"We need to wake up to these problems," said World Health Organization (WHO)Assistant Director General Tim Evans in an interview on the sidelines of an international conference in Mexico City. "Health systems are a binding constraint on progress."

Dozens of health ministers, officials from 55 countries and hundreds of researches and representatives of aid organizations are gathered here through Saturday for two parallel conferences on improving health research.

Evans said it was the first time ministers had gathered expressly to discuss health research at a summit.

Over the last 20 years global health research spending has tripled to around US106 billion, but poor countries are not reaping the same benefits as wealthy nations. In recent years, high-profile and well-funded privately-run aid programs have been launched to deliver drugs to developing nations afflicted by diseases such as HIV/AIDS in an effort to bridge the gap.

But Evans said overwhelmed local health systems are unable to effectively distribute donated drugs. He said developing countries, especially in Africa, are undergoing a massive brain drain of overworked and underpaid professionals who are immigrating to Europe and the United States.

"These countries don't just need doctors and nurses, but people to administer hospitals, people to manage supply chains," Evans said. "The shortage is critical." A key goal of the WHO-sponsored ministers summit is to encourage country-specific research on how to deliver existing medications, vaccines and technologies more effectively to the developing world.

"We know that two-thirds of the deaths of children under 5 are from preventable diseases with established interventions," Evans said. "What we don't know is how to get interventions there in time." Evans said the current global research agenda doesn't pay much attention to health system research. But he said showing how to more effectively deliver aid was crucial to keep wealthy countries interested in funding projects.

Pascoal Mocumbi, a former prime minister of Mozambique and current high commissioner for medical research of the European and Developing Countries Clinical Trials Partnership, said the international community needed to help African nations build up their own national health care systems.

"Communities are not seen as actors but only as recipients of aid," Mocumbi told a joint meeting ministers and researchers assembled by the Geneva-based Forum for Health Research. "Each country's needs have to be expressed by locals, not just development experts."

Developing countries currently face a host of daunting problems preventing local health systems from providing adequate care.

Evans also pointed to the widespread lack of death registries in Asia, Africa and, to a lesser extent, Latin America.

"Without this basic building block of public health, how can countries know how to set priorities?" he asked.

Lacking accurate data on who and how many are dying from which diseases, aid efforts may be skewed and critical health problems left unaddressed, he said.

Another obstacle is the lack of access to existing clinical research. Evans said he hoped ministers would agree to back a global clearinghouse of clinical trials that could be accessed by the public.

Evans said such steps were needed to help regain the public's trust in the global health research system, which has been thrown under suspicion from scandals like the mishandling of mad-cow disease or recent cases where the pharmaceutical industry suppressed clinical trials that showed either nil or adverse effects from marketed drugs.