Collaboration to address major health challenges over the next 10 to 20 years

In late 2013, the Collaboration for Applied Health Research & Delivery (CAHRD) embarked on a major Consultation that will end with a meeting in Liverpool on 12th and 13th June to shape its strategic direction to address major health challenges over the next 10 to 20 years. The aim of the 2014 Consultation is to foster dialogue between Partners, to scope out likely challenges on a selected range of health topics and to plan pathways towards solutions for these challenges.

CAHRD is a global collaboration of organisations, with a strong partnership between northern and southern institutions, working together across the full range of applied health research to transform health systems to improve the health of low and middle-income populations. The Collaboration is hosted and co-ordinated by the Liverpool School of Tropical Medicine’s (LSTM) Centre for Applied Health Research & Delivery led by Professor Bertie Squire.

Applied Health Research encompasses research that provides policy-relevant evidence, which includes operational, implementation and health systems research that helps to develop practical solutions to health needs and rights. This requires expertise from a range of disciplines to combine and integrate scientific, technological, economic and social insights. Applied Health Research maintains close links with Discovery and Translational Research. Delivery of Applied Health Research develops and supports individual and collective capabilities to implement and sustain best practices and wide-scale implementation of interventions in health service delivery.

Four areas of current CAHRD work (workstreams) representing a diverse range of health topics have been selected for this first Consultation: Lung Health, Maternal and Newborn Health, Neglected Tropical Diseases and Health Systems.

Lung Health is an area where experience in chronic infectious disease control (mainly tuberculosis) provides a starting point for approaching chronic non-communicable disease control. Specifically, the BREATHE Africa Partnership will research the health effects of household air pollution.

LSTM’s Centre for Maternal and Newborn Health is strongly positioned to maintain and expand as a leading, global Centre of excellence to improve the availability and quality of healthcare for mothers and babies to reduce maternal and child mortality demanded by the Millennium Development Goals.

Neglected Tropical Diseases (NTD) are nearing a period of transition in the approach required for control. Huge gains in the control of NTD’s have largely been achieved through the use of preventive chemotherapy in mass drug administration (MDA) targeting specific diseases such as schistosomiasis, lymphatic filariasis and onchocerciasis. These programmes have primarily used a “vertical approach” which will need to change to a more integrated approach with routine health services with the reduction in disease prevalence. The success of MDA programmes may be less achievable in countries starting out with these programmes as these countries tend to be fragile or conflict affected states. Moreover, some NTDs e.g. trypanosomiasis may not be amenable to the MDA approach. The Centre for Neglected Tropical Diseases based at LSTM has an outstanding record of achievement in the areas of implementation, research and capacity strengthening in NTDs. Substantial work is also being carried out in developing new diagnostic, drugs and insecticides for NTD control. The A-WOL Macrofilaricidal drug discovery and development programme is developing new drugs against onchocerciasis (river blindness) and lymphatic filariasis (elephantiasis).

Strengthening Health Systems including human resources, governance, financing, essential technologies and health information systems is critical for the delivery of health improvements in all disease-specific areas. In particular, increasing and sustained use of close-to-community providers is essential in tackling the severe shortage of human resources in developing countries and in fragile, post-conflict states. The REACHOUT project aims to generate knowledge to strengthen the role of Community Health Workers and other close-to-community providers in promotional, preventive and curative primary health services in LMICs in rural and urban areas in Africa and Asia. The ReBUILD Consortium is working to explore how we can strengthen policy and practice related to health financing and staffing in countries that have been affected by political and social conflict. Developing the capacity of people and the institutions and systems within which they work is also required which is the focus of the Capacity Research Unit based at LSTM. Evidence Synthesis by the Cochrane Infectious Disease Group spans these workstreams producing high quality, systematic reviews to impact on policy.

Cross-cutting themes already emerging from these workstreams include equity; devising sustainable approaches to health service provision for chronic ill-health and disability; the need for new, more effective multi-sector interventions and more intensive multi-disciplinary approaches; close to community healthcare delivery; development of health systems in conflict affected and fragile states and marginalised populations; and the need for new tools and modeling approaches for health system functioning and information systems. Addressing these themes presents opportunities for closer collaboration and sharing of experience and expertise between the workstreams.

The two-day culmination of the Consultation will open with plenary sessions addressing the three most important emerging issues in each of the four workstreams. These issues will then be discussed in small expert working groups and fed back to the plenary the following day. The LSTM Leverhulme Lecture “Delivery research in global health: a pregnant moment?” will be delivered by Tim Evans, Director of Health Nutrition and Population at the World Bank. Peter Sissons, one of UK’s most experienced broadcast journalists will facilitate a Question Time Debate on the second day.

We very much look forward to the presentation of options for further growth and development of work within these initial areas of research, identification of cross-cutting themes and strengthening existing and forging new collaborations with global partners.

Blog by Kerry A. Millington, Research Manager at the Liverpool School of Tropical Medicine and the Health & Education Advice & Resource Team (HEART); and Professor Bertie Squire, Director of CAHRD

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