International consultation on long-term global health research priorities, research capacity and research uptake in developing countries

DfID used this public survey as part of a wider consultation exercise, which included internal and external sources of feedback, and comprising a Delphi survey of infectious disease experts [10]. The wider process enabled targeted feedback to be combined with the public-facing open access nature of the public consultation. The outcomes of this process were subject to external peer review to validate DfID’s future health research priorities [11]. The approach, of multisource feedback to aid prioritisation of research funding, has the advantage of including a broad set of views, which can be used to inform and influence internal decision-making. This approach was chosen above other systematic approaches, such as the Child Health and Nutrition Research Initiative method [12], since it was felt that such approaches as well as Delphi methodologies tend to focus on expert views, which, while important, negate the inclusion of a wider public stakeholder base, who also have legitimate and important insights into research priorities.

The consultation results provide a valuable insight to both donors and researchers to help direct the long-term development of their respective research portfolios. It also adds to the knowledge base regarding approaches to integrate evidence into policy and practice, and to build research capacity in low-resource settings.

The consultation identified NCDs as the most important research priority for the long-term future. This correlates with the developing burden of disease globally, which shows increasing morbidity and mortality from NCDs in low- and middle-income countries [2, 13], often affecting the poorest people living in low-resource settings [14, 15]. However, there are still many gaps in the evidence base for NCDs in low-resource settings, particularly regarding risk-factors for disease, and which populations are most susceptible [15]. It should also be acknowledged that there is a shifting discourse in global health which recognises the growing importance of NCDs. This is reflected in their prominence in the Global Goals [4] and the development of the World Health Organization Global Action Plan for the Prevention and Control of NCDs [16].

Infectious diseases were identified as both an important theme for future research but also an area to be reduced. This may reflect the recognition of progress made in reducing the burden of infectious disease, and an increasing need to focus on other areas [17]. It could also suggest support for a change in approach to infectious disease research from population wide methods, to concentrating on accessing hard to reach groups and emerging threats. This suggests an important realisation from participants that the important agenda of infectious disease has not been dealt with [10, 18, 19], although there are new emerging threats that should not be overlooked as funders prioritise future investments. Owing to the already very high priority and associated funding given to infectious diseases, it is possibly not surprising that respondents felt this was going to be less important in the future. Nevertheless, this does not preclude support for further investment to consolidate and advance research progress made in this field. The outcomes from the survey regarding increasing and reducing priorities highlight the growing issue of a double burden of disease for infectious diseases and NCDs, which has a stronger impact on the poorest in low-resource settings [20–22].

For research to have a positive effect in low-resource settings, research funding must be based on target country need [23–26]. However, research priorities globally are often based on the requirements of international donor organisations, rather than the recipient countries [25–27]. This potentially leads to research which does not meet the needs of target populations, and where the knowledge generated is not incorporated into policy or practice [28–30]. The results from the consultation support this position, calling for research funding to be based on country need, and to be designed and delivered by the stakeholders in the country of interest.

Our consultation findings also emphasised the importance of early and meaningful engagement of stakeholders in the research process to facilitate effective research uptake. This has to go further than signing up a policymaker to support a research proposal; the key stakeholders must be given influence over the topic selection, research process and outcome implementation. International funding based on the requirements of international donors, rather than the priorities of countries, reduces the impact of research outcomes at a country level [29].

Research capacity building in low- and middle-income countries is essential if solutions to key health issues in low-resource countries are to be progressed [6], although this is a challenging task. Capacity building support for individuals (from a range of backgrounds) was recognised as being key to developing this area in low-resource settings in the consultation responses. Collaboration and partnership was noted as being an important vehicle for this, with particular attention given to North–South institution partnerships. Donors have a responsibility to ensure that research funding places research capacity building as central in funding decision criteria. This requires a more holistic approach, which works at the individual, institutional and the wider research environment [6].

There are limitations in the process and outcomes of the consultation survey. The opportunistic nature of the survey’s dissemination means the findings presented here may not be representative of the full range of stakeholders or views. Additionally, since the consultation was initially distributed by DfID, this may have resulted in a higher response rate from organisations and individuals already affiliated with DfID and may in turn have resulted in responses more in line with current DfID funding priorities and thinking. This was addressed in the wider consultation process, which also included opportunities for targeted feedback. This helped to ensure that opinion from outside of the established DfID relationships could be considered. It should also be noted that the variety of responses in the public consultation, and comparison against current DfID research funding allocations, suggests that respondents represented a far wider spectrum of stakeholders than those who were initially targeted for dissemination of the survey. The terminology used in the consultation questions enquiring to future research priorities uses the terminology ‘global health research’; the authors were keen to ensure as wide a breath of response as possible, but also acknowledge that this terminology may have resulted in quite generic responses. Finally, the thematic analysis will inevitably reflect the values and judgements of the investigators, and the interpretations they have made during and following the process of data analysis. However, by using a systematic and established approach for data analysis, we hope to have reduced inherent bias. Publication of the results also gives other stakeholders the opportunity to present reflections on our interpretation, and to present their own interpretation.