WHO Forskningsstöd 2016-2019

During the past phase of support, all three programmes have achieved their objectives and produced many relevant results. The three research programmes have shown good capacity to achieve the objectives of the interventions, and show active learning and adapting to a constantly changing environment. In addition, they have an increased collaboration amongst the programmes both at the leadership level and at the activity level. The programmes can learn from each other in areas such as capacity strengthening initiatives, innovation and implementation research.  An unexpected result from the recent years is the establishment of WHO Science Division, where all three programmes actively participate. They share experiences both in between the programmes, but also with other parts of WHO and strengthen research across the organisation. Another result is the increased collaboration with co-sponsors (i.e. Unicef and UNDP) which increases the impact of the programmes as well as its efficiency in budgetary terms. This is to be expected, although has proved difficult to achieve. A less positive development has been the increasing reluctance to SRHR issues of certain countries, especially with regards to safe abortion and comprehensive sexual education, which is a challenge especially for HRP. The development and success of the Social Innovation in Health Initiative of TDR is an unexpected result during the last phase, providing a potential platform for innovative approaches for all three programmes.  An extensive description of results is to be found in the annual statements and the recent appraisal of the new support. Some recent selected results are as follows: TDR: - 178 master’s students were trained 2015-2018 through postgraduate training schemes focused on implementation research - The 2018 performance measurements confirmed that TDR’s sustained efforts towards improving gender and socio-economic equity are yielding results: the proportion of women among recipients of grants and contracts increased to 47%, and the average amount of a grant was identical for women and men. In addition, 44% of first authors of TDR-supported publications and 57% of expert advisers were women. - TDR’s sustained focus on low- and middle-income countries is reflected in the fact that 83% of grants and contracts went to institutions and individuals in LMICs and 73% of publications had a first author from an LMIC. From the 222 peer-reviewed publications supported by TDR in 2018, 57% specifically addressed vulnerable populations, gender and disabilities. - TDR expanded training of researchers in the regions through TDR’s regional training centres, which have trained in total almost 2000 researchers in short courses, and they expanded the training reach through a Massive Open Online Course on Implementation Research to approximately 1600 researchers in 2018. - In 2018-2019, TDR developed over 20 new or improved solutions, tools and implementation strategies in collaboration with country institutions and/or WHO disease control programmes. These tools are aligned with the needs and priorities of disease endemic countries, to support translation of evidence to policy and practice. This way, by early engaging with local and national stakeholders in countries, the sustainable integration of TDR’s outputs in countries’ health systems is greatly facilitated. - The United States Food and Drug Administration’s approval of moxidectin for the treatment of river blindness will likely improve the health of millions of people in sub-Saharan Africa and speed up the elimination of this debilitating disease. It is the first new treatment for river blindness in 30 years, and TDR was instrumental in the development. In addition to supporting TDR, Sida contributed to GHIF through Guarantees, which made this progress possible. - An improved Early Warning and Response System (EWARS) tool has increased country capacity to detect and respond to outbreaks of dengue fever. The EWARS tool has been shown to be equally successful in predicting outbreaks of Zika and chikungunya in Colombia and Mexico, and will be expanded to other regions and arboviral vector-borne diseases. TDR has several interesting projects connecting health to environment and climate change, such as the development of malaria-specific, trypanosomiasis-specific and schistosomiasis-specific tools aimed at increasing population resilience to climate change. HRP: - Research on SRHR in health emergencies increased last years, including mental health of adolescent girls. - Research on Comprehensive Sexual Education has grown substantially, including implementation research. - Heat-stable carbetocin (used to prevent post-partum haemorrhage) is now available at a similar price as oxytocin and accessible in 90+ countries. - It was found that 28% of maternal deaths (excluding those related to abortion) are due to pre-existing medical conditions (such as diabetes, malaria), and 27% are due to severe bleeding. One reason is the alarming increase of caesarean section, many unnecessary. 2018, HRP provided evidence for guidance on interventions to decrease unnecessary caesarean sections. - HRP launched the WHO, UN Human Rights and UN Women interagency statement calling for the elimination of so-called “virginity-testing”, which has no scientific or clinical basis and is a violation of the human rights of girls. - In 2019 the Evidence for Contraceptive Options and HIV Outcomes (ECHO) study was finalized. HRP was leading these efforts, and Sida provided extra funds to HRP to keep the normative focus. Designed to provide high-quality evidence to help women at high risk of HIV make informed choices about contraception, the ECHO Study compared the risk of HIV acquisition among women randomized to the progestin-only depot-medroxyprogesterone acetate, given by intramuscular injection (DMPA-IM); a non-hormonal copper intrauterine device (copper IUD); and a progestin-based implant containing the hormone levonorgestrel (LNG implant). The study found no substantial difference in HIV risk among the 7,829 African women who were randomly assigned to use one of three highly effective methods of contraception. The study also showed a high HIV incidence among study participants, which highlights the need for more aggressive efforts to prevent HIV and for integration of HIV prevention in efforts of contraception use and control of sexually transmitted infections, as previously efforts are taking place in silos. - In 2018-2019 additional funding from Unit for Global Social Development were used for the so-called “combipack project”. Medical abortion using a combination of mifepristone and misoprostol has the potential to expand access to safe abortion. The project has resulted in an analysis of the production costs, the addition of the combipack on the list of essential care lists, a decrease in bulk price from 11.56 to 3.75 USD. Pilot testing to increase access is ongoing in seven countries. A great result is that in November 2019 WHO prequalified this combination mifepristone-misoprostol (combipack) for medical abortion. AHPSR: - Many of the research projects supported by the AHPSR respond to questions directly identified by policy-makers in LMICs, using an embedded research model to ensure findings from the projects are used to inform policies and have a real impact on health systems and society. One such is a collaboration with the Ethiopian Ministry of Health and the WHO country office, with 15 ongoing research projects addressing prioritised areas of the ministry.  - AHPSR, UNICEF, Gavi and the Vaccine Alliance supported projects leading to direct impact. One example is vaccination rates in Nigeria, where it increased from 61% to 91% in a few years. - In 2019, AHPSR worked in 42 countries around the world, provided research grants to more than 250 researchers, of which 60% are female and 26% are early-career researchers. - 55% of the 44 peer-reviewed journal articles have female lead authors and 38% have lead authors from LMICs.  - In 2019 AHPSR LEAP Forum partners (Learning, Engaging and Advocating for Health Policy and Systems Research) held a side event at the UN General Assembly. 

Swedish support to the three WHO-hosted research programmes TDR, HRP and AHPSR is well aligned with the Strategy for research cooperation and research in development cooperation 2015 – 2021 covering research of relevance to low-income countries and regions, research capacity building and promotion of research that, through innovation, can contribute to poverty reduction and sustainable development. Full names and main purposes of the WHO-based research programmes are: i) The UNICEF-UNDP-World Bank-WHO Special Programme for Research and Training in Tropical Diseases (TDR): TDR helps facilitate, support and influence efforts to combat diseases of poverty, with the mission to "support effective and innovative global health research, through strengthening the research capacity of disease-affected countries, and promoting the translation of evidence into interventions that reduce the burden of infectious diseases and build resilience in the most vulnerable populations". TDR main areas are i) Research for policy; ii) Research for implementation; iii) Research for innovation; and iv) Research for integrated approaches. ii) The UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP): HRP is the main instrument within the United Nations system for research in human reproduction, bringing together policy-makers, scientists, health care providers, clinicians, consumers and community representatives to identify and address priorities for research to improve sexual and reproductive health. The mission of HRP is "the attainment of all people of the highest possible level of sexual and reproductive health. HRP strives for a world where all women’s and men’s rights to enjoy sexual and reproductive health are promoted and protected, and all women and men, including adolescents and those who are underserved and marginalized, have access to sexual and reproductive health information and services". iii) Alliance for Health Policy and Systems Research (AHPSR): AHPSR work to improve the health of those in low- and middle-income countries by supporting the generation and use of evidence that strengthens health systems. Together with organizations around the world, the AHPSR aims to i) provide a unique forum for the health policy and systems research community; ii) support institutional capacity for the conduct and uptake of health policy and systems research; iii) stimulate the generation of knowledge and innovations to nurture learning and resilience in health systems; and iv) increase the demand for and use of knowledge for strengthening health systems. In brief, TDR focuses on infectious diseases of poverty, HRP on sexual and reproductive health and rights, and AHPSR on health policy and systems. Sida is a long-term supporter of TDR, HRP (over 40 years) and AHPSR (over 20 years) and has major insights into the programmes.