ICAI follow-up: The UK Department of Health and Social Care’s aid-funded global health research and innovation

Introduction

The Independent Commission for Aid Impact (ICAI) review, The UK Department of Health and Social Care’s aid-funded global health research and innovation (2024), scrutinised aid spending on global health research and innovation programmes, from 2018 onwards. It examined Department of Health and Social Care (DHSC) strategies, policies and guidance, reviewed sampled programmes, conducted country case studies of Brazil, India and Malawi, and consulted with people likely to be affected by UK aid-funded global health research in order to assess how well the UK’s approach to research and innovation improved health outcomes in low- and middle-income countries (LMICs).

The review found that DHSC was funding relevant and effective global health research and innovation and was working to enhance LMIC leadership of research projects, but needed to increase attention to impact and fully embed equitable research practices, including taking steps to align with partner country priorities, build institutional capacity and fully ‘untie’ aid – meaning removing restrictions that require aid to be spent on goods and services from the donor country.

Recommendations

The review made five recommendations:

Assessment of progress

ICAI has taken a tailored approach to following up on reviews from 2023-24. We wrote to DHSC in March 2026 to request a formal update on each of the recommendations made in the July 2024 review, detailing progress since the publication of the government’s initial response in September 2024. We have published the government’s own assessment of progress on our website. ICAI also requested accompanying evidence of progress, which we have reviewed.

DHSC published a comprehensive set of actions in its initial response to the review recommendations.  ICAI has seen clear evidence that these actions have been implemented and that DHSC has made credible progress against all five of the review recommendations.

ICAI has seen strong evidence that DHSC has strengthened its focus on impact across its global health research and innovation portfolios. It has increased its dedicated Monitoring, Evaluation and Learning (MEL) capacity and refreshed its MEL strategy, with updated theories of change and results frameworks, drawing on stakeholder consultation and learning from across government and other research funders.  This provides a foundation for improved impact measurement in line with international good practice in global health research. However, we note that DHSC’s plans to review its role in evidence synthesis were paused following the official development assistance (ODA) budget reductions. ICAI views evidence synthesis as more important when funding is constrained, and we urge DHSC to keep this under review.

DHSC has taken steps to ensure that the principle of equitable partnership is further embedded in its approach. For example, it has revised and published its approach to equitable partnerships, adopting the UK Collaborative on Development Research (UKCDR) definition.  It has introduced a new awards management system for all domestic and GHR schemes, to reduce the administrative burden for LMIC applicants or award holders. While it is too soon to see how this translates into grant awards, DHSC has a monitoring framework in place that will, in due course, allow it to assess whether these actions result in improved funding success rates or influence over decision-making by LMIC partners.

ICAI saw evidence of progress on our recommendation that DHSC should progressively untie its aid.  DHSC has reviewed its position and reaffirmed its commitment to the principle of untied aid. National Institute for Health and Care Research (NIHR) Global Health Research applications can be led by LMIC institutions, or UK institutions in partnership with LMIC institutions, who can freely choose their collaborators based on expertise and best science. However, one limited UK Vaccine Network scheme designed to connect UK vaccine-manufacturing innovation ecosystems with LMICs for technology transfer maintains a UK lead. DHSC has told us that it plans to review this requirement in the future and considers the assistance meets the OECD Development Assistance Committee requirements for reporting ODA. Nonetheless, untying all ODA and ensuring the right balance between primary and secondary benefits requires continued leadership focus.

ICAI saw good evidence of DHSC engagement to support improved cross-government collaboration, including with the Foreign, Commonwealth and Development Office (FCDO). DHSC reports that the ODA Ministerial Board for Delivery and Impact has facilitated a joined-up approach on ODA-funded research and development, with global health being highlighted as an area of good practice.  Senior officials meet regularly to share information, ensure complementarity and promote collaboration, for example sharing new calls for awards through the FCDO’s networks.  To improve data quality, joint efforts between DHSC, FCDO and other key stakeholders have been made to enhance UK-wide mapping of ODA research through the expansion of a public data dashboard, Mapping ODA Research and Innovation (MODARI). Work on outcome data is in progress, and we are pleased to see that DHSC has achieved a ‘green’ rating in the 2025 UK Aid Transparency Review.

We saw strong evidence of DHSC engaging and gathering insights on research priorities and capacity strengthening from LMIC stakeholders through various touchpoints, with the goal of increasing alignment on LMIC priorities. ICAI also saw good evidence that DHSC, through the NIHR, has continued to invest in research capacity strengthening (RCS), targeting both the individual and institutional level, with system-level benefits expected over time. Updated results indicators should help to increase the focus on RCS. DHSC has engaged with stakeholders to learn from best practices in RCS and better understand NIHR’s unique value in the RCS funding landscape.

Overall, ICAI was encouraged to see that DHSC has made clear progress in implementing the actions it outlined in its response to ICAI’s recommendations. We acknowledge that it will take some time for actions to translate into outcome- and impact-level changes and agree with DHSC that the work it has done to improve MEL has been strong, including the development of a new value for money framework, which will also position DHSC well to assess future impact. The department reports that the recent sharp reduction to its ODA allocation for global health research and innovation has meant an increased focus in the portfolio. Maintaining momentum on progress to date will be key, as ODA reduces and research is expected to be even more responsive to partner priorities.