Science, technology, research, development and innovation are the principle motors of progress in health, education, socio-economic development and political development [1]. Investment in national research has formed the backbone of economic development in Europe and the United States for several centuries and, in more recent times, the basis for the economic development of Asian economies – such as South Korea and Taiwan – supplying the ultimate proof that sustained development of industrial and scientific research capabilities is fundamental to the development of a country, its human resources, its healthcare services and economy. Based on serious consideration of these examples, a group of “innovative[2]” developing countries, including Brazil, South Africa, India and China, have rapidly increased development of their own research capabilities, making the investment in health research and technologies a key sector of development.

An efficient scientific research system forms the basis for the transition –from a natural-resources-based economy followed by an investment-based economy – to a knowledge-based economy. In the health research context, the most important results of developing national health research can be expected in the following domains:

Despite these important advantages resulting from investment in health research, many countries in the Middle East and the Gulf have yet to turn to their health research systems as a key development tool. Concern has been expressed about the lack of a favourable culture towards scientific and technological development in general and the lack of headway in health research in particular [3].  A study of management of national health research systems, carried out in ten countries from the region, concluded that a lot of work remains to be done – including in Bahrain, where the basis for a decent health research system was proceeding to be established [4].

The case of Tunisia – an example considered in perspective:

Since the creation of a secretariat of state for scientific research in 1991, Tunisia has made an important political commitment to invest in research, based on the strong conviction that research is a decisive factor for successful development. This commitment has led to an increased budget for research and development. Tunisia’s own investment rate in research and development has tripled in the past decade – from 0.43% of GDP in 1999 to 1.20% of GDP in the current year of 2008. The objective is to reach 1.25% of GDP by 2009.

With growing resources available for research, and thanks to the development of the health sector, the Minister of Public Health is trying to create mechanisms that would allow a reasonable allocation of research resources and would develop research-fields based on Tunisian healthcare priorities. Participation in a study – on national health research management systems in ten countries from the region [5] – encouraged the ministry to develop national priorities for health research.

The study in question, carried out in ten countries from the EMOR (WHO) region, was a collaborative effort between the World Health Organization’s Eastern Mediterranean Regional Office (WHO/EMRO/RPC), the Council on Health Research and Development (COHRED) and the Health Minister’s Council of the Gulf Cooperation Council (GCC) states. Two workshops were set up, in 2005 and 2006, to allow seven Gulf and three EMRO countries to carry out an analysis of their national health research systems. Tunisia was one of the three EMRO states to participate – with the specific goal of starting nationwide talks between its principal stakeholders, as well as building consensus for a future national health research system strategy, aiming to improving management in an efficient way.

This first study only looked into managing research. Assessing research and properly identifying the key areas in need of reform can be undertaken with interested countries at a later stage.

Where Tunisia is concerned, it was noted that:

In light of these results, the Ministry for public health decided that these pressing issues meant it was necessary to establish national priorities for health research and requested technical assistance from COHRED and from the WHO/EMRO/RPC to implement the strategy. The pertinence of a research topic should clearly be an important element in the decision to fund laboratories and research units. In 2007, COHRED’s step-by-step approach for establishing priorities was used to create a complete list of priorities for health research. Most, if not all, of the main Tunisian health research stakeholders took part in the process, including the Ministry of Higher Education, Scientific Research and Technology, the Ministry of Agriculture and Hydraulic Resources and the Ministry of Education and Training. The whole process revolved around preparatory meetings to create political and technical awareness of the issues; to identify the stakeholders and obtain their backing; to collect preliminary data with instruments designed for the participants themselves and, last of all, to organize a national forum where health research priorities were fine-tuned and formalized for the first three year period [6]. The whole process took less than 18 months from the moment analysis of the national health research system began and at the end, priorities for health research have been established.

Outcomes in Tunisia

The Ministry of Health published these priorities and sent a call for proposal to all researchers in Tunisia, in accordance with these. So the studies would be funded if they fit with the priorities. To give an example, all research on health systems were not considered as priorities before, while this was really highlighted as an important domain. If we want to strengthen the research capacities, we have to work on the health systems, through research that is not necessarily costly, like for example on how to improve the quality of care for diabetic patients. This is a simple question, but it needs a systemic response. It involves that the patient should be educated, and that the doctor should be working on life styles, while before they would only prescribe drugs and would not think about prevention at all. It also needs to take into account how the system gets supplies and makes drugs available for the patients to comply with their treatments. So we can see that the solutions are more systems related than individuals related.

Priorities should be also regularly updated. All the more reasons given that it was done in 2007, and now with all the political changes in Tunisia (that had three different ministries of health in 1 year and a half!), there will be some obvious need of updating and continuity after that.

Research priorities are essential for national management of research. They must be able to mobilize skills in a coherent and convergent way, while also ensuring public support and enthusiasm. Research and development require an effort that is simultaneously large-scale, long-term and indeterminate – which is why, to counter these dilemmas, national and institutional research priorities should be established. Today, other measures need to be taken as well to ensure that Tunisia is able to develop its potential to become a prime mover for health; to guarantee a more equitable healthcare system; and to fulfil its ambitions for scientific, technological, economic and social development.

Expanding the efforts to the Arab World

 The Arab spring is a major historical event in Middle East. Millions, in the Arab world, have moved to the streets to demand change to the status quo. People are calling for freedom, democracy and equitable development. The political changes happening now provide a great opportunity to renew interest in research, science and innovation for the Arab countries.

Lately, Tunisian representatives, along with other stakeholders from Arab countries, participated in a meeting organized by COHRED on “Boosting Research for Health (R4H) as a driver of equity and development in the context of political and social change in the Arab world” (Bellagio, Italy, 26 February to 1^st of March 2013). The overall objective of the proposed meeting was to discuss how best to use the current opportunities to strengthen research, science and innovation for health in the region.

A consensus was reached that more in depth discussion and preparation of position papers were required around the three following areas of: Research for health system strengthening, public health institutions capacity building and policy for equity. This option builds on the fact that the Arab spring is still not finished yet and may take a long time. A small technical meeting was held in Beirut (Lebanon, 19 and 20 June 2013), to prepare a proposal for further working in the region, for a more enlarged consultation (likely to be held in 2013 in Morocco), and then a regional conference that will launch the process for a wide and long term movement.

References: 

Text inspired from the article:

“Développement du système de recherche en santé: analyse et établissement des priorités en Tunisie” (Tunisie Médicale 2009; 87(1): Editorial, 1-2.)

* Director, Council on Health Research and Development (COHRED) Geneva, Switzerland.

**Professor of Community Medicine, Head of the Department of Epidemiology, Farhat Hached University Hospital, Sousse, Tunisia.

***Professor of Infectious Diseases, CEO Biotechpole Sidi Thabet, Sidi Thabet – 2020 – Ariana. Tunisia.