Research in primary health

17 – 19 March 2016 | Dubai, UAE
Research in Primary Health Care
Professor Faisal AbdulLatif Alnasir
FPC, FRCGP, MICGP, FFPH, PhD
Chairman; Dept. of Family & Community Medicine
Arabian Gulf University. Bahrain
Former President; Scientific Council Family & Com. Medicine
Arab Board for Medical Specializations
General Secretary: Inter. Society for the History of Islamic Medicine
Faisal Alnasir 2006 1

‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬
‫اقرأ‬‫ذي‬َّ‫ل‬‫ا‬ َ‫ك‬ِ‫رب‬ ِ‫باسم‬‫ق‬َ‫ل‬‫خ‬‫من‬ َ‫اإلنسان‬ َ‫ق‬َ‫ل‬‫خ‬َ‫ل‬‫ع‬‫ق‬َ‫ك‬ُّ‫ب‬‫ور‬ ‫اقرأ‬
‫األكرم‬َ‫م‬َّ‫ل‬‫ع‬ ‫ذي‬َّ‫ل‬‫ا‬‫م‬َ‫ل‬‫بالق‬‫لم‬ ‫ما‬ َ‫اإلنسان‬ ‫م‬َّ‫ل‬‫ع‬‫يعل‬‫م‬
‫العظيم‬ ‫هللا‬ ‫صدق‬
(‫العلق‬96)
‫اول‬‫أمر‬‫إلهي‬‫لإلنسان‬{‫اقرأ‬}ِ‫ق‬ْ‫ر‬َ‫ط‬‫ل‬‫أبواب‬‫العلم‬،‫والمعرفة‬َّ‫م‬‫ث‬‫الكت‬‫ابة‬
‫بالقلم‬‫تنبيها‬‫وإشارة‬‫إلى‬‫أن‬‫حضارة‬‫اإلسالم‬‫لن‬‫بنى‬ُ‫ت‬‫إال‬،‫بالعلم‬‫و‬‫عماد‬‫العلم‬
‫البشري‬‫القراءة‬‫والكتابة‬.

What, Why is Research
Our life is a continuous process
of search and re---search

It always starts with a question
????

Research:
The systematic inve
stigation into and
study of materials
and sources in
order to establish
facts and reach
new conclusions
The Oxford Dictionary

Physician
Educator
(Teacher)
Researcher
Doctor’s Role

Evidence emerged that
the greatest potential
for improving
population health can
be found in the
application of simple
research principles
even in the most
under-developed and
under-resourced health
care systems.
Sant’Ana AM et al 2002, Isaakidis P, et al 2002Faisal Alnasir 2006 7

The presentation will cover:
• A global overview about amount of
research
• Why research in PHC
• Benefits of research in PHC
• Challenges for research in PHC

The real rate of
growth of
scientific
publication
globally is 8-9%
each year.
i.e. Doubling
every nine years.
Bibliometric analysts Lutz Bornmann, at the Max
Planck Society in Munich, Germany and Ruediger
Mutz, at the Swiss Federal Institute of Technology in
Zurich

Essential Science Indicators at Thomson Reuters
(http://sciencewatch.com/dr/cou/2009/09decALL/).

Country Population GDP(Million USD) Papers
Papers Per
Capita*1000
GDP/Paper
Switzerland 7,997,000 631,183 21,372 2.673 29.533
Denmark 5,590,000 314,889 11,787 2.109 26.715
Sweden 9,517,000 523,804 18,645 1.959 28.094
Norway 5,019,000 499,667 9,207 1.834 54.27
Netherlands 16,770,000 770,067 29,296 1.747 26.286
Australia 22,680,000 1,564,419 38,607 1.702 40.522
Finland 5,414,000 247,389 9,207 1.701 26.87
Singapore 5,312,000 276,520 8,768 1.651 31.537
New Zealand 4,433,000 171,256 6,805 1.535 25.166
Belgium 11,140,000 483,402 16,111 1.446 30.004
Canada 34,880,000 1,821,445 49,947 1.432 36.468
United Kingdom 63,230,000 2,417,600 90,018 1.424 26.857
Ireland 4,589,000 210,638 6,429 1.401 32.764
Israel 7,908,000 241,069 10,492 1.327 22.976
Austria 8,462,000 394,458 11,011 1.301 35.824
Taiwan 23,340,000 474,149 24,255 1.039 19.549
Germany 81,890,000 3,425,956 82,550 1.008 41.502
United States 313,900,000 16,244,600 310,206 0.988 52.367
Spain 47,270,000 1,322,126 43,300 0.916 30.534
France 65,700,000 2,611,221 57,751 0.879 45.215
Portugal 10,530,000 212,139 9,034 0.858 23.482
Greece 11,280,000 248,941 9,451 0.838 26.34
South Korea 50,000,000 1,129,598 39,285 0.786 28.754
Italy 60,920,000 2,013,392 47,403 0.778 42.474
Czech Republic 10,510,000 196,446 8,163 0.777 24.065
Japan 127,600,000 5,960,180 68,308 0.535 87.254
Poland 38,540,000 489,852 17,186 0.446 28.503
Turkey 74,000,000 788,299 19,753 0.267 39.908
Romania 21,330,000 169,396 5,240 0.246 32.327
Iran 76,420,000 551,588 17,598 0.23 31.344
Malaysia 29,240,000 304,726 6,565 0.225 46.417
Argentina 41,090,000 477,028 6,766 0.165 70.504
Russia 143,500,000 2,029,812 22,926 0.16 88.538
Brazil 198,700,000 2,254,109 27,808 0.14 81.06
South Africa 51,190,000 384,313 6,988 0.137 54.996
PR China 1,351,000,000 8,358,400 142,645 0.106 58.596
Thailand 66,790,000 385,694 5,190 0.078 74.315
Mexico 120,800,000 1,183,655 8,626 0.071 137.219
Egypt 80,720,000 254,671 5,592 0.069 45.542
India 1,237,000,000 1,875,213 39,640 0.032 47.306
Top 40
Countries
by the
number of
scientific
Papers
published

www.reddit.com/r/dataisbeautiful/comments/20k5dk/top_40_countries_by_the_number_of_scientificFaisal Alnasir 2006 13

http://unesdoc.unesco.org/images/0018/001898/189883E.pdf

Rank Country/Region
Expenditures on R&D % Of GDP
PPP
Expenditures on R&D
per capita
(billions of US$, PPP), (US$ PPP)
1 United States 473.4 2.74% 1,442.51
3 China 370.1 2.05% 270.56
4 Japan 170.8 3.58% 1,344.31
5 Germany 106.5 2.84% 1,313.46
6 South Korea 91.6 4.29% 1,518.47
7 France 58.4 2.26% 914.54
8 India 47.9 0.82% 39.37
9 UK 43.7 1.70% 677.44
10 Russia 42.6 1.19% 290.21
22 Israel 11.2 4.11% 1,361.56
47 Egypt 6.2 0.68% 73.18
73 UAE 2.5 0.49% 288.69
41 KSA 1.8 0.25% 60.01
74 Qatar 1.3 0.47% 698.5
79 Kuwait 0.83 0.30% 214.16
54 Iran 0.70 0.12% 9.08
81 Oman 0.26 0.17% 73.66
64 Algeria 0.16 0.07% 4.13
82 Bahrain 0.02 0.04% 18.83
List of
Countries
by
Research
and
Develop-
ment
Spending
2012-2014
World Bank. Retrieved 2016-02-09
PPP: Purchasing Power Parit

Rank Country/Region
Expenditures on R&D
% Of GDP PPP
Expenditures on
R&D per capita
6 South Korea 91.6 4.29% 1,518.47
22 Israel 11.2 4.11% 1,361.56
4 Japan 170.8 3.58% 1,344.31
5 Germany 106.5 2.84% 1,313.46
1 United States 473.4 2.74% 1,442.51
7 France 58.4 2.26% 914.54
3 China 370.1 2.05% 270.56
9 UK 43.7 1.70% 677.44
10 Russia 42.6 1.19% 290.21
8 India 47.9 0.82% 39.37
47 Egypt 6.2 0.68% 73.18
73 UAE 2.5 0.49% 288.69
74 Qatar 1.3 0.47% 698.5
79 Kuwait 0.83 0.30% 214.16
41 KSA 1.8 0.25% 60.01
81 Oman 0.26 0.17% 73.66
54 Iran 0.7 0.12% 9.08
64 Algeria 0.16 0.07% 4.13
82 Bahrain 0.02 0.04% 18.83
List of
Countries
by
Research
and
Develop-
ment
Spending
2012-2014
PPP: Purchasing Power Parity

Rank Country/Region
Expenditures on R&D
% Of GDP PPP
Expenditures on R&D per
capita
6 South Korea 91.6 4.29% 1,518.47
1 United States 473.4 2.74% 1,442.51
22 Israel 11.2 4.11% 1,361.56
4 Japan 170.8 3.58% 1,344.31
5 Germany 106.5 2.84% 1,313.46
7 France 58.4 2.26% 914.54
9 UK 43.7 1.70% 677.44
10 Russia 42.6 1.19% 290.21
3 China 370.1 2.05% 270.56
8 India 47.9 0.82% 39.37
74 Qatar 1.3 0.47% 698.50
73 UAE 2.5 0.49% 288.69
79 Kuwait 0.83 0.30% 214.16
81 Oman 0.26 0.17% 73.66
47 Egypt 6.2 0.68% 73.18
41 KSA 1.8 0.25% 60.01
82 Bahrain 0.02 0.04% 18.83
54 Iran 0.7 0.12% 9.08
64 Algeria 0.16 0.07% 4.13
List of
Countries
by
Research
and
Develop-
ment
Spending
2012-2014
PPP: Purchasing Power Parity

http://www.ub.edu/LinkingMedGulf/docs/kickoff_meeting/scientific_research.pdf

Scientific research & higher education in the Arab world
Dr. Sultan T. Abu-Orabi Secretary General 1 Association of Arab UniversitiesFaisal Alnasir 2006 19

scientific research & higher education in the Arab world
Dr. Sultan T. Abu-Orabi Secretary General .Association of Arab Universities
Arab countries
No. of publication / million inhabitants (2008)

Number of
researchers / million is
450 in Arab
Countries, versus
5000 / million in the
developed countries.
SCIENTIFIC RESEARCH & HIGHER EDUCATION IN THE Arab WORLD Dr.
Sultan T. Abu-Orabi Secretary General 1 Association of Arab Universities

scientific research & higher education in the Arab world
dr. sultan t. abu-orabi secretary general 1 association of Arab universities

In the USA:
National institute of health
(NIH) spends 80% of its
budget (33.1 Billion in 2016)
on external research by:
funding >300000
researchers at >2500
universities, medical
schools, hospitals, research
institutions in USA and
around the world.
It reviews annually 50,000
research and training
applications. The national institute of health (NIH) in USA, 2000
http://www.nih.gov/about-nih/what-we-do/budgetFaisal Alnasir 2006 24

Research in PHC

PHC has a generalist nature, and several
research approaches are therefore required
to understand the complex interplay between
medical and psychosocial factors in the
discipline.
Paul Thomas et al 2001 BMJ
PHC research is the missing link in the
development of high-quality, evidence-
based health care for populations.
Walter W. Rosser, and Chris van Weel,2004

PHC is the cornerstone of
any health system.
• Its health-promoting
influence is distinguished.
• It helps preventing illness
and death.
• It is associated with a
more equitable distribution
of health in populations.
Barbara Starfield et al 2005

A strong PHC system
is essential to provide
effective and efficient
health care in both
resource-rich and
resource-poor
countries.
Beasley et al, 2007

The importance of PHC
within health systems in
improving the health and
equity has been
supported by reports
from WHO (2008) and
regional WHO offices in
Pan American Health
Organization, South-East
Asia Region and
Western Pacific Region
in 2007.
Barbara Starfield et al 2009

Studies in high, middle and low
income countries show that
areas with better PHC have:
• better health outcomes,
including total mortality
rates, heart disease
mortality rates and infant
mortality,
• earlier detection of disease
such as cancers.
• The opposite is the case for
higher specialist supply,
which is associated with
worse outcomes.
Starfield et al., 2005; Macinko, Starfield and Erinoso 2009

In England, 10% more PC
doctor increases the
probability of people
reporting very good health
by 6%.
In USA, increase of one PC
doctor (approximately a 15%
increase) is associated with
1.44 fewer deaths per
10,000
Barbara Starfield

74 PC experts from 34 countries met
(in 2003) at Queens University, Ontario,
Canada.
They concluded that family medicine
is a well-defined discipline in which
research is essential to guide FPs to
appropriate clinical decision making.
(Van Weel C, Rosser W. Improving health globally: the necessity of family medicine research - a
critical review of its implications and recommendations to build its capacity. Ann Fam
Med. 2004;2:S5–S16.)

FPs have great responsibilities and
accountability to the communities in
providing quality care to raise the
health standard of the nation.

FPs on a daily basis have several tasks:
• coping with large variety of problems
• Consultations
• promoting health
• treating illnesses
• preventative & health education services
• counseling and satisfy patients’ expectations
• attempting to answer the frequent queries
• working with health personnel and liaising with
other agencies to raise the health standard of
whole family and the community
• identify health threatening factors in the
community.

To do so efficiently, FPs are
compelled to have the evidence
supporting their decision.
Research

Why research in family medicine?
• Better health care for the patients.
• Improve the quality of PHC by improving
the understanding and practice of it.
Jan M. De Maeseneer & An De Sutter, 2004

Advantage of research in PHC:
• Identification of critical issues
• Gathering of relevant information
• Decision making and implementation of
the right course of action
• Raising the health standards of the
nation & Improving the outcome
• Decreasing the prevalence of
communicable and non-communicable
diseases
• Solving non-medical issues that
influence health

• Relives pain and suffering
• Improve equity in health
• Helps in developing better health policies
• Increase PFs confidence and self-
esteem
• Evidence-based approach to primary
care will become the norm
• Improve the status of primary care as a
career choice

• Better economic status. When the
population health is improved it reduces
the economic costs of illness. (The
economic costs of illness in the U.S. are
approximately $3 trillion annually, representing
31% of the nation’s GDP).
• Improves the quality of life
• Reduces the mortality and morbidity
rates
• Increases life expectancyFaisal Alnasir 2006 39

Death rates from various causes has dropped in USA due to research

During the 20th
century, average life
expectancy in the USA
rose from 47 years to
more than 76 years.
Much of this increase,
is the result of medical
advances stemming
from research.

Challenges for research in FM in Arab world:
•Expenditures: 0.2-0.4% of the national income
spent on scientific research in Arab countries
versus 4-6% in industrialized and developed
countries.
Dr. Sultan T. Abu-Orabi Secretary General 1 Association of Arab Universities
Institutional obstacles to data access
Martin et.al 2012
•low awareness of the importance and impact of
good scientific research. Research is not
considered as an integral part of FPs work.
Beasly et al 2007
SCIENTIFIC RESEARCH & HIGHER EDUCATION IN THE Arab WORLD Dr.
Sultan T. Abu-Orabi Secretary General 1 Association of Arab UniversitiesFaisal Alnasir 2006 42

• Difficulty of research in Family Medicine: many
nonmedical context interfere with medical
research such as the doctor-patient
relationship, the cultural context, the
occupational context, the support networks, the
socioeconomic context.
Jan M. De Maeseneer & An De Sutter, 2004
• Weak infrastructure: Poor academic
departments, weak training programs for
future primary care researchers.

• Lack of journals
• Lack of collaborations or joint research with
other discipline in the secondary care or
tertiary care
• Lack of electronic medical records in the PHC
where data could be obtained and utilized
• Problems with time: FPs do not have spare
time among their busy schedule for research.
(overloading, no specific allocation)

• No national strategies for promoting research
in FM
• No incentives for conducting research
• No encouragement in participation in national
and international conferences
• Lack of FPs association: Lack of links and
collaborations with international bodies such as
WONCA, NAPCRAG, AAFP etc………

The evolution of the
academic discipline
of PHC in medical
colleges throughout
the world has
resulted in more
FPs taking part in
research.
Paul Thomas et al 2001 BMJ

Textbook of Family Medicine in
The Arab World/MENA
Prof. Faisal Alnasir, Prof. Salman Alrawaf, Prof. Tawfik Khoja, Prof. Salim Adeeb, Prof. Nabil Kurashi Prof.Waris Qidwi
Section 1: Health and Burden of ill health in the MENA
Section 2: Family Medicine origin and current status
Section 3: Principals of Family Medicine
Section 4: Practice management
Section 5: The community role of FD
Section 6: Legislations
Section 7: Health problems in PHC
faisal@agu.edu.bh
Faisal Alnasir 2006
48

Thank you
‫الرحمن‬ ‫هللا‬ ‫بسم‬‫الرحيم‬
{..‫ذين‬َّ‫ل‬‫وا‬ ‫منكم‬ ‫آمنوا‬ ‫ذين‬َّ‫ل‬‫ا‬ ‫هللا‬ ِ‫يرفع‬َ‫م‬‫ل‬ِ‫ع‬‫ال‬ ‫أوتوا‬‫در‬‫جات‬..}
‫العظيم‬ ‫هللا‬ ‫صدق‬
58‫آية‬ ‫المجادلة‬11

AHRQ Agency for Health Research and Quality
http://archive.ahrq.gov/about/gpra2001/gprafig1.htmFaisal Alnasir 2006 50

‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬
{َّ‫إن‬‫في‬ِ‫ق‬ْ‫ل‬‫خ‬ِ‫ت‬‫موا‬َّ‫س‬‫ال‬ِ‫واألرض‬ِ‫واختالف‬َّ‫ل‬‫ال‬ِ‫ل‬‫ي‬ِ‫هار‬َّ‫ن‬‫وال‬
‫آليات‬‫ألولي‬‫األلباب‬*‫ذين‬َّ‫ل‬‫ا‬َ‫ُرون‬‫ك‬ْ‫ذ‬َ‫ي‬‫هللا‬‫ق‬‫ياما‬‫وقعودا‬‫وعلى‬
‫نوبهم‬ُ‫ج‬َ‫َّرون‬‫ك‬َ‫ف‬‫ويت‬‫في‬ِ‫ق‬ْ‫ل‬‫خ‬ِ‫ت‬‫ـموا‬َّ‫س‬‫ال‬‫و‬ِ‫األرض‬‫ـنـا‬َّ‫ب‬‫ر‬‫مـا‬
‫ت‬ْ‫ق‬َ‫ل‬‫خـ‬‫هذا‬‫باطال‬‫ك‬َ‫ن‬‫سـبحا‬‫ا‬َ‫ن‬ِ‫ق‬َ‫ف‬َ‫عذاب‬َّ‫ن‬‫ال‬‫ار‬}
‫صدق‬‫العظيم‬ ‫هللا‬
(3‫آل‬‫آية‬ ‫عمران‬190‫ـ‬191)

SCIENTIFIC RESEARCH & HIGHER EDUCATION IN THE Arab WORLD Dr. Sultan
T. Abu-Orabi Secretary General 1 Association of Arab Universities

Sa’ed H. Zyoud, Samah W. Al-Jabi, and Waleed M. Sweileh. Scientific publications from Arab world in leading journals of Integrative and
Complementary Medicine: a bibliometric analysis. BMC Complement Altern Med. 2015; 15: 308.

0.00
20.00
40.00
60.00
80.00
100.00
120.00
140.00
160.00
KSA
Kuwait
Egypt
Lebanon
Morocco
UAE
Tunisia
Jordan
Syria
Algeria
Iraq
Oman
Sudan
Qatar
Bahrain
Libya
Mauritania
Yemen
Number of Patency in Arab countries registered in USA
over 10 years (2009)

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