GHF2008 – PS37 – Enduring Research Infrastructures in Low-income Countries

Session Outline

Parallel session PS37, Wednesday, May 28 2008, 11:00-12:30, Room 14
Chair(s): Jon-Andri Lys, Executive Secretary, Commission for Research Partnerships with Developing Countries (KFPE), Switzerland
ICDDRB as a Research Institution in the Developing World
Alejandro Cravioto, Executive Director, ICDDRB, Dhaka, Bangladesh 
Contributing to Health Research Capacity Building in Chad
Jacob Zinsstag, Department of Epidemiology and Public Health, Swiss Tropical Institute, Switzerland 
Sustainable Ethical Review Mechanisms: TRREE for Africa
Dominique Sprumont, TRREE for Africa, Institute of Health Law, University of Neuchâtel, Switzerland 

Session Documents

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Session Report

Contributors: Fabio Weissert (ICVolunteers)

Truly global access to health not only includes universal access to healthcare, but also the availability of medical research infrastructure in both high- and low-income countries. However, at present, knowledge is highly concentrated in the North where science and technical expenditure amounts to roughly 200 to 500 times that of developing countries. In order to narrow this gap, enduring research infrastructures in low-income countries need to be established. Past experiences and ongoing projects can tell us what works and what does not work when it comes to constructing research infrastructures in the developing world.

Dr. Alejandro Cravioto, Executive Director of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR), a research institution in the developing world, offered insights into his institution and into the conduct of medical research in a developing country setting.

Convinced that "all people, especially the poor, can become healthier and reach their full potential through the application of new knowledge", the ICDDR aims to develop and promote realistic solutions to the most pressing health, population and nutrition problems of Bangladesh and the developing world in general.

The ICDDR, which was established almost 50 years ago, initially focused its activities on diarrheal diseases and progressively also on non-infectious diseases. Its research initiatives have, inter alia, led to the development of an oral re-hydration solution (ORS) saving millions of children's lives each year and zinc supplements to reduce diarrhea morbidity. In addition, the ICDDR is a leading training centre and runs two major hospitals (in Dhaka and Matlab), as well as several field sites.

According to Dr. Cravioto, there are two key factors accounting for the ICDDR sustainable research infrastructure: first, its unique standing as an international centre with diversified funding resources, open to different people from all over the world and benefiting from the necessary operational independence; secondly, its full financial accountability confirmed by up to twenty audits from different donors every year.

The biggest challenge for the ICDDR's long-term sustainability remains the volatility of donor funds which is exacerbated by the fact that many donor agencies do not provide funds for medical research outside developed countries.

Jakob Zinsstag, of the Swiss Tropical Institute (STI), argued that "what makes research sustainable in developing countries depends much on the approach you take". For well over two decades, the STI has been involved in Chad with nomadic pastoralists who are excluded from the traditional healthcare system. Professor Zinsstag and his fellow researchers had to adapt their research capacity building to the particular characteristics that define Chadian nomadic pastoralists (mobility imposed by environmental conditions, a highly patriarchal society, close coexistence with livestock, etc).

First, they adopted the "one medicine" concept uniting human and veterinary medicine. Additionally, they relied on a transdisciplinary approach "combining scientific knowledge with the know-how of lay people", linking local communities, scientists from different disciplines and authorities. This paradigm permitted them to look at health not merely from a medical, but also from an anthropological, sociological and geographical perspective, which added considerable value to their undertaking, enabling them to provide "culturally validated health education" for example.

Long-term North-South research partnerships yield an added value of knowledge generation by amalgamating highly technical and specific local knowledge, one of which on their own both parties lack. They should adopt an intervention-based perspective, rather than concentrating on a merely descriptive approach. Community involvement, relying on a triangular connection between authorities/decision makers, concerned populations and scientists, is crucial to success.

Many challenges for health research capacity building in the South remain: the absence of critical mass, the brain drain to other sectors/jurisdictions, politics paralysing research activities and a lack of South-South networks in the developing world.

Dominique Sprumont, of the Institute of Health Law (at the University of Neuchâtel) is the coordinator of TRREE for Africa, a "web-based training and capacity building initiative on the ethics of research involving humans conducted in Africa countries". Bringing together partners from both African and developed countries, it aims to promote "high quality research" and "protection of research participants in Africa".

TRREE capacity building relies on e-Learning (distance learning modules) and on e-Resources (a participatory web-based collection of international, regional and national regulatory and policy resources).

The TREEE for Africa initiative is an interesting illustration of how in our globalised world ideas can travel not only from North to South, but also increasingly from the South to the North: a first assessment of top training priorities and objectives in African and a subsequent one in Switzerland revealed that participants in both continents largely coincided in their preferences. Thus, a concept developed with, by and for African countries is now being taken up in Switzerland and other Western countries.

While universal access to e-Learning and e-Resources is virtually guaranteed in the North, in the South limited internet access and insufficient computer skills to use these interactive resources remain a problem.

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