Asking the right research questions to achieve global health goals

In this guest post, Kristina Gryboski—technical advisor for the Child Survival and Health Grants Program at the US Agency for International Development (USAID)—writes about the importance of partnerships to advance health research. This post is the third in a series highlighting USAID’s new strategy for global health research and development (R&D). It was adapted from a post that originally appeared on the IMPACT blog.

Asking the right questions is the first step to generating both the “upstream” research needed to create new health products and the “downstream” evidence needed for the implementation of health policies and practices, as my colleague E. Callie Raulfs-Wang described in her March 12 blog. And fostering the right partnerships is crucial to determining the right questions. Partnerships facilitate both product development and operations research, or the testing of scalable solutions that overcome barriers to access, demand, and quality in real world settings. Product development and operations research work in a continuous loop to improve public health around the globe—for example, downstream operations research can help identify a specific vaccine, drug, or device needed in a particular community or setting, thereby informing the more upstream research needed to successfully create this tool.

We’ve previously detailed how USAID has established effective partnerships with a range of sectors—governments, nonprofit groups, and philanthropic organizations—to advance the development of new health tools, like microbicides, HIV and AIDS vaccines, and tuberculosis diagnostics. Further down the research spectrum, investing in operations research to accelerate results is also a key strategy in the Global Roadmap of the Child Survival Call to Action. This pledge, signed by more than 160 governments, renewed their commitment to child survival and to eliminating all preventable child mortality in two decades, as USAID Administrator Rajiv Shah explained.

USAID’s Child Survival and Health Grants Program (CSHGP) supports new operations research partnerships among nongovernmental organizations (NGOs), academia, and ministries of health to generate evidence about how to solve critical challenges in the implementation and scale-up of high impact maternal, newborn, and child health interventions. By working in partnership with ministries of health, studies are designed to meet the ministries’ expressed needs for evidence that would strengthen their systems. Solutions are tailored to local contexts, with relevance to global implementation challenges, such as how best to: integrate services within and across sectors; improve the continuum of care to maximize access and lower costs; ensure equity in access to health information and appropriate use of services; and strengthen systems’ capacity for accountability to communities.

As USAID’s Jim Shelton commented in Nature magazine this year, promoting health literacy for preventive health behaviors such as hand-washing and breastfeeding, and deploying community-based interventions for services and health education, are among the priority public health approaches needed now for universal access to health.

Some questions that must be addressed in order to operationalize these approaches include:

• How can community health workers more effectively reach households with timely information, case management, and referral?
• What are effective models for partnerships between health care providers and community agents/traditional caregivers to improve the continuum of care and increase demand for services through culturally appropriate and respectful care?
• How can data collected by communities be used as a communication and planning tool to improve the quality of care and accountability?

The answers to these questions would facilitate the research goals of integrated maternal and newborn health, child health, and nutrition, as outlined in USAID’s Report to Congress: Health-Related Research and Development Strategy. As stated in the research goals for health systems strengthening (HSS), “Ensuring equitable access to high-quality essential health services requires an increase in the evidence base on how to best implement HSS interventions and promote uptake of best practices.” These partnerships have the potential to achieve more than the sum of their parts by bringing together perspectives and skills that yield rigorous, relevant, and practical evidence.

At this year’s Global Maternal Health Conference in Arusha, Tanzania, presenters from CSHGP’s NGO partners in Peru, Liberia, Pakistan, and Ecuador shared experiences on bridging the gap between communities and health systems to meet the maternal and newborn health needs of their most vulnerable populations. These research projects are helping ministries of health learn how best to operationalize and improve current policies on providing culturally competent, respectful care, and are testing new systems for overcoming geographic and financial barriers to safe childbirth. These partnerships are meeting the evidence needs of ministries of health that are striving to implement policies that make access to care more equitable. Partnerships also help ensure that USAID supports the most effective and efficient research across the spectrum of global health, from developing and delivering new health tools to discovering the most effective policies and strengthening systems to improve health around the world.

To learn more about some of these 30 research partnerships in 23 countries check out this brief .