Changing health environment in a fast-paced world
Across the world, healthcare is shifting towards integrated and value-based care. This fundamental change has led to the design and implementation of improved models of care that focus on preventive care. To support this, leading health systems are putting a stronger focus on health research and innovation with the expectation of generating improved evidence-based therapies.
The Middle East is no exception to this trend. In fact, extensive sector reforms to achieve better care, better access, and cost efficiency are already transforming some of the region's healthcare systems.
With the pandemic, many of these transformative efforts, as well as the push for more research and innovation have been accelerated to ensure rapid integration of innovative therapies.
The increasingly relevant role of health research
As the world continues to battle the pandemic, global health systems have been placed on the spot, and consequently, agile innovation, continuous improvement and resilience are becoming a priority amongst global healthcare systems. In this context, health research is a core driver of innovation and continuous improvement; extending from scientific discoveries expected from basic research, up to the study of new approaches to drive better outcomes in applied / system research.
In the Middle East, we have observed a growing interest in improving capabilities, infrastructure and funding for health research. This interest is not only to support the ambition of positioning regional systems on the map of health innovation but also given the high contribution that health research can have in yielding new drugs or vaccines, new technologies (genome sequencing, biomarkers, etc.) and even new pathways to improve health outcomes.
To fulfil the ambition of better care and better access in a cost-efficient way, systems should not be constrained to deliver services only with existing technologies, as such, accelerating access to innovation is the main driver for health research to increase in relevance. For this to be successful, a more coordinated approach is required to break the barriers between researchers and practitioners and ensure more inclusive governance and alternative ways to fund projects.
Improving the Health Research ecosystem
Overcoming the issues of a fragmented approach to research and a slow process to integrate innovation will ensure good alignment of research priorities with system goals. This will improve the fundamental role of health research through translating scientific discoveries and technological advancement into outcome-based therapies.
We have identified four essential elements that can help improve the impact of research in the overall health system:
A. Fit for purpose governance
A governance configuration to establish an integrated approach to health research, from basic and translational research to applied research at the provider level. Alignment with system-wide priorities should happen across all stakeholders (Fig.1) and research stages (Fig. 2) to ensure a coordinated ecosystem in which clearly defined roles and accountabilities towards research priorities, funding, execution, and evaluation are agreed and implemented.
Fig 1 - Research stakeholders
This coordination should include mechanisms to ensure research identity follows the local needs and capabilities at the provider level while facilitating cross-collaboration and preventing duplicated efforts. A robust governance should also consider mechanisms to support decision making and research oversight (i.e., decentralised Institutional Review Boards to oversee ethics and expedite research approvals). Finally, a centralised approach to horizon scanning and innovation dissemination helps establish the desired integrated approach and better coordination.
Changes are required at the sector level to redefine how the academia, government, and health provision services interact with each other to organise, fund and execute research to ensure outcomes drive care delivery improvements.
Fig. 2 - Research stages
Funding is essential to sustain a research project and adequate funding should match the purpose, commercial interest, scale and time horizon of the research project to the right source and funding scheme. It is also important to ensure access to a diverse set of funding sources: from “Hard Funding” that can limit the autonomy but bring longer-term research stability through endowments and block government funding; to “Soft Funding” through project-based grants that can be more adaptive to the latest research needs. Additional needs such as infrastructure and facilities are also key enablers for the quality and speed of research outputs. Ensuring access to specialised facilities or equipment may have its own specific approach to funding (from capital investments to agreements to utilize shared infrastructure).
It is also important to highlight that while discovery and translational research funding are essential, there is a big need to better support research on applied solutions and population health as this ultimately drives operational efficiencies that help improve satisfaction.
C. Establish a Health Research/Health System partnership
The prevalent model that separates health research from health provision must be challenged to ensure knowledge and expertise from researchers informs decision making.
Strong collaboration between researchers and providers helps ensure that innovation and improved pathways respond to the priority needs and health conditions of patients and citizens. This collaborative approach should translate into research teams where there is significant value perceived from non-researchers clinician’s contributions.
While basic and translational research is essential for innovation, it also requires epidemiologists, front-liners and model of care experts to anticipate needs and to frame research evidence into interventions that will help regulators, healthcare leaders and providers implement innovations in an effective and equitable way.
All levels of care, from primary care through to specialist quaternary providers, have a role to play in health research and innovation.
The current pandemic has also evidenced the importance of collaboration between clinical researchers, internal medicine, and emergency departments to successfully develop, update and implement care guidelines for a relatively unknown disease.
Health research should become more agile and move away from the preconception that 15-20 years are required for most research projects to yield results. This doesn’t mean that multiple phases for clinical trials or long-term longitudinal studies should stop. COVID-19 has demonstrated that with the right governance mechanisms, funding and timely decision making, research outcomes can be significantly accelerated to support real-time decision making. Embedding researchers into multidisciplinary teams to challenge the day-to-day operations can also improve the chances for successful implementation of research findings.
Additionally, a culture that promotes innovation and collaboration helps attract, retain, and develop researchers. It helps when research values and culture are also strongly rooted in academic environments, as it can also provide solid educational programmes that will yield the required future talent. Establishing the right culture should consider a structured approach to:
I) Leadership, mentoring and human capital development
II) Integrated clinical and academic programs to foster collaboration
III) Career progression models, recognition platforms and incentives
The health research environment is multi-layered and diverse, presenting many opportunities and challenges. Therefore, it is important to design health research ecosystems to harness these opportunities and respond to these challenges by leveraging existing capabilities and aligning to local priorities and future needs.
Mohamed Berrada Abraham Calvo
This article appears in the latest issue of Omnia Health Magazine. Read the full issue online today.