., 1V -, QS. 44* 1, "~~~~~~~~~i,tr~;k

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1 ., 1V -, QS. 44* 1, "~~~~~~~~~i,tr~;k Pan American Health Organization PAHO/ACHR/23/6.2 Original: Spanish TWENTY THIRD MEETING OF THE ADVISORY COMMITTEE ON HEALTH RESEARCH Washington, D.C. 4-7 September RECOMMENDATIONS OF THE 22tft MEETING OF THE PAHO/ACMR AND ACTIONS CARRIED OUT BY PAHO IN RELATION THERETO The issue of this document does not constitute formal publication. It should not be reviewed, abstracted or quoted without the agreement of the Pan American Health Organization. Authors alone are responsible for views expressed in signed papers.

2 RECOMMENDATIONS OF THE 2221 MEETING OF THE PAHO/ACMR AND ACTIONS CARRIED OUT BY PAHO IN RELATION THERETO 1. HEALTH SERVICES RESEARCH 1.1 It was recommended: a) That PAHO collect and organize the available information on health services research (HSR), so that a concise and comprehensive document may be written which introduces the concept of the discipline as such and produces general guidelines on how the research should be conducted and, where appropriate, defines and suggests uniform criteria for such matters as coverage, unit costs, demarcation of levels of care, etc. b) That PAHO support research on the role of drugs in the health services, and particularly on their use, distribution, and socioeconomic impact. A subcommittee or a specialized interdisciplinary meeting should be created to indicate the best and most urgently needed policies for research in this field. 1.2 Actions taken: a) A study was carried out about research trends in health services in 17 countries of Latin America and the Caribbean area, for the purpose of identifying research projects carried out in the last 10 years. In collaboration with the Ministry of Health and Welfare and the School of Public Health of Mexico, a seminar-workshop was conducted in that country in July of the present year on trends and perspectives for health services research (HSR). The seminar analyzed in depth the results from the above-mentioned study and established strategies and lines of action for the development of HSR. On the basis of this analysis, a publication was prepared on Trends in Health Services Research for distribution in the countries of the Region. Also, the proceedings of the seminar-workshop will be published and distributed. A directory of institutions that carry out health services research was prepared, and of investigators active in this field, as a contribution to the development of information on HSR at the regional level.

3 -2- A detailed report on these activities will be forthcoming meeting of the ACHR (Doc. ACHR/23/2.1). presented in the b) The Regional Program of Essential Drugs has included in its plan for the period activities for the promotion and support of research related to the supply, quality and effectiveness, adverse reactions, utilization, and consumption of drugs, medicinal plants, and to the transfer of pharmaceutical technology. During the present year the following activities have been initiated with the support of the Regional Program: a) Development of an industrial and technological strategy in the field of Ibero-American pharmacochemistry._ b) Studies on topics relative to essential drugs in Peru: structure, markets, and strategy for the pricing of some of the drugs. c) Study on the development of the clinical pharmacology in Latin America. d) Evaluation of the use of drugs in the health services of Honduras. e) Study on the utilization of drugs in Barbados. f) Studies of a system of joint purchasing of raw materials and drugs for Central America and Panama. * * / g) Research to identify priority areas of activity for the definition of national policies on drugs in Colombia. */ This document served as a working paper for the International Preparatory Meeting for the Promotion of Industrial Pharmacochemical Production among Argentina, Brazil, Mexico, and Spain, held in Mexico this year under the auspices of PAHO. **/ This document constitutes the basis for the subregional project under which PAHO and the Central American Bank of Economic Integration will act as executing agencies.

4 -3-2. RESEARCH MANAGEMENT 2.1 The following was recommended: That the Organization sponsor the conduct, as needed, of courses especially designed for the training of professional staff employed in the management of health research programs and institutions. These courses must cover both the general aspects of administration and activities pertaining to science and technology in the health field. The Organization can join with a Latin American institution of established competence to offer these courses from time to time, and should allocate a few fellowships for the training of personnel with responsibilities in this area. 2.2 Actions taken: PAHO continues to collaborate in the development of short-term seminars on Health Research Management. The following events were carried out: a) Managerial Aspects of Health Research, Department of Training and Research, Ministry of Health of Argentina (Buenos Aires, July 1983). b) Project Management in Health Research. National Council of Science and Technology (CONACYTEC) of Peru (Lima, November 1983). c) Regional Seminar on Research Management. Special Program on Research and Training in Tropical Diseases, UNDP/World Bank/WHO (Iquitos, Peru, August 1984). PAHO, in collaboration with the National Research Council of Brazil (CNPq), has developed a diagnostic methodology for research management in health institutions. An essential element of this methodology is an open questionnaire, which will be tried in a Latin American country prior to its application in six other countries. Based on the results of this diagnoses, better criteria will be available for defining the objectives and content of the seminars and courses required for institutional development in research management. 3. WHO COLLABORATING CENTERS 3.1 The following was recommended: a) That the policies and procedures for the establishment of Collaborating Centers be reviewed once again to find out whether the number of these Centers in Latin America can be increased, particularly in the areas in which there are not enough of them or additional centers are needed.

5 -4- - b) That Centers which have not fully accomplished their purpose, be eliminated from the program and that the possibility be explored of designating new Centers for shorter periods of time (two years), at the end of which time their scientific record would be reviewed to determine whether they should be continued. c) That research groups interested in developing of PAHO's research policies be identified. d) That an effort be made, in consultation with national entities (science and technology councils, universities, institutes, etc.), to identify research groups and centers that could be selected in new areas related to health, such as biotechnology, molecular biology, immunology, social sciences, etc. e) That an effort be made to set up truly operational networks for active collaboration among Collaborating Centers, whether existing or new, in related or complementary areas. f) That quality be encouraged rather than quantity. g) That there be flexibility in applying the requirements for the accreditation of Centers when they have interest in the priority research policies. h) That financial support be given to Centers whose activities further research policies of interest to the Organization. 3.2 Actions taken: The procedures that govern the designation of Collaborating Centers is a prerogative of WHO. The procedures that are currently in effect were reviewed in Although current regulations do not permit that the initial designation of an institution be made for a period of less than four years, redesignations can be made for shorter periods. At present steps are being taken to redesignate several of this Region's centers for periods of one or two years. The Government of Brazil, with the assistance of the PAHO office in that country, is carrying out an evaluation of all the existing collaborating centers in that country for the purpose of determining the impact of their activities. Institutions have been identified in the Region in such areas as Drugs and Molecular Biology, and consideration is being given to their designation as Collaborating Centers.

6 -5-4. MIGRATION AND HEALTH 4.1 The following was recommended: a) That PAHO continue its research along the lines indicated in the presentations made to the Committee. b) That PAHO support multidisciplinary research on the problem of migration and health that exists in the refugee camps of Chiapas, Mexico. c) That PAHO promote epidemiological studies on selvatic yellow fever, with especial reference to the Darien region. d) That the Region of the Americas collaborate with the other WHO regions in research on the health problems of migrants. Such collaborative endeavor should make it possible to develop action-oriented research programs which, if carefully planned, could attain the level of at least quasi-experiments. 4.2 Actions taken: a) PAHO set up a working group with the participation of the Tropical Diseases Program, Research Coordination, and the Unit of Epidemiology. This group has the support of consultants in social sciences as applied to the problem of tropical diseases. The program of comparative research on migrations and malaria is fully under way, and guidelines have been developed for the preparation of research protocols. The objective of the project is to determine the relation that exists between the forms of production, migration in the rural sector, and the changes in the epidemiological profile of malaria. Belize, Colombia, Costa Rica, the Dominican Republic, Guatemala, Haiti, Mexico, Nicaragua, and Panama have indicated their interest in participating in this type of study. Preliminary surveys conducted to date have made it possible to better understand the living, working, and health conditions of the population and could serve as a basis for programming activities and for implementing the strategy of primary health care in relation to the needs. The PAHO working group has shared its experiences with the WHO Malaria Action Program and the WHO/World Bank/UNDP Special Program on Research and Training in Tropical Diseases, through which contact has been established with other regions of WHO, particularly with SEARO.

7 - 6- b) The Entomology Group at the University of Panama, with financial support from the National Academy of Sciences of the United States of America initiated studies on the behavior of hemagogos species in the eastern part of Panama and on circulation of the yellow fever virus. On the other hand, investigators at the Gorgas Memorial Laboratory, together with investigators from the Yale University and the Smithsonian Institution of the United States of America, are studying the relation that exists between the neotropical wild animals in the eastern part of Panama and arbovirus of the Changuinola and Simbu group. 5. ACUTE RESPIRATORY INFECTIONS 5.1 The following was recommended: a) PAHO should continue its activities in promoting research and control measures for acute respiratory infections (ARI) in children. b) PAHO should accept the generous offer of the Government of Mexico to translate into Spanish the document of "Acute Respiratory Infections in Children," RD-21/ Actions taken: a) Efforts continued to promote studies on ARI in children under five, including support to specific projects. PAHO regular funds were assigned for clinical-etiological studies in Argentina, Peru, and Uruguay and for a comparative study of strategies for the management of cases in Brazil. The projects under way in Brazil and Panama continued to receive PAHO technical advisory services, as well as materials. Research carried out in Argentina and Uruguay also received support from the National Academy of Sciences of the United States of America (BOSTID program). A meeting of investigators from throughout the world who are involved in ARI projects, held with the support of BOSTID, took place in Washington, D.C., in June of this year. Technical staff from PAHO/WHO participated in this meeting. The main topics were: strategies for cooperation among investigators, the standardization of basic laboratory techniques, and characteristics of the main information to be collected on the formularies to be used for the surveys. In view of the number of clinical-etiological studies under way and the extent of control activities, the emphasis of research has now shifted to operational research as it relates directly to the execution and evaluation of the interven'tions that have been programmed.

8 - 7- In regard to the control of ARI, the initial program of the State of Pará is being extended to the rest of Brazil. National norms have been prepared and approved with the participation of the ministries of health and of social welfare, thus ensuring coverage of the great majority of the population. A national control program was initiated in Panama [in Panama City and in Coló6n], with' financial support from WHO. This - program will be extended to the rest of the country in Costa Rica, El Salvador, Honduras, and Guatemala have prepared national norms and are initiating control activities as part of a broader program of child care. UNICEF has shown special interest in supporting activities for the control of ARI in children, and it will cosponsor with PAHO and the Government of Brazil a regional seminar on this topic in Rio de Janeiro in October PAHO has continued to distribute technical material, including the semiannual bibliography on this topic prepared with the collaboration of the National Library of Medicine of the United States of America. In addition, PAHO has published several studies on ARI and has ensured their broad dissemination through the distribution of reprints to professional and technical personnel in the countries. b) With regard to the document "Acute Respiratory Infections in Children," PAHO/RD/21.3, 1983, the Government of Mexico prepared the version in Spanish, which is currently in press. 6. MENTAL HEALTH 6.1 The following was recommended: it a) That PAHO continue its efforts in this field and ensure that sufficient attention was paid to research on the behavior of the adolescent mother. b) That research on the behavior of the family group during the perinatal period be promoted, in accordance with the topics to be discussed in the workshop to be held at PAHO from 29 August to 2 September Actions taken: a) A meeting was convened for 1984 on risk-inducing behavior among adolescents, which was postponed to the first quarter of 1985.

9 -8- b) Investigators in the Region have been informed that the behavior of adolescents is a priority in the mental health area, and they are being urged to present research proposals. c) In a workshop on aspects of behavior and mental health in primary health care, with emphasis on maternal and child health, eight topics of research were approved, of which four deal with the reproductive behavior of adolescents. 7. ENVIRONMENTAL HEALTH 7.1 The following was recommended: a) That studies be undertaken, through an appropriate mechanism, of the research problems in environmental health as the basis for a review of the current situation, and for the determination of priority fields of action and an operational strategy. b) That PAHO give support to programs for the training of specialized manpower and research in environmental sanitation, particularly in pest and vector control (medical entomology) at the technical level, and particularly at the professional level, with a medical orientation. 7.2 Actions taken: a) The Environmental Health Program, including CEPIS and ECO, has incorporated research-related objectives and activities in each of the four components of its medium-term program ( ). In addition, one technical staff was designated as focal point in Headquarters to coordinate all its research activities. There has been a review and classification of the criteria to be considered for the establishment of priorities, and priorities for research have been identified. There has been increased emphasis on developing the capacity at the country level to carry out research on collaborative projects. Within the objectives and activities proposed under the mediumterm program, a study has been included on the status of research in environmental health in Latin America and the Caribbean area. With this study it is expected that unmet needs can be identified as well as areas requiring concentration of efforts. As an example, and in collaboration with CEPIS, a research proposal was developed and approved by the International Development Research Centre (IDRC) which has the following objectives:

10 -9-1. To develop survey mechanisms and methodologies to evaluate the current status and trends of research on drinking water supply and environmental health in Latin America. 2. To design a data base for research activities and the institutions involved, as well as to develop inventories of research projects in progress. 3. To test survey mechanisms and methodologies in Peru. 4. To prepare a manual on survey methodology. 5. To develop surveys in Chile, Colombia, Guatemala, and Peru. To evaluate the quality of the data collected and to disseminate the results to regional and national institutions. To establish procedures for extending the program. b) Educational materials have been developed for the adequate use of pesticides in areas where there are agromedical conflicts. Workshops have been programmed for Brazil, Chile, Colombia, Costa Rica, Cuba, the Dominican Republic, Guatemala, Honduras, Mexico, and Uruguay. 8. PAHO RESEARCH POLICY 8.1 It was recommended: That the item "PAHO Research Policy" be included permanently in the agenda and that at its next meeting there should be a discussion of the document "Research Policy in Health" which represented the proceedings of the Pan American Conference on Health Research Policies. 8.2 Taken action: A document on the past and present research policies of PAHO was included in this committee meeting (Doc. CAIS/23/1.1). ID-0348u

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