In 1990, the Commission on Health Research for Development identified international health research partnerships as key to advancing health in developing countries and promoting global health equity. (1) Reports from the World Health Organization (WHO) and global ministerial summits have subsequently linked health research to achieving the United Nations Millennium Development Goals. (2,3) Two-thirds of child deaths and three-quarters of maternal deaths could be averted if existing interventions achieved high population coverage in developing countries. (4,5) However, there is a lack of knowledge about the barriers in health systems that hinder the delivery of these interventions and the strategies required to overcome them. While further basic research is needed to develop better interventions, the Millennium Development Goals will not be achieved without greater investment in health policy and systems research. According to a report by the WHO Task Force on Health Systems Research, it is "essential to channel most resources to address the preparedness of health systems to delivering interventions". (3) This position has since been reiterated numerous times, with the Mexico Statement on Health Research calling for international funders of health research to establish substantial and sustainable programmes of health policy and systems research that are aligned with developing countries' needs. (6,7)
Even so, figures derived from a 2008 Global Forum for Health Research report indicate that funding for international research makes up a tiny percentage (1.6%) of the 160.3 billion United States dollars (US$) of total global health research expenditure. (8) We define international research as research that is externally funded by organizations from high-income countries but is conducted in low- and middle-income countries.
Of the limited funding available for international research, most is channelled towards the development of new interventions rather than to health policy and systems. (9,10) In 2005, US$ 2.6 billion was spent on international research in developing countries by foreign public, philanthropic and private for-profit funders, but estimates show that only US$134 million is spent annually on health policy and systems research in developing countries. (8,11) Since this estimate was made, several new funding schemes for health policy and systems research have been created or mentioned in international funders' strategy documents, but it is unclear whether they have led to sizeable increases in investment. There is no equivalent for health policy and systems research to the G-FINDER survey (a database of global funding of neglected disease). In the light of this neglect, the field is still in the process of defining its scope, methods and agenda. (12-14)
In this paper, we show that this research imbalance is largely determined by the laws and policies governing research in high-income countries. The regulatory environment privileges the economic function of national health research systems over their health-promoting function. In the United States of America (USA) and the United Kingdom of Great Britain and Northern Ireland, international research is structured to boost national economic competitiveness, which results in a focus on the development of new health technologies. This paper argues that current policies restrict the capacity of international collaborative health research to promote global health equity by diverting funding away from research that is needed to implement existing interventions and strengthen health systems, i.e. health policy and systems research.
Economic strategies shape research
In the transition to knowledge-based economies, the United Kingdom and the USA have adopted research competitiveness strategies that support increased investment in science and technology. It is purported that, through such investment, a country can enlarge its share of the lucrative global high-technology market (through the privatization and commodification of science-based intellectual property) and generate high-salary jobs in its domestic economy. …