BOOKS & ELECTRONIC MEDIA
World Report on Knowledge for Better Health: strengthening health systems
Adetokunbo O. Lucas
25 Adebajo Street, Kongi, PO Box 30917, Sec. BO, Ibadan, Nigeria (email: adelucas@AOL.com)
Publisher: World Health Organization, Geneva, Switzerland; 2004
ISBN: 92 4 156281 1; 146 pages (softcover); price SFR 30; SFR 15 (developing countries)
It is a painful irony that in parts of some developing countries, it is not uncommon for people to fall sick and die of diseases that can be easily prevented and treated. A simple solution of sugar, salt and water could save the lives of thousands of children who die of diarrhoeal diseases every year. Malaria kills hundreds of thousands of children who could have been protected by sleeping under insecticide-treated bednets or cured by the use of effective drugs. Lacking access to antiretroviral drugs, thousands of HIV-infected persons die prematurely. These and other examples illustrate the gap between existing knowledge and health technologies and their application.
The authors of the World Report on Knowledge for Better Health have tackled the important question of how to close the gap between knowledge and its application in the health sector. The book's five chapters (Learning to improve health, Towards a scientific basis for health systems, Strengthening health research systems, Linking research to action, Recommendations and action plan) present a well-argued and carefully illustrated case for the systematic use of knowledge derived from research. It draws on previous studies and reports that have addressed aspects of the problem and provides a useful synthesis of current thinking. The 1990 report of the Commission on Health Research for Development provided many of the seminal ideas and concepts on global health research. Follow-up initiatives by the Council on Health Research for Development (COHRED) and by the Global Forum for Health Research (GFHR) have extended the Commission's work. It would have been useful if the Report had highlighted the lessons that could be learned from these and other initiatives. For example, a critical review of COHRED's experience in strengthening national health research would have revealed to readers how the authors used those lessons to inform their proposed recommendations and action plan.
The Report recommends a strengthening of national health research systems, with particular emphasis on strategic research, to facilitate the translation of advances in knowledge into effective intervention programmes. The authors point out that many developing countries do not provide appropriate financial support for health research. Not only does this severely limit the effectiveness of national scientists in these countries, but also more seriously, reflects a persistent failure among health officials to recognize how health research could facilitate better analysis of problems and more effective interventions.
The complementary recommendations on strengthening health systems aim at ensuring that policy-makers and health-care givers use knowledge generated from research more effectively. The proposed road map involves the strengthening of relevant health research and a fast tracking of the translation of the new knowledge into effective programmes.
The main findings and the recommendations of the book are cogent and convincing but some issues need further clarification. The ultimate goal of strengthening research and health systems is to reduce the disparities in the health status of people between and within countries. It is well known that the direct operations of health services do not provide the sole tool for achieving equity in health. The book does not discuss the role of intersectoral action. The authors could have included a broader analysis of factors outside the health sector that have significant effects on the health status of populations. They could also have discussed the implications of evidence relating health outcomes to poverty, to the education of girls, and to other variables that are not directly controlled by the health services.
The roles of scientists and health-care providers in closing the application gap remain a contentious issue. The authors somewhat over-emphasize the role of national scientists in this respect, without sufficiently stressing the responsibilities of the health-care providers. National scientists have the responsibility of working on problems of high priority and communicating their findings in ways that should guide policy, planning and the delivery of health care. However, health-care providers must access not only locally generated information but also knowledge derived from experience outside their national boundaries. For example, research in Papua New Guinea half a century ago demonstrated that immunization of pregnant women with tetanus toxoid protects babies from neonatal tetanus. And yet, as recently as year 2000, neonatal tetanus killed 200 000 children worldwide! This and similar cases raise questions on how effectively policy-makers and health care providers make use of global scientific knowledge. The authors do not discuss the factors that make it difficult for responsible officials to access such knowledge. Nor do they discuss the limitations imposed by scarce resources that force policy-makers and planners to make hard choices. Furthermore, they don't sufficiently emphasize the value of policy research in drawing up priorities. Rather than a concept of health equity based on the goal of Health For All, it might have been more realistic to have adopted UNICEF's approach of linking expectations on health performance to the GNP of the country. In this respect, UNICEF's concept of National Performance Gap provides a more realistic goal that is applicable to countries with widely different levels of financial resources.
This book should be essential reading for health officials, especially those who are involved in making major decisions affecting health policy and health care delivery including individuals in public and private institutions, leaders of professional associations as well as credible representatives of civil society. It provides relevant stakeholders in the health sector with a forum for examining national and local issues. 