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Panelists of Creating Opportunities for Health Scientists in Disease Endemic Countries and GHDonline staff

Creating Opportunities for Health Scientists in Disease Endemic Countries

Posted: 09 Aug, 2013   Recommendation: 1   Replies: 75

Health scientists play a vital role in the health system. They contribute evidence for disease control and elimination; they participate in the creation of ethical and evidence-based policies, and they enhance national technical capacity. The evidence they produce is utilized to improve health and health equity at all levels of the health system. Furthermore, countries investing in health research foster a conducive environment for opportunities, which attracts and retains health research professionals and creates positive spillovers.

Unfortunately, as many of us know firsthand, research capacity in disease-endemic countries remains one of the biggest unmet challenges. In sub-Saharan Africa for example, health research in most countries has an allocation of less than 0.5% of national health budgets (only Malawi, Uganda and South Africa spend more than 1% of their GDP on R&D). Worldwide, the Council on Health Research for Development estimates that 98% of health R&D expenditures are made in high income countries, and that only 25% of research on neglected diseases is done in developing countries. (WHO. 2004) (COHRED Global Forum for Health Research. 2012 Report)

Please join us to discuss the current and future state of career opportunities for health scientists in countries where malaria, TB, HIV/AIDS, and other tropical diseases are endemic.

Some questions we will be considering during this discussion:

• What are examples of successful collaborations between academic centers that advance research in-country?

• What has or hasn't worked for attracting and sustaining health scientists in endemic countries? Are there some models of success?

• What is the role of the private sector in health research capacity?

• How can we make the case to governments that health research is an investment for national development?

• What is the role of the major funders (US PMI, UN/WHO RBM, GFATM, Gates, etc.) in fostering opportunities for local health research? Should they do more?

Joining us for this panel discussion:

Professor Carel IJsselmuiden, MD, MPH, FFCH(SA) is Director of the Council on Health Research for Development (COHRED) in South Africa. Carel is a public health physician and epidemiologist. He has worked in rural medicine, peri-urban and urban health care and environmental health services, as well as in academic public health education and research ethics training. He has also published in various areas in applied research and public health, and is the founding Director of the University of Pretoria’s School of Health Systems and Public Health.

Corine Karema, MD, MSc Epidemiology is the head of Malaria & Other Parasitic Diseases Division in the Rwanda Biomedical Center, an agency of the Ministry of Health in the Republic of Rwanda. Corine is the vice–chair of the EARN Coordination committee and member of the Global Malaria Control and Elimination technical working group as well as of the Scientific Advisory Committee (SAC) for malaria policy and access of TDR/WHO Special Program. She is also a member of the WHO Drug Resistance and Containment Technical Expert Group and an observer of the WHO Malaria Policy Advisory Committee (MPAC). She has been involved in developing malaria control strategies and policies as well as all research studies which have guided most of the evidence-based malaria control interventions in Rwanda. She has designed and led the impact evaluation of malaria control interventions which show important reduction on malaria morbidity and mortality in Rwanda.

Dr. Clive Shiff is an Associate Professor at the Johns Hopkins Bloomberg School of Public Health. Apart from teaching, he has extensive interest and experience in research on tropical parasitic diseases, particularly schistosomiasis and malaria. He was President of the Rhodesia Scientific Association in 1969 and 1976, and was Deputy Director of the Blair Research Laboratory of the Ministry of Health which was responsible for medical research in the country. He co-authored with the late Stephen Chandiwana a paper on Science-Based Economic Development: the Eureka factor presented to the Harare Meeting of the New York Academy of Science in March 1998. He has been the PI and lead scientist running the Malaria Institute at Macha in southern Zambia since its inception in 2003. Dr. Shiff plans to train local university faculty in outbreak epidemiology so as to increase local expertise in data collection and analysis. He has recently been invited to join the WHO Expert Committee on Integrated Vector Control, and the UNEP Committee on DDT and its use against malaria. Dr. Shiff has under his belt a wealth of experience developing and working under strong and rewarding historical civil service structures in Zambia and Zimbabwe during the federation era and beyond, until he moved to the USA in 1979.

We hope to discuss past and current models of sustainable professional health research systems and collaborations, and how they contribute to national success in overcoming diseases and attaining development goals. We aim to shape advocacy and create opportunities for health professionals and researchers in endemic countries.

So join the conversation and share your thoughts and a quick introduction of your work and research right away!

We look forward to this discussion.

Sincerely, Sungano

Replies

 

Jacob Sheehama Replied at 4:21 PM, 9 Aug 2013

The topic is very important and need to be supported in the southern African country. It is a tradegy at the moment for this region that we do not have a harmonized program for the region, on health and medical research nor a regional research agenda. Most of our research are reactionary and donor driven and are most short term impact designed, as the donors come for a five year program and they should complete the project on time.
This interfer with the local research agenda and sometimes the country have just a lot of topics, but cannot develop a long term agenda or even capacity building.

Establish more research teams in all teaching hospitals and diagnostic lobaratories, this will put all the medical scientists in these countries in touch.
The creation of local complete health and medical research teams, on infectious, non infectious and trauma medicine.

Namibia has invested a lot in treatment and diagnosis, but we have not achieved enough in prevention on some of the preventable diseases.

I hope we can have some action on the ground.

Sophie Beauvais Replied at 4:37 PM, 9 Aug 2013

Dear All,

In advance of our expert panel on “Creating Opportunities for Health Scientists in Disease Endemic Countries” next week, please note the following:

- This panel is hosted in the following GHDonline communities: HIV/AIDS Treatment & Prevention; MDR-TB Treatment & Prevention, and Malaria Treatment & Prevention.
- If you are a member of one of these communities and have “Per Post” email notifications for one of these, you will receive this discussion panel as you would receive any other discussions.
- If you would like to change your email notifications for this panel, please sign in www.ghdonline.org and update your email settings in your profile.

To recap, we are delighted to welcome the following panelists next week, August 12-16:
- Prof. Carel IJsselmuiden, Council on Health Research for Development (COHRED), South Africa
- Dr. Corine Karema, Rwanda Biomedical Center
- Dr. Sungano Mharakurwa, Macha Malaria Research Institute, Zambia; Johns Hopkins Malaria Research Institute
- Dr. Clive Shiff, Johns Hopkins Bloomberg School of Public Health
-- For complete bios, please see full introduction here: http://www.ghdonline.org/opps-for-scientists/discussion/creating-opportunitie...

As many of us know firsthand, research capacity in the very countries where malaria, HIV/AIDs, and tuberculosis are endemic remains one of the biggest unmet challenges. In sub-Saharan Africa, health research in most countries has an allocation of less than 0.5% of national health budgets. (WHO Bulletin) Worldwide, 98% of health research and development expenditures are made in high income countries. (Global Forum for Health Research Report)

Initial questions:

• What are examples of successful collaborations between academic centers that advance research in-country?

• What has or hasn't worked for attracting and sustaining health scientists in endemic countries? Are there some models of success?

• What is the role of the private sector in health research capacity?

• How can we make the case to governments that health research is an investment for national development?

• What is the role of the major funders (US PMI, UN/WHO RBM, GFATM, Gates, etc.) in fostering opportunities for local health research? Should they do more?

Please also see the attached publications for our discussion.

We look forward to this expert panel.

Sincerely, Sophie

Attached resources:

Wellington Oyibo Replied at 6:46 PM, 9 Aug 2013

It may be correct when we say that Donors come into our countries to drive "their own agenda" and the question is: how many disease endemic country actually had an agenda for controlling the endemic diseases, which most often is localized to the country itself? The truth is that the lack of agenda by endemic country itself is an obstacle to the efforts of these donors because most times they would have to build capacities, most times in-service training to accomplish set goals. What happened to the Universities/teaching hospitals who should be providing the updates during pre-service training?

Disease endemic countries should have clearly defined agenda/purpose and targets for the attainment of these goals and it will be easier to roll back these preventable diseases in the region. In malaria for example, the need to have a holistic approach given the peculiarities of  DECs are yet to be put in place. Architectural re-design of houses to allow for ventilation to support net use is still not considered yet. Budgetary allocation to simple environmental approaches are not available; the Universities are not part of the solutions to resolve endemic disease issues.  A GENERAL RE-ORIENTATION AND MIND-SET CHANGE IS RECOMMENDED HERE.


Malaria vaccine trials can only be initiated in DECs because the infrastructure to carry out basic research is hardly available; so also is the untapped medicinal plant resources for drug discovery.
Lets drive this process through engagements and watch what happens. Fortunately, some countries like Rwanda are telling some good stories about how they are causing changes and other s should follow.

Geyoul Kim Replied at 8:34 PM, 9 Aug 2013

My name is Geyoul Kim. I have been member of ghdonline since last April 2012. I have not engaged any of your discussion yet; however, I am thingking about following your discussion from now on time to time. My original back ground is nursing. I have been working with HIV/ AIDS population as a Patient Research Coordinator since 1991. I just got a degree on B.S Clinical Research Mangement last May 2013 from Washington University St. Louis MO. I am going to take graduate classes for M.S in Applied Health Behavioral Science Research from this fall from Washington University Scholl of Medicine.

I need to learn that how can I contribute to your panel and your organization. WHat is our goal to reach from this organization? What is our accomplishment from each of us and this organization? I am so behind get to know on GHD online. Thanks.
Geyoul Kim RN. B.S CRM

Pierre Bush, PhD Replied at 9:34 PM, 9 Aug 2013

Dear Sungano,
Thank you for your warm welcome. I will be ready and glad to participate in this forum

Pierre Bush, PhD Replied at 10:03 PM, 9 Aug 2013

Dear Colleagues,
It is imperative that researchers continue to work on the most devastating diseases that humankind has ever known. Malaria, HIV/AIDS, TB and other neglected tropical infectious diseases must be dealt with without further delay. Malaria has been declining in many parts of the world, but there is still a lot of work to be done in order to completely eliminate it. I have been interested in malaria research for sometime, and I am planning to continue after I complete my first study in Kalomo district in Southern Zambia. We cannot allow to lose the progress that were achieved through the President's Malaria initiative, the rollback malaria, the WHO, the effort of the Macha Malaria Initiative, and others. Let us work together and I am sure that in the next 20 years, malaria will be eiiminated throughtout the world

Believe Dhliwayo Replied at 11:57 PM, 9 Aug 2013

I am an SRHR Technical Advisor and currently doing a BA in Health Systems Management here in Malawi. The created thread of discussion is very important I will loop in CHAI and other int. Orgs. Based in Malawi providing clinical services to weigh in these discussions.
My quick reaction would be every country in Southern Africa has or should have a roll out plan to mitigate the impact of Tropical diseases (Malaria, TB, and HIV and AIDS) .
The Health scientist should play a critical role in ensuring they impart skills and knowledge to existing personnel in highly endemic countries. Their research and ultimate findings should ultimately improve the Health systems delivery and the quality of life of those impacted by the disease itself.
They can help by mobilising equipment and basics required in rural Health settings. A medical Doctor or a researcher could learn a lot as well as impart a lot of skills to their counterparts based in the south. Researchers can facilitate KTE (knowledge Transfer Exchange) . North to South knowledge exchange.
Most of these countries for example in Malawi where I am based there are plans BUT faced with or threatened by limited resources. Currently Malawi is implementing a switch from Stuvidine to a second regime less toxic and with lesser side effects. While this is being done a lot of deformities to body structures of PLWHIV has taken place. How can scientist help in reducing these side effects ? These are some of the questions that need medical people to respond to . Prevalence of Malaria and TB is still high and there are a number of cross cutting issues research scientists need to tackle to ensure there are answers that will inform effective interventions.
Mobilise resources , gloves , pain killers and monitoring machines, while on the other hand assisting local Govt. To improve of essential service delivery in highly endemic countries.

Believe Dhliwayo
SRHR Tech. Advisor
COWLHA - Malawi

Rumidzai Mapfumo Replied at 12:34 AM, 10 Aug 2013

This is interesting. I am an advocate and I agree that as Africa we are relaying on external donation for us to be able to move forward our health issues. My worry is, our governments are reluctant to the fact they need to allocate more towards health and that in the event that donors withdraw, what will happen?. So I think more teams, more research labs that are equipped will help us move forward, and retain our experts back home to make the changes we need.

Lachlan Forrow Replied at 5:55 AM, 10 Aug 2013

On this very, very important topic, I recently returned from a symposium of Nobel laureates, scientists, and others from around the world, hosted by Gabon President Ali Bongo Ondimba, celebrating the 100th anniversary of the Albert Schweitzer Hospital in Lambarene, Gabon. The symposium culminated in a "Lambarene Declaration" (see attached), which emphasizes the urgent need to strengthen African science and health worker training in the fight against the "Triple Epidemic" (HIV/AIDS, TB, and malaria). To help concretely with this, Gabon is completing construction of a new research/training campus in Lambarene, adjacent to the grounds of the Schweitzer Hospital, which will include creating of a new Albert Schweitzer School of Public Health. The goal is to create a resource for Africa, including curricula and training programs available at little or no cost to anyone in Africa and beyond. We have the great opportunity, since we are starting from scratch, to do things right.

I look forward to the ideas that will emerge from this Expert discussion, which I hope will feed into the Second Annual Albert Schweitzer Global Health Symposium we will hold in Gabon in 2014 (tentatively July).

For those interested, the program and high-quality videos from all of the sessions of the First Annual Albert Schweitzer Global Health Symposium are available at http://schweitzerlambarene100.com/en/centennial-symposium-celebration#

Lachlan Forrow, MD
Immediate Past President (2010-2013), Hopital Albert Schweitzer
Beth Israel Deaconess Medical Center
Harvard Medical School

Attached resources:

Jean Nachega, MD, PhD, MPH, DTM&H Replied at 6:38 AM, 10 Aug 2013

Dear All
To add to this interesting discussion ahead of next week panel, please find attached an open access publication via IJE website or PubMed and recently published by prof Carel IJsselmuiden and few other colleagues and which focus on building research capacity within WHO Afro.
Regards, Jean

Current status and future prospects of epidemiology and public health training and research in the WHO African region.
Nachega JB, Uthman OA, Ho YS, Lo M, Anude C, Kayembe P, Wabwire-Mangen F, Gomo E, Sow PS, Obike U, Kusiaku T, Mills EJ, Mayosi BM, Ijsselmuiden C.
Int J Epidemiol. 2012 Dec;41(6):1829-46. doi: 10.1093/ije/dys189.

Jean Nachega, MD, PhD, MPH, DTM&H Replied at 3:49 PM, 10 Aug 2013

Dear All
Below is the abstract and now attached the pdf of our open access IJE paper as another resource to the upcoming panel: “Creating Opportunities for Health Scientists in Disease Endemic Countries”
Best, Jean
----------------------------
Current status and future prospects of epidemiology and public health training and research in the WHO African region.
Nachega JB, Uthman OA, Ho YS, Lo M, Anude C, Kayembe P, Wabwire-Mangen F, Gomo E, Sow PS, Obike U, Kusiaku T, Mills EJ, Mayosi BM, Ijsselmuiden C.
Int J Epidemiol. 2012 Dec;41(6):1829-46. doi: 10.1093/ije/dys18

Background: To date little has been published about epidemiology and public health capacity (training, research, funding, human resources) in WHO/AFRO to help guide future planning by various stakeholders.

Methods: A bibliometric analysis was performed to identify published epidemiological
research. Information about epidemiology and public health training, current research and challenges was collected from key informants using a standardized questionnaire.
Results From 1991 to 2010, epidemiology and public health research output in the WHO/AFRO region increased from 172 to 1086 peer-reviewed articles per annum [annual percentage change (APC)=10.1%, P for trend<0.001]. The most common topics were HIV/AIDS (11.3%), malaria (8.6%) and tuberculosis (7.1%). Similarly, numbers of first authors (APC¼7.3%, P for trend<0.001), corresponding authors (APC=8.4%, P for trend<0.001) and last authors (APC=8.5%, P for trend<0.001) from Africa increased during the same period. However, an overwhelming majority of respondents (490%) reported that this increase is only rarely linked to regional post-graduate training programmes in epidemiology. South Africa leads in publications (1978/8835, 22.4%), followed by Kenya (851/ 8835, 9.6%), Nigeria (758/8835, 8.6%), Tanzania (549/8835, 6.2%) and Uganda (428/8835, 4.8%) (P<0.001, each vs South Africa). Independent predictors of relevant research productivity were ‘in-country numbers of epidemiology or public health programmes’ [incidence rate ratio (IRR)=3.41; 95% confidence interval (CI)
1.90–6.11; P=0.03] and ‘number of HIV/AIDS patients’ (IRR=1.30; 95% CI 1.02–1.66; P<0.001).

Conclusions: Since 1991, there has been increasing epidemiological research productivity in WHO/AFRO that is associated with the number of epidemiology programmes and burden of HIV/AIDS cases. More capacity building and training initiatives in epidemiology are required to promote research and address the public health challenges facing the continent.

Keywords Epidemiology, public health, training, Africa, capacity building,
retention, research, WHO/AFRO

Attached resource:

Jubeida Nyangari Replied at 5:28 PM, 10 Aug 2013

This is a very interesting discussion, For most African countries it will be difficult to convince governments that health research is an area that needs investing in not only for national development but also to enhance health systems. Health systems strengthening is a major factor for most African countries.

Jean-Francois de Lavison Replied at 6:39 PM, 10 Aug 2013

We will need to find inovative ways of collaborations and develop some Public Private Partnership, in the field of Research.
I am impressed to see during my trips the high level of competencies in Africa, Asia, Latin America, we need to develop such a strong network and find ways to better coope with funders and researchers from others countries.
I fully support initaivies such the one from Lachlan Forrow, in Gabon, some others exist in Asia and in Middle East. We don't need to reinvent the wheel, we just need to bridge the existing initaitves. We need to bettter coope.
Please go to visit that Gates Foundation website on Grand Challenge for Global Health.
Would be happy to coope on such an initiaivie for research.

ANA MARIA BACUDIO Replied at 11:38 PM, 10 Aug 2013

Dear collegues,

I am interested to know about the data from the Asia Pacific Region, is there a survey done about our region, if none, can we collaborate with you for an expansion of the research survey in the APR

Thank you and Godbless us all!

ANA MARIA A BACUDIO,RMT,MPH
Chief Controller, NTP QA Center
Manila Public Health Laboratory
208 Quiricada Street Sta Cruz,
Manila Philippines, 1003

Jean Nachega, MD, PhD, MPH, DTM&H Replied at 4:41 AM, 11 Aug 2013

Dear Ana Maria
The series of articles in the International Journal of Epidemiology took stock of the status of epidemiology and public health burden of disease, research and training in the five continents to include the WHO South-East Asia and West Pacific Regions. Data were not in area of basic sciences, an important area to explore further. Below and attached are the remaining citations and publications--all open access at IJE website and PubMed.
All the Best, Jean
---------------------------

1) Blakely T, Pega F, Nakamura Y, Beaglehole R, Lee L, Tukuitonga CF.
Health status and epidemiological capacity and prospects: WHO
Western Pacific Region. Int J Epidemiol 2011; 40: 1109–21.

2) Barreto SM, Miranda JJ, Figueroa JP, et al. Epidemiology in Latin
America and the Caribbean: current situation and challenges.
Int J Epidemiol 2012; 41: 557–71.

3) Dhillon PK, Jeemon P, Arora NK, et al. Status of epidemiology in
the WHO South-East Asia region: burden of disease, determinants
of health and epidemiological research, workforce and training
capacity. Int J Epidemiol 2012; 41: 847–60.

3) Nachega JB, Uthman OA, Ho YS, et al. Current status and future
prospects of epidemiology and public health training and research
in the WHO African region. Int J Epidemiol 2012; 41: 1829–46.

4) Toporowski A, Harper S, Fuhrer R, et al. Burden of disease, health
indicators and challenges for epidemiology in North America.
Int J Epidemiol 2012; 41: 540–56.

Attached resources:

ANA MARIA BACUDIO Replied at 11:34 AM, 11 Aug 2013

Thank you and Godbless Dr Jean Nachega

Mary Nnankya Replied at 1:49 PM, 11 Aug 2013

Thank you very much for this notification . Such discussion panels are under represented at international level yet health science in endemic areas cannot improve in a sustainable manner without the full cooperation and inclusion of local scientists. Could you please specify which diseases you will be discussing so as to direct us to which countries you are referring to.

Thank you again for this notification,

With regards,

Mary







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Subject: Creating Opportunities for Health Scientists in Disease Endemic Countries

Mary Nnankya Replied at 1:55 PM, 11 Aug 2013

Thank you very much for this notification . Such discussion panels are under represented at international level yet health science in endemic areas cannot improve in a sustainable manner without the full cooperation and inclusion of local scientists. I have finally seen the diseases discussed (which did not appear in the e-mail). Looking forward to the exchange!

Thank you again for this notification,



With regards,



Mary

Sungano Mharakurwa Replied at 6:47 PM, 11 Aug 2013

Dear Colleagues,
Thanks for the great contributions so far. This is an important topic and discussion is building up fast, with a number of important points emerging and experiences being shared. It is helpful to learn of initiatives such as the Lachlan Forrow, in Gabon and others.
These are noble. One critical question that has been re-iterated is that, once training has been provided, how can endemic countries move forward to attract (usually back) and retain their highly skilled scientists? Many still find that there is little or no opportunity to contribute in-country, yet this is where the burden is greatest and their skills are needed most. Initiatives such as the Gates Foundation, Wellcome Trust and others must be commended, as they are opening up ways. How can more such initiatives be engendered, if possible?
Secondly, how can political will be inculcated for DECs to see the value and commit to investing in opportunities for their health scientists to address the national health needs, thus providing continuity for the invaluable contribution from donors? Are there known models of success, past or current, with benefits to national health and economy that can be shared?

Pudupakkam Vedanthan Replied at 12:55 AM, 12 Aug 2013

Dr.Sungano,thanks a lot for the kind invite.Basically I am an Allergist-immunologist involved in educational initiative for patients and physicians in the developing world for the past 25 years. This work brings me in close contact with several patients with TB, HIV, as well as Malaria since they are all endemic. I will be happy to participate in the program. thanks again, P.K.Vedanthan MD (www.globalchestinitiatives.org)

j Am Replied at 4:03 AM, 12 Aug 2013

Thanks for the email and I hope to participate in this constructive forum

K. Rivet Amico, PhD Replied at 5:09 AM, 12 Aug 2013

Thank you for all these valuable posts and resources. I am hopeful that the ensuing discussions will also include the need for capacity building in the area of health psychology and health communications/counseling. Given that identification and treatment of major infectious diseases typically rely on some aspect of self-presentation at medical sites and self-administration of treatment and other treatment-related recommendations, strong investments in health behavior research, either as part of or as the main focus of research, is critical, yet too often underestimated or underemphasized.

Looking forward to these discussions.

Rivet Amico

Asfawesen Gebreyohannes Woldegiorgis Replied at 7:27 AM, 12 Aug 2013

Very relevant and timely topic for discussion. The importance of research for any kind of development initiative is not arguable. Evidence based planning, implementation and decsion issue is bound to be successful than arbitrarly done issue. Gov in third world countries is known to be short-sighted towards research and do also have serious shortage of finance and capacity towards health research. Moreover, those governments who understand the value of research demand researchers to conduct research which are relevant to their context issues which can be utilized in problem solving. Therefore, my suggestion is that governments need to have a national framework on health research which identifies research priorities for their countries which can help to guide in forexample relevant capacity buidling. As sceitists we do not have to advice gov to establish a set up to study the wavelength range of light which can be visualized by fish ( this was stated by the late Prime Minster of Ethiopia) which consums resource with no immediate development return to countries. Other worrisom problem which is emerging many of our countries is the deficiency of nationa and instituional capacity in protecting the right of participants and generation credible research reports by scientists. Establishing instituitonal and national IRBs should get priority. We should not allow our communities to bear the pitefalls of unethical researchs which we know had happened in many countries.

Carel IJsselmuiden Panelist Replied at 9:58 AM, 12 Aug 2013

COHRED (www.cohred.org) issued a statement in 2007: “Responsible Vertical Programming. Are international health research programmes doing enough to develop research systems and skills in low and middle income countries?” (http://www.cohred.org/downloads/cohred_publications/COHREDStatement2007Respon...). The point it makes is that in countries where the bulk of health research is funded through external grants and research partnerships, such research is inevitably oriented to a primary product or finding – not to building the research systems of the countries where the research is taking place. And that is an opportunity missed: you can do health research to address a problem, and you can do health research to address the same problem but done in a manner that strengthens a country to use the skills, competencies, expertise, personnel, facilities, equipment, communication abilities, scientific writing and, indeed, improved links between research and policy.
These two goals are complementary, not competitive – and we believe that it would not cost (substantially) more to practice international collaborative health research in this way. If that is the case – there would be many more opportunities for scientist beyond and after ‘research projects’ are over. What do you think ?

One way of achieving this is not by simply ‘calling’ on external donors and partners to act in a more system-supportive manner, but by negotiating better contracts – that provide a better deal for technology transfer, capacity building, data and publication ownership, intellectual property rights, and post-research benefit sharing – among others. We tried recently to explain this in our ‘Fair Research Contracting’ project (www.cohred.org/frc) . Have a look and let us know if you think this is good enough – where can we make it better?

All this does, or course, not excuse low and middle income countries to invest in health research themselves. They do not have to wait for ‘global health’ to come to the rescue – they can, and should, start now. Given the growth of national incomes in low income countries in Africa, for example, even a small percentage of GDP/GNI would outstrip international research funding many times. Did you know, for example, that the President of Tanzania committed 1% of GDP to science and technology, in 2009. That would translate into roughly $250 million per year. It is a pity that they have not gone this far yet – but it shows that low and middle income countries can take on the lead of their own development, if they want. For more on this, please check the report on the Global Forum for Health Research, Cape Town, 2012. (http://www.cohred.org/wp-content/uploads/2011/05/COHRED_forum2012_web_NEW.pdf...) Please share other great example from across the ‘low- and middle income world’ !

Attached resources:

Francisco Becerra Replied at 2:15 PM, 12 Aug 2013

In response to the question "How can we make the case to governments that health research is an investment for national development?", it is important for governments to realise that research is an ongoing activity, even in underfunded countries. International funds will always find a way and someone to support that research in the country. Unfortunately, the lack of a proper research and innovation system causes that local research institutions and researchers have no available funding at country level. as the country has no priorities established, external funds dictate such agenda and even more, external 'partners' use countries as research sites, take data, get credit and leave almost nothing behind.

Maybe there are many trials in LMIC that governments are unaware of them as there is no regulation for research for health and n ethical framework to control all research being performed. This places populations at risk, and opens a big question on researchers' ethics. Governments have a responsibility to protect their population, they need to realise that strategic actions (research and innovation to foster growth and social equity) should be under their direct stewardship, and that only by investing in research, will they find the local answers to many problems they are facing.

The best way to achieve a structured, coordinated, and good managed research for health system, is through showing political will and support to the designated ministries to make this happen.

With no control and no stewardship in place, many LMIC will continue to be research sites for many universities and funding organisations that take most and leave almost nothing behind.

Clive Shiff Panelist Replied at 2:38 PM, 12 Aug 2013

Dear Carel,
It has been a long time, my word. Anyway it is good to be on the panel with you.

I wanted to raise a point before the discussion becomes dry, it is important to be positive and try to develop a strategy that can be developed. It is important to impress the local politicians of the need for a scientific base. The point is made in your discussion that in Tanzania the President has set aside money for science. Tanzania has an excellent scientific base in the NIMR and benefits greatly by the body of scientists employed in country, but few African politicians see the value of science and it is up to the community to show how powerful a scientific community can be. It is similar in South Africa, and it is happening in a few other places, but not so much elsewhere as we can see in the discussions. So what can we do about it….. here is an example:-

We all eat bread in Africa, and in many parts we grow our own wheat. How many know that all wheat grown in Africa was bred in Africa. The initial breeding and selection for tropical wheat was done at the Salisbury Experimental Station in what is now Harare in the 1960’s as was the maize grown all over the continent. (see attached paper by Chandiwana and myself). NO ONE is going to grow specialist crops for African conditions except Africans. So let’s make a case. There are three sets of conditions necessary for science to flourish:

1) effective training in all scientific arenas (this can be done in non domestic countries initially if the local universities are not sufficiently set up). Expatriates and foreign aid can help with this, but it will require - -
2) career opportunities with competitive conditions of employment. Governments must realize that expertise is exportable, hence the brain drain, so the career needs to be real, challenging and competitive. It should also welcome foreigners (immigrants of all shades and colours) because a home grown scientist is also accountable for decisions. When expatriates are employed they go off after a year or so, and are not responsible for any mistakes… hence politicians (and public) lose confidence in the scientific approach.
3) A local scientific association that keeps interest in science, looks after its memberships, provides expertise for Government in making decisions about health, and other scientific matters, helps universities and in the long run documents local natural history, education and local expertise. This keep political interest

In summary, it is important to show politicians that there is a direct benefit for countries to develop scientific communities. Without science there will little progress. This is a first step to develop a scientific community… initially within the Civil Service.

Pierre Bush, PhD Replied at 3:22 PM, 12 Aug 2013

Hi Dr. Clive,
Well said. Africa scientific future belongs to Africans themselves. Outside help will not be enough to do everything that is needed to bring Africa where it is supposed to be in terms of scientific development. The steps you outlined and the willingness of African educated scientists will be a cornerstone for this important journey.

Jose Albany Chavarria Picado Replied at 3:50 PM, 12 Aug 2013

hola pues de mi punto de vista la búsqueda de mas información y de estudios científicos acerca de estas enfermedades endémicas son de mucha importancia. mas en los países con bajos presupuestos en esa área es mas importantes. en este momento Nicaragua atraviesa por una situación grabe que es la epidemia del dengue las autoridades de salud del país estén haciendo todo lo posible por tratar de evitar los casos de dengue ya que hasta el momento son muchos al igual que la malaria es un problema de salud y el VIH SIDA. para nosotros como organismo aveces hacemos charlas y talleres ha cerca de como evitar estas enfermedades pero solo trabajamos en un municipio del país y sentimos que la información a ayudado mucho ya que en el municipio en que enseña por salud trabaja es uno de los mas pobres del país y por lo cual es mas propenso a padecer de estas enfermedades. por eso el estudio y la superbision para la eliminasion de estas enfermedades es para mi y para mi país de mucha importancia. de antemano te felicito por el hermoso trabajo que estas realizando y en lo que yo te pueda ayudar estoy ala orden.
buen día.

Serge Blaise Emaleu.MD Replied at 3:54 PM, 12 Aug 2013

There are many African educated scientist willing to initiate and conduct
basic or fundamental medical research in their respective countries of
origine, as you may know no efficient research can be conducted without
necessary funding, laboratories need reagents/equipments and salaries need
to be secured for researcher and staff, without government incentives ,
private and or international NGO'S the only wheel of african researcher and
scientist will not be enough to quick off the medical research in the
continent In United States for example the National Institute of Health, a
government funded institution is the primary driver and funder for
scientific research ,without that institution in place and structured the
way it is ,the only desire of medical researcher would have not been enough
I believe.

Maopa Lewabeci Raikabula Replied at 12:16 AM, 13 Aug 2013

Hi,
I am the Senior Laboratory Technician under the National TB Programme in Fiji. The National TB Programme is working hand in hand with the health care facilities, community and other government entities in the fight against TB. Sorry, we don't have Malaria in Fiji but TB and HIV are seen to be a problem. TB in Fiji is not really bad when compared to other countries in the Asia Pacific region. Global fund is now 1 of the major funding agency financially supporting Fiji on fight against TB.
For research, the initiative is mostly not internally created but externally. The knowledge is not usually utilized and that is an individual initiative. But if the initiative is there, the funding would be the problem and we're mostly lack the resources.
I am happy to see the comments and views by colleagues from other countries in a different setting as ours.

thanks.

Carel IJsselmuiden Panelist Replied at 7:27 AM, 13 Aug 2013

Hi again,

The correspondence seems to confirm the lack of internal resources and lack of political will or insight into providing more funding for health research, or, more specifically, for research related to specific conditions. I would like to know more about internal health research funding in Ethiopia, Fiji, Gabon, and the many other countries where this discussion is taking place. My guess is that ‘research’ does not feature high in the budget allocation process in many countries.

There may be many reasons for this – but the key one has to be that decision-makers apparently do not see the benefits : they see research expenditure as a ‘cost’, not as an ‘investment’. Health researchers have difficulty making their case to convince those who allocate financial resources in governments about the purpose of health research. Ministries of Finance think about ‘return on investment’ in terms of more trade. Ministries of Science & Technology think about ‘return on investment’ in terms of ‘jobs created’. Ministries of Health tend to think about ‘better health care, more access, less morbidity and mortality’.

How to get these different agendas to converge is key to finding longterm, sustainable, national funding. Perhaps it is essential to change from doing ‘health research’ towards conducting ‘research for health’. It is health, health for all, and economic development that are the final goals of our work. The Ministerial Meeting in Bamako in 2008 put this firmly on the map.

Clearly, individual researchers can not be only responsible – but working through national associations may help – see the latest call of the Inter-Academy Medical Panel

Are you aware of your national science academy ? Is there one ? Does it work and is it supportive ?

Attached resources:

Mary Nnankya Replied at 8:37 AM, 13 Aug 2013

The discussions are outlining lack of government involvement and involvement of international funding bodies with management based in non endemic areas, dictating research, taking all the credit but leaving not much sustainable follow-up within the endemic areas. The funding bodies or donors and external NGOs should be made accountable on similar basis as external investors to ensure sustainability of the projects, give due credit of research outcomes to local scientists and research organizations and equally share the additional funding they then received based on the reports they submit following outcome of research projects. Local governments should ensure that this happens especially following clinical trials

Sophie Beauvais Replied at 10:32 AM, 13 Aug 2013

Dear All,

Yesterday Jose Albany Chavarria Picado, a member in Nicaragua, posted a comment to this panel discussion in Spanish (http://www.ghdonline.org/opps-for-scientists/discussion/creating-opportunitie...). One of our Spanish-speaking moderators, Maggie Sullivan from the Nursing and Midwifery community, kindly provided us with the translation below:

Hello. From my point of view, the search for more information and for scientific studies about these endemic diseases is of great importance, especially in low-income countries. At this time, Nicaragua is undergoing a serious situation with the Dengue epidemic. Health authorities are doing as much as possible to try and avoid cases of Dengue. At this time, the epidemic it is similar to that of malaria and HIV/AIDS. For us as an organization, we try to do presentations and workshops about how to avoid these diseases, but we only work in one municipality of the country. We feel that the information has greatly helped despite this area being one of the poorest in the country and, as a result, is most vulnerable to illness. For this reason, the research and supervision around eliminating these diseases is for me and my country of great importance. Congratulations on the wonderful work you're doing, and let me know if I can help in any way.

Thank you.

Manuel Lluberas Replied at 11:52 AM, 13 Aug 2013

The situation pointed out by Jose Albany in Nicaragua points out some major basic differences in how we think of research. There are two basic types of research. One leads to scientific knowledge that is often referred to as academic while to other, while still being scientific in nature is often referred to as operational. These are both useful, but in Jose's situation, a more operational approach would have a more immediate use and immediate benefit while an academic research has a more long-term affect. The key thing is to know when to focus the attention on one more than the other. I may be biased, but it is my impression that operational research on vector-borne disease control would be very beneficial to Nicaragua and neighboring countries bearing the brunt of Dengue and other vector-borne diseases. More academic research could be conducted as an extension of this operational research as the local technical capacity increases.

For Jose's benefit, allow me to comment in Spanish.

La situacion en la que se encuentra Jose Albany en Nicaragua trae a colacion dos diferencias fundamentales en lo que respecta a la investigacion. Hay dos clases de investigacion. Una llega a conocimiento cientifico conocido comunmente como academic mientras el otro, aunque aun cientifico, es conocido como investigacion operacional. Ambos tipos son utiles, pero en el caso de Jose, un acercamiento mas operacional le seria de utilidad inmediata y seria de mas uso para resolver el problema en que se encuentra mientras que la investigacion academica le seria util a largo plazo. El detalle es saber cuando es major enfocar el esfuerzo en uno y no el otro. A mi entender, especialmente en lo que respecta a enfermedades de transmission vectorial, muchos paises como Nicaragua deberian enfocar su esfuerzo en la investigacion operacional y progresar hacia la investigacion academica segun progresan.

Lachlan Forrow Replied at 12:05 PM, 13 Aug 2013

I think Carel posed the fundamental question: what are the "returns on investment" of funding for scientific research in disease endemic countries? I think that the answer depends in large part on how "scientific research" is conceptualized and implemented. It seems to me that one of the barriers is that "research" is too often too separate from implementation and impact. If a country with limited resources and urgent immediate health problems sees the choice as (1) investing more resources in health system strengthening with clear/direct expected impact on health results, or (2) investing in "research" with unclear or at least less direct impact on health results, then (1) not only will, but actually should, almost always get priority.

I think that part of the answer is given in Malcolm MacLachlan's paper that Carel attached: "Rethinking global health research: towards integrative expertise." His abstract says:

"The Bamako Call for Action on Research for Health stresses the importance of inter-disciplinary, inter-ministerial and inter-sectoral working. This challenges much of our current research and postgraduate research training in health, which mostly seeks to produce narrowly focused content specialists. We now need to compliment this type of research and research training, by offering alternative pathways that seek to create expertise, not only in specific narrow content areas, but also in the process and context of research, as well as in the interaction of these different facets of knowledge. Such an approach, developing 'integrative expertise', could greatly facilitate better research utilisation, helping policy makers and practitioners work through more evidence-based
practice and across traditional research boundaries."

This emphasis on multi-sectorial integrative approaches was one of the main points of the recent First Annual Albert Schweitzer Global Health Science Symposium in Gabon, and the Lambarene Declaration I appended in an earlier posting. We are hoping that the new Albert Schweitzer International University Center for Research and Health in Lambarene, whose campus has been built by the government of Gabon directly adjacent to the Schweitzer Hospital, can become a model for demonstrating the benefits of tightly _integrating_ clinical care, public health/prevention, basic and applied research, and training. The quality and impact of each of those four components of a strong academic institution is greatly enhanced by synergies with the other three.

One concrete example can be found in the attached 2007 paper from the Medical Research Unit of the Albert Schweitzer Hospital, reporting results of a randomized, double-blinded, placebo-controlled trial of intermittent treatment of malaria in a cohort of ~1,000 infants in the Lambarene Region. While the highlighted result in the paper (see the abstract) was the reduction in anemia in the treatment arm compared to placebo, the most dramatic result was the "incidental finding" reported on p. 1601:

"Our study design led to the creation of an outstandingly
healthy study cohort, which almost represents a Lambaréné
birth cohort of more than a year. Only 5 deaths occurred between
months 3 and 18 of life in 1000 infants, attributable to
our close-knit passive and active follow-up system, which also
included basic health care support for siblings and other family
members, thus further indirectly improving the health and living
conditions of our study subjects."

Achieving "all-cause mortality" of only 5 deaths per >1,000 children from 3 months to 18 months (and in unpublished results from longer-term follow-up only 8 deaths per >1,000 children at 3 years), is almost unheard of in Sub-Saharan Africa. The explanation almost certainly is that in the process of doing rigorous research every child was followed up with regularly, and if the child was sick then s/he was cared for (whether in the treatment or the placebo arm). And when that happens the children don't die.

Another unreported "impact" of the conduct of this study (and others) is that the many African staff involved learned, in the process of conducting the research, skills in study design, epidemiology, and village-outreach follow-up that are directly applicable in any subsequent community-based public health initiatives. Staff for this and our other studies include many young Gabonese women who have developed skills and experience in public health monitoring and follow-up that could prepare them for roles as skilled community health workers.

While this is just one example, I am sure that others involved in this discussion can provide many, many more examples of ways in which "returns on investments" in "research" have much broader impact than the research results themselves. Learning about more examples could help us build a more convincing case for governments and others to invest in research activities, or at least the kinds of research activities that embody the "integrative" approaches that MacLachlan and the Bamako Call to Action propose.

--Lachlan

Attached resource:

Emily Donaldson Replied at 1:39 PM, 13 Aug 2013

This panel is extremely informative, and has provided much background on the necessity for country-driven research priorities and in turn, country-ownership of research processes. Is there any information available on what, if any, financial investment is going towards health R&D, aside from that of donor countries/philanthropies? Is there any information available on which countries have met the criteria in the Bamako Call to Action?

I am part of the HIV Vaccines & Microbicides Resource Tracking Working Group (www.hivresourcetracking.org) which collects annual data on global investment in HIV prevention R&D. As part of our ongoing efforts, we are trying to quantify both direct financial and in-kind investment in research by LMICs in which HIV prevention research is taking place outside of donor country and philanthropic funds. These countries make important contributions to HIV prevention R&D that the Working Group has not been able to quantify in the past. We're looking for in-country HIV prevention research initiatives funded by local governments. Please feel free to contact me directly at if you have information on such country-led/funded projects.

Mary Nnankya Replied at 2:54 PM, 13 Aug 2013

I would like to share the link here as the article does cover the some of the points discussed here: Aid Expats: Breaking the culture of dependency

Attached resource:

Leonard Mboera Replied at 2:19 AM, 14 Aug 2013

Dear Carel,
Thanks for sharing this discussion. I realy agree on what you say.
However, it is an issue that needs a broader discussion, both locally
and internationally.

L

Manuel Lluberas Replied at 9:13 AM, 14 Aug 2013

Here's something on the report of the new malaria vaccine that came out on the New York Times that I thought relevant to the discussion. “'This is a scientific advance rather than a practical one,' said Dr. William Schaffner, of Vanderbilt University’s Medical School to the New York Times. So goes the fate of the latest in research reports on efforts to develop a malaria vaccine. Prof. Schaffner goes on to explain that, 'Giving multiple IV doses of any vaccine is also impractical because it requires sterile conditions, trained medical personnel and follow-up. IV drips are particularly hard to administer to children.'”

This is what I meant by academic research. It is valuable and can be the foundation for further research and development, but is not the kind of research that can be done outside very sophisticated and expensive labs. The world needs more practical investigations in a parallel path as academic ones.

Carel IJsselmuiden Panelist Replied at 9:50 AM, 14 Aug 2013

Thanks for those of you who commented on the issue of ‘return on investment’ or ‘making research relevant to decision-makers’. Over the years, we have found that in many countries, ‘health research’ is often carefully kept in and guarded by the Ministry of Health, while other research is usually located in Ministries of Science & Technology or Education.

This can complicate life for health researchers. Think about it this way – a Minister of Health is faced with a near-endless list of urgencies : HIV/AIDS, malaria and DR-TB, of course, but also many others: maternal and child health, outbreaks of any sort, malnutrition, health care strikes, critical notes in the press, lobby groups for special interests, and more. On top of that, health budgets are really very small in many countries. It is no surprise then, that it is very difficult to get $1million for a randomized controlled trial, and even more impossible to get such funding for more basic science research for health, from any health budget. And, if you can not get money for one trial – how then can you even begin to think about creating real opportunities for health scientists in low and middle income countries ?

I like to use ‘vaccinology’ as a great example of how health researchers can access much more funding and develop careers. It is simple really – the basic science, the material and product development, and potential genetic engineering can all be done under the budget of a Ministry of Science & Technology. That is where competitive funding often is available, sometimes through national research funds or foundations. Once the vaccine is proven effective, it can then move to Ministries of Health who can research cold-chain maintenance, do coverage surveys, monitor side-effects, and more, usually low-budget but meaningful research. In this way, ‘health scientists’ become ‘scientists for health’ – irrespective in which Ministry they work, and the ‘territorial fights’ about who should set a national health research agenda become superfluous.

In fact, most countries in the world deal with the problem of ‘conflicting emergencies’ by creating separate Ministries of Science & Technology that are tasked with developing science, products and jobs. On top of that, most high-income countries have a substantial pharmaceutical industry that conducts trials and employs many health scientists. Ironically, I met with a director of a small pharmaceutical start-up in South Africa recently, and he complained that he had enough financing but could not find the scientists to conduct the product development and testing!

My question for today then – what would need to happen (where you are working) to change ‘health scientists’ to ‘scientists for health’ – less interested in which Ministry pays the salaries, and more in how we can increase the financial and human resources for the important research that still needs to be done? How can we attract private sector research and development funding? Is there actually a national science fund? Do you have other solutions ?

Attached resource:

Lachlan Forrow Replied at 10:18 AM, 14 Aug 2013

Thanks Carel -- these are great questions. I would just add an invitation to people to suggest exactly what kind of "research" or "science" they think should be prioritized in their own countries, with of course important differences in what the different possible funders of that research (ie a Ministry of Health v. a Ministry of Science & Technology v. a pharmaceutical or other private sector company, etc.) will see as a "good investment". I think it would also be helpful to hear ideas about how to answer the director of the pharma start-up Carel spoke to, who said he had enough financing but couldn't find the scientists he needed. We need to get beyond the paralysis of the status quo, of people saying (rightly or wrongly) that "we need more African scientists" but "we don't have enough African scientists even to get started".

Mary Nnankya Replied at 10:43 AM, 14 Aug 2013

Lachlan, it would be interesting to find out where that director of a Pharma/Biotech is looking for the African Scientists!!!! whom he alleges he cannot find. Several in this panel discussion will be able to him/her

Lachlan Forrow Replied at 11:20 AM, 14 Aug 2013

Mary: Exactly!!

Sometimes the perceived lack of sufficiently-skilled local people is really just a matter of not knowing how to identify/find them. I think this is one of the barriers that internet-linked networks of knowledgeable people, like many of the the members of GHDOnline, can help overcome quickly.

But we also need to admit that sometimes the perceived lack is because the tragic reality today is that there truly are not (yet) enough sufficiently-skilled local people. In Gabon (the only country I know well), there is frequently-expressed anger by many Gabonese that petroleum companies so often hire expatriate petroleum engineers rather than Gabonese. But people I completely trust in Gabon (both Gabonese and people there from outside who are trying to help Gabon develop) tell me that at least some of the companies they know would do (and are doing) everything they possibly can to identify and hire Gabonese engineers, but there just aren't enough Gabonese today who can do the work required. The answer to that problem is obviously _not_ just to continue to hire expats; it also requires companies and others to invest in training programs for Gabonese, so that today's gaps in sufficiently-skilled local personnel can end as quickly as possible. That's not just idealism/altruism or political correctness -- people tell me that having to recruit and hire expats is _extremely_ expensive, including because many of them are unwilling to stay very long. So even from the totally-crass financial "bottom-line" perspective, strengthening the pipeline of local skilled professionals, whether we are talking about petroleum engineers or health scientists (or Carel's wonderful phrase "scientists for health"), has a very high "return on investment".

Virginia Lipke RN, MHA, ACRN, CIC Replied at 11:45 AM, 14 Aug 2013

I believe that Manuel is on the right track. When I think of the practical application of evidence-based research, my thoughts go to the education of nurses and how they can employ nurse-driven research protocols to benefit their patients and their country while adding to our base of knowledge. Today's complex health problems are not amenable to single-discipline research approaches. Nursing, social science, and biomedical research approaches make unique and independent contributions to the public's health, but they also complement each other. The interdisciplinary characteristic of nursing research uses multiple perspectives to study the health, illness experiences, and acceptance or rejection of new medical interventions in a society. “In order for nursing to be at the forefront of knowledge generation and address societal issues and health care, nursing research must be relevant to health and illness situations, scientifically rigorous, and readily translatable into practice and health policy” (Potempa & Tilden, 2004). Nursing research can encompass a wide scope of scientific query including clinical research, health systems, outcomes research, and nursing education research. While clinical research provides the scientific basis for the care of individuals, practical query into health systems and outcomes research examines the availability, quality, and costs of health care services as well as ways to improve the effectiveness and appropriateness of clinical practice. Finally, as seen in more developed countries, nursing research can be a way to strengthen the healthcare system by way of showing nurses that they are valued for their engagement and effectiveness.
While we are improving educational strategies to prepare clinicians and scientists, let’s not forget the professional training, education and retention of a critical resource, our professional nurses.
Many thanks,

Carel IJsselmuiden Panelist Replied at 11:50 AM, 14 Aug 2013

Hi Mary,

indeed - good question. In fact, the director of the start-up is an African himself - doctor turned 'entrepreneur' - and was very much looking at every scientist he could lay his hands on. One explanation for lack of scientists in South Africa is that there is so much more to be earned elsewhere. Another is that there are too few - so, those that are available, end up in industry. And another is that too few women go into science - roughly halving the potential workforce.

Lachlan Forrow Replied at 12:29 PM, 14 Aug 2013

Carel: Crucial point! Being much more proactive about recruiting/training women obviously doubles the potential pipeline for any traditionally male-dominated field.

One effort, led by Professor Geraldine Richmond of the University of Oregon, is COACh International, which on its website explains itself this way:

"COACh International (iCOACh) is working on projects around the globe to build scientific and engineering leadership capacity in scientific areas of global need and in countries where the need is the greatest. The projects are research focused and aimed at catalyzing and sustaining scientific collaborations and networks across international and cultural boundaries, with women as leaders and active participants in these activities."

Professor Richmond led a training workshop in Gabon last year -- see link below for more details.

Attached resources:

Mary Nnankya Replied at 12:58 PM, 14 Aug 2013

Carel-If the pay is poor then he should not pretend that he has ALL the necessary funding. It is about sustainability not just barely surviving or exploitation while looking elsewhere. He should be encouraged to join this panel and maybe realise how valuable a well remunerated workforce can be productive especially in South Africa!!! In many East African countries instead of partnering with European/American research organizations for collaborative research and training, scientists are sent to South Africa more regularly!!!

Manuel Lluberas Replied at 3:18 PM, 14 Aug 2013

As a public health entomologist, my bias is vector-borne diseases. Within those, my work revolves mostly around malaria, dengue fever and Chagas disease. I do not pretend to know anything related to clinical medicine or therapeutic drugs used in these. My limited knowledge in that area is based on decades of involvement.

From my perspective, there is a lot of practical research needed in Africa and other parts of the world. Considering that about a billion US dollars have been spent annually on malaria control during the past decade and that we are no better off than we were in the early sixties with regards to malaria, I have to ask two basic questions: Are we doing the right thing? Are we doing things right?

These questions should be the basis of any possible research in Africa or any other part of the world fighting vector-borne diseases (or anything else for that matter). There are a number of things I could propose, but they all revolve around vector control, so I will not bore you with my bias by expanding this any further. However, regardless of where one stands in the public health arena, the question of what research line one can follow must be preceded by preparation. Research for the sake of research is okay for the institutions and organizations with the means and infrastructure to conduct them, but they are of no real value for those institutions with limited resources or budgets or when there is no employment opportunity or career path linked to it. As investigators, we need to be careful not to try to turn a biology or zoology department of a university with limited resources and/or career path into South Africa’s Malaria Research Center (MRC) or a Mayo Clinic. The path taken should be like the one taken by MACHA in Zambia, Ikafara in Tanzania and a handful of others. Only this way can we begin to provide some direction that is appropriate and beneficial to the countries involved and a foundation from which the country can help herself grow. In addition, this will generate a sense of pride and ownership in the participating staff and the visibility the organization needs to generate interest and funding for her future and that of her country.

I hope this is helpful.

Junior Bazile Replied at 3:35 PM, 14 Aug 2013

That's an interesting discussion.
Looking at the idea of change of health scientist to scientist for health makes me think that one key thing that needs to happen is more recognition, guidance, support and capacity building opportunities to those who are in the field dealing with the day to day implementation of projects.

Ministries will be constantly overwhelmed with urgencies and there will never be enough money in the budget to do everything that is supposed to be done. However sometimes there are small scale intervention that can bring significant evidence on what local, national and even international teams should focus on. And the success of those intervention depends highly on groups of people who might not have high level skill sets or good grasps on complicated concepts.

One thing that we have observed is often time the health scientist are completely unaware of what is really happening on the ground. They might not even have the cultural competence to understand what is at stake but they are at the forefront of everything related to research and publication whereas those who are really doing the good work of delivering services (can we call them the scientist for health?) while they are accumulating experience that can be shared with broad audience are on the sideline. Most of the time they don't have any recognition, sometimes they are simply acknowledged when they were supposed to be given opportunities to learn from the research team, participate in the discussions, data collection, analysis and publication as co-authors.

It's clear that more opportunities are needed for those who are dealing everyday with the endemic diseases in the resources poor settings. Those opportunities should be clinical, they should also be focusing on research in order to generate more evidence.

The fight against endemic disease cannot be fought only in fancy labs and offices where sophisticated technology is paramount. This fight should happened mainly at grassroots level where implementers are asking everyday for more skill building opportunities and more recognition for the difficult and tedious work that they are doing.

Corine Karema Panelist Replied at 6:15 PM, 14 Aug 2013

Dear All,

I find most of the comments and questions interesting for this topic.

The first and most important thing is the vision of the leadership of the health sector in this case the Ministry of Health.

One would ask, how many countries have research as a pillar or key strategies in their health sector strategic plan as Rwanda does?

Evidence and research should be one of the guiding principles of the health sector.

I'm sure that many countries can do research with minimum funds and budget should not be an obstacle or barriers.

For instance, the simple and cheapest way of doing research would be operational research and documenting impact or benefits of health activities, research should not only or always been seen as vaccine trial or drug efficacy trial, using funds of activities, one can do research and look at the impact of an intervention, what is needed is a protocol at the beginning.

Currently what matters for us program managers is the global health delivery, a discipline which matters in saving lives, whereby it is important to document field ( true)experiences of health care from the design and implementation looking at all factors involved for the program successes/ failure helping us program managers to replicate and adapt/adjust in our own settings.

In brief research does not always need huge funds or settings, what matters is the vision and leadership of the health sector in implementing evidence based strategies

Corine Karema Panelist Replied at 6:36 PM, 14 Aug 2013

Thanks Carel and Lashlan for your comments and ideas

In responding to whether we do not have enough african scientist, I'm convinced that we do have many African Scientist as most of the field research work is done by Africans in Africa particularly for infectious diseases.
Most of data collection is done in african language, data are collected on Africans and this work is done by local people.

Since we all known an african scientist is known when his name appear on a peer review paper.The right question would be how many African scientists know the importance of being an author or co-author in any publications of work-research their have been involved?
Do African scientist get their name in publications resulted from data they have collected?

Most of the African scientist do not known the importance of publications and this is why most of the time we think that there are not enough scientists.

It is ourselves Africans, to create our opportunities by setting up policies and research guidelines since most of research are done in our country given that we have diseases under study as well as study participants.
African scientist collecting data should be authors as research collaborators team!

Capacity building should also be an important point for any research collaboration in order to empower local people.

Sandeep Saluja Replied at 8:12 PM, 14 Aug 2013

I entirely agree.Research is not merely conducting clinical trials on new drugs or vaccines.There has to be a scientific methodology in whatever we do.If so,research happens automatically.We just need to analyse and document.
In the most severe resource constrained situations too,we need to innovate.In fact the need for innovation is even more there.
One of the areas where GHD already is and can possibly do much more is to be open to practical problems faced by workers in such areas,suggest solutions and offer ways for easy documentation of results.The last part is important for others to be able to learn.The requisite software for such work can be provided to workers,so that they just need to log in and keep tabulating.If the workers are not comfortable with analysis or reporting that may also be helped by GHD team and if it is decided to publish it again GHD team can take the lead if needed with due credit to workers who actually did it.

Corine Karema Panelist Replied at 7:23 AM, 15 Aug 2013

Dear Sandeep

Than you for your contributions and agree with you that GHD is the way to go in short term while capacity building is important for African Scientist to be able to analysis, report and documents research.

The beauty of GHD is its strategic understanding for the conception, scaling-up, and replication of programs and services by documenting the experiences of health care programs and organizations in the field, and examining the role of diverse factors on program strategy, design, and implementation. This is what is urgently needed for existing interventions in the health sector for Africa and developing countries to move and improve the health of our populations.

Agree with you that innovations are needed for us to control/eliminate diseases and for this it is very urgent to strengthen our health system in Africa for us to be able to use our facilities for innovations, drug or vaccine discovery, etc

Corine Karema Panelist Replied at 9:58 AM, 15 Aug 2013

Dear All,

Can colleagues share with us the role of major funders (US, PMI, UN/WHO RBM, GFATM, Gates, etc) in fostering opportunities for local research and whether if they should do more?

For the 13 years I have been working in malaria control program in Rwanda, major funders have increased funds allocated to research as well as for evidence based malaria control strategies, that is why we are seeing declines of diseases like malaria in Rwanda and other countries as well as increase in health interventions with clear impact in lives savings.

Most of major funders which are funding malaria control in Rwanda, usually easily fund research with knoŵn and approved international (WHO, MACRO MEASURE, etc) protocols , mostly for monitoring and evaluating their support like The GFATM and PMI have funded for many years in Rwanda the Malaria indicator surveys, malaria drug efficacy test, insecticide sistance test, the demographic and health surveys, entomological surveys, etc.

PMI have also funded multi country ( including Rwanda) research to understand any change like the monitoring of LLIns insecticide efficacy ( durability test), prevalence of malaria in pregnancy, etc

Some research have been refused to be funded although sound protocols have been submitted and also questions to be studied have been seen as priority for the country or the region.

Most of the major funders like PMI, GFATM are different from Gates since they are funding research which are directly benefiting to the impact of their support and do not always support research which are found to be a priority by the endemic country.
This maybe is linked to their principles and fundamentals in the conception of this funding programs-projects.

The Gates Foundation support many innovations, new ideas, awarding young researchers, funding PhD training for african scientist, etc and the proportion of R&D in the Gates Foundation is big and thanks to Gates support, the world is moving to new tools to eliminate public health problems like the development of the recent malaria vaccine, understand the burden of diseases, elimination of NTds with new approaches, etc.

Funders like PMI, GFATM should therefore increase their envelop to be allocated to new research to be implemented by African scientist as for the past years they have increased funds allocated to monitoring and evaluation, they should also increase the proportion allocated to African scientist capacity building as well as long term training such as PhDs etc

One would argue and ask if research is a priority for major funders given the burden of diseases? Why should they fund research when money can be used to existing evidence -based health interventions which have impact?
Is research considered as an investment for health? This question has to be addressed both to Ministries of Health as well as to major funders.

Would need experiences of other countries to get more insights and ideas

Sophie Beauvais Replied at 10:47 AM, 15 Aug 2013

Dear All,

Thank you for a very productive panel so far. Please share your thoughts on the role of major funders (US, PMI, UN/WHO RBM, GFATM, Gates, etc) in fostering opportunities for local research and whether they should/could do more.

Also, the WHO just released today a new report which is quite on point for our panel discussion: "Research for universal health coverage" http://www.who.int/whr/2013/report/en/index.html

In it they argue that "universal health coverage – with full access to high-quality services for prevention, treatment and financial risk protection – cannot be achieved without the evidence provided by scientific research."

Among main messages:

> Why is research important for universal health coverage?

Despite a multinational commitment to universal coverage, there are many unsolved questions on how to provide access to health services and financial risk protection to all people in all settings.

Currently most research is invested in new technologies rather than in making better use of existing knowledge. Much more research is needed to turn existing knowledge into practical applications.

Many questions about universal coverage require local answers (e.g. how the system should be structured, health-seeking behaviours, how to measure progress). All countries need to be producers of research as well as consumers.

> Three examples among many in the report to help progress towards universal health coverage

Bednets reduce child deaths
Surveys in 22 African countries showed that household ownership of at least one insecticide-treated mosquito net was associated with a 13-31% reduction in the mortality of children under five years of age.

Cash payments improve child health
Review of evidence from 6 countries found that conditional cash transfers, in which cash payments are made in return for using health services, resulted in an 11-20% increase in children being taken to health centres and 23-33% more children making visits for preventive healthcare.

Health care is affordable for ageing European populations
Between 2010 and 2060, the estimated annual increases in health expenditure due to ageing will be less than 1% and falling in five European countries. While the number of older people suffering chronic diseases and disability is expected to grow, the costs of health care were found to be substantial only in the last year of life.

> What research trends are highlighted in the report?

More research is being done in more creative ways and the process of doing research is becoming more robust:

Most low- and middle-income countries now have research foundations to build on.
Research investment in low- and middle-income countries has grown rapidly (5% per year during the 2000s compared to zero growth in high-income countries).

More authors of published research are coming from emerging economies, in particular China, but also Brazil and India.
Increasing partnerships between universities, governments, international organizations and the private sector.
What is needed now?

> The World health report 2013 calls for:

Increased international and national investment and support in research aimed specifically at improving coverage of health services within and between countries.

Closer collaboration between researchers and policymakers, i.e. research needs to be taken outside the academic institutions and into public health programmes that are close to the supply of and demand for health services.

Countries to build research capacity by developing a local workforce of well-trained, motivated researchers.

Every country to have comprehensive codes of good research practice in place.

Global and national research networks to coordinate research efforts by fostering collaboration and information exchange.

Thoughts? What next?

Thank you, Sophie

Joel Breman Replied at 3:44 PM, 15 Aug 2013

I have been following with interest the marvelous exchanges tied to Creating Opportunities for Health Scientists in Disease Endemic Countries. As so many have pointed out, long term (>5 to 10 years) investments for strengthening institutions through research training are the keys. As well, I support fully the comment regarding development of a science culture in low-income countries where curative medicine has the priority due to financial and manpower constraints.

I draw your attention to the Fogarty International Center, NIH programs for capacity strengthening in low- and middle-income countries. FIC experiences cover over 25 years and were initially targeted to confronting HIV/AIDS. The programs have widened to include other infectious diseases and non-infectious conditions such as environmental and occupational health, cardiovascular diseases, injuries, mental illness, population and health, research ethics, and a variety of other topics of priority to countries in Africa, Asia and Latin America. During this time we have trained over 3,600 young leaders in science and public health for over 6 months and tens of thousands more in short-term courses including technology transfer. The training has occurred in over 150 countries through “north-south” and “south-south” collaborations.

Details of these institutional strengthening programs are in a paper titled “Global Health: The Fogarty International, Center, National Institutes of Health: Vision and Mission, Programs, and Accomplishments” which is attached. And yes, close to 90% of the trainees have returned to their home country after long-term training.

Regards to all on the front lines,

Joel

Joel G. Breman, M.D., D.T.P.H.
Senior Scientist Emeritus
Fogarty International Center
National Institutes of Health

Sophie Beauvais Replied at 10:27 AM, 16 Aug 2013

Dear All,

Practical question: how much ethical clearance fees for health research is ethical and what is the process for clearance in your country? Is it helping/fostering research or hindering it?

A few members of the HIFA2015 list (Health Information for All 2015) have discussed this question and their comments are copied below with the ok of Neil Pakenham-Walsh, Coordinator, www.HIFA2015.org. Thoughts?

Thank you, Sophie

--
“We are 2 PIs, one based at the Catholic University of Cameroon and the other based at Walden University planning a research on chronic kidney disease in Cameroon. I must mention that routine care for patients with chronic disease (diabetes and hypertension) in Cameroon does not focus on estimating glomerular filtration rates and they only occasionally recommend urinalysis for patients. Our study intends to study the public health implication of this and also do an economic evaluation of CKD. The national ethics committee of Cameroon is expecting us to pay 200,000 XAF (450 USD) as fees for the ethics committee to give us a national clearance for the study. Please could I get experiences on fee rates from other countries? Also can we also discuss how much fees is actually ethical for research?”
Posted by Mbah P Okwen (HIFA profile: doctor working for the Catholic University of Cameroon. Professional interests: Rational use of medicines in malaria treatment. Evidence based medicines. Evidence informed policy making.)

---
“As an ex-member of the National Ethics Committee in Sudan, I am aware that these committees are not well funded and we could hardly cover the running costs, especially with the habit we have in Sudan that any committee member should be paid for sitting for the meetings. There have been times where the 'regular' meetings were delayed until a budget is secured. There was an alternative of making the PIs pay a small amount of money (around $ 25 USD) to secure that the meetings are held and that their proposals are reviewed. This was not adopted and the head of the department thought we are in a phase where we need to encourage the researchers for ethical review, not the opposite. She also said that the PIs have enough financial burdens.
Personally, I think that these committees should be given a budget from their institutions, especially those affiliated with ministries. However, it would be practically acceptable to have the PIs pay moderate fees, not exceeding 1-2% of the total budget of the research project.”
Posted by Ghaiath Hussein (HIFA profile: a registrar of community medicine and bioethicist by training. His expertise varied from providing assistance for researchers on technical and ethical issues, to editing and developing ethical guidelines and training manuals on research ethics. He has been working in the department of research at the Federal Ministry of Health (Sudan), before being assigned as the Senior Project Officer a MARC (Mapping African Ethics Review Capacity) project managed by COHRED and funded by the European and Developing Countries Clinical Trials Partnership (EDCTP). Currently, he is an assistant professor of bioethics in King Saud University for Health Sciences, King Fahad Medical City Faculty of Medicine. He also provides voluntary ethics teaching and consultation services for some regional and international organizations, especially on public health ethical issues.)

----
“In Botswana we do not pay any money. Your fee is steep and this will stifle knowledge development which we so need in Africa”
Posted by Sheila Shaibu (HIFA profile: a Senior Lecturer at the School of Nursing, University of Botswana in Gaborone.)

---
“It is sad with such health research barriers. Yes ethical clearance is very important as we all appreciate that some researchers use human beings as objects without consideration of their rights. It is appreciated that ethical clearance procedures are in place to protect human beings from researches which may be unethical, however my feeling is that the fees to be paid by researchers should not be prohibitive because we may block researchers especially the novice. At the moment even if we may share the ethical clearance fees from different countries, little will be achieved because each country/committee has its own structures of the fees. My message to the Ethical committees in different countries is that they need to be considerate when setting the fees which can be affordable by beginners. Secondly they need to call for research proposals for reviewing and clearance at scheduled times in the year so that a numbers of proposals can be reviewed at one meeting to cut the costs of allowances if at all they are coming from distant towns/ areas.”
Postes by Flemmings Nkhandwe (MPH, Bsc Nur Adm & Ed.UCM) Technical Advisor/Executive Director, Association of Malawian Midwives (AMAMI)

Virginia Lipke RN, MHA, ACRN, CIC Replied at 11:01 AM, 16 Aug 2013

I believe that Manuel is on the right track. When I think of the practical application of evidence-based research, my thoughts go to the education of nurses and how they can employ nurse-driven research protocols to benefit their patients and their country while adding to our base of knowledge. Today's complex health problems are not amenable to single-discipline research approaches. Nursing, social science, and biomedical research approaches make unique and independent contributions to the public's health, but they also complement each other. The interdisciplinary characteristic of nursing research uses multiple perspectives to study the health, illness experiences, and acceptance or rejection of new medical interventions in a society. “In order for nursing to be at the forefront of knowledge generation and address societal issues and health care, nursing research must be relevant to health and illness situations, scientifically rigorous, and readily translatable into practice and health policy” (Potempa & Tilden, 2004). Nursing research can encompass a wide scope of scientific query including clinical research, health systems, outcomes research, and nursing education research. While clinical research provides the scientific basis for the care of individuals, practical query into health systems and outcomes research examines the availability, quality, and costs of health care services as well as ways to improve the effectiveness and appropriateness of clinical practice. Finally, as seen in more developed countries, nursing research can be a way to strengthen the healthcare system by way of showing nurses that they are valued for their engagement and effectiveness.
While we are improving educational strategies to prepare clinicians and scientists, let’s not forget the professional training, education and retention of a critical resource, our professional nurses.
Many thanks,
Ginny Lipke RN,MHA, ACRN, CIC
TB/HIV Team Infection Control Practioner
Center for Global Health
Center for Disease Control and Prevention

Clive Shiff Panelist Replied at 11:46 AM, 16 Aug 2013

From Clive Shiff:

It is enlightening to read all the comments and suggestions, frustrations and realities that affect the training, and career development of scientific people in disease endemic countries. It seems to distill into a series of circumstances. It is not only that there are insufficient people from these countries that are being trained (we can meet them in all walks of life, in all different places, but not usually in the endemic countries (unless employed by International agencies or private industry). The overarching problem is lack of career opportunities for scientifically trained personnel on the ground and in country. As one colleague mentioned, one can earn far more overseas than at home.

In fact one feels that the administrators in endemic countries are not interested in local scientific development, and also the public is unaware of the contributions that we contribute when working at home on local problems. It seems that in some places (e.g. Cameroun see in the note below) scientists are “fat cows” that can be fleeced for funds, can provide new vehicles, and run around providing useless information. So it is important for SCIENCE to be seen as a public good, can create health and knowledge that will benefit the nation. (that is why the late Steve Chandiwana and I wrote the paper on the role of science and development in Africa, read it, It is an attachment to the series). The problem is illustrated in situations where local scientists are needed to monitor interventions. I saw this myself at a recent meeting on malaria control where a representative from the Global Fund was asked why the GF doesn’t pay for monitoring. His answer was that GF always sets aside funds for monitoring in the national agreement, but the money is not used because there are no people to do the work in the health system, and very likely there is no demand from the administration that evaluation is carried out!. Evaluation is a key component in any intervention, but it is not seen as important by administrators. We need to change the attitude of the administrators. How?

So what can be done: I believe that this is a role for scientific institutions in more developed countries to show the benefit of a local scientific civil service (we should be inclusive and not only speak of health systems here). This can be done by example, e.g. the Fogarty programme in the US as mentioned by Joel Bremmer. This can be arranged by others as well e.g other donors who can organize high level regional meetings for administrators and show the benefits of science. It can be emphasized by donors who should require counterpart scientists to be present and take over programmes funded for long term action – it can be made a requirement for sustained funding, but as part of the local civil service not a once off grant. There is no point to get into details here, there are many ways to influence politicians who have the development of their country at heart (maybe this is asking a lot, but one can hope). But when donors require local counterparts in order to provide funds for a programme, the penny will drop and careers will appear. I has been done but requires a positive attitude from the donor as well.

Mary Kasule Replied at 12:14 PM, 16 Aug 2013

Dear All
Thank you for your valuable contributions on the debate of “Research Ethics Committee Service Fee”. It’s true that high fees may block research but there is a lot that goes into having quality and efficient Research Ethics Committees. Many research ethics committees (RECs) and medicines regulatory authorise (MRAs) in Africa charge fees for services for sustainability especially those not supported by government or external grants (www.researchethics.org ). For example:
a) Gambia: $ 1500 per protocol,
b) Burkina Faso: 500 000 (USD 1008)
c) Tanzania FOOD AND DRUG REGULARATORY AUTHORITY charges a fixed fee of USD 3000 per clinical trial protocol for a new application, amendment USD 200 and expedited review USD 6000
2. What payment is ethical?
Research ethics committees (RECs) need administrative and financial support for quality and efficient review of protocols and the costs are high. For example it is estimated that in the UK the operating costs of one research ethics committee in the UK are £36,000 per annum, if both direct and indirect costs (such as time taken by committee members for review) are taken into account. This does not include start-up costs, reimbursement of costs of travel, costs of interacting with other committees, or of monitoring and evaluating approved projects1. In the US, ethics review committees may cost up to S$500,000 per annum to support2. Although the costs in Africa may be lower, most of the RECs in Africa do not have a dedicated budget for REC administrative purposes (www.researchethics.org), therefore they either rely on government funding or external grants. Those that have no access to these have to levy fees for reviewing research protocols by charging either a fixed or negotiable fee based on the research budget. This fee is generally recognized by sponsors as legitimate to cover overhead costs, and some even encourage such costs to be clearly identified in funding applications, and are often less willing to pay a proportion of the research budget for such review, particularly when this amounts to a significant sum.
The question as to how much is ethical should be determined by the RECs depending on the quality of work, volume of work, overheads met and the how much funding is available to the researcher. The RECS are expected to function with integrity and apply the principles of autonomy, beneficence and justice in determining the fee.
1Squires SB (2001).Personal communication. Liverpool school of Tropical Medicine
2Wikler D (2000). Personal Communication .WHO

Mary Kasule (COHRED)

Attached resource:

Pierre Bush, PhD Replied at 11:39 AM, 17 Aug 2013

Somebody told me that I will pay 500 US $ in Zambia. I have not send my proposal yet!
Pierre

Sungano Mharakurwa Replied at 7:28 PM, 18 Aug 2013

Dear Colleagues,
Thank you for a very informative and important discussion on Creating Opportunities for Endemic Country Scientists. Widely participated, it was an instructive sharing of expertise, ideas and experiences towards cracking a global public health challenge, which is what GHDonline is about. The next task will be to synthesize the instrumental contributions and chart some possible strategies and recommendations on how to make a difference. Thanks again to All.

egh Eduardo Gotuzzo Replied at 9:08 PM, 18 Aug 2013

clive
100% AGREE WITH YOUR POSITION AND WE NEED TO EMPHASIS IN OUR DEVELPOMNET
THE SCIENCE is basic and important
severla issues are need
1.- our countries need to acepted the impact of pour roles in the control
on NTD and other inf diseases with impact also in quality of life.and cost
etc
2.-the international instituion also need top change and promot as the PI
some from local country.usually the overhead of the USA CANADA OR
EUROPEAN university is near to 40%.also the salaries of our friends from
those countries aere 4 to 8 times more than pur salaries,in sumary if they
mention we expoended 100 millons in UGANDA probaly to UGANDA only arrive
as 35 MILLONS OR EVEN LESS.WE NEED TO PRO0MTOE A CHANGE IN THE
INTERNATIONAL COOPERATION
3.we need to trainee in our facilities in our diseases with our
equipments.some time our reserachers depend of sofistically equipment onmly
availabe in 1er world,we need to promte also chanmge in this part
the brain drainge still is important also in latinamerica but as high as in
AFRICA
best rergards
eduardo gotuzzo

--
************************
Dr. Eduardo Gotuzzo
Director
Instituto de Medicina Tropical
Alexander von Humboldt
UPCH
www.upch.edu.pe/tropicales
www.gorgas.org

Christine Sizemore Replied at 3:45 PM, 19 Aug 2013

Dear Colleagues,
Thank you for this interesting discussion! I work for the United States National Institute of Allergy and Infectious Diseases (NIAID) which is part of the National Institutes of Health (NIH). We support biomedical, clinical and product development oriented science through grants and other avenues. Being the organization at NIH that is focused on Infectious Diseases, we recognize as part of our Global Health Research Strategy that encouraging, conducting, and supporting research and research training in disease endemic countries is important. We have research portfolios in global infectious diseases such as Tuberculosis, HIV/AIDS, Leprosy, Malaria and other neglected tropical diseases that benefit from collaborations between United States and endemic country researchers. These collaborations have been important for building research capacity in countries. We also provide training for a variety of clinical research activities to help contribute to research knowledge and procedures.
Here are a few links that will hopefully give you an overview of how we at NIAID, and others at NIH contribute to global health research.

• NIAID’s Global Research Program: http://www.niaid.nih.gov/topics/globalresearch/Pages/default.aspx.
• Report of a recent expert panel review we have undertaken for one of our operational unit’s International Research Program http://www.niaid.nih.gov/about/organization/dmid/Documents/IntlreviewDMID.pdf
• Example of a country specific funding opportunity for biomedical research: http://grants.nih.gov/grants/guide/pa-files/PA-13-179.html
• Website for one of our sister organizations at NIH – The Fogarty international Center http://www.fic.nih.gov/Pages/Default.aspx




Christine F. Sizemore, Ph.D.
Chief – TB, Leprosy and other Mycobacterial Diseases Section
National Institute of Allergy and Infectious Diseases
National Institutes of Health
USA

j Am Replied at 5:26 AM, 20 Aug 2013

Here is another piece of news, that can be positive of negative depending on how it's set up

FYI
Africa: China Eyes Health Research Cooperation With Africa
BY LI JIAO, 15 AUGUST 2013




Beijing — China plans to improve the health services it provides in Africa and expand its medical aid there, according to the International Cooperation unit at China's National Health and Family Planning Commission.
"We will expand medical aid in Africa, although there are many challenges," Ren Minghui, director general of International Cooperation at China's National Health and Family Planning Commission, tells SciDev.Net.
Further collaboration will be discussed at the Ministerial Forum on China-Africa Health Cooperation in Beijing later this week (16 August).
Ren says he will make changes so that more African patients can be treated, and will also improve the quality of the Chinese researchers in medical teams that go to Africa.
This year marks the 50th anniversary of the first Chinese medical team arriving in Africa. There are more than 1,000 medical researchers providing health services in 42 African countries.
The Chinese government has spent about US$4.9 million on building 30 modern hospitals in Africa. It has also set up more than 30 anti-malaria centres in Africa and spent another US$81 million on medical and anti-malaria equipment.
China aims to improve not only the medical service, but also education and research programmes, teaching African researchers about traditional Chinese medicine.
"China plans to train Africans to understand public health policies, prevention services and key infectious diseases," says Ren.
Ren hopes Chinese local governments, NGOs, enterprises and international organisations can provide financial support for medical aid in Africa.
Some local Chinese governments have built small medical centres in African countries. Jiangsu province, for example, has built several medical centres, including a minimally invasive surgical centre and an ophthalmology centre, in Tanzania.
Kong Qingyu, the leader of a medical team in Guinea and vice-president of An Zhen Hospital of the Capital University of Medical Sciences, says Guinea is "too weak in orthopaedics, cardiology, internal neurology and neurosurgery because the equipment is too expensive".
When his team arrived at the hospital, there were only a few patients in orthopaedics, but after they carried out successful operations, the number of patients increased tenfold and the wards became full, Kong says.
The ministerial meeting this week is expected to yield further collaboration, especially on traditional medicine.
"Several African health ministers have made proposals asking the Chinese government to help them develop their traditional medicine," Ren said at the 4th International Roundtable on China-Africa Health Cooperation in Botswana in May.

http://www.chinadaily.com.cn/opinion/2013-08/16/content_16898295.htm




China, Africa and global health
Updated: 2013-08-16 08:52
By Michel Sidibe ( China Daily)

The headline for this week's Ministerial Forum on China-Africa Health Development is clear: Solidarity on global health is essential and imperative. It is value for money. It saves lives. The commitment by Chinese leaders, and more than 30 ministers of health from African countries, representatives of businesses, civil society and academics, demonstrates that working together to ensure universal access to healthcare sets a new stage for South-South cooperation.
Economic growth in China and Africa, spurred by bilateral trade and cooperation, has improved the lives of people and lifted millions out of poverty. Investments in healthcare and education have increased all around, but inequalities remain both in Africa and China. So the unfinished agenda of the UN's Millennium Development Goals have to be completed in Africa as well as in China.
China and Africa are in a unique position to leverage their business and trade relationship to encourage breakthrough progress in healthcare. Trade between China and Africa is projected to reach $385 billion a year by 2015. To capitalize on this, China's State-owned enterprises should be encouraged to invest in and promote healthcare in Africa. Since seven of the world's 10 fastest growing economies are in Africa, Chinese investments in the healthcare sector in the continent can produce substantial financial gains as well as generate invaluable public goods.
Take for example the AIDS epidemic. Leadership has been pivotal in transforming the response to HIV/AIDS. China's response to HIV/AIDS, with firm support of its State leaders, has ensured that its spread does not spiral out of control, as many had feared.
Similarly, presidents and heads of states of African countries have acted decisively over the past decade to halt, and even reverse, the spread of HIV/AIDS by making treatment more easily accessible to people. Leaders both in China and Africa have used scientific and advanced methods to tackle the disease and have been committed to respecting the dignity of the people living with HIV/AIDS.
China, for example, has introduced the harm-reduction programs for people who inject drugs - effectively halting the spread of HIV among drug users. And African countries have made it easier for people to access antiretroviral medicines despite the challenges facing their healthcare systems. Today, more than 7.5 million people living with HIV/AIDS are on lifesaving antiretroviral medicines in Africa, and about 3.5 million lives have been saved. The majority of the active pharmaceutical ingredients (APIs) in these medicines are produced in China. As Africa builds its capacity to indigenously produce its essential medicines and diagnostic capabilities, access to quality APIs and raw materials from China could go a long way in ensuring viability and sustainability of manufacturing medicines in the continent.

Mary Nnankya Replied at 6:35 PM, 20 Aug 2013

Check this out, a good example of what creating opportunities and investing in African Scientists can achieve towards developments to their communities' needs

http://www.forbes.com/sites/mfonobongnsehe/2012/02/09/young-african-invents-t...

http://www.bdlive.co.za/life/gadgets/2013/07/31/an-african-soap-that-might-wa...

Attached resources:

Pierrette Cazeau Replied at 7:56 PM, 20 Aug 2013

"Malaria has been declining in many parts of the world, but there is still a lot of work to be done in order to completely eliminate it". I totally agreed with you Pierre Bush but how could scientist eliminate the disease such country like Haiti.

Manuel Lluberas Replied at 7:52 AM, 21 Aug 2013

Pierrette:

Malaria has been eliminated from a number of places with similar conditions affecting Haiti. It can be done. The approach, however, cannot be to try to implement in Haiti what has been done in Africa. For one, the vectors are not the same and have somewhat different biting and resting habits that make IRS and LLINs not so effective. The approach should be more comprehensive. One that addresses the mosquito -not just malaria mosquitoes- and also attacks the disease in humans. So, mosquito control attacking the vector from several flanks (environmental management, larval control, adulticiding and community involvement) while attacking the parasite with therapeutic drugs will work. Unfortunately -and forgive me for being so direct- no amount of effort will work without political will and participation of the community; in Haiti or any other country.

Again, it can be done. It may take some effort, but it can be done. To do so, Haiti will need to treat malaria, or any other vector-borne disease control program as if they were pregnant. That is, you cannot be partially pregnant. You need to commit to it 100%. Unfortunately, after a couple of decades of work in mosquito control, it is my impression that many countries do not take this approach. Those that have have been able to eliminate or reduce malaria (look back at the US, Europe, the USSR, the Panama Canal, Fred Soper's work in Brazil, etc.), but only after a comprehensive approach was taken.

I'll be happy to help you in any way.

Pierrette Cazeau Replied at 2:39 PM, 22 Aug 2013

@ Manuel Lluberas no need to apology for being direct with the subject. I am not part of any organization in Haiti but thank you very much for your input

j Am Replied at 4:30 AM, 23 Aug 2013

Pierrette

koman ou ye? That's some of the things I have left, after my time Haiti

Malaria can be eliminated in Haiti, and that needs a comprehensive and multi-sectoral approach, including environmental. I fully agree with Manuel. In addition to the donor approaches, the country( and its communities) should integrate it's willingness to do so. The same goes for most of the low income countries. First, lets the countries believe that the can eliminate it, then put into place all necessary strategies to do so.

Pierrette Cazeau Replied at 12:48 PM, 23 Aug 2013

J Am thanks for your input I am involved on any situation in Haiti therefore I could not add any comments to your posting. But I am fine thank you for asking

Nadege Belizaire Replied at 12:13 AM, 24 Aug 2013

I agree with you J Am . So we can do it. It's possible.

chris macrae Replied at 4:50 PM, 3 Sep 2013

Hi

I dont know if this is a topic that has already been covered but I am researching leading edge open education resources and health is one of the 5 foci that I see as most urgent for open education

so does anyone have experience of the open education resource for african healthcare www.oerafrica.org/healthoer/Home/tabid/1858/Default.aspx

Carel IJsselmuiden Panelist Replied at 8:12 PM, 3 Sep 2013

Hi Chris, I was not aware of AfricaOER - looks like a great resource. Some
time ago (perhaps 4-6 months), there was a discussion on the Global Public
Health group on Linked In about open resources in public health - and a lot
were listed. However, it seems the discussion was closed - at least, I can
no longer see it. Perhaps you can join up and ask for access to get this
info.

Carel


--

*Prof Carel IJsselmuiden*
*Executive Director: the COHRED Group
Geneva/Switzerland
*-------------------------------------------------------------------------
COHRED - Council on Health Research for Development
*Incorporating the Global Forum for Health Research*

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Panelists of Creating Opportunities for Health Scientists in Disease Endemic Countries and GHDonline staff