World Hospitals and Health Services - International Hospital ...

More documents

Recommendations

Info

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
POLICY: PUBLIC HEALTH RESEARCH Causes of the problem at global level The global agenda has for too long neglected the diseases affecting the poor populations. Malaria research has just started to receive its due recognition after decades of despair in the period 1960s and 1980s although it still receives comparatively low funding compared to the size of the problem. Michaud and Murray (1996) estimated that the global expenditure on research for HIV/AIDS and asthma was, respectively, US$952 million and US$143 million, whereas for malaria and tuberculosis it was about 15- and 5- fold less at US$60 million and US$26 million respectively. Taking cancer as an example, the UK expenditure is about US$225 million, equivalent to US$1,525 per single UK cancer death (Anderson et al, 1996). Malaria, on the contrary, has global expenditure of the order of US$65 per single death, while it is responsible for a much higher death toll. Priority setting at the global level has not yet involved sufficiently for the developing world’s voice to have a strong focus on the causes of the greater global burden. The facilities for generating powerful scientists are lacking in the developing world due to historical reasons, and the tendency not to invest for the creation of infrastructure in the developing world is still a major stumbling block. Many funding agencies do not allow the inclusion of capacity building in developing countries in proposals seeking funds for public health research. It is difficult to persuade development agencies to allow for the inclusion of a research component when obviously the success of development projects depends on good data and monitoring processes. There is a glaring lack of strong training institutions for tropical medicine, low production of medical doctors and other scientists in biomedical fields. The brain drain from developing countries continues thrive, even when we are aware of the negative consequences and there are no policies to halt it. Causes of the problem at regional level At the regional level, there is lack of strong research advocacy and coordination. Such mechanisms either do not exist or, as in Africa, have just been started and are still struggling to get on their feet. A few developing countries like India, Brazil and China have moved faster forward, because they rectified this anomaly earlier on. Consequently, there is little advocacy for political support and financial support by regional economic bodies. Funding mechanisms are lacking or poor, leading to little sense of ownership of the research agenda and of strategies for capacity building. It is not right that Africa has no common research funding mechanism similar to Europe or America. It is even unethical, given the huge disease burden. Regional priority setting is absent and regions have little influence on the global agenda. Networking at the regional level is especially poor and uncoordinated in Africa, resulting in poor research output – unlike the PAHO region and India. There is poor development of peer review systems, research monitoring and control bodies, leaving developing countries as sites to be used for sample and data collection for developed world laboratories, rather than being equal partners in research. Causes of the problem at national levels At the country level there is also weak research coordination, advocacy and promotion, leading to poor quality or lack of research prioritisation. Only a few countries in Africa have well-functioning national health research mechanisms. The industrial base is lacking and product development efforts linking research and industry are rare. National guidelines for partnership are lacking and ethical review bodies are weak or inexistent. Research funding is negligible and mechanisms to facilitate research to implementation are missing. Burden (as % of total DALYs), 1990 Condition World Sub-Saharan Africa Childhood communicable diseases Lower respiratory tract infections (pneumonia) 8.2 10.2 Diarrhoeal diseases 7.2 10.9 Vaccine-preventable childhood infections* 5.2 10.3 Malaria 2.3 9.2 Bacterial meningitis and meningococcaemia 0.5 0.3 Intestinal nematodes 0.4 0.2 Malnutrition (direct effects only) 3.7 3.2 Total burden from these conditions 27.5 44.3 *Diseases preventable with the vaccines currently available through the Expanded Programme on Immunization: diphtheria, pertussis, tetanus, polio, measles. Adopted from: WHO Ad-Hoc Committee, 1996 Table 1: The burden of childhood disease Vol. 41 No. 3 | World Hospitals and Health Services | 15
Page 1 and 2: 2005 Volume 41 Number 3 Internation
Page 3 and 4: EDITORIAL Learning from the tsunami
Page 5: Board of the Ambulance Service of N
Page 8 and 9: IHF NEWSLETTER AMERICAS Hurricane K
Page 10 and 11: COUNTRY PROFILE: FRANCE The French
Page 12 and 13: COUNTRY PROFILE: FRANCE precautiona
Page 16 and 17: POLICY: PUBLIC HEALTH RESEARCH Reco
Page 18 and 19: MANAGEMENT: TSUNAMI EVALUATION Mana
Page 20 and 21: MANAGEMENT: TSUNAMI EVALUATION No D
Page 22 and 23: MANAGEMENT: TSUNAMI EVALUATION spec
Page 24 and 25: MANAGEMENT: TSUNAMI EVALUATION brid
Page 26 and 27: IPSI ihf 7 9/30/05 12:38 Page 27 MA
Page 28 and 29: diabetes_care 9/30/05 12:40 Page 29
Page 30 and 31: diabetes_care 9/30/05 12:40 Page 32
Page 32 and 33: Abstracts IHF7 10/3/05 11:13 Page 4
Page 34 and 35: Members_D_list IHF7 9/30/05 12:36 P
Page 36 and 37: Members_D_list IHF7 9/30/05 12:36 P
Page 38 and 39: opinion matters 9/30/05 12:39 Page
Page 40: opinion matters 9/30/05 12:39 Page

World Hospitals and Health Services - International Hospital ...

Create successful ePaper yourself

Delete template?

Save as template?