Aziza Sayed Omar MD
Outline • WHY prioritize for Research development? • WHO does the prioritization? • WHAT areas are prioritized? • HOW are these prioritizations accomplished? • “Take home” messages
Health Research &Development: A Global Imperative 1.Population:The most Vluable Asset of a country. 2.Value of the Asset is measured by its Health Status. 3.Health Status depends on many determinants. 4.With unlimited resources, we could act on all determinants. 5.Resources being limited, we have to select the determinants which have the greatest impact on health. 6.Only through research can a country identify the key determinants for the health of the country. 7.Condition of success : Keep research out of isolation.
Why Prioritise a Research Agenda Limited RESOURCES Balance interest of costituencies Coordination amongst players Local requirements Tool development vs.implementation Levels of intervention
Participants in Setting Priorities Communities (Health Perception and Needs)
Researchers (multidisciplinary) World Health Organization
Policy and Decision makers (Health Experts)
Fields of Health Research Biomedical issues 2. Behavioural and Community issues 3. Sectors outside Health with profound influence on health 4. Good governance issues affecting health research 1.
Priority Setting Process Problem definition Identification of stakeholders Description of an “ideal” control situation Identification of literature of research Description of information gaps Review of institutional comparative advantage Matching requirements of other programms
The <Five Steps>in priority setting Magnitude (what is the burden of the disease) Determinants (why does the burden of disease persist)
Knowledge today (what is known today about existing
interventions, how cost-effective are they) Cost-effectiveness of future interventions Investments (what are the resource flows for that
disease/risk factor).
“” SELECTION OF TOPICS FOR RESEARCH
Scales for Rating Research Topics 1. 2. 3. 4. 5. 6. 7. 8. 9.
Interest Relevance Avoidance of duplication Feasibility Political acceptability Applicability Cost-effectiveness Ethical considerations Timeliness
World Health Organization
Each parameter score 1-3 Priority Scale: • >19 High • 10-18 Moderate • <10 Low
Priority Ratings for Research Topics 1. Interest -
How much interest the researcher has in the topic!
2. Relevance – How big is the problem? (Magnitude or burden of disease) – Who is affected? (Demographic profile) – How severe is the problem? (Mortality and Morbidity)
3. Avoidance of duplication – What are the questions that deserve further investigation? World Health Organization
Priority Ratings for Research Topics (Cont.2)
4. Feasibility - Resources required to carry out the project. (manpower, time, equipment, money)
5. Political acceptability - Support of the authorities, policy makers, & society 6. Applicability - Applicability at local level. World Health Organization
Priority Ratings for Research Topics (Cont.3)
7. Cost-effectiveness -
Whether the resources invested in the study are worthwhile given the expected results!
8. Ethical considerations - Ensure respect of humanity, beneficence and equity
9. Timeliness - Solutions to a current burning problem! World Health Organization
Burden of disease â&#x20AC;˘ A specialised area of research that quantifies ill-health, by measuring and analysing the extent and causes of health problems. Together with evaluations of cost-effectiveness, burden of disease provides the information policy makers need to help them make decisions. World Health Organization
â&#x20AC;˘ Global Burden of Disease analysis provides a comprehensive and comparable assessment of mortality and loss of health due to diseases, injuries and risk factors for all regions of the world. The overall burden of disease is assessed using the disability-adjusted life year (DALY), a time-based measure that combines years of life lost due to premature mortality and years of life lost due to time lived in states of less than full health. World Health Organization
Classical Measurements of Disease Burden • • • • • •
Incidence rate. Prevalence rate. Mortality rate. Case fatality rate / ratio. Survival rate. Trends in mortality and morbidity
World Health Organization
Difference Between Prevalence & Incidence Rates â&#x20AC;˘ Prevalence: Number of cases of a disease in a defined population at a givin time. Number of people with the disease or condition at a specified time
P=
------------------------------------------------------------------------------------------------
(x10n)
Number of people in the population at risk at the specified time
â&#x20AC;˘ Incidence: Number of new cases arising in a given period in a
specified population. Number of people who get a disease or condition at a specified period
I=
----------------------------------------------------------------------------------------- -------------------------
Sum of the length of time during which each person in the population is at risk
World Health Organization
(x10n)
Mortality & Fatality Rates â&#x20AC;˘ Mortality rate: Number of deaths in a specified period of time, divided by the total population at risk. Number of deaths in a specified time MR = ----------------------------------------------------------------------- (x10n) Average total population at risk in the same time â&#x20AC;˘ Case fatality rate: The proportion of cases or condition which are
fatal within specified time. (measure of disease severity) Number of deaths from a disease in a specified period CFR = -------------------------------------------------------------------------------------- (x10n) Number of diagnosed cases of the disease in the same time World Health Organization
(Indicators of Health Level)
Infant and Maternal Mortality Rates â&#x20AC;˘ Infant mortality rate: It measures the death rate in children during the first year of life. Number of infant (<1 year) deaths in a year IMR = ------------------------------------------------------------------ (x10n) Number of live births in the same year â&#x20AC;˘ Maternal mortality rate: It measures maternal deaths related to
maternal pregnancy. Maternal pregnancy-related deaths in one year MMR = ---------------------------------------------------------------------- (x10n) Total births in the same year World Health Organization
The Research Loop 1.Creation of knowledge 2.Validation of knowledge 3.Transformation into best practices 4.Dissemination 5.Identification of gaps and development of initiatives to fill the gaps 6.Development of indicators to measure impact on health status 7.Feedback on orientation and design of future researchfocus on the weakest link/s
Communication and Information Special Reports Web Site Strategic Papers Work with the media Communication with Decision Makers
Conclusions Identifying priorities is an important as conducting
research itself The process is a critical part The methods presented here are tools Consider a wide variety of areas including conditions and risk factors
Take Home Messages “… priority-setting is a complex interaction of various
decisions at diverse levels… There is no self obvious set of ethical principles or scientific tools to determine what decisions we should take at various levels … nor is there an easy or obvious way to resolve the dilemma of the increasing gap between what we can and would like to do on one hand and the resources on the other Priority-setting is a political process which involves bargaining between different lobbies, modified by shifting political judgments made in the light of changing pressures.
REMEMBER
TEAM= T= Together
E= Everyone A=Achieve M= More