From responding to evidence gaps to setting research priorities
How did the R2HC start?
In 2011, the UK government’s Humanitarian Emergency Response Review called for a stronger scientific evidence base for emergency responses. The report noted that there was a limited evidence base on the effectiveness of interventions to improve humanitarian public health, steered by only a few guidelines and handbooks for practitioners. Recognising this gap, the Department for International Development (DFID) now the Foreign Commonwealth & Development Office (FCDO) and Wellcome partnered with Elrha in 2013 to establish Research for Health in Humanitarian Crises (R2HC). The programme’s main purpose was to increase the evidence base for public health response in humanitarian crises.
Documenting peer-reviewed evidence
One of R2HC’s first tasks was to commission a comprehensive review of the existing evidence informing humanitarian decision making on public health interventions.
Published in 2015, the Humanitarian Health Evidence Review (HHER) provided the first rigorous assessment of existing peer-reviewed evidence informing humanitarian public health programming. The Review looked at literature from the previous 30 years in multiple areas, including communicable and non-communicable disease (NCD), maternal and child health, water, sanitation and hygiene (WASH), sexual and reproductive health, nutrition, mental health and psychosocial support (MHPSS), injury and rehabilitation, and health systems and services. In 2020, we commissioned an update to assess changes to the evidence base since 2013. A substantial increase in humanitarian health intervention research was identified across nine topic areas. WASH and NCDs were found to have the most limited evidence base on intervention effectiveness in both reviews.
Findings from the HHERs reinforced the need for an improved humanitarian health evidence base, and justified the foresight of our donors in establishing R2HC as a mechanism focused on funding humanitarian health research. Using the HHER as a reference, applicants to our annual open research calls have aligned the topics and focus of their research questions with identified evidence gaps. More than 60 studies addressing priority evidence needs have been funded, and the evidence of impact for a selection of them has been documented in our impact case studies, shared earlier this year. A further 35 studies have been conducted through our rapid research calls, focusing primarily on Ebola and COVID-19.
From evidence reviews to research priority setting
Whilst the HHERs provided a valuable ‘baseline’ of rigorously tested evidence, the evidence gaps within and between each thematic area were still very broad. We needed a more nuanced understanding of priority research questions by thematic area.
Since 2019 we have supported research priority settings in selected areas: MHPSS, WASH and cardio-metabolic syndrome as a critical NCD (currently underway). Using an adapted Child Health and Nutrition Research Initiative (CHNRI) methodology, contributions have been sought from humanitarian practitioners, academics and key stakeholders from local and global levels in each thematic area, to identify specific research priorities and key questions that need answering.
The resulting research agendas are intended to guide humanitarian practitioners and academics who want to improve humanitarian interventions through research. We will use them – alongside priority research agendas generated by others in different thematic areas – to help define the focus of thematic research calls which we plan to fund in future years. These research agendas will be used to steer the focus of calls for proposals and support application reviews by our Funding Committee. They will ensure that proposed research questions address critical evidence gaps identified by humanitarian practitioners, who are in most need of better evidence to support our collective goal of improving health outcomes for people affected by humanitarian crises.
