Setting Priorities in Child Health Research Investments for South Africa

Research can play a critical role in the response to global health challenges. But when resources are limited, guidelines are needed to assist decisions on defi ning the priorities for health research investments. An early attempt at the global level to defi ne health research priorities was made through the Commission on Health Research for Development in 1990 [1]. A number of subsequent initiatives addressed this problem by attempting to set priorities in global health research [2–4]. However, these approaches promoted funding for research predominantly focused upon the generation of new technologies, knowledge, and processes. Research concerned with implementation of already proven technologies and interventions was downplayed [5]. The persisting unacceptable burden of under-age-5 mortality of 10.6 million each year [6], which could be reduced by up to 63% with existing low-cost interventions [7], points to the potential role health research could play. The lack of systematic prioritization of child research funding perpetuates the neglect of interest in research on how to implement costeffective interventions. Delivery of interventions is rarely considered a research priority; research on creating new interventions far exceeds that on delivering existing ones [5]. The Child Health and Nutrition Research Initiative (CHNRI) has developed a systematic methodology for setting priorities in health research investments that can be applied at global and national levels and for different purposes (addressing a disease, group of diseases, risk factors, etc.) [5]. The proposed major conceptual advance of CHNRI’s methodology is the recognition that there should be a broader defi nition of health research as an activity that is not limited to generating new knowledge, but also has a vision of implementation that should help to reduce present disease burden. The methodology also attempts to systematically incorporate wider societal values and priorities. This article reports on the fi rst experience with countrylevel implementation of this new methodology in South Africa. It is estimated that nearly 100,000 children under 5 years of age still die each year in South Africa. The overall infant mortality rate of 59 per 1,000 live births has been rising over the last decade [8]. This rate also masks great variation within the country with some districts reporting an infant mortality rate of 28 and others 68 per 1,000 live births [9]. HIV/AIDS is now the leading cause of under-age-5 deaths (40.3%). Diarrhoeal disease, lower respiratory tract infections, and malnutrition, when adjusted for HIV/AIDS comorbidity, are together responsible for 20.3% of all under-age-5 deaths [10]. The two aims of the study were: (1) to determine whether the CHNRI methodology was implementable for setting child-health care priorities at the national level, and (2) to identify “child health priorities” in South Africa. Setting Priorities in Child Health Research Investments for South Africa Mark Tomlinson, Mickey Chopra, David Sanders, Debbie Bradshaw, Michael Hendricks, David Greenfi eld, Robert E. Black, Shams El Arifeen, Igor Rudan