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From great trials to better systems: NIHR's global health research

Professor Kara Hanson

Published: 22 November 2023

Professor Kara Hanson joined NIHR in July 2023 as the first Programme Director for Global Health Research. She is Professor of Health System Economics and Dean of the Faculty of Public Health and Policy at the London School of Hygiene & Tropical Medicine, and President-Elect of the International Health Economics Association. Here, she reflects on achievements to date, and sets out her priorities for the future.

We, as health researchers, aim to make a positive impact on the world. We develop projects that we believe will improve health outcomes and services. We hope that our research will have lasting benefits locally and can be applied in other settings globally.

Since 2016, NIHR has funded high-quality applied health research in low and middle income countries (LMICs). Our Global Health Research portfolio has funded over 700 projects in more than 100 countries.

These projects are addressing the changing global burden of disease. They are tackling a number of areas which traditional global health research funders have neglected, such as surgery, injuries, trauma, and mental health.

We seek to engage with health systems, and to build resilience to future global health threats. We also develop future research leaders and strengthen the global research ecosystem. To date, we have supported over 1,000 individual researchers and support staff.

Despite their diversity, our funded projects have three key foundations for success:

  1. They address the priorities of health system policymakers and managers.
  2. They engage and involve communities.
  3. They are undertaken through equitable partnerships between UK and LMIC researchers and stakeholders, ensuring that the benefits and opportunities arising from research are shared fairly.

Building pathways to impact at scale

Many of our projects are already making a difference, influencing policy and practice. One example among many is the NIHR Global Health Research Unit - CleanAir-Africa. This team works in Kenya, Cameroon and Ghana to tackle lethal household air pollution.

Smoke from dirty fuels like charcoal and dung is a major health hazard. Globally, it causes more illness and death than malaria and HIV combined. CleanAir-Africa partners with governments, NGOs and industry to assess cleaner alternatives.

The project has shown that cooking with gas improves women and children's health. This switch also has benefits for the economy and the environment. In Kenya, the team is now training several thousand health workers nationwide. It has support from the President’s office and Ministry of Health to roll out the training in communities and schools.

To achieve lasting impact, we need a multi-disciplinary approach. New interventions should not only be effective, but also affordable, acceptable, and workable. This requires input from social scientists, economists, and policy analysts.

To implement new interventions at scale, we need to collaborate with health system actors. These include local authorities, service providers, and national policy makers. Sometimes, we may need to get involved in global-level policy discussions, such as contributing to World Health Organization (WHO) guidelines. The best research anticipates this engagement, building relationships with stakeholders from the beginning.

When writing a NIHR Global Health Research proposal, it is important to include a clear plan for sharing and using the research findings. How will this research help improve practice, inform policy, and have lasting benefits in partner countries? We have a Theory of Change model for the portfolio. This shows how we expect our funding to make a difference.

Engaging and involving communities, building equitable partnerships

To make a real difference in global health research, it's important for patients and communities to have a say. They should be involved in every step, from funding to study design and sharing the results. This will help us achieve our goal of making lasting research impacts and improving lives.

NIHR champions the involvement of LMIC communities in all aspects of the research we fund. To apply for NIHR global health research funding, you must include community engagement and involvement as a core part of the process.

Only by involving communities in the research process can we ensure that research is relevant to the needs of the people we are trying to help. Such engagement is never easy. It takes time, effort and resources to build relationships and trust.

NIHR Global Health Research must show how it is conducted through equitable partnerships. As well as partnership with communities, this means working across research teams to develop shared decision making processes and a fair distribution of financial resources. It also means sharing authorship on research papers fairly, and LMIC-based partners having opportunities to present the research in national and international forums.

We are committed to promoting equity of opportunity for LMIC-led research. This involves strengthening research capability at individual, institutional and systems levels. We now fund proposals from researchers in LMICs, and are increasing funding for research partnerships led by LMIC institutions.

Looking ahead

Over the next few years, we will continue to shift the centre of gravity of our portfolio. We will continue to fund LMIC-led research teams and partnerships to solve health issues in their communities. At the same time, we will promote multi-country and multi-disciplinary collaboration. We will create funding calls that address important health system challenges, like climate change and urbanization. We will also consider pandemic threats.

I want the NIHR global health offer to be clear and predictable, so that researchers can bring their best ideas to our funding streams. Early in 2024 we will publish a forward-looking schedule of regular funding calls. I also want NIHR processes to be as simple as possible, reducing the burdens on researchers.

Finally, I want to see our global health programmes making the best use of NIHR’s strong capacity in the UK. By working in a more joined-up way with clinical, public health and health systems research, we can learn from each other to the benefit of all.

NIHR has been funding global health research for only 7 years, and has already achieved a great deal. Indeed, we are becoming recognised as a leading funder in this area. I am proud to be part of this journey, and look forward to seeing our programmes continue to deliver sustained impact at scale.

Read more about NIHR's Global Health Research

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