New opportunities in a changing landscape

Kathryn Strachan

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African countries are at a turning point, where they have an opportunity to invest in research capacity and ‘leapfrog’ over research institutions in other parts of the world.

This was the optimistic message from Val Snewin, international activities manager for Britain’s Wellcome Trust, who was addressing a session of Forum 2012 on the topic of developing research capacity.

Snewin said that, in light of the recession in Europe and the United States, and set against positive economic growth in Africa, a new opportunity presented itself for African research capability.

Getting fitter: new opportunities are opening up for health research in Africa (Credit: Flickr/Oxfam)

“The world is shifting on its axis here,” she said. “But very few national governments are stepping up and engaging with it. We need political will, and for governments to invest in research capacity, where they can afford it.”

Two examples were Ghana and Tanzania, both of which were showing commitment to creating research and innovation.

Rene Loewensen, of EQUINET in Zimbabwe, said that a changing landscape, in which countries were being encouraged to take charge of their own health research agendas, also brought an opportunity to shift the paradigm of how research is carried out.

Previously the focus had been on building capacity in research institutions in universities, she said. Now there was a need to extend this research to a broader context.

Placing research capacity in the community and in health services would enable it to be more responsive to the needs of both the community and the country.

“It allows us to look at the real world, rather than at theoretical issues,” said Loewensen.

But this new focus on community and multidisciplinary research had also brought new challenges, such as how to keep track of quality in a rapidly changing field.

Yogan Pillay, deputy director general of the South African health department, said that policymakers were increasingly recognising the importance of research, but were now seeking an answer to “how to make it happen”.

The questions they faced were around the implementation of research results, and scaling them up to make a wide impact.

Kathryn Strachan is a freelance health and development journalist working in Johannesburg.

This blog post is part of our Forum 2012 coverage — which takes place 24–26 April 2012. 

Enterprise comes to the aid of health

Kathryn Strachan

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Forum 2012 has heard several examples of ways in which entrepreneurs in developing countries are beating a new path for bringing health innovation to poor communities.

In Bangladesh, where there are not enough doctors and nurses to provide care for a population of 160 million, almost 70 per cent of care comes from the ‘barefoot doctors’ – 400,000 informal healthcare providers.

An enterprise based on providing these informal health workers with medical information –  particularly in prescribing medicine to diabetic and chronic patients – through mobile and smart phones has gone a long way to providing better care for these patients.

Sikder Zakir, managing director of the Telemedicine Reference Centre, said the enterprise had so far reached 1.5 million people with diabetes. But with a total of seven million people with diabetes in Bangladesh, they still had a long way to go.

Another of its projects was aimed at the 11 million Bangladeshi migrants who are working in eight countries in the region. The scheme provides a hotline number for them – and their family members back home – which refers them to the local health services.

The enterprise has been operating for seven years, and in the past two years it had extended to India and Pakistan.

The advantage of the service has been that it could be provided at a far lower cost than by government – and it made business sense too.

The element that worked in favour of his enterprise was that the technology had become significantly cheaper over time. And the potential market of 160 million people made it a powerful platform for attracting investors.

Another example came from South Africa, where the enterprise Care Cross is offering high quality medical care for half the cost of a normal doctors’ visit to members under its medical scheme.

And in Rwanda, a public-private partnership One Family Health was setting up primary healthcare clinics on a franchise system, a business-model which was bringing health care to the village level.

An issue discussed over several of the forum’s sessions was how to stimulate private sector interest in African countries. In India part of the success was the support from its government in attracting private investment, and this government-level support needed to be encouraged on the African continent.

Ralph Schneideman of PATH, the non-profit organisation based in Seattle which aims to transform global health through innovation, said companies in the United States and Europe had lost out on the opportunity to form public-private partnerships with India in the 1990s.

However they now had a window of opportunity in Sub-Saharan Africa. Similar initiatives were starting up in Africa, and these companies did not want to lose out again, he said.

Kathryn Strachan is a freelance health and development journalist working in Johannesburg.

This blog post is part of our Forum 2012 coverage — which takes place 24–26 April 2012. 

Making the most of the Arab Spring

Kathryn Strachan

Freelance health and development journalist working in Johannesburg

 Research for health has traditionally received little attention in the Arab world. And the extent to which the situation that has followed last year’s ‘Arab spring’ is influencing the region’s agenda for health research was discussed in a session at the Forum 2012 meeting.

In particular, several speakers pointed out that people in the Arab world now have a voice – and that this presents an opportunity to change the way decisions about both health research and development are made.

According to Hassen Ghannem, professor of medicine at the university hospital Farhat Hached in Sousse, Tunisia, people in his country were now asking about issues that had been accepted without questions in the past.

“The main message from Tunisia is to listen to the population,” he said. People were now demanding answers from policymakers. This created an opportunity to change that way decisions were made, and to place research at the centre of those decisions.

Fouad M Fouad, co-ordinator of the Syrian Centre for Tobacco Studies, said that in an emergency situation, where there was no food or proper sanitation, the place of research was not always clear.

Virtually no research had been carried out in Syria in peaceful times, he said. But the current conflict in the country had brought a renewed need for research on questions such as why vaccination rates had fallen over the past year.

“This should keep us motivated to work harder for research. We should keep going, even when we are in such a shaky position, and work together for change,” he said.

Francisco Becerra, the head of projects at the Council on Health Research for Development (COHRED), said change in Egypt had to be about more than replacing one group of leaders with another.

Political leaders had to listen to the voice of the people. Otherwise the previous neglect of the needs of the population would be repeated, and the opportunity for changing society would be lost.

Other speakers pointed out that the changes sweeping across the Arab world had brought opportunities at every level. But there was a danger that previous hard-won gains – such as progress in women‘s rights – could be lost if they were not adequately protected.

“We have achieved a lot in the past in the areas such as reproductive health, informed choice, and family law, but now the old language is reappearing again,” Hoda Rashad, director of the Social Research Centre at the American University of Cairo, Egypt told the meeting.

“In people’s excitement with the new revolution, they want to cut all ties to the past, and this includes throwing out all the achievements that have been made over the past few years.”

It was essential for researchers to remain aware of the complexities of the issues that they faced, and to have informed debates about them. Otherwise there was a risk that progress made in women’s rights and in health equity would be lost.

This blog post is part of our Forum 2012 coverage — which takes place 24–26 April 2012. 

Health research funding is no gambling matter

Kathryn Strachan

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While many country representatives described to the Forum 2012 meeting their battles to create a flow of financing for health research, an unusual problem has come up in Colombia: how to make it stop.

Mery Barragan Avila, head of the research division at Columbia’s Department of Science, Technology and Innovation’s research division, told a session at the meeting that being selected as a recipient for the funds derived from a tax on gambling had created its own share of problems.

Health research funding should not be left to chance (Credit: Flickr/sincerelyhiten)

“It was like winning the lottery,” she said of the unexpected windfall. But problems followed, as the department lacked the capacity to manage the funding.

In addition, the stipulation that royalties remained in the regions in which gambling took place had also created conflicts – and the potential for unequal treatment – between the regions.

Her example reflected the need for health research to retain government support at its core. Other forms of funding were often erratic, and based on a shorter timescale than that required for effective in-depth health research.

An example from Panama, on the other hand, showed the importance of advocacy, as the research community had made a strong case to government, to donors and to the pharmaceutical industry, emphasising the value of research.

Partnerships with pharmaceutical companies are widely quoted as one way forward, for example by the UK Medical Research Council (MRC), but this route has to be navigated with care.

“We have to ensure that we all understand each other, because we all have different aims,” said Catherine Elliot, the MRC’s head of clinical research support. It could take 40 years of research to develop a major breakthrough. But pharmaceutical companies needed research to be translated into results in three to four years, she said.

Kathryn Strachan is a freelance health and development journalist working in Johannesburg.

This blog post is part of our Forum 2012 coverage — which takes place 24–26 April 2012. 

How the mobile telephone is revolutionising global health

Kathryn Strachan
Freelance health and development journalist working in Johannesburg

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The widespread adoption of mobile phones in developing countries is opening up a world of possibilities for the health sector, a session of Forum 2012 devoted to “mobile health” was told.

Expectant mothers in South Africa, Bangladesh and India, for example, are being reached through a mobile phone campaign that sends them health information and continues through to the first year after the birth of a child.

The programme, the Mobile Alliance for Maternal Action (MAMA), is run by the USAid-supported mHealth and the pharmaceutical company Johnson and Johnson, and has in its first two years has already reached half of pregnant women in South Africa.

The project already has several sources of revenue, and the intention is that its initial donors will withdraw after two years, leaving it to stand on its own feet.

The session was also told that telecommunications has not only made it possible to reach people in remote areas, but has allowed people to make informed decisions on their health.

“It has allowed us to target low-income women in hard to reach areas, and has also helped in our goal of promoting gender equity,” said USAid advisor Lauren Marks.

Telecommunications has also come to the aid of health in fighting the US$75-billion market in counterfeit medicine.

A system run by mPedigree, a non-profit organsition based in Ghana, allows customers to scratch a panel on a medicine package and text the code to a central authority, which can then verify in seconds whether the medicine is safe.

mPedigree president Bright Simons told the session that this not only saved lives, but had a wider health impact, as counterfeit medicines had contributed to the growing problem of drug resistance.

The real power, he said, was not in the technology, but in the wide range of partners that had come together to create this system. “It’s about sharing accountability,” he added.

Another example, of “mobile health” came from South Africa, which has 75% mobile phone penetration, and where Vodacom had agreed to support 70,000 volunteer community health care workers through its Nompilo project.

By helping them keep track of patient details, the community workers are able to improve the care that they provide. And based on the success of the project, Vodacom is planning to extend it to Kenya and Tanzania.

These were just some of the ways in which the mobile telephone is revolutionising health-care in the developing world. And the future promises to be even brighter.

Kathryn Strachan is a freelance health and development journalist working in Johannesburg.

This blog post is part of our Forum 2012 coverage — which takes place 24–26 April 2012. 

Declarations, dancing… but will the Forum deliver action?

Ochieng’ Ogodo
Sub-Saharan Africa regional news editor, SciDev.Net

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In an evening of a cosy buffet and free flowing drinks, many at the Forum’s conference dinner discussed Africa’s love of conferences and the lack of implementation of their outcomes.

Kenya’s Minister for Higher Education Science and Technology, Margaret Kamar, who was the host, could have not been more apt in terming the continent “a sleeping giant with tons of declarations with nothing being done to fulfil them.”

And she said she hoped that at the end of the Africa Forum on Science, Technology and Innovation that scenario would change.

“I hope tomorrow will mark the end of declarations for Africa and we must translate these outcomes into development,” she said.

She had some food for thought for the delegates, that unlocking the continent’s potential won’t come from meetings and resolutions but on the ability of her people to wake up the giant and give it the much needed push to development.

“It’s time for science, technology and innovation in Africa and there is no short cut. We must do it. We want solutions that will work. Practical solutions for practical problems,” Kamar said.

The dinner was also a chance for delegates to relax after a long day’s deliberations, with African beats belching out from big speakers.  There was talents galore in footwork, and some very intricate and rare dance steps.  It was a reminder that everyone there, irrespective of their stations in public life — academics, diplomats, and even journalists like me — have many other gifts… including dancing.

Nonetheless, Kamar’s remarks echoed what has been said in many other places, at other meetings in other posh hotels, where excellent declarations have been made that rarely translate into tangible solutions for Africa’s people, the majority of whom are trapped in abject poverty.

Africa can only come unstuck with a paradigm shift, not business as usual.

We are now waiting to see how — and whether — this Nairobi meeting that had at its theme the promotion of Youth Employment, Human Capital Development and Inclusive growth will contribute to bringing about real change.

Better support needed for Africa e-health solutions

Maina Waruru
Freelance journalist, SciDev.Net

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While mobile phones use has expanded at an astonishing rate in Africa, this on its own is insufficient to bring so-called E-health solutions to the millions of people living in remote, poor rural areas.

Cellphone use must be complemented by other relevant technologies, infrastructure and applications that will ensure the cost of accessing health ICT is made cheaper and cost effective, the first African conference on Science Technology and Innovation for Youth Employment, Human Capital Development and Inclusive Growth was told on Monday.

“We must never over-rely on mobile phones alone as a means of delivering E-health, and must move to other technologies such telemedicine and video conferencing — which could be a bit expensive, but whose cost can be brought down if we start manufacturing of the requisite devices here in Africa,” said Robert  Jalang’o of the Multimedia University College of Kenya.

Mobile phone use has expanded enormously in Africa, but the conference heard other technologies and infrastructure is needed to roll out e-health solutions to all the continent's peoples.

Mr Jalang’o addressed a session on E-health at the conference, which is underway in Nairobi, saying that the high cost of foreign technologies must be brought down if ICT use in the sector is to be fully realised. This, he said, needed to involve undergraduate and post-graduate students  in producing these technologies, which he added would not only give them specialist knowledge, but provide them with jobs as well.

Speakers at the session noted that back-up infrastructure — such as transmission masts and solar power facilities to power the stations and handsets —  must also be in place to serve people living in the most remote regions of the continent.

While it was agreed that mobile phones should not be over-relied on to deliver health solutions, there was a consensus at the session that these gadgets will be the most popular option to deliver E-health in rural Africa into the foreseeable future.

As a result, the participants said, there is a need to make addressing the challenges relating to access a priority at all levels — not just for policymakers.

“Let’s teach our people  how they can develop content for e-health even at grassroots level as well, so that through using [mobile] phones they can share their expertise in fields such as indigenous health knowledge,” Muhammadou Kah, vice-chancellor of the University of the Gambia, told the session.

He said involvement in generating content for e-health solutions should engage people at village level, noting that locally-produced content would be the most relevant in addressing local health needs.

News story from the conference: Ethics left behind in race for drug trials in the South

Paula Leighton

Credit: WCSJ

28 June 2011 | EN

The number of clinical trials in developing countries has surged in recent years but the legal and ethical frameworks to make them fair are often not in place, the 7th World Conference of Science Journalists, in Qatar (27–29 June), heard today.

By 2008, for example, there were three times as many developing countries participating in clinical trials registered with the US Food and Drug Administration (FDA) than there were in the entire period between 1948 and 2000, with many ‘transitional’ countries, such as Brazil, China, India, Mexico and South Africa, taking part.

For the pharmaceutical industry, the attractions are the lower costs and the availability of ‘treatment-naive’ patients, who are much less likely to have been previously exposed to drugs or trials.

Full news story here

WHO polio eradication target may continue to be missed

The WHO target for the global eradication of polio may continue to be missed, with the media, the international community, planners and medics underestimating the complex dynamics of the disease.

Donors and countries are committing only 60 per cent of the money needed to fight the polio. Credit: Flickr/Gates Foundation

Thomas Abraham, director of the Public Health Media Project at the University of Hong Kong , told a session on ‘Underground Epidemics’ that the paralysing disease is continuing to evade deadlines set by the WHO to consign the disease to history, partly because of the failure to see polio as an epidemic requiring more serious and urgent action.

Abraham said that while the WHO is concentrating its efforts on vaccination in the endemic countries of Afghanistan, India, Nigeria and Pakistan, the disease is busy spreading to West and Central Africa from Nigeria, seriously eroding gains.  

And a serious funding problem has arisen, he said, with donors and countries committing only 60 per cent of the money needed to fight the problem. Currently a gap of US$665 million exists, jeapordising the Global Polio Eradication Initiative’s final push to eradicate the disease by 2012.

“This gap in finances is a big source [of] worry,” Abraham told the session. “If the money is not found quickly, efforts to tackle polio will continue to be delayed, and fatigue may set in – with governments and donors going for other diseases that may become a priority tomorrow.”

Maina Waruru, freelance science journalist and SciDev.Net contributor

Problems in the South, research in the North

Poor countries bear the brunt of health problems. Credit: Flickr/Kaj17

The problems –  such as mothers and babies dying during delivery, and inadequate care – are all there in poor countries. And the research to solve them is all there in the rich countries.

The number of publications focusing on low and middle income countries (LMICs) has increased between 2004 and 2009, according to the WHO’s Alliance for Health Policy and Systems Research.

The lead authors are from the high income countries, John-Arne Rottingen, chief executive of the Norwegian Knowledge Centre for the Health Services, said on Friday. Only ten per cent of health systems research on LMICs is by researchers based in these countries.

In the area of human resources for health, for example, high income countries account for 63 per cent of the publications, compared to 11 per cent from Latin America and the Caribbean,  nine per cent from the Middle East and seven from South Asia.

Grants for health policy systems research may appear to have increased in LMICs, but all this is due to international funding.

There is a  need to bridge gaps in many areas, said Rottingen. For example, between researchers and policymakers (we’ve heard that before many times);  between disease-oriented and systems-oriented research; between epidemiology and economics, and policy analysis and social sciences; and between knowledge translation and knowledge management …

There are many platforms to build too: platforms for collaborative research and training; for coordinating working methods; for creating and sharing teaching material; and for translating health systems research into a  more understandable format for policymaking.

Looks like there’s lots of bridge- and platform-building ahead …

T. V. Padma, South Asia Regional Coordinator, SciDev.Net