Kirsten Patrick: COHRED Forum 2012

Kirsten PatrickThis week I attended and participated in a panel discussion at the Council for Health Research and Development (COHRED)’s 14th Global Forum for Health Research in Cape Town, South Africa. Last year the Global Forum merged with COHRED, and this year’s forum has had a distinctly different focus from the thirteen previous meetings. Whereas in the past focus was on how to get aid efficiently from richer countries to poorer ones, this year’s forum focused on how to stimulate research and development for health in low and middle income countries (LMICs). As I walked into the conference venue I was greeted by a banner that read “Change, not just exchange.” This represents a rather radical shift in thinking, away from the delivery of aid in a vertical giver-receiver fashion and towards considering how to strengthen health systems and creating capacity for research, development, and innovation within poorer countries themselves.

So what did this group of eminent researchers, policy-makers, politicians, and funders talk about for three days? The three themes of this year’s forum were financing for research and innovation, partnerships and networking for research an innovation, and building capacity to support these endeavours long term.

Financing, of course, cannot be ignored, and forum participants acknowledged that funding is still required. But there was lots of talk about receiving communities having a stronger voice in how money is spent, i.e. doing the kind of research and cost-effectiveness analyses that will benefit those who receive aid. It is important that LMICs should earmark some of their own budgets, however small the portion may be in comparison to donor aid, for contribution to research and development projects to give them a sense of purpose and ownership of that research. However, it is equally important for developing countries to be recognised for giving too, not just money, but skilled people, unique local knowledge, and more.

There was much discussion about how to develop effective partnerships. Marian Jacobs of the University of Cape Town said that partnerships do not receive enough recognition. Major recognition is given to individuals in research but not enough to partnerships (“perhaps we need not an H-index but a P-index” she said). There are already partnerships in LMICs that do great work. Regional networks in countries in Africa pool research resources and collaborate to collect data for monitoring purposes. The East Africa Consortium for Clinical Research (EACCR) is a partnership of about 30 research and academic institutions in five East African countries (Tanzania, Uganda, Kenya, Sudan, and Ethiopia) and five European countries (United Kingdom, Netherlands, Germany, Sweden, and Norway). It is sponsored by the European and developing countries clinical trials partnership (EDCTP), the Netherlands-African partnership for capacity development and clinical interventions against poverty (NACCAP), Medical Research Council (MRC)-UK and other development partners.

But forum participants stressed the need for partnerships to be established across many different platforms. Marian Jacobs called for academic engagement from “bench to bedside to bundu and beyond.” (You have to be South African to know what “bundu” means and luckily, being a native, I can translate – it means “the bush,” which refers to rural areas.) Basic scientists need to collaborate with clinical scientists and doctors to make sure that the research that is being done ultimately meets the needs of the populations under study. But beyond that, researchers in the health sector need to form partnerships with researchers and innovators in technology, transport, education, and infrastructure sectors, and also with policy-makers. Furthermore, without minimising the importance of other contributors, the voice of society/communities is very very important and needs to be given much greater weight. There was a feeling that currently feedback from the community comes in at the very end of research and policy-making processes, which is paternalistic. Partnerships with peoples’ organisations should be sought at the very beginning, particularly if our goal is health equity. People feel their own burden of health and they want treatments and systems for it. Given the chance they will help to shape what they need. Traditionally people who need health services to work for them are the most disempowered (older people; children). We can learn from the successes of the HIV+ community who, perhaps because they are largely adults of working age, have managed to develop a strong voice that has driven workable systems and new technologies.

Marilyn Aniwa of Uganda, representing The Union for African Population Studies (UAPS), told a networking success story. UAPS aims to urge research driven policies across the continent of Africa. It was developed in 1984 to “promote the scientific study of population and the application of research evidence in development planning in Africa.” UAPS undertakes tech training workshops for new researchers in partnership with participating training institutions. It also funds a small grants programme that offers grants to young researchers intent on researching topics of local relevance, some beneficiaries of which have gone on to be African research leaders. It also publishes the African population studies journal. Although Marilyn acknowledged that when it was set up the organisation was focused mainly on doing research, she says that it now puts a lot of effort in trying to use its research to influence health policy in Africa. She urged everyone to remember, however, that policy making is not objective or neutral but an inherently political process, and that sometimes even when you bring compelling evidence to policy-makers they choose to disregard it for political reasons.

The third theme of building capacity, of creating environments that develop and nurture innovation and research, was more difficult to pin down. Lalit Dandona, Director of the Wellcome Trust capacity building programme and from the Public Health Foundation of India, said that the devil is in the detail and that there need to be a lot more discussions about the nuts and bolts of what needs to happen rather than the grand purpose. Organisations like UAPS help to develop capacity for research in lower income countries by training researchers, but those countries need to find ways to retain their researchers (rather than losing them to developed countries) and also to create an appetite for scientific knowledge and innovation within their communities. Challenges come in the form of sustainable funding, local scientific leadership and ownership, and forging win-win partnerships across sectors (not just health). And countries need to find ways to deliver health information to all people innovatively too or we will never achieve health equity.
Mario Tristan, the loveliest man from Costa Rica, representing the International Health Central American Institute (IHCAI) quoted from The Knowledge Translation Toolkit.

“Knowledge is like fine wine. The researcher brews it, the scientific paper bottles it, the peer reviewer tastes it, the journal sticks a label on it, and archive systems store it carefully in a cellar. Splendid! Just one small problem: wine is only useful when somebody drinks it. Wine in a bottle does not quench thirst. Knowledge Translation (KT) opens the bottle, pours the wine into a glass, and serves it.

“The researcher might reasonably leave that part of the work to a broker, but must surely never leave it to pure chance.”

And this brings me to my part in the proceedings. I was on a panel (along with Brenda Zulu, founder of Africa Interactive Media, Denis Jjuuko, a media communications consultant from Uganda, Bongiwe Ndondo of the Soul City Institute for Health and Communication Management in South Africa, and David Dickson, Editor of SciDevNet that discussed the role of new media in science communication. See twitpic image here. Sadly, I think the panel were preaching mainly to the converted as most of the audience comprised journalists with only three researchers present. Sad, because my talk was aimed mainly at researchers. Get on the social networks and promote your research, discuss your research, forge links with other researchers in your field through social media. Just DO it. Don’t think about how to do it, and don’t necessarily have a plan, just follow people who say things that interest you and a whole world will open up. Retweet. Participate. Blog. Make amateur videos. Reach people whichever way they can be reached. In the past we did research and then we handed it over and lost control of it to a large extent, either to the media or to mass ignoring. Now we have a voice post-publication and we have a responsibility to use it. The anti-research and misinformation people are out there using it and we have to be doing our bit to communicate evidence to influence and shape policy. I think I might have inspired one or two to follow @bmj_latest, @trished, @fgodlee and @KirstyPatrick at the very least.

A little cherry on the top of the COHRED cake for me was an appearance at the closing ceremony by Yvonne Chaka Chaka. Again, you have to be African to appreciate the significance of this. Yvonne is one of the most famous singers in South Africa and, for South Africans, nearly as famous as Nelson Mandela. She’s a goodwill ambassador for Roll Back Malaria. So this conference ended on a high note. (see photo above)

Kirsten Patrick is the editorials editor, BMJ.