Health Research Priority setting experiences from Uganda, Tanzania and Zambia
Presentations
Overview
Overview
abstract
Health research provides evidence for improving health systems and health interventions. Many low income countries, including Uganda, Tanzania and Zambia have instituted National Health Research Authorities (NHRAs) to manage their health research systems. Among their duties, NHRAs should set research priorities. While the three countries have conducted several health research priority setting exercises and there is a potential for them to learn from each other’s experience; there are no standardized approaches for facilitating this sharing of experiences. We conducted case studies in Zambia, Uganda and Tanzania to describe and evaluate their health research prioritization based on a framework (including ethical values) which was validated in Zambia and internationally (1-5).
Ethical challenges
All three countries have a functioning NHRA. They have all identified research priorities throughout the time they have been in existence. In some cases, the priorities have been aligned with the national health strategic plan. However, in some cases,
i) Fragmentation of the priority setting process by multiple organizations: While in the three countries NHRAs have been mandated to set national health research priorities, other competing organizations within the countries also set health research priorities and often with no clear linkages with the national health research priority setting processes. These lead to undermining of the legitimacy and work of the NHRAs; it also fragments health research priority setting, and further impacts the trust that the public and health system has in the NHRAs. Yet, the NHRAs do not have the authority to streamline the health research PS processes.
ii) Competing stakeholder research priorities, whose priorities should count: While all NHRAs recognized the importance of broad stakeholder involvement, they are challenged by the power imbalances at all levels of decision making. At the national level, NRAs spoke of the health research funders hijacking the priority setting process. While the sub-national respondents thought the national level organizations made all the decisions without consultation- yet research is implemented in their jurisdiction. This leads to questions about; Whose priorities should count? Who and where should health research priorities count?
iii) External expertise which is not always shared and/or translated into local capacity strengthening: Within the three contexts, the most common health research prioritizing exercises have been facilitated by experts. These exercises have often used different approaches e.g. CHNRI, James Lind, e.t.c. However, time constraints do not allow for local capacity strengthening and ensuring that the approaches are well understood by the NHRAs. As a result, the NHRAs are left with poorly understood un-contextualized priority setting approaches, which they may not be in position to use in future HRPS. Such practices are contrary to the best practices in ethical Global Health Research which requires emphasizes a commitment to local capacity strengthening.
iv) Limited adaptation of the approaches which were developed in other contexts to local contexts: In all contexts where the known HRPS approaches were employed, there was no process through which these approaches were adapted for local use. Adaptation would ensure that the local realities, especially the resource requirements for conducting systematic HRPS (e.g. financial, human- with the necessary capacity- and evidence), are considered. Furthermore, there might be unique local considerations that the NHRA’s might need to consider. While the NHRA recognize the need for using the current HRPS approaches, their limited adaptation to local contexts have, in part, contributed to their sustained use and limited institutionalization.
v) Limited evaluation of HRPS: A common finding was that while several countries have conducted different HRPS exercises, employing various systematic approaches,rarely do the NHRAs conduct systematic evaluation of their processes and the impact of their prioritization processes. This is in part, due to the NHRA’s limited resources and capacity. Furthermore, while there’s a growing body of literature on systematic approaches to HRPS, there has been limited focus on frameworks/ approaches to guide systematic HRPS evaluation.
Conclusions and recommendations
Since NHRAs are the legitimate institutions for coordinating health research, they should be strengthened and supported to deliver on this mandate. They should establish systematic mechanisms for identifying and evaluating their prioritization processes, collecting of data on the implementation of the identified priorities and their impact on health policy.
Within the NHRAs, there is need to identify an approach, or a hybrid of approaches that is suitable for their contexts, to be used to guide priority setting. The approach should be participatory, feasible and reflect the local values. Where possible, this framework could be used across the three countries to allow for standardized processes, and shared learning. This approach should have agreed upon criteria, techniques for wide stakeholder engagement, explicit mechanisms for ranking the priorities. Such an approach will limit the fragmented and expert- led, un-contextualized HRPS.
A participatory process as that proposed in the guidance manual whereby NHRAs are introduced to the current health research priority setting approaches, with their critical assessment of the strengths and limitations of each approach discussed- would support informed decision making on the choice and contextualization of the potential framework (as used for the Zambia case study).
Systematic and standardized evaluation of the health research prioritization processes will facilitate the gleaning and sharing of lessons of good practice and areas where improvements are necessary. This standardized sharing of experiences will support cross- country and regional learning.
