Australia Ahead of the Curve Blog Series #5: Research as the foundation of health development and equity

Brendan Crabb and Michael Toole

13 Oct, 2016 | Research

This post forms part of ACFID’s blog series on Australia Ahead of the Curve: An agenda for international development to 2025. Views contained in submissions to Australia Ahead of the Curve are those of the authors and do not necessarily reflect the views of ACFID or its members.

To learn more about this series, read the introductory blog post. To view other submissions and find out how you can contribute your ideas on the future of development, visit the page on the ACFID website

The context

Progress toward the Sustainable Development Goals (SDGs) will go a long way to ensuring that the world continues along a path toward a more equitable and sustainable existence.  Perhaps more than is widely appreciated, their success will depend a great deal on robust data and the embedding of research and evidence into all decision-making.  Innovation, the development and application of appropriate technology, and knowledge generation will be crucial components of the approaches adopted to meet SDG targets.  In a resource constrained international development world, making intervention choices based on robust evidence and effective tools will be even more crucial.

The role of research in achieving universal health coverage

The Good Health SDG reflects the earlier commitment made by the world’s nations to Universal Health Coverage (UHC).  Broadly defined, UHC means all people receiving the services they need, including initiatives designed to promote better health (such as improved infant and young child feeding practices), prevent illness (such as vaccinations), and provide treatment, rehabilitation, and palliative care of sufficient quality. A central premise of UHC is that provision of these services does not expose the user to financial hardship.

While more people have access to essential health services today than at any other time in history, global coverage remains inadequate. For example, according to a joint report of the World Health Organisation and World Bank, in 2013 only 55% of new TB patients were diagnosed and successfully treated; only 37% of people living with HIV were on antiretroviral treatment; only 52% of children in high-risk malaria settings slept under an insecticide-treated bed nets; and 36% of pregnant women did not receive adequate antenatal care.

Progress in generating research evidence to support UHC has been uneven, and low-income countries have yet to see a significant increase in research production. Currently, a mere 10 percent of health policy and systems research globally is conducted on low- and middle-income countries.

There has been inadequate investment in the development and production of drugs, vaccines, and diagnostic agents for communicable diseases that cause a major disease burden among the poorest people in the world. For example, the standard prevention and treatment of tuberculosis in low and middle income countries employs a not very effective vaccine developed in 1921, a diagnostic procedure developed in 1895, and drugs that were developed in the 1950s and 1960s.

Research in the Australian aid program

In the not-so-distant past, the very word ‘research’ was anathema to the managers of Australia’s official aid program and research was not often a significant element of the work supported by Australian NGOs. This attitude changed significantly in 2011 when the Independent Review of Aid Effectiveness proposed that research – specifically health and agriculture research -- be one of seven ‘flagships’ of the aid program.  The Australian government of the day agreed ‘in principle’ with the review panel’s recommendation to support medical and agriculture research within the aid program.

The new Coalition government’s aid policy, announced in June 2014, included the intention to ‘Invest in research for health development to improve the effectiveness and efficiency of health investments including supporting the development of new technologies.’

Soon after, the Office of Development Effectiveness (ODE) commissioned an evaluation of the uptake of research by DFAT under the assumption that a critical precursor to aid innovation is the availability and use of good-quality research.

The evaluation found that from FY 2007–08 to 2012–13 investment in research more than tripled to $181 million, with the average spend of those 6 years being around 3 percent of DFAT’s programmable aid (compared to around 5 percent of the US and UK aid budgets).  The themes that received the most funding were food security and rural development ($140 million), compared with smaller amounts for environment ($60 million), health ($32 million) and education ($17 million).  There is no evidence that this lack of proportionality between sectors has been redressed since 2012-13.

The evaluation found that the largest competitive research initiative funded by the aid program was the Australian Development Research Awards Scheme (ADRAS), established in 2007.  Total funding for the 2012 ADRAS round was over $32 million, spread over several years, to 50 research projects. However, ADRAS has since been discontinued.

From research to policy and practice

‘On the road to universal health coverage, taking a methodical approach to formulating and answering questions is not a luxury but a necessity. (World Health Report, 2013)

The World Health Report (2013) identified research questions of two kinds. The first asks how to choose the health services needed in each setting, how to improve service quality and coverage and financial protection, and consequently how to protect and improve health and well-being. Answering these questions requires a range of approaches, including intervention, operational, health systems and cost-effectiveness research.

The second type of research questions asks how to measure progress towards universal coverage for each population setting, in terms of the needed services and the indicators and data that measure their coverage. The answer to this group of questions is a measure of the gap between the existing coverage of services and universal coverage, and through this to identify how to best fill that gap.

The Burnet Institute is a development organisation committed to achieving better health for vulnerable communities in Australia and internationally through translating discovery, research and evidence into sustainable health solutions. 

Our vision for the health component of an Australian aid program is that all activities are informed by relevant and ethical research, and that this builds the research capacity of local research institutions. Indeed, research should be embedded in certain development initiatives, such as malaria elimination and the control of MDR TB, where it is critical to identify local contextual factors. Not embedding research in development programs may represent a major missed opportunity because it is often more cost-effective than stand-alone research.

In 2025, as we assess the impact of the Australian aid program on progress towards achieving the SDGs in the Asia-Pacific region, let’s hope that we will have access to rigorous, research-generated data on health service coverage, equity and quality; access to effective and affordable drugs, vaccines and diagnostics; cost-effectiveness of interventions; acceptability of services to communities and healthy behaviour change; and health workforce capabilities (including research).

 

This post has been adapted from a submission to Australia Ahead of the Curve: An agenda for international development to 2025. The full submission is available here.

 

  • Brendan Crabb and Michael Toole
    Brendan Crabb and Michael Toole

    Brendan Crabb is the Director & CEO of the Burnet Institute

    Michael Toole is the Deputy Director of the Burnet Institute


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