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POLICY: PUBLIC HEALTH RESEARCH
Building capacity for
public health research
ANDREW Y KITUA
DIRECTOR GENERAL, NATIONAL INSTITUTE FOR MEDICAL RESEARCH, TANZANIA
The developing world bears 90% of the global burden
of disease (WHO Ad-Hoc Committee, 1996; Global
Forum for Health Research, 2002), much of it in the
tropical countries. Here the climatic and environmental
conditions are most favourable for the survival and
propagation of disease vectors and pathogens (bacteria,
parasite or virus). These are the countries with the lowest
economic status and often experience a vicious cycle of
disease, poverty and more disease.
Africa bears the brunt of this unfortunate situation,
contributing 90% of the 300-500 million annual malaria
cases, and around a million child deaths each year. Except
for leishmaniasis, the burden of the other tropical diseases
like schistosomiasis, lymphatic filariasis, leprosy,
tuberculosis, African trypanosomiasis, etc., are also greatest
in Africa. Children are the most affected and the huge
burden of childhood diseases demonstrates the grave
situation in Africa (see Table 1).
In recent years, HIV/AIDS has spread like bush fire in
Africa and is causing irreparable damage to the economical
productive section of its populations.
In the case of available capacities for public health
research, we find the reverse. About four-fifths of global
working scientists of all disciplines, including health are
concentrated in the Western industrialised nations, Japan
and large Asian countries. Africa, Latin America and the
Middle East have together 13% of the world’s scientists.
While Japan has one scientist for every 250 people, the ratio
in many developing countries is one in thousands (WHO
Ad-Hoc Committee, 1996). The developed/rich world,
which only bears 10% of the global disease burden, has the
lion’s share of well trained scientists available globally and
due to its better economic status continues to suck in
further skilled people from the developing world, causing
the brain drain phenomenon.
The core problem is the inequity in the distribution of the
capacity to generate public health knowledge, make it
accessible and affordable to the needy and ensure adequate
utilisation of current knowledge.
Therefore, while there is general agreement that there is a
need for capacity building for public health research, this
need is greatest in developing countries and for Africa it is a
matter of urgency.
Consequences of the lack of capacity
Developing countries are not able to access the available
global resources for health research due to:
➜ insufficient research capacities to compete for the
funds;
➜ shortage of well-trained and competent scientists;
➜ lack of well-equipped laboratories adapted for high
quality research and good practices;
➜ unfavourable conditions for access to funding by
developing country scientists;
Lack of critical mass of scientists for R&D makes it hard
for developing countries to use and implement effectively
the available tools for improving their health status.
Diarrhoeal diseases, intestinal worms and vaccinable
diseases continue to spread even when tools and knowledge
for their prevention are available, because of lack of capacity
to translate the knowledge into action.
Because of the absence of researchers capable of
generating the evidence, policy-makers are unable to benefit
from the much-needed evidence base for taking decisions
about the use of alternative strategies for intervention or for
planning healthcare services (Nchinda TC, 2002).
Lack of scientific capacity is therefore greatly pronounced
in poor developing countries. This exacerbates the vicious
cycle of ‘poverty – disease – poverty’ through the following
chain of events:
➜ Lack of scientists results in low generation and
utilisation of knowledge.
➜ Low technology development and utilisation of current
technology.
➜ Low level of competition for global health research funds.
➜ Lack of power to drive the global agenda.
➜ Poor and dilapidated facilities.
➜ Scientific frustration hence departure to better pastures.
➜ Heavy disease burden, low productivity and increase of
poverty.
➜ Limited technology transfer.
➜ Failure to implement and sustain health research
programmes including disease interventions.
14 | World Hospitals and Health Services | Vol. 41 No. 3