UK aid contributes positively to global health with results such as the Oxford COVID-19 vaccine, but more focus on achieving impact is needed

16 Jul 2024

• Global health research and innovation funded by DHSC is largely relevant and effective, ICAI finds.
• However, the department should focus more on enhancing and tracking the impact of research projects.
• The principle of equitable partnership between high- and low- and middle-income countries should be central to all aspects of the work.
• DHSC needs to untie its aid, giving researchers in low- and middle-income countries the choice of partners from around the world, not only the UK.
• DHSC should also take a more strategic approach to strengthening research capacity in low- and middle-income countries.

Research funded by UK aid has helped to improve healthcare around the world, but the government should pay more attention to enhancing and measuring impact, the aid watchdog reports today (Tuesday 16 July).

Between 2018-19 and 2024-25, the Department of Health and Social Care (DHSC) will have spent almost £1 billion of UK aid on global health research and innovation – an area that grew significantly in scale and importance during the COVID-19 pandemic when it contributed to the development of the Oxford vaccine.

The review by the Independent Commission for Aid Impact (ICAI) defines global health research as that aiming to advance knowledge and innovation to improve health outcomes and achieve health equity globally, centred on health problems and solutions in low- and middle-income countries (LMICs) where the burden of ill health is highest.

It looks at the relevance of DHSC’s strategy and approach to global health research and the effectiveness of its programming. It also assesses how well the department is learning and adapting its global health research portfolios.

ICAI’s country case studies and direct consultation with people most affected in Malawi, India and Brazil confirmed that the research projects funded by DHSC are generally relevant to the health challenges experienced in low- and middle-income countries (LMICs), including issues that can be stigmatised or underfunded such as skin diseases and mental health.

However, the review found that DHSC was not always focusing on research which could drive the greatest impact, such as evidence synthesis, and reporting of results to ensure accountability for research impact was weak, considering the scale of the department’s official development assistance (ODA) spending.

The review also found that although LMIC research institutions are now able to apply to lead aid-funded projects, few have been successful. If its aid is to be most effective, ICAI said DHSC needs to ensure it is ‘untied’ – removing limitations to the countries in which aid can be spent so that researchers in LMICs can choose the best partners rather than only those from the UK.

Dr Tamsyn Barton, former ICAI Chief Commissioner who led the review, said:

“We were pleased to see the positive difference UK aid is making to global health research and innovation, especially in areas that have been underfunded or subject to stigma such as mental health.

“We recommend that the Department of Health and Social Care should now focus on increasing the impact of its work, embedding the principle of equitable partnership between high and lower-income countries, and untying its aid to get the best science and value for money so people around the world can benefit.”

In 2023, DHSC’s ODA spend was the third largest of all government departments, after the Foreign, Commonwealth and Development Office (FCDO) and the Home Office.

ICAI found that DHSC’s programming aligns well with UK government strategies related to global health research, which prioritise economic and trade objectives alongside resilience to health threats such as pandemics.

The department also takes account of global stakeholder and expert views when scoping new areas of programming, including through an Independent Scientific Advisory Group that has strong LMIC expert participation. However, ICAI found input from LMIC governments and organisations to DHSC’s strategic approach and priority-setting was limited, and recommended that its principle of equitable partnership should be embedded in all aspects of the work.

Stigmatised or underfunded issues were also found to be benefiting from UK aid in the case study countries – for example, ICAI engaged with researchers working on cutaneous leishmaniasis (a skin condition that can cause serious disability) in Brazil, LGBTQIA+ wellbeing in India, and multi-morbidity (the presence of two or more long-term health conditions) in Malawi.

However, until recently, most of DHSC’s global health research programmes required projects to be led by UK institutions. While most schemes are now opening calls to LMIC proposals, few LMIC applicants have been selected, even for projects that need no science and innovation infrastructure, the review found. It also said that in most cases LMIC researchers had to choose partners in the UK rather than wherever the best scientific expertise was to be found, going against the principle of ‘aid untying’.

Until late 2020, the National Institute for Health and Care Research (NIHR), which oversees some awards from the global health research portfolio, was unable to issue contracts to non-UK entities. ICAI noted that NIHR appeared comfortable with UK institutions being the only high-income country participants engaged through its programming.

ICAI also recommends that DHSC take a more strategic approach to strengthening the capacity of research institutions and systems in low- and middle-income countries.

On learning, ICAI found that formal monitoring and evaluation mechanisms are not yet used consistently across DHSC’s portfolios, and the department has been slow to complete and publish programme-level annual reviews. However, the review found good evidence that, where evaluations have been conducted, findings were being used to support learning and improvement.

The review also noted that UK embassies and FCDO health advisers did not have access to accurate information about DHSC-funded research projects in partner countries, and the two departments should ensure more country ownership by collaborating.

ICAI makes the following recommendations:

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.

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.

Recommendation 3: DHSC should progressively untie its aid for global health research, to ensure value for money and to allow low- and middle-income country researchers to identify the most appropriate partners for their projects.

Recommendation 4: DHSC should purposively collaborate with FCDO to strengthen UK health ODA coherence and alignment to partner country needs and priorities.

Recommendation 5: DHSC and NIHR should take a more strategic approach towards institutional and system level capacity strengthening in low- and middle-income countries, and develop metrics to track plausible contributions in these areas.