of the gaps in health research, priority setting efforts, and development of initiatives with a purpose of bringing together partners in key areas of health research. Mr Currat also elaborated on the possible role of the Global Forum within the framework for overall health research governance. The characteristics of the Forum were summarized as a network linking the efforts of many partners, as a potential catalyst and promoter of equality. Members appreciated the initiatives and the support extended by the Global Forum in health research, especially for developing countries. As many initiatives of the Forum were falling within the purview of global Report of the Twenty-fifth Session Page 37 health development initiatives by WHO, for example Roll Back Malaria and Stop TB, the work supported by the Global Forum at the country and regional levels needed to be coordinated. WHO Centre for Health Development, Kobe, Japan Dr Ataollah Amini, Public Health Consultant and Senior Adviser to the Director, WHO Centre for Health Development, Kobe, Japan, briefed members about the history of the Centre (since its inception in 1996) and its future plans. The WHO Kobe Centre had been established with the support of WHO and the Kobe Group, through a Memorandum of Understanding signed in August 1995. Its main mission was to undertake multisectoral research in health development and its determinants with a view to improving scientific knowledge on the interrelationship among social, cultural, economic, demographic, epidemiological and environmental variables. The WHO Kobe Centre, an inter-disciplinary and inter-sectoral centre for research and symposia, intends to provide evidence-based information required by decision-makers. The Centre plans to bring together decision-makers and researchers to explore common health and welfare problems, to define relevant research agendas, and to organize internally commissioned research. It was utilizing international and national networks of academic, research and development institutions, ranging from governments, universities, foundations, the private sector, national and international NGOs, multilateral and bilateral agencies. It also organized a series of international meetings and symposia on topical health development issues, such as urbanization, women's health, ageing, traditional medicine and social security systems. The Centre used its information technology resources to strengthen information networks. WHO SEARO and some countries of the Region were involved in the activities of the WHO Kobe Centre. Members noted the progress of this work and WHO South-East Asia Advisory Committee on Health Research Page 38 expressed their desire to continue collaboration, especially in international health research and information technologies. 3. CLOSING SESSION (Agenda items 3.9 and 4) The Chairperson, Professor N K Ganguly, summarized the discussion, conclusions and recommendations of the meeting. The draft report was reviewed by plenary, which members endorsed with minor modifications. Professor Ganguly, in his closing remarks, reiterated that the speeches by the Hon Minister of Health of the Republic of Indonesia and by the WHO Regional Director had set a new tone for the new SEA-ACHR. He emphasized that the regional ACHR mechanism should support the policy-making processes of national health administrations, as well as help in strengthening national health research capabilities. This year’s session had covered major themes on health research management, such as ethical review, development of research culture, priority setting, research policy formulation, health research information management. Decentralization and enhancement of linkages had been emphasized. The Chairperson urged members to bring the needs of health research to centre stage of health policy development, so as to facilitate availability of simple health interventions for widespread use. Within the context of the new WHO Corporate Strategy, Professor Ganguly requested members to identify an appropriate niche in the new international health research environment. After the International Conference on Health Research in October 2000, new directions for health research should become much clearer. To this end, the Chairperson urged members to participate fully in that Conference and to plead for a stronger regional voice. In conclusion, Professor Ganguly pointed out that the Committee had thoroughly Report of the Twenty-fifth Session Page 39 reviewed and debated the outcome of the various working groups and was very satisfied with the conclusions and recommendations. He hoped that these would be acceptable to the WHO Regional Director. While South-to-South cooperation needed to be strengthened, there was also a need to expand and enhance the partnership and networking mechanisms. The Chairperson urged SEA-ACHR members, who were attending the meeting not only in their personal capacity as eminent scientists, but were also representing their respective national health research authorities, to take prompt action to implement the recommendations of the meeting. The Chairperson expressed high appreciation for the longstanding and valuable contributions to the Committee’s deliberations rendered by Dr Samlee Plianbangchang, Deputy Regional Director and Director, Programme Management, WHO SEARO. Professor Ganguly also commended the Secretariat for their thorough, comprehensive documentation and technical support, and the national organizers for the excellent local arrangements. Dr Uton Muchtar Rafei, WHO Regional Director, in his closing remarks, congratulated members and special invitees for their valuable contribution, especially on the fruitful outcome of the meeting. As WHO was emphasizing the product approach, Dr Uton was pleased to note the concrete results coming out of this meeting. WHO would implement these recommendations with the assistance of all SEA-ACHR members and also with the support of the national and international health research community . Dr Uton further emphasized the importance of appropriate marketing of health research results and also the need for communicating health research information to relevant users. The Regional Director hoped that next year, the Committee would be able to share such communication and marketing experience. He urged participants to continue to make WHO South-East Asia Advisory Committee on Health Research Page 40 maximum use of communication technologies and to foster linkages of health research networks, which were already becoming stronger in the Region. Following appreciation expressed by members for the conduct of the meeting, the twenty-fifth session of the WHO South-East Asia Advisory Committee on Health Research was declared duly closed. Report of the Twenty-fifth Session Page 41 Annex 1 ADDRESS BY DR UTON MUCHTAR RAFEI REGIONAL DIRECTOR, WHO SOUTH-EAST ASIA REGION I am deeply honoured to address this august gathering at the inauguration of the Twenty-fifth session of the WHO South-East Asia Regional Advisory Committee on Health Research (SEA-ACHR). I extend my sincere thanks to the Ministry of Health of Indonesia for hosting this session in the enchanting island of Bali. I warmly welcome the distinguished members of ACHR, special invitees, dignitaries from the Government of Indonesia, and our colleagues from WHO headquarters. I am especially pleased to welcome our eminent new members of ACHR. In view of the pace of globalization and its impact on international health development, WHO has recently developed a new strategic framework for its secretariat . This WHO Corporate Strategy will guide in improving the Organization’s effectiveness and efficiency. As a guiding framework, the Corporate Strategy has identified four main strategic directions, and these are: (a) to reduce the burden of disease especially among the poor and marginalized populations; (b) to promote a healthy lifestyle and to reduce factors of risk to human health; (c) to develop health systems to equitably improve health outcomes; and (d) to develop an enabling policy and institutional environment in the health sector to promote an effective health dimension to social, economic and development policy. These strategic directions are complemented by the six core functions of the WHO Secretariat. Among these core functions is: “Managing information, assessing trends and comparing performance of the health systems, setting the agenda for, and stimulating, research and development.” WHO South-East Asia Advisory Committee on Health Research Page 42 How will the new ACHR mechanism fit in with this Corporate Strategy? At the global level, linkages will be created through global health research development. As you may be aware, the global ACHR is also being reconstituted with new terms of reference. As you are aware, WHO’s priority is to reduce the burden of disease among the poor and disadvantaged. WHO will continue to facilitate health research and provide evidence based information to policy makers. It is, therefore, important to strengthen the links between health outcome and research outputs. While old health problems like malnutrition, malaria, tuberculosis, diarrhoeal diseases and acute respiratory infections are still major killers in our Region, diseases like HIV/AIDS, cardiovascular diseases and cancer have emerged as major problems. The Regional Health Declaration, adopted by the Health Ministers of the Region in 1997, had identified the double burden of communicable and non- communicable diseases and the opportunities to address them, which require health research. We have learnt from experience that the barriers to applying scientific and other advances in our development efforts are not necessarily confined to technological issues. Even simple and affordable technologies have not been widely applied due to lack of human capacity, organizational support or financial resources. While much is known about the determinants of maternal mortality, more operational research is needed to help reduce the persistent burden of maternal mortality in our Region. As part of the development of a regional vaccine policy, WHO/SEARO established a Regional Core Group for Vaccine Policy Development in October 1999. The core group covered major issues ranging from vaccine selection policy to vaccine delivery. What we need now is in-depth research to develop a viable regional vaccine policy. HIV/AIDS has emerged as a major epidemic in our Region and considerable research from operational to clinical areas has been conducted. What is needed is practical application of the findings for effective interventions. Report of the Twenty-fifth Session Page 43 To ensure a greater impact on health development in the countries, the work of WHO will have to complement the work of development partners, both at the national and international levels. I would urge the ACHR members and the research community at large to consider maximizing cooperation with our development partners. These include WHO collaborating centres and national centres of expertise and the international research networks. We always need new knowledge but let us not ignore existing knowledge. We also have to ask ourselves why – all too often – proven, affordable and available technologies or approaches are still not applied to benefit peoples’ health. We should learn from successful research institutions and efforts. We should use all experience of successes and failures, to reduce the disease burden and promote health. Finally, there is a need for effective utilization of research findings in the development of health programmes. This is critical if the ultimate benefits of research are to reach those in need, which is our main goal. For this, research findings need to be clearly understood and implemented by managers at all levels of the health system. In conclusion, I wish you success in your deliberations and keenly look forward to the outcome of this important meeting. I wish you all a pleasant and enjoyable stay in Bali. Thank you. WHO South-East Asia Advisory Committee on Health Research Page 44 Annex 2 LIST OF PARTICIPANTS SEA-ACHR Members Dr Harun-ar-Rashid Director, Bangladesh Medical Research Council Mohakhali Dhaka, Bangladesh Tel. 00-880-2-8828396 & 880-2- 8811395 (O) Fax. 00-880-2-8828820 E-mails: bmrc@bd.drik.net bmrc@citechco.net Professor Shahjada Chowdhury Director, National Institute of Preventive and Social Medicine Mohakhali Dhaka, Bangladesh Telefax: 00-880-2-8821236 E-mail: director@nipsom.medinet.agni.com Dr Sangay Thinlay Secretary, Ministry of Health & Education Royal Government of Bhutan Thimphu, Bhutan Tel. 00-975-2-326627 Fax: 00-975-2-324649 E-mail: Sangay@Druknet.net.bt Professor N K Ganguly Director-General Indian Council of Medical Research New Delhi, India Tel. 00-91-11-6517204 (O) and 00-91-11-6493145 Res. E-mail: icmrhqds@sansad.nic.in Dr Indrani Gupta Reader, Institute of Economic Growth, Health Policy Research Centre University Enclave Delhi, India Tel. 00-91-11-7257288 and 91-11- 7257101 Fax: 00-91-11-7257410 E-mail: indrani@ieg.ernet.in Professor Umar Fahmi Achmadi Director-General Communicable Diseases and Environmental Health Ministry of Health Jakarta, Indonesia Tel. 00-62-21-4209930 E-mail: umar@indosat.net.id Report of the Twenty-fifth Session Page 45 Professor Ramdan Panigoro Director, Health Research Unit Padjadjaran University School of Medicine Hasan Sadikin Hospital Bandung 40161 West Java, Indonesia Tel. 00-62-22-203 8218 Fax: 00-62-22-203 0776 E-mail: ramdan@fk.unpad.ac.id Dr Agus Suwandono Secretary National Institute for Health Research and Development Ministry of Health Jakarta, Indonesia Tel. 00-62-21-4243122 Fax: 00-62-21-4243933 E-mail: dragus@indosat.net.id Dr Soeharsono Soemantri Senior Researcher, Health Ecology Research and Development Centre National Institute for Health Research and Development Ministry of Health Jakarta, Indonesia Tel. 00-62-21-4261088 Fax: 00-62-21-4244226 E-mails: ssoem@dprin.go.id soeharsono@litbang.depkes.go.id Professor Eddy Pranowo Chairperson Department of Public Health and Preventive Medicine Medical Faculty University of Airlangga Surabaya 60131, Indonesia Tel. 00-62-31-502 7830 or 502 0251 (Ext. 134) Fax: 00-62-31-502 2680 or 502 2472 E-mail: msdfkua@rad.net.id Dr Than Swe Retired Director-General Department of Medical Research Ministry of Health Yangon, Myanmar Tel: 00-95-1-290900 Fax: 00-95-1-251514 Professor Paing Soe Director-General Department of Medical Research (Lower Myanmar) Yangon, Myanmar Tel: 00-95-1-284419 Fax: 00-95-1-251514 Professor Gopal Prasad Acharya Chairperson Nepal Health Research Council Kathmandu, Nepal Tel: 00-977-1-254220 Fax: 00-977-1-262469 E-mail: gacharya@healthnet.org.np WHO South-East Asia Advisory Committee on Health Research Page 46 Dr K C S Dalpatadu Deputy Director-General (Planning) Ministry of Health and Indigenous Medicine Colombo, Sri Lanka Tel: 00-94-1-692694 Fax: 00-94-1-679997 E-mail: ddgp@sri.lanka.net Professor Dulitha N Fernando Professor ,Community Medicine and Head, Department of Community Medicine Faculty of Medicine University of Colombo Colombo, Sri Lanka Tel: 00-94-1-695300, 00-94-1- 696243 Fax: 00-94-1-691581 E-mail: cmcol@slt.lk Dr Mongkol Na Songkhla Director-General Department of Medical Sciences, Ministry of Public Health Nonthaburi, Thailand Tel: 00-66-2-5906001 Fax: 00-66-2-5918233 E-mail: mongkol@health.moph.go.th Professor Porapan Punyaratabandhu Associate Professor, Faculty of Public Health Mahidol University Bangkok, Thailand Tel: 00-66-2-2459673 Fax: 00-66-2-2483299 E-mail: phppy@mucc.mahidol.ac.th Professor Chantapong Wasi Associate Professor Department of Microbiology Faculty of Medicine Siriraj Hospital Mahidol University Bangkok, Thailand Tel: 00-66-2-4113111 or 00-66-2- 4197068 Fax: 00-66-2-4184148 or 00-66-2- 4110263 E-mail: sicws@mahidol.ac.th Special Invitees Professor Charas Suwanwela College of Public Health Chulalongkorn University Bangkok 10330, Thailand (Also responsible for Council on Health Research for Development (COHRED) Geneva) Tel: 00-66-2-2188187 Fax: 00-66-2-2556046 E-mail: charas@cph.chula.ac.th Professor Natth Bhamarapravati Professor of Pathology Director, Dengue Vaccine Development Project Institute of Sciences and Technology for Development Mahidol University Bangkok, Thailand Telefax: 00-66-2-4419744 E-mail: stnbm@mucc.mahidol.ac.th . Report of the Twenty-fifth Session Page 47 Professor Sudarto Ronoatinodjo Dean, Faculty of Public Health University of Indonesia Kampus UT West Java, Indonesia Tel: 00-62-21-7863471 Fax: 00-62-21-7863472 Dr Ataollah Amini Senior Adviser to the Director WHO Centre for Health Development Kobe, Japan Tel: 00-81-78-2303178 E-mail: dramini@aol.com Professor S Modasser Ali National Institute of Opthalmology Sher-e-Bangla Nagar Dhaka, Bangladesh Tel: 00-880-2-8114807 Fax: 00-880-2-9118336 E-mail: sadia@citechno.net Mr Louis J Currat Executive Secretary Global Forum for Health Research c/o WHO/HQ, Geneva Tel: 00-41-22 7913418 fax: 00-41-22 7914394 E-mail: curratl@who.ch Professor Chandravati Head Department of Obstetrics and Gynecology KGM Medical College Lucknow, India Tel: 00-91-522-266007 or 266839 Fax: 00-91-522-266007 Dr Astuti Soedarto Suparmanto Director-General National Institute for Health Research and Development Ministry of Health, Jakarta, Indonesia Tel: 00-62-21-4245214 Fax: 00-62-21-4243933 Dr Muharso Senior Adviser to the Minister of Health on Health Technology Ministry of Health Jakarta, Indonesia Professor Sangkot Marzuki Head, Eijkman Molecular Biology Institute Jakarta, Indonesia Tel: 00-62-21-3148694 and 00-62-21-3147982 E-mail: smarzuki@eiikman.go.id Dr Triono Sundoro Head Bureau of Science and Technology National Development Planning Board Jakarta, Indonesia Dr Ingerani Director of Diseases Control Research and Development Centre Jakarta, Indonesia Dr Nyoman Adiputra Head of Research Institute, University of Udayana Bali, Indonesia WHO South-East Asia Advisory Committee on Health Research Page 48 WHO Secretariat WHO HQ Dr Tikki Pang Director, Research Policy and Cooperation E-mail: pangt@who.ch Dr Wang Yi-fei Area Manager, Asia and the Pacific UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction Department of Reproductive Health and Research (RHR) E-mail: wangy@who.ch WHO SEARO Dr Uton Muchtar Rafei Regional Director WHO South-East Asia Region E-mail: rafeiu@whosea.org Dr Samlee Plianbangchang Deputy Regional Director/ Director, Programme Management E-mail: samleep@whosea.org Dr U Than Sein Director Department of Evidence and Information for Policy E-mail: thansein@whosea.org Dr Adik Wibowo Regional Adviser Research Policy and Cooperation E-mail: wibowoa@whosea.org Mr Abdul Muhid Meliala Scientist Research Policy and Cooperation E-mail: melialaa@whosea.org Dr Stephan P Jost Technical Officer Health Systems Research E-mail: josts@whosea.org Dr Arun B Thapa Medical Officer EPI, Vaccines and other Biologicals E-mail: thapaa@whosea.org Dr Jai Prakash Narain Regional Adviser HIV/STI Initiative and Stop Tuberculosis E-mail: narainj@whosea.org Dr Suniti Acharya Regional Adviser Reproductive Health and Research E-mail: acharyas@whosea.org Dr U Myint Htwe Regional Adviser Evidence for Health Policy E-mail: htwem@whosea.org WHO Country Office Dr Georg Petersen WHO Representative to Indonesia E-mail: petersen@who.or.id Dr Stephanus Indradjaya Senior National WHO Consultant on Health Financing E-mail: stevei@indosat.net.id Report of the Twenty-fifth Session Page 49 WHO South-East Asia Advisory Committee on Health Research Page 50 Annex 3 TERMS OF REFERENCE OF THE WHO SOUTH-EAST ASIA ADVISORY COMMITTEE ON HEALTH RESEARCH (SEA-ACHR) (as revised in April 2000) To advise the WHO South-East Asia Regional Director in the following areas: � Formulation and implementation of health research policies and health research agenda in the Region in line with the resolutions and policy guidance of the World Health Assembly, Executive Board and the Regional Committee, and also within the overall framework of the global WHO health research policy. � Coordination and harmonization of health research activities of various national health research bodies/councils/departments, institutions with those of WHO, with the purpose of strengthening national research capability and research management for health development. � Development, management and improvement of health research information system , including research monitoring and evaluation , for evidence-based decision making. � Collection, analysis and dissemination of existing health research findings on emerging scientific knowledge and technology, with a view to promoting and fostering research application and practices at the national and institutional level. Report of the Twenty-fifth Session Page 51 Annex 4 AGENDA 1. Inaugural Session 2. Introductory Session 2.1 Introductory remarks by Chairperson, Professor N K Ganguly 2.2 Introductory remarks by Dr Uton Muchtar Rafei, Regional Director, WHO South-East Asia Region 2.3 Introduction of participants 2.4 Adoption of agenda and working schedule 3. Business Session 3.1 The work of WHO Regional Research Policy and Cooperation (RPC) programme 3.2 South-East Asia Advisory Committee on Health Research – Terms of reference, memberships and method of work 3.3 The work of WHO Scientific Working Groups on: (a) Management and coordination of health research activities in the countries (b) Criteria for setting health research priorities (c) Management of heal th research information (d) Formulation of national health research policies and strategies (e) Operational research on reproductive health 3.4 Regional priorities in HIV/AIDS research (Expert group meeting on HIV/AIDS research) 3.5 Regional vaccine research and development policy 3.6 Operational guidelines for ethics committees reviewing biomedical research 3.7 Global and regional coordination in health research WHO South-East Asia Advisory Committee on Health Research Page 52 (a) Council on Health Research for Development (COHRED), Geneva (b) WHO RPC and Global Advisory Committee on Health Research, Geneva (c) Global Forum for Health Research, Geneva (d) WHO Centre for Health Development, Kobe, Japan 3.8 Selected global health research activities: (a) UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) 3.9 Adoption of conclusions and recommendations 4. Closing Session Annex 4 (contd.) Working Schedule Date Morning Session(8:30 – 12:30) Afternoon Session(14:00 – 17:00) 17 April 2000 (Monday) 1 . 2 . 3 . 3 . 1 3 . 2 Inaugural session Introductory session Business session The work of WHO Regional Research Policy and Cooperation (RPC) programme South-East Asia Advisory Committee on Health Research – Terms of reference, memberships and method of work Introduction to Group work I {Agenda items 3.3 (a) to (e)} Group Work I Report of the Twenty-fifth Session Page 53 Date Morning Session(8:30 – 12:30) Afternoon Session(14:00 – 17:00) Grou p 1 Grou p 2 Grou p 3 Work of Scientific Working Groups on: Management and Co-ordination of health research activities (Agenda item 3.3a) and Management of health research information (Agenda item 3.3c) Work of Scientific Working Groups on: Criteria for setting health research priorities (Agenda item 3.3b) and Formulation of national health research policies and strategies (Agenda item 3.3d) Work of Scientific Working Group on Operational research in reproductive health (Agenda item 3.3e) & Selected global health research activities: UNDP- UNFPA-WHO-World Bank Special programme of research, development and research training in human reproduction (HRP) (Agenda item 3.8a) Group Work II18 April 2000 (Tuesday) Presentations on Group work I Introduction to Group work II {Agenda items 3.4, 3.5 & 3.6} Grou p a Grou p b Grou p c Regional priorities in HIV/AIDS research (Agenda item 3.4) Regional vaccine research and development policy (Agenda item 3.5) Operational guidelines for ethics committees reviewing biomedical research (Agenda item 3.6) WHO South-East Asia Advisory Committee on Health Research Page 54 Date Morning Session(8:30 – 12:30) Afternoon Session(14:00 – 17:00) 19 April 2000 (Wednesday) Presentations on Group work II Discussion 3.7 Global and regional coordination in health research (a) COHRED (b) WHO RPC and Global ACHR (c) Global Forum for Health Research (d) WHO Kobe Centre 20 April 2000 (Thursday) 3.9 Discussion and adoption of conclusions and recommendations 4. Closing session Report of the Twenty-fifth Session Page 55 Annex 5 LIST OF WORKING DOCUMENTS Document Name Terms of reference List of participants SEA/ACHR/25/ A Agenda SEA/ACHR/24/ B Working schedule SEA/ACHR/25/ C The work of WHO Regional Research Policy and Cooperation (RPC) programme SEA/ACHR/25/ D (Agenda item 3.1) South-East Asia Advisory Committee on Health Research – Terms of Reference, membership and method of work SEA/ACHR/25/ E (Agenda item 3.2) Work of WHO Scientific Working Groups (a) Management and coordination of health research activities in the countries SEA/ACHR/25/ F (Agenda item 3.3a) (b) Criteria for setting health research priorities SEA/ACHR/25/ G (Agenda item 3.3b) (c) Management of health research information SEA/ACHR/25/ H (Agenda item 3.3c) (d) Formulation of national health research policies and strategies SEA/ACHR/25 /I (Agenda item 3.3d) WHO South-East Asia Advisory Committee on Health Research Page 56 (e) Operational research on reproductive health SEA/ACHR/25/ J (Agenda item 3.3e) Regional priorities in HIV/AIDS research SEA/ACHR/25/ K (Agenda item 3.4) Regional vaccine research and development policy SEA/ACHR/25/ L (Agenda item 3.5) Operational guidelines for ethics committees reviewing biomedical research SEA/ACHR/25/ M (Agenda item 3.6) Global and regional coordination in health research (a) Global Advisory Committee on Health Research, Geneva SEA/ACHR/25/ N (Agenda item 3.7a) (b) Global Forum for Health Research, Geneva SEA/ACHR/25/ O (Agenda item 3.7b) (c) WHO Centre for Health Development, Kobe, Japan SEA/ACHR/25/ P (Agenda item 3.7c) (d) Council on Health Research for Development (COHRED), Geneva SEA/ACHR/25/ Q (Agenda item 3.7d) Selected global health research activities UNDP/UNFPA/WHO/World Bank Special Programme of Research Development & Research Training in Human Reproduction (HRP) SEA/ACHR/25/ R (Agenda item 3.8a) Report of the Twenty-fifth Session Page 57 Annex 6 LIST OF INFORMATION DOCUMENTS 1. Recommendations of the WHO South-East Asia Advisory Committee on Health Research, 1976-1999 (SEA-ACHR-25), WHO SEARO, 2000 Related to Agenda item 3.3a 2. Management and coordination of health research activities in the countries, Report of the meeting of the Scientific Working Group, Bangkok, Thailand, 6-8 October 1999 3. Development of research culture in the country – India (SEA/SWG- RCO/D) 4. Mobilization and management of resources, including resource flows for health research – Thailand (SEA/SWG-RCO/E) 5. Ethical review, peer review and technical review of research proposals – Myanmar (SEA/SWG-RCO/F) 6. Development of human resources for health research including research capacity building – Sri Lanka (SEA/SWG-RCO/G) 7. Role of Health (Medical) research councils in research promotion, development and coordination - Nepal (SEA/SWG-RCO/I) 8. Monitoring and evaluation of progress in national health research system – Indonesia (SEA/SWG-RCO/J) 9. Issues on management and coordination of health research (SEA/SWG/RCO/L) Related to Agenda item 3.3b WHO South-East Asia Advisory Committee on Health Research Page 58 10. Criteria for setting health research priorities, Report of the meeting of the Scientific Working Group, New Delhi, 1-3 November 1999 11. Priority setting in health research. – A guideline containing strategies, criteria, tools and processes used for priority setting of health problems and health research (April 2000) 12. Research Prioritization (SEA/SWG-PRIOR/P) Related to Agenda item 3.3c 13. Management of health research information, Report of the meeting of the Scientific Working Group, New Delhi, 15-17 December 1999 14. Procedure and mechanism to identify health research information need in relation to available resource allocation for health research at country level (SEA/SWG/HRI/H) 15. Health research information flow and its potential networking - India (SEA/SWG/HRI/I) 16. Approaches and methods for validation of the health research data and information – Bhutan (SEA/SWG/HRI/J) 17. The role of research council in monitoring and evaluation of research information at country level – Bangladesh (SEA/SWG/HRI/K) 18. Monitoring and evaluation of health research information system at country level (SEA/SWG/HRI/L) Related to Agenda item 3.3d 19. Formulation of national health research policies and strategies, Report of the meeting of the Scientific Working Group, Jakarta, Indonesia, 6-8 December 1999 20. Experience in translation of national health research policy into action (SEA/SWG-FPS/F) Report of the Twenty-fifth Session Page 59 21. Role of research institutions in formulation and translation of national health research policy into action (SEA/SWG-FPS/H) 22. Monitoring and evaluation of the implementation of national health research (SEA/SWG-FPS/I) 23. Epidemiological methods used in policy analysis (SEA/SWG-FPS/J) 24. Health research policy formulation implementation and evaluation (SEA/SWG-FPS/K) 25. Issues in health policy research (SEA/SWG-FPS/L) Related to Agenda item 3.3e 26. Operational research on reproductive health, Report of the second meeting of the Scientific Working Group, New Delhi, 17-19 November 1999