Corporate report

Government response to the Independent Commission for Aid Impact recommendations on ‘The UK Department of Health and Social Care’s aid-funded global health research and innovation’, July 2024

Published 10 September 2024

Introduction

The Department of Health and Social Care (DHSC) welcomes the Independent Commission for Aid Impact’s (ICAI) review of our aid-funded health research and innovation.

As part of a cross-government approach to international development, DHSC has delivered a targeted portfolio of global health research since 2016. Across the global health research (GHR) and global health security (GHS) portfolios in the period reviewed (between the 2018 to 2019 financial year and the 2024 to 2025 financial year), DHSC has invested £974.5 million into the global life sciences sector. Our Official Development Assistance (ODA) funded health research and innovation portfolio prepares low and middle income countries (LMICs) to address health threats and the rising tide of non-communicable diseases.

Health research contributes to better health directly, through improvements to the way disease, illness and injury are prevented and managed. It also strengthens economic performance through its contributions to a healthier and more productive workforce. This report illustrates how DHSC’s activity delivers positive health and economic outcomes where they are needed most and is designed to complement wider UK aid investments by the Foreign, Commonwealth and Development Office (FCDO), UK Research and Innovation and other strategic funders.

We welcome ICAI’s findings and fully accept the report’s recommendations, noting that we are already making good progress in implementing many of these recommendations.

We particularly welcome ICAI’s recognition that DHSC’s ODA funds relevant and effective global health research and innovation and is working to enhance LMIC leadership of research. We are also pleased ICAI cites many examples of effective research projects, such as:

• the Oxford COVID-19 vaccine
• research on traditionally underfunded areas, such as addressing severe stigmatising skin diseases in East African populations
• a cognitive therapy-based intervention for perinatal depression in Pakistan, cited in Nature Medicine as one of “11 clinical trials that will shape medicine in 2024”

Since the end of the review period, we have already implemented actions supporting ICAI’s recommendations, for example, launching:

• a streamlined structure for National Institute for Health and Care Research (NIHR) programmes, providing annual funding opportunities that give applicants predictability and enhance equitable partnerships
• new LMIC-only NIHR GHR Development Awards, with annual funding opportunities
• a new Global AMR Innovation Fund (GAMRIF) project with the Centre for Cellular and Molecular Platforms in India. This is GAMRIF’s first LMIC-based primary delivery partner and will contribute to India’s life sciences sector

Our responses to ICAI’s recommendations are below.

Recommendation 1

DHSC should focus on pathways to impact across its global health research portfolios, including by strengthening guidance for potential applicants and putting in place mechanisms for planning and measuring impact.

Response: accept

As DHSC’s ODA funded global health research and innovation portfolio matures, we agree now is the appropriate time to strengthen our focus on pathways to impact and considerations of how best to achieve this.

We recognise that strategies for research uptake and pathways to impact need to be considered and embedded in project design. We are already working with NIHR and delivery partners to enhance our approach to gathering and publishing impact case studies from across our portfolio.

By spring 2025 we will:

• work with colleagues at FCDO and other funders to draw learnings on best practice on tracking impact in research
• recruit a new monitoring, evaluation and learning (MEL) lead who will work to refresh and strengthen our overarching MEL strategy and programme-level theories of change, with an emphasis on learning from other funders, including FCDO, to better track outcome and impact level changes
• work with stakeholders to review GHR’s role in evidence synthesis to maximise research uptake and translation into use
• review, and refine where needed, guidance provided to NIHR funding applicants and awardees, and guidance to funding committee members. This will enable better planning, identification, tracking and scrutiny of their pathways to impact
• publish appropriate impact case stories on our website

Recommendation 2

DHSC should ensure that its principle of equitable partnership is embedded and tracked across all areas of activity related to its global health research portfolios, including research funding, knowledge translation, learning, programme monitoring and evaluation.

Response: accept

We understand empowering partners in LMICs increases development impact and strengthens research capacity and we are proud of recent efforts to progress in this area (see also recommendation 3).

We continue to focus on ‘levelling the playing field’ for LMIC researchers to submit competitive applications. For example, since the ICAI review, we have launched NIHR GHR Development Awards, which provide finance to LMIC applicants to increase the competitiveness of their global health research proposals. In addition, GAMRIF and the UK Vaccine Network (UKVN) have set up opportunities for collaboration for delivery partners to improve LMIC applicants’ success rate to our programmes, through sharing best practice and feedback on writing applications.

We plan to strengthen our approach to equitable partnerships yet further, with an emphasis on ensuring LMIC partner parity in access to funding.

By spring 2025, we will:

• undertake a consultation with LMIC applicants to better understand the award holder experience and review our internal assurance processes. We recognise that administration and reporting processes are a barrier for some LMIC researchers and institutions. This consultation will be used to consider options for improvements in our commissioning and monitoring systems that strike an appropriate balance between assurance and burden on the award holder (see also recommendation 5)
• revisit and publish our approach to defining and approaching equitable partnerships across our whole portfolio
• review our results indicators with a focus on capacity strengthening
• review our approach to community engagement and involvement, strengthening engagement with LMIC communities and policy makers throughout the full research and innovation delivery cycle, where appropriate

Recommendation 3

DHSC should progressively untie its aid for global health research, to ensure value for money and to allow LMIC researchers to identify the most appropriate partners for their projects.

Response: accept

In line with the UK’s International Development Act 2002, DHSC remains wholly committed to the principle of untied aid and ensuring maximum benefit for ODA-eligible countries. We have been progressively untying our ODA-funded research and innovation programmes as the portfolio evolves from set-up to maturity and are delighted to announce that in May 2024 (following the completion of this review) we were able to remove the requirement for NIHR Global Health Research awards to be administered by a UK-based partner. As a result, all NIHR Global Health Research applications can now be led by LMIC institutions who can freely choose their collaborators based on expertise and best fit rather than geographical location, including partners from high-income countries.

By spring 2025, we will continue to review and evolve our approach in line with our commitment to the principle of untied aid as we look ahead. We will do so with a constant eye to ensuring we commission the best science and value for money, making sure we deliver maximum impact for LMIC health systems and populations.

Recommendation 4

DHSC should purposively collaborate with FCDO to strengthen UK health ODA coherence and alignment to partner country needs and priorities.

Response: accept

DHSC and FCDO’s health ODA research relationship is the strongest it’s ever been. We are committed to working more closely together in areas such as clinical trials.

We recently worked with Bangladesh Science and Innovation Network (SIN) advisers in FCDO, where an NIHR cohort held their first annual symposium. These SIN advisers continue to champion locally relevant DHSC-funded health research opportunities to ministers and stakeholders, aiming to increase evidence uptake into policy. For the UKVN-funded UK-Southeast Asia Vaccine Manufacturing Research Hub, DHSC collaboration with FCDO was instrumental in understanding regional context and enabling engagement with the Association of Southeast Asian Nations secretariat. We intend to replicate these relationships across our portfolios where appropriate. 

DHSC and FCDO will further deepen collaborative efforts, making full use of FCDO’s overseas network to strengthen UK health ODA coherence and alignment to partner country needs and priorities.

By 2025, we will:

• map and communicate UK government-funded global health research opportunities, outputs and outcomes, including through engagement with the FCDO’s regional research hubs, the SIN, health advisers and other staff in LMICs. This includes protecting staff resources to ensure accurate information about DHSC’s ODA-funded research projects through DevTracker and Mapping ODA research and innovation platform (MODARI)
• strengthen our understanding of LMIC research priorities in line with LMIC government ambitions and the sustainable development goals. This will be supported by improving our cross-government coherence and strengthening the impact of our health research ODA offer through regular meetings, joint reviews and communications and country-level consultations
• engage with relevant stakeholders to ensure that LMIC priorities inform our research calls to improve uptake and impact
• continue to ensure appropriate LMIC representation on our funding committees and advisory boards and strengthen guidance and monitoring of pathways to research uptake and impact (see recommendation 1)

Recommendation 5

DHSC and NIHR should take a more strategic approach towards institutional and system-level capacity strengthening in LMICs, and develop metrics to track plausible contributions in these areas.

Response: accept

DHSC recognises the importance of capacity strengthening across the whole LMIC health research system. We note the importance of a partnership approach to strengthening LMIC research capacity at the individual, institutional and system level.

Mirroring NIHR’s domestic expertise, we play a vital role in research system capacity building. We do this through:

• individual development awards
• collaborative research programme awards (for example, through the Research on Interventions for Global Health Transformation programme)
• investment into institutional capacity strengthening through dedicated schemes such as the NIHR Global Health Research Centres or the NIHR Financial Assurance Fund
• funding appropriate project management, finance, monitoring and learning staff to strengthen institutions (see recommendations 2 and 3)

Our consortium approach brings together researchers from different disciplines and institutions, further supporting system capacity strengthening.

Together, these build critical mass in LMICs and strengthen research culture and impact. 

Since the conclusion of the review in May 2024, all NIHR global health research projects can be led by researchers in LMICs, contributing to research leadership capacity building. A successful system approach is best achieved through close collaboration with partners each contributing their key strengths.

By spring 2025, we will:

• consider how we can more clearly articulate our offer on research capacity strengthening and how we work with others in this area
• explore opportunities with partners to complement wider capacity strengthening activities, maximising the value and impact of UK government ODA investments
• gather good practice examples and learning on effective strategic approaches to institutional and system-level research capacity strengthening in LMICs, replicating lessons learned from the UK Public Health Rapid Support Team across the portfolio where appropriate, and through engagement with other funders and beyond
• review our guidance and training to support research management capability, which underpins wider research system capacity
• review our strategic priorities for our ODA spend going forward