Priority Setting

History:

More than half of the period set by the UN has passed and mortality of children globally has not decreased enough. The latest 2008 Count down report showed that 26 out of 68 count down countries have made no progress at all and another 26 have made insufficient progress in reducing child mortality and most unlikely to achieve their goal. Why is this case? One of the answers may lie in current practices in which funding priorities are being set in global child health research.

There is considerably less interest in research on how to implement these interventions in the context of health services in countries with limited resources. Implementation research is not ranked highly by the scientific community or by most funding agencies. As it is rarely considered a research priority, research on new interventions far exceeds that on delivery. Research funding for global child health currently favors opening new frontiers with their attractive promises over realizing the full public health impact of the interventions which led from past advances in knowledge. Even if work on new research avenues proves successful, the beneficiaries are only those who can afford the results of the research success. This further increases already unacceptable levels of inequity. The methodology for setting investment priorities is needed which could carefully balance between long-term investments and supporting research on better use of the existing knowledge.

In March 2005, the OSLO CHILD HEALTH RESEARCH CENTER (OCHRC) launched a project to develop a systematic methodology for setting priorities in health and nutrition research investments and to apply it to global and national child health and nutrition. It noted that current practices of global and national research investment prioritization suffer from many shortcomings and hypothesized that these may partly be responsible for the persisting high levels of mortality in children globally. OCHRC gathered a large trans-disciplinary group of more than 30 experts and organized a series of meetings, consultations, workshops and e-forums to define universal challenges to health research priority setting and to propose solutions.

Eventually, OCHRC proposed a methodology that represents an entirely novel approach to setting priorities in health research investments. Evolving versions of the methodology were presented at different international conference around the globe in 2006 and 2007, which included 9^th and 10^th Annual meeting of Global Forum for Health Research in Mumbai and Cairo. At all these occasions, the methodology generated a substantial interest and support. Because of this, OCHRC already managed to engage more than 300 experts world-wide to apply the methodology in different contexts and for different purposes.

To support this judgment we note that the World Health Organization’s Child and Adolescent Health Department has welcomed this methodology and organized eight working groups with twenty-five leading global technical experts in each group who are presently in the process of defining research priorities for eight major causes of child deaths globally using this methodology, to reduce child mortality by two-third by 2015, Millennium Development Goal- 4.

In 2007 the project focused primarily on defining the products in terms of publishable articles and working towards completion of the scoring processes needed to finalize and submit these articles.

Activities were also conducted to validate OCHRC methodology against other approaches for setting research priorities. Finally, there some work has been undertaken to open a novel and potentially interesting line of work that relates vast amount of literature and experience with investments into stock market to investment strategies and risk management when performing investment decisions in health research.

Current investment practices in regional, national and global levels suffer from lack of formal analysis of the impact of the research and inability to set priority of research investment that can potentially reap most benefit. It is hypothesized that these lacks of systematic prioritization of research investment may be partly responsible for the persisting high levels of mortality in children globally.  Adopting the strengths of the previous approaches to priority setting in health research, OCHRC has developed a new model for priority setting. The advantage of the new methodology is that it addresses several components of research options, incorporating views of both technical experts and stakeholders to identify priority research topics. On the other hand, usually the research topic is selected on the merit of generating new knowledge without taking into consideration the possible impact in terms of lives saved.