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Improving health research
Correspondence
Improving health research Your Editorial “The state of health research worldwide” (Nov 1, p 1519)1 identifies three key gaps, including assessment of health programmes, that have hindered progress in health systems, policy, and health services and research. However, in relation to the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Editorial is misleading in asserting that “not once has there been an independent, full, and scientifically rigorous evaluation of its programme since it was created in 2002.” In October, 2003, the Global Fund Board mandated an independent Technical Evaluation Reference Group (TERG) comprising public-health experts appointed by the Board to oversee monitoring and assessment of activities and programmes financed by the Global Fund. Since 2004, TERG has commissioned a series of assessments addressing key elements of the Global Fund’s architecture and processes. These assessments, which are publicly available,2 have led to adjustments in Global Fund practices. Additionally, academic institutions and government agencies have undertaken assessments of the Global Fund’s activities and supported programmes. In November, 2006, less than 5 years after the creation of the Global Fund, the Global Fund Board decided to commission a substantial independent assessment under the oversight of the TERG. The TERG is currently overseeing this 5-year assessment of the Global Fund, which comprises three interlinked studies: examining organisational efficiency and effectiveness of the Global Fund; the effectiveness of its partner environment; and the combined effect on the reduction in the burden of the three diseases.3 The results of this significant effort will be available in Spring, 2009. TERG welcomes the commitment of the Global Fund to Fight AIDS, Tuberculosis and Malaria and encourages collaboration with external www.thelancet.com Vol 373 January 17, 2009
Technical Evaluation Reference Group, Global Fund to Fight AIDS, Tuberculosis and Malaria, 1214 Vernier, Geneva, Switzerland
have incorporated and housed it in the Netherlands. It is modelled on other national advisory bodies such as the US National Research Council and the UK Royal Society. It has already provided several independent policy advisory studies to the Secretary General of the UN on matters with important bases in science and technology. What is important is its independence from political influence from national or international political entities—something unavoidable in UN-housed or WHOhoused advisory bodies.
1
I declare that I have no conflict of interest.
institutions to monitor, assess, and research its functioning and effects. Additionally, the Global Fund encourages countries to request in their grant proposals monies to invest in strengthening country-level monitoring and assessment systems and to fund operational research.4 We declare that we have no conflict of interest.
*Rolf Korte, Rose Leke [email protected]
2
3
4
The Lancet. The state of health research worldwide. Lancet 2008; 372: 1519. The Global Fund evaluation library. http:// www.theglobalfund.org/en/library/ (accessed Nov 5, 2008). The five year evaluation of the Global Fund. http://www.theglobalfund.org/en/terg/5year/ (accessed Nov 5, 2008). Evans T, Nishat S, Atun R, Etienne C. Scaling up research and learning for health systems: time to act. Lancet 2008; 372: 1529–31.
Your Editorial on the state of health research worldwide1 raises several interesting points that merit further comment. Research indeed needs political traction, and institutions to create such traction, but my experience suggests that an institution based on the G8 model is not likely to be successful. The annual G8 host country chooses the political and policy agenda items for the meeting and invites its national science academies to weigh in on any relevant science and technology issues related specifically to that agenda. I doubt very much that the political leadership would be interested in providing a platform for their health research agencies of government or their independent science and medical academies to issue their own “research agenda” for the political leaders. There is a nascent approach which could speak to the first of your “key gaps”—ie, the independent assessment of health programmes. The globe’s national science, medicine, and engineering academies have established a young, international, independent science and technology advisory body called the InterAcademy Council and
The printed journal includes an image merely for illustration
David R Challoner drc@ufl.edu University of Florida, Gainsville, FL 32610, USA 1
The Lancet. The state of health research worldwide. Lancet 2008; 372: 1519.
The Lancet’s call for a G8 for research (R8)1 is welcome. In a review of the current state of neurology in Africa, for example, Owolabi and colleagues2 detailed the appalling state of research facilities, which has in turn led to poor contributions from Africa to the frontiers of neurology. The poor state of neurological research mirrors the current state of research in all health fields in Africa and other resourcepoor nations. An institution such as R8 should work closely with regional organisations such as the African Union to ensure a progressive reduction of the disease burden in these countries. That the Global Ministerial Forum on Research for Health was held in Bamako, Mali, is historic. In 1987, Bamako hosted a meeting of African Health Ministers where the Bamako Initiative, incorporating strategies to increase the availability of essential drugs and other health-care services for sub-Saharan Africans, was adopted. One hopes that political leaders now move from rhetoric to concrete actions geared at improving global access to quality research funding, facilities, and institutional support. African political leaders need to use the African Union and similar platforms to strengthen 213
Improving health research Your Editorial “The state of health research worldwide” (Nov 1, p 1519)1 identifies three key gaps, including assessment of health programmes, that have hindered progress in health systems, policy, and health services and research. However, in relation to the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Editorial is misleading in asserting that “not once has there been an independent, full, and scientifically rigorous evaluation of its programme since it was created in 2002.” In October, 2003, the Global Fund Board mandated an independent Technical Evaluation Reference Group (TERG) comprising public-health experts appointed by the Board to oversee monitoring and assessment of activities and programmes financed by the Global Fund. Since 2004, TERG has commissioned a series of assessments addressing key elements of the Global Fund’s architecture and processes. These assessments, which are publicly available,2 have led to adjustments in Global Fund practices. Additionally, academic institutions and government agencies have undertaken assessments of the Global Fund’s activities and supported programmes. In November, 2006, less than 5 years after the creation of the Global Fund, the Global Fund Board decided to commission a substantial independent assessment under the oversight of the TERG. The TERG is currently overseeing this 5-year assessment of the Global Fund, which comprises three interlinked studies: examining organisational efficiency and effectiveness of the Global Fund; the effectiveness of its partner environment; and the combined effect on the reduction in the burden of the three diseases.3 The results of this significant effort will be available in Spring, 2009. TERG welcomes the commitment of the Global Fund to Fight AIDS, Tuberculosis and Malaria and encourages collaboration with external www.thelancet.com Vol 373 January 17, 2009
Technical Evaluation Reference Group, Global Fund to Fight AIDS, Tuberculosis and Malaria, 1214 Vernier, Geneva, Switzerland
have incorporated and housed it in the Netherlands. It is modelled on other national advisory bodies such as the US National Research Council and the UK Royal Society. It has already provided several independent policy advisory studies to the Secretary General of the UN on matters with important bases in science and technology. What is important is its independence from political influence from national or international political entities—something unavoidable in UN-housed or WHOhoused advisory bodies.
1
I declare that I have no conflict of interest.
institutions to monitor, assess, and research its functioning and effects. Additionally, the Global Fund encourages countries to request in their grant proposals monies to invest in strengthening country-level monitoring and assessment systems and to fund operational research.4 We declare that we have no conflict of interest.
*Rolf Korte, Rose Leke [email protected]
2
3
4
The Lancet. The state of health research worldwide. Lancet 2008; 372: 1519. The Global Fund evaluation library. http:// www.theglobalfund.org/en/library/ (accessed Nov 5, 2008). The five year evaluation of the Global Fund. http://www.theglobalfund.org/en/terg/5year/ (accessed Nov 5, 2008). Evans T, Nishat S, Atun R, Etienne C. Scaling up research and learning for health systems: time to act. Lancet 2008; 372: 1529–31.
Your Editorial on the state of health research worldwide1 raises several interesting points that merit further comment. Research indeed needs political traction, and institutions to create such traction, but my experience suggests that an institution based on the G8 model is not likely to be successful. The annual G8 host country chooses the political and policy agenda items for the meeting and invites its national science academies to weigh in on any relevant science and technology issues related specifically to that agenda. I doubt very much that the political leadership would be interested in providing a platform for their health research agencies of government or their independent science and medical academies to issue their own “research agenda” for the political leaders. There is a nascent approach which could speak to the first of your “key gaps”—ie, the independent assessment of health programmes. The globe’s national science, medicine, and engineering academies have established a young, international, independent science and technology advisory body called the InterAcademy Council and
The printed journal includes an image merely for illustration
David R Challoner drc@ufl.edu University of Florida, Gainsville, FL 32610, USA 1
The Lancet. The state of health research worldwide. Lancet 2008; 372: 1519.
The Lancet’s call for a G8 for research (R8)1 is welcome. In a review of the current state of neurology in Africa, for example, Owolabi and colleagues2 detailed the appalling state of research facilities, which has in turn led to poor contributions from Africa to the frontiers of neurology. The poor state of neurological research mirrors the current state of research in all health fields in Africa and other resourcepoor nations. An institution such as R8 should work closely with regional organisations such as the African Union to ensure a progressive reduction of the disease burden in these countries. That the Global Ministerial Forum on Research for Health was held in Bamako, Mali, is historic. In 1987, Bamako hosted a meeting of African Health Ministers where the Bamako Initiative, incorporating strategies to increase the availability of essential drugs and other health-care services for sub-Saharan Africans, was adopted. One hopes that political leaders now move from rhetoric to concrete actions geared at improving global access to quality research funding, facilities, and institutional support. African political leaders need to use the African Union and similar platforms to strengthen 213