WHO Forskningsstöd 2020-2025

Alliance for HPSR Since the last conclusion on performance, summer 2023, the Alliance has started to settle since several major changes: the new Director of the Alliance (autumn 2022), the appointment of several new Board members as well as its Chair, Helen Clark (started in 2023). The Board composition has slightly changed in character the past years, resulting in a less scientific and a more policy-maker and strategic profile of the board members. There is still a strong scientific council, and the roles are clearer this way. The Board members have been engaged in connecting the Alliance to other global and national partners, such as the Chilean and Japanese governments, Global Fund, and Médicins sans Frontières. The new Strategy was launched in April 2024 and is valid 2024-2028. As part of the strategy development process, more than 200 stakeholders were consulted in order to gather input on the objectives, values, functions, and focus areas. New indicators for measuring progress in line with the new Strategy are being developed, and Sida is part of the monitoring and evaluation working group, who is in charge. As the majority of the budget now is project-based, a lot of the indicators will also need to be aligned with various donor requirements. The development is in its final stages. There is continuous interaction with the other research programmes based at WHO, both TDR and HRP. A monthly lunch takes place with the Directors of the three research programmes and the Chief Scientist of WHO. 2023 was a time of transition, wrapping up projects while positioning the Alliance in a new strategic period. In 2023, the Alliance supported 14 ongoing projects, representing 147 grants across 69 countries. 57% of the 89 peer-reviewed journal articles were led by female authors (38% in 2021, 51% in 2022), and 67% are from LMICs (38% in 2021, 53% in 2022). - 24 case studies on primary health care in the context of the COVID-19 pandemic were published. - Four new primary health care-related projects were launched on primary care financing, on implementation research to reach zero-dose children with vaccinations, on exploring the pathways through which primary health care reforms are contributing to universal health coverage outcomes in two states in India, and on implementation research studies on digital health solutions to support primary care managers in eight countries. - The Alliance extended its research initiative applying health policy and system research to the climate crisis in another six countries. It also initiated an new focus area on climate co-benefits which aligns with the new strategy and shapes the future engagement in this field. - The Alliance partnered with the WHO hub for Pandemic and Epidemic Intelligence to enhance their work on emergency preparedness and response. This partnership aims to better understand the health system factors that have enabled national public health agencies to function effectively in response to COVID-19 and other public health emergencies as well as to understand governance of these essential public health functions in the context of post-COVID-19 reform efforts underway in these countries. - 2023 marked the conclusion of the Alliances four-year project, BIRD, with the primary focus on Building Institutional Capacity for Health Policy and Systems Research. The project engaged six institutions across Nigeria, Cambodia, Indonesia, Georgia, United Arab Emirates, Trinidad and Tobago and a mentor institute in Lebanon. 106 policy fellows were trained and over 30 knowledge products and 20 scientific articles were published. The project led to the formalization of research procedures, enhanced opportunities for networking and training, increased international recognition and funding and greater involvement in government evidence initiatives. As part of the BIRD initiatives, different research institutions were encouraged to collaborate with policy-makers at the national level. __________________________________________________________________________________________ HRP An interactive annual report 2023 is found here: https://hrp-annual-report-2023.srhr.org. Some main results in 2023 from these resources are: - 157 articles were published in peer-review scientific journals. 43% are published by an institution in a LMIC (excl. those published with WHO as lead). 73% have a female lead author. - 53 systematic reviews were published in 2023, 85% with a female lead author. 26% of those (excl WHO reviews) had a lead author from a LMIC. This is a little higher than last year (21%) and pointed out by the evaluators. - 27 collaborations were underway with UNFPA in 2023, and 7 with UNAIDS. In total there were 68 collaborations between HRP and either co-sponsors, IPPF and/or other UN-actors at global level. - 85% of the ongoing research projects (146) have a lead organisation in a LMIC, 40% in the Africa region (AFRO). - In 2023, 403 individuals were trained as part of HRP Alliance activities which is fewer than 2022 (1124). 61% are female. No new PhD or MSc students were admitted in 2023, due to funding constraints and incertitude of future funding. Training activities were halted, including the mentorship programme for early career female researchers. In 2023, HRP launched for eaxmple: - the global infertility prevalence estimation - A roadmap to combat postpartum haemorrhage 2023-2030 - A joint call for action on impacts of climate change to protect maternal, newborn and child health from the impacts of climate change (WHO, Unicef, UNFPA, HRP) - Trends in maternal mortality 2000-2020. It's remarkable that a woman dies every two minutes due to preventable causes, still these days. 97% of unsafe abortions take place in LMICs in Africa, Asia and LA. Facilitated adoption of WHO handbook for quality abortion care were developed with tools to facilitate the practice. It includes mobile application, step by step guidance for health practitioners. There is also online WHO training for community health workers, pharmacists etc. The "Maternal mortality project" was finalised in 2023. There are country success stories here: www.who.int/activities/addressing-unsafe-abortion-through-a-health-systems-approach Beyond reproduction: women are more than reproducers. Sexual Health Assessment of Practices and Experiences (SHAPE) was launched to increase our understanding of sexual behaviours and practices. The objective is to build a strong evidence-base and scientific grounding taking this into account. HRP are strong in self-care, both in building evidence for what works, and for developing support material. There are also innovative ways of spreading tools, such as the Digital Adaptation Kits, which includes digitalization of SRH services within health systems. Another example is the Self-Care Wheel, which recently won the World Health Organization internal Director-Generals Excellence Award for Innovation 2023, is now set to help demystify self-care and increase understanding of WHOs recommended self-care interventions in several countries. HRP has launched research on digital tools and AI, including reporting on the accuracy of a smartphone application for blood pressure estimation in three countries. A brief on AI and SRHR was published: www.who.int/news/item/22-03-2024-unpacking-artifical-intelligence-in-sexual-and-reproductive-health-and-rights ___________________________________________________________________________________________ TDR TDR's new strategy 2024-2029: "Building local research solutions to improve global health" was approved at the JCB in June 2023. It aims to support research to address global health challenges TDR will focus on four major global health challenges affecting infectious diseases of poverty using a One Health approach. These challenges are: 1) climate change, 2) Epidemics and outbreaks, 3) Resistance to treatment and control agents (AMR) and 4) Control and elimination of diseases of poverty. A major achievement for TDR in 2023 was the demonstrated impact of long-term collaboration with research institutions and control programmes. One of TDRs longest and most successful implementation research programmes contributed to the success of the VL elimination work in the Indian subcontinent, with Bangladesh becoming the first country in the world to be officially validated for having eliminated visceral leishmaniasis (VL) as a public health problem in 2023. Implementation research on VL is a TDR-supported and country-led, long-term project that aims to generate the evidence base for policy uptake and roll out of approaches and interventions deployed by national programmes to promote VL elimination, continually seeking solutions to challenges emerging in the course of progress. As one of the longest and most successful implementation research programmes at TDR6, these efforts have contributed to a sharp reduction of cases in three endemic countries on the Indian subcontinent, Bangladesh, India and Nepal. TDR contributed to the historic milestone in Bangladesh by working for nearly two decades with research institutions and control programmes and played an important interface role, bringing together governments, medical practitioners, the academia, the private sector and global donors, to design new, innovative tools for diagnosing and treating this deadly disease. The learning from the Indian subcontinent are now applied to East Africa. These achievements were in collaboration with icddr,b in Bangladesh. In 2023, 59 fellows representing 37 countries started a postgraduate training in four universities; 33 graduated. Fourteen episodes of the Global Health Matters podcast were released, reaching a total of 50 000 downloads. Sustainability was one of the core topics for the Social Innovation in Health Initiative (SIHI), with one of the noteworthy results being the Nigerian hub inaugurating the Goodwill Medical Centre at the Pan African Community Initiative on Education and Health, dedicated to incubating social innovation in health care and facilitating related research. GENDER: 47% of peer-reviewed publications supported by TDR have women as first author. 49% of total research grant/ contract amounts have been awarded to women. SOCIAL AND ECONOMIC EQUITY: 77% of peer-reviewed publications supported by TDR have first authors from disease endemic countries. 88% of total research grant/ contract amounts have been awarded to recipients in disease endemic countries.

Three WHO-based research programmes are proposed for continued support: i) The UNICEF-UNDP-World Bank-WHO Special Programme for Research and Training in Tropical Diseases, TDR; ii) The UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, HRP; and iii) Alliance for Health Policy and Systems Research, AHPSR, or "the Alliance". Sida/Sweden is a long-standing supporter of TDR since its creation in 1974. TDR is one of the earliest examples of a Global Health Partnership and has repeatedly received good reviews by external evaluators because of its relevance to both health and development. TDR is the 2011 recipient of the Gates Award for Global Health. With its long history of support, Sida is well familiar with the achievements of the programme. 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. Sida/Sweden is an as long-standing supporter of HRP, even since a couple of years before its creation in 1972. As such, Sida is equally familiar with the HRP's achievements. 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 womens and mens 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". AHPSR is a younger programme than TDR and HRP and recently celebrated its 20th anniversary. Sweden was one of the drivers of the creation of AHPSR and has been actively involved since then, leading to good insights into their activities. 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.   HRP and TDR are special programmes of WHO which gives them an independent status in relation to WHO. They are co-sponsored by a number of UN-agencies (UNICEF, UNDP, World Bank and WHO are co-sponsors of both TDR and HRP, and additionally, UNFPA is co-sponsor of HRP). As a WHO-hosted partnership, AHPSR is also guaranteed its independence. The difference between the two set-ups used to be the co-sponsorship of the special programmes, although today the definitions are being discussed at WHO. The future format of AHPSR is described later in this appraisal. When the special programmes were created in the early 1970s WHO did not actively engage in research, but as a number of member states could see the importance of producing research of relevance (in this case tropical diseases and human reproduction), TDR and HRP were created. Over the years, the importance of producing evidence to feed into policies and guidelines was increasingly recognized and other UN agencies joined the effort as co-sponsors. Similarly, the areas of health policy and systems research were neglected and in the late 1990s a group of global health leaders, including senior scientists, policy makers and representatives of various agencies and programs with a stake in health policy and systems research agreed on the need to create a body that would address these areas, and AHPSR was created as a hosted partnership at WHO. Being based at WHO and having a close interaction with the co-sponsors provides the research programmes with a unique opportunity to accelerate translation of research results into policies and guidelines. Through country and regional offices and their close relation to a country's Ministry of Health, the possibility for implementation at this level is also improved. As WHO is now putting more emphasis into the country and regional offices, this is expected to play an even more important role in the coming years. The importance of research and evidence is even more clear now that WHO has assigned a first Chief Scientist and a Science Division, and one can foresee a closer interaction between the research programmes and WHO at all levels. Over the years, as the world changes, the areas of research addressed as well as the ways to address the need of evidence and implementation have changed in the three programmes. The research programmes show an embedded ability to adapt their activities to changes in global health and to take leading roles in the global research agenda. There are still pertinent questions to be addressed in the programmes respective areas. For example, there is presently a strong focus on implementation research and interaction with decision-makers, as well as strengthening research capacity in LMICs and ensuring that high quality research is done in countries. As the bulk of Sida's support to the programmes is given as undesignated funding, the results of the upcoming phase are expected to contribute to the attainment of the respective missions.