Challenges in Healthcare Research in Nepal: What is the way forward?

This study aims to chart Nepal's evolution of health research ethics over time and the role of the Nepal Health Research Council (NHRC) in its regulation. This narrative review article mentions the pervasiveness of contract research and the contribution of universities and international organizations in producing data and supporting pilot projects. It further highlights the structural inequalities and limitations of health research in Nepal, including lack of technology, infrastructure, funding, limited access to resources and global scientific networks. It discusses Nepal's emerging regulatory and ethical field, establishing the NHRC and developing ethical guidelines and review committees. The challenges faced by NHRC in terms of capacity and resources and the need to strengthen research ethics monitoring and compliance are also marked. This article also discusses several key challenges and areas of concern regarding research ethics and capacity building in Nepal's health research context. The conflicts arising from defining health research and determining which activities require ethical review are highlighted, especially about programmatic interventions and monitoring and evaluation exercises. The need for comprehensive mapping of health research activities is emphasized as an initial step toward understanding the research landscape. Additionally, issues related to timely ethical reviews, the co-investigator’s role, institutional research capacity, data ownership, publication practices, and the ethical considerations of health and development interventions are discussed. It emphasizes redressing these challenges and promoting responsible research practices in Nepal.

Research Ethics Committees (RECs) play a critical role in safeguarding ethical integrity in health research by reviewing protocols for scientific validity, social value, and ethical compliance. FERCAP, a regional initiative under WHO-TDR, has supported harmonization and capacity building in research ethics across the Asia-Pacific region for the past 25 years. The 24th FERCAP International Conference, hosted by the Nepal Health Research Council in 2024, provided a platform to examine ethical challenges and innovations under the theme "Maximizing Benefits through Responsible Conduct of Research." A cross-sectional qualitative study was conducted using secondary data sources from the conference, including video recordings, agendas, presentations, transcripts, and reports. Descriptive analysis was performed on participant demographics, while thematic analysis was applied to content from plenary and parallel sessions. Three researchers independently coded the data and identified major themes through consensus. The conference was attended by over 500 participants from 23 countries and featured presentations across 18 thematic sessions. Three primary themes emerged: strengthening ethical oversight through post-approval monitoring and capacity building; promoting inclusivity and contextual relevance in ethics review, especially in social science and community-based research; and addressing emerging ethical issues posed by new technologies and decentralized trials. Discussions also emphasized integrating open science principles, harmonizing international guidelines, and recognizing institutional contributions to ethics governance. The findings from the 24th FERCAP Conference highlight the region's progress and challenges in upholding ethical standards amidst rapidly evolving research contexts. The conference reinforced the need for collaborative frameworks, continued ethics training, and responsive policies that address both biomedical and social research landscapes. These outcomes will inform future directions as FERCAP prepares for its 25th anniversary and continues to strengthen ethical research environments across the region.

The Journal of Karnali Academy of Health Sciences (JKAHS) is an official publication of Karnali Academy of Health Sciences (KAHS), a government organization founded on October 20, 2011, by an act of the Parliament of Nepal [1]. KAHS was established with the objective of enhancing the quality of healthcare services, medical education, and research in remote and underserved areas of Nepal. The establishment of JKAHS in 2018 is a reflection of commitment of KAHS to these goals, providing a dedicated platform for the dissemination of scientific knowledge and clinical experiences in the health sciences [2].JKAHS is a peer-reviewed, international medical journal that operates under a diamond open access model, that means all its contents are freely accessible to readers without any subscription or paywall barriers [2]. This model not only broadens the journal’s audience, including researchers, students, policymakers, and the general public, but also aligns with the mission of KAHS to disseminate knowledge widely and equitably [1]. Importantly, JKAHS does not charge any fees for the submission, processing, or publication of manuscripts, thus removing financial barriers for authors and promoting inclusivity in scientific publishing. Additionally, to ensure the long-term preservation and accessibility of its content in the internet, JKAHS archives all its articles in LOCKSS (Lots of Copies Keep Stuff Safe) and CLOCKSS (Controlled Lots of Copies Keep Stuff Safe) [2]. These archiving systems safeguard the integrity and usability of the published work, ensuring that it remains available to future generations.It is triannual journal publishing three issues per year, and is available both online and in print with pISSN 2616-0064 and eISSN 2676-1327 [2]. This regular publication schedule ensures a steady flow of new research and insights, contributing to the continuous advancement of medical knowledge.Achievements and milestonesOne of our significant achievements has been in indexing of JKAHS in two national databases namely Nepal JournalOnline (NepJol) in 2019 [3] and NepalMedLine (NepMed) in 2020 [4]. The NepJol is hosted by Central Library (TUCL) and it is hosted by Ubiquity Press [3] whereas NepMed is hosted my Nepal Health Research Council (NHRC) [4]. A part from these national databases, we have been indexed in DOAJ (Directory of Open Access Journal) [5] and Hinari [6] in 2023. In the earlier days after indexing in NepJol, individual articles were assigned an unique DOI (digital object identifier) from NepJol (10.3126/jkahs). Later on we have taken our own DOI (10.61814/jkahs) directly from CrossRef under the sponsroship under GEM (Global Equitable Membership (GEM) Program from CrossRef [7]. This recognition is a testament to the quality and impact of our published research. Being indexed has enhanced the visibility and accessibility of our articles, attracted a broader readership and fostered greater academic collaboration.

This case study outlines an ethics approval process experienced during a maternal health research project in Nepal. The Government of Nepal established the Nepal Health Research Council (NHRC) in 1991, along with the Scientific and Ethics Committee reviewing health related research. However, not all researchers apply for ethics approval. Although researchers may claim a lack of clarity on the kinds of research studies needing approval, the authors argue that the guidelines are sufficiently clear if explored and duly followed. The inconsistencies in seeking ethics approval from NHRC could simply mean that researchers are not aware of this ethical review process. Perhaps the guidelines are not strictly enforced. Nevertheless, as researchers it is our responsibility to seek ethical approval as a matter of principle, without considering it a barrier to research.

Global health research for America's vital interest

Health research in Nepal initiated with a survey in malaria in 1952. The first regulatory body for health research was Nepal Medical Research Committee formed under Ministry of Health. Ethical Review Body is the first ethical review structure. Nepal Health Research Council is now an independent body to regulate health research in Nepal. Development of research ethics in Nepal is clearly evident with the development of ethical guidelines; functioning of Ethical Review Board; expansion of institutional review committees and initiation of online submission system. However, monitoring compliance with research ethics could be a challenge for the Nepal Health Research Council.

Unlike other countries in South Asia, in Nepal research in the health sector has a relatively recent history. Most health research activities in the country are sponsored by international collaborative assemblages of aid agencies and universities. Data from Nepal Health Research Council shows that, officially, 1,212 health research activities have been carried out between 1991 and 2014. These range from addressing immediate health problems at the country level through operational research, to evaluations and programmatic interventions that are aimed at generating evidence, to more systematic research activities that inform global scientific and policy debates. Established in 1991, the Ethical Review Board of the Nepal Health Research Council (NHRC) is the central body that has the formal regulating authority of all the health research activities in country, granted through an act of parliament. Based on research conducted between 2010 and 2013, and a workshop on research ethics that the authors conducted in July 2012 in Nepal as a part of the on‐going research, this article highlights the emerging regulatory and ethical fields in this low‐income country that has witnessed these increased health research activities. Issues arising reflect this particular political economy of research (what constitutes health research, where resources come from, who defines the research agenda, culture of contract research, costs of review, developing Nepal's research capacity, through to the politics of publication of data/findings) and includes questions to emerging regulatory and ethical frameworks.

Health research activities have advanced considerably in Nepal over the past several years. However, stakeholders' confidence on scientific community is shaken as the latter failed occasionally in adhering to ethical principles. Nepal Health Research Council has exercised regulatory authority to control and support research works. However, much more is needed given the scale at which studies are being carried out. It is high time to conduct an analysis of the current situation followed by the development of an overarching framework to strengthen health research that facilitates a range of actions along the continuum of identifying information needs to translation of knowledge into policies and practices for ultimately improving people's health. Keywords: Ethics; health research systems; knowledge management; research regulation.

HINARI: Providing Global Access to Health Care Information

The health and health care of women veterans

A bibliometric analysis was performed to map the current status and development trends in medical research in Nepal. It aims to visualize research hotspots within this field and provide effective guidance for future research directions. A systematic search of the Scopus database was performed to identify high-cited papers (HCPs) on medical research in Nepal between January 1, 1994, and December 31, 2023. Bibliometrics techniques were applied to analyze the publication dates, countries, institutions, journals, authors, and research hotspots. Statistical analysis and visualization were carried output by MS-Excel and VOSviewer software. A total of 326 HCPs were identified that have received 100 to 10719 citations and registered 223.05 Citations Per Paper (CPP). The 47.54% and 95.40% share of the 326 HCPs have received external funding support and are involved in international collaboration, respectively. The 15892 (417 from Nepal) authors, affiliated to 12830 (177 from Nepal) organizations and published in 138 journals participated in 326 HCPs from Nepal. USA (60.45% share) and India. (51.45% share) were the most collaborative countries, while Spain (1609.15 CPP) and Mexico (1597.08 CPP) made the largest citation impact in collaboration with Nepal. C.L. Ranabhat (n=27) and B. Sathian (n=26) were the most productive authors, while D. Acharya (3652.29 and 16.5), and S. Bhattarai (2880.11 and 13.01) registered the highest citation impact (CPP and RCI). Tribhuvan University, Kathmandu (n=72) and Nepal Health Research Council, Kathmandu (n=34) were the most productive organizations, while Kathmandu University (3652.29 and 16.5) and Nepal Academy of Science and Technology, Lalitpur (2941.67 and 13.29) registered the highest citation impact (CPP and RCI). The Lancet (n=75) and British Medical Journal (n=11) were the most productive journals, while The Lancet Neurology (1749.5 CPP), and The Lancet (1371.13 CPP) registered the highest average citations impact. B. Basnyat has the most citation as first author in health and medical research. The present study offers an overview of research characteristics and trends of medical research output in Nepal. It identifies main contributors, core journals, and significant subject topics. The study hopes to assist researchers and practitioners in comprehending the development and trends of medical research in Nepal and discovering potential directions for future research.

ChatGPT is an artificial intelligence (AI)-based conversational large language model (LLM). The potential applications of LLMs in health care education, research, and practice could be promising if the associated valid concerns are proactively examined and addressed. The current systematic review aimed to investigate the utility of ChatGPT in health care education, research, and practice and to highlight its potential limitations. Using the PRIMSA guidelines, a systematic search was conducted to retrieve English records in PubMed/MEDLINE and Google Scholar (published research or preprints) that examined ChatGPT in the context of health care education, research, or practice. A total of 60 records were eligible for inclusion. Benefits of ChatGPT were cited in 51/60 (85.0%) records and included: (1) improved scientific writing and enhancing research equity and versatility; (2) utility in health care research (efficient analysis of datasets, code generation, literature reviews, saving time to focus on experimental design, and drug discovery and development); (3) benefits in health care practice (streamlining the workflow, cost saving, documentation, personalized medicine, and improved health literacy); and (4) benefits in health care education including improved personalized learning and the focus on critical thinking and problem-based learning. Concerns regarding ChatGPT use were stated in 58/60 (96.7%) records including ethical, copyright, transparency, and legal issues, the risk of bias, plagiarism, lack of originality, inaccurate content with risk of hallucination, limited knowledge, incorrect citations, cybersecurity issues, and risk of infodemics. The promising applications of ChatGPT can induce paradigm shifts in health care education, research, and practice. However, the embrace of this AI chatbot should be conducted with extreme caution considering its potential limitations. As it currently stands, ChatGPT does not qualify to be listed as an author in scientific articles unless the ICMJE/COPE guidelines are revised or amended. An initiative involving all stakeholders in health care education, research, and practice is urgently needed. This will help to set a code of ethics to guide the responsible use of ChatGPT among other LLMs in health care and academia.

Ageing research directions for Australia

Public health emergency is vulnerable time where maintaining ethical principles is obligatory while doing research, on the other hand, it is the same time when breach in ethics is much likely whenever a researcher is unaware, unprepared or hastens to do research. The aim of this study was to assess ethical issues of the coronavirus disease 2019 (COVID-19) related research proposals submitted during the early stages of pandemic in Nepal. Retrospective analysis of COVID-19 related research proposals and their informed consent document submitted to the ethical review board at Nepal Health Research Council was done for the study. The analysis was done as per the National Ethical Guidelines, Standard Operating Procedure for Health Research in Nepal and World Health Organization guidelines for infectious disease outbreak, 2016 under ethically relevant headings. Descriptive data were analyzed in SPSS v24. The major issues were observed in the informed consent documents where 55% were lacking principal investigator's contact information, 68% not having participant selection criteria, 70% without clear informed consent taking process, 57% without explanation of possible risks. Similarly, 68% of the interventional studies' consent form didn't mention possible adverse events and mitigation mechanisms. Most of the research proposals related to COVID-19 were devoid of major ethical elements which took longer time for receiving approval and eventually delayed the opportunity for evidence generation in critical time. More attention is needed to increase awareness and to develop capacity of researchers, reviewers, ethics committees and relevant stakeholders at the time of health emergencies.

Knowledge and skills in research ethics are essential for conducting ethically responsible research. Despite some local policies, strategic guidelines, and manuals on the antithesis of research misconduct, researchers’ adherence to research ethics, especially ethically responsible conduct of research, is still critical in developing countries like Nepal. This study explores the policy provisions to develop researchers’ capacity on research ethics in Nepal. With the aim, we identified ten key documents related to research ethics from the University Grants Commission (UGC), Nepal Health Research Council (NHRC), and Ministry of Education, Science and Technology (MoEST). We analysed the provisions using the adapted version of Cooke’s framework for research capacity development. The result shows that although there are provisions for capacity development for scientific research, none provisioned that the higher education research institutions need to take action for developing early career researchers’ capacity on research ethics. Further, this review depicts several structural, institutional, and procedural limitations that make the condition difficult to adopt and implement those policies, strategic guidelines, and manuals.