FROM RESEARCH MAPPING TO SHAPING
PUBLIC HEALTH RESEARCH
IN THE REGION
Iman Nuwayhid, MD, DrPH
Research on Research in the Arab Region: The case of Non-Communicable Diseases (NCD)
January 20, 2017
College Hall B1, AUB
From mapping to shaping:
Approaches to Evaluating Research
MAPPING
• Quantity
• Quality
• Relevance
• Impact
SHAPING
Understanding “Why”:
Social and political
determinants of research
Number of Scientific Papers Published in the
Arab Region (1985-2010)
Source: Hanafi, Sari, Arvanitis, Rigas (forthcoming, 2013). The broken cycle between research, university and society in Arab countries: proposals for change,” Lebanese CNRS and ESCWA Technology Centre.
Source: Knowledge Production in the Arab World: The impossible promise. Sari Hanafi and Rigas Arvantis. Routledge Advances in Middle East and Islamic Studies, London and New
York (originally published in December 19, 2015)
Lowest Number of Publications!
 Less than 1% of articles published in
impact factor journals
 0.2% to 0.4% of the GNP invested in public
funding of research
 Fair number of PhD holders and of
universities BUT not researchers or
research-oriented
 Less than 1% of all science and
engineering articles published globally
[Iran alone > All Arab countries]
Source: News in brief: “Latin America records rapid rise in research publications.” Nature
432:8,2004
Number of Scientific Papers Published in the
Arab Region (1985-2010)
Source: Hanafi, Sari, Arvanitis, Rigas (forthcoming, 2013). The broken cycle between research, university and society in Arab countries: proposals for change,” Lebanese CNRS and ESCWA Technology Centre.
Research Productivity depends on:
 Size of population
 Wealth and resources
 Dynamism in Less Resourced Countries
Collaboration within and outside the country
Seeking external funding

Group I: Large research system with slower growth (comparatively large or rich
countries)

Group II: small dynamic and integrated research systems (small countries with
proportionally high numbers of researchers and scientific production)

Group III: very small countries with rapidly expanding research systems (very
small, rich Gulf countries)

Group IV: All other Arab countries (small and less integrated research systems)
Source: Knowledge Production in the Arab World: The impossible promise. Sari Hanafi and Rigas
Arvantis. Routledge Advances in Middle East and Islamic Studies, London and New York (originally
published in December 19, 2015)
AUB
What Could Be Done at The Institutional
Level?
Level I:
 Adopting research as a primary mission of the institution
 Setting administrative bodies to facilitate and support research (OGC,
IRB, financial control)
 Providing internal funding and facilitating access to external funding
 Enforcing a monitoring and evaluation system (feedback): promotion,
merit
Level II:
 Encouraging and facilitating cross-departmental, interdisciplinary
research
 Adopting university-wide priorities with major investment
 Providing tenure to productive faculty to allow for risk taking and
innovative ideas
Research Environment in the Arab World
“Inequalities… ”
Top five causes of disability-adjusted life-years in Arab region by national income*
Low-income
countries
1 Lower respiratory
infections
2 Diarrhea
Middle-income
countries
Ischemic heart disease
Lower respiratory
infections
3 Malaria
Stroke
4 Preterm Birth
Major depressive
Complications
disorder
5 Congenital anomalies Preterm Birth
Complications
High-income countries
Road Injuries
Major depressive disorder
Ischemic heart disease
Low back pain
Diabetes
* LIC: Comoros, Djibouti, Mauritania, Yemen, and Somalia. MIC: Algeria, Egypt, Iraq, Jordan, Lebanon, Libya, Morocco, Palestine, Sudan, Syria, and
Tunisia. HIC: Bahrain, Saudi Arabia, Kuwait, Oman, Qatar, and the United Arab Emirates.
The Lancet, 2014; 383 (9914): 303-320.
Only region to spend more on military than on health (as %
GDP)
Health Expenditure, Total, as % of GDP
Military Expenditure as % of GDP
Ratio of Total Health to Military Expenditure
18%
6
16%
5
14%
12%
Expenditure
as %GDP
4
10%
3
8%
6%
2
4%
1
2%
0%
0
Arab World
East Asia &
Pacific
Europe &
Central Asia
El-Zein et al. The Lancet 2014
European
Union
Latin America North America
& Caribbean
OECD
members
South Asia
Sub-Saharan
Africa
World
Ratio of
Health to
Military
Expenditure
A Region in Turmoil… 10/22 Arab countries
Syrian Refugees in Irsal, photo: Joseph Eid
Destruction in Gaza: July 2014. Photo: CNN
Beirut Palestinian Refugees camps
Source: http://www.forbes.com/sites/niallmccarthy/2015/06/18/the-countries-with-the-most-refugees-per-1000inhabitants-infographic/#832c33c2c0a1
Universities
• Heavy-handed political and bureaucratic influence rather than driven
by scientific inquiry or population needs (Maziak, 2004).
• ’near absence of linkages and networking among scientists’
(Fedorowicz et al. 2007, p.728).
• Brain drainage
On knowledge to policy--- barriers:
(El-Jardali et al., 2011; D'Souza &Sadana, 2006; Hennink & Stephenson 2005; Saleh et al., 2009; Law et al., 2011)
•
•
•
•
•
•
inadequate resources allocated to research and to dissemination
poor value given to research
lack of publicly accessible and quality data
difficulty in accessing research evidence by policy makers
lack of systematic reviews of what works for whom
lack of policymaker involvement in setting research priorities and lack of
collaborative or multi-disciplinary research
• lack of structured mechanisms (who talks to whom?) through which noncommissioned research is disseminated
• lack of skill of researchers in dissemination in terms of both communication and
format of reports
• production of research that has little relevance to policy.
Signs of improvement
• Regional foundations/ research funding
• More international funding directed to region
• National research agendas
Aspects of National Health Research System (NHRS)
Governance and Management
Component
No.
Countries
Formal NHRS governance structure
(e.g. health research committee)
4
Jordan, Lebanon, Oman,
Tunisia
Formal NHRS management structure
(e.g. research council)
4
Jordan, Lebanon, Oman,
Tunisia
National health research
policy/plan/strategy
2
Oman, Tunisia
National health priorities
6
Bahrain, Oman, Qatar, Saudi
Arabia, Tunisia, Yemen
National health research priorities
3
Lebanon, Oman, Yemen
Statement of values for the NHRS
2
Oman, Tunisia
Statement of aims for the NHRS
5
Jordan, Lebanon, Oman,
Tunisia, Yemen
Monitoring and evaluation system for
the NHRS
1
Oman
Source: Kennedy, A., Khoja, T.A.M., et.al. National health research system mapping in 10 Eastern Mediterranean countries. La Revue de la Santé Mediterranée Orientale, Vol. 14, No. 3, 2008
Overcoming barriers
(El-Jardali et al., 2011; Ghannem et al., 2011; Hennink& Stephenson 2005; Fedorowicz et al., 2007)
• building capacity of researchers
• building capacity of universities and research institutes
• engaging stakeholders, such as concerned communities and policy
makers in research priority setting
• collaboration between research institutions in the region
• aligning research with community needs
• prioritizing research at a national level as a tool to advance
knowledge and inform public health practice and policy
Who can take action?
People said NO!
https://en.wikipedia.org/wiki/Egyptian_revolution_of_2011#/media/File:Tahrir_Square_during_8_February_2011.jpg
It is “political”!
• Global organizations/ agencies
• Regional organizations (role of WHO-EMRO)
• Universities
What can be done?
• Call for strengthening of the public health infrastructure
• Advocate for an engaged role for universities as beacons for free expression
and knowledge production.
• Build structures and systems within universities to support research and establish
centers that help in this regards, including engaging in defining research priorities for
country or region
• Strengthen/promote the discipline of public health
• advocate for self-governed schools of public health
• Adopt a comprehensive population health framework and a model, subscribing to
health as a social construct and to public health as a multidisciplinary field with social
sciences and humanities standing alongside core public health and medical sciences.
• Build regional networks of researchers and of academic public health
institutes
FHS Model:
Integrating and enhancing synergy between research,
knowledge translation, and outreach and practice.
Research
Networks/
Collaborators
CRPH
Teaching/
Learning
Policy
CRPH:
CPHP:
K2P:
Center for Research on Population and Health
Center for Public Health Practice
Knowledge to Policy Center
K2P
GPHP
CPHP
Practice
Departments