Seizing the chance to influence global health policy
One of the roles of the Horizons Institute is to enable Leeds researchers to respond quickly to promising external enquiries by providing funding or advice – a response that can end up paying dividends in terms of close client relationships and real-world results.
In March 2020 Professor Garrett Brown, a global health policy expert, was approached by the evidence and analytics team at World Health Organisation (WHO). The United Nations agency, responding to the Covid-19 pandemic, was working on a global and regional pandemic preparedness plan for governments around the world. The team had noticed Professor Brown’s ideas on health system strengthening, included in a piece for the British Medical Journal he’d written about failures in pandemic control and response.
The WHO team asked Professor Brown to review their principal framework document, Health Systems for Health Security, which included recommendations and toolkits for governments to increase health security through sustainable health system strengthening.
But he soon found that the framework needed more than a light-touch review. He recalls: “The framework was lacking clear evidence for some of the claims, and it also needed case studies of successful strategies in order to convince governments to implement the ideas into their national strategic plans. In addition, the focus was entirely on preparedness; there was little on prevention, or on how other sectors could feed in to healthcare.”
Finding the evidence
After his assessment, WHO offered him the chance to take charge of the framework document. It was a great opportunity, but with few resources and little time available, he turned to the Horizons Institute to see what might be done. Recognising the importance of this opportunity, the team were offered a Horizons grant of £16,000 to conduct the necessary research.
Professor Brown, and a newly-created team of Masters graduates and Postdoctoral researchers, started working on the framework, combing through existing literature and studies and finding the necessary information and evidence.
Within three months the team was able to produce 343 pieces of specific evidence to support WHO’s case for adopting a health-systems for health security approach, as well as providing a total of 12 case studies. They also took over some of the writing, adding new sections on primary healthcare and on ‘Common Goods for Health’.
The resulting framework was officially launched at the University jointly with the WHO, with 700 people in attendance.
Online dashboard
That was just the start of the relationship with the WHO, leading to a number of subsequent projects, some of which have been UKRI-funded.
Professor Brown has since played a key role in designing the new WHO Dynamic Preparedness Matrix for health emergencies, an online dashboard enabling countries to see a real-time health emergency preparedness score across three fields — hazards, vulnerabilities and capacities. He explains: “This allows countries to figure out where weaknesses are, and to target and prioritise investments.”
He is also involved in helping design a ‘return on investments’ toolkit – looking at a range of investments in different types of health system capacity strengthening and the likely outcomes. This again gives international policymakers important information they need in assessing next steps.
Cost implications
Professor Brown and the team have also carried out global pandemic preparedness cost estimates, looking at what initiatives are needed and how they might be financed. These costings have fed into WHO, G7, G20 and World Bank estimates, and have led to more work on prioritisation modelling of cost implications. He says: “Even under the best GDP estimates, the estimated cost of the global pandemic preparedness is not supportable, so now we’re looking at what options would work best.”
Meanwhile, the original Health Systems for Health Security framework is being piloted in several countries around the world, including Sri Lanka, Vietnam, Kenya and Uruguay. The framework is being implemented by these countries into their everyday health system performance standards, and will be evaluated after one year.
As a result of this and other work, the University of Leeds is becoming an official WHO Collaboration Centre on Health Systems and Health Security, with Garrett Brown as the director. This will launch another 4-year projected research agenda with the WHO.
Direct impact on health policy
Even though the later work, after developing the initial framework, was funded by UKRI grants, Professor Brown knows how crucial that first response from Horizons was.
He says: “I could not have done this hugely important work without Horizons. Without that initial funding, we wouldn’t have been able to scope the evidence properly and the framework itself would have been far weaker.
“Instead, we’ve directly influenced global health policy for the better, and it’s already being implemented, so it will save lives – as well as huge amounts of resources – around the world. The ongoing research will allow us to continue to play a key role in health policy too.”
The wider University has benefited from the relationship too, with WHO internships and opportunities to participate in WHO-focused Crucible sessions. Stuart Taberner, Director of Horizons Institute, says: “Horizons is all about getting our researchers talking to people with real-world challenges, and this is a great illustration of how that can unfold, leading to exciting work and real impact.”