Who, What and Why are We? Global Health Research at the Norwegian Health Services Research Centre Atle Fretheim Researcher, Coordinator International Health

About the Centre  Established Jan 1, 2004  Mission: to provide relevant, research-based information to decision makers at all levels of the health services  Main activities:  Research synthesis (HTAs, Systematic reviews)  Research (RCTs of interventions; studies on barriers to quality improvement; methodological research)  Monitoring of quality (collection and analysis of indicators)  Dissemination/information of research based knowledge  Three departments  HTA, Reviews and Dissemination Department  Informed Choice Research Department  Quality Evaluation Department

Current Global Health Research activities  Pragmatic Randomized Controlled Trials in Health Care (PRACTIHC)  developing and evaluating tools, training and mentoring to support the design and conduct of pragmatic randomized trials in low and middle income countries (LMIC)  investigating the use of research evidence by policy makers  developing tools to support the use of research by policy makers in LMIC  Partners in UK, Canada, South Africa, Zimbabwe, Uruguay, Colombia, Argentina, Mozambique, Sweden, Cuba and Germany  follow up programme in the pipeline

Current activities cont’d  Cochrane systematic review: Interventions for skin changes caused by nerve damage in leprosy.  Protocol published in latest version of The Cochrane Library (Issue )  Partners in India and UK

Current activites cont’d  Several activities that focus in part on global health issues  Investigation of the use of evidence in WHO recommendations  Hosting The Norwegian branch of the Nordic Cochrane Centre  Collaboration on the development of methods for incorporating equity considerations into grading evidence and recommendations and applying the GRADE Working Group’s system for grading in LMICs  Participation in projects aimed at improving the use of research evidence by policy makers in LMIC through preparation for the WHO World Health Summit and a systematic review of the effects of pharmaceutical policies  Contribution to methodological research that is of direct relevance to research in LMIC

In the pipeline...  Directly observed therapy (DOT) versus self-administered therapy plus support and defaulter tracing (SAT+) for tuberculosis treatment  Proposal for an international, multi-centre cluster-randomised controlled trial of patients receiving treatment for pulmonary tuberculosis under WHO-DOTS programme conditions  Partners in South Africa, Uganda, Ethiopia, Slovakia, UK and Norway  Addressing Uncertainties about How to Achieve the Millennium Development Goals: An International Network of Trial Support Units  Proposal for setting up a network of trial support units and conduct pragmatic randomized controlled trials that are of relevance to achieving the MDGs  Partners in Argentina, South Africa, Zimbabwe, Mozambique, Colombia, UK, WHO, Peru, Thailand and Greece

Strengths  Wide experience in the planning and conduct of randomised controlled trials of health service interventions  Strong methodological competence  Broad international network  Research groups in many low- and middle income countries  Cochrane Collaboration  Enthusiastic staff

Weaknesses  Not yet firmly established on the global health research scene in Norway  Relatively small (but increasing....)

Opportunities  GLOBINF-membership – facilitates collaboration with global health research partners in Oslo and other institutions in Norway  Strong links to WHO and the Alliance for Haelth Policy and Systems Research  Close relations with several research groups abroad

Threats  Not primarily a research institution – global health research may suffer under pressure to produce reports etc  however, research synthesis for global health issues is also an important contribution