The Road to Bamako

1. The Road to Bamako Tim Evans Assistant Director General, WHO Scaling Up Research and Learning for Better Health Divonne, June 2, 2008

2. Overview • The historical context • The value of research • Some important antecedents • The "Call to Action" • The Ministerial Discussions

3. The value of research The health research system is the brains of the health system: it is a tool to organize, understand, operate and improve it Prawase Wasi

4. Value of Research for Health • Describe the health situation • Discover the causes of ill-health • Development of solutions • Delivery of solutions • Determine impact

5. Understand causes of the problem – determinants Measurement of the problem – diagnosis Research on neglected priority needs Evaluation of the impact of the solution Development of solutions Translation and delivery of the solution WHO Research for Health Strategyframework for research priorities WHO research priorities framework identifies 5 types of research that are pertinent to any given health need.

6. Commission on Health Research for Development (1990) : Action Agenda • Essential national health research (ENHR) in every country • International partnerships • Capacity building • More financial resources for health research • Mechanisms to monitor progress and generate support

7. Ad Hoc Committee on Health Research Relating to Future Intervention Options (1996) : • R&D priorities … "Best Buys" • Products for neglected diseases • Child and maternal health • Microbial threats • Non-communicable diseases and injuries • Health care systems

8. International Conference on Health Research for Development, Bangkok (2000) : Key challenges for health research • Adherence to values of ethics, equity and excellence • Sustainable health research systems • Favorable research environment • Knowledge production and application

9. Ministerial Summit on Health Research, Mexico (2004) : Key messages • More investments in health systems research • Better management of health research • Secure public confidence in science • Stronger emphasis on turning knowledge into actions to improve people's health

10. 58th World Health Assembly, Geneva, May 16-25, 2005

11. The Bamako Call to Action • Based on consultations in all WHO regions in 2007/2008 • Reflects: • the WHO Research Strategy • The World Health Assembly approved Global Strategy and Plan of Action on Public Health Innovation and Intellectual Property • Identifies priority directions for research policy • Both the "what" and the "how" • Priority areas of focus • Capacities • Standards - • Translation • Will be further revised over the next three days of Ministerial discussions

12. Ministerial Discussions Agenda • Day 1 – Monday 17 November • Session 1 – • Introductions • Overview • Report of WHO/AFRO Consultation in Algiers • Session 2 – • Reports from other regional consultations • Overview of the Call to Action

13. Ministerial Discussions (cont'd) Day 2, Tuesday November 18 • 3 sessions • Focus: • a broad topical area of research • Presentation: • Brief overview • Panelists: • to provide inputs from Forum parallel sessions • Moderated discussion: • " how can countries and international partners work more effectively on these issues? "

14. Ministerial Discussions (cont'd) • Session 3 - 11:00-12:30 • Research for Health Product Innovation • Session 4 - 13:50- 15:50 • Research for Global Health Security • Session 5 - 16:20 – 18:20 • From Global Health Initiatives to Primary Health Care: Scaling up Research and Learning for Health Systems

15. Research for Health Product Innovation • Longstanding focus of recommendations and action • WHO Special Program on Tropical Disease Research 1976 • Concerns in 1990s… • "dry pipelines"; "market failures" • Major global response: • Product-development partnerships - many! • Reconsidering rules and incentives • WTO/TRIPS – public health considerations • Advanced market commitments • Commission on Public Health Innovation and Intellectual Property followed by Intergovernmental Working Group, Global Strategy and Plan of Action 2008

16. 2003 Map of Initiatives Addressing Communicable Diseases

17. IGWG on Public Health Innovation and Intellectual PropertyGlobal Strategy and Plan of Action, May 2008

18. Research For Global Health Security • A relatively new and quickly growing focus of research • Reflects complex health challenges that are often driven by globalization: • Unpredictable crises/threats • pandemics, humanitarian, food, energy, and financial • Largely predictable challenges - • NCDs, social determinants of health, aging, lifestyle behaviors • Demands research response that is cross-sectoral and cross-border and fast!

19. Commission on Social Determinants of Health Overarching Recommendations 1. Improve Living Conditions 2. Tackle the Inequitable Distribution of Power, Money, and Resources 3. Measure and Understand the Problem and Assess the Impact of Action.

20. From Global Health Initiative to Primary Health Care: Scaling up Research and Learning for Health System • Specific focus of progress from Mexico Summit 2004 • Reflects growing policy interest in health systems e.g. G8, UNGASS • Draws on 12 parallel and special sessions of Bamako forum related to health systems research • Recommendations from WHO High Level Task Force

21. Common systems constraints to scale up services for HIV, TB, malaria, and immunization HIV/UA assessment report Global Plan to stop TB World Malaria report GAVI/Norad report • Inadequate financing • HR crisis • Affordable commodities • Stigma, discrimination… • Accountability • Partnership alignment • Inadequate financing • Laboratory capacity • HR crisis • Quality drugs • HR crisis • Inadequate financing • Leadership and • management • Inter-agency • coordination • Drug efficacy • Information system • Inadequate financing • HRH and Community services • M&E

22. C. Research for Primary Health Care

23. Ministerial Discussion (cont'd) Day 3 19 November 11:00 – 12:30 Final review of the Call to Action 13:50- 15:5- Reading of the Call to Action in the plenary