Structure, function and five basic needs of the global health research system

Abstract

BackgroundIn 2013, an estimated 2.8 million newborns died and 2.7 million were stillborn. A much greater number suffer from long term impairment associated with preterm birth, intrauterine growth restriction, congenital anomalies, and perinatal or infectious causes. With the approaching deadline for the achievement of the Millennium Development Goals (MDGs) in 2015, there was a need to set the new research priorities on newborns and stillbirth with a focus not only on survival but also on health, growth and development. We therefore carried out a systematic exercise to set newborn health research priorities for 2013–2025.MethodsWe used adapted Child Health and Nutrition Research Initiative (CHNRI) methods for this prioritization exercise. We identified and approached the 200 most productive researchers and 400 program experts, and 132 of them submitted research questions online. These were collated into a set of 205 research questions, sent for scoring to the 600 identified experts, and were assessed and scored by 91 experts.ResultsNine out of top ten identified priorities were in the domain of research on improving delivery of known interventions, with simplified neonatal resuscitation program and clinical algorithms and improved skills of community health workers leading the list. The top 10 priorities in the domain of development were led by ideas on improved Kangaroo Mother Care at community level, how to improve the accuracy of diagnosis by community health workers, and perinatal audits. The 10 leading priorities for discovery research focused on stable surfactant with novel modes of administration for preterm babies, ability to diagnose fetal distress and novel tocolytic agents to delay or stop preterm labour.ConclusionThese findings will assist both donors and researchers in supporting and conducting research to close the knowledge gaps for reducing neonatal mortality, morbidity and long term impairment. WHO, SNL and other partners will work to generate interest among key national stakeholders, governments, NGOs, and research institutes in these priorities, while encouraging research funders to support them. We will track research funding, relevant requests for proposals and trial registers to monitor if the priorities identified by this exercise are being addressed.

Setting health research priorities using the CHNRI method: II. Involving researchers

“…In such cases, there is scope for involving further groups of people whose knowledge and experience can provide informative input, particularly if this input is limited to the certain priority–setting criteria where the researchers would be unlikely to possess any first–hand knowledge. For example, hundreds of programme managers contributed to the scoring of questions on the newborn research agenda in relation to its deliverability, affordability and sustainability [ 7 ]. Our analyses of previous exercises have shown that the researchers tend to be less optimistic than programme managers on the criterion of answerability, while they tend to be more optimistic on the criterion of deliverability, affordability, sustainability and maximum potential for burden of disease reduction; similarly, programme managers tend to prioritise implementation research questions, whereas researchers prioritised technology–driven research [ 2 , 8 ].…”

“…This study has been published in its extended form in this theme issue [ 7 ]. Although the field of newborn health in low–income settings is very recent and the research community is still quite small, and although the process of involving researchers followed many steps that were in common to the exercise on pneumonia 5 years earlier, several important innovations were introduced.…”

“…The team met in Geneva for a week to consolidate the initial list of research ideas they had received from about 400 down to about 200 that were eventually scored. In summary, this exercise stands out in three ways: (i) the targeted sampling of researchers; (ii) the inclusion of programme managers as the majority of invited scorers, to better reflect the community with useful knowledge on the criteria, which is not necessarily reflected in academic articles; and (iii) the tracking of score responses in real time using survey monkey [ 7 ].…”

Research Priorities for Eight Areas of Adolescent Health in Low- and Middle-Income Countries

“…The CHNRI approach has previously been applied to more than 50 health areas [11], [12], [13], [14], [15], including adolescent sexual and reproductive health [9].…”

Opportunities and Challenges in Global Perinatal Research

“…Five of the CHNRI exercises incorporated impact on equity scores which ranged from 66 to 93 for the included questions [9, 10, 13-15]. …”