Research, Malian style

As a great add-on to the conference proper, we got the chance to see some Malian research in action today. I was pleased and surprised to see that thanks (largely) to various sources of international funding, the standard of equipment was high (similar in fact to the UK university labs that I worked in a few years ago).

First stop was the Malaria Research and Training Centre (MRTC), part of the Faculty of Medicine at the University of Bamako, where research into malaria, HIV, TB, leishmaniasis and filariasis is underway. High on a hill above Bamako, the flower-covered campus buildings hide air-conditioned labs where amongst others things, mosquitoes are bred and monitored for mating behaviour, resistance mutations to antimalarials in Plasmodium falciparum are tracked, and Mycobacterium tuberculosis is cultured and tested for multidrug resistance. TB culture is notoriously tricky, and from the pride on the researchers’ faces as they told us “it is now easy”, the possibility of the MRTC becoming the regional centre for MDR-TB testing doesn’t seem like a pipedream.

Next we were taken to the Traditional Medicine Department of the National Institute of Public Health Research, where traditional medicines are tested, processed and administered. Existing traditional medicines that healers use are first tested for toxicity, and if given the all clear are given to patients, who are then monitored for the alleviation of symptoms and any ill effects.

There are many issues to iron out when it comes to traditional medicine, from the validity of such drugs — and administering them almost blind to patients — to the morality of selling a placebo effect, but the attempts being made by the TMRC to apply the scientific method to traditional drugs and to start some kind of system to approve traditional medicine healers can only be applauded.

Last stop of the day, after a delicious lunch of beef skewers and rice, was a visit the Centre for Vaccine Development, where researchers are working on infectious diseases from E. coli to meningitis. But one of their main specialisations is leprosy, certainly not a trendy disease on the global health list. The centre was set up in 1934 to treat the disease and Mali still suffers a burden from leprosy so it’s especially encouraging that it remains a focus.

Around 20 of us went on the visits, a paltry number considering the number of Bamako 2008 attendees. It was a particular shame as I found that the discussions with researchers really crystallised the comments made at the conference; it was inspiring to see first hand how researchers are concentrating on the health problems specific to Mali, and producing results that feed into policy.

Katherine Nightingale, SciDev.Net

Reflections on a Call for Action

So after long hours of discussions and negotiations, the Bamako Call to Action has been agreed upon and officially announced to the world.

Spending three days attending various sessions on research for health as well as sitting in on the ministerial discussions left me with three distinct impressions.

First: Awareness needs to be hammered into the heads of political leaders that health is an investment, not an expense. And that no health means no development.

A fairly common sense understanding I would have thought, but perhaps one that needs to be waved vigorously, and continuously, in front of the eyes of our leaders. And maybe shoved down their throats as well, considering how similar the Bamako Call to Action is to other such previous documents.

Second: International bodies that have similar objectives need to be consolidated so that their efforts can be coordinated and programmes carried out more efficiently and without duplication.

Similarly, governments need to set national health agendas, and these really need to be carried out across several ministries and governmental departments in order to be fully effective.

Of course, I fully realise this is easier said than done. Consolidating international organisations is not impossible, but highly improbable; while getting several different governmental bodies to work together coherently and efficiently without mini turf wars erupting or plain miscommunication is as difficult as getting a stubborn donkey to move when it doesn’t want to. Not that I’m comparing government agencies to stubborn donkeys – honestly!

Third: Southern countries want to become more self-reliant in terms of conducting research. Many representatives from developing nations called for national or regional capacity building, rather than relying on the North to help provide training.

However, with the money still coming from developed nations, it is going to be quite a tricky balance satisfying everybody’s wants and needs, as well as avoiding any potential chips-on-the-shoulders, even if both sides have the very best of intentions.

At the end of the day, I believe it all boils down to individuals. If each person who attended the Forum goes away firmly believing and committed to carrying out whichever part of the Call to Action that is the most relevant to them, we might indeed see some progress in global health.

It may not be immediate, but as was said during the meeting, health is both a current and future investment.

We just need to remember the big picture, but work on our small part of it. And maybe pray for visionary leaders who think in the long term, rather than the short.

Shiow Chin Tan, SciDev.Net

Bamako ‘Call to Action’ unites 69 countries on health research

[BAMAKO] Ministers from across the developing world say they want to take control of their own health research agendas as part of a wish list presented at the Global Ministerial Forum on Research for Health yesterday (19 November).

Launching the much-awaited ‘Call to Action’ at the closing event of the Forum they said they want to prioritise policies dealing with research for health and improve coordination between ministries so that their respective countries can have more ownership of research.

Read the full story on SciDev.Net

Academics ‘have too much say’ on health research agendas

[BAMAKO] Tricky decisions about research priorities should not be left in the hands of academics, according to a speaker at the Global Ministerial Forum on Research for Health.

Instead, policymakers, recipient communities and those who implement policies — an often-neglected group — should be setting the agendas, Irene Akua Agyepong, regional director of the Ghana Health Service told the conference in Bamako, Mali.

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Have we left pharma out in the cold?

The contentious topic of the role in industry in research to strengthen health systems was the hot topic at this morning’s plenary session.

Bamako 2008 was billed as an opportunity for policymakers, researchers, industry and civil society organisations to get together for discussion, but representatives of pharmaceutical companies have been in short supply, as both speakers and participants.

And Merck’s Mark Feinberg may have wished he’d stayed away. His assertion that pharmaceutical and other sectors need to find more creative ways to collaborate and partner, and a reference to the sometimes adversarial nature of the relationship between such sectors was met with questions about the trustworthiness of big pharma.

Feinberg added that pharmaceutical companies have an important role to play in the research for health dialogue and presented numerous examples of where Merck has made a big difference by providing free or cheap drugs, while maintaining that the pharma industry has a very specific role to play.

But it was Mark Walport, director of the Wellcome Trust, who was more forceful. “Blind attack [of pharmaceutical companies] has no value,” he said. “At the end of the day, it’s pharmaceutical companies that make drugs, not academics.”

A representative of the Global Forum for Health Research stated that within a year it will have provided a platform on which researchers, industry and civil society can communicate.

Katherine Nightingale, SciDev.Net

All in the words

Sitting in on the ministerial discussions reviewing the draft Bamako Call to Action, I was struck by just what a delicate process crafting such a document is. Giving ministers of health and science and technology the opportunity to comment on each version of the document is surely a laborious process but a necessary one if the recommendations are to be acted upon.

Semantics is the key issue, with ministers asking for specific words to be put back in or removed, or pointing out where certain words could be interpreted differently; such as whether the word “efficiencies” means making health systems more effective, or cutting staff.

To someone with little experience of ministerial processes like myself, this can seem petty or pedantic. But these are the words that will hopefully be taken back to countries and acted upon — the time this takes is irrelevant if it means that everyone understands the intended meaning and ultimate aims.

These are the words that could — and should — have real-world effects, and choosing them is quite rightly a careful process.

Katherine Nightingale, SciDev.Net

Funding available

There is one area of health research where you don’t have to fight for funding.

As Dr Roger Glass, chair of the session on Implementation/Operational Research held on the second day of the meeting, said, ″When have you ever attended a conference where you have three organisations saying there is funding available [for research]?″

So, people interested in conducting operational or implementation research (or as the World Bank calls it: impact evaluation), put in that proposal now to The Global Fund, the World Bank and USAID.

And the best part is, all three groups encourage incorporation of training schemes for local personnel in the field in the proposal for funding, so that meets capacity building agendas as well. This is especially important as most of the ground personnel are usually community workers, and not trained researchers.

However, participants who regularly work on the ground brought up the very relevant fact that although the funding bodies say there is flexibility in funding to include operational research, the reality is many people on the ground are either not aware of this flexibility or those in charge of the funds are not themselves that flexible.

Another interesting observation brought up was the continued usage of paper and pen in conducting surveys when most field workers would have a ″pocket computer″ with them in the form of their mobile phone. Time to bring surveying techniques into the 21st century?

Shiow Chin Tan, SciDev.Net

Let’s stop and take stock

The halls have been ringing with calls for more in the last couple of days. More research, more capacity to do that research and more focus on the kind of research that should be pursued, whether it be basic, clinical, health systems or implementation research.

So it was something of a surprise when one speaker called for a one-year moratorium on research in a session on social and technological innovation for health. “We should see what we’ve got and how it can be used,” she said. Whether she was serious or not, it raises an important question – do we already have enough research? Should we not be concentrating more on what that research has found and making sure that the right people know about it?

The problem is that no one can say whether we have all the research we need for now, because no one person has access to it all. Language and publication barriers, and no trend in students publishing their research is leading to a lot of research ending up in the so-called ‘grey literature’, inaccessible to the global and sometimes local communities and rendering other researchers incapable of determining whether they are “reinventing the wheel”.

There was much debate on the HR4D-net discussion forum before the conference about the need to create repositories and such for less visible research. Maybe I’ve missed it, but there doesn’t seem to have been much discussion here – which seems like a missed opportunity.

Katherine Nightingale, SciDev.Net

Looking for concrete results

Grumblings around the conference are indicating that not all the delegates are convinced the Bamako Call to Action will result in real-world deeds. One delegate at a session on health system strengthening said yesterday that we could simply photocopy the various communiques from previous meetings, such as the Mexico Ministerial Summit on Health Research, and change the dates. “We’re not saying anything new – what is the progress we’ve made?” he questioned.

But while progress may not be revolutionary, others feel the health research community has come a long way since Mexico. The focus on research for health in this forum, rather than health research, has been highlighted by many speakers as a move towards a more inclusive research community, and one which can consider the determinants and effects of both poor and good health, rather than simply focusing on biomedical research.

And sometimes meetings such as these can have immediate effects at a country level. Aissatou Touré from the Institute Pasteur Dakar in Senegal told the same session that after the Algiers meeting, a decision was made to create a commission for research in the country’s health ministry, incorporating all the different actors involved in research for health to define the national research agenda for years to come. Let’s hope actions like these are not unusual, and the Bamako meeting will have many such legacies.

Katherine Nightingale, SciDev.Net

A regional answer?

Equatorial Guinea is a lonely country in Africa.

Being the only Spanish-speaking nation on the continent certainly makes it difficult for regular day-to-day communication with their French- and English-speaking neighbours, much less collaborate on scientific projects or publish research results in regional journals.

They are a rather extreme example of the problem faced by non-English speaking African countries.

As mentioned by the representative from Chad at the morning ministerial discussion on the second day of Bamako 2008, Francophone scientists have trouble getting their results published as French journals are few and far between, and even French scientists are publishing in English!

He and a few other representatives made the point that it may not necessarily be that research is not being done, but that it is not getting published for various reasons.

However, achieving a critical mass of researchers and trying to justify why health should be given a higher priority as compared to say, food security, to quote the example from Angola, were also among the concerns of the poorer countries at the meeting.

A strong suggestion that seemed quite practicable was the creation of regional networks of scientists or centres of excellence for research. This would enable resource-poor countries to pool expertise and facilities, as well as concentrate funding.

An interesting point brought up by the representative from Morocco was that scientists who are trained abroad sometimes face “passive resistance” from their team, despite having all the resources and political support available. She said that this was due to the view that these scientists were “elite” or because they do things differently.

She opined that this barrier could be overcome by training scientists locally, possibly at the regional centres of excellence mentioned above.

Consolidation was also the call by Norway and the United Kingdom. The Norwegian representative frankly said that the world needed less governing bodies and more action. He suggested that it might be better for some of the many coordinating health bodies to merge to avoid overlapping efforts and increasing efficiency.

It certainly makes sense, but when one imagines the amount of time needed to review and restructure all the operations of each organisation, and worse, the policy paralysis that will result during that time, it doesn’t seem a very practical move in the short-term.

Shiow Chin Tan, SciDev.Net