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This paper, published in the Bulletin of the World Health Organization, argues that in most low- and middle-income countries, foreign-funded initiatives determine national health research agendas, even in countries in which governments contribute substantially to supporting national health research systems, institutions and personnel.

As a result of the above challenges, the authors argue that research activities in many low- and middle-income countries reflect more closely foreign and global health research priorities than the research needs of the countries in which research is being conducted. Externally funded research is virtually monopolised by HIV and AIDS, tuberculosis and malaria, with little if any funding or research capacity left to deal with other diseases, conditions or the improvement of health systems, let alone for research with a more expanded goal of social and economic development (i.e.“research for health”).

The authors call upon countries to take responsibility to put in place and resource a basic national health research system that provides mechanisms for research governance, identifies national priorities and formulates and implements a policy framework to enhance the effectiveness of the national research effort. Also, they conclude that national health information systems and national health research systems are key tools in generating the evidence needed to guide health and health system improvement in low- and middle-income countries, just as they are in high-income countries.

Aware that vertical programmes cannot conduct their research in isolation from national contexts, the authors recommend that the research activities must – as a minimum – align with, rather than fragment, national research system needs. Additionally, they call for increased investment in equitable partnerships that strengthen the capacities of national researchers, research institutions and research systems.

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