November 2004 UNICEF/UNDP/World Bank/WHO Special Programme for Research & Training in Tropical Diseases (TDR) Strategic Social, Economic and Behavioural Research I RATIONALE Despite significant, global efforts over the last 50 years, communicable diseases continue to obstruct social and economic development in developing countries, and disproportionately affect the poorest and most marginalized populations. A better understanding of how social, behavioural, political, economic and health systems factors operate to affect disease patterns and disease control efforts will be important for identifying future needs, opportunities and innovations for improved control of TDR diseases (African trypanosomiasis, Chagas disease, dengue, lymphatic filariasis, leishmaniasis, leprosy, malaria, onchocerciasis, schistosomiasis, tuberculosis). From the beginning, TDR has recognized the importance of social science research for communicable disease control. From 1979-1994, TDR supported social science research through its Steering Committee on Social and Economic Research (SER). After 1994, some of the work begun under SER continued to be supported by the Applied Field Research (AFR) task forces. In June 1999, the TDR Joint Coordinating Board (JCB) approved the creation of a new Steering Committee on Strategic Social, Economic and Behavioural Research (SEB). SEB is located within the Strategic and Discovery Research unit (SDR) to reflect its focus on addressing basic social, economic and behavioural research on issues of trans-disease and global importance. A Scientific Working Group (SWG) of experts from a range of social, economic and policy sciences met in Geneva from 31 May to 2 June 2000 to set the overall direction for SEB and identify priority areas for research for the period 2000-2005 (http://www.who.int/tdr/publications/publications/seb.htm). The SWG strongly recommended that the SEB Steering Committee (SC) focus on promoting and supporting basic/strategic research that: increases understanding of the role and importance of social, economic and behavioural factors for the prevention and control of neglected, infectious diseases. addresses issues of multi/trans-disease and global importance. contributes to identifying needs, opportunities and innovations for improved disease control and prevention. contributes to and supports the overall goals and objectives of TDR. The first SC meeting for SEB took place in Geneva, 25-28 September 2000, and SC members agreed that the following principles and concerns would guide its future work: Globally, infectious and parasitic diseases remain major contributors to morbidity and mortality, and disproportionately affect populations living in poverty. In most instances, social, political and economic inequalities are central to the persistence and spread of these diseases. In most cases, the performance of health systems in protecting vulnerable populations from the impact of these diseases falls far short of potential These issues need to be examined within the context of globalization, the changing role of the state, and the emerging role of non-state actors (the private sector, nongovernmental organizations [NGOs], civil society).
II OBJECTIVES SEB aims to promote and support research that critically examines these issues and contributes to innovative thinking about improved control and prevention of TDR diseases. During the years 2000-2005 SEB has been focusing on contributing to better understanding of the following: Determinants of inequality of access to prevention, therapy and information. Implications of changing economic, social, political and civil structures (including health reforms) for disease persistence, emergence, resurgence and factors affecting them such as drug and insecticide resistance. Social and economic impact of infectious disease on populations. Effects of globalization and widening social inequalities on transmission dynamics of disease, and on health policy and health systems and services. Implications of linkages between global, national and local level policies for their ability to respond to key health issues related to TDR diseases. In 2005, SEB will request full research proposals on the following three topics and letters-ofintent for another set of three topics. Topic 1: Inequality of access to prevention, therapy and information Elucidating and, if possible, remedying limited access of poor and marginalized populations is a major aspect of TDR's strategy for the years 2000-2005. Basic social research elucidating socioeconomic, gender, ethnic and other forms of inequalities can help to understand and remedy - through public health and health policy measures - limited access of poor and marginalized populations to proven therapies, preventive measures and health information regarding TDR diseases. The portfolio looks at factors that affect access of populations to prevention, existing therapies, and information regarding TDR diseases. Factors that could be examined include those at the household/community, health systems and services, and non-health sectors/central government levels and may examine a wide range of inequalities (i.e., social, socio-economic, political, geographic, gender- or ethnicity-related inequalities). SEB is particularly interested in studies that consider two or more levels of analysis and the links between them. Research questions of particular interest include but need not be confined to: How can governments extend access and improve equity through provision, financing and regulation? An example may entail 'An economic and social science analysis of provision for disease control programs in contracts between the Central Board of Health and District Health Management teams in country x'. What are the implications of different kinds of public/private partnerships for equity in access to pharmaceuticals and services? What can be learned from existing or past partnerships, and how might we best assess their impact on equity? To what extent are the needs of vulnerable populations being met through such partnerships? Partners might include the public sector, private-for-profit firms, donors, NGOs etc. How can different approaches for increasing access to proven therapies, prevention and information be best utilized to contribute to improved disease control? (An example may be investigating Changes in access to information about treatment and prevention of malaria in urban and rural (name of country). seen in the context of exposure to new communication channels and media and general socio-cultural factors.
Topic 2: Implications of changing economic, social, political and civil structures for infectious disease persistence, emergence and resurgence; and for drug and pesticide resistance Globalisation may have potential for certain people and population groups, however, for poor marginalized populations, in both the non-formal as well as formal economic sectors of developing countries, globalisation can bring along more inequality, more marginalization and more poverty. Globalisation brings about the need to develop new approaches to public health. Specifically, for the ten TDR disease, we don t exactly know how processes of globalization affect disease control efforts and/or the epidemiology of infectious disease. Research questions of particular interest include but need not be confined to: What is the impact (positive and negative) of large-scale economic processes and policies on the production and availability of effective drugs, diagnostics and vaccines? What are the global forces and conditions promoting or retarding the development and equitable distribution of effective preventive, diagnostic, and/or therapeutic technologies? What are the social, economic and political determinants of drug use patterns (at household, community, health systems and central government levels), and what are the implications of these, e.g., for drug resistance? How are household choices and actions constrained or enabled by local and large scale forces and processes? Topic 3: TDR diseases and their control during and in the aftermath of conflict The public health effects of complex humanitarian emergencies in general and complex political emergencies in particular include high direct and indirect mortality, and the collapse of health systems. There is an increasing body of knowledge, particularly on the technical aspects of humanitarian responses. However, the implementation of appropriate regimen of new infectious disease control interventions and the rationale for making program choices in the protracted phases of conflict is far less obvious and there is lack of research regarding options for health service delivery/policy implementation in societies suffering from protracted conflict. Research questions of particular interest include but need not be confined to: How are disease patterns affected by violent political conflict? What is the role of non-governmental organisations in responding to TDR diseases in conflict and post-conflict settings? What are the disease control priorities and how have they been addressed in the immediate aftermath of violent political conflicts? What is the role of the military in addressing TDR related diseases in conflict and post-conflict settings? What innovative mechanisms have been used by health systems and health personnel to maintain services and boost resilience during periods of political instability and violence?
LETTERS-OF-INTENT only are requested on the following: 1. LOI 1: International labour markets and disease control programmes 2. LOI 2: Transaction costs and targeting disease control among the poor: 3. LOI 3: Ethical, Legal and Social Implications (ELSI) of biotechnology in resource-poor settings Topic LOI 1: International labour markets and disease control programmes Human resources are increasingly recognised as the critical element determining the functioning of disease control programmes. The availability of human resources, and some of the factors determining motivation and performance derive from the characteristics of local, national and international labour markets. Although the allure of better paid employment appears self-evident, little is known about the relationships between relative levels of pay of health workers internationally, relative levels of pay between health workers and other professional groups at national level, push factors at national and local level such as poor working conditions and HIV/AIDS, and pull factors at international level such as active recruitment campaigns and the development of skills shortages in richer countries. Within local economies, possibilities for operating parallel private businesses and opportunities for alternative private sector employment also appear important. These issues are critical for disease control programmes which seek to place high calibre health staff in peripheral locations, usually the worst affected once the chain of substitutions for lost skills occur across the health economy. In the absence of better knowledge of the relative importance of all these factors, it is difficult to identify the most promising opportunities for interventions to improve the availability of skills to the periphery and to disease control. The objective of this TDR activity will be to compare the effectiveness of interventions such as rural practice allowances and nonrecruitment agreements with Northern countries in securing scarce skills at the periphery. We particularly encourage multi-country studies that will enable comparison of local labour market conditions, skills gaps in disease control programmes and their interaction with the global economy. Topic LOI 2: Transaction costs and targeting disease control among the poor Transaction cost economics (TCE) deals with how institutions arrange themselves in order to minimise the transaction costs of getting things done. In infectious disease control programmes in low-income countries, different transaction types favour different modes of operation, and mixes of transaction types vary by context. Questions over the use of explicit contracts, the integration of disease control into other public health activities, appropriate roles for the private sector and the effectiveness of different modes of control, continue to be debated. As part of an ongoing programme of research to apply the insights of transaction cost economics (TCE) to the design of infectious disease control programmes, TDR is seeking expressions of interest for country- and disease-specific research into the transaction costs of different means of delivering such programmes for a subset of the ten diseases [probably malaria, TB and onchocerciasis] which TDR addresses.
Research questions of particular interest include but need not be confined to: Do different transaction types, driven primarily by the nature of the output (including treatment activities, prevention activities, health outcomes) argue for different institutional arrangements? The features of institutional arrangements can include varying degrees of explicitness and longevity in contracts between public health systems and third-party providers, different relationships between central and local institutions in public health systems, and varying integration of programmes into the public health system. What transactions costs are observed in different designs of these disease control programmes? What attempts, including contracting innovation, are made to economise on these costs? What implications do they have for sustainability, efficiency, equity and public health impact for the programmes in question? Are certain institutional forms best suited to the control of certain diseases? How does the success of different institutional forms vary with cultural context? Topic LOI 3: Ethical, Legal and Social Implications (ELSI) of Biotechnology in Resource- Poor Settings Genome-based biotechnologies to fight infectious diseases have great relevance to, and importance for health in resource-constrained settings of the developing world. In order to better harness these biotechnologies in a responsible manner, efforts need to be undertaken to promote debate, reflection and research on the Ethical, Legal and Social Implications (ELSI) of biotechnology use and transfer of biotechnologies from the North to the South. Research should focus on biotechnologies related to infectious diseases under TDR mandate (excluding AIDS/HIV) and elucidate ELSI issues in development and transfer in disease-endemic countries. The LoIs should be formulated as concise texts of not more than two A4 pages (12 point), excluding CVs, outlining the following: i. Project title ii. Proposed Principal Investigator (PI), research institution and study team iii. Background and problem statement, overall relevance with respect to overall program as described in the call for letters-of-intent iv. Overall and specific objectives v. Methods; and vi. Estimated budget. Short one-page CVs of PI and proposed scientists, including letters from scientists of other institutions confirming their willingness to collaborate on the proposed activity, should be attached. Please indicate which topic your LoI is referring to.
III HOW THE STEERING COMMITTEE WORKS The SEB Steering Committee holds one meeting per year (in May) during which it updates its work-plan, reviews new research proposals, and monitors overall progress of the Committee. The next meeting is scheduled May 29-4 June, 2005. The Committee invites individual research projects with budgets normally not exceeding US$ 25 000-35 000 per year for a period of one to two years. The Committee is particularly interested in supporting projects that involve South-South and South-North partnerships between institutions and individuals and will contribute to research capacity building for social science research in disease endemic countries. For group projects, and in exceptional cases individual projects, the Committee will consider projects that require greater levels of funding. IV HOW TO APPLY Collaborative Research Grant (CRG) application forms and instructions are available from TDR at http://www.who.int/tdr/grants/grants/collgrant.htm. Please read and carefully follow the instructions for completing the application and closely follow the call for grant application http://www.who.int/tdr/topics/social-research/grants.htm. Applicants are invited to be succinct, but may exceed the page limits given in the instructions for describing, in greater detail, the research design. If you are interested in submitting a proposal to the SEB Steering Committee, an early letter of intent can be submitted to the SEB secretariat to request feedback before developing a full proposal. Applications will be reviewed by the Steering Committee each May. For further details, please contact: Dr Johannes Sommerfeld Manager Steering Committee on Strategic Social, Economic and Behavioural Research (SEB) TDR, World Health Organization 1211 Geneva 27 Tel: (41-22) 791-3954 Fax: (41-22) 791-4854 E-mail: sommerfeldj@who.int
PRODUCT AND INTERMEDIATE PRODUCT 1. Health Sector Reform (TDR Product ID A.03.07) MILESTONES STATUS (target date) Product 1: Evidence of the opportunities and threats of health sector reform and financing schemes for public health efforts to reduce the burden of infectious (TDR) diseases Intermediate product: 16 research studies Projects approved for funding September 2000 Intermediate product: Research studies written up and disseminated Methods workshop for 2000 studies Writing workshop for 1998 studies Data collection, analysis and write-up of studies resulting from 2000 call Completed Completed 2 special journal issues ( Health Policy and Planning) published; One special journal issue ( International Journal of Health Management and Planning ) in print for publication in late 2004 Research-to-Policy seminar conducted in China 2. Implications of Changing Economic, Social, Political and Civil Structures for Infectious Disease Persistence, Emergence and Resurgence and Drug and Pesticide Resistance (TDR Product ID A.03.09) Product 1: Increased scientific knowledge of the implications of globalization for the prevention and control of TDR focus diseases Intermediate product: 2-4 research studies Call for proposals Ending February 25, 2005 Communication with interested researchers December 2004-February 2005 Deadline for receipt of full proposals 25 February 2005 Review of proposals May 29 - June 4, 2005
PRODUCT AND INTERMEDIATE PRODUCT Intermediate product: Review of globalization and infectious disease MILESTONES Review commissioned and received Published 2004 STATUS (target date) Intermediate product: finalization of ongoing studies Technical assistance to studies resulting from 2000-2003 call for grant applications Ongoing Commissioned review on Globalization research: Challenges in design and methodology Review commissioned and received Under revision 3. Conflict and Infectious Diseases (TDR Product ID A.03.10) Product 1: New scientific and strategic knowledge on the relationship between conflict and infectious diseases and health policy options for public health in societies undergoing protracted conflict Intermediate product: Research agenda and portfolio established International conference "Coping with instability" Multi-site study "Resilience of community & health systems under conflict for responding to infectious disease: a multi-country study" commissioned Held in 2002, proceedings in preparation Writing workshop held and results being compiled for publication (2005) 4 studies commissioned Two studies completed, two ongoing Intermediate product: New studies commissioned Intermediate product: Additional reviews Proposals being solicited on "TDR diseases and their control during and in the aftermath of conflict" Literature review on "Conflict and infectious diseases" commissioned Literature review on "Research ethics in conflict settings" commissioned 2004 call, deadline 25 February 2005 Work in progress Work in progress
PRODUCT AND INTERMEDIATE PRODUCT MILESTONES STATUS (target date) 4. Eco-Bio-Social Research on Dengue - TDR-IDRC Partnership (TDR Product ID A.03.11) Product 1: Producing increased scientific knowledge of the linkages between ecological, biological and social factors related to dengue & its control (in collaboration with the International Development Research Centre (IDRC), Program & Partnership Branch, Ecosystem Approaches to Human Health Programme) Intermediate Product: 2 studies in Brasil & Colombia Proposal Development Workshop Held Two ongoing projects Technical assistance Ongoing Ongimg Product 2: Book on social science issues in dengue fever and its control Scientific writing and dissemination Planned for 2005/06 Book on generating and synthesizing new knowledge about the biosocial factor involved in dengue Manuscript In preparation 5. Ethical, Legal and Social Implications of Biotechnology Development and Transfer (TDR Product ID A.03.12) Product 1: New scientific and strategic knowledge on the Ethical, Legal and Social Implications (ELSI), applications and transfer of biotechnologies into disease-endemic and resource-poor settings Intermediate product: Issues and research topics identified and portfolio established in the African context Intermediate product: One review commissioned International conference "Ethical, Legal and Social Implications of Biotechnology Development and Transfer in Africa"" Research priorities identified Terms of Reference for one review established and review commissioned Planned for early 2005 Conference proceedings of 2005 conference expected Planned Intermediate product: Research projects prepared Research agenda and research topics identified Call for letters-of-intent, deadline February 25, 2005
PRODUCT AND INTERMEDIATE PRODUCT MILESTONES STATUS (target date) 6. Inequality of Access to Prevention, Therapy and Information regarding Infectious Diseases (TDR Product A.03.08) Product 1: New scientific and strategic knowledge on inequalities of access to preventive and curative services, and information on, TDR diseases Intermediate product: 2-4 new research studies Call for proposals Ending February 25, 2005 Communication with interested researchers December 2004-February 2005 Deadline for receipt of full proposals 25 February 2005 Review of proposals May 29 - June 4, 2005 Intermediate product: Review of Access and Accessibility to TDR-related Disease Control Tools" Review commissioned and received Under peer-review 2004 Intermediate product: finalization of ongoing studies Technical assistance to studies resulting from 2000-2003 call for grant applications Ongoing 7. Macro-Economics, Health Policies and Infectious Disease Control among the Poor (TDR Product ID A.03.14) Product 1: New scientific and strategic knowledge on the impact of international labour markets on the availability of human resources for infectious disease control programmes among the poor Intermediate product: Research agenda and portfolio established (in collaboration with Health Systems Development Programme, London School of Hygiene and Tropical Medicine) International statistical analysis Commissioned, work in progress Call for letters-of-intent issued October 2004 Proposal development workshop Early 2005 Intermediate product: New studies commissioned 2-4 studies 2004 call for letters-of-intent, deadline 25 February 2005
PRODUCT AND INTERMEDIATE PRODUCT MILESTONES STATUS (target date) 8. Cost of Interventions and Priority Setting for the Poor (TDR Product ID A.03.15) Product 1: New scientific and strategic knowledge on the utility of transaction cost analysis (TCE) in the design of infectious disease control programmes in specific resource-poor settings Intermediate product: Research agenda and portfolio established (in collaboration with Health Systems Development Programme, London School of Hygiene and Tropical Medicine) Literature review of the issue Commissioned, work in progress Call for letters-of-intent issued October 2004 Proposal development workshop Early 2005 Intermediate product: New studies commissioned 2-4 studies 2004 call for letters-of-intent, deadline 25 February 2005 9. Research Capacity Strengthening for National Tuberculosis Control Programs (TDR Product ID E.09.19) Intermediate product: Proposal development methodology and workshop curricula Conduct workshops in Kazakhstan and Haiti Conducted in 2002 Intermediate product: Research work in two countries Finalize proposals and fund research Research ongoing in Kazakhstan and Haiti Conduct and write up research 2005