Launch of the World Health Report 2013: Research for universal health coverage
Dr Margaret Chan
Director-General of the World Health Organization
Excellencies, honourable ministers, distinguished guests, ladies and gentlemen,
I commissioned this World Health Report on research for universal health coverage as part of WHO’s efforts to support countries seeking to extend health services and financial risk protection to more people.
This is a state-of-the-art report on health research, and on investigative tools and networks, that can help countries make the right decisions as they move towards universal health coverage. It sets out the scientific research agenda needed to translate the growing commitment to universal coverage into evidence-based action.
I have personally been encouraged by the large number of countries, at all levels of development, that have embraced the goal of universal health coverage as the right thing to do for their citizens and societies.
This enthusiastic response goes against historical trends. During times of financial austerity, the tendency has been to cut back on health services, not expand them.
Universal coverage means quality health care for all delivered in ways that protect users from financial ruin or impoverishment. It is a powerful social equalizer, contributing to social cohesion and stability. It is not cheap. But when well-planned, universal coverage is affordable.
The challenge is to expand health services with constant attention to causes of waste and inefficiency that can be reduced through smart policies and wise decisions.
Research offers this guidance. It brings precision to the understanding of problems, and it offers proof of the solutions that work best. Research can uncover ways to scale up services and dial down spending.
These are central goals of the report: to stimulate the right kind of research, but also to open the eyes of policy-makers to the power of research and evidence as a decision-making tool.
With these goals in mind, the report demystifies the research landscape, gives it a structure, and demonstrates the potential of different kinds of studies to support the most efficient expansion of services.
As just one example among many, research has shown that a new drug combination for the treatment of visceral leishmaniasis is just as effective as the existing treatment. It requires a shorter treatment time, has a good safety profile, and carries a lower risk of drug resistance. It does this at a lower cost per treatment and with a lower demand on health services.
Such findings support policy shifts towards greater efficiency. They also give scientists inspiring proof of the real-life impact of their work. And they contribute to better health, sometimes for millions of people.
While some research, such as clinical studies, has broad application, many problems that arise along the route to universal coverage will need local solutions investigated through local research. As the report notes, all countries must be producers as well as consumers of research.
In this regard, the report has some good news. Research on health is flourishing in every part of the world. More research is being done in more creative ways, and the process of doing research is becoming more robust.
Most countries now have the foundation for building effective research programmes. Some low-income countries have thriving research communities with a growing number of international collaborations.
Countries like Brazil, China, and India have established their leadership roles. African nations are moving forward. In the past few years, research productivity on the African continent has enjoyed an average yearly increase of 26%, strongly driven by concern about HIV, tuberculosis, and malaria.
Thanks, in part, to international collaboration, researchers in low- and middle-income countries have acquired confidence and gained an articulate voice. They want a greater say in the research agenda. This is another welcome trend.
African researchers have argued that support for research on neglected tropical diseases should not be the sole responsibility of external donors. They believe that their own governments must also take responsibility for providing infrastructure and job opportunities.
A highlight of the report is the inclusion of twelve case studies showing how priority questions were investigated and how the results led to changes in policy and practice, with some affecting the lives of millions of people.
These case studies also illustrate the range of methods that are commonly used in health research, from observational studies to randomized controlled trials. In this way, the role of research in operationalizing universal coverage becomes readily and compellingly visible.
Unfortunately, this role is far from being exploited to its full potential. The World Health Report makes some strong calls for change.
Ladies and gentlemen,
Our world spends more than $100 billion on health research each year. The lion’s share of this investment goes to the discovery and development of pharmaceutical and biotechnology products.
Research on health systems and service delivery receives only a tiny proportion of this investment. But it is never too late to start research on health systems and delivery.
We need to change the research landscape. We need to invest in the science of delivery. We must give more attention to the three Ds: discovery, development, and delivery. What are the roadblocks that prevent delivery? This question needs attention.
The report points to a large number of effective and inexpensive interventions that are simply not reaching the people most in need. Many proven interventions are hardly used at all.
How can such a potentially life-saving resource be so neglected? This is another clear case of waste and inefficiency. Here is the reality: far more research is invested in developing new technologies than in making better use of existing technologies.
For example, syphilis is easily diagnosed and treated, with diagnostic tests and treatment each costing less than $1. Why are two million pregnant women infected with syphilis each year, with more than half transmitting the infection to newborn children?
Recent efforts to address the problem did more than just reduce the disease burden. They provided a model for delivering services to hard-to-reach populations and a template for the introduction of new technologies.
The report strongly recommends that research should be strengthened not only in academic centres but also in public health programmes that are close to the supply of, and demand for, health services.
It calls for closer collaboration between researchers and policy-makers, who tend to work in parallel, with too little understanding of each other’s priorities and methods.
Not surprisingly, the report calls for much greater emphasis on operational and bench-to-bedside research that aims to ensure that existing, effective, and inexpensive interventions reach those who need them.
Finally, the report recognizes that health depends on having access to medical services and a means of paying for these services. But it is also strongly shaped by a wide range of social and environmental determinants.
The research agenda for universal coverage, especially with preventive services, must address these determinants as well.
Ladies and gentlemen,
It is my sincere hope that this World Health Report will support countries in their move towards universal health coverage, and that it will also stimulate some changes in the health research landscape.
This report belongs to countries, and WHO is here to support you.