Importance of health research in South Asia

doi:10.1136/bmj.328.7443.826

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Ritu Sadana (sadanar@who.int), scientist1,
Carol D'Souza, policy analyst1,
Adnan A Hyder, assistant professor, health systems programme2,
A Mushtaque R Chowdhury, visiting professor3

¹ Health Research Systems Analysis Initiative, Research Policy and Cooperation Department, Evidence and Information for Policy Cluster, World Health Organization, CH-1211 Geneva 27, Switzerland
² International Health Faculty, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
³ Heilbrunn Department of Population and Family Health, Columbia University, 60 Haven Avenue, New York, NY 10032, USA

Correspondence to: R Sadana

Accepted 15 March 2004

South Asian countries face similar health problems and would benefit from collaboration in health research

Research is essential to guide improvements in health systems and develop new initiatives.1 South Asia has a quarter of the world's population, weak public sector health care, and a staggering disease burden, and thus research is particularly important. Although investment has increased in infrastructure for health research over the past decade, gaps remain in evidence to guide reduction of important problems such as communicable diseases, maternal and perinatal conditions, childhood diseases, and nutritional deficiencies.2 Furthermore, even when technical knowledge is available, political commitment, managerial competencies, and incentives for changing behaviour within health systems are often lacking.3^–5

One region, eight countries, complex challenges

Despite diversity in their geographical, linguistic, and political structures, Afghanistan, Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, and Sri Lanka face common health challenges. Most bear a triple burden of persisting infectious diseases, increasing chronic conditions, and a growing recognition of injuries and violence. Incomplete demographic transitions, HIV and AIDS, massive unplanned urbanisation, and a host of social determinants of health compound these problems.6 Another common characteristic is that national estimates of health mask large variations within countries (fig 1).7 8

Fig 1

Life expectancy and healthy life expectancy by gross domestic product per capita9

Health systems across the region also have to confront challenges such as a lack of evidence based policies and limited social accountability. With no or limited national health insurance schemes and the large role of the private sector, individuals face high out of pocket payments on top of other economic and social consequences of ill health (fig 2).10 In many countries, the devolution of financial responsibility for health services has outpaced capacity and decision making authority, contributing to fragmentation of policies and services.11 Striking …