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Strengthening Research Capacity in the Developing World

I am currently working at the World Health Organization (WHO) in Geneva, Switzerland, as a grant programme manager for building research capacity to its full potential in the least developed countries of the world. This position falls under the UN co-sponsored Special Programme for Research and Training in Tropical Diseases (TDR). My position also entails working as the co-ordinator of schistosomiasis research at TDR. Schistosomiasis is a parasitic infection that is endemic in 74 developing countries and an extremely important public health problem, particularly in sub-Saharan Africa.

How did I get here? I was born in Mvuma, Zimbabwe, and grew up in Ntcheu, Malawi, where I completed my elementary education and began secondary school. I completed my secondary education in the United States, where I lived with a wonderful family on a farm in southwest Iowa. It was there that I first developed my fascination with biology, thanks to a high school biology teacher who made the subject--and the sciences in general--very interesting. In the early 1970s, I majored in human biology at Brown University in Providence, Rhode Island, where my faculty adviser's research interest was in the biochemistry of schistosomes. I took one of his parasitology courses and also worked in his laboratory. This was my introduction to the world of biomedical and schistosomiasis research.

Research an Integral Part of the Work

Upon graduating in 1975, I returned to Malawi, where I was eventually employed by the schistosomiasis control programme of the Ministry of Health in 1979. Our team's responsibility was to better understand and control schistosomiasis. Thus research became an integral part of the work to meet our primary aim of controlling the disease. We fed the fruits of our research back to the Ministry of Health at the policy level; to public health staff, through training; and to the community in the form of manuals, community mobilisation leaflets, and films. It was a very challenging position; we had to set up the laboratories ourselves and train the available staff, most of whom had had no previous science background. During this period I learned how to work with available resources and to try to translate solutions for various levels of implementation, from community to government. This experience helped me gain credibility within the public health sector, that was valuable for my further career.

In 1981, I decided to do postgraduate work to gain a better grounding in research and parasitological skills and to be better able to apply the results of published research to our situation. I also felt I needed more background in epidemiology, public health, and statistics. After an M.Sc.-taught course at the London School of Hygiene and Tropical Medicine, I went back, in 1985, to the United States to do my Ph.D. on the diagnosis of schistosomiasis at Tulane University in New Orleans, Louisiana. During this period I was also attached to the Parasitic Diseases Division of the Centers for Disease Control and Prevention (CDC) in Atlanta. In my Ph.D. work I found it exhilarating to have access to wonderful professors and excellent facilities. Being at CDC was also invaluable, because I was working with some of the best public-health practitioners and scientists and what seemed to me to be limitless resources. I also had the opportunity to do most of my dissertation research at their field site in Egypt.

I received my Ph.D. fellowship in the United States on condition that I return home afterward. I honoured my obligation, and in 1990, upon completion of my studies, I went back to work at the Malawi Ministry of Health, as Officer-in-charge of the Community Health Sciences Unit. Over the 18 years that I worked in the Ministry of Health, I held various positions, culminating in management of the country's National AIDS Control Programme. In these positions, research findings were an essential part of trying to provide practical policy choices in health services delivery, and substantial external research funds were made available to address tropical diseases and other health issues. However, these funds came with very specific research agendas - meaning a focus on getting results published as quickly as possible. Another drawback was that Malawian involvement was mostly limited to providing staff for fieldwork and as study subjects. Training and capacity building of local staff were not normally incorporated into these research projects which would normally include students from the sponsoring institutions. In some cases these research projects have remained islands of excellence within a relatively underfunded national health system.

I continued to argue that long-term research would not be sustainable without local research capacity. My colleagues and I also lobbied for scholarships for our staff. Under my supervision at the Community Health Sciences Unit, we trained two Ph.D.-level and two M.Sc.-level epidemiologists. Externally funded research institutions have since followed suit. From my time working at the ministry, I learned how to balance arguing my case with a willingness to compromise.

Support Research Groups to Establish a Research Culture

As I had gone as far I could within the Malawi public service, and I looked for other possibilities in the international arena. I joined the WHO, first to advise on schistosomiasis control, in 1997, and in December 2000 to take a fixed-term position in TDR. Having worked in both field research and control gave me a good understanding of public health needs within limited resource environments, something that made me a suitable candidate for the position. My work with TDR entails trying to support research groups in establishing a research culture, in different situations and environments just as I had done earlier in Malawi.

TDR is an independent global programme of scientific collaboration that was established in 1975 and is cosponsored by the United Nations Children's Fund, the United Nations Development Programme, the World Bank, and the WHO, under which the programme is administered. TDR has two objectives: firstly, to improve and develop new approaches for preventing, diagnosing, treating, and controlling neglected infectious diseases; and, second, to strengthen the capacity of countries with endemic disease (disease-endemic countries, or DECs) to participate in research that leads to new tools and strategies to control these diseases.

This second objective presupposes that the people affected have to take part in defining the needs and finding the solutions to their particular problems. This is not only a matter of empowerment; additionally, such individuals may have a deeper insight into how best to communicate the solutions to their societies. Over the past 29 years, TDR has supported scientists both in developed countries DECs to produce new tools and strategies for controlling tropical diseases.

My current position at TDR is as Grant Manager for the Research Capacity Strengthening ( RCS) programme. In my "capacity building" job my objective is to ensure that scientists and public health experts in DECs with low research capacity begin to participate in the search for new tools and encourage the adoption of future disease-control programmes. For example, the Malaria Research Training Centre in Mali, which had significant TDR/RCS support in its early years, is now highly competitive in malaria research. There are severe constraints on scientific research in many of the least developed countries (LDCs), including a scarcity of qualified personnel, poor laboratory infrastructure, and no local investment in research. Although nominal research institutions exist, there are no straightforward career paths for scientists and researchers.

My job involves working with an international team to help LDC investigators formulate research that is feasible in the context of their institutions. Under the capacity-building programme, TDR accepts investigator-initiated proposals for research on any of its portfolio of diseases (1). Proposals are reviewed by an independent group of experts according to not only scientific merit and relevance but also to capacity-building potential. Support to investigators is provided throughout the research process, with periodic review of progress, data analysis, and report writing. We organise workshops on ethics, good clinical practices, project planning, scientific writing, and other specialised activities. Hardware and software are provided to ensure that even in remote places investigators can access scientific literature--of critical importance to scientists who do not receive published journals routinely.

My portfolio of activities involves a lot of organisation, applying ideas that have worked well elsewhere to our own challenges, and having the conviction that solutions exist to surmount constraints that are part and parcel of the situation. My experience in Malawi is proving beneficial in that researchers seem more willing to listen to someone who has faced similar challenges. With programme grants we also provide support, on an institutional level, to build a research culture in a supportive environment. Thus co-investigators can receive training fellowships and reentry grants under other TDR initiatives. It is extremely enjoyable and rewarding to work with researchers; when things go well for them, the feeling is unbeatable.

Working for an international organization like WHO, one is seen as working for member states according to an agreed agenda for health development. There are many advantages--for example, almost unlimited access to scientists and public health experts, who not only review and guide our work but also are mobilised to assist researchers in all parts of the world. We can get supplies and equipment to all investigators at reasonable cost.

Many disease endemic countries (e.g. Brazil, China, and Thailand, etc.) now have sustainable tropical-disease research programmes. Some of the LDCs have also become competitive for research grants in particular diseases or disciplines. There is a track record of success and TDR has been part of it. Clearly there are also many problems still to be addressed, such as the sustainability of investing in research in resource-poor environments.

I like to think of my work as building systems and networks to support researchers in the same ways that my many mentors helped me at all stages of my educational and professional career. I am still interested in schistosomiasis research, but I now see it more from the angle of the "big picture." From a knowledge management perspective, my involvement is a challenging and very rewarding alternative to a career in classical research.

1) African trypanosomiasis, Chagas disease, Dengue, Leishmaniasis, Leprosy, Lymphatic filariasis, Malaria, Onchocerciasis, Schistosomiasis, and Tuberculosis.

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