Thirty-second Session of WHO South-East Asia
Advisory Committee on Health Research
Bangkok, Thailand
11-13 October 2011
SEA/ACHR/32/2.1
8 September 2011
Agenda Item 2.1
REPORT ON IMPLEMENTATION
OF THE RECOMMENDATIONS OF
THE THIRTY-FIRST SESSION OF
WHO SEA-ACHR
Report of Implementation of the Recommendations of the
Thirty First Session of WHO SEA-ACHR
The Thirty-first Session of the WHO South-East Asia Advisory Committee on Health
Research (SEA-ACHR) was held in Kathmandu, Nepal on 21-23 July, 2009. The 31st
Session ACHR was attended by 13 ACHR Members, 12 special invitees, 16 WHO
secretariat and 3 resource persons.
The Thirty-first Session of the WHO SEA-ACHR made the following recommendations:
1. Recommendations pertaining to the follow up actions on the recommendation of
the thirtieth session of the SEA-ACHR
2. Recommendations pertaining to the area of avian influenza research
3. Recommendations pertaining to the area of promotion of research and
development in areas of drugs and vaccines
4. Recommendations pertaining to research management in countries
5. Recommendations pertaining to research management in WHO/SEARO
6. Recommendations pertaining to review of global work of WHO on health research
7. Recommendation pertaining to UNDP/World Bank/UNICEF/WHO Special
Programme for Research and Training in Tropical Diseases
8. Recommendation pertaining to UNDP/UNFPA/WHO/Wolrd Bank/Special Funding
of Research Development and Research Training in Human Reproduction
9. Recommendations pertaining to research priorities in communicable diseases
10. Recommendations pertaining to research priorities in non-communicable
diseases
11. Recommendations pertaining to review of the Regional Strategy on Health
Research
12. The overall recommendations
Follow up meetings:
WHO SEARO has organized three major meetings to discuss follow up of the 31st
Session of the SEA ACHR. The first meeting was conducted on 29 July 2009. There
were 8 major follow up actions taken after the meeting:
1.
2.
3.
4.
Consolidating the recommendations
Writing of proceeding and full report of the meeting
Formulation of regional and country strategy for research for health
Establishment of ACHR Subcommittee on Vaccine and Drug Development to
build capacity in South East Asia for public private partnership.
5. Review of the Regional Policy on Vaccine for South East Asia.
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6. Review of the last five ACHR meetings and recommendations whether
recommendations have been implemented and were possible to be implemented.
Only the recommendations that could be implemented should be considered.
7. Assess the quality of research conducted during 2008-2009 in order to ensure
the quality of research proposals and reports as well as research capacity.
8. Strengthening research capacity in Bhutan, Maldives and Timor-Leste through
countries visits for needs assessment.
The second meeting was conducted on 18 September 2009 with three outputs:
(3) Establishment of the Sub-committee of SEA-ACHR on Vaccine and Drugs
Development, including its rationale, term of reference, composition of the subcommittee, modus operandi.
(4) Immediate actions to be taken to strengthen research capacity in Bhutan,
Maldives and Timor-Leste, including:
a. The framework for country visits
b. Establishment of three teams to visit Bhutan, Maldives and Timor-Leste.
(5) Guidance on the development of regional strategy on research for health for
South East Asia at the regional and country office.
The third follow up meeting on implementation of the 31st SEA-ACHR was held on 11
May 2010. There were 3 agenda of the third follow up meeting:
1. To review the consultants reports on assessing country health research activities
for further capacity building in Bhutan, Maldives and Timor-Leste
2. To update the actions taken on the recommendation of 31st SEA-ACHR focusing
on research priorities of communicable and non-communicable diseases
3. To review and discuss on the report of quality of research implemented in 20082009 funded by WHO in SEAR countries.
Strategic follow-up actions taken
During the past two years, among 12 broad recommendations, WHO SEARO has
selected relevant and implementable six key strategic areas. Actions taken in the six key
areas will be reported and discussed in different session. The six strategic
recommendations are:
1.
2.
3.
4.
Development of regional strategy for research for health
Establishment of ACHR Subcommittee on Vaccine and Drug Development
Review of the Regional policy on research aspect of immunization
Review of the last five ACHR meetings (26th – 30th Sessions) and
recommendations.
5. Assess the quality of research supported by WHO SEARO and Country Offices
implemented in 2008-2009.
6. Strengthening research capacity in Bhutan, Maldives and Timor-Leste through
countries visits.
Most of the rest of the recommendations need continuous follow up actions. An overview
of the some activities undertaken related to each recommendation implemented in
different countries and at regional level is given below.
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1. Follow up actions on the recommendation of the thirtieth session of SEA-ACHR
(1) WHO SEARO has reminded country offices to work closely with Member Countries in
developing WHO biennial work-plans, including work plan to support research and
research capacity strengthening activities.
(2) WHO has worked with SEA Network of Medical Council Network and medical
councils at the national level in further strengthening the institutional mechanisms for
improving ethical standards including research, particularly through developing and
disseminating learning modules for teaching medical ethics in undergraduate medical
education. Several WHO Country Offices have been supporting Ethical Review
Committees in implementing ethical review to research involving human subjects.
(3) Advocacies on Ethical Review Boards (ERB) have been done by WHO staffs in
countries in their respective technical areas. SEA Network of Medical Council has
developed and disseminated modules for teaching medical student on ethics.
2. Avian influenza research
(1). There has been no systematic review of surveillance for avian influenza in the region
by WHO. The only country which continues to be severely affected in the region is
Indonesia and surveillance for AI is an ongoing issue under periodic scrutiny. Influenza
surveillance, including for AI, but in the context of the pandemic was formally reviewed
by a joint WHO / MoPH team in Thailand 5-9 October 2009.
(2). A system already exists through the WHO Global Influenza Surveillance and
Response System (GISRS- new name for GISN): there are eight National Influenza
Centres (NICs), one regional influenza reference laboratory and one global H5 reference
lab in SEAR. There is a network of National Influenza Centres in SEAR and WPR and
annual meeting is organized to share influenza information since 2007. Regional meeting
of National Influenza Centres (NIC) with emphasis on determination of drug resistance in
influenza virus was held in Bangkok in August 2010. Influenza Pandemic related meeting
in SEA Region was held in Cochin, Kerala (India) in February 2010 which was jointly
organized by SEARO and CDC Atlanta. The objectives of the meeting were to review
surveillance efforts and progress in the region as well as to discuss challenges and to
share and document lessons learned from the current H1N1 influenza pandemic.
(3)
WHO collaborates closely with FAO and OIE and there are regular ‘tripartite’
meetings under the ‘One Health’ banner – and this is precisely the kind of approach we
advocate for and support in SEAR Member States. WHO SEARO held a regional
meeting to discuss a ”Public Health Research Agenda for Influenza” in August 2010,
which included consideration of all the technical areas mentioned above.
(4)
An informal consultation was held in New Delhi from 29-30 October 2009 to
assess regional pandemic influenza vaccine production capacity and discuss possibility
of public private partnership.
3. Promotion of research and development in areas of drugs and vaccine.
(1)
Map of centres of research and development of drugs and vaccine of countries in
the region has been developed.
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(2)
Clinical trials conducted in the countries of the Region has been identified and
reviewed.
(3)
Harmonization of drug regulation in the South East Asia Region has been
initiated.
At the 14th International Conference of Drug Regulatory Authorities (ICDRA) 30
November – 3 December 2010 in Singapore, a lunchtime meeting for drug regulators
from the SEA Region was organized by RA-EDM. Regulators from all participating
countries (except India and Myanmar who were absent) attended. In the meeting
member states mentioned that they would like SEARO to facilitate more regional
meetings and training programmes for them.
In addition, mention was made of the advantages of the ASEAN pharmaceutical working
group as a useful forum for the concerned countries (Thailand, Indonesia, and Myanmar)
to collaborate and help each other. Since 1999 in ASEAN a process of harmonization
with regard to drug registration has been on-going with the lesser developed countries
with weaker Drug Regulatory Authorities (DRAs) relying on the more developed
countries with stronger DRAs.
There are already existing mechanisms within SAARC to collaborate and even fund joint
activities on health. There is no technical professional in the SAARC secretariat but they
have a Technical Committee on Health and Population which represented by health
officials from all SAARC countries. There is also a SAARC development Fund (SDF)
which may be used for harmonization of drug regulation.
Promoting rational use of medicine and containing antimicrobial resistance
(4)
WHO SEARO updated the WHO database on use of medicine in primary care in
developing and transitional countries with survey up to including in 2009. This data
provides evidence of trends in irrational use of medicines remain serious in the Region.
WHO SEARO continued to collaborate with HQ in collecting information on drug policy
from Member states through questionnaire sent to MOHs. There were surveys in 2003,
2007 and again survey is underway in 2011. Some policies being monitored are:
prescription audit in the last 2 years, national strategy to contain AMR, antibiotic nonavailability in OTC, public education on antibiotics undertaken, DTCs in more than half of
government hospitals, national drug information center for prescriber, obligatory
continuing medical education for doctors, training for medical students on EML and
STGs, national EML used in public sector procurement, national EML updated in the
past 2 years, and national STGs updated in the last 2 years.
In the area of advocacy, the following publications were done:



Three reviews on promoting rational use of medicine: The World Medicine
Situation 2011: Rational use of medicine; Combating inappropriate use of
medicines; and promoting rational use of antibiotics
Two articles on methodological lessons learned on community surveillance of
antibiotic use and antimicrobial resistance in resource constrained setting based
on pilot projects conducted in India and South Africa first published by WHO in
2009.
Five articles on various aspects of the essential medicine concept, medicine use
in children and safety.
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A number of educational programmes were supported:



Bi-regional (SEAR/WPR) training on pharmacovigilence held in New Delhi in
February 2011
Regional training on promoting rational use of medicine in the community held by
the IIHMR in Jaipur February 27 – march 10, 2011.
Regional training programme on drug and therapeutic committee to be held by
Delhi Society for Promoting Rational Use of Drugs in Delhi, November 2011.
The inter-country meeting on promoting rational use of medicines was held in SEARO
13-15 July 2010. The recommendations of the meeting included the following:




Regional resolution on promoting rational use of medicines
Countries to establish a dedicated, fully resources unit in the government to
monitor medicine use and coordinate the implementation of national policy to
promote rational use of medicine and that the unit be guided by a broad-based
steering committee involving all stakeholders
Countries to undertake a situational analysis to develop a road map for action
WHO SEARO to support countries in the above endeavors.
In September 2011, 64th Regional Committee discussed a report by secretariat and
adopted resolution SEAR/RC64/R5 on National Essential Drug Policy including the
rational use of medicines.
(6) Pharmacovigilance
Phramacovigilance has been implemented in India, Sri Lanka, Indonesia, Maldives,
Bhutan, Thailand, and Nepal.
The National Pharmacovigilance Programme in India started in 2004. This has been
revamped last year as the Pharmacovigilance Programme of India by the Central Drug
Standard Control Organization (CDSCO) under the aegis of Ministry of Health & Family
Welfare, Government of India in collaboration with Indian Pharmacopeia Commission,
Ghaziabad.
In Sri lanka the Department of Pharmacology, Faculty of Medicine, University of
Colombo in collaboration with the Ministry of Health, undertakes monitoring of adverse
drugs reactions (ADR) and providing drug information. In Indonesia, pharmacovigilance
is carried out by the pharamcovigilance unit which is coordinated by the National Agency
of Drug and Food Control (NA-DFC).
In Maldives, pharmacovigilance activities are conducted by the Medicine and
Therapeutic Goods Division (MTG) of Maldives Food and Drug Authority (MFDA) in
collaboration with Indira Gandhi Memorial Hospital (IGMH) and ADK private hospital. In
Bhutan, the National Pharmacovigilance Centre is at the Pharmacy Department, Jigme
Dorji Wangchuk National Referral Hospital (JDWNR) Hospital. Theis is coordinated by
the Drug Regulatory Authority, Royal Government of Bhutan.
The Thailand ADR monitoring Centre was set up in 1983 as part of the Thai Food and
Drug Administration. 18 centres were set up in 1992. In 1997 the activities were
expanded to cover all health products. In 2010 the focused changed from hospital based
to community based monitoring of all drug related problems. The National Centre is
known as Health Product Vigilance Cntre which is under FDA. Reporting of adverse drug
reactions (ADR) is a national program and all hospitals send reports of ADRs to this
Centre.
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The national pharmacovigilance centre in Nepal is at the Department of Drug
Administration under the Ministry of Health and Population. The programme was started
in 2004.
(7) Development of traditional medicine for the prevention and treatment of avian
influenza
There is no specific study conducted on the use of traditional medicine for prevention
and treatment of avian influenza. However, there are lessons learned from clinical
research projects combining TCM with modern medicine for prevention, treatment and
rehabilitation from SARS in China.
4. Research management in countries
In the last two years, WHO Country Offices have been working with Member countries
and partners in:
(1) Strengthening institutional capacity to report and share good practice, by
facilitating regional and global networks, and with the involvement of WHO
collaborating centres;
(2) Developing portal for digital journals in Thailand and Indonesia.
(3) Strengthen its advocacy in support of both research and the development of
robust national systems for research for health;
(4) continue to promote the development of the comprehensive systems for health
information that are necessary in order to support national research priorities;
(5) providing technical assistance to support the strengthening of national systems
for health research;
(6) Message has been conveyed to every units in SEARO and country offices that
funds provided for carrying out a research project should include provisions for
publication of good quality papers.
5. Research management in WHO/SEARO
(1) All research proposals to be funded by WHO SEARO had been reviewed by
Research review Committee. Similar mechanism has been implemented in most of WHO
country offices as well.
(2) WHO Country Offices have been supporting medical research council/ health
research council to strengthen their capacity in research management, including in
coordinating all research being carried out in the country .
(3) WHO SEARO has developed digital library.
6. Research priorities in communicable diseases
(1) Assist Member countries in identifying research priorities in communicable diseases.

South-East Asia Regional Conference on epidemiology held in New
Delhi 8-10 March 2010. Representatives from Member countries
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participated. Participants remarked that they all benefited by attending
the conference.

Research Methodology workshop was organized and Bangladesh,
Bhutan, Maldives, India, Indonesia from the Region Participates.

Informal Consultation on Research to assess the impact of climate
change on communicable diseases was organised at SEARO from 15
to 17 September 2010. Participants from Bangladesh, Bhutan, India,
Indonesia, Maldives, Nepal, Sri Lanka and Thailand attended the
consultation and learnt develop appropriate research protocol in
relation to climate change impact on communicable diseases. They
were exposed to retrospective and prospective study protocols.

Regional meeting of the WHO Collaborating Centres (WHO CC)on
Communicable Diseases was held in New Delhi from 2 to 4 June
2010. During the meeting emphasis was given for formation of a net
work amongst WHO CCs for strengthening research capacity. Two
institutes in India were identified to initiate the networking
(2) Eight small research grants have been funded each amounting to US$ 7500 from
SEARO/CDS funds.
7. Research priorities in non communicable diseases
(1) Intersectoral collaboration among various programmes is being solicited at the
regional and country levels. In March 2011, a regional meeting was organised
involving multiple stakeholders and partner agenecies to discuss health and
social challenges of NCDs and mechanisms to address these. As a follow-up to
the Jakarta meeting, 9 out of 11 MS have conducted national level multisecotral
advocacy meetings during July-September 2011 to raise the priority of NCDs at
the country level as well as to sensitize stakeholders about the importance
of different sectors in the prevention and control of NCDs.
(2) Surveillance for NCD risk factors have been carried out in 10 out of 11 countries
in the REgion. SEARO is providing technical and partial financial support for at
the country level for designing protocols and questionnaires, capacity building
and dissemination of survey findings.
(3) Cost effective interventions for NCD prevention and control have been identified
globally; studies will be planned in the next biennium to validate the efficiency
and feasibility of these measures.
(4) SEARO has conducted several awareness activities in 2011 including regional
and country level meetings, updating of website, preparation of FAQs and fact
sheet and advocacy dockets as well as development of human interest stories on
NCDs.
7. The overall recommendations
(1) Report of the WHO 31st Session SEA-ACHR has been developed and distributed
to all WHO Country Offices, all Departments within SEARO, and all relevant units
in WHO HQ.
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(2) WHO SEARO has instructed WHO Representatives to use of the WHO Regular
Budget (Assessed Contribution) and Voluntary Contribution to support research
activities in line with national research priorities.
(3) WHO SEARO has organized workshops on to technically support Member
Countries in developing proposal to GAVI and Global fund, including research in
priority areas. WHO Country Offices has provided technical support to Member
Countries in the proposal development.
(4) Research focal points in WHO Country Offices have been working with national
stewardship mechanisms, e.g. National Health Research Council / NIHRD
(5) The Regional Office has developed research management modules and
conducted workshops on health research management in most of the countries.
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