Research Priority Setting AZIZA OMAR

Aziza Sayed Omar MD

Outline • WHY prioritize for Research development?

• WHO does the prioritization?

• WHAT areas are prioritized?

• HOW are these prioritizations accomplished?

• “Take home” messages

Health Research &Development: A Global Imperative 1.Population:The most Vluable Asset of a country.

2.Value of the Asset is measured by its Health Status.

3.Health Status depends on many determinants.

4.With unlimited resources, we could act on all determinants.

5.Resources being limited, we have to select the determinants which have the greatest impact on health.

6.Only through research can a country identify the key determinants for the health of the country.

7.Condition of success : Keep research out of isolation.

Why Prioritise a Research Agenda Limited RESOURCES

Balance interest of costituencies

Coordination amongst players

Local requirements

Tool development vs.implementation

Levels of intervention

World Health Organization

Participants in Setting Priorities

Communities (Health

Perception and Needs)

Policy and Decision makers (Health

Experts)

Researchers (multi-

disciplinary)

Fields of Health Research 1. Biomedical issues

2. Behavioural and Community issues

3. Sectors outside Health with profound influence on health

4. Good governance issues affecting health research

Priority Setting Process Problem definition

Identification of stakeholders

Description of an “ideal” control situation

Identification of literature of research

Description of information gaps

Review of institutional comparative advantage

Matching requirements of other programms

The <Five Steps>in priority setting

Magnitude (what is the burden of the disease)

Determinants (why does the burden of disease persist)

Knowledge today (what is known today about existing

interventions, how cost-effective are they)

Cost-effectiveness of future interventions

Investments (what are the resource flows for that

disease/risk factor).


“” SELECTION OF TOPICS FOR RESEARCH

Scales for Rating Research Topics 1. Interest

2. Relevance

3. Avoidance of duplication

4. Feasibility

5. Political acceptability

6. Applicability

7. Cost-effectiveness

8. Ethical considerations

9. Timeliness

Each parameter score 1-3

Priority Scale:

• >19 High

• 10-18 Moderate

• <10 Low


Priority Ratings for Research Topics

1. Interest - How much interest the researcher has in the topic!

2. Relevance – How big is the problem? (Magnitude or burden of disease)

– Who is affected? (Demographic profile)

– How severe is the problem? (Mortality and Morbidity)

3. Avoidance of duplication – What are the questions that deserve further investigation?


Priority Ratings for Research Topics (Cont.2)

4. Feasibility

- Resources required to carry out the project.

(manpower, time, equipment, money)

5. Political acceptability

- Support of the authorities, policy makers, & society

6. Applicability

- Applicability at local level.


Priority Ratings for Research Topics (Cont.3)

7. Cost-effectiveness - Whether the resources invested in the study are

worthwhile given the expected results!

8. Ethical considerations - Ensure respect of humanity, beneficence and equity

9. Timeliness

- Solutions to a current burning problem!


Burden of disease

• A specialised area of research that

quantifies ill-health, by measuring and

analysing the extent and causes of

health problems. Together with

evaluations of cost-effectiveness,

burden of disease provides the

information policy makers need to help

them make decisions.


• Global Burden of Disease analysis

provides a comprehensive and

comparable assessment of mortality

and loss of health due to diseases,

injuries and risk factors for all regions of

the world. The overall burden of disease

is assessed using the disability-adjusted

life year (DALY), a time-based measure

that combines years of life lost due to

premature mortality and years of life lost

due to time lived in states of less than

full health.


Classical Measurements of

Disease Burden

• Incidence rate.

• Prevalence rate.

• Mortality rate.

• Case fatality rate / ratio.

• Survival rate.

• Trends in mortality and morbidity


Difference Between

Prevalence & Incidence Rates

• Prevalence: Number of cases of a disease in a defined

population at a givin time.

Number of people with the disease or condition at a specified time

P = ------------------------------------------------------------------------------------------------ (x10n)

Number of people in the population at risk at the specified time

• Incidence: Number of new cases arising in a given period in a

specified population.

Number of people who get a disease or condition at a specified period

I = ----------------------------------------------------------------------------------------- ------------------------- (x10n)

Sum of the length of time during which each person in the population is at risk


Mortality & Fatality Rates

• Mortality rate: Number of deaths in a specified period of time,

divided by the total population at risk.

Number of deaths in a specified time

MR = ----------------------------------------------------------------------- (x10n)

Average total population at risk in the same time

• Case fatality rate: The proportion of cases or condition which are

fatal within specified time. (measure of disease severity)

Number of deaths from a disease in a specified period

CFR = -------------------------------------------------------------------------------------- (x10n)

Number of diagnosed cases of the disease in the same time


(Indicators of Health Level)

Infant and Maternal Mortality Rates

• Infant mortality rate: It measures the death rate in children

during the first year of life.

Number of infant (<1 year) deaths in a year

IMR = ------------------------------------------------------------------ (x10n)

Number of live births in the same year

• Maternal mortality rate: It measures maternal deaths related to

maternal pregnancy.

Maternal pregnancy-related deaths in one year

MMR = ---------------------------------------------------------------------- (x10n)

Total births in the same year

The Research Loop 1.Creation of knowledge

2.Validation of knowledge

3.Transformation into best practices

4.Dissemination

5.Identification of gaps and development of initiatives to fill the gaps

6.Development of indicators to measure impact on health status

7.Feedback on orientation and design of future research-focus on the weakest link/s

Communication and Information Special Reports

Web Site

Strategic Papers

Work with the media

Communication with Decision Makers

Conclusions Identifying priorities is an important as conducting

research itself

The process is a critical part

The methods presented here are tools

Consider a wide variety of areas including conditions and risk factors

Take Home Messages “… priority-setting is a complex interaction of various

decisions at diverse levels…

There is no self obvious set of ethical principles or scientific tools to determine what decisions we should take at various levels … nor is there an easy or obvious way to resolve the dilemma of the increasing gap between what we can and would like to do on one hand and the resources on the other

Priority-setting is a political process which involves bargaining between different lobbies, modified by shifting political judgments made in the light of changing pressures.

REMEMBER

TEAM= T= Together

E= Everyone

A=Achieve

M= More

Research Priority Setting AZIZA OMAR

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