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Mohammad Afzal¹

¹Acting Regional Adviser, Research Policy and Cooperation, World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt (Correspondence to Mohammad Afzal: This e-mail address is being protected from spambots. You need JavaScript enabled to view it ).
EMHJ, 2008, 14(Supplement): S67-S73

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Introduction

Research has been an integral part of World Health Organization (WHO) collaborative programmes with Member States since the inception of the Organization in 1948. Article 2(n) of the WHO Constitution states that WHO is “to promote and conduct research in the field of health” [1]. The principles governing the research functions of WHO were endorsed by the Second World Health Assembly in 1949. In the early life of WHO, most research was managed by the technical units of WHO headquarters. An Advisory Committee on Medical Research was established in 1959 [2] to provide the DirectorGeneral with the necessary scientific advice in relation to WHO’s research programme. With time, the regional offices of WHO assumed a greater role in managing health research among their Member States, and regional advisory committees were created.

Institutionalization of health research in EMRO

WHO’s Regional Office for the Eastern Mediterranean (EMRO) had been involved in medical research since 1966, by assisting and promoting medical and health research in the Region, as deemed appropriate and feasible. However, these collaborative activities were intensified in 1976 with the establishment of the Eastern Mediterranean Advisory Committee on Biomedical Research [3] as a result of a proposal by the WHO Committee on Medical Research, supported by resolutions of the World Health Assembly and the Executive Board (WHA27.61 and RB55.R35), for greater involvement of the regional offices in research activities in their respective regions. The name of the committee was later changed to the Eastern Mediterranean Advisory Committee on Health Research (EM ACHR), as was done in the WHO headquarters and other regions, in order to reflect a broader scope and remit [4]. It comprises senior and outstanding researchers from the Region and represents a balanced disciplinary and geographical distribution.

EM ACHR functions to advise the Regional Director on all issues related to health research and development in the Region. Among its aims is to strengthen the informational, scientific and ethical foundations of health research systems. Since its inception, numerous activities have been undertaken by the Regional Office covering almost all aspects of the research needs of the Region.

Another milestone for health research promotion in the Region was the establishment of a Research Promotion and Development unit in the Regional Office in 1978 [5], subsequently renamed Research Policy and

Cooperation (RPC) unit. RPC maintains close contacts with its counterparts at WHO headquarters and in the regions as well as with national focal points for research or medical research councils and major health research institutions in the Region. RPC works in close collaboration with other technical units of the Regional Office and other national and international partners.

Research promotion and development in Member States

The Regional Office has been involved in many activities to promote research in the Region, including: assessment of the health research potential and research priorities of Member States; determination of areas of collaboration; designation of collaborating centres; training in research methodology; research management and scientific writing, funding of research within the Region; and assisting Member States with strengthening their capacity and setting their priorities to undertake health research with a view to strengthening their health research systems.

The establishment of the Health services journal in 1986 and its replacement, the Eastern Mediterranean health journal, in 1995 facilitated the publication of results of research by scientists in the Region [6].

Support to health research

Since the establishment of regional mechanisms for promotion and development of research in the late 1970s, EMRO has funded a small number of research proposals received from within the Region. However, until 1992 the proposals were supported on an ad hoc basis and dealt with a wide range of topics. A scheme of small grants was established in 1992 in collaboration with the Tropical Disease Research (TDR) unit in WHO headquarters. A similar scheme operates under the UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction. The scheme aims to support researchers from the Eastern Mediterranean Region to address local problems in disease control and to raise the research capacity of regional researchers in operational research. The research topics were initially limited to problems such as malaria, schistosomiasis, tuberculosis, leishmaniasis and lymphatic filariasis. In 2002, the scope of the small grants scheme was expanded to include other communicable diseases such as HIV and sexually transmitted infections, vaccine-preventable diseases, haemorrhagic fevers, brucellosis, meningitis and echinococcosis. More than 340 proposals have been funded in 17 countries of the Region under this scheme since 1992.

In 2002, a new grant for research was established by EMRO, the Eastern Mediterranean Regional Office Special Grant for Research in Priority Areas of Public Health. The aim of this grant is to address local problems and issues of public health importance, with special emphasis on health systems research. So far 140 proposals have been funded under this scheme.

The Regional Office, in partnership with the Standing Committee for Science and Technology of the Organization of Islamic Countries, established a special grant for research in applied biotechnology and genomics in 2004 to promote research, encourage networking, generate new knowledge and stimulate the application of biotechnology and genomic driven interventions in health care [7]. Thus far, 35 proposals have been supported in 2 rounds of research funded through this grant. The third call for proposals is in process.

The Regional Office also catalysed the establishment of an Eastern Mediterranean Health Genomics and Biotechnology Network in 2004, with its secretariat hosted at the Pasteur Institute of the Islamic Republic of Iran [8].

Capacity building in health research

The Regional Office has long been advising and assisting Member States to develop their capacity to undertake health research. It has supported efforts for capacitybuilding in health research, especially in research methodology, clinical research, research proposal and scientific paper writing, community-based research for health and user-driven research. So far more than 500 health researchers have been trained from almost all countries of the Region. Human resources development in health research is among the key strategies emphasized in the Renewed Policy for Health Research and Development in the Region.

With a view to developing innovative and effective strategies for strengthening national health research systems in the Region, in 2002 and 2003 the Regional Office and TDR supported a detailed and systematic situation analysis of health research in 5 countries, namely Egypt, Islamic Republic of Iran, Morocco, Pakistan and Sudan. More recently, the Regional Office in collaboration with the Council on Health Research for Development and Gulf Cooperation Council (GCC) States conducted a survey of health research in 7 GCC states and in Jordan, Lebanon and Tunisia.

The situation analysis highlighted the absence or inadequate development of integrated, well designed and functioning national health research systems. However, from the information collected it appears that a well developed infrastructure for health research exists in most of the countries and some useful research is carried out both in specialized centres and in academic institutions. Nonetheless, there is a great need to strengthen the existing systems to improve the quantity and quality of demand-oriented research for health and for developing mechanisms for translating research results into policy.

A database on the regional institutional capacity in genomics and biotechnology was made available on the Internet by the Regional Office in 2005 [9]. Further development of the database on institutional capacity for conducting research in the Region is continuing by extending the information to several other aspects of research for health, such as health researchers of the Region, their highest qualifications, affiliations, current projects, research areas of interest, latest publications.

Eastern Mediterranean health research strategies and policies

At the close of the last century several of the international agencies involved in funding health research, including WHO, tried to seriously examine the role of health research as an important contributor to sustainable human development. They also attempted to assess how governance of research at national, regional and global levels could be made more effective and efficient. As a result of these deliberations a landmark conference, the International Conference on Health Research for Development, was held in Bangkok, Thailand, in October 2000 and was attended by over 700 participants. It was recognized at the conference that the research efforts in many countries were fragmented, with much duplication of work, and were not focused on national needs and priorities. This led to the emergence of a vision of a systems approach to health research, driven by equity, focused on national goals and priorities, and operating within an interactive regional and global framework.

During 2000–2001 the Regional Office undertook a review and restructuring of the regional policy for health research through intensive debate and dialogue within the Office and with Member States. This had become necessary with the realization that health research, a key to promotion of equitable health care, had largely been ignored in the Region (and indeed in most developing countries). The outcome of the review was the Renewed Policy for Health Research and Development in the Eastern Mediterranean Region, which was endorsed in a resolution at the 48th session of the Regional Committee in 2001 [10]. The regional policy on health research emphasizes the necessity to promote equitable health care in the Region through the development of sustainable health research systems that promote the use of research for providing evidence for decision-making, policy formulation and actions. The Regional Committee agreed to allocate 2% of the Joint Programme Review and Planning Mission funds (the regular biennial budget allocated to countries of the WHO/EMRO) in support of regional health research. In addition, Member States were requested to consider allocating 2%–3% of their budget for activities related to health research in their countries.

The Regional Office in collaboration with WHO headquarters held a regional consultation for health research and development in 2004 in Cairo, Egypt [11]. The objectives were to identify critical issues facing the development of health research in countries of the Region, and to obtain regional and country input and perspectives.

The Ministerial Summit on Health Research was convened by WHO and the Government of Mexico in Mexico City in 2004. The Summit emphasized the need for global cooperation to reduce disparities in health between developing and developed countries. A major theme of the discussion was the need to bridge the gap between what is known about how to improve performance of health systems and what is actually done to change policy and practice – the “know–do” gap. The Regional Office held a regional consultation to follow up on the Mexico summit, in Rawalpindi, Pakistan, in 2005, to formulate and suggest a strategic direction for health research for the Regional Office and Member States [12].

Recently, the Regional Office has been actively involved in the preparatory activities for a global ministerial forum on research for health at the regional level. In this regard a ministerial preparatory meeting was held in Tehran in collaboration with the Government of the Islamic Republic of Iran in November 2007. This meeting was followed by the ministerial and heads of delegations meeting from which a communiqué was issued that proposes a stronger focus on the research priority areas relevant to the disease patterns in each country. This will help advocate the regional perspective at the Global Ministerial Forum on Research for Health, to be held in Bamako, Mali at the end of this year.

Effective knowledge transfer and translation of research into policy and practice

The Regional Office has recently initiated some measures to promote health systems research. Training programmes are being organized to bring policy-makers and researchers together to work to optimize the use of research for policy formulation and implementation of efficient and effective health systems and health services. The aim is to develop a core of “conveners” who can facilitate knowledge translation to bridge the know–do gap.

Considering the potential of journalism for creating public awareness about health research issues, the Regional Office held a workshop in 2007 to improve the technical skills needed by science journalists and health information specialists from countries to cover science and healthrelated issues and the use of research findings. Further workshops will be held in several countries of the Region.

The Regional Office has also planned to establish an EMR evidence-informed policy network (EM EVIPNet), which will bring together policy-makers, health systems managers and researchers to develop a continuous and sustainable mechanism to promote the access and use of research evidence (primarily systematic reviews), focusing on emerging needs experienced by local, national and regional health authorities and shaped by the local context. In addition, EM EVIPNet will enhance linkages between the producers and users of evidence and will provide training opportunities that will develop the capacity of decisionand policy-makers to access and apply evidence in lowand middle-income countries of the Region.

Research ethics

Ethical practice in health care and research is not only needed to ensure equity in health care and research, but also to protect individuals and communities from unnecessary risks and harm. Given the regional social, cultural and religious norms, the Region must have its own set of guidelines and regulations so that Member States can define and draw upon codes of ethical practice. This has been stated explicitly by the Regional Office on several occasions and at the policy level by the Regional Committee, the Regional Consultative Committee and the Eastern Mediterranean Advisory Committee for Health Research.

The focus of the WHO drive to strengthen regional bioethics capacities is through advocacy, consultations, meetings, seminars, workshops and research through national and regional level activities and in partnership with interested stakeholders. The Regional Office has carried out shortterm training programmes within Member States. Currently, EMRO, in partnership with the University of Toronto, is funding a programme to train health care professionals from Member States for a Masters in bioethics; so far 4 scholars from the Region have been supported. A similar short-term training programme has been initiated in collaboration with the University of Maryland.

The Regional Office has translated 2 WHO publications on ethical issues into Arabic for dissemination in the Region and made them available on the Internet [13,14]. In addition, the Regional Office engages with international organizations such as the Council for International Organization of Medical Sciences, Islamic Organization of Medical Sciences, Islamic Educational, Scientific and Cultural Organization, United Nations Educational, Scientific and Cultural Organization to organize meetings and seminars on key issues related to bioethics. The Regional Office established an EMR Research Ethics Review Committee in October 2007; in future all health research proposals involving human subjects that are conducted or supported by the Regional Office will be reviewed by this Committee.

For 2008–2009 the Regional Office has several programmes for enhancing national capacity in ethical review of research for health.

• Short-term training course in ethics of research for health in collaboration with the University of Maryland
• Mapping the infrastructure for ethical review of research in the Region
• Provision of technical assistance to Member States to establish national ethics review committees
• Regional meeting of experts to develop regional guidelines for ethics of embryo research (completed)
• First meeting of the forum on bioethics for the Eastern Mediterranean Region of WHO and Arab Region of UNESCO
• Second regional meeting for national bioethics committees.

Future directions

The Regional Office will continue capacity building and supporting research for health in Member States. This support will be aimed at:

• Providing health research policy support and advice to Member States
• Further strengthening health research capacities in Member States. This will entail:
• providing research grants in health systems research and in applied biotechnology
• providing training to improve quality of research for health, addressing priorities and improving capacities in research ethics
• Building capacities and mechanisms for effective use of the results of health systems research
• Undertaking situation analysis of health research systems in more countries of the Region
• Engaging stakeholders in regional health research efforts
• Developing further collaboration and partnerships with international health research organizations, universities and other partners.

Conclusion

The activities promoted and supported by the Regional Office over the years have had a positive impact on the development of health research in the Region. Political commitment has grown, national coordinating mechanisms have been established and allocations for research have been made in WHO collaborative programmes. However, there is a need for intensified efforts to enable Member States to develop their health research systems further and increasingly to make use of research to provide evidence for policy-making and health actions, especially in reducing health inequalities and in addressing the health problems of the poor.

References

1. Constitution of the World Health Organization (http://www.who.int/governance/ eb/who_constitution_en.pdf, accessed 4 June 2008).
2. World Health Organization. Twelfth World Health Assembly Geneva, 12–29 May 1959 (http://www.emro.who.int/rpc/pdf/ WHA12-17.pdf, accessed 4 June 2008).
3. Report on the meeting of the Regional Advisory Committee on Biomedical Research, Alexandria, 6–8 April, 1976. Alexandria, WHO Regional Office for the Eastern Mediterranean, 1976 (EM/ADV. COM.BIOMED.RSR/5).
4. Report on the Twelfth Session of Regional Advisory Committee on Health Research, Lahore, Pakistan, 31 March–2 April, 1987. Alexandria, WHO Regional Office for the Eastern Mediterranean, 1987 (EM/RSR/36-E).
5. Report on the third meeting of the Regional Advisory Committee on Biomedical Research, Alexandria, Egypt, 27–31 March, 1978. Alexandria, WHO Regional Office for the Eastern Mediterranean, 1978 (EM/ RSR/6, EM/#RD.MTG.ACMR/16, EM/ ICP/HMD/ 035/RB).
6. Eastern Mediterranean health journal [website] (http://www.emro.who.int/emhj. htm, accessed 4 June 2008).
7. World Health Organization Regional Office for the Eastern Mediterranean. Development and use of genomics and biotechnology for public health. Resolution EM/RC51/R.11 (http://www.emro. who.int/governance/PDF/RC51_Resolutions.pdf).
8. Report on the Eastern Mediterranean consultation for establishing a regional biotechnology network Tehran, Islamic Republic of Iran 31 July–2 August 2004. Cairo, WHO Regional Office for the Eastern Mediterranean, 2004 (WHO-EM/ RPC/016/E).
9. Health related research institutes on genomics and biotechnology in the Eastern Mediterranean Region [website] (http:// www.emro.who.int/rpc/Biotechnology_Genomics-institutes.htm, accessed 16 June 2008).
10. Forty-eighth session of the Regional Committee for the Eastern Mediterranean, Riyadh, Saudi Arabia, 30 September–3 October 2001. Cairo, Regional Office for the Eastern Mediterranean, 2001 (http:// www.emro.who.int/RC48/index.htm, accessed 16 June 2008).
11. Report on the Eastern Mediterranean regional consultation in preparation for the Ministerial Summit on Health Research Cairo, Egypt 4–6 April 2004. Cairo, Regional Office for the Eastern Mediterranean, 2004 (WHO-EM/RPC/015/E).
12. Summary report of the regional consultation to follow up on the Mexico Ministerial Summit on Health Research, Rawalpindi, Pakistan, 29–30 November 2005. Eastern Mediterranean health journal, 2006, 12(Suppl. 2):S258–61).
13. [International ethical guidelines for biomedical research involving human subjects] (http://www.emro.who.int/rpc/ pdf/InernationalEthicalGuidelines.pdf0 2005, accessed 4 June 2008) [in Arabic].
14. [Operational guidelines for ethics committees that review biomedical research] (http://www.emro.who.int/rpc/pdf/Guidelines%202003.pdf, accessed 4 June 2008) [in Arabic].