Extra information

Box 1: National Health Research Policies and National Health Policies

Box 2: Challenges in Estimating the Amount and Flow of Research Funding

Box 3: BRAC: Investing in research for action

Box 1. National Health Research Policies and National Health Policies
A former chair of the Nepal Health Research Council, Mathura Shrestha, noted "there is disjunction, even mismatch, between reality and policy development, between policy and strategy development, between strategy and programme development, between programme and its implementation, between implementation and evaluation."^w1 Since 1993, the Council on Health Research for Development has built on the essential national health research (ENHR) strategy to promote the implementation of a national health research agenda for more effective research for development. A wide range of stakeholders � including governmental and non-governmental groups � in Bangladesh, India, Nepal, and Pakistan have used the strategy to set a health research agenda. In 1997, a small survey in India, Nepal, and Pakistan showed that although none of these three countries had a written policy on national health research, all had a plan of work: Nepal had incorporated ENHR priorities within its national health plan, and respondents from India and Pakistan noted the preparation and funding of new research protocols based on ENHR identified priorities.^w2
Since then, most South Asian countries have formulated explicit national health policies, as well as references to planning or implementation of health systems research. Led by the Indian Council of Medical Research, India has drafted its first national health research policy, which explicitly links with the national health policy updated in 2002, and has also established guidelines for stem cell research and ethical guidelines for biomedical research on human subjects.

Box 2: Challenges in Estimating the Amount and Flow of Research Funding
The CHRD recommended in its 1990 report that countries invest 2% of national health expenditure in essential national health research and strengthening research capacity.¹ Some South Asian governments have attempted to reach this target. In India�s National Health Policy of 2002, the government pledged to increase the proportion of health expenditure allocated to health research from less than 0.5% in 2002 to 2% by 2010. A quadrupling of the annual budget allocation to the Indian Council of Medical Research between 1996-7 and 2003-4¾ to about $31m¾ reflects the increased political interest and recognition of health research. For the South Asian region as a whole, 2% of expenditure on health would have amounted to $2.1bn total expenditure on health in 2001, or $465m of government expenditure on health.^w3

Box 3: BRAC: Investing in research for action
Established in 1972, Bangladesh Rural Advancement Committee (BRAC) is a large development NGO in Bangladesh with two broad aims of alleviating poverty and empowering the poor. Within this organisation is the Research and Evaluation Division (RED) which seeks to improve the implementation of BRAC�s programs through research and evaluative support. RED is a full-fledged research unit with a multi-disciplinary team of nearly 100 researchers who publish in national and international journals.^w4 BRAC�s innovative funding scheme for research has ensured the sustainability of RED: by earmarking 2 to 4% of its project budgets for research, BRAC increased the credibility of RED, which now attracts external funds for research activities and depends on BRAC for less than half its expenditure.
BRAC�s use of research in program implementation demonstrates the value of health systems research. Notable cases in using research to achieve program objectives are BRAC�s program using community health workers to control tuberculosis^w5 and its oral rehydration therapy (ORT) programme. For the latter, rural households in Bangladesh during the 1980s received in-person training on making the ORT solution which was invented in Bangladesh and India. Throughout the programme�s 10-year existence, research was undertaken to address the challenges in reaching the programme�s objectives, and research findings were immediately incorporated into the programme.^w6 Bangladesh now has one of the highest rates of ORT use in the world.
To strengthen its research quality and capacity, BRAC has collaborated on several projects with research institutions from within and outside the country. One example is the collaboration since 1992 between BRAC and the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) in studying non-health interventions and their effect on the health of participants and their families. For instance, an analysis using data from Matlab, the field laboratory of ICDDR,B, found that a BRAC programme on woman-focused development had a significant positive impact on childhood mortality.^w7 Placing health research within the larger development agenda is a key approach to engage civil society.

References

Shrestha MP. Country updates: health research in Nepal. Research into Action 1996;7:5-6.
Figueroa JP, Baris E, Chandiwana S, Kvaale E. A survey of essential national health research in nine developing countries. W Indian Med J 2002;51:97.
World Health Organization. World health report 2003: shaping the future. Geneva: WHO, 2003.
Bangladesh Rural Advancement Committee. BRAC research 2002. Dhaka, BRAC, 2003.
Chowdhury AM, Chowdhury S, Islam MN, Islam A, Vaughan JP. Control of tuberculosis by community health workers in Bangladesh. Lancet 1997;350:169-72.
Chowdhury AMR, Cash RA. A simple solution: teaching millions to treat diarrhoea at home. Dhaka: University Press, 1996.
Bhuiya A, Chowdhury M. . Beneficial effects of a woman-focused development programme on child survival: evidence from rural Bangladesh. Soc Sci Med 2002;55:1553-60.