An overview on health research in the Eastern Mediterranean Region
June 10th, 2014
34 slides
The status of health research in the key priority areas across the region is not satisfactory.
There are critical deficits in: stewardship; translation of research into policy and practice; and often research agenda.
These problems are mainly attributable to the weak political and subsequently financial support available to health research systems.
Main message
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Publication in selected key priority areas from 2007-2012
Equity in access
Maternal health
Child health Tobacco Obesity Diabetes Breast
cancer HIV/AIDS Malaria Polio Influenza ARI
Afghanistan 20 26 231 11 3 4 3 43 53 58 10 3Bahrain 1 7 92 6 27 39 6 3 8 0 2 0Djibouti 0 0 21 4 1 2 0 5 7 0 2 0Egypt 11 200 2096 54 170 448 226 78 41 10 132 1Iran 18 409 4288 131 499 1337 490 365 161 17 116 271Iraq 11 34 323 13 20 55 20 18 10 0 8 1Jordan 7 57 576 33 60 132 62 29 2 1 17 2Kuwait 1 31 336 9 79 163 62 15 6 2 11 0Lebanon 9 76 788 47 107 140 110 84 9 2 23 1Libya 0 4 83 0 6 24 12 18 2 0 1 0Morocco 3 32 415 15 33 73 43 39 19 0 13 2Oman 1 30 271 10 39 99 18 16 7 1 12 0Pakistan 26 284 1551 113 99 351 118 173 115 84 32 2Palestine 0 12 90 4 12 29 1 3 1 1 1 0Qatar 1 19 168 10 36 92 12 10 5 1 4 1Saudi Arabia 6 140 1834 46 219 490 153 66 32 8 80 3
Somalia 2 9 53 1 1 6 0 10 15 4 1 0
Sudan 7 52 339 22 19 32 19 44 161 9 6 0
Syrian Arab Republic 1 9 52 15 10 10 6 0 0 0 0 0
Tunisia 0 56 912 51 95 230 117 39 6 5 12 0
United Arab Emirates 1 32 248 22 63 138 29 24 10 2 9 0
Yemen 1 16 121 11 5 14 17 10 23 3 4 1
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Quantity of research, by means of number of publications, in each priority area is not satisfactory to fill the knowledge gap.
Composition of Systematic Review, Health Service Research and Clinical Trials in the region, 2007-2012.
92.6%
5.1%
1.2%
1.1%Other
Clinical trial
Systematic review
Health Service Research
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H-index of publications (1996 -2012) by countries group
Brazil
Turkey
Saudi Arabia
United Arab Em
irates
Qatar
Iran (Islamic Republic of)
Tunisia
Morocco Ira
qLibya
PakistanYemen
Djibouti
South Sudan
0
25
50
75
100
125
150
175
200
Source: The SCImago Journal & Country Rank, the Scopus® database (Elsevier B.V.), (http://www.scimagojr.com/index.php), Nov, 2013.5/23
AmericaEuropeWestern Pacific South-East AsiaEastern MediterraneanAfrica
Source: Røttingen JA, et al. Lancet. 2013 Oct 12;382(9900):1286-307.
Share of the region in the on-going clinical trials
20500; 24.9%
43880; 53.4%
13280; 16.1%
2080; 2.5%
1100; 1.3%
1400; 1.7%
Clinical Trials
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EMRO is even lagging behind AFRO in number of registered clinical trials.
Number of patent applications registered in medical technology, biotechnology and
pharmaceuticals, 1997 - 2011Saudi Arabia
Kuwait
Qatar
Egypt
Tunisia
Morocco
Libya
Pakistan
Sudan
Djibouti
South Sudan0
5001000150020002500300035004000
Total of 5753 for15 years
383.5 per year
Source: The World Intellectual Property Organization (WIPO) (http://www.wipo.int/about-wipo/en/), Nov, 2013.7/23
The published papers seem to lack the answers to the very needs of the health priority areas by means of:
Quantity; Relevance; and Type.
A large proportion of the region’s research do not result in tangible outputs (product manufacture and/or decision-making).But contradictory to this discouraging state of affairs, there are some opportunities still remain.
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AmericaEuropeWestern Pacific South-East AsiaEastern MediterraneanAfrica
Publication in Medicine by WHO regions
212,898
241,546
56,75711,734
6,1114,123
2002
Source: The SCImago Journal & Country Rank, the Scopus® database (Elsevier B.V.), (http://www.scimagojr.com/index.php), Nov, 2013.9/23
In 2002, the region’s share was 6111 articles.
AmericaEuropeWestern Pacific South-East AsiaEastern MediterraneanAfrica
Publication in Medicine by WHO regions
300,220
329,019
148,90724,430
12,4219,195
2007
212,898
241,546
56,75711,734
6,1114,123
2002
Source: The SCImago Journal & Country Rank, the Scopus® database (Elsevier B.V.), (http://www.scimagojr.com/index.php), Nov, 2013.
More than 2 times
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This was doubled and reached 12421 after 5 years in 2007
AmericaEuropeWestern Pacific South-East AsiaEastern MediterraneanAfrica
Publication in Medicine by WHO regions
212,898
241,546
56,75711,734
6,111
4,123
2002
357,821
367,895
173,946
37,532
35,940
13,537
2012
Source: The SCImago Journal & Country Rank, the Scopus® database (Elsevier B.V.), (http://www.scimagojr.com/index.php), Nov, 2013.
Almost 6 times
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In 2012 the number of articles has grown by almost 6 times compared to 2002.
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0
100
200
300
400
500
600
700
800
900
1000
LebanonJordanUnited Arab Emirates Kuwait Qatar IraqOmanSudanSyrian Arab Republic
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
Iran (Islamic Republic of)EgyptSaudi ArabiaPakistanTunisiaMorocco
Trend of publication in medicine by the EMR countries
All the countries have had considerable Rises in their publications.
More than 1000 publications/year
200 -1000 publications/year
To support health care programs through sustainable health research systems and develop necessary capacities for generation of appropriate knowledge and its utilization towards improved health.
Mission statement
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To support health care programs through sustainable health research systems and developing necessary capacities for generation of appropriate knowledge and its utilization towards improved health.
Stewardship
Production and utilization of
research
Resources
Financing
Source: Pang T, Sadana R, Hanney S, Bhutta ZA, Hyder AA, Simon J. Knowledge for better health: a conceptual frame- work and foundation for health research systems. Bulletin of the World Health Organization, 2003, 81(11):815–820.
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•through sustainable and transparent processes for mobilizing and allocating funds for research
Financing
•generation of scientifically valid research findings that respond to health challenges, and allow for translation into new tools (e.g. drugs, vaccines) and policies.Production and
utilization of research
•human and institutional capacity to support research work
Resources
Stewardship • provision of leadership to direct, coordinate, manage and review research
Source: Pang T, Sadana R, Hanney S, Bhutta ZA, Hyder AA, Simon J. Knowledge for better health: a conceptual frame- work and foundation for health research systems. Bulletin of the World Health Organization, 2003, 81(11):815–820.
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Financing
Production and
utilization of research
Resources
Stewardship
AmericaEuropeWestern Pacific South-East AsiaEastern MediterraneanAfrica
Financial investment in R&D and health research
30.2%
28.7%
25.0%
8.7%
4.6%2.7%
Gross Income
Source: World Health Organization, Global Health Observatory Data Repository. http://apps.who.int/gho/data/view.main.GNI2020?lang=en (Nov 24, 2013).
Financing
Production and
utilization of research
Resources
Stewardship
4.6% of the world’s financial resources are produced in this region.
AmericaEuropeWestern Pacific South-East AsiaEastern MediterraneanAfrica
Financial investment in R&D and health research
35.8%
28.9%
30.6%
2.9%
1.1%
0.8%
Gross domestic expend on R&D (GERD)
30.2%
28.7%
25.0%
8.7%
4.6%2.7%
Gross Income
25%of the proportional
ity
Source: World Health Organization, Global Health Observatory Data Repository. http://apps.who.int/gho/data/view.main.GNI2020?lang=en (Nov 24, 2013).Røttingen JA, et al. Lancet. 2013 Oct 12;382(9900):1286-307.
Data for 15 countries are based
on modeling
Source: World Health Organization, Global Health Observatory Data Repository. http://apps.who.int/gho/data/view.main.GNI2020?lang=en (Nov 24, 2013).Røttingen JA, et al. Lancet. 2013 Oct 12;382(9900):1286-307.
Financing
Production and
utilization of research
Resources
Stewardship
The share of research resources in the region is 1.1%.
AmericaEuropeWestern Pacific South-East AsiaEastern MediterraneanAfrica
53.7%
27.0%
15.8%2.3%
0.6%
0.5%
Health Research budget
Financial investment in R&D and health research
30.2%
28.7%
25.0%
8.7%
4.6%2.7%
Gross Income
14% of the proportional
ity
Source: World Health Organization, Global Health Observatory Data Repository. http://apps.who.int/gho/data/view.main.GNI2020?lang=en (Nov 24, 2013).Røttingen JA, et al. Lancet. 2013 Oct 12;382(9900):1286-307.
Data for all countries are based
on modeling
Source: World Health Organization, Global Health Observatory Data Repository. http://apps.who.int/gho/data/view.main.GNI2020?lang=en (Nov 24, 2013).Røttingen JA, et al. Lancet. 2013 Oct 12;382(9900):1286-307.
Financing
Production and
utilization of research
Resources
Stewardship
The budget share of health research is 0.6% .
Trend of investment on GERD/GDP
Expenditure on research does not exceed 0.3% of GDP, 97% of which comes from government sources.
Source: UNESCO Science Report, 2010. http://unesdoc.unesco.org/images/0018/001898/189883E.pdf.
1.25
2009
1996
0.03
Financing
Production and
utilization of research
Resources
Stewardship
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R&D investment was 0.03% in Tunisia in 1996, but had crossed 1% in 2000.
The countries’ plan in R&D investmentin all areas –not specific to health
Expenditure on research does not exceed 0.3% of GDP, 97% of which comes from government sources.
Source: UNESCO Science Report, 2010. http://unesdoc.unesco.org/images/0018/001898/189883E.pdf.
3.0
2016
Financing
Production and
utilization of research
Resources
Stewardship
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Iran has a Five-Year Plan to reach 3%
The countries’ plan in R&D investmentin all areas –not specific to health
Trend of investment on GERD/GDP
Expenditure on research does not exceed 0.3% of GDP, 97% of which comes from government sources.
Source: UNESCO Science Report, 2010. http://unesdoc.unesco.org/images/0018/001898/189883E.pdf.
2.8
2011
Financing
Production and
utilization of research
Resources
Stewardship
15/23
The countries’ plan in R&D investmentin all areas –not specific to health
Qatar had a plan in which this figure was to reach 2.8% in 2011
Expenditure on research does not exceed 0.3% of GDP, 97% of which comes from government sources.
Source: UNESCO Science Report, 2010. http://unesdoc.unesco.org/images/0018/001898/189883E.pdf.
1.0
2012
Financing
Production and
utilization of research
Resources
Stewardship
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The countries’ plan in R&D investmentin all areas –not specific to health
Egypt had targeted 1% by 2012
Expenditure on research does not exceed 0.3% of GDP, 97% of which comes from government sources.
Source: UNESCO Science Report, 2010. http://unesdoc.unesco.org/images/0018/001898/189883E.pdf.
Financing
Production and
utilization of research
Resources
Stewardship
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The countries’ plan in R&D investmentin all areas –not specific to health
Many countries have shown their interest in greater investments in R&D.
Number of academic institutions in health by countries group
Saudi Arabia
Bahrain
Kuwait
Egypt
Libya
Lebanon
Jordan
Palestine
Pakistan
Afghanestan
Somalia
05101520253035404550
Source: University of Copenhagen. The Avicenna Directory for medicine. http://avicenna.ku.dk/database/medicine/(Nov, 2013).
Financing
Production and
utilization of research
Resources
Stewardship
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Pakistan, Iran, Sudan, Egypt and Saudi Arabia have the highest numbers of institutes.
0 10 20 30 40 50 60 700
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
Chart Title
Number of academic institutions in health vs publication in 2012
Pakistan
Sudan
Pub
licat
ion
in 2
012
Number of academic institutions
Financing
Production and
utilization of research
Resources
Stewardship
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Pakistan and Sudan academic institutions haven’t had as many publications as expected.
Human capital: skilled migration among countries of the region(2006 estimate by World Bank)
Turkey
Brazil
Kuwait
Qatar
Saudi Arabia
Morocco Ira
q
Palestine
Egypt
Afghanistan
Djibouti
Yemen
0%
5%
10%
15%
20%
25%
30%
Source: Measuring international skilled migration. Michel Beine, Frédéric Docquier and Hillel Rapoport, July 2006. (World Bank contract PO. 7641476)
Financing
Production and
utilization of research
Resources
Stewardship
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The emigration rate is high in group 2 and 3 countries.
Human capital: skilled migration among countries of the region(2006 estimate by World Bank)
Turkey
Brazil
Kuwait
Qatar
Saudi Arabia
Morocco Ira
q
Palestine
Egypt
Afghanistan
Djibouti
Yemen
0%
5%
10%
15%
20%
25%
30%
Source: Measuring international skilled migration. Michel Beine, Frédéric Docquier and Hillel Rapoport, July 2006. (World Bank contract PO. 7641476)
A report by the International Monetary Fund in 2009 indicated that Iran tops the list of countries losing their academic elite, with an annual loss of 150,000 to 180,000 specialists. It's equivalent to a capital loss of $50 billion.
Financing
Production and
utilization of research
Resources
Stewardship
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2003 2005 2009
Djibouti
Somalia
Egypt Iran Morocco
Sudan
Bahrain
Jordan
Kuwait
Lebanon
Oman
Qatar
Saudi
Arabia
Tunisia
UAE
Yemen
Afghanistan
Iraq Pakistan
Palestine Syria
Formal NHRS structure
Data is not
available
Health research priorities
2009
Health research policy/plan
NHRS Monitoring and evaluation
Result of National Health Research Systems (NHRS) assessment in the countries of the region
Sources: A study of national health research systems in selected countries of the WHO EMR. Cairo World Health Organization’s Regional Office for the Eastern Mediterranean, 2004.Kennedy A, et al. East Mediterr Health J. 2008 May-Jun;14(3):502-17.Ghannem H., et al. East Mediterr Health J. 2011 Mar;17(3):260-1.
6 did not have structure
9 were not functional
10 did not have all componentsFinancing
Production and
utilization of research
Resources
Stewardship
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Based on the numbers of registered clinical trials and patents it can be induced that studies that lead to the manufacture of tangible products are not well-grounded in the region.
The few studies that have been conducted across the region indicate that research evidence does not influence decision-makings much.
Absence of data on health-specific research financial investment.
Investment in health research has remained low. However, there is a political will in several countries to increase their GERD.
More effective stewardship is required for the region’s health research systems.
Conclusions
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We need better research and research done for the right
reasons
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Global Monitoring Framework9 global voluntary targets for 2025
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Five areas: Epidemiology and burden Governance for NCD Prevention and reduction of risk factors Health system response
Implementing priority interventions Improving access
Surveillance, monitoring and evaluation
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What are the barriers, and potential solutions of inter-sectoral collaboration on NCD?
What is the situation of political economy of healthy vs.unhealthy nutrition? What measures can be considered for improving situation of access and utilization of healthy foods?
What are the actual impacts of priority interventions on risk factor levels and global risk profile distribution?
What are the impacts of community health workers on NCD prevention and control?
What is the impact of patient education on improving adherence and strengthening the self-care?
NCD research priorities
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Which social groups are most adversely affected by NCD and its risk factors and determinants?(upgrading STEPS with appropriate questions and methods of analysis in this regard)
Are people at high risk of cardiovascular disease receiving recommended drug therapy and counseling?
What are the health system-related barriers to access NCD services in primary health care?
What are the practices of delivery of evidence-based NCD interventions at primary health care level?
Are evidence-based guidelines being applied to guide utilization of high-tech approaches (for example coronary revascularization)?
Country specific
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IRA-28
IRA-23
IRA-25
IRA-26
JOR-11
LEB-4
PAK-13
IARC
EMRAIN
EMPHNET
DCPN
AHPSR
AGKU
1 Inter-sectoral collaboration √ √ √ √ 2 Political economy of healthy nutrition 3 Impacts of priority interventions √ √ 4 Impacts of community health workers √ 5 Impact of patient education √ √ √ √ √ 6 Impact of capacity building on improving registration 7 Projected costs (e.g. MPOWER ) √ 8 Economic costs of NCD and key risk factors † 9 Population-attributable fractions of risk factors †
10 Social groups affected by NCD 11 Coverage of interventions for people at risk of CVD √ √ 12 Health system-related barriers to access NCD √ √ √ †13 Delivery of evidence-based NCD interventions at PHC √ √ √ †14 Application of evidence-based guidelines √ √ 15 Policy brief on adherence of health care professionals to
guidelines
16 Policy brief on impact and cost of implementing a package of essential NCD interventions
17 Effect of NCD policies on ameliorate or worsen NCD social disparities
18 Cost-effectiveness of priority interventions
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