Where the rubber hits the road: Evidence informing impact for global health
In this guest post, E. Callie Raulfs-Wang –research advisor for the US Agency for International Development’s (USAID) Center for Accelerating Innovation and Impact—writes about the relationship between research and evidence when developing and delivering new global health products. This post is the second in a series highlighting USAID’s new strategy for global health research and development (R&D). It originally appeared on the IMPACT blog.
Like strands of human DNA, the genetic underpinnings of life, research and evidence are so closely intertwined they cannot be separated. Whether testing the efficacy of an HIV vaccine or the marketing strategy of a new contraceptive technology, quality research, careful methodology, and rigorous analysis are fundamental for acquiring evidence useful in decision-making. As outlined in USAID’s Report to Congress: Health-Related Research and Development Strategy, the agency supports a range of research activities, including both ‘upstream’ product research and ‘downstream’ implementation research. Along this continuum, USAID places a strong emphasis on evidence for informing development policies, practice, and strategy.
As global health products are developed, we need evidence to demonstrate their effectiveness in developing country settings.For example, despite the fact that effective treatments exist for pneumonia, over 1.2 million children die each year from the disease. In the last few years, USAID has supported studies in Pakistan investigating the effectiveness of community-based treatment of severe pneumonia. Results from these studies have shown that oral antibiotics administered at home are as effective as injectable antibiotics administered in a hospital setting. This evidence prompted a 2012 revision of World Health Organization guidelines on outpatient management of severe pneumonia.
Beyond effectiveness studies, like the one conducted in Pakistan, we need studies that focus on the implementation and adoption of public health interventions, also known as implementation science. USAID’s 2012 Global Health Strategic Framework: Better Health for Development iterates a commitment to implementation research and the “scale-up of evidence-based, equitable, inclusive, and locally adapted health solutions.”
- To increase understanding of the ‘what’ and ‘how’ of implementation research, USAID in partnership with Johns Hopkins University and The George Washington University, has launched an open-access peer-reviewed journal called Global Health: Science & Practice.
- To accelerate product development and the introduction of new technologies, USAID has initiated the Center for Accelerating Innovation and Impact (CII), which engages key experts to identify state-of-the-art ‘best practices’ around product marketing, introduction, and scale.
- To expand knowledge of interventions that have “high impact,” the Bureau for Global Health has developed several High-Impact Practices (HIPs) in family planning; maternal, newborn, and child health; nutrition; and health systems strengthening. For example High-Impact Practices in family planning are best practices that, when scaled up and institutionalized, will maximize investments in a comprehensive family planning strategy.
Since 2011, USAID and partners have hosted three evidence summits addressing critical challenges in global health. Not an ordinary conference, an evidence summit is an organized process that convenes leading scholars and health practitioners to review the latest research and provide evidence-based guidance for improved health performance, an understanding of knowledge gaps, and research agenda recommendations. These summits have addressed: Protecting Children Outside of Family Care, Enhancing Provision and Use of Maternal Health Services through Financial Incentives, and Enhancing Community Health Worker Performance. A fourth evidence summit on Behavior Change Communication for Child Survival will be held later this year.
The local adaptation of health solutions is where the rubber meets the road. Each developing country is characterized by its own unique population, culture, health challenges, and infrastructure. To enable the development of local solutions to local problems, USAID is supporting the Partnerships for Enhanced Engagement in Research (PEER) Health program. PEER Health is a capacity-building program which provides research grants to developing country investigators in partnership with National Institutes of Health researchers focused on addressing local health challenges.
Asking the right question, at the right time, in the right way, is not easy. As global health moves into the 21st century, more complex health challenges, including non-communicable diseases, the integration of health services, and the strengthening of health systems, present themselves. Solid evidence based on rigorous research is an indispensable ingredient for the successful introduction and scale of health products and services. As the 2012 health research report to Congress attests, USAID remains committed to pursuing an evidence-based agenda in global health.