Document(s) 17 of 21

A recent COHRED issue paper, “Health Research: Powerful Advocate for Health and Development Based on Equity” (COHRED 2000e), provides a full discussion of each of the key messages, including ways of reaching the objective contained in the message and the risks involved. The remainder of this section briefly describes each of these three messages (based on the issue paper).

However poor a country may be, it should use its limited resources to ensure that it does the research that is relevant to its people.

— Professor Raphael Owor, Faculty of Medicine,
Makerere University, Uganda

There are always problems which are unique to a country which need to be dealt with effectively and efficiently, and this cannot be achieved by borrowing a research agenda from another country.

— Dr Izzy Gerstenbluth, Department of Epidemiology and Research,
Medical and Public Health Service of Curaçao, Curaçao

Perhaps the strongest argument for putting countries first is the tremendous success of those nations that have done exactly that. Self-interest has driven R&D in developed countries — such as Japan, the United States, and those in Western Europe — to great effect. Obviously, owing to limited resources, developing countries face a tremendous challenge in investing in R&D. However, the point remains that national research efforts that respond directly to specific health problems have had the most success.

Current trends in globalization and increasing inequities make the country focus even more important, particularly a focus on the poorest, most marginalized countries. Although technologies are now available to rapidly disseminate new knowledge around the world, the reality is that developed countries are the main beneficiaries — the “globalization of knowledge” is a misnomer. Privatization of research, tighter intellectual property rights, and the growing gap in access to communication technologies are all factors working against the interests of the poor in developing countries. Although these countries try to take advantage of the “global economy,” they need to ensure that the concerns of their people are not lost in the process.

The objectives of national research in developing countries are at least fourfold. The first is to make more effective use of existing knowledge, technologies, and health interventions. In some cases, this may mean adapting knowledge and technologies for local use; in others, it will mean making current interventions more efficient and effective. A second objective is to make currently effective (yet expensive) interventions simpler and more affordable. Often, this will involve collaboration with researchers from other countries where people experience similar health problems. A third objective is to participate in research to discover new ways of dealing with priority problems. In some instances, developing countries may get involved in the research; in others, they may only advocate research to address their priorities, without necessarily participating in it. Their advocacy may focus on international investors and agencies, as well as on researchers in developed countries. A fourth objective is to protect against misinformation and exploitation; for example, manufacturers and distributors of pharmaceutical and health products in developing countries often use distorted information, together with incentives, when marketing their products. The tobacco industry has used similar tactics, such as misinforming people about filtered cigarettes.

Health must be seen as an integral part of economic development. Then equitable distribution of health resources would become part of larger political movements.

— Dr Michael Phillips, Research Centre of Clinical Epidemiology,
Beijing Hui Long Guan Hospital, China

Each country is responsible for putting equity up front.

— Dr Lye Munn Sann, Institute of Medical Research, Malaysia

Left to market forces and curiosity alone, health research would tend to reflect the priorities and health problems of the rich. Instead of helping to narrow the gap between rich and poor, it would simply widen existing disparities. Health research should actively work to eradicate such disparities. Underpinning this argument is the belief in the worth of every individual and the belief that every person is entitled to realize that worth.

Another compelling argument is that health for all promotes national development. Countries impede their economic growth and social development by underinvesting in the health of the poor. A high burden of disease — found largely among the poorest countries — hinders both economic growth and human development and limits international competitiveness. We now see evidence that equity-oriented strategies contribute directly to economic growth.

Working for equity also improves efficiency. Countries can make the biggest reduction in the burden of disease if they concentrate on improving the health status of those who carry the heaviest burden of disease, and these are almost invariably the poor and other marginalized groups.

Unlike improvements in the health status of wealthier nations, which will require dramatic technological breakthroughs to make giant leaps forward, relatively small investments in the application of existing knowledge can substantially improve the health of at least some of the poor. Efforts to further reduce the burden of disease through existing technologies depend largely on enhanced technical efficiency, better allocation of resources, and greater cost-effectiveness.

With local knowledge and customized application, we can squeeze far more benefit out of new or existing interventions. In many African countries, for example, people widely access both the traditional and the Western health-care systems. A growing concern has been that some practices of African traditional healers place them and their patients at risk for HIV–AIDs. Healers may use the same razor to scarify several patients, take a patient’s blood into their own mouth in the practice of “biting out,” or rub herbal medicines into open cuts with unwashed hands. Ethnographic research has highlighted the importance of the sociopolitical and cultural context of healing practices, as well as indigenous understanding of AIDs, in developing a culturally appropriate HIV–AIDs educational intervention in which traditional healers collaborate in identifying risky therapeutic practices and in finding and applying solutions (Willms et al. 1996).

In Indonesia research is still something that looks serious and something policymakers feel is not really important to do because they can decide by themselves. Another problem is also that the environment is not really supportive of research. Research is said to be expensive and so on.

— Dr Agus Suwandono, Health Services Research and Development Centre,
National Institute of Health Research for Development,
Ministry of Health, Indonesia

A key challenge is to make research demand-driven and to sensitize researchers to the needs and priorities that are in the national interest.

— Dr Lye Munn Sann, Institute of Medical Research, Malaysia

The private sector is driven by profit and zeal to yield the best rate of return on investment. Perhaps that is why the private rather than the public sector leads the way in redefining processes of innovation and replacing fairly static and step-by-step approaches with more dynamic and interactive ones. The priorities of private industry differ in many important ways from those of the public sector, especially the public sector’s global role in safeguarding and promoting fundamental research. Nevertheless, researchers working to promote health can learn much from the experience of technological development.

Weak demand for research may lead to inefficient outcomes: the failure of research to meet the needs of potential users; or even the complete neglect of important research topics. This has several implications:

• Researchers in developing countries with severe resource shortages may handicap themselves even more if they do not make the most efficient use of these scarce resources (many developing-country researchers were trained in developed countries in programs emphasizing research design and methodology, rather than planning and management);

• Researchers and national research coordinators can engage with user groups to stimulate demand for research and thereby improve the efficiency of the research process; and

• Although there is demand for research to improve the health of the poor — at least by the poor — this demand is not revealed in the market for research. This leads to an underinvestment in pro-poor research.

Some concrete ways to overcome these inefficiencies would be to promote research by the poor themselves and to link research to action to improve the health of the poor. (See Chapter 4 on participatory research and empowerment.)

Linking research to action can improve the quality of research as well. Testing and revising knowledge by applying it to real-world problems can strengthen the quality of the research, rather than compromising it. This is an important argument to make with people in the academic community, who are less likely to be persuaded by the above-mentioned arguments of effectiveness or efficiency.

Currently, COHRED’s primary function is to take its three messages to developing countries and the international health R&D community. COHRED also continues to provide technical support to countries implementing ENHR. It works with national research leaders to promote health research as a tool for development, establish research priorities, strengthen mechanisms to support research, and build research and user capacities. Specifically, it facilitates the interaction between health-research leaders, within and between countries. In this way, it helps these countries share experiences and insights into creating a stimulating research environment focused sharply on the goals of better health and greater equity. COHRED also provides an active forum for sharing experiences of ENHR. Through a series of printed and electronic publications, forums for discussion, and joint initiatives, COHRED is enabling researchers, health workers, ministries of health, community organizations, and others to share experiences and learn from one another. COHRED’s regional- and country-level initiatives aim to share information and ideas as widely as possible.

Africa

Just over a year after the creation of COHRED, the first African ENHR networking meeting convened in Mombassa, Kenya (May 1994). The participants (more than 30 individuals from seven African countries) recognized the value of sharing country experiences of ENHR and strongly recommended that such meetings be held regularly. As a result, the regional network has been holding these meeting each year in various African locations (Accra, Arusha, Harare, Kampala). Professor Raphael Owor of Uganda was the first regional network coordinator; he was succeeded in 1999 by Dr Steve Chandiwana of Zimbabwe. These meetings have been contiguous with others, such as the Fourth Africa ENHR meeting in Arusha, held in conjunction with a special conference on health policy in Africa (which IHPP cosponsored) and the World Conference of Public Health Associations. A joint meeting of ENHR, the African Clinical Epidemiology Network, and the Public Health School Without Walls took place in Kampala, in October 1996. A subregional network for French-speaking countries has operated for the past several years, providing a subregional francophone coordinator. The regional network has established communication links with other African regional health-research organizations, in part as an outcome of a “networking-the-networks” meeting held in January 1996, in conjunction with a global meeting of INCLEN held in Victoria Falls.

The African ENHR Mentoring Team manages the program and activities of the network. This team includes the regional coordinator and African members of the COHRED Board. It has taken on various functions, such as providing advice and support for individual countries, liaising with the COHRED Secretariat and Board and regional organizations (such as the WHO Regional Office for Africa), and planning the annual ENHR networking meeting. To prepare for the October 2000 conference in Bangkok, the Mentoring Team has participated in an intensive consultation process to ensure that a strong and clear “African voice” speaks for Africa at the conference.

Asia

Representatives have been meeting from Asian countries engaged in the ENHR strategy: their first meeting was in Thailand in 1995, followed by meetings in the Philippines (1996), Viet Nam (1997), and Lao PDR (1998). The Asian ENHR network has created collaborative regional task forces and project groups, such as working groups on resource flows and a regional study on equity. It rotates its secretariat every 2 years. Bangladesh initially hosted the network, followed by the Philippines and, currently, Thailand. Regional cooperation has characterized a number of national activities, such as priority-setting workshops in Indonesia, Lao PDR, Nepal, and Viet Nam and a training workshop on research management and networking, in Thailand.

During the past year, the Asian ENHR network has been involved in an intensive review of the status of health research for development in Asia in preparation for the Bangkok conference. It has attempted specifically to “widen the circle” and involve as many Asian groups with direct involvement in health research as possible. To do this, it made innovative use of information and communication technologies over the several months leading up to the dynamic Asian Forum on Health Research, in Manila in February 2000.

The Caribbean

The Commonwealth Caribbean Medical Research Council (CCMRC) (now the Caribbean Health Research Council [CHRC]) strongly facilitated the introduction and development of ENHR in the Caribbean region (specifically, the 18 English-speaking countries and the Netherlands Antilles). At the November 1995 joint CCMRC–COHRED workshop in Jamaica, teams from five countries discussed issues of priority-setting for health research, and they prepared country ENHR plans. Four of the five countries presented progress reports in April 1996 at a meeting of CCMRC in Trinidad.

As the regional ENHR networking body, CCMRC also created a dedicated position for an ENHR scientist. Between September 1995 and May 1998, this scientist supported processes for preparation and prioritization of research proposals and organized workshops on research skills.

During a regional consultation in 1997, the Caribbean Cooperation in Health (CCH) initiative identified eight health-research priorities for the region, along with strategies for implementation and joint action. CCMRC became CHRC and began the process of defining a regional health-research agenda for the eight priorities. So far, four countries in the region have established ENHR committees: Barbados, Curaçao, Jamaica, and Trinidad and Tobago.

Eastern Europe–Central Asia

Eastern Europe launched its network-building process through the leadership of Dr Peter Makara. In June 1996, a workshop was jointly organized by the Hungarian National Institute for Health Promotion, COHRED, and the International Forum for Social Sciences in Health. This was followed in November 1997 by the Workshop on Inequity and Health: From Research to Policies. Participants discussed building the capacity of Central and Eastern European countries and the Baltic states for research, policy, and action to meet the challenges of inequity in the region, which include poverty, social exclusion, unemployment, migration, homelessness, minority issues, and other important aspects of socioeconomic disadvantage.

In 1999, the Bishkek Declaration extended the regional network to include the Central Asian republics and Kazakhstan (CARK). A workshop was held with representatives from the CARK countries, researchers, and members of the CARK Mother and Child Health Forum. Many international agencies and donors attended the workshop, including COHRED, the WHO Regional Office for Europe, the United Nations Children’s Fund, the United Nations Fund for Population Activities, the Centres for Disease Control, and the World Bank. Participants made a commitment to adopt ENHR.

Recently, the network also undertook a regional consultation to help develop its health-research agenda for the next decade and prepare for the conference in Bangkok.

Latin America

In November 1999, the Latin America region launched a consultation process to prepare for the Bangkok conference. Similar to consultations in the other regions, it involved representatives from a number of existing networks (the Latin American and Caribbean Women’s Network, INCLEN, and the Health Systems and Services Research Network in the Southern Cone), various government agencies (Health ministries and science and technology councils), and a number of universities. It culminated in a synthesis meeting in Buenos Aires, in June 2000, where the various participants purposed forming a more permanent link (that is, a network of networks). The momentum created by the consultation process, it is hoped, will carry over, with participating countries strengthening their health-research systems through a clear orientation in favour of equity and social and gender justice.

In parallel with the many preparations for the October 2000 conference, COHRED continued to review its activities of the last several years, as well as look ahead to its possible future contribution. Past and present COHRED Board members participated in this process, which has clarified the council’s future tasks and roles.

COHRED has broadened its role in support of ENHR. It continues to serve as an advocate of ENHR, but with a newly articulated and focused set of messages, as well as a stronger communication strategy. When country groups asked for support to improve their ENHR competencies, COHRED responded with tool kits, forums for sharing country experiences, and leadership training. In doing so, it has become a learning community and a collegium in which colleagues encourage and support each other in the ongoing work of achieving COHRED’s goals: putting countries first, working for equity in health, and linking research to action. As it looks ahead to the next decade, COHRED envisions an enhanced role as broker of coalitions and partnerships. Thus far, it has developed partnerships with like-minded organizations, such as WHO (headquarters and regional offices), INCLEN, GFHR, and the Alliance for Health Policy and Systems Research; worked to create networks; and helped to link countries with donors. COHRED would like to strengthen its efforts in these areas and build coalitions with the widest possible range of stakeholders.

The organization sees the following as its key tasks for the coming years as it fulfills each of the four roles described above:

As an advocate

• Sharpening its communication strategy;

• Changing the perception that ENHR is for poor countries only;

• Finding ways to get the “country voice” into international research;

• Emphasizing that ENHR is not another vertical program; and

• Correcting the perception that COHRED is a mobile bank.

As a broker

• Working with countries to see how coalitions can effect change;

• Building effective research networks among developing countries; and

• Acting as a broker with donors.

As a learning community

• Strengthening leadership for research management and promotion; and

• Identifying and preparing the next generation of leaders for COHRED.

As a collegium

• Continuing to foster the development of regional ENHR structures; and

• Building links with other global partners.

Additionally, COHRED will work to develop qualitative and quantitative measures of ENHR’s success and COHRED’s own performance. This will entail, among other things, choosing a definition of equity and making it practical by describing specific gauges and initiatives to promote and measure equity trends.

Between July 1999 and May 2000, COHRED collected the views of a number of national research leaders on key challenges and future directions for ENHR. On an opportunistic basis, it invited 19 national research leaders to participate in in-depth interviews. All agreed to the interviews, and relevant portions of each were transcribed. A document analysis of the reports of four site visits conducted during the African consultation also offered some interesting perspectives.

The overarching message from national leaders was that ENHR must work to simultaneously effect change at the local (community and district), national, regional, and global levels, but without losing its focus on countries. Specifically, the research leaders called for the following:

• Local solutions for local problems;

• Strengthened national leadership;

• Greater regional cooperation; and

• A new deal with donors.

To let the voice of the national research leaders come through, the remainder of this chapter presents direct quotations from these individuals and from the reports of the site visits, followed by a short summary of the key points that the participants raised under each of the above recommendations. (Appendix 8.1 provides a list of these individuals and of the site-visit reports used.)

The real business is at the district level. Needed are researchers who are oriented to the community and have experience conducting district level research… . Research at the community and district level is able to identify where inequities are and the means of correcting them can even be local… . The health research system has not yet penetrated local levels enough to help identify inequities and correct them. I think we are still at the national top level and we need to put research at a lower level in order to achieve that.

— Professor Raphael Owor, Faculty of Medicine,
Makerere University, Uganda

A major challenge is to really work with all three stakeholders. So far, the community has been neglected. Researchers are not trained to perceive communities as real stakeholders. When we invite “the community,” we invite NGOs but they are NOT the community. Communities are not professionals, therefore they need a different approach, based on partnership and understanding. If we really want to work with them, we need researchers who are engaged, and researchers who can dedicate enough time to understand the culture they work in.

— Benin site-visit report

The role of traditional healers in research is not clear, yet they are very important stakeholders. There is a need to value and elaborate on their possible contribution to ENHR and equity in development.

— Benin site-visit report

Health-research priority-setting should follow a bottom-up rather than top-down approach. Local (community and district) health problems and needs should drive national health-research agendas, and the resulting policies and programs must be locally appropriate, taking account of the social, cultural, economic, and political context. Community members need to have a real voice in determining health-research priorities, and the researchers should empower them to find solutions to their health problems. Traditional healers, along with women’s groups and other previously overlooked segments of the community, should be counted among the various stakeholder groups and given equal respect. The local level is where we are likely to realize the greatest improvements in equity.

A comprehensive approach to strengthening national leadership must go beyond skills training and recognize the fundamental need to change attitudes, values, and motivations in research, health, and equity. Without such changes, we are unlikely to achieve a pro-equity political agenda, allocate greater resources to health research, link research to action, or build research capacity.

Achieving a pro-equity political agenda

Politicians prefer solving the kinds of problems that can be addressed over the short term rather than the long term. They have a four-year term in which to make some perceptible difference in the eyes of the general voting population. What can they achieve in that time? It’s pretty rare that you will find a politician who is willing to transcend his own political career — to look past the 4-year term and see that putting money into health research will make a difference in the long term.

— Dr Izzy Gerstenbluth, Department of Epidemiology and Research,
Medical and Public Health Service of Curaçao, Curaçao

Research has helped greatly to elucidate inequities. Doing something about them also requires political will. Research may help to formulate and evaluate policy options, but a pro-equity political agenda is paramount. Much political will (and, consequently, research) focuses on improving the efficiency of health systems. It is assumed that greater efficiency will create savings, which can in turn be redistributed to the benefit of the poor; in addition, decision-makers like to focus on problems for which they can find a “quick fix.”

Allocating greater resources to health research

African countries must put research higher on the agenda and give money for real research, not just money to maintain vehicles for the directors of the institute, or to maintain buildings; that is not enough. We need money to be put into the research process itself … . Funding for health research must be built into national budgets — even if budgets are supported largely by international agencies rather than local taxes … . What I have been trying to tell them is, “Look, if you can beg to build a health centre why don’t you beg also for health research?” I think this has sunk in. The strategic plan of the Ministry of Health this year is such that it includes research — which it has never done before.

— Professor Raphael Owor, Faculty of Medicine,
Makerere University, Uganda

No matter how poor the country, national leadership must make research a priority and allocate a portion of its budget accordingly.

Linking research to action

We were always concerned that policy was only ever developed on an ad-hoc basis, and more often than not, it was financially geared. So, we decided to try and change this trend. We wanted policy to be based on research, hard facts, or real information.

— Dr Izzy Gerstenbluth, Department of Epidemiology and Research,
Medical and Public Health Service of Curaçao, Curaçao

A major challenge has been changing the mindset of the past generation of policymakers and convincing people of the vital role research plays in national development and trying to inculcate a research culture and institutionalizing that. A key strategy was to gain commitment at the highest level in recognizing and supporting research as an important factor in development.

— Dr Lye Munn Sann, Institute of Medical Research, Malaysia

Governments need to develop a culture of evidence-based, transparent, and accountable decision-making. To bridge research and policy, we also need research managers who can communicate with both sides and understand the policy uses and implications of research.

Strengthening research capacity

Unless we change our attitude toward our researchers and give them incentives, give them career structures, they will go away.

— Dr Akhtar Ali Qureshi, Health Services Academy,
Ministry of Health, Pakistan

In Bénin the university is still in its infancy. Most of Bénin’s researchers are trained abroad and don’t come back. Researchers face competing demands on their time. The main causes of the brain drain are insufficient local incentives compared to foreign offers and unfavourable working conditions. Local capacity is being supplemented by external visiting researchers but the inflow is not significant. They mostly collaborate in the fields of community health, health-care financing, and clinical research. Contribution to capacity development is limited to providing equipment. Most of the foreign researchers work according to the priorities set by their (foreign) institution.

— Benin site-visit report

In the newspaper, I read an article on brain drain which argued that developing countries should not necessarily think in geographical terms, but instead keep a database of their human capacity abroad including their areas of work and availability to do consultancies in their home country. Countries could make use of such a database whenever they felt it was needed and in that way local people would keep on contributing to development in their own country.

— Burundi site-visit report

Communication is a huge challenge. The only effective means of communication with people at the district level is through radio — the walkie-talkie system. If you look, for example, at our own institute, which is internationally recognized, only the Director has access to the internet and email.

— Dr Soumare Absatou N’iaye,
Community Health Department, Mali

Research capacity-strengthening is not only about training more researchers but also about retaining them once they are trained. Stemming the flow of researchers out of developing countries remains a significant challenge. National leadership needs to invest in health researchers as much as in health-research projects and programs. Researchers should reap rewards in recognition and remuneration. An interim solution to the brain-drain problem might be for national research-coordinating bodies to think less in geographical terms and attempt to enlist national researchers abroad to work on health problems in their home countries. Information poverty is a serious obstacle facing health researchers in the developing world. The simple lack of equipment, computers, telephones, and electricity is a major barrier.

Countries need to join hands at the regional level to have a stronger voice at the global level to say that these are our problems and ensure that there is greater equity in the distribution of resources for health research.

— Dr Akhtar Ali Qureshi, Health Services Academy,
Ministry of Health, Pakistan

There should be an effective African network in which research results and experiences are shared amongst African countries. This would allow those countries that are less fortunate to benefit from the results and experiences of other African countries. It will also allow for identification and recognition of the experts within Africa. … Cooperative agreements between countries in Africa should be strengthened and harmonized so that donors cannot play countries against each other.

— Sudan site-visit report

Countries try to get donors on board at the country level, but are often unsuccessful. I would love to see a donors’ meeting facilitated by COHRED for East Africa or West Africa. We need the donors’ goodwill to sit down around a table, listen to country priorities and then allocate monies, say for the next three years, in these specific areas to specific countries.

— Professor Raphael Owor, Faculty of Medicine,
Makerere University, Uganda

That there is “strength in numbers” is a prevailing truism, not only when comes to mobilizing external donor funding, but also when it comes to sharing research expertise. African-country representatives, in particular, perceive the need to build regional networks to give a stronger voice to country concerns at the international level. As well, those countries with fewer resources may benefit from the experience of the more fortunate ones. A regional research program would eliminate duplication of effort and the resulting waste of the region’s limited resources.

Countries should stop their “beggar attitude” in regard to donors and realize that it is their global right to demand equity in research for health internationally.

— Sudan site-visit report

Africans should stop looking at global resources as charity — money which you get from the North so that you can do a few small studies here and there. Global resources are actually common resources which are available to the best scientists who can put together the best proposals to answer the most difficult questions which benefit the greatest majority of people.

— Dr Steve Chandiwana, Blair Research Institute,
Ministry of Health and Child Welfare, Zimbabwe

International donors need to develop trust to work with countries.

— Dr Mohamed Said Abdullah, National Health
Research and Development Centre, Kenya

The donors have double standards with respect to overhead fees, giving the developed world up to 30 percent administrative overheads and the developing world between five and 10 percent only. This should be harmonised according to an international performance output criteria.

— Sudan site-visit report

Research is a global good. Many developing countries must lose their “beggar attitude” toward international donors. By the same token, we need a new global research-funding architecture and donor mind-set to allow funding to go directly to Southern researchers and institutions. Currently, a two-tier research architecture is in place that views scientists from the South as second-class researchers — “field researchers” or “national scientists.” Donors channel funds through Northern institutions, and the institutions use these funds largely to support the work of their own Northern researchers, not that of their Southern “partners.”

At the start of the new century, ENHR appears well poised to improve health for all, based on country-led research and action. A clearer sense of mission will guide this work, one of putting countries first, working for equity in health, and linking research to policy and action. Yet, the future demands change, not just at the country level, but at the district, regional, and global levels as well, to achieve the goals of ENHR. COHRED has emerged from its adolescent years with a keener sense of its organizational identity. In its multiple roles as advocate, broker, learning community, and collegium, it will continue to respond creatively and effectively to the needs and concerns expressed by countries.

National research leaders

Dr Mohamed Said Abdullah
National Health Research and Development Centre, Kenya

Prof. Gopal Prasad Acharya
Nepal Health Research Council, Nepal

Dr Said Ameerberg
Mauritius Institute of Health, Mauritius

Dr Boungnong Bhoupa
Council of Medical Sciences
Ministry of Health, Lao PDR

Dr Steve Chandiwana
Blair Research Institute
Ministry of Health and Child Welfare, Zimbabwe

Mr Abu Yusuf Choudhury
Programme for the Introduction and Adaptation of Contraceptive Technology, Bangladesh

Dr Somsak Chunharas
National Institute of Health
Ministry of Public Health, Thailand

Prof. Pham Huy Dung
Centre for Social Science Research for Health
Ministry of Health, Viet Nam

Prof. E.M. Essien
Haematology Department
University of Ibadan, Nigeria

Dr Izzy Gerstenbluth
Department of Epidemiology and Research
Medical and Public Health Service of Curaçao, Curaçao

Dr Samia Yousif Idris Habbani
Research Directorate
Federal Ministry of Health, Sudan

Dr Soumare Absatou N’iaye
Community Health Department, Mali

Prof. Raphael Owor
Faculty of Medicine
Makerere University, Uganda

Dr Michael Phillips
Research Centre of Clinical Epidemiology
Beijing Hui Long Guan Hospital, China

Prof. Akhtar Ali Qureshi
Health Services Academy
Ministry of Health, Pakistan

Dr Bassiouni S. Salem
Upgrading Primary Health Care Services
Ministry of Health and Population, Egypt

Dr Lye Munn Sann
Institute of Medical Research, Malaysia

Dr Agus Suwandono
Center for Health Systems Research and Development
Ministry of Health, Indonesia

Prof. Tissa Vitarana
Technology and Human Resources Development
Ministry of Science, Sri Lanka

Site-visit reports

Benin

Burkina Faso

Burundi

Sudan

Document(s) 17 of 21