Health Research Priority Setting

Health Research Priority Setting in the Cooperation Council States Prepared & Revised by Dr. Tawfik A. M. Khoja Dr. Mohamed S. Hussein Safar 1430H - February 2009-1-

Excutive Board of the Health Ministers Council, 2009 King Fahd National Library Cataloging-in-Publication Data Khoja, Tawfik Health Research Priority Setting. / Tawfik Khoja - 2.. - Riyadh, 2009. 150 p. ; 24 cm. ISBN: 978-603-90062-4-4 1- Medicine - Research - Arabian Gulf States 2- Medical care - Arabian Gulf States 3- Medical policy - Arabian Gulf States I- Title 610.72053001 dc 1430 / 1372 L.D. no. 1430 / 1372 ISBN: 978-603-90062-4-4 Executive Board Of the Health Ministers Council For GCC States P.O.box 7431 Riyadh 11462 E-mail: sgh@sgh.org.sa www.sgh.org.sa -2-

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Contents - Preface....... 9 - About the Health Research Priority Setting Gulf Workshop... 15 - Scientific Programme Health Research Priority Setting Workshop Riyadh 29-30 Dhual-Qa dah 1428H / 9-10 December 2007... 17 - Address of Dr. Tawfik A. M Khoja, Director General Executive Board, Health Ministers Council for Cooperation Council States... 21 - Health Research Priority Setting in the GCC Dr. Tawfik A. M Khoja, Dr.Mohamed S. Hussein... 27 - Application of Combined Matrix Approach : Experiences and Way Forward Dr. Abdul Ghaffar Health Policy and Systems Specialist, GFHR,Geneva... 45 - Role and contribution of research (evidence) in improved decision making Dr. Abdul Ghaffar Health Policy and Systems Specialist, GFHR,Geneva... 55 - Prioritizing health research and development needs: Eastern Mediterranean Experience Dr. Mohammad Afzal Regional advisor, Research Policy and Cooperation, WHO-EMRO, Cairo, Egypt... 73-7-

- Research Priorities Setting: King Abdulaziz City for Science and Technology Experience Prof. Abdulrahman Alabdulalaaly... 91 - The Mechanism of Selection of Health Research Priorities in King Abdulaziz City of Science and Technology Prof. Othman A. Al-Shabanah, Ph.D.... 99 - Country Presentations: 1- UAE: Dr. Saeed Abdu... 105 2- Kingdom of Bahrian: Dr. Jamal Alsayyad... 113 3- Kingdom of Saudi Arabia: Dr. Faisal Abu-Dhuhier... 119 4- Sultanate of Oman: Mr. Hilal Al-Kharusi... 125 5- Qatar: Dr. Hassan AlHail, Dr. Sink and Dr. Ahmad AlMulla, Medical Research Centre... 139 6- Kuwait: Health Research Agencies... 143 7- Yemen: Mr. Tarek Salah Asad Al-Aghbary, Dr.Nour Addin Al-Jaber, Dr. Yahia Raj a... 149 - Recommendations... 153-8-

Preface Praise be to Allah and Peace and Blessings on the most honorable of the Messengers and the last of the prophets Mohammad, Peace be Upon Him. The Health Ministers Council for the Cooperation Council States gives a special priority to health research and positions it on the top of its agenda. This is in realization that health research is an investment for health which should be given the due care at all levels, notably decision makers and takers. Appropriate and enough budgets should be allocated and effective coordination with all health bodies, whether regional or international, should be done. The impact of scientific research in various aspects of life became the main drive for the process of development. There is no doubt that health research, with the increase in the science and health technologies coupled with the importance of provision of high quality, evidence-based health care, has become a principal requirement. This led to study of the current situation from the perspective of scientific research and the world trends in this respect. -9-

Many studies and reports (national, regional and international) showed that there is a gap in knowledge, data and research to make well-considered health information on which constructive health concepts, activities and policies can be adopted. Hence the Global Forum for Health Research in Geneva affirmed the presence of an extremely important and serious gap, called the 10/90 gap. This gap illustrated that the amount of expenditure and allocations to face 90% of the real health problems especially in the developing world is no more 10% only and vice versa. At the Gulf level, the process of coordination and integration in the field of scientific research and technical development in health research in the Council States has become a necessity which is mandated by the nature of the current circumstances, due to the common positive elements owned by these countries, which made it a principal pivotal issue for improving health care services. In this respect, a Fund for Health Research at the Executive Board, Health Ministers Council for the Cooperation Council States has been established through which research projects (which are agreed upon according to certain criteria set for the priorities of these researches) are funded and supported in the member states. -10-

This fund is supported from the annual contribution of each country after endorsement of those granted capacity at the MOH of the country. On the other hand, the accumulation of previous research experiences, namely the Child Health Study, The Gulf Family Health Survey, in addition to conduction of a lot of research and studies in the member states such as the Global Tobacco Youth Survey, Burden of Diseases, STEP wise approach for non-communicable diseases as well as the World Health Survey which is currently underway. To affirm this concept, The Health Ministers Council for the Cooperation Council States in collaboration with the Eastern Mediterranean Region (EMRO) and the Global Forum of Health Research organized the regional joint Health Research Priorities workshop which was held in Riyadh (29-30 Dhual- Qa dah 1428 H / 9-10 December 2007). This workshop also emphasized the continuous role of the Executive Board in promotion of health research, and support of information technology and making this a basis for taking health decisions based on documented data and credible evidence as well as support of Gulf national caders in this respect. -11-

Based on the preliminary national health research mopping that was done in the Gulf countries and some EMR countries which revealed that there is a gap in health research priority setting in the Gulf countries And, realizing the importance of bridging this gap and to give effect to the recommendation made by the Executive Body in ITS 65th meeting (held in Riyadh 4-6 Dhul Qaeda 1427 H corresponding to 25-27 November 2006 G) about holding a joint workshop on health priority setting in the Kingdom of Saudi Arabia, the Executive Board with collaboration with MOH, KSA with undertake this mission. The objectives of this regional workshop were as follows: 1. Orienting the participants with the importance / objectives of setting priorities for health research. 2. Presentation of various methodologies and tools for priority setting in health research with comparison. 3. Presentation of some international/regional experiences. 4. Lessons learnt from presented experiences. 5. Practical applications and group work. I found it useful to collect the proceedings of this important scientific workshop in a book which will give an expressive glimpse on health research in the Cooperation Council States. -12-

This highlights how health research, priorities are set, what are these priorities and what are the constraints and fading facing this process, as well as the achievements and proposals for improvement of health research priorities setting and the future challenges. I do ask the Almighty Allah to make this effort useful as required to support the Gulf research march and to depict the future directions and visions in this respect for more improvement of quality. I do also ask the almighty Allah to grant us rightness and success. Wishing you all the best Dr. Tawfik A M Khoja MBBS, DPHC, FRCGP, FFPH, FRCP Director General, Executive Board For Health Ministers Council For GCC States -13-

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About the Health Research Priority Setting Gulf Workshop Gulf Health Research Priority Setting Workshop Based on the preliminary national health research mapping that was done in the Gulf countries and some EMR countries which revealed that there is a gap in health research priority setting in the Gulf countries And, realizing the importance of bridging this gap and to give effect to the recommendation made by the Executive Body in its 65th meeting (held in Riyadh 4-6 Dhul Qaeda 1427 H corresponding to 25-27 November 2006 G) about holding a joint workshop on health priority setting in the Kingdom of Saudi Arabia, the Executive Board with collaboration with MOH, KSA with undertake this mission. Objectives 1. Orienting the participants with the importance / objectives of setting priorities for health research. 2. Presentation of various methodologies and tools for priority setting in health research with comparison. 3. Presentation of some international / regional experiences. 4. Lessons learnt from presented experiences. 5. Practical applications and group work. Organization It is a joint organization between: 1. Executive Board, Health Ministers Council for Cooperation Council States. 2. Ministry of Health, Kingdom of Saudi Arabia. 3. KACST (King Abdul-Aziz City for Science and Technology). 4. EMRO (Eastren Meditenanean Regional Office). 5. GFHR (Global Forum for Health Research). -15-

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. Scientific Programme Health Research Priority Setting Workshop Riyadh 29-30 Dhual-Qa dah 1428H / 9-10 December 2007 Day I 29 Dhual-Qa dah 1428H (9 December 2007G) 08:00-08:30 Registration 08:30-08:40 Welcoming and Opening Address Dr.Tawfik A. Khoja Director General, Executive Board, HMC/CCS 08:40-09:00 Application of Combined Matrix Approach : Experiences and Way Forward Dr. Abdul Ghaffar Health Policy and Systems Specialist, GFHR,Geneva 09:00-09:20 WHO/EMRO Dr. Mohammed Afzal, WHO/EMRO / RPC 09:40-10:00 Role and contribution of research (evidence) in improved decision making Dr. Abdul Ghaffar Health Policy and Systems Specialist, GFHR,Geneva 10:00-10:30 Discussion 10:30-10:45 Tea Break 10:45-11:10 Research Priorities Setting: King Abdulaziz City for Science and Technology Experience Prof. Abdulrahman Alabdulalaaly -17-

11:10-11:30 The Mechanism of Selection of Health Research Priorities in King Abdulaziz City of Science and Technology Prof. Othman A. Al-Shabanah, Ph.D. KACST 11:30-11:50 Health Research priorities in GCC Dr. Tawfik A. Khoja, Director General, Executive Board, HMC/CCS 11:50-12:10 Discussion 12:10-01:15 Prayer and Lunch Break 01:15-01:30 Country Presentation (UAE) 01:30-01:45 Country Presentation (Bahrain) 01:45-02:00 Country Presentation (KSA) 02:00-02:15 Country Presentation (Oman) 02:15-02:30 Country Presentation (Qatar) 02:30-02:45 Country Presentation (Kuwait) 02:45-03:00 Country Presentation (Yemen) 03:00-03:30 Discussion 03:30 Prayer and Tea Break -18-

Day II 30 Dhual-Qa dah 1428H (10 December 2007G) 08:30-09:30 Group Work 08:30-09:30 Introduction to Group Work Dr. Tawfik Khoja ( Participants will be divided into 2 Groups to deal with various tools of priority setting, based on early presentations made by GFHR, and EMRO experts..) Group A (EMRO) Group B ( GFHR) 09:30-10.00 Group Presentations (A & B) 10:00-10:30 Discussion 10:30-10:45 Tea Break 10:45-12:00 Work and action plan 10:45-11:30 Group Work (A & B) 11:30-12:00 Presentation of workplan 12:00-01:30 Prayer and Lunch 1:30-02:15 Consensus on the workplan 2:15 2:30 Conclusions and Recommendations -19-

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Address of Dr. Tawfik A. M. Khoja, MBBS,DPHC,FRCGP,FFPH, FRCP (UK) Director General, Executive Board, Health Ministers Council for Cooperation Council States, Riyadh Saudi Arabia In the Opening Ceremony of the Gulf Workshop on Health Research Priority Setting Riyadh, 29-30 Dhul Qa da, 1428 H 9-10 December, 2007 It gives me great pleasure in this blessed day in this nice evening to welcome you all surrounded by the care of Allah. We convene on the land of your second country, in Riyadh, - Riyadh of good and growth - Riyadh of affection and giving, in the Kingdom of Saudi Arabia in one of the important Gulf Scientific gathering. This is the Gulf Workshop on Setting Health Research Priorities which is held under the kind patronage of HE the Minister of Health Dr. Hamad Al-Mana. I raise my deep thanks and gratitude for the great support and care of HE to hold this important Gulf workshop. It also gives me great pleasure to have with us and among us the representative of HE the Minister, my dear brother Dr. Obaid Bin Sulaiman Al-Obaid, Deputy Minister for Planning and Development to open this ceremony. Dr. Obaid spares no effort in supporting all research activities, health systems improvement and development in general and primary health care and family medicine in particular. This is no strange for Dr. Obaid, he is reputed for full and continuous support of all programmes and activities of the Health Ministers Council for the Cooperation Council States and its Executive Office. This workshop represents an important turning point in the field. Thanks are due to Your goodselves and to the Ministry of Health, Kingdom of -21-

Saudi Arabia for this strong response and support. Before this workshop, a regional workshop about partnership in Health Research in the Eastern Mediterranean Region was held in Riyadh (12-13 Shawal, 1426 H/ 14-15 November, 2005). This was followed by a workshop for Health Research Current Situation Analysis, in Muscat, Oman (2-3 Jumada I, 1427 H / 29-30 May 2006), the outcome of which was presented in the 10th Global Forum for Health Research in Cairo (29 October 1 November, 2006) and in this forum, it was agreed to hold a Gulf workshop about setting health research priorities. Hence, we are here today to witness the opening ceremony of this said workshop which was prepared for with active participation from the WHO/Eastern Mediterranean Regional Office (represented by my Brother Dr. Mohamed Afzal, and with the Global Forum for Health Research (represented by my Brother Dr. Abdul Ghaffar). I do express my great thanks and appreciation for both of them for coming to share us this gathering and enrich our experience and knowledge. - I do also express my deep thanks and gratitude to my brother Professor Dr. Abdulrahman Al-abdulalaaly Supervisor of the Research Fellowships General Directorate in King Abdul Aziz Medical City for Sciences and Technology and my brother Professor Dr. Othman A. Al-Shabanah Chairman of the Health Sciences Group, in KAMCST, who both insisted on taking part in the activities of such workshop to enrich it with their rich experiences and knowledge and to present the experience of KAMCST, this great scientific castle in the field of setting and implanting health research priorities. - Many thanks are extended to my brother Dr. Khalid Al-Hussain, Executive Body member, Kingdom of Saudi Arabia, for his outstanding efforts exerted in overcoming all constraints faced to hold this workshop as well as for supporting the Executive Board to realize its -22-

ambitious mission and securing material and logistic support for the workshop. I do also thank my brother Dr. Faisal Abu Zaheer, Director General of Medical Research Department and his working staff for the efforts exerted in coordination of this workshop. I highly appreciate the outstanding and effective support and contribution of Astra Zeniza for this Gulf Workshop which indicates the effective partnership of the private sector and the dedication to develop manpower and disseminate knowledge and promote research. The executive board is highly interested in and focuses on the issue of health research. This is in realization on the part of the Health Ministers Council for the Cooperation Council States that health research is an investment for health which should be given utmost care at all levels especially that of decision makers and takers. Appropriate budgets should be allocated in addition to effective coordination with all international and regional research bodies and institutes. Let me in my person and in your name appraise the blessed launching of King Abdul Aziz University for Sciences and Technology which the Custodian of the Two Holy Mosques King Abdullah Bin Abdul Aziz Al- Saud (Allah may protect him) has laid its foundation lately will- Insha Allah support our efforts in upgrading research. This university together with its sister Saudi and Gulf universities will contribute in producing leading scientific research leap towards preparing qualified manpower in the fields required by the developmental plans, conduction of research and postgraduate studies, as well as contribution in general in raising the cultural, social and scientific standards of the Arabic and Muslim citizens, and producing a national, regional and international partnership in the field of global health research in an integrative and coordinative relation together with removal of constraints faced and improving management. -23-

I would also alike to refer to and appreciate the kind gesture and initiative by the Custodian of the Two Holy Mosques whereby 3000 million US$ has been allocated for the basis of program that funds scientific research related to energy, environment and climatic change. Both initiatives clearly reflect the wise vision and the human scientific approach on the part of our leaders Allah protect them In this setting, I do urge the participants in this workshop to make full use of these two initiatives and take actions towards coordination with concerned people in this respect and finding a joint channel for cooperation within the frame of a Gulf partnership at the scientific and research level. This is due to the fact that, building national capacities in the field of research is an objective which is sought by the Health Ministers Council for the Cooperation Council States and its Executive Office. It strives hard to realize this in an effective way in belief that human power development is an important if not the most important elements of health research promotion. That was the subject of the World Health Organization Report in 2006. In the same context, I did admire what was published in Al-Iqtisadia Newspaper, issue number 5160 issued on Tuesday 17/11/1428 H in the name of Dr. Abdul Rahman Sulaiman Al-Tariri saying : If we closely examined our universities, we will find all specializations and a lot of experts. We just need to have confidence in these expertise people and give them a chance to prove themselves and extract their knowledge store. In the Kingdom, there are universities that include all specialties, in addition to other bodies outside universities which have research interest. He proposed, that I quote research should not be restricted to the material aspects only in energy, environment or climatic changes, but should include the human aspect (behavior, values, culture) which has a very prominent role and is closely related to the above mentioned fields. Marketing, administration, negotiation and communication with -24-

the environment are basically knowledge, values, practices, skills and behaviors. I am not going to elaborate more, you have a very comprehensive program. I do pray to Allah the Almighty to grant you success and rightness to come up with useful results that are reflected on the current situation of health research in the Gulf and contribute effectively in promotion and development of health research, support of its priorities and depicting a more clear and luminant picture to this side at the present and in the future utilizing all facilities and capacities provided by our wise governments in the Gulf countries to consolidate efforts in a very clear and outstanding manner with research and studies that enable us to review and restore the glory of our leading Islamic and Arabic nation in development of all sciences. Once again, I welcome you all and I raise my thanks and acknowledgement to HE Dr. Hamad Al-Mana, Minister of Health for his kind patronage of this workshop. Thanks are also extended to my brother Dr. Obaid Bin Sulaiman Al-Obaid, Deputy Minister for Planning and Development and to all concerned brothers in the Ministry of Health and in particular Dr. Khalid Al-Hussain Executive Body Member and to all MOH workers, also to all participants in this important Gulf workshop. Your presence is the real support to such eminent initiative with the support of Allah. I do pray to Allah the almighty to make our work pure for the sake of Allah, and see you in other meetings Insha Allah. Peace be upon you and the mercy and blessings of Allah Dr. Tawfik A. Khoja -25-

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Health research Priorities In the Gulf Cooperation Council States Health Research Priority Setting Workshop Dr. Tawfik A. M. Khoja Riyadh, 29-30 Dhual Qa dah, 1428 H / 9-10 December 2007 Functions of the Health Ministers Council. The Council, for realization of its objectives, undertakes the following:- (1) Setting and developing health strategies, policies and systems development in the Council states. (2) Realizing coordination and integration as well as strengthening aspects of cooperation in the various health fields. (3) Control and elimination of infectious diseases in the Council States. (4) Protection of the member states from imported diseases and unifying related systems. (5) Unifying joint situation in the international circles and strengthening common relations with all related regional and international organizations. (6) Depicting a unified drug policy that assures full control of the imported drugs, and prepare for establishment OF self sufficiency for the Council States. (7) Realizing coordination and integration in the field of Group purchasing of drugs, Sundries and Central Drug Registration. (8) Encouraging joint studies and research in such a way that serves the sets objectives. (9) Approval on the plans and executive programmes for conduction of studies and research in the field of health problems, control of endemic and chronic diseases, health education, protection and safety of the environment, in the Council States. -27-

(10) Organizing exchange of experiences in the field of health learning and education, for the objective of developing and unifying education systems in the health colleges and institutions among the Council States. RESEARCH The main objectives of the HMC/GCC research programme may be summarized as follows: To develop the capacity to undertake research in the core areas of health. To develop the capacity to undertake in-depth research in a specified set of critical population and health issues in the region. Functions of the Studies and Research Division 1. Proposing studies and researches related to raising the health standard and development of health services in the Council states. 2. Setting a plan for studies and research, taking part in its preparation and follow up of implementation after being approved by the Director General. 3. Studying the technical reports, health statistics about diseases, mortalities, health problems in the Council States. Necessary proposals and recommendations are made in this regard. 4. Cooperation with specialized scientific and technological agencies inside and outside the Gulf States to help in preparing studies and research proposals. FIELD RESEARCH In collaboration with health ministries of the member states throughout the period from 1992 to 1997, the Executive Board completed a study on The child health in the Gulf States which involved data of over 277,000-28-

citizens, 38,000 mothers and 56,000 children. (The study achieved its objective of providing an extremely important database). Another study had been carried out since 1994 The Gulf Family Health Survey, its objective being to delineate the biological, environmental, demographic and economic factors that affect the health of the family (children-youth husbands aged people) in the Gulf region; in addition to studying the patterns of morbidity and mortality in the different age groups among the citizens of the region. These two projects had been implemented by HMC/GCC under the auspices of H.R.H. Prince Talal Bin Abdul Aziz, President of AGFUND and with the collaboration of GCC, WHO, UNICEF, UNFPA. Both projects helped to formulate the base-line data for health and health determinants. These data help in planning, setting priorities evaluation of health programmes and projects in the member states. The main objectives of the (Gulf Family Health Survey) are: To provide policy-makers, programme planners and researchers with a timely and integrated flow of reliable information suitable for formulating, implementing, monitoring and evaluating the family health and related development polices and programmes in a costeffective manner, To expand the health and demographic information systems at both the national and regional levels. To advance research methodology for the collection, processing and analysis of data on the health problems of families and their determinants; and To strengthen the technical skills required for handling interlinkages and connections between family health, bio-demographic, socioeconomic and cultural parameters which influence national and regional development policies and programmes. -29-

GFHS Background (Continued) Community and tools of the study The project has been implemented in each of the UAE, BAHRAIN, KINGDOM OF SAUDI ARABIA, OMAN, QATAR and KUWAIT throughout the period 1995-1998. Study included samples of resident families selected randomly through probability designs that ensures representativeness of the community. The total number of Gulf households included in the study was 34481. Burden of diseases Studies in the Gulf Countries. Rationale - there is a very strong need for comprehensive evaluation of the burden of diseases in the Council States due to lack of full population-based data about morality, morbidity, disability and the underlying causes, in most of the Council States, AND Calculating the DALY, (Disability Adjusted Life Years) and DALE (Disability Adjusted Life Expectancy). Objectives A. Consistent estimation of mortalities and its causes. B. Consistent estimation of incidence, prevalence and case fatality rates for the main causes of disability. C. Utilization of the results of burden of diseases in conduction of cost effectiveness analysis. D. Utilization of information in health planning and decision making processes. E. Promotion of national capacities and analytical skills in the field of epidemiology of population health and health information.. World Health Survey (WHS) The Cooperation Council states are in the process of implementing the WHS. -30-

Objectives of the WHS: Develop a means of providing low-cost, valid, reliable and comparable information. Build the evidence base to monitor whether health systems are achieving the desired goals. Provide policy-makers with the evidence they need to adjust their policies, strategies and programmes as necessary. WHO CONTRIBUTION $ 50,000 for each Gulf Country except Yemen ($ 150,000) WHO provides technical assistance + training and experts. HQ and regional office of the WHO provide technical training to the WHS teams, experts, quality assurance and assistance in data analysis and extracting results. Focal point in the EMRO. Has been assigned Workshop has been conducted in Muscat Oman (June 2005). Countries will be provided with the agreement with WHO (from the HQ in Geneva). An agreement between the WHO/HQ & The Executive Board has been signed lately (it outlines the terms of reference and the technical assistance given by the WHO to implement the WHS project in the Gulf countries ( UAE- Bahrain- KSA Oman Kuwait and Yemen). Qatar has implemented the survey. Role of the Executive Board Facilitation to the meetings, agreements and training Assistance in mobilization of resources Coordination with various participating bodies in the survey. -31-

Responsibilities of GCC States Logistic preparation Assigning the body which will implement the survey (General directorate of Statistics, Ministry of Planning or Ministers Cabinet). Deciding on the sample (representative to the community) Defining the requirements for training the surveyors Estimated cost of the survey Current Situation UAE conducted this survey 2003, planning to implement another round on a larger sample. Qatar has finished the field work and data analysis of the survey is underway. Saudi Arabia has finished the field work and the data entry will be finished soon. Cs Pro training is being conducted in Muscat, Sultanate of Oman. (1-5 December, 2007). The rest of the Gulf countries will start the field work in the beginning of 2008. Global Youth Tobacco Survey (GYTs) This survey focuses on the age group 13-15 years and it defines the knowledge, attitudes and practices of those children and adolescents as related to tobacco consumption. It also emphasizes on the effectiveness of the preventive programmes and the activities directed to this age group through the school curricula, the social programmes and the media with the objective of reduction of tobacco consumption among them. The research provides accurate information about how children and adolescents obtain tobacco products, and how to use it, and it evaluates the actions taken in this regard. -32-

Emphasis has been made on the following in this survey: Defining the % of consumption of tobacco and its products. Estimation of the age of the child / adolescent at the start of consumption of tobacco and its products for the first time. Estimation of the readiness of the child / adolescent to become a smoker in the future. Estimation of the extent the child/adolescent is exposed to involuntary smoking. Estimation of how much is the child / adolescent is exposed to smoking advertisements. Defining the basic factors such as attitudes beliefs and behaviours about tobacco consumption which may contribute in preparing future preventive programmes. Defining the extent of success of the preventive programs about tobacco consumption as well as the views of children / adolescents. The WHO STEPwise approach to Surveillance of Non- Communicable Diseases (STEPS) The approach is based on the concept that surveillance systems require data collection in a standardized way to ensure comparability across time and place and allow development of an increasingly comprehensive surveillance system which is based on local needs and resources. General Aim Development of manuals and infrastructure related to monitoring of risk factors for non-communicable diseases with emphasis on developing countries. Work towards provision of global informatics resources about the burden of risk factors, its trends and distribution. Developing a global database for decision makers in the field of public health. -33-

Expected Outcomes 1- Increasing awareness about the value of monitoring risk factors for non-communicable diseases and its control. 2- Production of manuals for monitoring risk factors of non-communicable diseases and / or its development in half of the WHO member states. 3- A global database about the burden of risk factors of non-communicable disease, its patterns, and trends for decision makers in the field of public health. Collaborators Various departments and units in the WHO WHO Regional offices Others United Nations Agencies WHO collaborating centers Governments and donor agencies Ministries of health and leading scientific establishments Related Non-governmental organizations. Current initiatives and networks about monitoring risk factors of noncommunicable diseases. Joint Risk factors in most non-communicable diseases Disease Risk factor Respiratory CVD* Diabetes Cancer Diseases** Smoking Alcohol Nutrition Decreased physical Activity Obesity Hypertension Increased Glucose in blood Hyperlipidemia * includes heart diseases, stroke and hypertension ** include chronic obstructive pulmonary diseases and bronchial asthma -34-

COHRED is an international organisation established in 1993, based in Switzerland with a strong global network. Vision COHRED works for a world in which health research is recognised as essential to optimising health and reducing inequity and poverty. To achieve this vision, we support countries to optimise their health research potential to: Improve health and reduce health inequities. Improve health sector performance. Link health research with science, technology and innovation. Promote health sector accountability. Encourage donor alignment and harmonisation. Generate economic and social prosperity. In its work, COHRED prioritises the poorest countries, regions and populations. Why health research? COHRED helps countries address the health needs of the poor Health research is necessary for countries to achieve better health, equity and development. COHRED s business is to enable countries to set and meet health research objectives, especially those aimed at improving equity in health. Mission COHRED is passionate about enabling countries to put in place and use health research to foster health, health equity and development. They work globally - prioritising the poorest countries. COHRED values and working principles to ensure that health research is used to achieve better health, equity and development as well as -35-

strengthen health research systems, COHRED operates according to certain fundamental values and working principles. COHRED values and working principles COHRED value social justice, good governance, sustainability, human rights, excellence and relevance, evidence-based action and southsouth alliances in health research. Working principles are: Country focus long-term commitment to work within countries enables them to strengthen their health research system and institutions. Partners & Collaborations COHRED works in an inclusive and participatory way, with a broad range of partners at national, regional and international level. COHRED s partners traditionally include members of the following constituencies: Government decision-makers. Research councils and institutions. Universities. Development agencies. Multilateral agencies. International organisations. National and international. Non governmental organisations as well as community organisations. Foundations. Networks. -36-

COHRED Interim Executive Committee COHRED s Executive Committee facilitates the rapid response of COHRED to challenges of health research for development. It meets several times a year. The Interim Executive Committee consists of Marian Jacobs, Somsak Chunharas, Ernesto Medina, Carel IJsselmuiden and Sylvia de Haan. The Global Forum for Health Research was established as an independent international foundation in Switzerland in 1998. Its origins lay in the recognition of three key facts: Improving health is not only an outcome of development but also a prerequisite for development. Consequently, investment in health yields one of the highest rates of return that a country can achieve. Improving health requires the effective application of existing research. It also, crucially, requires research aimed at creating new knowledge and new technologies. This includes the whole spectrum of research: - biomedical sciences (creating affordable and accessible new drugs, vaccines, diagnostics and appliances). - health systems and policy research. - social sciences. - political sciences. - health economics. - behavioural and operational research. - research into the relationship between health and the cultural, physical, political and social environments. - Few of the world s resources for health research are directed to solving the health problems of developing countries. Mission COHRED believe that more health research needs to be devoted to improving the health of people in developing countries. -37-

The Global Forum is working to: change the priorities governing how existing resources for health research are used. encourage new resources that will be directed to research in the neglected areas. foster research in the neglected areas to reduce the burdens of disease and disability. Recommendations of the Consultative Meeting About the Priorities of Health Research Executive Board, Health Ministers Council for GCC & the Global Forum for Health Research, 23-24 Rajab 1424 H / 20-21 September 2003, Abu Dhabi UAE I- At the level of the member states 1- Establishing a council or national body for health research (or its equivalent) in each country that involves representatives from the Ministry of Health, and various sectors of health services, governmental and private, as well as the universities, health colleges and institutions and health research centers. The council should aim at setting priorities of health research at the national level and bridging the gaps in supporting the priorities of health research and follow up and utilization of its results. 2- Increasing financial allocations for health research in the Ministry of Health, and supporting the infrastructure of the health research centers and departments, as well as calling upon raising the % expenditure on health research from Gross Domestic Product. 3- Calling upon the member states to:- - establish units or departments for research in the organizational structure in the Ministries of Health and granting the required capacities to supervise health research in the Ministry. -38-

- work towards finding mechanism for documenting research conducted in each country and its production in a printed form to be disseminated locally and regionally. - Gulf participation in the annual meeting of the Global Forum for Health Research. - the countries should continue holding training workshops to raise the standard of the workers in the health research field. 4- Preparation of a Gulf joint media plan to raise the attention and awareness towards the importance of defining priorities of health research in the member states in the decision makers of the Gulf health committees and the entire research community. II- At the level of the Executive Board, HMC-GCC 1- Call to establish the GCC Regional Health Research Forum, involving representatives from national health research committees, various sectors of health services, research centers and institutes, related national societies and organizations, supportive economic organizations, associations and centers, to define and depict health research priorities in the Council States to be implemented in a collective way. 2- Encouraging joint Gulf research and studies and provision of technical advice and recommendations together with finding mechanisms for strengthening relation between scientific research centers in the ministries health in the Council states. 3- Promotion and support of constructive integration and collaboration in the field of health research through : - - encouraging visits and meetings with exchange of experiences among specialists in the research and academic establishments in the Council States. - Raising the attention and awareness about the importance of scientific research in the community. -39-

- Continue holding educational workshops about methods and tools of defining priorities of health research, and giving effect to the role of the Council in this field. 4- work toward unification of common Gulf situations in the international gatherings and strengthening common relations with national regional and international organizations related to health research Health Research Priorities KSA Experiences Health Sciences Group in KAMCST Prelude The process of supporting health research started since the very early stage of establishment of KAMCST in 18/12/1397 H, which consequently required the importance of setting priorities. The General directorate of fellowships programmes in the KAMCST has undertaken support of health research through the following actions. 1. Exploring the views of governmental agencies and the production sectors concerning problems faced. 2. Defining priorities : This mission was originally done by a team form the fellowships general directorate, then it was assigned to the Health Sciences Group. 3. Announcing the priorities : This is done annually through issuance of booklets and posters about the health research program, which are disseminated to the universities, research centers, ministries, production sectors and agencies. 4. Draft research projects are received from the researchers. 5. Exploring the views of the ministries, governmental agencies and other concerned bodies in the submitted research projects. 6. Scientific evaluation of the research projects, these are sent to 4 specialized peer reviewers. -40-

7. Overall review of research projects : Specialized personnel in the general directorate with the help of consultants in the various fields included in the research projects conduct a very comprehensive review for each project. 8. approval of the research project which fulfills the priorities requirement and which can be supported from the program. 9. A scientific discussion with researchers whose research projects have been accepted is made. 10. Follow up of supported research projects. EMRO / COHRED / GCC Collaboration in Health Research Workshop to Develop a Strategic Partnership to promote Research for Health in the EMR Countries Riyadh, Saudi Arabia, 14-15 November, 2005 Purpose of the meeting The purpose of this meeting was to initiate a dialogue for an active collaboration between WHO/EMRO, COHRED, and GCC and other partners to support and strengthen national health research systems in EM Region countries. The ultimate aim is that these systems begin to address national health research priorities and start providing evidence for policy development and for changes in health practice, driven by the principles of fairness and equity. The objective is to draw together the strengths and capacities of both WHO/EMRO, COHRED, and GCC, to build on the work already carried out by EMRO and COHRED in the Region, to involve other interested parties, and to suggest possible mechanisms for future collaboration in Health Systems Research. This meeting is being organized as a first step in the establishment of the joint WHO/EMRO COHRED GCC partnership in health research. The meeting will attempt to reach an agreement on the potential areas of collaboration, on identifying partners for collaboration and on some key areas for undertaking research. -41-

Objectives of the Workshop: To review the national health research systems (NHRS) analysis that was undertaken in selected countries of the EM region in 2003 and 2004 specifically from the point of view of assessing the ability of these national health research systems to help in achieving the Millennium Development Goals and to reduce poverty and increase health equity. To identify the priority areas that require (urgent) health systems research inputs. To discuss and agree on the outline of a proposal focusing on priority areas and develop a joint plan for research for the 2006-2007 biennium, at least. To define the role and responsibilities of partners in the project. Expected Outcomes: Establishment of priority areas for collaboration A plan of action for joint WHO/EMRO COHRED GCC partnership in health research, including identification of potential sources of funding and outline of research activities Key partners (institutes, lead persons and deputies) are identified, their roles in the partnership defined, and their commitment obtained EM Regional health research systems strengthened Possibly, an EM Regional Forum for health research is established. RECOMMENDATIONS 1. Holding a one or 2 day meeting before the 10th Global Forum of Health, Cairo (29 October 2 November 2006). The Executive Board will undertake the arrangements of this said meeting by establishing committees for preparation in the proper way and securing the effective participation of the countries in the forum. -42-

2. Preparation of the questionnaires and health research situation analysis tools by the WHO/EMRO and the COHRED, including issues of equity. 3. Conduction of the situation analysis study in the Gulf countries and some of the EMR countries in which health research situation analysis has not been yet made. The Executive Board will bear the cost in the Gulf countries from the Research Fund, and the EMRO will bear costs of the non Gulf countries. How do decision makers make use of Health Systems Research in the field of Primary Health Care.? There are a lot of difficulties that prevent the utilization of the results of health research, where the applicability of any research is dependent on a number of items and requirements linked to many options that are associated with the various stages of the research process. 1. focus on the priority problems at all health service levels ( central middle peripheral community level) in order not to waste the research efforts in problems which are of low or unimportant priority. 2. Primary focus on the priority and the most stressing problems at all levels with the importance of using modern tools and mechanisms to set health research priorities 3. Research should be practically oriented, i.e. it seeks finding simple and practical solutions for problems. 4. In-depth research in particular (dealing with various aspects of health system) should involve various partners in evaluation of health care starting with decision makers, the middle level (provinces and directorates) and service providers at the health centers, and the beneficent community. 5. The Research should be timely conducted, in order to provide results that enable decision makers to take appropriate and significant decisions at the proper time. -43-

6. Limited publicization. The way the results of research is published may lead to its non-utilization. Mostly peer-reviewed journals and periodicals, where the results are presented in a highly technical and difficult language which is not comprehended by the policy makers and directors of health systems, therefore, they cannot take necessary decisions to improve the quality of health services. Recommendations & Future Perspectives 1- The importance of research lies in how much of its results can be utilized, and therefore, it is important to establish national mechanism to promote the utilization of research results and to efficiently and effectively publicize it. 2- Based on the recent global trends, the Global Forum for Health Research (GFHR) collaborating with the World Health Organization proved the presence of an extremely important and serious phenomenon which is 90/10 gap. This showed that the size of allocations and costs spent on 90% of real health problems especially in the developing world does not exceed 10% and vice versa. 3- As the Gulf level, the process of coordination and integration in the field of scientific research, and technical development in health research in the Cooperation Council states, has become a necessity imposed by the current situation due to the many common positive elements they posses. It has become a pivotal case to better health services. 4- Based on this, scientific research in general, and research directly related to health care quality with all its specialties and subspecialties in particular, became the cornerstone for continuous improvement of performance level in all aspects. 5- The relation of scientific research to the activates of quality is an integrated close relation towards betterment and safety of health care and its promotion at various levels. * * * -44-

Global Forum for Health Research HELPING CORRECT THE 10/90 GAP Workshop on Health Research Priority Setting Saudi Arabia Riyadh 9-10 December 2007 Application of Combined Approach Matrix (CAM): Experiences and Way forward Dr Abdul Ghaffar MBBS, MHA, MPH, PhD Health Policy and Systems Specialist Global Forum for Health Research, Geneva Why research and why priorities? What is CAM and how to use it? CAM Experiences Way Forward Priority setting for research in developing countries Health plays a vital role in development - not only as an outcome, but also as a co-determinant - investment in health yields exceptionally high rates of return Not enough is spent on health and health research by many developing countries Not enough is spent on health research for the needs of developing countries Research Research is the systematic application of tools and procedures, whose results are expected to lead to improvements in health, social and economic development of a population. Purpose Identification of gaps and of solutions Development of Programmes Empowerment of stakeholders -45-

Kinds of Health Research Research = new knowledge and technologies Biomedical Drugs, vaccines, diagnostics, appliances Health policy and systems research Scaling up, burden, demand, evaluation Social sciences and behavioural research Equity, social determinants of health Operational research Human resources, effectiveness, access Why research.. Difficulty in translating promising product cultural sensitivities affordability application to the local environment Synthesis of available information/sharing good practices Search for new knowledge Knowing is not enough, we must apply. Willing is not enough; we must do. (Goethe) 1990 Commission on Health Research for Development About 5% of resources for health research spent on 90% of world s health problems -46-

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Measurement issues How do we measure health? Selected examples Human development indexes Measures of Social Determinants on Health Healthy life years Life expectancy Levels of mortality, morbidity, disability Gap measures: DALYs, HEALYs, QUALYs Gross National Happiness (?) Lack of consensus on methods to measure health. Indicators: Standard (coverage, morbidity, mortality) Equity Sensitive indicators (equity disaggregated analysis, transparency, accountability, personal experiences and real life stories). -49-

Combined Approach Matrix Objective is to incorporate both the public health and the institutional dimensions Helps to classify, organize and present the large body of information Identifies gaps in health research Identifies health research priorities Three elements in priority setting 1. Values Equity considerations Cost of interventions 2. Process Diversity of stakeholders Participatory (COHRED) 3. Tools Markers of health and disease Sectors other than MOH (Global Forum). Actors and Factors involved in priority setting 4. Level of the central government 3.Sectors other than the MOH 1. Individual, family and community determinants HEALTH 2. Level of health ministry, health research institutions, health systems and services -50-

Examples of Application of CAM Institutions and national governments - IMRC and MOH Pakistan Programs - TDR, NCD Action Plan in Pakistan Diseases - Malaria, TB, Schizophrenia Risk factors - Indorr Air Pollution CAM Dimensions Steps Disease burden National, regional or global level Individual, household and community Health ministry and other health institutions Sectors other than health Macroeconomic policies Determinants Present level of knowledge Cost and effectiveness Resource flows -51-

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Challenges and Way Forward Availability of required data Competencies and capacities Political will Involvement of Stakeholders Working together Public interest shall take a priority over the organizational interests Development of a tool, which is comprehensive, takes into account the needs and voices of all concerned and is easy to use Two relevant quotes All diseases have two causes, one pathological, the other political (Rudolf Virchow) It isn t the strongest of the species that survive, nor the most intelligent, but the ones most responsive to change (Charles Darwin) * * * -54-

Role and promise of research in decision making Dr Abdul Ghaffar MBBS, MHA, MPH, PhD Health Policy and Systems Specialist Global Forum for Health Research, Geneva Why health research? Research is not a luxury, but is An indispensable way to create solutions, learn how to apply them and evaluate their impact A way to develop local ownership scope for considerable progress towards improving health status if existing knowledge was used optimally -55-

BUT: complex and urgent context of health sector development in LMICs: not possible to research all issues and use scientific analysis to solve all problems political processes are not deeply influenced by scientific evidence nor by researchers Health research or research for health a paradigm shift Health research is not principally responsibility of Health Ministry Health research depends and need to involve other sectors What do we mean by other sectors? Why health systems research? Limited application of available knowledge and technological interventions There are no clear answers for many issues commonly confronted by the policy planners There is an absolute lack of knowledge of which health system strengthening strategies are effective, and under which conditions Non-functional and fragile health care systems It has been estimated that full use of existing health interventions could reduce child deaths by at least 63% and maternal mortality by as much as 74%. Source: Freedman et al. (Lancet 2005) -56-

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Chronic diseases: the new epidemic Becoming the dominant source of ill health and death in the Middle East driven by - poor diet - lack of physical activity - tobacco use Death statistics Estimated 57 million deaths (approx.) occurred in 2003: 33 million are attributed to chronic diseases, and of these: - 17 million are attributed to cardiovascular disease - One third of these occurred in mid-aged people - One third occurred in China and India Urbanization Tipping point: 2007 marks a turning point in human history: the world s urban population for the first time equals the world s rural population -60-

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Changing demographics In 68 countries: over 40% of population is below age 15 But populations also ageing -62-

Changing demographics Opening and closing demographic windows of opportunity Bars show the range of years for which the dependency ratio the number of dependents relative to people of working age is falling. World Development Report 2007-63-

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Neglected health systems Health systems that are: weak/failing inadequately funded and staffed poorly managed lacking investment in health policy and systems research lacking in utilization of the evidence/research base - systematic, sustainable data collection and use for health policy/planning - use of the data for national and international policy- making to ensure more equitable direction of funds for research on health Stressed by epidemics AND by demands of vertical programmes: 3x5, GFATM, PEPFAR, RBM, etc -66-

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1990 Commission on Health Research for Development Not enough is spent on health research for the needs of developing countries Not enough is spent on health and health research by many developing countries -71-

The spectrum of health research for development Biomedical research Basic research: physical and biological sciences including chemistry, pharmacology, toxicology, genetics, etc R&D for drugs, vaccines, diagnostics, appliances, etc Health policy and systems research Research on policy formulation, relationship to evidence, prioritization, etc Research on health systems management, functions, efficiency, effectiveness, system factors affecting access scale-up, monitoring and evaluation, etc Social sciences and behavioural research Research on social and behavioural factors influencing health and their relation to equity, access, lifestyle and healthseeking behaviours, etc Operational research Research on factors affecting functioning of programmes, effectiveness of targeting, impact on behaviour, disease burdens and public health, etc Understanding the biological nature of diseases; creating products to prevent or treat disease states Understanding how to test, scale-up and follow through the introduction of interventions and optimise their benefits Biological, economic, environmental, political and social determinants of health Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition. WHO Constitution 1948 The carrying power of a bridge is not the average strength of the pillars, but the strength of the weakest pillar. I have always believed that you do not measure the health of a society by GNP but by the condition of its worst off. Zygmunt Bauman -72-

Prioritizing health research and development needs: Eastern Mediterranean Experience Dr. Mohammad Afzal A/Regional advisor Research Policy and Cooperation WHO-EMRO, Cairo, Egypt. - In recent years the world has seen a rapid increase in technological and economic potential, implying an enhanced ability to overcome problems related to poverty and poor health. - But there has also been an actual deterioration in health status in many developing countries, largely as a result of HIV/AIDS but also because of a resurgence in other infectious diseases and a growing burden of non-communicable diseases. Public health care systemnarrowly defined -73-

How could we know? - Am I going the right way? - How fast am I going? - Who else should I ask for directions? - Am I doing the right things right? - How will I know when I arrive in my destination? The participatory nature of public health research To ensure that the research is relevant and appropriate, everyone directly concerned with a particular health or health care problem should be involved in the research project(s) focused on it. - If decision-makers are only involved after completion of the study, the report may just be shelved. - If staff of health and other public services are only involved in data collection and not in the development of the proposal or in data analysis, they may not be motivated to collect accurate data or -74-

-carry out the recommendations. - If the community is only requested to respond to a questionnaire, the recommendations from the study may not be acceptable. - If professional researchers are not involved in the implementation of recommendations, they may have little concern for the feasibility of the recommendations. Basic questions which health policy makers need be answered What are the health needs of (different groups of) people, not only according to health professionals but also according to the people themselves? Can shared priorities be agreed upon? To what extent do the present health interventions cover these priority needs? Are the interventions acceptable to the people in terms of culture and cost, especially to the poor? Are they provided as costeffectively as possible? Given the resources we have, could we cover more needs, or more people, in a more cost-effective way? Is it possible to introduce or expand cost-sharing through insurance, to reduce the risk of unexpected high costs, in particular for the economically vulnerable? Could co-operation with the private/ngo sector be improved? Could donor agencies help solve well-defined bottlenecks in the system? Is it possible to better control the environmental factors which influence health and health care? Can other sectors help (education, agriculture, public works/roads, etc.)? (See Figure.) Specific questions for specific levels of service HR is not only of use to policy makers; at each level managers may have questions that require further research, e.g., - Health policy makers: What are the prospects for voluntary community-based insurance? - Managers at district/provincial level: Why is cholera outbreak in -75-

certain districts more fatal than in other districts? - Hospital directors: Why do we have such a high rate of complications due to Diphtheria? Are malarial patients coming late for treatment and, if so, why? Are the first-line services available and adequate? Are our own services adequate? - Managers at village level (village health committees: How can we assist women with little or no education so that they can effectively recognize the symptoms of pneumonia and go in time to the health centre with their children? Three Types of Diseases Type I - Incident in both rich and poor countries. - The strategy will focus on the following Type I diseases, increasingly prevalent in developing countries: diabetes, cardiovascular disease and cancer. Type II - Incident in both rich and poor countries, but with a substantial proportion of the cases in poor countries. For the purposes of the strategy, the focus is on HIV/AIDS and tuberculosis. Type III - Incident in developing countries. For the purposes of the strategy, the focus is on the 9 neglected infectious diseases populations prioritized by the TDR: Chagas disease, dengue and dengue haemorrhagic fever, leishmaniasis, leprosy, lymphatic filariasis, malaria, onchocerciasis, schistosomiasisand human African trypanosomiasis. -76-

Prioritizing research and development needs Health research and development policies in developed countries need to reflect adequately the health needs of developing countries. Gaps in research on Type II and Type III diseases and on the needs of developing countries in relation to Type I diseases need to be identified urgently. A better understanding of disease determinants is essential to drive sustainable research and development on new and existing products. The actions needed to prioritize research and development needs : 1. Identifying gaps in research on diseases that disproportionately affect developing countries: a. develop methodologies to identify gaps in research on Type II and Type III diseases and on developing countries needs in relation to Type I diseases b. provide an assessment of identified gaps 2. facilitating upstream research on new and existing products for diseases that disproportionately affect developing countries a. improve accessibility to compound libraries for identification of compounds with potential activity against the above-mentioned diseases, by means including public private collaboration b. provide technical support to developing countries in order to create libraries of new compounds at both national and regional levels. 3. coordinating research activities between developed and developing countries: a. coordinate international efforts in research and development in order to optimize resources b. support developing countries in building technological capacity c. promote the active participation of developing countries in the -77-

innovation process 4. formulating explicit prioritized strategies for research and development at country level: a. developing countries to set research priorities so as to address public health needs and implement public health policy based on appropriate and regular needs assessments b. conduct research appropriate for resource-poor settings and research on technologically appropriate products to combat diseases in developing countries (including Type I diseases) c. include research and development needs for traditional medicines in a prioritized strategy -78-

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Known Methods for priority setting Horizon Scanning Looking across an area to identify future challenges and opportunities Delphi A two stage process starting with a questionnaire to seek initial views from a wide range of experts and the responses are collated and sent out again to the contributors for comments Trend Analysis Extrapolating historical data forward, thus more suited when looking at an issue that takes time to change, rather than an issue that is very responsive to immediate pressure The Global Forum Combined Approach Matrix for health research priority setting - Help decision-makers make rational choices in investment -80-

decisions so as to have the greatest reduction in the burden of disease for a given investment (as measured by number of DALYs averted), on the basis of the practical framework for priority setting in health research. - Priorities should be set by all stakeholders. - Transparent and iterative process. - Approach should be multidisciplinary (biomedical sciences, public health, economics, environmental sciences, education sciences, social and behavioural sciences). The Priority Setting Process:Practical Steps The aim of priority setting is to increase the effectiveness of the ongoing R&D effort with a focus on improving public health in developing countries. Step 1: Planning the process of priority setting Step 2: Situation Analysis (Assembling the Needed Information) Step 3: Identifying and Involving Stakeholders Step 4: Selecting and Using Criteria Step 5: Setting Priorities Step 6: Resource Allocation and Priority Setting Step 7: Implementing & Reviewing Priorities -81-

Priority Evaluation The final selection of priority research areas will depended on the interaction of two sets of factors (illustrated with a plot): 1. Stakeholders input (through a public consultation process): - Feasible economic and social benefits (Feasibility) - Degree of importance, including socio-political aspects (Attractiveness) 2. Experts input - High scientific priority with promising solution for health issues (Strong emphasis) - High priority for solving health issues with promising scientific gains (Selective emphasis) - Low priority for solving health issues with or without scientific gains (Limited emphasis) -82-

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EMRO SPECIAL GRANT FOR RESEARCH IN PRIOIRTY AREAS OF PUBLIC HEALTH (RPPH) First Round 2002 Health Systems Research Health life styles and Non Communicable diseases Mental Health. Second Round 2003 Health Systems Research Impact of environment on Health of Children Issues of ethics and equity in health Poverty alleviation and health development Third Round 2004 Health Sector Reform Strengthening District Health System Management Information System Quality of Care and Client Satisfaction Fourth & Fifth Rounds 2006 Health Policy and Systems Research Human Resources for Health Sustainable and Reliable Health Information System: Social Interventions for sustainable development, equity and gender issues Mental Health Nutrition and Health Environment and Health EMRO SPECIAL GRANT FOR RESEARCH IN PRIOIRTY AREAS OF PUBLIC HEALTH (2008-2009 ) A. Stewardship function of health care systems: A.1. Utilization of research results in policy making. A.2. Development and Sustainability of Community Ownership in health and socioeconomic interventions. A.3. Enabling environment for women s greater participation at different levels of health management. A.4. Role of cultural and religious fora and values to promote health and healthy life style A.5. Inter-sectoral linkages for the achievement of the Millennium -84-

Development Goals. B. Resources for health: B.1. Health care financing B.2. Innovative models of public-private partnership and their impact on the delivery of health services. B.3. Impact of Community Health Workers and health volunteers on achieving Millennium Development Goals. B.4. Evaluation of the Basic Development Needs (BDN) initiatives on health. B.5. Continuous professional development of health workers. B.6. Job satisfaction among health care providers. C. Health Services: C.1. Accessibility, referral systems and equity of health services especially for vulnerable groups. C.2. Health seeking behavior and satisfaction with health care services among beneficiaries. C.3. Adherence to the universal measures of patient safety and provider safety. C.4. Accreditation of health care services. C.5. Health systems capacities in identifying, treating and responding to domestic violence against vulnerable groups. C.6. Evaluation of programs on prevention and management of disability including blindness and deafness. C.7. Rational use of medications and access to essential drugs. D. Knowledge generation and utilization: D.1. Improving the use of the Health Management Information System (HMIS) as a tool for decision making and estimating the disease burden. D.2. Availability, accessibility and use of information and communication technologies. D.3. Evaluation of the quality and appropriateness of health publication in national languages. -85-

D.4. Availability, quality and utilization of standard medical records in health care facilities. D.5. Quality, dissemination, and impact of health-related information provided to the public. D.6. Availability and utilization of resources for students of health professions in their national languages. E. Problems of Public Health Importance: E.1. Environmental health: safe water, sanitation and food safety. E.2. Evaluation of prevention programmes of occupational hazards E.3. Evaluation of prevention programmes for road traffic injuries. E.4. Interventional programmes for promoting healthy lifestyle E.5.Evaluation of mental health programmes E.6. Assessing the burden of non-communicable diseases: cancer, diabetes, cardiovascular, and renal diseases. Proposed procedure for selection of priorities from a priority list : - A reviewer may decide his/her own method of scoring for a priority from a list, or use a scoring scheme provided by or agreed with other stakeholders. - All reviewers may use the same or different ranges of scoring for different priorities. Example of reviewer s scoring : Priority # : Impact of environment on Health of Children Criterion Score (s)* (e.g., 5-1) Weight (w)** Weighted score (Sw) Sw = s*w Need 2 1 2 Impact 3 2 6 Feasibility 4 4 16 Attractiveness 1 3 3 Ethical issues 3 1 3 Average 6 * Usually decided by reviewer ** Usually decided by approving authority or a committee. In case no weighting is desired all weights can be treated as 1s. -86-

Scoring for each priority by all a reviewers need be standardized by following the method described hereunder: 1. Make the grading unidirectional (preferably descending order), i.e., the higher number representing higher level of criteria. If a reviewer has used opposite order of grading that may be transformed as follows to make it descending: 2. Let in the original scoring the upper limit of the range be H, and the score recorded by the reviewer be So then the revised score, Sr, for the same value will be:sr = (H+1) - So 3. In case reviewers have used different upper limits for the ranges of their scoring but the sizes of the ranges are same (or almost same), then the scoring need be normalized as follows: Let the evaluation score (original or revised) given by a reviewer for the criterion i is Si, while the upper limit used by him/her for the score is Hi then the standardized value, Ssi, of the score will be: Ssi = (Si / Hi)*Hs where Hs is a normal upper limit (say 5) envisaged for a criterion (The selection of Hs is immaterial and shall not bias the overall scoring by different reviewers. 4. In case reviewers have used same or different upper limits for the range of their scoring but sizes of their ranges are different, then their scoring may be first normalized as above and then standardized as follows: Let the number of reviewer be n and the normalized score by the reviewer j for a statement i is Sij, then standardized score by the reviewer j for a statement i, Sdij will be:sdij = [(Sij - µs)/δs]max + [(Sij - µs)/δs Where µs and δs are the mean and standard deviation of all Sij values over the n reviewers. The term [(Sij - µs)/δs]max is added to avoid the negative values in the standardization. 5. Once normalized and/or standardized as required, the scoring data can further be processed as shown in the Table. -87-

6. As far as weighting is concerned, this may be decided by an approving authority, or a selection committee. 7. In case no weighting is recommended, the some of original, normalized or standardized scores over all the statement will suffice the purpose of overall scoring. -88-

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Research Priorities Setting: King Abdulaziz City for Science & Technology Experience King Abdulaziz City for Science & Technology Prof. Abdulrahman Alabdulaaly General Directorate of Research Grants Programs Introduction King Abdulaziz City for Science and Technology (KACST) which was established in 1977 is entrusted with the promotion of Science and Technology activities in the Kingdom of Saudi Arabia. The main objectives of KACST can be summarized as follows: Supporting and promoting applied scientific research in the kingdom. Coordinating the activities of the scientific research institutions and centers in line with the requirements of development plans in the Kingdom. Setting the national priorities in the fields of science and technology in cooperation with other sectors. KACST Funding Policy: The main thrust is to support applied research projects which are technically and financially sound. KACST funds projects which contribute to the development plans in the Kingdom, and which have : - Novel ideas, - Clear objectives, - Adequate project design and methodology, - Receive good comments and high scores from the reviewers, - Reasonable budget, - Contribute to the development plans of the Kingdom. -91-

Historical Background of Research Funding: 1979 1987 No Priorities setting 1987-1997 Setting Priorities in Coordination with government agencies 1997- present Initiation of Scientific groups with the adoption of priorities selection criteria. KACST supports research through eight grants programs: Program Year of Inception 1- Annual General Grants Program. 1979 2- National Grants Program. 1982 3- Graduate Students Grants Program. 1991 4- Limited Grants Program. 1996 5- Humanities Grants Program. 1998 6- Production Sectors Research Grants Program. 1999 7- Development Research Grants Program. 2006 8- Innovation Grants Program. 2007 Funded Projects in Different Programs Along with the Budgets 1401-1428 (1981-2007) Program Annual Grants National Grants Graduate Students Grants Limited Grants Humanities Grants Production Sector Development Research Grants Total Funded Projects Budget SR. Million 737 580.41 99 136.43 974 28.83 390 30.91 36 11.57 5 2.13 8 6.75 2249 797.03-92-

Funded Projects according to the Field Field Basic Sciences Health Engineering Agriculture Humanities Total Funded Projects 608 601 486 452 102 2249 Budget SR. Million 100.25 263.10 229.15 173.14 31.40 797.03 Sources of Priorities: - National policy for sciences and Technology. - Government agencies. - Recommendations of funded research projects. - Recommendations of Conferences. - Media. -93-

Examples of funded Health Research Projects: - Endemic and chronic diseases, such as Leishmaniasis, Malaria, Bilharzia, blood diseases, liver diseases, diabetes, renal diseases, bronchial asthma, tuberculosis, cardiac diseases and hypertension. - The use of genetic engineering in diagnosis of haematological and neurological diseases. - Disability among children. - Autism and related developmental disorders. - Leukemia and bone marrow transplantation. - Health problems related to the environment, such as lead pollution, chemical and microbial contents in drinking water, zoonotic diseases, usage of antibiotics in poultry production, smoking and air pollution. - Chemical and pharmacological studies on some medicinal plants, venoms of scorpions and snakes and studies on the practice of traditional medicine in Saudi Arabia. Examples of projects funded within the priorities: - Dengue mosquito, Aedes prevalence and dengue virus molecular & immunologic detection in Al-Madinah Al-Munawwarah. - Spinal Trauma in Saudi Arabia: A National Study. - The Role of Community Pharmacies in Primary Health Care in Saudia Arabia. - A Study of the Immunological, Haematological and Clinical Factors in Unexplained Fetal Loss in Saudi Arabia. - A study of the Health care Needs of the Saudi Elederly. Examples of projects funded outside priorities: - Bronchial Asthma in Saudi Arabia : Regional Variations and Impact of Allergens. - National Research Study of Disability Among Children in the Kingdom of Saudi Arabia. -94-

- Gene therapy for anaplastic thyroid carcinoma with a single chain interleukin 12 fusion. - Bone Mineral Density Measurements of Saudi Arabian Females. - Detection of the Presenilin-1 Gene Pathogenic Mutation From Saudi Patients with Alzhemier s Disease. -95-

Summary 1989-2007: Total No. of Priorities: 108 Total No. of projects funded within priorities: 15 % of projects funded within priorities : 13.9% Range : 0-40% % of projects funded within priorities to total funded Medical Projects: 10.6% Causes of the low Number of funded projects within the announced priorities: - There are more important issues other than the priorities. - The unavailability of interested specialists. - The specialists are too busy. - The subject of the priority is too big to be carried out. - The medical research infrastructure is not adequate. - Incentives for the researchers are not enough. Examples of Priorities Announced but not applied for: - Epidemic diseases of pilgrims. - A comprehensive Epidemiological survey of Psychological disorders in SA. - A comprehensive Study of Ophthalmic diseases that cause blindness in SA. - Medical Malpractice in SA. - Epidemic diseases in SA. Conclusions: - Over the past years, KACST have allocated over 33% of its funding to health research projects. - The funded projects have contributed to the improvements of health services in SA. -96-

- It is clear that the health research priorities set by KACST are not receiving as much attention from researchers as hoped. It is therefore suggested that a different approach should be adopted. * * * -97-

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The mechanism of selection of health research priorities in king Abdulaziz City of Science and Technology Othman A. Al-Shabanah, Ph.D. Professor of Pharmacology and Toxicology Department of Pharmacology, College of pharmacy, King Saud University king Abdulaziz City of Science and Technology publish their annual research grant program booklet in September of each year. The booklet contains the research priority proposal themes in all the scientific fields. At least, six to ten of these research priority proposal subjects are in the health field. The booklet also, includes a general invitation for the researchers to submit their research projects in the area of priority or in their own interest of research. Who is preparing the health research priorities? The selection of health research priorities in king Abdulaziz city of science and technology is accomplished by the health scientific group with the help of the general directorate of research grants at the king Abdulaziz city of science and technology. The health scientific group is a group of experts represents: 1. Universities 2. Hospitals 3. Different governmental and private institutes Selection of Health Research Priorities The selection of health research priorities in king Abdulaziz city of science and technology is accomplished through the following stages:- I- Communications with different governmental and private agencies This stage includes a general invitation for the different governmental and private agencies such as universities, ministries, hospitals, drug industries and the specialists to submit their health research priority proposals by filling the research priority form. -99-

The health scientific group is always encouraging the different governmental and private agencies and individuals to fill the research priority form and to send it back to the general directorate of research grants at the king Abdulaziz city of science and technology. The Research Priority Form The research priority form is available on the site of king Abdulaziz city of science and technology at the internet and it consists of four elements: 1- Title of priority 2- Importance of priority 3- Objective of priority 4- The impact of the expected results of priority. II- Collections of Information - This stage includes the collection of the research priority forms filled by the different governmental and private agencies such as universities, ministries, hospitals, drug industries and the individuals. III- Preliminary Evaluations - The health scientific group studies all the research priority proposal subjects submitted by the different governmental and private agencies and individuals from the stand point of logic and science. - Rewriting, abbreviation, addition and incorporation of the research priority proposal subjects are applicable in this stage. - This stage may involve contacting individuals who submit the research priority proposal subjects. -100-

1V- Selection of the Health Research Priority Theme The selection of health research priorities by the health scientific group in king Abdulaziz city of science and technology depend upon the following criteria: 1. The national needs for the research priority proposal theme. 2. The research priority proposal theme will study a specific health problem of the Saudi society. 3. The research priority proposal theme will study a general health problem but the solution will have a positive impact on the science and health service in Saudi Arabia. 4. The extent and strength of evidence available for the existence of the problem intended to be solved in the submitted health research priority theme. 5. The scientific and logic rational of the health research priority theme. 6. Absence of conflict between the research priority proposal theme and the religious and ethics values. 7. The impact of the results of the research priority proposal theme. 8. The economic benefits of the research priority proposal theme. Health Research Priority Theme Form To apply the previous criteria on each of the research priority proposal theme A health research priority theme form is designed. The form consists of eight questions and each question has three answer choices. These answers are: Yes, No and Not clear Within the question, the load of each answer is different ( Yes= 8; No= 0; Not clear = 3). -101-

Every member of the health scientific group should fill the form of the health research priority theme for each priority The average scores are calculated for each priority The priorities are arranged depending on their average scores The research priority proposal theme is rejected if their scores is less than 50% Health Research Priority Theme Form 1- Do you think this research priority theme is important to the national need? a) Yes b) No c) Not clear 2- Is this research priority theme represents a specific health problem of the Saudi society? 3- Is this research priority theme represents a general health problem and its solution will have a positive impact on the science and health service in Saudi Arabia? 4- Do you think the evidence of the existence of the problem intended to be solved in the submitted research priority theme is strong and enough? 5- Do you think the scientific and logic rational of this research priority theme is strong and acceptable? 6- Is there a conflict between the research priority proposal theme and the religious and ethics values in Saudi Arabia? 7- Do you think the research results of this research priority theme are useful and applicable? 8- Do you expect a an economic benefits of studying this research priority theme? -102-

Discussion Despite the effort of the health science group to select the most applicable research priority themes, only 10-15% of the research project subjects submitted to king Abdulaziz city of science and technology are within the health research priority themes. The majority of the researchers are not interested to submit research projects under the priority theme, they prefer to submit projects from their own research interest. The reasons For such a behave are not clear. Conclusion In conclusion, this presentation covered the mechanism of selection of health research priority themes apply by the health science group. * * * -103-

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Health Research In UAE Dr. Saeed Abdu Those who cannot remember the past are condemned to repeat it George santayna (1863-1952), American philosopher and poet. History Many activities and attempts to initiate health research activities in UAE have failed, as they do not remain in routine use. The Current Situation The Federal Ministry of Health, the major health service provider, is seriously hampered by the lack of aval1able and accurate data on health related issues. Health care research is fragmented and often week and this situation require a coordinated approach to strengthen and focus efforts and put priorities. We have to become more creative in putting the priorities and in using the available resources. The reality Presently within the United Arab Emirates there are many bamers that have been identified. The govemment acknowledges that health research is vital to developing any disease control program with high quality, responsive health care (United Arab Emirates Directory 1998). The current push for a sustainable and viable disease control program has made it clear to the health authorities that the success of such a program# and the assessment of its effect# depends considerably on the availability of quality data. Only appropriate health research can provide these data cost effectively. -105-

The best way to escape from a problem is to solve it (Brandon Francis) There are challenges facing the health research program developers performing the development of research this include addressing process and institutional arrangements in the Western World, but when development takes place in the Third World, it faces further challenges due to cross cultural issues. Cross Cultural Issues Developments always take place in an environment where culture has a main role to play. Developing research is far from being culture free. It is also difficult to accommodate cultural issues and ethnicity specifically. One major criticism raised by several who promoted a more participatory approach was that researcher program developers had paid insufficient attention to cross-cultural issues when designing and implementing their studies (Ginsberg 1988). Hopson (2001) states that the ability (or lack thereof) to capture multiple cultural perspectives accurately is a sign not only of addressing multicultural validity unsatisfactorily, but it implies that insufficient attention has been given to issues related to cultural competence. Organizational culture The term culture, and more specifically organizational culture, has recently come into the common parlance or phraseology. Culture in organizations can be thought of as the beliefs, values, and meanings shared by members of an organization. Understanding culture as something implicit and generating from interaction at all levels of an organization raises the question as to wnether it is advisable for managers to enter into quality improvement programs (Bright and Cooper 1993). -106-

Total Quality Management and culture Implementation of Total Quality Management programs varies considerably according to the culture of the organizations in which it is being implemented (Shortell et al 1995). Thus research stressed the importance of taking cross-cultural issues into consideration in order to increase an evaluators ability to provide reliable and useful information (Merryfield 1985). What is research A utilitarian definition Research may be viewed as rigorous inquiry to advance knowledge and improve practice. In management terms, building such capacity reflects a commitment to quality improvement and characterizes a learning organization (senge PM the fifth discipline: the art and practice of learning Organization) Type of Research Biomedical and clinical research. Epidemiological and related community health research. Health system research. Health service research. Operational research. It also implicit within other function: planning. evaluation. surveillance. investigation. problem analysis, and extemal audits. Research priority setting in UAE what we know already? Where are we from Executive summary presented in Riyadh as technicsl presentation? In the forty eight session of the regional committee for EMRO -107-

Inadequate political commitment An unfavorable research environment Lack of leadership Weak management and coordination of research Near absence of linkage and networking among those interested in research Poorly developed research capacity Inadequate resources Where We Are? When compared with other countries of the region the United Arab Emirates is characterized by a reasonable amount of resources, better infrastructure, higher health expenditure per capita and more institutional capacity. But as the UAE sets and implements national health research priorities, it faces challenges similar to those confronting other countries within the region. Health Reform in UAE There is health sector reform agenda in the UAE and massive investment in health care. Ministry of Health The Health Authority of Abu Dhabi The Health Authority of Dubai Other Governmental Health Partners The Private Sectors What impede the Implementation Health research is not yet put in this reform agenda. Lack of partnerships grind down the United Arab Emirate s research capacity. -108-

The ministry of health is suppose to be a champion in term of health research, especially in term of health system research, but in practice the research capacity constrains limit the ministry to introduce health research programs. Lack of clear national health research priorities impedes United Arab Emirate s ability to conduct relevant research and allocate resources. Where to Go? We have to set a number of collaborative efforts involving stakeholders from all levels of the national health system and other health related sectors. A national strategy has to be developed to address the broadly determined health research priorities. Our health research has to be coherent with health priorities defined in a national health plan. We to develop strong and accountable governance and management system for setting, evaluating, and communicating national health research priorities Develop a strategy to strengthen research and research management as part of the national research agenaa Develop link between researchers and decision makers that reinforce the message: Improved Research= Improved Health Share information on research among national peers and policy makers through conferences workshops and on line MOH portal We need to develop a national health research agenda We need to better establish and mange our research priorities We need to refine our ability to effectively communicate our health research agenda We have to strengthen our capacity to improve the organizationaf structure so we can accomplish the complex task of setting. communicating and implementing the United Arab Emiratets health research agenda -109-

We have to improve communication between researchers and decision makers. We have to develop better incentive structure to link researchers and decisions makers and make ministry of health to commission research that is better aligned to our national priorities We to make the volumes of unpublished studies carried out by national researcher be available on line resources What to Do? The development of national health research system will need to look beyond the Ministry of Health in terms of priorities putting or agenda for action. Developing Research Friendly Environment Responsibility for developing a research friendly environment applies beyond health issues to public policy as a whole, and it brings us to the issue of priorities, which relevant to capacity buildings Capacity uilding Levels: Strategic Operational The strategic management context It start from the vision and mission statement Prioritizing research The operational context The most critical element in any enterprise is usually the human resource The development of research skills generally requires additional, post graduate education -110-

To develop research manager research training alone is not enough. Equal attention should be given to managerial dimension, including skills in such areas as risk analysis, priority setting, planning, budgeting, human relations, team building, and development incentives and rewards.. Research management Situation analysis Setting goals and objective. Action plan Monitoring and evaluation Resource mobilization Research is not necessarily a costly venture with a supportive mission and trained personnel, even with little or no explicit funding, individuals and institutions can conduct research Governance as a critical success factors According to Roussel et al. there are some imp.ortant management rules related to resources mobilization: Research project are never nsacred ; projects must sometimes be suspended or terminated when condition render them unfeasible or when better proposal arise; Time given to unsuccessful venture can not be recovered and can be an opportunity cost, that is, the cost to passing up one opportunity in favor of anther; Just as in financial investments, one should not throw good money after bad; Good ideas require attention any time, not just at budget time. There should be no project in the It nothing better to do category; -111-

There should be overbooking that is, one should make more submissions than that capacity to implement them strictly allows, on the assumption that not all attempts to generate funds for research will succeed; Contracting out and partnerships are always an option for enhancing capacity The Six main stages Marsden and Oakley (1990) specify that effective evaluation should contain SIX main stages. These are to: discuss, explore and agree terms of reference for the evaluation With the stakeholder group; clarify... expected outcomes ; determine resp.0nsibilities; select appropriate methods and explore new ones durinr the evaluation process; encourage open debate of provisional conclusions and report the findings to all parties. They- put the strongest case for inclusion of another Objective, to build a meaningful and equitable partnership that is possible only when there has been some history of sharing and understanding over time. * * * -112-

National Health Research in Bahrain Dr. Jamal Alsayyad Situation analysis Health research is neither institutionalized nor managed properly. There is no national health research policy or plan. However, research was as one of the priority twelve strategic goals of the national health strategy. Strategic Goal No. 10: Education, Research and Development: Develop the role of the health system in education, research and development in Partnership with other agencies, and focus on health research for development. The Aims of this goal 10 were: - Develop a Center for Health System Research and Evidence Based Clinical Practice to ensure a structured approach to the assessment, organization and co-ordination of research. - Development of health policy based on research outcomes and epidemiology. - Establish a research training program for Ministry of Health employees. The key stakeholders involved in research for health that are the most influential in determining health research in the Kingdom of Bahrain are: - Ministry of Health. - Arabian Gulf University, Faculty of Medicine. - Bahrain Centre for Studies and Research. - Royal Medical Services Hospital (BDF Hospital). - NGOs: Bahrain Cancer Society - Others: Bahrain University, RCSI-MUB Research is part of graduate programme of medical schools It is part of Family Physician and specialty Training Residency Community surveys: National NCD survey 2006-113-

Clinical research is mainly of case reports and case series descriptive type Current Activities Reformation of Health Research Committee headed by the secretary (ministerial resolution no. 19 of 2005) Allocation of B.D. 100,000 from the ministry s budget for research Establishment of Bahrain Branch of UK Cochrane Centre Training: Research Methods Evidence-based Health Care Systematic Reviews Establishment of Research unit (Proposal) Health Research Structure In Ministry of Health Bahrain Health Research Committee Technical Support Team Primary Care Sub-Committee Secondary Care Sub-Committee College of Health Sciences Sub-Committee -114-

Functions of Health Research Committee Adoption of health research policies, strategies and priorities in the ministry. Monitoring medical researches and ensuring its adherence to medical ethics. Research capacity building for employees in the field of health research. Documentations and dissemination of research results. Approval of the release of research budget. Cooperation with local regional and international organizations in the same field. Functions of Technical Support Team The provision of technical support to research sub-committees. Approval of research proposals of employees of ministry head-quarter and the provision of technical support. Approval of research proposals of researchers from other health organizations and academic institutions who intend to conduct research by using ministry data or facilities. The provision of advice regarding medical ethics to research subcommittees and to researchers from other health organizations and academic institutions who intend to conduct research by using ministry data or facilities. National Capacity Building in the field of health research. Research priority Setting Based on leading causes of death Ex. of questions: To what extent does care provided to diabetic patients comply with quality standards? -115-

Bahrain Branch of UK Cochrane Centre Bahrain Branch of UK Cochrane Centre has been established in 2005 with the following core functions: 1. provide the policy makers with best available evidences on interventions and medical treatment 2. Training and support of researchers in doing systematic reviews relevant to their specialties 3. Hand searching 4. Translation of evidences to Arabic 5. Accessibility to Cochrane Library of RCTs and CCTs. DISSIMINATION AND UTILIZATION OF RESEARCH RESULTS: Recently, Cochrane evidence has been introduced as criteria for justifying or nullifying the adoption of new technologies including drugs. An example was the procurement of Rosiglitazone for diabetes mellitus Systematic reviews: Topical nasal Steroids for allergic rhinitis Anti-emetics Management of Diabetes Mellitus The ministry of health intranet displays research documents and results. It also has links to international research organizations / institutions. There are two medical journals which are widely distributed locally and regionally (the journal of Bahrain Medical Society and Bahrain Medical Bulletin). Individual researchers initiatives of bibliography production. Bahrain Television and local newspapers disseminate research results on ad-hoc bases in coordination with ministry of health. They also play an active role in media campaigns for conducting national surveys. -116-

Proposal of Establishment of Medical Research Group in Medical review Office Medical Review Office Medical Research And Evidence group Medical Review Group Challenges to National Health Research Priority setting approaches and methods Recognition of importance of research departmentalization Recognition of research as integral part in health care provision and quality Creation of culture and environment conducive of research and evidence-based policies and practices Incentives for researchers * * * -117-

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RESEARCH PRIORITY SETTING MOH, KSA DR.FAISEL ABU-DUHIER, PHD DIRECTOR GENERAL, ADMINISTRATION FOR MEDICAL RESEARCH Situation analysis Phase one A memorandum to all provinces a survey was conducted to prioritize research in MOH settings Phase two : RESPONSES FROM ALL PROVINCES WERE COLLECTED & GROUPED INTO Diagnostic (N=20) Therapeutic (N=37) Rehabilitation (N=7) Development and planning (N=25) Public health epidemiology (N=82) Phase three: Building on the survey results: Qualitative focus group discussions Consultation meetings Review of morbidity and mortality MOH reports Review of MOH research OVER the past 3 years Review major sources of priority setting including EMRO, WHO, CDC scoring form Consultation meetings: Meetings with WHO_EMRO experts on research priority setting Discussion with local consultant experts for prioritizing research in MOH -119-

Review of morbidity and mortality MOH reports (1426) Leading causes of Mortality 1- Cardiovascular diseases (CVD) (20%) 2- Accidents (20%) Leading causes of morbidity 1- Cardiovascular diseases 2- Accidents -120-

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Review of MOH research over the past 3 years (NCD) - Diabetes. - Risk factors for NCD - Elderly care - Infant mortality Review major sources of priority setting including : - EMRO, WHO, CDC Development of an abbreviated list of research priorities using the following techniques: - Focus group using priority setting criteria - Selecting 5 OR< priorities from each group - Adding priorities from the expert opinion meetings. Limitations: - No clear guidelines were attached. - No priority criteria forms were forwarded - In some sites it was completed by one person not a group Health Policy & system research. - Management information system - Estimation of disease burden - Situation analysis of samples sent abroad - Premarital screening - Outcome studies of diabetic care & costs - Public-private partnership in health care. - Evaluation of CME activities Life styles studies Life style pattern among school children Effects of interventional educational programs on nutritional habits among school children Risk factors for CVD in school children Epidemiological survey of substance abuse Community initiatives for changing life style -122-

Genetic - Studies to determine the genetic factors in various diseases Epidemiological studies - Childhood accidents - Obesity - Mental disorders Conclusions This is only a tentative exercise A need to follow a scientific, in-depth analysis There is a shift towards non-communicable chronic diseases (NCD), it is the prime time to conduct interventional studies for reducing risks of NCD A framework for continuing evaluation of research priority setting is needed. * * * -123-

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Research Priorities of Five Years Health Research Plan 2006 2010 of MOH Mr.Hilal Al-Kharusi Dep. Research and Studies MOH, Sultanate of Oman Health research priorities: The research priorities have been established since the fifth 5-years plan 1996-2000 along with the health research policy workshop. The WHO criteria and scoring for prioritizing the research topics was used during the workshop including: relevance, avoidance of duplication, feasibility, political acceptance, application of results, urgency of data needed, ethical acceptability. After identifying the health problems and approval of the sixth fiveyear health plan 2001-2005 a similar workshop was conducted to reestablish research priorities based on national health problems, the personnel attended the workshop were from different health disciplines. The participants identified the research priority topics. The list of top ten health research priorities is: 1- Malnutrition (PEM for children) 2- Anemia in pregnant women 3- Cardiovascular diseases and lifestyle risk factors 4- AIDs 5- Cancers 6- Road traffic accidents 7- Diabetes 8- Blindness 9- Viral hepatitis 10- Tuberculosis -125-

In addition to these topics, the following health research priorities are: hospital work (records, use of beds.. ), primary health care (availability, manpower, referral system, satisfaction..), environmental health problems (water, vector, occupation..) and health system research (development of human resources, cost of health services, utilization, quality of health and medical care ). Research priorities (based on national health problems) in the Ministry of Health are directing according to the Domains in the7th Health Development Plan 2006-2010. The Domains/fields are: Field of pharmacy care Nursing care Quality of health services Communicable diseases Control of AIDs and STDs Malaria eradication: Non-communicable disease Eye health Psychiatric Health Genetic health Environmental and occupational health Control of accidents & injuries Women Health Adolescent and youth health Health education and communication Nutrition Information & statistics and Researches. A workshop was carried out at the end of May 2006 to refine the topics of research priorities. The personnel attended the workshop were from different health disciplines. (see the following list of research priorities in the 7th Plan). -126-

D.N * Domain / Field Research Titles Year 4 1 PHC No 2,20 - Secondary & Tertiary Hospital-Based Services - Emergency Medical Services ( Accident & Injuries ) 3 Pharmaceutical care. Nursing Care 5 Laboratories No 6 Blood Services 7 Radiography No Assessment of Hospital Autonomy Initiative (HAI) Assessment of appropriateness and effectiveness of emergency medical services in MoH hospitals. (preliminary, external assessment) Study of environment and personal factors that affect the occurrence of accidents and injuries. Prescribing patterns of Statins drug in health facilities Economic impact of antipsychotic drugs. Investigation of current practice of prescribing antibiotic nationally. The roles and responsibilities of Ward Nurses / Nurse Managers at the Ministry of Health Institutions. Management and Leadership Evaluation of impact of specialty programs in clinical practice. Clinical practice Practices of standard precautions among health care workers during patient care. Infection Control Transfusion transmissible infection (targeting HBV). 2006 2006, 08 2007 2006-09 2006-09 2006-09 2007 2008 2008 2008-127-

D.N * Domain / Field Research Titles Year 8 Rehabilitation services 9 Quality Assurance and Improvement of Health Services and Patient Safety 10 Communicable Disease 11 AIDs and STDs 12 Malaria No 13 Non-Communicable Diseases. Community rehabilitation of the elderly at Al Amirate Wilayat (Muscat). User assessment of the quality of health care services Job satisfaction among health care professionals Medical errors reporting system: physicians and nurses views. Rotavirus diarrhea prevalence study. Pneumococcal disease in < 5 y children-assessment of costeffectiveness of vaccine. Immune response to fractional dose of IPV. Study of HIV risks among Drugs Users in Oman. Study of STD among community members (antenatal women, Dermatology Clinics ). Survey about HIV among general population (Ante-natal Clinic) National survey of tobacco use among adults ( WHO stepwise approach ). 2007 2009 2009 2010 2006 2006 2006 2006 2007 2008 2007 Lifestyle risk factors of adults 2007 Diabetes control study. 2007-128-

D.N * Domain / Field Research Titles Year 14 Eye Health Care 15 Ear Health Care 16 Oral & Dental Health 17 Mental Health 18 Genetic Diseases National glaucoma survey among > 30 year old Omani population Impact of Laser treatment of DR Outcome assessment of treatment of retinopathy of Prematurely Recurrence of trichiases after management by oculoplasty surgeon using new technique Visual function assessment for students in school mentally challenged (MoEd) Assessing hearing status of persons working in noisy industries Assessing hearing status of persons residing in areas with noisy traffic National oral health survey of 12 & 15 Years old Omani children -Profile trend of drug abuse of patients attending Ibn Sina Hospital.(Addiction Unit) -Prevalence of Depression In urban and rural Areas. (Psychiatry Unit) National survey of hemoglobin disorders in Omani children.? Community-based study of the prevalence of birth defects, genetic conditions and perinatal mortality. Work out most efficient ways of health education in genetic health. -129-2005- 2007 2007-08 2008 2007-08 2008 2008 2008-09 2006/07, 2010 2008 2008-2009 2006, 2010 2006-2008 2006-2008

D.N * Domain / Field Research Titles Year 19 Environmental & Occupational Health Annual comprehensive studies to evaluate drinking water resources and the diseases result from its contamination. Comprehensive study on occupational health & safety Study the environmental factors that affect injuries and accidents National Household survey on type and outcome of injury 2006 2006 2007 2007 Study of low use of IUD 2007 21 Women s Health 22 Child Health No 23.24 Health education and communication / Adolescent and youth health / Risk behaviors 24 Adolescent and youth health 25 Nutrition Female circumcision 2007 Birth spacing and Unmet needs 2007 KAP survey on hereditary & congenital anomalies in Oman. KAP survey on risk behaviors among community including adolescents and youth. An evaluation study to identify the health services available to adolescents. Anemia among pregnant women National PEM survey among children < 5 years old Survey to monitor infant and young child feeding practices 2007 2007, 2010 2006 2007 2007 2008 School nutrition survey 2008-130-

26 D.N * Domain / Field Research Titles Year Community Participation Healthy Life style 27 Health Administration 28 Health Information and Statistics 29 Research and Studies 30 Development and Omanization of Human resources Assessment of NCD risk factors in Nizwa Healthy Life Style project. Assessment of NCD risk factors in Sohar Healthy City Base line assessment of NCD risk factors in Salalah Healthy City. Job satisfaction among administrators of health facilities ( with Quality Assurance Domain, No.9) Study for validation of routine health information Study of the old people profile at Nizwa wilayat Health Research System (HRS)with EMRO, COHRED and GCC: NHRS Mapping Study. World Health Survey (WHS ) of GCC in Oman Secondary analysis of WHS data Intervention Study for elderly care and life style health promotion. Costs of health researches in the 7th Health Development Plan,2006-2010. No 2007 2007 2007 2008 2005/06 2007,08 2006/07 2008,09 2008-09 -131-2007- 2010

Follow-up and Evaluation Centrally Regionally Challenges Resources (Financial-manpower-time) Skills (training) Support from Private sectors Share of information between governmental and non governmental Strength of research components curriculum in medical schools The bodies of health research producers in Oman are consisted from: 1- Ministry of Higher Education: - Sultan Qaboos University (SQU): Colleges of Medicine & Health Science. - Phan11acy, Nursing and Some depari111ents of Colleges as Agriculture (nutrition zoonosis). - Private universities which are recently established. 2- Ministry of Health(MoH): as the Directorate of Studies & Researches, health programs, Some regional Health Affairs and health institutes. 3- Other related ministries: as Ministry of National Economy which conducted the national population census in 1993 and 2003 and has Statistical Consultative Committee, Ministry of Social Development.. etc. 4- Private sector and Civil Society Organization (CSO s): as some pharmaceutical companies and few Women organizat1ons. The Ministry of Health (MOH) which was established in 1970 - is the main providers of health care in the country at all levels to achieve the goals of health for all strategy through comprehensive primary health -132-

care. Since 1976. six 5- Year health Development Plans have been implemented. The department of Research and Studies was established under the Directorate General of Planning since 1991. It includes four sections: health system research, epidemiology, clinical research and health survey. The department acts as a national focal point for research. The health research in MOH of Oman is being reformed particularly with respect to priority setting and utilization of research products. The researches provide data and information necessary for the planning, implementation, monitoring and evaluation of programs to reduce the priority health problems. The health policy integrates health research into planning, policies and programs. Coordination mechanism: On the national level: Scientific Research Council: H.M. the Sultan of Oman emphasized the importance of scientific research in development and solving the socio economic problems. Recently the council was established in June by Rova1 Decree No.54./ 2005 to design a national scientific research plan including hea1th research with prioritization and supervision of the implementation. The counci1 regu1ates, promotes, encourages, supports the scientific research and coordinates between the research institutes. Statistical Consultative Committee: It was estab1ished by Royal Decree No.29/2001 through the Statistical Law in the Ministry of National Economy to: - Regulate and coordinate the collection and analysis of social, economic, financial, demographic and health statistical data or surveys from the country. -133-

- Approve the long ten11 plans and annual statistical plans & surveys from different ministries and other agencies with prioritization. - Promote statistical studies & surveys and provide technical support. - Establish national data-warehouse. - Periodic dissemination and publications of collected statistical data, surveys or census. On the MOH level: Scientific and Ethical Research Review Committee: The committee is headed by the undersecretary of Health Affairs and constitutes of members from different disciplines. The committee reviews the scientific and bioethical issues in proposed study protocols for final approval. The Department of Research and Studies is the official responsible body and focal point for research at MOH. The proposed studies are conducted through this department where technical support is given in a11 phases, Also, it coordinates between the directorates and between the health regions to avoid duplication of research. At the beginning of the five-year health plan, the program managers/ principal investigators suggest a proposal in their programs and should be in the line with research priorities. The directorate of research & studies and the managers review the proposal. A disciplinary task force is formed at central level. The task force meets regularly during the planning, implementation, analysis phase and report writing. At regional level the director general of health services is responsible for the research activities at his region. The regional research coordinator is responsible for technical part of the project. Data are analyzed in Oman- with technical support from foreign agencies, or abroad. -134-

Financing resources: There is no specific budget allocated for research at MoH share indirectly through transportation, stationary, equipment supply and manpower. The international agencies as WHO, UNFPA, UNICEF, UNSD, GCC States... work through joint programs between the donors and program managers directly toward similar goals. Infrastructure for health research(capacity building): The main sources for literature are the libraries in the main hospitals in each region, health institutes, Sultan Qaboos University and coi1ege of medicine. Computers and software packages are availab1e. Network is a tool to increase collaboration and to facilitate development of research capacity. Access to information particularly through the Internet facilities are available free of charge. The medical laboratories in the main hospitals, public health laboratories and institutes of health sciences as well as other laboratories in other relevant ministries are eguipped for biomedical research. Manpower and training: A number of training workshops were conducted to increase the number and qualification of researchers and supporting staff in the central level as well as regional Level. Majorr training courses: - Workshops for training on research methodology, data analysis, research ethics, proposal writing, Dissemination, reproductive health research, introductions to research in medical laboratory science, EBM, - Symposium on research methodology - Planning & producing a newsletter for MoH staff. - Short courses and graduate studies: Few short courses and a master degree for Omani nationals abroad at -135-

Nuffield Institute for Health Services Studies, Leeds University, London School of Hygiene and Tropical Medicine - Social Research Center, American University in Egypt - Cairo Demographic Center, Institute of Statistic, Cairo University - Harvard School of Public Health, USA. Dissemination and using research outputs: Publications A series of workshops for dissemination and utilization of research outputs were conducted. The participants are from different disciplines from MOH and other health related organizations e.g. education, environment, social development, municipality, Diwan Royal court, AL- Shura Council and Qaboos University. MOH conducted 34 studies from 1992-2006. The listed 34 studies with major findings are disseminated through the Annual Health Report of the MOH 2006. Most of health system researches and community surveys ended as official report to health authorities, but few data were published in scientific Journals. Therefore publications in peer-reviewed journals are not reflecting the research outputs and the capacity of the personnel s in carrying out research. Evidence-based decision-making and research result utilizations: There are evidence based decisions and research utilization made by the MOH. The research results had changed the health problem priorities in the country and many actions have been taken. Due to high prevalence of iodine deficiency, the Sultanate adopted the universal salt iodination strategy in 1995. Vitamin A deficiency was prevalent in pre-school children therefore a strategy based on the provision of vitamin A capsule has been adapted to infants and mothers. In addition to this, the high prevalence of PEM revealed by family health -136-

survey in 1995 and iron deficiency anemia particularly in vulnerable groups had changed the health problems priorities and placed malnutrition as one of the most important health problems priorities. Accordingly Department of Nutrition and Diploma course at the Public Health Institute were established. As for non-communicable diseases or problems, Oman is witnessing an epidemiological transition from communicable to non-communicab1e diseases/problems. The health care delivery system currently deals wit11 a double burden of some communicable diseases, MCH problems and malnutrition, in addition to new epidemic of non-communicable health problems. Accordingly, decision was taken for expanding the health services and developing new services as for diabetes. Generally results from the surveys are used as a base-line data during formulation, monitoring and evaluation of the five year health development plans and base-line for the following plan. Collaboration: Internal collaboration: The MOH and the Sultan Qaboos University collaborate in training workshop as evidence-based medicine, some joint researches and meetings. Research activities between different stakeholders of the College of Medicine & Health Sciences and the programs of MOH have been integrated particularly in the area of risk factors of chronic diseases (Nizwa healthy life-style project) and hypertension projects at Nizwa District, the environmental health activities and glaucoma survey in Oman. External collaboration: - Omani child health survey, 1988 and family health survey, 1995 were carried out as part of the Gulf Health Survey Project in six countries, -137-

with collaboration of AGFUND UNFPA, UNICEF, WHO and Ministry of Health. - Multi-center study with selected GCC countries. 1999 to determine the prevalence of HBe Ag in pregnant women (funded by Smithkline Beecham). - The inten1ational Study of Asthma and Allergies in children (ISAAC, 1994). - Mu1ti -center growth reference study to construct growth reference curve for children <5 years by putting together data from 7 different sites to be used as standard curve for all countries(supported by WHO). - International multi-center study as part of Inter Heart Study. - Multi-center study for smoking in Muscat. - Collaboration with universities and research centers as John Hopkins- SRC. American University in Cairo / Egypt and Harvard University in the areas of family planning, fertility and health transition. - Collaboration in the field of research training. At the end of the five-year health plan (2001-2005), the health managers collaborate with WHO (provides seed money and technical support) to conduct the following studies: - Assessment of environmental risk factors in Oman households & surrounding and impact on the health of child. - Assessing the impact of HBV vaccination. - Birth spacing assessment and evaluation. - Glaucoma survey in Oman. - World Health Survey in GCC countries with WHO (in the field work phase 24/11/2007 for 3 months. * * * -138-

Research Opportunity in HMC: Role of Medical Research Centre Dr Hassan Al hail Dr.Sink & Ahamad Al-Mula Medical Research Centre, HMC State of higher education and research activities in Qatar The government of Qatar is committed to diversify its economy and building sustainable knowledge based economy. The goal is to build up national health system, higher educating and construction of world-class teaching and training facilities. During the last five years several international recognition have set up campuses within education city: 1. National heath authority 2. Hamad medical corporation 3. Weil Cornell medical college- Qatar (WCMC-Q ) 4. Sidra medical and research center (SMRC ) 5. Al Shfallah center (AC) 6. Qatar university (QU) 7. The university of Calgary 8. Education city (TAMU-Q,CMU-Q) 9. Qatar science and technology part (QSTP) 10. Qatar national research fund (QNRF) Mission Promote, support and coordinate research Provide financial & logistic support for research Produce skilled researchers Function of Medical research Provides: - Funds for research - Awards for best publication -139-

- Scientific support for research Creates: - Rules and regulations for research - Data registry to all HMC departments Checks: - Feasibility of research - Scientific interest of research - Novelty of research - Ethical issues of research - Relevancy of research Assists: - Designing of research - Statistical analysis of research - Interpretation of results - Sample size and power analysis Looks: - Authenticity of research - Planning of research - Cost effectiveness of research - Revision of research proposals - Quality of scientific publications Service - Research Committee - Providing Statistical support - Establishing /updating data registry - Research Fellowship - Annual award for published research Research Ethical Committee Rules and regulations Research that requires review at a convened meeting of FULL REC -140-

Research that may be reviewed by the REC by an expedited review process Research that may be exempt from REC Review Suspension/ termination of research projects Informed consent Ethical principles of informed consent Recruitment of subjects Advertisement for research subjects Guidelines for consent documents Who may obtain consent When and where consent should be solicited The consent process Required signature The effective period of signed consent Modification of the informed consent Modification in the documentation of the informed consent Pediatric subjects in research studies Studies only involving blood drawing Forms for Guidelines, Research projects grant form etc. Forms for evaluation Check list Address: Medical research Centre Room No. 2, Old OPD, HGH Phone: 4392440/4422671 - Fax: 4392402 Email: research@hmc.org.qa * * * -141-

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Health Research Agencies in Kuaiwt Kuwait Foundation for the Advancement of Sciences (KFAS). Kuwait Institute for Scientific Research (KISR) Kuwait University Research Administration (KURA) Ministry of Health via Kuwait Institute of Medical Specialization (KIMS) Ministry of Health research bodies Kwait Institute of Medical )Specialisation (KIMS Food and Catering Department Department of Statistics & Medical Records The Planning & Follow up Department- Health Systems Research Unite KURA s Priorities 1. Diabetes in relation to obesity. 2. Musculoskeletal Disorders. 3. Nutrition. 4. Dental Caries. 5. Pharmaceutical Services. KFAS s Priorities Awards subdivision with focus on:- Aspects of the Environment. Public Health. -143-

KISR s Priorities Occupational health issues. Environmental health issues. Health Research in Kuwait Aiming at managing and preventing of common diseases in Kuwait. Affecting health of larger strata of the population. Serving the developmental strategies of the country, in particular those with industrial and economic applications. Field surveys aiming at determination of magnitude of common diseases in Kuwait. Research aiming at evaluation of existing health systems and procedures, and testing new health systems and protocols. Multidisciplinary research involving health sciences and other disciplines like social, environmental and safety. Promote health and health education in relation to leading causes of death in Kuwait, common causes of morbidity in Kuwait, and healthy behaviour and life style Research Priorities 1. Diabetes Mellitus. 2. Road Traffic Accidents. 3. Ischemic Heart Disease. 4. Allergic Diseases and Bronchial Asthma. 5. Malignancy Diseases. 6. Pregnancy & Child-related Diseases. 7. Infections. 8. Child Health. 9. Nutrition. 10. Brain Research. -144-

Financial Support KFAS derives existence from legislation and obtains grant funds from profits of Kuwait shareholding companies. The Board of KFAS is under the Chairmanship of His Highness, the Amir of Kuwait, and its mandate is to support all forms of research in the country. Medical Research Ethics Committee Aim:- To integrate the process of research with the aim of protecting the rights of involved subjects How? Members of this committee undertake comprehensive ethical review including the research protocol, consent form and the letter of information to participating subjects. Journey of a Research Research to KIMS (Research Unit) Medical Research Ethics Committee for ethical review Grant awarding agencies for comprehensive scientific reviewing If accepted Research Unit is notified to resume its responsibility of monitoring, evaluating and implementing of the project. Research findings dissemination 1. Bulletin of the Kuwait Institute for Medical Specialization. 2. Medical Principles and Practice, Health Science Centre, Kuwait. 3. Kuwait Medical Journal (KMJ), Kuwait Medical association. 4. Al-Taqaddum Al-Ilmi, KFAS. 5. Research Administration, Kuwait University. -145-

The responsible bodies of monitoring and evaluation of the impact of new health policies or intervention Ministry Of Health - Department of Statistic and Medical Records - Department of Planning & Follow Up The Planning Higher Committee The National Assembly Department of vital & health statistics past studies Use of Indicators in Monitoring & Evaluation of Health Care Services in Kuwait (Aug. 1992). Effect of Oil Well Fires on Human Health in Kuwait (Feb. 1993). Average Length of Stay in Government Hospitals of Kuwait (Aug.1994). Cardiovascular Mortality & Morbidity in Kuwait: 1980-1993 (Sep. 1995). Health Care in Kuwait at the Regional Level A Comparative Study (Feb.1996). Road Traffic Mortality in Kuwait: Trends & Differentials (Dec.1996). Bed Utilization Performance at the Government Hospitals of Kuwait (Jan.1997). Cancer Mortality in Kuwait: Trends & Differentials (Aug.1997). Primary Health Care in Kuwait the State at Present (Dec.1997). Incidence and Prevalence of Diabetes Mellitus in Kuwait (Aug.1998). Mortality due to External Causes: The Kuwait Experience (June 1999). Dynamics of Surgical operations in Kuwait (Oct.1999). Infectious & Parasitic Diseases in Kuwait: A Statistical Study (Dec.1999). Congenital Anomalies in Kuwait: Trends & Differentials (April 2000). Endocrine, Nutritional, and Metabolic Disorders in Kuwait (Sep.2000). -146-

Mental & Behavioral Abnormalities in Kuwait: A Statistical Analysis (Jan.2001). Respiratory Disorders in Kuwait: A Statistical Perspective (April 2001). Digestive system Disorders in Kuwait: A profile (Sept. 2001). Cause of-death Certification in Kuwait: An Evaluative Study (Dec.2001). Musculo-skeletal Disorders in Kuwait: A Statistical Analysis (Feb.2002). Major current projects World Health Survey Global Burden of Disease Study EMAN STUDY * * * -147-

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Health Research Priorities in Yemen Mr.Tarek Salah Asa d Al-Aghbary Dr. Nour Addin Al-Jaber Dr.Yahia A. Raja a Health status in Yemen Population of Yemen is 19.721.643, according to 2004 census. Rural 75%. Urban 25%. Administratively, Yemen is divided in to 332 districts located in 21 governorate. Population growth rate is 3.02 and the family average size is 7p./ one family. The age-sex composition is characterized by young population community because of the high total fertility rate (6.2 for one women). Demographic indicators(2006): Crude birth rate 39.2 % Crude death rate 11.4 % Health expenditure indicators(2006): Total expenditure on health (per capita) 33$. General Government expenditure on health (Per Capita) 11$. General Gov. expenditure on health 5.2 % Health Status Indicators (family health survey 2003): Infant mortality rate is75 per 1000 live birth. Under 5 mortality rate is 92 per 1000 live birth. Maternal mortality ratio is 356 per100000 live birth. Life expectancy at birth is 62.9 years. -149-

Selected Morbidity Indicators (2006) : Malaria 800,000 Tuberculosis 2724 AIDS 1585 Setting Health Research Priorities: A workshop was organized in June 2003 to set the priorities. Participants were; leaders from MoPHP, researchers from academia, health programs managers, doctors from hospitals and CSOs. Health problems were identified according to the following criteria: - High mortality rates. - High prevalence rates. - High endemicity. - High economic burden. - Problems that effect the national health system. A list of 32 health problems were identified within 5 domains. These are: 1. Epidemiological studies on; - Malaria. - TB. - Gastroenteritis. - ARI. - Schistosomiasis. - HIV/AIDS. 2. Reproductive health studies on; - MCH - Nutritional problems. 3. Health system studies on; - Health policies - Health economics -150-

- Human resources. - Health legislations. 4. Behavioral and environmental research on: - H.Ed. - School health. - Rational drug use. - Khat. - Traditional healing. 5. Non-communicable diseases resarch on; - Nephrotic problems. - Cardio-vascualr problems. - Malignant neoplasms. - Blood diseases. - Diabetes mellitus. * * * -151-

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The workshop came up with very good recommendations including: 1- Encouraging the research bodies to use of the scientific methodologies to set the health research priorities as an endorsed tool in these bodies at the national and Gulf level and not to depend on traditional methods. 2- Promoting conduction of high priority research to provide required information to draw evidenced based policies and decisions. 3- Conduction of a Gulf workshop to strengthen communication between public and private sector, to promote partnership in the field of supper of health research, logistically and materially. 4- Work towards participation of various sectors with the Ministry of Health in the process of setting health research priorities including civil community organizations, stakeholders, and local community, universities, as well as research bodies and establishments. 5- Holding a regional workshop about translating research into health policies and mechanisms for utilization at the national and Gulf level. 6- Work towards exerting efforts within systematic well studies approach to change the social culture about the importance of health research. 7- Promotion of joint Gulf Cooperation in the field of exchange and marketing of research programmes between the member states, especially those that are community based. 8- Urging the member states to develop and the skills of health workers in the field of health research and their support to effectively participate in the process of health research. 9- Strengthening cooperation between the Executive Office the World Health Organization and Global Forum for Health Research for the exchange of research, and provision of technical assistance in building and strengthening national and Gulf capacities, and urging them to support the Executive office with the required experiences and skills in this regard. -153-

10-Urging the ministries of health in the member states to give health research the highest priorities, and assigning required budgets as well as informing decision makers about the research results. 11-Strengthening cooperation between the Executive Office the World Health Organization and Global Forum for Health Research for the exchange of research, and provision of technical assistance in building and strengthening national and Gulf capacities, and urging them to support Executive Office with the required experiences and skills in this regard. - The Director General of the Executive Board participated as a member in the Regional Consultative Committee for Health Research in Cairo (28-29 October 2006) which issued very important recommendations. These recommendations have been circulated to the Cooperation Council States to be put it into action as appropriate. - The Director General of the Executive Board has also participated in the special meeting of the Health Research Ethics Committees held in Cairo(18-20/4/1428 H / 5-7 May 2007) organized by the Eastern Mediterranean Regional Office and UNESCO. The Director General of the Executive Board has delivered an address about the activities of the Health Minister s Council for the Cooperation Council States about Bioethics and ethics of science and technology. - The Health Ministers Council for the Cooperation Council states participated in the meetings of the Global Forum of Health Research. -154-

The Gulf Committee for Health Research in its first meeting issued extremely important recommendations as well as it formulated the Gulf Strategy for Health Research. The Recommendations involved the following : 1- The committee acknowledges with appreciation and gratitude the great initiatives presented by the Custodian of the Two Holy Mosques King Abdullah Aziz donating 300 million US dollars as seed money for energy, environment and climate change research and as well as the donation of HH Amir of Kuwait of 150 million US doollars for the same purpose. 2- The committee apprecriates with gratitude the initiative made by the Prime Minister of the UAE, Sheikh Mohammed Bin Rashid Aal-Maktom establishing scientific research centers in the Arab universities, offering fellowships to Arab students and researchers, to bridge the knowledge gap. 3- The committee praises with appreciation and gratitude the efforts of the leaders in the Council Countries for their concern about scientific research, notably what was presented in the last Gulf Summit held in Doha Qatar and the initiative made by HH Amir of Qatar Sheikh Hamad Bin Khalifa assigning a budget in the Cooperation Council States for scientific research. The committee urges the Cooperation Council States to fully utilize these important initiatives in supporting health research. 4- Request to adopt the vision, mission, objectives and targets as well as the strategic plan for promotion of health research in the Cooperation Council States set by the Gulf Committee for health research. 5- Coordination among the member states in relation to the use of available tools and mechanisms for setting priorities of health research whether from COHRED, GFHR or CHNRI or WHO. 6- Request from the member states to provide the Executive board with a list of researches done in order to give effect to exchange of knowledge and experiences between the council states. -155-

7- Assigning the member of the Gulf committee for health research, Kingdom of Bahrain to set a list of the 10 priorities for the health problems in the member states using available information about (DALYS) and provision of Executive Board with the report within 2 months as of the date of this meting. * * * -156-

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