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GENEVA -- Health systems research has the potential to produce dramatic improvements in health worldwide and to meet some of the major development challenges in the new millennium. Effective research could prevent half of the world's deaths with simple and cost-effective interventions, the World Health Organization (WHO) says in a new World Report on global health research.
The WHO World Report on Knowledge for Better Health: Strengthening Health Systems highlights aspects of health research that, if managed more effectively, could produce even more benefits for public health in future. It sets out the strategies that are needed to reduce global disparities in health by strengthening health systems.
Inequities in health are among the major development challenges in the new millennium and malfunctioning health systems are at the heart of the problem. Moreover, the culture and practice of health research should reach beyond academic institutions and laboratories to involve health service providers, policy makers, the public and civil society.
The report also argues that science must help to improve public health systems and should not be confined to producing drugs, diagnostics, vaccines and medical devices. Biomedical discoveries cannot improve people's health without research to find out how to apply them within different health systems and diverse political and social contexts, thus ensuring that they reach those who need them the most.
"There is a sense that science can do more, especially for public health," said Dr. Lee Jong-wook, WHO director-general. "There is a gap between today's scientific advances and their application -- between what we know and what is actually being done. Health systems are under severe pressure and there is an urgent need to generate knowledge for strengthening and improving them."
A team of 12 internationally prominent health researchers in both developed and developing countries, coordinated by Dr. Tikki Pang, WHO director for research policy and cooperation, developed the 143-page World Report on Knowledge for Better Health over 18 months. Based on a wide-ranging consultative process and on previous reviews of global health research, the report advocates that health equity can only be achieved through better management of health research and increased investment in health systems research.
Health systems research suffers from a poor image and has been under-funded compared to biomedical research despite widespread recognition of its importance. The field attracts less than one tenth of 1 percent of total health expenditure in low-income countries.
The lack of attention given to this field is also reflected in the fact that only 0.7 percent of scientific articles published globally in the year 2000 were in the area of health systems research.
"It is extremely important to get this report out now. The report demonstrates the enormity and complexity of the problem and outlines a way to go forward," said Eva Harris, president of the Sustainable Science Institute based at the University of California, Berkeley. "It anticipates how the global community can get a handle on the problem in a constructive manner instead of lamenting a lack of action".
In Africa, for example, it is estimated that only between 2 percent and 15 percent of children slept under bed-nets in 2001 -- a simple, effective and proven method to prevent malaria. "We need to put a stronger emphasis on translating knowledge into actions -- health systems research will help us to bridge this know-do gap.' Also, that research is an investment, not a cost," said Pang.
The report also illustrates how health systems research can strengthen human resources for health, health financing as well as information and delivery of health services, with some projects already yielding impressive results. Among the research projects mentioned in the report is the Tanzania Essential Health Interventions Project (TEHIP) which was set up to find new ways to plan, set priorities and allocate resources as part of a major reform of the country's healthcare system. The aim was to evaluate the impact of health interventions in terms of burdens of disease and per capita cost.
Researchers found that in two Tanzanian districts, malaria alone accounted for 30 percent of all healthy years of life lost due to deaths in 1996-1997. In response, government planners increased the budget for malaria prevention and treatment programs from 10 percent to 26 percent by 2000-2001. Overall, the research has resulted in a better match between disease burden and health budget allocation, and the child mortality rate has been reduced by more than 40 percent since the late 1990s.
"Health systems should nurture a stronger culture of learning and problem-solving to tackle the major health challenges of our times," said Tim Evans, assistant director-general, WHO. "This could be achieved by understanding how elements within a health system interact with each other and by finding innovative ways to solve complex problems."
What is a health system?
A health system includes all actors, organizations, institutions and resources whose primary purpose is to improve health. In most countries a health system has public, private, traditional and informal sectors. Although the defining goal of a health system is to improve health, other goals are to be responsive to the population it serves. This responsiveness is determined by the environment in which people are treated, and should ensure that the financial burden of paying for health is fairly distributed. Four key functions determine the way inputs are transformed into outcomes that people value: resource generation, financing, service provision and stewardship. The effectiveness, efficiency and equity of national health systems are critical determinants of population health status.
Ministerial Summit on Health Research
Ministers of Health from more than 30 nations as well as representatives of research institutions, academia, non-governmental organizations, pharmaceutical companies and various key stakeholders in health/medical research will gather in Mexico City, Mexico, November 16-20, 2004, to address the vital role of research in strengthening health systems and how it can better serve the health needs of the global population. Hosted by the Government of Mexico and World Health Organization (WHO), the Ministerial Summit on Health Research will focus on the know-do gap - how to translate knowledge into action to improve health. The summit will also discuss research needed to achieve the health-related Millennium Development Goals (MDGs) by 2015.
By gathering a large number of key players in health research, the summit represents a unique opportunity to develop a platform of specific initiatives to strengthen health systems and to improve information access. The key recommendations of the Summit will be incorporated into the Mexico Agenda on Health Research.