Arab divisions: how can the rich Gulf help the poor Maghreb build research capacity?

Andrea Rinaldi
Freelance journalist, SciDev.Net

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The need for networking and the challenges posed by diversity within the vast Arab world are two of the issues that emerged prominently from the Boosting research for health in the new Arab world meeting in Bellagio, north Italy which ended on Friday (1 March).

No one doubts that much cooperation and coordination will be necessary in order to tackle the research for health demand, but it is honestly difficult to see how virtually failed states such as Somalia, economically advanced realities like the Gulf States, and the Maghreb and Mashriq countries with their variable income levels, can be brought together to put forward a unified vision for public health in the region.

Up to now, there has been very limited dialogue among these countries, and not only regarding research- or science-related issues (the overall value of trade exchange between Arab countries, for example, is low). However, those involved in the health research agenda are positive that diversity in the Arab world, if wisely used, can actually benefit the requested change, as delegates present at the Bellagio meeting told SciDev.Net.

“Diversity should be perceived as an important factor for complementarity instead of a reason for division,” said Ziad Abdel Samad, Executive Director of the Arab NGO Network for Development in Beirut, Lebanon. “There is the necessity to create processes at various levels that must include academia and research. I’m aware of many existing initiatives among different universities and research centers focusing on health from different countries of the region.”

Samer Jabbour, from the Faculty of Health Sciences of the AmericanUniversity of Beirut, Lebanon, said: “All countries have a stake in cooperation as it will promote development and contribute to stability and legitimacy. Regional cooperation based on solidarity is simply the right thing to do. But we need to push, and from the bottom up, for this to happen in light of a prior history of poor functioning of formal regional platforms for common work. This is the task ahead of us.”

The role of the Gulf States might play in the effort is a matter of particular importance, given both their economic prominence and the considerable resources some of them, notably Qatar, dedicate to R&D.

Hanan Abdul Rahim, at QatarUniversity in Doha, Qatar, said: “There is a great interest in the Gulf in developing R&D systems. For example, Qatar partners with well known international universities in specific fields, such as medicine, engineering, and computer science, and links to a number of international research initiatives.”

“At the same time, the Qatar National Research Fund presents an opportunity for research collaborations with all parts of the world. Regional and international collaborations are not mutually exclusive. One does not have to preclude the other,” said Rahim.

But some believe that, in order to lead the research-for-health revolution in the new Arab world, the Gulf States must genuinely believe in their spearheading function while seriously reconsidering their attitude towards neighbours and potential partners.

“Regarding the Gulf states, many in the region want to see them play a greater role in promoting health and development,” said Jabbour. “This is another subject for advocacy for those interested in promoting research for health and development.”

But Abdel Samad said that “Gulf countries are supporting other Arab and Islamic countries; they are even considered among the largest donors worldwide. However, most of their donations are dedicated to charity and faith based initiatives. Few of these donations are directed to fund development programs and research projects.”

There is a lack of structured and transparent process of selecting partners and programs, and the way support is channelled is often conditioned by subjective choices, which highly affects the impact of allocated funds, argued Abdel Samad.

“This is a source of frustration which is leading people in the Arab world to rather address foreign donors that have their own requirements and conditions,” said Abdel Samad. “The objective is to advocate the Arab donors in order to motivate them to change this perception, and to create a properly transparent system, participatory methodologies and efficient strategies for implementation.”

This blog post is part of our coverage of Boosting Research for Health in the New Arab World meeting which takes place 26 February – 1 March 2013, in Bellagio, Italy. To read further news and analysis please visit our website.

Health research in the Arab world needs a ‘Big Idea’

Andrea Rinaldi
Freelance journalist, SciDev.Net

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Work progresses at the Boosting research for health in the new Arab world meeting in Bellagio, north Italy. Today, discussion shifted from general topics to more practical issues.

Working groups gathered to think on country-specific needs for health research system strengthening, focusing on three main aspects: regional strategy and plan of action, engaging partners and building networks, funding perspectives.

The fund-raising problem is of course a crucial one, so a large part of the broader discussion that followed was devoted to explore possible avenues to get potential donors and financing bodies involved. Since the all initiative of strengthening health research in the Arab world is brand new, and the group of people that is coordinating the effort met here for the first time, one should not be surprised to know that only vaguely shaped plans were brought to the table so far. However, good, solid common ground was found to build on by selecting shared pointers for future action.

First, delegates agreed on the need for coming out with a ‘Big Idea’ about boosting health research as a driver of improvement of public health, advancement of fairness of health and equity, and socio-economic development in the region.

This should be something that captures imagination of donors and funding bodies, while being amenable to be efficiently communicated and appealing to politicians and the lay public as well.

“Something exciting is needed, but I still don’t see it here. This is necessary not only, or primarily, to allure donors, but to have a sharp vision of the common goal to achieve,” said Ibrahim Daibes, from the Canada-based aid agency International Development Research Centre, confirming that work has to be done in this direction.

Another consultation, opened to a larger panel of researchers, policymakers and stakeholders, will be held in a 6-months time frame to develop the ‘Big Idea’ concept further.

It was also noted that for the change to become structural and to impact substantially on health and related societal issues, donors will not be enough, but rather national governments need to be convinced to allocate appropriate resources to R&D in the health sector in their budget over a long period of time.

This – in a region where health and R&D expenditure is (with a few exceptions) relatively low (but that, on the other side, boasts the highest ratio of military expenditures as a percentage of GDP in the world) – is not going to be easy, as those around the table here in Bellagio are well aware.

Certainly, a carefully planned communication strategy will be key to the project, both to persuade international funding agencies to take the risk of investing in research in countries in conflict and transition and to raise advocacy at the national and regional level. “We have to speak clear, so to be sure that people don’t think we are asking for money just to fund our own research or academic institutions,” said Hoda Rashad, from the American University in Cairo, Egypt.

This blog post is part of our coverage of Boosting Research for Health in the New Arab World meeting which takes place 26 February – 1 March 2013, in Bellagio, Italy. To read further news and analysis please visit our website.

Health research in the Arab world can benefit from experiences in Africa and Latin America

Andrea Rinaldi
Freelance journalist, SciDev.Net

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Future work needed to develop efficient health research systems in Arab countries can find a good starting point in previous experiences from other regions of the world. This is the main take-home message of the talk by Francisco Becerra, COHRED, staged today at the Boosting research for health in the new Arab world meeting in Bellagio, north Italy.

“COHRED aims to make an essential contribution to improve health, equity and development around the world. While there are many ways to do so, we focus on research and innovation – by and for low- and middle income-countries and populations,” said Becerra. “Our focus is on the systems needed for research and innovation for health. We believe that strong systems produce more and better research and innovation, with a greater relevance to the country and its population.”

Group at work at the Rockefeller Foundation Bellagio Center

Becerra presented COHRED work in Africa and Latin America, often performed in close collaboration with key regional partners, such as the New Partnership for African Development Agency (NEPAD) and the Pan-American Health Organisation (PAHO/WHO). In Latin America and the Caribbean, COHRED has developed regional and country based activities. Most notable is the work with Paraguay, which led to a presidential decree on research and innovation for health; and the collaboration with Uruguay on the establishment of a financial mechanism for research for health.

“A key aspect of COHRED’s work is to facilitate exchange and interaction among countries in a region. We strongly believe in this exchange with peers to stimulate research and innovation development,” Becerra said. “Regional meetings were therefore organised in Latin America in the recent past, and a knowledge exchange workshop for the African countries was organised in 2012 in Tanzania.”

Each country has its own peculiarities and needs specifically tailored solutions, experience shows. Also, countries are called to invest in their own systems, and to strengthen research and innovation capacity. If this does not happen and countries themselves are not interested, there is little that can be done through external aid.

“What is happening in the Arab world? Is there a similar interest in research and innovation and an assertiveness to take this development into own hands? What are the key political and regional players, and how can organisations such as COHRED make a meaningful contribution to research and innovation in the region?” asked Becerra. These are the questions the Bellagio meeting and subsequent discussions will aim to answer.

This blog post is part of our coverage of Boosting Research for Health in the New Arab World meeting which takes place 26 February – 1 March 2013, in Bellagio, Italy. To read further news and analysis please visit our website.

Arab academic institutions need rethinking to improve health outcomes

Andrea Rinaldi
Freelance journalist, SciDev.Net

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Brainstorming discussion is taking place at the ‘Boosting research for health in the new Arab world’ meeting in Bellagio, north Italy. The common view presented so far is that health is both a causative agent and an end-point of development, and that health research is a major driver of the entire process.

“Health is a societal good, not the exclusive interest of the Ministries of Health,” said COHRED Director Carel IJsselmuiden.

Iman Nuwayhid, from the Faculty of Health Science of the American University of Beirut, Lebanon, spoke about the role academic institutions can play in fostering the shaping of national health research strategies in Arab countries.

“Academic institutions are partly responsible for the status of research in the region,” said Nuwayhid. “On one hand, they have suffered from regional conflicts, lack of funding, a dearth of qualified researchers, lack of institutional collaboration, and restrictions on free scientific inquiry and access to information. On the other hand, these institutions have accepted the status quo and some have even served as a mouthpiece for the political regimes.”

However, exceptions exist, Nuwayhid added, and a few centers of excellence present models that are distinct but homegrown and worth scaling up in the region. “Building a regional network of such core academic institutions is no doubt a strict pre-requisite for any effort to support and shape research for health in the region,” Nuwayhid said.

According to the data presented by Nuwayhid, the Arab world is, at least on paper, well equipped with both public and private higher institutions (some 1,200) and universities (more than 400), with good geographic spread.

Quality, of course, differs greatly.

The Ranking Web of Universities (also known as Webometrics Ranking) in its last edition lists some 726 higher education institutions in the Arab world, with world rank position running from 420 (King Saud University, Saudi Arabia) down to 21,100!

As the UNESCO Science Report 2010 remarked, poorer countries like Egypt, Tunisia and Morocco are home to some of the oldest universities in the Arab world, and can be seen as regional leaders in terms of S&T human resources and scientific publications. On the other hand, institutions based in the Gulf States “have the material and financial resources to carry out R&D but lack the solid S&T and higher education systems to generate knowledge”.

But for academic institutions to be engaged as authoritative catalyzers of the transformation in the Arab world, they first have to rethink themselves. As an instructive example, Nuwahyd quoted the Kasr Al-Ainy School of Medicine of the Cairo University, inaugurated back in 1827, where teaching faculty is limited to graduates from the same institution.

“The uprisings in the Arab World have confirmed that people are ready for change. Academic institutions in this region are simultaneously the target of such a demand as well as the beacon of hope and change. It is a dilemma that we all, and especially donors and international organisations, need to face,” Nuwahyd said. “We have to invest heavily in academic institutions of this region. It is a leap of faith that we cannot afford missing. If entrusted, academic institutions will deliver.”

This blog post is part of our coverage of Boosting Research for Health in the New Arab World meeting which takes place 26 February – 1 March 2013, in Bellagio, Italy. To read further news and analysis please visit our website.

Mapping national health research systems across the Arab world

Andrea Rinaldi
Freelance journalist, SciDev.Net

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The Boosting research for health in the new Arab world meeting officially takes off today, in Bellagio, north Italy. Delegates from several Arab countries and representatives of the Council on Health Research for Development (COHRED) and of other institutions are swarming in, while sessions will begin early tomorrow.

Among the background papers distributed to participants in advance of the conference, several deal with the crucial aspect of the evaluation of the national health research systems (NHRS) of Arab countries. This is not trivial matter, as no comparable international indicator of the quantity/quality of health research exists.

An easily feasible – although admittedly limited – approach is to count medical research publications by researchers based in institutions in each country, as proposed by Martin McKee (London School of Hygiene & Tropical Medicine) and colleagues in a recent PLoS Medicine study. According to this indicator, the performance of Arab countries is (not surprisingly) a mixed bag, with countries such as Yemen and Somalia laying close to the bottom of the rank, and others, like Tunisia, doing fairly well, especially considering the available resources.

Other NHRS-mapping studies analysed the situation in the Arab word by using a more holistic approach, in particular trying to focus on the most important (but maybe most elusive to measure) outcome of health research: improved health of people, fair access to health care services, and reduced health inequities.

Using such a conceived method, COHRED-associated researchers have assessed the NHRS in most Arab countries, and recently published a study that completes the baseline information on health research systems in the region. In this last work five countries (Afghanistan, Iraq, Pakistan, Palestine and Syria) agreed to map their NHRS and collect information on research policies and regulations, governance and management mechanisms (including ethics review boards), and institutions that commission, produce and use research.

More soon.

This blog post is part of our coverage of Boosting Research for Health in the New Arab World meeting which takes place 26 February – 1 March 2013, in Bellagio, Italy. To read further news and analysis please visit our website.

More and better health research is needed in the Arab world

Andrea Rinaldi
Freelance journalist, SciDev.Net

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The day is coming. Tomorrow, 26 February, a meeting on ‘Boosting research for health in the new Arab world’ will begin in Bellagio, north Italy. Before formal discussion kicks off, we asked Hassen Ghannem, senior consultant to the Geneva-based Council on Health Research for Development (COHRED) and meeting organizer, about the background and objectives of the conference.

What is the current situation of health research in the Arab countries?

“Policymakers in the developed world understand that research, science and technology are vital components of economic growth and prosperity. But, in the Arab world, translating this realization into policies and actions backed by resource commitments has been a major challenge.

In particular, weaknesses of research for health in the Arab world are seen in three areas: low investment in research and development; weak national health research systems, with considerable fragmentation and little or no coordination at the national and international level; poor scientific production and impact, as a result of low investment and weak systems.”

In your personal opinion, what is to be done to change this situation? Is the Arab Spring going to have a significant impact on the status quo?

“This region is currently experiencing major historical changes with the aspiration to freedom, democracy and more equitable development. Research for health is essential to understanding the current and future projected health needs of the population and developing approaches and solutions that can contribute to health improvements.

Because research for health and national systems of research for health have been weak in the region, this time of change creates a historic opportunity to undertake key strategic actions in research and innovation, with particular focus on strengthening national systems of research for health leading to improvements in health and development. This could be done, among other things, by engaging policymakers and stakeholders to equip them with tools and skills needed for making informed decisions, and by hosting dialogues and consultative meetings to bring a range of stakeholders together to facilitate policy dialogues leading to more commitment to fund research in the region.”

What do you hope will come out of the Bellagio’s meeting?

“The overall goal is to end up with a strong call to action to strengthen system capacity for research and innovation for health in the Arab world, and to develop an effective communication strategy to disseminate and keep this alive until the regional conference that is planned for later this year or 2014.”

Stay tuned.

This blog post is part of our coverage of Boosting Research for Health in the New Arab World meeting which takes place 26 February – 1 March 2013, in Bellagio, Italy. To read further news and analysis please visit our website.

Why your bulging tummy is a global sustainability agenda

T. V. Padma
South Asia regional coordinator, SciDev.Net

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This morning, I learnt something new about ‘somatic’ and ‘extra somatic energy’, thanks to Tony Capon, head, discipline of public health at the University of Canberra, Australia. And that its about time the fat in our (or at least mine) expanding tummy lines gets included in the global sustainability agenda.

Capon told a morning session on urban health and well being that the focus of the sustainability discourse so far has been on ‘extra somatic energy’, or energy produced outside our bodies. For example, electrical energy in power stations.

But look at the global obesity epidemic around you and there is something that can’t be missed. Capon says that all that food resting snugly as fat in our expanding waistlines, is also unused energy of another kind — ‘somatic energy’ to be more precise. “The global obesity epidemic is a problem with our somatic energy account — too much in, too little out,” Capon said.

“Get somatic energy on the (global sustainability) agenda,” Capon said. This would include diet and physical activity; as well as level of physical activity and how it is affected by urban transport systems.

“What we eat, and its relationship to the wider food system – from farm to fork – is important, he said.

“The global obesity epidemic is a sustainable development issue.”

Getting somatic energy on the sustainability agenda is one of Capon’s key recommendations at the session. Also, start a new narrative aligning concerns about human health with concerns about planetary health; and sending positive message about ‘co-benefits’ for health from action on climate change.

The others are to transcend disciplines to understand urban health and well-being, which also means going “beyond medical sovereignty of knowledge about health”; and finding alternate ways of understanding health, for example, by tapping into indigenous knowledge and human ecology concepts.

This blog post is part of our Forum on Science, Technology and Innovation for Sustainable Development blog which takes place 11-15 June 2012. To read news and analysis from the conference please visit our website.

A bit of lateral thinking on access to medicines

Mićo Tatalović
Deputy news editor, SciDev.Net

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In an ideal world, all people should have access to all important medicines, Thomas Pogge, chair of comparative Research P(CROP), at Yale University, told the key event on Global Change and Social Transformation at the forum yesterday.

R&D should target medicines that can make the greatest difference to human health and the money spent on medicines should be ploughed back into R&D.

What we have now is a system in which the poorest people can’t access life-saving medicine because of high prices based on return of profits; little R&D geared towards medicines for the poor, such as neglected diseases; and vast amounts of money are spent on advertising, instead of further R&D, Pogge said.

The patent regime set out in the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), in which countries had to sign up to a Western model of intellectual property rights, is partly to blame he said.

But, he offered a solution: a Health Impact Fund (HIF). This fund could work alongside the TRIPS agreement and allow innovators and companies to earn money even on drugs that would not make a a profit through sales.

The idea is that pharma companies holding patents could register their products with the HIF and then sell them globally at production costs.

The HIF would then evaluate the health impact of registered drugs annually, and distribute payments from the fund – coming from governments and donors – to firms based on the impact of each drug. So the more lives your drug saves the bigger amount of money you would get from the fund.

The HIF would foster the development of new high-impact medicines, and the incentives would be greatest for treatments of diseases concentrated among the poor.

“This system … could also work in other areas, for example in key new technologies and agriculture,” Pogge concluded.

Watch the video:

This blog post is part of our Forum on Science, Technology and Innovation for Sustainable Development blog which takes place 11-15 June 2012. To read news and analysis from the conference please visit our website.

Beyond Forum 2012: some final reflections

David Dickson

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There’s been much talk in Cape Town at Forum 2012 over the past week of the need for a paradigm change in thinking about health research for development.

Certainly the concept is a useful one to describe the switch from an approach focussed primarily on the allocation of research resources, to one that addresses the need to build systems of innovation in the health field (as elsewhere).

It helps us move beyond a fixation with the famous 90/10 imbalance between research expenditure on developed and developing world health priorities, to embrace a wider perspective.

But at the end of three days of lively discussions, I remained unclear whether talking about “Beyond aid” – the theme of the meeting – represented a radical idea, or a useful way of labelling a set of trends that have been in motion for some time, and identifying the general direction in which they point.

Either way, however, such a discussion is timely.

First, as Carl Ijsselmuiden, executive director of the Council on Health Research for Development (COHRED), the main organiser of the conference, pointed out in his opening remarks, it captures the growing feeling that “foreign aid as hand-outs to the poor” is no longer workable.

The approach may not be one that wins many votes for aid-providing governments. But in the long-term, these realise that “foreign aid as capacity building” is much more likely to produce lasting results.

 Second, talking about what happens next – particularly in an area such as health research and innovation, and at a time when external sources of funding are drying up – provides a spur to developing country governments to address their own responsibilities.

Ending on an up-note: the singer Princess Chaka Chaka, UN Goodwill Ambassador and a champion of Africa's fight against malaria, leads participants of Forum 2012 in a farewell chorus (Gabi Falanga)

This has both funding and policy implications. Health research spending needs to become a higher priority for these governments. And they need to create the incentives that will allow the result of this research to be translated into medical products – such as drugs – and services.

Finally, there is the pragmatic issue that, as aid budgets start falling in many developed countries as a result of their financial difficulties, anything that promises to “do more with less” with what funding remains available becomes increasingly attractive.

Moving from “aid as hand-out” to “aid as capacity building” does just that.

So, three good reasons for embracing the concept of a paradigm change. But it also became clear in the Forum 2012 discussions that there are reasons for not expecting too much, too soon.

There may be consensus on what needs to change. But this consensus does not necessarily extend to agreement on what this change should be.

For example, those seeking a new international convention on health research and development argue that it is needed to make up for the failure of the market system to provide developing countries with access to medicines at affordable prices.

Pharmaceutical companies may agree that this is a challenge. And that they need to work with governments – and aid agencies – to tackle it. But their interests ultimately lie in benefitting from the market, not in seeing alternatives put in place.

Similarly health ministers may be persuaded of the arguments for developing home-grown health industries, better equipped to meet local health needs.

But the people who really need convincing work in finance ministries. And the financial case for operating in a new way, rather than, for example, just importing technologies from abroad, is not always self-evident.

Paradigms get embedded in social – and political – systems. Changing them is not just a question of rational debate (even in science). It also requires challenging the interests that the old paradigm served.  And it can have costs attached.

So, big challenges ahead. The major contribution of Forum 2012 was to help cement the idea that “aid for capacity building” is the new mantra that needs to frame aid and government policies, in developed and developing countries alike.

Also that, as in fields such as agriculture and energy, health needs to move away from the idea that developments are research-driven, to recognising that research is one component of a holistic system of innovation – each part of which needs to be addressed.

The immediate task, as always, is to work out what all this means in practice, identifying needs and opportunities, and assessing the potential contributions of all interested parties (including the media).

Not quite the “Beyond aid” vision that the organisers are aiming for. But a step in that direction.

David Dickson is editor of SciDev.Net

This blog post is part of our Forum 2012 coverage — which takes place 24–26 April 2012.

Journals play a key role in bridging knowledge gaps

Lia Labuschagne

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What role can scientific journals play in bringing the knowledge divide, not only between North and South, but also between researchers and policymakers?

A lively general discussion at Forum 2012 focussed on the role of journals in knowledge transfer in the field of sexual and reproductive health and rights. But the same issues relating to disseminating scientific information also apply to other disciplines.

Some current topics relating to the international output of scientific journals were introduced by Marge Berer, editor of Reproductive Health Matters, and Ann Strode, senior lecturer at the School of Law, University of KwaZulu Natal, and editorial advisory board member of AIDS Care.

Journal articles can help bridge the gap between research and policymakers (Credit: Reproductive Health Matters)

Berer commented that “there has never been so much information before, nor so many means of disseminating and using it”.

Participants in the general discussion nevertheless pointed out that, especially in developing countries, there is often a big time lag between research being completed and finding its way into text books.

Factually outdated information is often still being taught. And although new health and other policies may be adopted, there may be no change in teaching material.

Scientific journals provide a useful link across this divide, partly because their up-to-date research findings and information is increasingly becoming available in accessible, electronic format to a global readership of academics and practitioners within various disciplines.

Advocates and lobbyists also use the information in journals as the basis of advancing well-founded arguments for change of policies and practices.

Strode said journals such as AIDS Care are therefore used by both researchers and policymakers as a high-quality source of knowledge that they can provide from a multi-disciplinary perspective.

Some additional ideas to emerge from the discussion of ways to use the contents of scientific journals to aid development included translations of articles into local languages, and selecting key pieces of writing on specific topics to be made them available as thematic packages.

In terms of the North/South divide, Berer pointed out that “more authors from developed countries than from developing countries have access to the resources to publish in international journals”.

To help to redress this imbalance, she said that RHM gives preference to papers about developing countries by authors from those countries, or written with authors from those countries.

Broader issues discussed at the session included the continued debates around open and closed peer review processes, formal recognition for reviewers, and questions of ownership and funding.

Lia Labuschagne is a freelance journalist based in Cape Town

This blog post is part of our Forum 2012 coverage — which takes place 24–26 April 2012.