Let’s stop and take stock

November 18, 2008

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

November 18, 2008

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?

November 18, 2008

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

Scientist–policymaker misunderstandings ‘hindering research’

November 18, 2008

[BAMAKO] Tense relations between scientists and policy-makers are a barrier to ensuring science achieves its potential impact on health in Africa, delegates at the Global Ministerial Forum on Research for Health heard.

The two groups perceive each other to have different world views and different timeframes for action — and policymakers say scientists provide overly technical, inaccessible information.

Read the full story on SciDev.Net

Key African countries ‘not keeping health research promises’

November 18, 2008

[BAMAKO] Several key African countries have done “very little” to invest in health research since pledging to do so at a world meeting of health and science ministers in Mexico four years ago, say critics.

But others – including Tanzania, Rwanda and Mali – have made significant progress in investing in their health research.

Read the full story on SciDev.Net

Wanted: TB test for US$100mil

November 18, 2008

Create a quick, accurate test for tuberculosis (TB) that can be administered with minimal training and resources, and you might just win yourself US$100 million in prize money.

Of course, you would have to allow the test to be sold at cost – meaning no extra royalties from sales; and you’ll only get the money after it has been proven effective over a period of at least seven years.

This prize fund is one of the new ways of stimulating research and development in TB mentioned by speaker Tileman-Dothias von Schoen-Angerer of Doctors without Borders during the session on Tuberculosis Research.

If that amount of time seems too long even for US$100 million, fear not, there is also a suggestion that smaller sub-prizes of maybe US$10 million be given out for important developmental goalposts in the research for such a test with only a two-year proving period needed.

So, any bright ideas for a quick ID on Mycobacterium?

Shiow Chin Tan, SciDev.Net

Global health’s ′Cinderella′

November 18, 2008

Described as the ″Cinderella″ of global health by chair Richard Horton, editor-in-chief of The Lancet, the session on non-communicable diseases (NCD) certainly shared the topic’s luck.

Technical problems struck first when a video from Ala Alwan, WHO assistant director-general of non-communicable diseases and mental health, on ″After Bamako: Taking the agenda forward″ was unable to be played.

Noise from a couple of rooms off the back of the hall where the session was being held also plagued the talk, although the sharp questions that were asked during Q&A showed that the audience hadn’t allowed that to distract their attention from the speakers.

Horton also pointed out that ″if NCD is Cinderella, mental health is the ugly stepsister″; for while WHO has recently developed a programme for tackling NCDs, mental health is still not being given the attention it deserves. Especially when depression is among the top three causes of disability around the world.

One of the speakers, Sania Nisthar, president of non-governmental agency Heartfile, Pakistan, also brought up the interesting situation where researching NCDs in her country has indirectly led to the improvement of the health information system.

For example, morbidity surveys are based on assessment of risk factors rather than actual cause of death as overlapping diseases make it difficult to accurately define the cause of death.

Data on these risk factors are integrated into general demographic surveys due to resource constraints. Researchers using this data have discovered gaps in the data collection, which has resulted in them reviewing and refining the methods of national health data collection in order to facilitate their own research into NCDs, thus improving the health information system.

Shiow Chin Tan, SciDev.Net

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