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Research resourcesCapacity strengthening forglobal health researchArticle by Gunvanti Goding (pictured), Michael Chew and Jimmy WhitworthDisparities around the globe in life expectancy, childsurvival, maternal mortality and health expenditure allhighlight the gross inequity of health and welfare inthe world today. Several of the Millennium DevelopmentGoals focus on health. The goals of reducing child mortality,improving maternal health, and combating HIV and AIDS,malaria and other diseases all require major improvements indelivery and uptake of health services. We need both newinterventions and better application of existing proveninterventions. A concerted response is urgently required toensure the generation of new knowledge for effective diseaseprevention, development of affordable diagnostics andtherapeutics, efficient delivery of cost-effective interventions,and health promotion. Central to this response is the need forresearch and increased uptake of research outcomes.The developing world faces many challenges in relation tohealth research: lack of funds; poor institutionalinfrastructure; a lack of appropriately trained personnel; hugehealth burdens of both communicable and noncommunicablediseases; and a lack of cohesive politicaladvocacy.Since its establishment in 1936, the Wellcome Trust hasplayed a significant role in promoting global health. TheWellcome Trust’s mission is to foster and promote researchwith the aim of improving human and animal health. Withannual grant support of over £500 million, a significantproportion is devoted to fund global health research. Forexample, in 2006, we spent £73 million on health researchin low- and middle-income countries.Strengthening research capacity in biomedical science andpublic health constitutes a major component of the WellcomeTrust’s international funding strategy. We aim to build acritical mass of sustainable research capacity in developingcountries. In doing so, we support researchers to tackle theThe Wellcome Trust’s mission is to foster andpromote research with the aim of improving humanand animal health. With annual grant support of over£500 million, a significant proportion is devoted tofund global health researchmost pressing local health problems and to deliver healthbenefits for people and their livestock.Personal supportBuilding capacity locally includes encouraging excellentresearchers to develop their careers in their home countries orregions (see Example 1). Support needs to be long-term tonurture the organic development of teams, centres andnetworks. A good example of this working successfully is ourrelationship with research teams in Kenya which hasflourished over the past 50 years. The Trust’s currentprogramme, led by Dr Norbert Peshu and Professor KevinMarsh, undertakes laboratory, clinical, field and policyresearch on issues of public health importance to Kenya andthe region. There are strong links with the Kenyan Ministry ofHealth through the Kenya Medical Research Institute(KEMRI), which ensure that important research findingsmake their way into policy and make a difference to medicalcare (see Example 2). This programme has influence acrossSub-Saharan Africa and is attracting research workers frommany parts of Africa and beyond.We provide flexible training and career progressionopportunities for the best people at all stages in their careersto work on diseases of importance in a developing countrysetting. We have recently established a range of fellowshipawards for applicants from Africa, Asia and South Americawishing to carry out public health and tropical medicineresearch. Awards are available from junior fellowships forMasters students to senior fellowships for outstandingindividuals wishing to establish themselves as researchleaders.Institutional supportCrucial to boosting research capacity is the need to ensurethat the research that we support helps to consolidate localinfrastructures and national institutions, and is geared tonational priorities. To this end, the Trust has committed £10million over 5 years to a partnership with the UK Departmentfor International Development, and the InternationalDevelopment Research Centre, Canada, which aims tostrengthen health research capacity in Kenya and Malawi.The partnership aims, through working with local ministriesof health and key national institutions, to strengthen thegeneration and use of health research at a national andGlobal Forum Update on Research for Health Volume 4 ✜ 137
Research resourcesinternational level. Key components of this initiative include:✜ supporting and training promising individual scientists;✜ strengthening key academic research and policy-makinginstitutions;✜ facilitating collaborative engagement of nationalrepresentatives;✜ improving regulation and co-ordination of the nationalresearch environment.There are significant difficulties with building researchcapacity in developing countries. Funding opportunities forindividuals are often fragmented and difficult to access. Thepipeline of young school leavers and graduates needed toembark on scientific careers is thin and unreliable. There is alack of credible career pathways and few role models ofsuccessful research leaders. Research infrastructure is ofteninadequate and there is a lack of connectivity betweenteaching in universities and the institutes in which research isconducted. Over time we aim to help support thedevelopment of a critical mass of skilled and adequatelyremunerated academic and technical staff working in avibrant academic environment with strong national andinternational links with research partners and networks. Thisrequires strong national political advocacy for science andresearch and development of national strategies for researchpriorities. This will involve not only the scientific perspectiveof what will work but also the social viewpoint of healthdelivery to those in most need.ChallengesLooking to the future we need to think about how we can useour funding schemes and other mechanisms as drivers ofchange. We need to encourage more partnerships andnetworks between institutions in developing countries andalso to encourage more equitable partnerships betweennorthern institutions and those in developing countries (seeExample 3). The issues of attrition and brain drain need to beaddressed. This requires not only sensitive policies indeveloped countries to avoid pulling skilled scientists awayfrom their home countries, but also local Government andinternational support for developing mechanisms for theretention of high quality trained professionals.We all need to be advocates for science and technology,and to support the skilled individuals who are essential toenhance the health, lives and livelihoods of those in thepoorest countries of the world. ❏Example 1In 2002 Dr Mayfong Mayxay received a Wellcome TrustResearch Training Fellowship for a clinical and laboratoryassessment of antimalarial drug efficacy in the Lao People’sDemocratic Republic (Lao PDR or Laos). His researchinvolved spending long periods in rural Lao studying how bestto treat malaria patients in one of the poorest countries in theworld, living and working in villages where initially there wereno modern utilities like piped water and grid electricity, letalone telephones, televisions and the Internet.When Mayfong obtained a scholarship under a SEAMEO-TROPMED programme he contacted Mahidol UniversityProfessors Sasithon Pukrittayakamee and Nick White, whotook him under their wing. Mayfong completed a PhD,succeeded in obtaining a competitive Trust fellowship, and isnow a critical member of the Lao Project funded by the Trustas a part of its Major Overseas Programme in South-East Asia.Since 2001 Mayfong, in collaboration with his mainly Laoand British colleagues, has published nearly 30 papers ininternational peer-reviewed journals, many having real impactin directing health policies and practice in Laos. His clinicaltrials on artemisinin-based combination therapies (ACT)provided key evidence for the Lao Government to change itsnational malaria treatment policy to ACT. He has also beeninvestigating the causes of fever in rural Laos and made keyExample 2Dr Michael English is a Wellcome Trust Clinical Senior Fellowbased at the Kenya Medical Research Institute/Wellcome Trustprogramme in Nairobi, Kenya. His previous research fundedthrough the Trust’s Research Career Development Fellowship,also based in Kenya, has demonstrated that health workerscontributions to the first post-colonial medical journal in Laoswhich describes the Project’s infectious disease research inEnglish and Lao languages.In July 2007, Mayfong published a paper, in collaborationwith his colleagues in the Lao Project, the Lao Governmentand the USA, in the prestigious American Journal of TropicalMedicine and Hygiene, reporting a sophisticated study onpopulation genetic markers in malaria parasites. This papersuggested that the previous national antimalarial treatmentpolicy of chloroquine would not be efficacious in any parts ofLaos and that ACT would be superior over the whole countryand not just where clinical trials had been conducted. Itexemplifies the nature of the research emanating from theTrust’s Major Overseas Programme in South-East Asia whichincludes work in Laos. Under the overall direction of ProfessorNick White, University of Oxford, the South-East AsiaProgramme, which includes developing the research site inLaos, has its major base at Mahidol University, Bangkok,Thailand. Professor White’s interest in the pharmacology ofantimalarial drugs and the studies on artemisinin derivativeshas provided the basis for treatment trials for malaria on alarge scale in Thailand and Viet Nam, and subsequentrecommendation by WHO as the treatment of choice formalaria in many countries.are unaware of the evidence defining appropriate hospitaltreatment of children with severe diseases includingmalaria, anaemia, pneumonia, diarrhoea/dehydration, severe malnutrition and simple neonataldisorders. Treatment is therefore commonly inappropriate,inadequate or occasionally, even actually dangerous. Such138 ✜ Global Forum Update on Research for Health Volume 4
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Contents096 Child immunization: acc
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IntroductionResearch contributions
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