Who, What and Why are We?

1. Who, What and Why are We? Global Health Research at the Norwegian Health Services Research Centre Atle Fretheim Researcher, Coordinator International Health atle.fretheim@nhsrc.no

2. 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

3. 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

4. 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 3 2004) • Partners in India and UK

5. 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

6. 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

7. 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

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

9. 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

10. 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