Recent Development in Ngos
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Secondary menu Contact Groups My basket Login. The Commission on Health Research for Development declared in that "For the most vulnerable people, the benefits of research offer a potential for change that has gone largely untapped" [ 6 ]. The Commission highlighted several obstacles in undertaking this research, and among others: 1 the insufficient worldwide funding of health research directed towards health problems of people in developing countries; 2 the inefficient application of resources; 3 the neglect of major health problems; 4 the lack of individual and institutional health research capacity; 5 the lack of technology transfer; and 6 fragmentation and competition among research initiatives.
Networks were created to facilitate national level activities in Africa, Asia, and the Commonwealth Caribbean. For example, AFRO-NETS, the 'African Networks for Health Research and Development', was established in to facilitate exchange of information among different networks active in this type of research in English-speaking Africa, and to facilitate collaboration in the fields of capacity building, planning and research.
Regional and global working groups and projects were established which allowed experiences with ENHR to be shared. Several communication strategies were utilized, including quarterly newsletters, websites and other publications to share experiences and lessons learned. A framework for capacity development, a critical component of ENHR, was established through partnerships and like-minded networks and organizations. The book, ' Forging Links for Health: Perspectives from the Council on Health Research for Development ", [ 14 ] and the discussion paper ' Health Research for Development: The Continuing Challenge [ 1 ] review what has happened in the intervening years since the Commission on Health Research for Development made its first major recommendations in Several questions remain unanswered:.
The International Conference on Health Research for Development provided COHRED and several partner organizations with an opportunity to review and reflect on their experience with health research, its impact on health and equity and to devise a global strategy for the first years of the coming millennium [ 14 ]. The Global Forum is managed by a council of 20 members representing government policymakers, multilateral and bilateral agencies, foundations, international NGOs, women's associations, research institutions, and the private sector. It holds funding competitions on targeted global health topics and awards research grants to applicants from low and middle income countries.
Its most recent report [ 18 ] emphasized the need for action by combined efforts of the public and private sectors. It also recognized the role of NGOs as a partner in contributing to these efforts. This marked the first time in Canadian history that Canada's two overseas development agencies, Health Canada and Canada's major federal health research funding agency have collaborated to address global health research.
The Canadian Coalition for Global Health Research CCGHR is developing into a network of health researchers, funding agencies, NGOs, and other stakeholders committed to support the pursuit of effective global health research by ensuring that all these groups work together as effectively as possible with researchers in developing countries. This collaborative approach serves as a framework for future research projects in the area of global health, with each organization bringing its own specific area of expertise to the table.
It aims to improve the effectiveness of development assistance and to increase the sustainable health gains per dollar of Canadian funds invested in research. Inequities in health are caused by a number of determinants, including the use of or access to health care facilities. Research which addresses these issues requires an intersectoral approach, involving trans-disciplinary teams and methodologies. Building trans-disciplinary teams requires commitment from the research community to seek out colleagues from other disciplines, from the funding agencies to appreciate innovative initiatives, from the community at large as partners and contributors, and from the policy arena to develop strategies for intersectoral policies and programs which may well have the lead outside ministries of health.
Indeed, working outside government altogether may well be a solid and sustainable strategy. Understanding and engaging the broader community on these issues comes naturally to communities unrestricted by bureaucratic boundaries. This is where NGOs excel. We describe the key roles of NGOs below, using, as a framework, the categories of primary functions of health research systems as recently identified by Butler [ 1 ].
One of the strengths of NGOs has been as advocates for the populations they serve. Health research can make NGOs become more effective advocates. Governments depend on health research for needs assessments, formulation of policy options, implementation of interventions and evaluation of action plans.
Empowered citizens and NGOs can demand accountability of the government. They can also encourage international donors to focus on the health priorities of countries and thus facilitate a check and balance mechanism for good governance. Good governance is needed to improve collaboration and cooperation at the international, national and regional levels in order to tackle inequity.
High scientific standards are fundamental components of effective health governance, particularly as they relate to health research systems. The role of research in mobilizing and supporting NGOs, particularly around issues of inequities, is important. NGOs can provide stewardship in terms of the promotion and advocacy for relevant research, shaping research priorities, and the setting and interpretation of ethical frameworks for research.
NGOs can often play a more powerful role using the results of research than can the research community itself. Mobilizing communities, utilizing mechanisms for advocacy and acting as an interface between the research community and its wider community will enhance a sense of strong governance and stewardship. There is widespread agreement that health research is not sufficiently valued by many societies as a critical input to human and socioeconomic development. The result is often an environment that is neither conducive to, nor supportive of, research.
A culture is necessary that recognizes the value of research and one which builds a supportive environment for research [ 19 ]. There is a need not just to allocate funds for research, but also to allocate these funds to areas of research that would have the greatest or maximum social benefit. Advocacy for relevant research, that is, the type of research that will make a difference in terms of equity, health, well-being and development of people, is an important role for NGOs [ 20 ].
Not only can NGOs identify researchable topics, but they can also stimulate demand for relevant research. However, the existing power structure in the research arena often works against NGOs because of a narrow view of research as merely producing new knowledge, with limited consideration of upstream operations identification of research needs, questions, and priorities , downstream actions knowledge management, dissemination and translation , and the advocacy efforts required to connect research with policies, programs and training. Historically, the influence of the biomedical researchers' lobby has been the strongest with regard to agenda-setting and fundraising.
Behavioral scientists and social health researchers generally have much weaker potential to influence resource allocation, agenda-setting and policy formulation. Partnerships could be strengthened and supported between NGOs and social science researchers in resource-poor countries to improve influence potential, as the social sector issues that tend to be most relevant to human populations are also of utmost importance to NGOs.
Creating a favorable environment for "relevant" research requires a health system that is supportive and provides financing opportunities. It also requires the existence of a culture of "evidence-generating and evidence-based research". There must be a healthy relationship between communities, researchers and policy makers. Networks to share experiences, lessons learned and policy impact can be enhanced by partnerships with NGOs.
A disproportionately large number of people living in developing countries suffer large disease burdens. There is a role for NGOs in advocating for more research on these neglected topics see under 4. Health research needs to generate knowledge that will facilitate the identification of choices and options to reinforce equity-based policies and programs. In doing so, it also needs to address the difficulties of collecting data that are of primary importance when inequities are discussed. The essential function that data serve will allow tracking and monitoring of resources for research and for improving opportunities for those researchers in more disadvantaged countries.
NGOs often have access to information that will highlight inequities and the determinants of inequities.
Similarly, NGOs can advocate for formative and evaluative research on programs that address major health problems, but which are generally a low priority for funding agencies. In doing so, they can contribute to making data available for evidence-based decision-making in policy and program planning. Food system-based approaches to reducing micronutrient deficiencies and malnutrition in general are one of these under-researched areas.
NGOs are well-placed to foster public participation in decisions about health research, as they are close to communities. They can provide the mechanisms by which such public participation is ensured in decision-making processes. Significant progress has been made over the last decade in health research priority-setting for the implementation of ENHR at the country level. Among the lessons learned, it appears that community involvement is in most cases an unresolved issue [ 21 ].
What is certain is that, critically at the priority-setting stage of the research cycle, the community must be involved, and NGOs may be instrumental in achieving this. Defining the research that needs to be done requires the input of civil society and NGOs as much at the beginning as at the end, in terms of dissemination, communication and action. NGOs assume a range of roles in research, but a thread that runs through all these is their representation and advocacy for the vulnerable. Broad research roles are described in greater detail in other sections of this paper. This section focuses on the role of NGOs in shaping and interpreting ethical frameworks [ 22 — 25 ], that is, the incorporation of ethical principles in their research partnerships with other organizations.
As researchers or research partners, NGOs have a responsibility to ensure that ethical issues are addressed in both the design and conduct of the research. There are distinctive challenges in conducting health research in developing countries, namely to fulfill moral duties of justice and respect in the face of poverty, lack of resources and the potential for exploitation. The Nuffield Council on Bioethics [ 26 ] designed an ethical framework for health research in developing countries based on the duty to alleviate suffering, to show respect for persons, to be sensitive to cultural differences, and to not exploit the vulnerable.
As NGO research is often conducted among the most vulnerable populations, where power relations are tipped in favor of researchers and those who are literate and eloquent, issues of informed consent and participants' understanding of it and the research, as well as participants having access to the benefits of research, are of special concern. Particularly when research is conducted by first world researchers in resource-limited settings, NGOs who partner in this research at times need to recommend and advocate for reviews from local research and ethics committees, as well as those from industrialized countries.
Where relevant, they may also encourage the development of independent national ethics committees and national ethical guidelines, taking account of existing international guidelines [ 22 — 25 ]. This process may involve interpreting cultural ethical frameworks and beliefs, for instance, culturally appropriate means of obtaining informed consent from research participants. In addition, NGOs can make sure that the development of local expertise in health research is an integral component of research proposals.
As watchdogs, NGOs actively seek breaches of ethics and hold researchers to account when the principles of respect for persons, beneficence and justice are not upheld, a role they are well positioned to assume given their understanding of and links to marginalized groups. Watchdogs, as they uncover ethical breaches that may be defined by culture or power relations, have assisted in shaping ethical frameworks to better address ethics when research is conducted among vulnerable groups.
In the communities where NGOs work, they can act as community partner members of and witnesses to research. In this role they can assist with, for example, interpreting research objectives to participants to ensure that consent is informed and the rights of subjects are respected. They may provide researchers with enumerators or local information to expedite the data collection process. NGOs can also monitor the long-term outcomes arising from research, and make sure that the participants benefit from successful intervention.
As knowledge translators, NGOs interpret the knowledge generated by research to their constituents, a key role in working towards the vulnerable having access to the benefits of research that could improve their lives. This may be research conducted in these communities or globally. While current levels of financial resources are not sufficient to adequately respond to the demonstrated need for health research, there are many sources of "funds" for health research.
Some are monetary contributions and some are in-kind contributions. NGOs can provide not only direct funding for projects albeit in a limited manner but, and perhaps equally important, they can provide valuable in-kind funding. Thus, personnel or materials developed by NGOs can be used in health research projects at little or no cost.
Some NGOs are directly involved in the administration of research grants.
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Others may be the fiduciary agent for a grant to a research organization that is exploring an issue related to an NGO program. However, most are organizations that work with communities. A major role is therefore to identify resource gaps using networks to link communities, health providers and managers, and funding agencies in a meaningful way so that financing can appropriately be directed to targeted health issues.
NGOs may also contribute by identifying other potential sources of funding, for instance, in the local private sector. Knowledge can be acquired in various ways, by many methods, and by different types of people; there are different cultures of enquiry. Because of their typical 'grass-roots' experience, several NGOs are able to access indigenous knowledge and specific information, which may be less attainable for other types of organizations. This type of knowledge might be very useful when pooled with knowledge acquired by others; in this way, a more comprehensive analysis can occur.
NGOs can be particularly adept in conducting formative research baseline studies, needs assessment , in operational or action research and in process and impact evaluation.
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This type of research is particularly relevant for setting priorities, for informing intervention, as well as for identifying further research needs. Although knowledge generation is generally not a primary NGO activity, there may be specific 'knowledge generation' research niches for NGOs. Tomlinson, CCIC. The research knowledge generation cycle adapted from McKenzie . While asserting that the production of knowledge is the primary function of research, and that levels of knowledge have increased considerably, a discussion paper for the International Conference on Health Research [ 1 ] also recognizes that the ability to draw from research in terms of lessons learned, application to interventions, and programming and policies which support the overarching goal of equity, is often lacking.
Inadequacies include the inability of developing countries to access pertinent international research literature and knowledge bases either as contributors or users , the inability to access new information technologies, and the inability to ensure closer links among the research community, health service managers and health policy makers. The effective use of research findings and their dissemination is an increasingly important public health policy concern. In , an international research conference was held in Vancouver, Canada, on dissemination research.
NGOs are frequently at the interface of applied research and policy-making, at least at the administrative level, and their potential input into research utilization for policy-making needs to be valued. Research can make a substantive contribution in at least three phases of the policy-making process: agenda-setting, policy formulation, and implementation [ 27 ]. It is widely recognized that health research is underutilized in policy-making.
The generation of new knowledge is highly valued, but its translation and use does not appear to be valued as much [ 28 ], which may partly explain why application of newer knowledge is often a weak link in the research cycle. Factors potentially enhancing utilization can be identified by exploration of priority-setting, activities of the health system at the interface between research and policy-making, and the role of recipients, or "receptors", of health research [ 27 ]. There are several models of research utilization in policy-making, but interactive or exchange models may be more conducive to the effective use of research than unilateral models because they bring researchers and decision-makers closer together [ 10 , 27 ].
NGOs often play a critical role in interpreting the evidence and translating its relevance for local communities.
Inevitably the level of involvement by the community depends on relevance and opportunity for action and advocacy. Assessing and evaluating opportunities for advocacy and action occur as NGOs work with communities on these issues. Effective involvement of the community and its participation is a "matter of reciprocity and continuing dialogue in which participation takes different forms and influences change in several directions" [ 14 ].
Once the evidence has been analyzed and assimilated, NGOs can serve as intermediaries in delivering feedback to communities and in the planning, implementing and monitoring of new interventions, policies or other actions which might have been proposed. The knowledge and information acquired by NGOs can be unique and offer added insight into new ideas for future health research.
This is, in part, because of the extensive interrelationships NGOs have forged with different communities, organizations, the private sector and governments, among others, often over decades of dedicated work. Additionally, NGOs are in a good position to test the ability of research findings to be scaled up in a 'real world' environment.
According to Lavis et al [ 10 ], while the "knowledge loop" needs to be completed, that is, from knowledge production to knowledge-based decision-making through knowledge transfer or brokering, not all research organizations should become involved in knowledge transfer; if they do, the knowledge pyramid may be shaky. Innovations stemming from research are at the base of the pyramid, and actionable messages are at the top. Individual studies and synthesis of research knowledge are the intermediate layers.
Lavis et al contend that it may not be relevant to transfer knowledge from individual studies, but rather, from bodies of cumulative research knowledge, and that knowledge transfer brokers are needed for this purpose. This model of specialized roles is probably more relevant at the macro level and in industrialized countries. In resource-poor countries, polyvalent organizations such as NGOs have a key role in sharing, translating and implementing research findings at the community and country level.
They provide channels for the use of research results at the community level, as they are closest to the communities themselves. For that very reason, they may also feel more compelled to complete the research cycle, including application of the findings. NGOs may also be involved in testing pilot models of intervention and in their subsequent scaling-up.
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The preliminary examination of the functions performed by the some organizations involved in a significant way in health research reveals that while knowledge generation is a concern shared by most, research capacity strengthening receives relatively little attention [ 1 ]. One weakness or inattention in research capacity strengthening activities, for example, has been the lack of a recognized career path for local health researchers which has resulted in diverting promising researchers to other careers or to other countries.
The development and retention of research capacity remains a challenge in many countries [ 29 ]. Quality control and assurance requires skills and structures which support these objectives. Skills such as leadership, advocacy, networking and communication are important and need to be built through capacity development. Research management is also a skill which needs to be strengthened and a skill that will improve the quality, appropriateness and timeliness of research and its dissemination.
NGOs in the North and in resource-poor countries often have the capacity for facilitating training and for sharing the lessons learned in needed skills. Partnership with NGOs in such capacity-building needs to be valued and reinforced. Support for such sharing and building capacity makes sense and should be facilitated by donor agencies. WHO, through its creation of a Department of Research Policy and Cooperation within the cluster of Evidence and Information for Policy, has defined as one of its objectives: "the development of initiatives aimed at strengthening research capacity in the developing world with the ultimate aim of enshrining research as a foundation for policy".
First, applied research should have a practical application, reinforce knowledge and skills, and introduce and promote innovative, effective strategies and approaches for improving human health and well-being. Not only should research results be for local application, they should also be shared and adapted to other venues and contexts.
Second, efforts need to be made to build knowledge and understanding about the benefits accruing from applied research. NGOs, by their very nature, are action-oriented. Applied research is often perceived as of limited use to their ends, an esoteric, academic exercise of limited value to the immediate needs of the poor and disadvantaged. Time and effort need to be invested in nurturing an understanding within the academic community of the value of applied research within the context of development efforts. Third, applied research should be used to develop and strengthen local research capabilities.
NGOs do not, as a rule, possess the internal capacity and skills to design and conduct applied research studies. Attention should be paid to assisting NGOs in making contact with qualified researchers, and increasing NGO knowledge and skills to negotiate the terms of reference for applied research studies. This cannot be achieved simply through providing information about applied research methodologies or organizing a single workshop.
Trust has to be developed between the NGO and academic communities, as a means of reinforcing linkages between them and building upon and using their comparative strengths, characteristics and areas of expertise to design and conduct applied research. Fourth, local communities should be involved in the design and implementation of applied research activities.
The local people need to understand the purpose of the proposed research, provide input and advice about its design and conduct, and be actively involved in the application and dissemination of research results. Without the active participation of the community, the utility and eventual application of the research results will be of little value. Source : [ 30 ]. Part of this funding was used to strengthen primary health care in developing countries through the NGOs that implemented the immunization and primary health care activities through the auspices of CIIP2.
NGOs who wish to become more involved in research generally recognize the need for extramural training and support. Partnering with universities and research institutions may provide such training opportunities. Those NGOs that are part of international networks can draw from the body of research conducted elsewhere. NGOs may also provide substantive input into research training, be it by grounding research methods in reality so that research is more applicable, or by providing research sites and questions for academia and graduate students.
NGOs may also be in a good position to identify young scientists and promising investigators in host countries. NGOs and communities as user groups could be the target of capacity-building efforts. The interviews and discussions covered the specifics of the implication of the NGO in health research, lessons learned through the experience, and respondents' perceptions on the role of NGOs in global health research, and on the strengths and weaknesses of their organization in this regard.
These selected NGOs provide insight into some of the critical issues facing NGO involvement in global health research. It should be kept in mind that this selection is small and not meant to be representative. Nonetheless, all of these NGOs are involved, directly or indirectly, in global health research, and they are all Canadian or present in Canada. The interviews covered a broad range of cases, from NGOs little involved in research to those actually conducting independent research.
The types of involvement are briefly described below. A salient observation is that what is considered as research by different NGOs is, for the most part, unclear and highly variable. This suggests the need for NGOs to develop common views on what is research, the various types of research, and the components of the research process.
The interviews also revealed that while some NGOs are reluctant to be involved in research, others are eager to strengthen their capacity to do so. CECI has long been involved in health research, although it is reluctant to call this 'research'.