Health research: services and evidence for better national health

Urbain Olanguena Awono
Former Minister of Public Health, Cameroon (2001-2007)

In this interview he discusses Cameroon’s updated health sector strategy and the importance of having a health research system that is an integral part of the health care system. Research needs to provide evidence to support the reform process  and define the real health and health research needs of the country.

Cameroon’s new health sector strategy and reforms are centered around the Millennium Development Goals and with a strong research focus, is this correct?

Yes but it is not a new strategy. We are updating our thinking by consulting with different parts of our society. A reform process for the health sector – and for research – is emerging from these discussions. The updated health sector strategy will be aligned with specific components of the Millennium Development Goals related to health, development and poverty reduction.

How does research fit into the strategy?

The health research strategy is an important piece of the broader health sector reform that Cameroon is pursuing. It will be implemented in line with the Paris Declaration on Aid Effectiveness to encourage donors to align their activities with the national health priorities that we are setting. Research will support evidence needed for the success of the reforms.

Our strategy starts with the concept of a research department in the Ministry, which we have created four years ago, and will also be embedded in the health system at different levels. For example, we will create research units in hospitals and increase the culture of ‘evidence creation’ in schools of medicine. This will feed into the current dialogues we are having with different research beneficiaries on the national research policy and on health and health research priorities for Cameroon.

How do you see the links between health research system development and health systems development?

They are two parts of the same system, you cannot separate them. The research arm produces information and evidence to feed into the health system and policy arm. In a case like Cameroon where we are moving forward with a new strategy and health sector reforms, the health research service provides data and information that helps us define needs and argue credibly for the changes that we see are necessary.

What advice can you give to countries that are embarking on the health sector reform process?

You really need the political will to make this happen, to create space for the technical specialists to start their work. This includes issues such as how to secure the investment and clearly define what to invest in.

The best way to do this is to build a group of people with a deep interest on health and health research for the country. They need to reflect on the national priorities and how to develop them; and on the partnerships needed to make the reforms work – for example with other ministries, community organisations and the educational communities. And with the media – which we call the ‘4th arm of government’. This is an important group in the country that provides policy to help drive policy.

My first advice to a country considering health sector reforms: know that it will not be easy, so you really have to have political will to do this.

I believe you are an economist. What convinced you that health research was a priority focus for the health sector strategy, rather than for example, expanding health services?

Because this economist is a health minister! And to do his work properly the health minister needs evidence.

When I was appointed, the Ministry had no department for research. One of the first actions I took was to propose to the President that we create a research department, explaining that the Health Ministry cannot hope to produce effective health programmes and policies if you do not have information to guide their decisions. Economists may not call as loudly as their colleagues for research, but we do need data on which to base decisions – so the need is the same.

Looking at the 2007 WHO’s World Health Assembly and the Resolution that has been adopted on ‘roles and responsibilities of the WHO for research’ – to have a more consultative and coordinated approach. This looks to be good news for developing countries.

Yes it is. Cameroon and the ‘Africa Group’ at the Assembly support this resolution but we do also note that the contribution of the African continent in the debate is below the appropriate level.

The participation and influence of African countries on the health research agenda of WHO and other international mechanisms is growing. It is becoming clear that strong political will and commitment, is creating change. For example the efforts of some African countries last year in Abuja and Accra have permitted a clearly articulated African position on the role that TDR (WHO, UNDP, World Bank Special Programme on Tropical Disease Research) should play. And this has been included in the newly adopted TDR ‘ten-year vision and strategy’. This is a step forward. Our hope is to see more countries taking advantage of this and backing its implementation phase. There is much more to be done, but this is a good start.

I have also been privileged to serve as chair of the Portfolio Committee at the Global Fund and representative of the Western and Central Africa Constituency. I have seen how low the ranking of research activities in countries’ applications submitted to the Global Fund have been and how difficult it was to get the Global Fund to finance operational research as an integral part of grants.

Improvements and awareness are also needed at country level. Few countries were including operational research in their Global Fund proposals because research was not recognised as a priority in many countries. Ministries of Health can make a strong case for health research by stressing the importance of having high quality appropriate evidence for health systems development.

© 2007 Copyright Council on Health Research for Development (COHRED) and Republic of Cameroon Ministry of Public Health. Re-use and circulation of this text its current form, or referral to this text, is encouraged provided the following credit is given. Interview published on © Council on Health Research for Development (COHRED) and Republic of Cameroon Ministry of Public Health, used by permission. For reuse in a publication, contact COHRED for permission. The Perspectives on Research for Health series is published in the interest of strengthening the voice of research for health in, by and for the “south”. The opinions expressed in these articles do not necessarily reflect the opinions or policies of COHRED. Interview by Michael Devlin, COHRED