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  • Between February and November we

    2019-05-14

    Between February and November, 2015, we conducted a priority-setting exercise to set research priorities for ECD to 2025. This is part of WHO\'s larger initiative to set priorities for maternal, newborn, child, and adolescent health. We used the Child Health and Nutrition Research Initiative (CHNRI) methodology for setting priorities in health research investments because: (a) it buy glibenclamide is a carefully developed and documented conceptual framework available in the public domain; (b) it has demonstrated usefulness in several previous exercises; and (c) it is increasingly being used by policy makers, large donors, and international organisations. We adapted a set of five criteria from the CHNRI methodology—answerability, effectiveness, feasibility, impact, and effect on equity—against which an expert group scored research investment priorities. Library searches and snowball sampling were used to identify 348 experts (both researchers and programme experts) who were then approached by email to provide their three to five top research questions. 74 participants responded, generating 406 research questions, which we then collated into a composite set of questions by eliminating redundancies and overlaps, excluding irrelevant questions, and identifying thematic areas. This process yielded 54 questions that were then scored by 69 of the original experts against the five criteria outlined above. Composite scores ranging from 0 to 100% were calculated for each research question. The experts who completed scoring were geographically diverse, with 7% from WHO African Region, 34% from the Americas, 5% from Eastern Mediterranean Region, 18% from European Region, 11% from South-East Asian Region, and 8% from Western Pacific Region; 18% considered themselves international (WHO or UNICEF or international non-governmental organisations or agencies). The research questions were organised by six thematic goals. The presents the goals and the top three research questions for each of the goals, including their ranking. Research priority scores among the top 10 priorities ranged from 82% to 87%. All of the top-ranked priorities were related to the impact of implementation of interventions, whether by community health workers or through increased support to parents and families. Three of the top 10 ranked priorities related to integration, such as integrating ECD services within maternal, newborn, and child health services or the additive costs of integrating health or nutrition interventions into early childhood education programmes. There were no questions in the top 10 about epidemiology, basic science, or discovery, although questions arose about interactions between nutrition and physical and cognitive development. The results of this process clearly indicate that the crucial priorities for future research relate to the need for services and support to parents to provide nurturing care and the training of health workers and non-specialists. What is most striking about the top-ranked priorities is the emphasis on creating enabling environments to support families in providing nurturing care for young children, which is a key message of series on Early Child Development. In addition, the emphasis on integration is important—also emphasised in series—as it speaks to the importance of implementing programmes using existing delivery platforms such as maternal and child health and nutrition services. Given the current global focus on quality of care, the high priority given to questions of maintaining impact when going to scale is important as well as improving the policy environment, improving quality of interventions, and increasing effectiveness and improving demand.
    The next WHO Director-General faces major challenges: operational responsibilities for epidemic response, universal health coverage (UHC), and the rise of non-communicable diseases. Given the vast gap between daunting health challenges and WHO funding, what should be the Director-General\'s foremost priority? The answer lies in the organisation\'s main constitutional pillar, the right of everyone to the highest attainable standard of health. WHO\'s next leader should bring human rights to the forefront, ensuring the universal right to health.