Geneva,10 Nov. 04 (WAM) - Health systems research has the potential toproduce dramatic improvements in health worldwide and to meet some ofthe major development challenges in the new millennium. Effective researchcould prevent half of the world's deaths with simple and cost-effectiveinterventions, the World Health Organization (WHO) says in a new WorldReport on global health research.

The WHO World Report on Knowledge for Better Health: Strengthening HealthSystems highlights aspects of health research that, if managed more effectively,could produce even more benefits for public health in future. It setsout the strategies that are needed to reduce global disparities in healthby strengthening health systems.

Inequities in health are among the major development challenges in thenew millennium and malfunctioning health systems are at the heart of theproblem. Moreover, the culture and practice of health research shouldreach beyond academic institutions and laboratories to involve healthservice providers, policy-makers, the public and civil society.

The Report also argues that science must help to improve public healthsystems and should not be confined to producing drugs, diagnostics, vaccinesand medical devices. Biomedical discoveries cannot improve people's healthwithout research to find out how to apply them within different healthsystems and diverse political and social contexts, thus ensuring thatthey reach those who need them the most.

"There is a sense that science can do more, especially for public health,"said Dr LEE Jong-wook, WHO Director-General. "There is a gap between today'sscientific advances and their application - between what we know and whatis actually being done. Health systems are under severe pressure and thereis an urgent need to generate knowledge for strengthening and improvingthem."A team of 12 internationally prominent health researchers in both developedand developing countries, coordinated by Dr Tikki Pang, WHO Director forResearch Policy & Cooperation, developed the 143-page World Report onKnowledge for Better Health over 18 months. Based-on a wide-ranging consultativeprocess and on previous reviews of global health research, the reportadvocates that health equity can only be achieved through better managementof health research and increased investment in health systems research.

Health systems research suffers from a poor image and has been under-fundedcompared to biomedical research despite widespread recognition of itsimportance. The field attracts less than one tenth of 1% of total healthexpenditure in low-income countries.

The lack of attention given to this field is also reflected in the factthat only 0.7 % of scientific articles published globally in the year2000 were in the area of health systems research.

"It is extremely important to get this report out now. The report demonstratesthe enormity and complexity of the problem and outlines a way to go forward,"said Eva Harris, President of the Sustainable Science Institute basedat the University of California, Berkeley, USA. "It anticipates how theglobal community can get a handle on the problem in a constructive mannerinstead of lamenting a lack of action".

In Africa, for example, it is estimated that only between 2-15% of childrenslept under bed-nets in 2001-a simple, effective and proven method toprevent malaria. "We need to put a stronger emphasis on translating knowledgeinto actions - health systems research will help us to bridge this "know-do"gap". Also, that research is an investment, not a cost", said Dr Pang.

The report also illustrates how health systems research can strengthenhuman resources for health, health financing as well as information anddelivery of health services, with some projects already yielding impressiveresults. Among the research projects mentioned in the report is the TanzaniaEssential Health Interventions Project (TEHIP) which was set up to findnew ways to plan, set priorities and allocate resources as part of a majorreform of the country's health-care system. The aim was to evaluate theimpact of health interventions in terms of burdens of disease and percapita cost.

Researchers found that in two Tanzanian districts, malaria alone accountedfor 30% of all healthy years of life lost due to deaths in 1996-97. Inresponse, government planners increased the budget for malaria preventionand treatment programmes from 10% to 26% by 2000-2001. Overall, the researchhas resulted in a better match between disease burden and health budgetallocation, and the child mortality rate has been reduced by more than40% since the late 1990's.

"Health systems should nurture a stronger culture of learning and problem-solvingto tackle the major health challenges of our times," said Tim Evans, AssistantDirector-General, WHO. "This could be achieved by understanding how elementswithin a health system interact with each other and by finding innovativeways to solve complex problems."WHAT IS A HEALTH SYSTEM? A health system includes all actors, organizations, institutions and resourceswhose primary purpose is to improve health. In most countries a healthsystem has public, private, traditional and informal sectors. Althoughthe defining goal of a health system is to improve health, other goalsare to be responsive to the population it serves. This responsivenessis determined by the environment in which people are treated, and shouldensure that the financial burden of paying for health is fairly distributed.

Four key functions determine the way inputs are transformed into outcomesthat people value: resource generation, financing, service provision andstewardship. The effectiveness, efficiency and equity of national healthsystems are critical determinants of population health status.

Meanwhile, Ministers of Health from more than 30 nations as well as representativesof research institutions, academia, non-governmental organizations, pharmaceuticalcompanies and various key stakeholders in health/medical research willgather in Mexico City, Mexico, from 16-20 November 2004, to address thevital role of research in strengthening health systems and how it canbetter serve the health needs of the global population. Hosted by theGovernment of Mexico and World Health Organization (WHO), the MinisterialSummit on Health Research will focus on the "know-do gap" - how to translateknowledge into action to improve health. The Summit will also discussresearch needed to achieve the health-related Millennium Development Goals(MDGs) by 2015.

By gathering a large number of key players in health research, the Summitrepresents a unique opportunity to develop a platform of specific initiativesto strengthen health systems and to improve information access. The keyrecommendations of the Summit will be incorporated into the "Mexico Agendaon Health Research."