Access to new interventions
Implementation research key to access to disease interventions
Research on how to translate scientific and medical advances into effective and accessible health interventions is crucial to the drive against diseases of poverty such as dengue and malaria. A new initiative aims to boost such implementation research and to spread its benefits to those who need it most.
TDR in conjunction with the Ugandan Ministry of Health organized a meeting in Kampala 28-30 June on the use of implementation research (IR) to increase access to improved tools against infectious diseases and map existing and new strategies. Lack of access to these tools and interventions is currently a major barrier to better health and healthcare and the achievement of the Millennium Development Goals to cut infant and maternal mortality, malaria and other diseases of poverty.
Nearly 70 researchers, implementers, scientists and representatives from Product Development Partnerships (PDPs) attended the consultation, which centred on a planned report identifying gaps and priorities in implementation research into diseases of poverty.
Challenges and achievements
TDR has long championed implementation research because it provides maximum benefit for end users at minimum cost. For instance, implementation research led to successful community-directed treatment for onchocerciasis (river blindness) and the development of unit-dose blister packs for easy home use of antimalarials.
Dr Sabine Beckmann, senior programme adviser in the Global Fund/Global Health Partnerships cluster at the UN Development Program, one of TDR's co-sponsors, said that it is not enough simply to develop and provide new health interventions. For instance, bed-nets must be used in a certain way and so distribution must go hand in hand with behavior change strategies, she said in an interview with TropIKA.net ahead of the meeting. Implementation research is vital to provide evidence and cost- effective strategies and help prevent stock-outs, wastage, spoilage and drug resistance, said Beckmann.
"In other words, it’s not enough to just have a medical or technical solution. It’s never just about giving out a drug. There really needs to be hands-on guidance on how to implement a programme," said Beckmann, who chaired the opening plenary sessions at the Kampala meeting.
The TropIKA.net website created a dedicated 'Knowledge Hub' about the access initiative with opinion pieces from experts in health systems research, and full coverage of the consultation.
“For implementation research to achieve results, the global IR community must improve its co-ordination, strengthen partnerships with health systems, and create more opportunities for cross-learning and transparency,” said Dr Jane Kengeya-Kayondo, TDR’s Coordinator of Strategic Alliances. Successful research must cut across public and private sectors, using an interdisciplinary approach, and take into account the local context of the health system and political commitment, she said.
Dr Soumya Swaminathan, TDR's Co-ordinator for Research on Neglected Priorities, said the highest levels of government in many countries still did not recognize the value of health research. Consequently, scientific advances had not been translated into health impacts, particularly for the most vulnerable sectors of society namely women and children.
This was reinforced by Dr Walter Flores, Director of the Center for the Study of Equity and Governance in Health Systems in Guatemala who said that many countries did not view implementation research as research. “Consequently, they provide little funding which results in most of this research being conducted by NGOs. There’s an important need to advocate for implementation research with ministries of health and donors.”
The debates at the consultative meeting highlighted other gaps and needs that have obstructed implementation research or blunted its impact. These included:
•ethical issues and private/public collaborations that reduce public access to products;
•the inadequacy of the “pipeline approach” in translating research findings into meaningful results;
•the dearth of awareness and funding for implementation research in many countries, and the lack of a central database;
•community-level resistance to coordination among a diverse set of stakeholders;and the weak links between institutes of higher learning and ministries of health.
Commissioner Dr Henry Mwebesa of the Ugandan Ministry of Health said the lessons learned from the meeting would be incorporated into the health department’s third strategic plan. He said the government was committed to supporting research initiatives and that the evidence generated through research would guide the government’s future health interventions. He also announced the establishment of the Uganda National Health Research Organization.
The discussions at the meeting will feed into a planned report which will have ten chapters and revolves around the following broad areas:
Part I. Introduction and conceptual framework. This will address the critical challenges and opportunities that access and delivery of new/improved tools, strategies and interventions face in improving the health of the poor, and the role of implementation research in addressing them. It will present a framework to analyse architecture, availability, affordability and adoption applied to both innovative products and strategies. It will also propose a framework to address the reciprocal challenges that health systems strengthening and improved tools, strategies and interventions place on each other.
Part II. Available concepts and methods. This will identify implementation research from the perspective of actors working in tools, strategies and interventions development and implementing them in health systems and disease control programmes. Chapters include one on patient safety and counterfeit and substandard medicines. Perspectives will be illustrated with case studies to show how implementation research on access and delivery is making a difference in real life.
Part III. Way Forward. This will include overviews of concept and methods on implementation research for access and delivery, characteristics of research platforms and programs, approaches for the uptake of research results and their use in evidence-based decision-making. It will make suggestions for appropriate research governance and oversight. It will outline a real-life way forward highlighting critical points in the development and implementation chain on the basis of which to identify a global findings on implementation research.
Conclusions and Findings. The key messages from each chapter will be pulled together to support the findings of the report.
The draft report will be presented at into the Global Symposium on Health Systems Research taking place in Montreux, Switzerland from 16 to 19 November 2010. It will also be used as a resource for TDR's Global report for research on infectious diseases of poverty which will identify gaps and priorities in international research and is due for publication in June 2011.
Dr. Jane Kengeya Kayondo