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Journal of the Academy of Hospital Administration

Website of The Global Forum for Health Research

Author(s): Surfed and Reviewed by: Rajiv Kumar Jain*

Vol. 16, No. 1 (2004-01 - 2004-06)

The Global Forum for Health Research is an independent international foundation established in Geneva (Switzerland) in 1998 with the objective of helping correct the 10/90 gap in health research.

Health research is essential to improve the design of health interventions, policies and service delivery. Every year more than US$70 billion is spent on health research and development by the public and private sectors. But only about 10% of this is used for research into 90% of the world's health problems. This is what is called 'the 10/90 gap'.

The human and economic costs of such misallocation of resources are enormous if we consider that good health is essential for economic growth and development, the fight against poverty, and global security.

Perspectives on the 10/90 gap

  • Correcting the 10/90 gap is possible: it requires the individual and concerted efforts of thousands of institutions.
  • Correcting the 10/90 gap constitutes a major contribution to growth, development, the fight against poverty and global security.
  • The Global Forum works as a catalyst to spur such efforts and to monitor results on a regular basis.
  • With the efforts of all partners, it is not unrealistic to move from a 10/90 gap today to a 20/80 gap in ten years' time.

To reach the objectives, the Global Forum applies the following strategies:

  • The Forum: each year, the annual meeting of the Global Forum brings together a wide range of partners from around the world to discuss progress in helping to correct the 10/90 gap.
    Forum 4 (Bangkok, 10-13 October 2000) was part of the International Conference of Health Research for Development.
    Forum 5 (Geneva, 9-12 October 2001) assembled over 700 participants at the Geneva International Conference Centre (CICG).
    Forum 6 (Arusha, Tanzania, 12-15 November 2002) was the Global Forum's first annual meeting in Africa.
    Forum 7 will be held in Geneva, 2-5 December 2003.
  • Analytical work on the 10/90 gap and health research priorities
    The Global Forum supports analytical work on the 10/90 gap in health research, focusing on the following four dimensions:
    – development and application of priority-setting methodologies: following the review of the main methodologies in the field of priority-setting and the development by the Global Forum of the "Combined Approach Matrix" during the period 2000-2002, the Global Forum is interested in the further development of the matrix and the dissemination of the results regarding research priorities, at the national and global levels;
    – the 10/90 gap and priorities regarding the global cross-cutting issues affecting health (such as gender, poverty, health policies, research capacity);
    – the 10/90 gap and priorities regarding the major risk factors affecting health (such as malnutrition, unsafe water/sanitation, unsafe sex! , alcohol, tobacco, indoor air pollution, occupational risks, hypertension, illicit drugs, violence and traffic injuries);
    – the 10/90 gap and priorities regarding diseases and conditions (such as childhood diseases, CVD, mental health and neurological disorders, HIV/AIDS and other sexually transmitted diseases, TB and tropical diseases).
    The support given by the Global Forum may be of different nature, such as support for the financing of analytical studies, for the publication of papers/monographs, for the financial of critical meetings, or for partnerships and networks in key areas of health research.
  • Communication: the development of an interactive network of partners and the dissemination of information regarding the10/90 gap are vital to the Global Forum’s mission. The third 10/90 Report on Health Research, published in May 2000, critically evaluates the reasons for the gap and ways to change it.
  • Monitoring and evaluation: the fourth strategy of the Global Forum to help correct the 10/90 gap is measuring results through the monitoring of progress indicators and periodic external evaluations. A first external evaluation was conducted in 2001. An external evaluation is planned every five years.

The Foundation Council, composed of a maximum of 20 members representing the constituencies of the Global Forum, is the highest policy and decision-making body. It gives the broad orientations of the Global Forum and is responsible for the definition of its objectives and priority areas as well as its long-term vision. The Foundation Council is assisted by a Strategic and Technical Advisory Committee (STRATEC), composed of six members selected from Council members.

The Global Forum believes that solutions to current health challenges will depend on the strength of the partnerships created between members of the following constituencies:

  • government decision-makers
  • research institutions and universities
  • multilateral organizations
  • bilateral development organizations
  • international foundations
  • private-sector companies
  • women's organizations
  • national and international NGOs and community organizations
  • media

Within the foundation, there are no "members" as such, but partners - each supporting the objectives and activities of the Global Forum in very different ways, but united in the belief that, by joining forces, they can help improve the 10/90 gap. Any person or institution actively supporting the objectives of the Global Forum is a partner in the Global Forum and may be selected to become a member of the Foundation Council.

DONORS:The Global Forum is currently supported by donations from the Rockefeller Foundation, World Bank, World Health Organization and the governments of Canada, Denmark, the Netherlands, Norway, Sweden and Switzerland.

In addition, individual networks supported by the Global Forum receive funding from the Bill and Melinda Gates Foundation, the Institute of Medicine of the US Academy of Sciences, the UK Department of International Development and others.

The home page is simple, well organised, and informative for all kind of surfers. It has sections on ‘About us' 'Annual Meeting' 'Analytical Work' 'Publications' 'For the Media' and 'Links'. Besides these there are a number of other sections.

The key area is 'Analytical Work' . a key strategy of the Global Forum is to support analytical work on the 10/90 gap in health research, focusing on these four dimensions, which are all part of health research and competing for the same funds:

Since the early 1990s, an attempt has been made to set priorities in health research based on a systematic assessment of the burden of diseases, basically identifying as priority any disease (or condition) representing a very high burden on the world's health (in terms of mortality and morbidity as given by the Disability-Adjusted Life Year or DALY indicator or similar indicators), while research funding for that particular disease remained limited. [The DALY is an indicator developed for the calculation of the burden of disease which quantifies, in a single indicator, time lost due to premature death with time lived with a disability. A number of explicit choices about age weighting, time preference, and preference for health states are made in the calculation of the DALYs. Other indicators have been developed in recent years (HEALYs, QALYs for example) based on the same model.]

Following this first effort at systematization, it was quickly realized that the 'disease focus' is only one dimension of health research and that major risk factors affecting health also have to be prioritized, as they are competing for the same funding as disease-focused priorities. In addition, there are at least two other dimensions to health research which have to be prioritized: these are global cross-cutting issues affecting health and the methodologies for priority-setting themselves.

The health status of a population is influenced not only by behaviour, genetics, health care and immediate risk factors but by a number of cross-cutting issues such as gender, poverty, research capacity and government policies. Cross-cutting issues are different from risk factors in that the former are more generic, and are likely to permeate all risk factors and determinants.

The Global Forum for Health Research considers the following cross-cutting issues throughout its work:

Health Policies and Systems
Public-Private Partnerships
Research Capacity strengthening

Research into determinants and their modification can identify interventions to prevent disease or premature death. Modification of determinants, such as reducing malnutrition in a given pop! ulation, is likely to have a large impact on a variety of diseases. In some cases, determinants may not only be relevant to prevent disease but also be part of its treatment, as is the case of reducing salt intake for high blood pressure.

Risk factors causing the heaviest burden in low- and middle-income countries as reported in the 2002 World Health Report include the following: malnutrition, unsafe water/sanitation, unsafe sex, alcohol, indoor air pollution, tobacco, occupational risks, hypertension, illicit drugs, violence, physical inactivity, and road traffic accidents. (This list does not include cross-cutting issues .)

The Global Forum is focusing particularly on risk factors for which there is little research activity and for which research is under-funded. These areas have the potential to produce significant results for the design of interventions to decrease the burden on people's health.

The Global Forum is currently working with partners on risk factors and determinants including:

According to the World Health Report 2002, the diseases representing the heaviest burden worldwide in 2001 were the following: childhood diseases, cardiovascular diseases, mental health and neurological disorders, HIV/AIDS and other sexually transmitted diseases, tuberculosis, maternal conditions, injuries, and tropical diseases.

The Global Forum is focusing efforts particularly on diseases and conditions for which there is little activity in research particularly for low- and middle-income countries. These areas have the potential to produce important results in designing interventions to decrease the burden of disease for the population.

The diseases and conditions the Global Forum and its partners are focusing on include the following:

Another imprtant and useful section is 'Links'. It links to all the Medical Research Councils.

This searchable listing is the product of information-gathering over the past two years on the part of the Global Forum for Health Research and theDepartment of Research Policy and Cooperation (RPC) of the World Health Organization.

The joint project had the primary objective of drawing up and making available to researchers a first list of medical research councils or equivalent bodies. Although there is no standard definition of a medical research council, we were looking for national bodies or organizations that direct, fund, track and/or conduct health research. In some countries, there is a clearly designated council. In others, such work takes place entirely within the ministry of health or partly under the aegis of the ministry and partly within a university or laboratory. In some countries, it appears that the! science research councils play a major role, in others the academies of medicine. In others still, we know too little about the governance to understand where the (health) research agenda fits. To be as inclusive as possible, we have tried to give information on at least two such organizations from each country. From many countries, though, despite our best efforts, we could not get reliable data.

The web designers have made the navigation easy by giving facilities of search by sign up for list serve, site map, and contact us. The section on 'Publications' gives online facility of obtaining all the Publications of the forum free.

The limitation of the website is non search-ability, very few graphics, little online facility of downloading the Research work.

Even then the website is very useful to persons looking for innovative methods, means, ideas and strategys for solving crucial global issues in Health Research. It can be starting point for researchers as well as research funders for basing their decisions on a very scintific footing.

* Deputy Chief Medical Director, Indian Railways Medical Service, New Delhi, Address for Correspondence: 157/4
Railway Officers Flats, Railway Colony, Basant Lane New Delhi-110055, E-mail: [email protected]

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