1. Global Health Research at Norwegian Institutions Strengths, weaknesses, opportunities and threats. Visions for the future S.Møgedal 22.09.04

2. ..research at “Norwegian Institutions”  Universities Dedicated centres for international health or international development Regular institutes and departments  Private Sector institutions Product development companies Consultancy companies  Non Governmental organisations Knowledge-based or interest-oriented networks, service delivery networks etc Foundations…  Public institutions Norway as a primary focus International primary focus ….etc Weak and poorly linked Internationalisation not understood as globalisation Small and limited Disproportional access to opportunities? Links to research based institutions? In the business but not seen as part of development research system Poverty related research in isolation?

3. Opportunities  Make the most of the centre of excellence rating and seek alliances to establish focus and critical mass  Make the most of diverse competencies in key universities, public and non public actors diverse funding opportunities (NUFU+++)  Sell a concept for research collaboration where building national research capacity in partner country is central in the model  Establish better linkages between the academic networks and partnerships and country based development cooperation (informed policy choice in complex priority setting processes, “implementation research”) engagement in global initiatives (GAVI, GFATM, Health Metrix etc) including bringing in “south” partners

4. International Health/Research Organisations Global & International networks & Partnerships International Initiatives International Research Centers & University Based inst. Drug industry R&D Regional Networks National Health Research Bodies HR Investors Development Banks Foundations and other funding agencies Bilateral Development Agencies What about national investors? -Public -Private Is there a hope for WHO as a normative body – and how must this be related to Research? Code of conduct?

5. Threats  That Global Health Research remains totally dependent on ODA type funding  That Global Initiatives and PD-PPPs and other PPPs occupy most of the space for new opportunities in the total Global health research system  That the drive for results on single challenges overpower the agenda and marginalise systems-related issues, equity, access, personnel…  That we are reactive rather than proactive in terms of strategic opportunities – also in terms of the relevant “nordic” experiences and our best practise partnership models (globalisation call for strengthening of identities)

6. A missed research field : personnel Building community support and innovation Non-public Services Not for profit For profit Public Services Training Institutions National Province District level Peripheral Unit Community level Increasing capacity/Output Changing curriculum Local volunteer incentives Aids competence – linking up GAP Retention: Work Environment Incentives Support Recruitment Distribution Innovation GAP 2, District and sub-district focused action 1. Community focused action 3. Training institution focused action 4. Focus on inefficiencies and potential for supporting district and sub-district level Deal with gap

7. Low salaries Poor working environment Inefficient spending Health worker dissatisfaction Reactive allowances Fix that backfires Livelihood under pressure Private services to supplement income Increasing inequities in access Public distrust in health services Weakened community support base Increasing push to deliver Freeze in public recruitment Increasing load on health workers Decreasing motivation Increasing public distrust Disrupted services Service collapse Conflicting expectations And pressures from donors, agencies and partners; the macroeconomic stability issue and the drives for scale up and results from global initiatives Fragmenting responses to the personnel crisis by donors and NGOs Health workers also themselves affected by the economic realities in communities “Escape” of human resources from the vicious circle at all points drain from public to non public employment outside profession rural to urban national to international THE VICIOUS CYCLE; HUMAN RESOURCES FOR HEALTH Country brief, Zambia 0904 PUBLIC HEALTH DISASTER