Beyond Scaling Up:Pathways to Universal Access

Institute of Development Studies, Brighton, 24-25 May 2010

Building evidence 

Stephen Matlin

How important is evidence of what works and what does not for the rapid implementation of sustainable change?

•Systems approach•Key Question:

What’s wrong with the system?

•Do we ask the right questions?•Do we have the right models/assumptions?

New Yorker, 2006 and thanks to R Terry, WHO

Preston curve

• 20th century mortality decline had its origin in technical progressEasterlin, European Review of Economic History 3: 257–94, 1999

• Much of the variation in country outcomes results from very substantial cross-country variation in the rate of technical progress

e.g. technical progress explains 66 percent of inter-country variation in the decline in infant mortality from 1962–1987, whereas change in income explains 9 percentJamison, Disease Control Priorities in Developing Countries (DCP2), World Bank, 2006

Too little research being undertaken to address the health needs of developing countriesCommission on Health Research for Development 1990

Ignorance is fatal

Technological and social innovation

“The health system does not just act on, but also interacts with ecological, social and microbial processes.”

•You can’t obtain information about any system without interacting with it.•Every interaction causes change (reversible or irreversible).

•Scaling up health system is itself an experiment•Research on scaling up: what kinds of ‘evidence’?•Capacity building

- Research- InnovationIndividual, Institutional, Systems

Research system

Innovation system

Health research system

Health sector

Other sectors

National Global

Research and innovation systems

Mapping of country scientific capability to adopt 16 technology applications

RAND, 2006: The Global Technology Revolution 2020 www.rand.org

Mapping of country scientific capability to adopt 16 technology applications

RAND, 2006: The Global Technology Revolution 2020 www.rand.org

Major drivers and barriers

• Cost and financing• Laws and policies• Social values, public opinion, and politics • Infrastructure• Privacy concerns • Use of resources and environmental health• R&D investment • Education and literacy • Population and demographics

FundersPublic SectorPrivate SectorNot-for-Profit Sector

IntermediariesPublic-private partnershipsAdvocacy organizationsGlobal health initiatives

Performers of R&D and innovation

Global Public GoodsProductsProcessesKnowledge

Commercial ProductsProductsProcessesKnowledge

Health BenefitsBetter health &health equity

Environment for research and innovation for health

Influences: push and pull mechanismsFlows of resources, ideas, information, products, mechanisms

Matlin & Samuels, The Lancet 2009, 374: 1662-3

Global Health Research and Innovation System

• Some of the most important innovations are now coming from developing countries

• Shifting power between different countries

“Developing countries”Developing world GDP (measured in PPP) to overtake advanced economies in 2013

Euromonitor: Countries and Consumers – October 2008www.euromonitor.com/Special_Report_Developing_world_to_overtake_advanced_economies_in_2013

Advanced economiesDeveloping and emerging economies

Researchers per million inhabitants, 2007 or latest available year

UNESCO Institute for Statistics, September 2009Based on FTEs where possible, or on headcountshttp://www.uis.unesco.org/template/pdf/S&T/Factsheet_No2_ST_2009_EN.pdf

• Territory size shows the proportion of all scientific papers published in 2001 written by authors living there.

• Scientific papers cover physics, biology, chemistry, mathematics, clinical medicine, biomedical research, engineering, technology, and earth and space sciences.

www.worldmapper.org

Science output

Dealing with multiple, contested goals and framings.

Are we talking the same language?

Where am I?

You’re 30 metres above the

ground in a balloon

You must be a researcher

Yes. How did you know?

Because what you told me is absolutely

correct but completely useless

You must be a policy maker

Yes, how did you know?

Because you don’t know where you are, you don’t

know where you’re going, and now you’re

blaming me

Martin McKee

Nobody asked me, anyway