research priority setting aziza omar
DESCRIPTION
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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
World Health Organization
Participants in Setting Priorities
Communities (Health
Perception and Needs)
Policy and Decision makers (Health
Experts)
Researchers (multi-
disciplinary)
Fields of Health Research 1. Biomedical issues
2. Behavioural and Community issues
3. Sectors outside Health with profound influence on health
4. Good governance issues affecting health research
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).
World Health Organization
“” SELECTION OF TOPICS FOR RESEARCH
Scales for Rating Research Topics 1. Interest
2. Relevance
3. Avoidance of duplication
4. Feasibility
5. Political acceptability
6. Applicability
7. Cost-effectiveness
8. Ethical considerations
9. Timeliness
Each parameter score 1-3
Priority Scale:
• >19 High
• 10-18 Moderate
• <10 Low
World Health Organization
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
• 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
• 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
• 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
• 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 = ----------------------------------------------------------------------------------------- ------------------------- (x10n)
Sum of the length of time during which each person in the population is at risk
World Health Organization
Mortality & Fatality Rates
• 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
• 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
• 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
• 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
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 research-focus 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.