‘HR-HR’ – Human Resources for Health Research: a neglected area of HRH?

Lack of attention and investment in health research systems and skills signals
‘crisis- within-a-crisis’ for health sector.

The WHO’s World Health Report, released today, rightly places the most valuable and scarce health resource – some 59 million health workers serving their countries in difficult, often impossible conditions – at the center of the developing world’s health crisis. The contribution of health workers’ as an essential factor in improving people’s lives needs to be better valued. Countries need to recognize this and focus their political and professional attention on it.

But there is a crisis within the health crisis for developing countries. It is the lack of attention and investment in building and sustaining skills in their health research systems and professional cadre. The report considers that: “Health workers are all people primarily engaged in actions with the primary intent of enhancing health.” It refers to the WHO definition of health systems as: all activities with the primary goal of improving health – inclusive of family caregivers, patient–provider partners, part time workers (especially women), health volunteers and community workers. But it is unclear if developing countries’ health research workforce is included in these figures or targets. It must be.

The imperative to build skills in the health research system

Behind a country’s primary health care interface – physician and care giver-to-patient – and the health system that delivers services and treatment, is the foundation provided by a national health research system. These are the universities and institutes of public health and their research managers, epidemiologists, public health physicians, statisticians and economists. They run medical trials, develop therapies and produce analyses that guide political decisions as part of a national health strategy and service delivery plan. These are also the cadre of health professionals who can ensure that health research matches country priorities and whose presence is essential for the research system to absorb the inputs by the large global health partnerships.

This is a profile of a well functioning health research system. Today’s reality in most developing countries is that some of these components are in place but there is a lack of investment and, sometimes, of political will – by government and international development partners – to support the development of system capacity in the health research sector.

How the international health agenda causes internal ‘brain drain’ in health research
It is a fact that brain-drain and the loss of qualified staff to foreign job markets have a huge negative impact on the health sector. The same holds true for health research, with the added problem of a significant internal brain drain. This is caused by donor priorities and the agendas of international health programmes that attract qualified researchers and institutes away from working on health problems that the country has defined as its priorities .

The effort to build a strong health research workforce rests on the same principles proposed by the World Health Report. High-level political commitment, both internationally and in countries, needs to be supported by national strategies and action plans for developing the system and people’s skills. But health research needs to be explicitly included in the targets and action plans proposed for the coming decade.

Arguably the single most effective way to build the skills and effectiveness of a national health research system is to encourage large international programmes to work with the national research system. Programmes need a plan to build professional capacity in partner countries as a part of their vaccine trials, drug delivery and other activities. Countries, on their side, need to be prepared to receive and negotiate with international partners based on a clear health research priorities .