Setting priorities for health research: lessons from low- and middle-income countries

During the past two decades, researchers and policy-makers have become interested in priority setting for health research both at the country and international levels, and this has increased its visibility. The 1990 report by the Commission on Health Research for Development1 clearly acted as a catalyst in creating this momentum. It recommended that each country should develop a strong national plan to conduct research on both country-specific and global health problems, and that each country should set its own national priorities for research. As a result, a number of low- and middle-income countries started to experiment with comprehensive and problem-focused approaches to setting priorities for health research involving various stakeholders from health and non-health sectors in a consensus-building process. The Council on Health Research for Development, which was established as a direct result of the commission’s report, facilitated, reviewed and documented many of these developments.2 In parallel, the WHO Ad Hoc Committee on Health Research Relating to Future Intervention Options published its report in 1996.3 This report was intended to complement the commission’s work which emphasized national-level research. This committee’s report focused on setting priorities for global health research, and recommended a five-step approach that could be used to inform decision-making about the priority allocation of research and development resources. As a direct result of this report, the Global Forum for Health Research was established in 1998 to help correct the “10/90 gap” in health research – the fact that less than 10% of the funds spent on health research target the health problems of the developing world, which account for 90% of the global disease burden. One of the main strategies adopted by the Global Forum for Health Research was to promote more evidence-based priority setting; it developed the Combined Approach Matrix as a tool that can be used for this purpose. The matrix has been applied by the Global Forum for Health Research “to a range of settings, including global programmes and national plans, communicable and non-communicable diseases, risk factors and vulnerable groups”.4 In January 2006, resolution EB117.R13 of WHO’s Executive Board highlighted the importance and relevance of priority setting, reflecting the growing consensus that setting priorities for health research is as critical as conducting the research itself. This paper looks at major issues emerging from countries’ experiences in setting priorities during the past 15 years, and at the challenges still to be addressed.