Enabling research in developing countries

Abstract

Ahead of the International Conference for Health Research for Development in Bangkok, Thailand, Oct 10–13, The Lancet is devoting much of this week's issue to research in developing countries. These articles provide a good opportunity to reflect on some of the difficulties and issues related to work in a developing-country setting. When representatives from more than 100 countries meet in Bangkok next month, fine words will be spoken. The meeting's agenda was initiated by WHO, the World Bank, the Global Forum for Health Research, and the Council on Health Research for Development. 10 years earlier, at the Karolinska Nobel Conference, the concept of Essential National Health Research (ENHR) arose, together with the vision of a worldwide healthresearch system that would foster national scientific groups in transnational networks. Those networks were to address both national and global health problems. For example, “all countries should vigorously undertake ENHR, investing at least 2% of national health expenditures to support ENHR and a long-term strategy of building and sustaining research capacity”. The objectives of this year's Bangkok conference are “to review past achievements in health research, develop a vision/agenda/action plan for the next ten years and mobilize international and national institutions behind them”. These aims, past and present, are worthy and wellmeant, but how does reality in the developing world measure up? When one takes a closer look at this week's collection of articles, research letters, and review and opinion papers, a preponderance of infectious-disease research is no surprise. Nor is the fact that most studies have been done in collaboration with researchers in a developed country. The most striking mismatch between the conference's objectives and the reality of prevailing research conditions in many developing countries lies hidden in the methods sections of published papers. James Whitworth and colleagues (p 1052) describe the Ugandan study area as rural, which, “just south of the equator, contains scattered farmsteads in low hills interspersed by swamps at about 1200 m above sea level”. Later they write, “HIV-1 testing was done at the central laboratory in Entebbe, over 100 km away”. Little imagination is needed to understand the practical difficulties researchers face when conducting studies in such conditions. The CONSORT diagram of the randomised trial completed in northern Thailand by George Watt and colleagues (p 1058) probably hides a similar tale. Research-capacity building by special education programmes is an important prerequisite to enable research in developing countries, according to The 10/90 Report on Health Research 2000 published by the Global Forum for Health Research earlier this year. In one instance, of 516 fellows who received external training grants between 1988 and 1996, 93% returned to their home country. At follow-up in 1996/97 about half of those who did return were still at their home institution and spent more than 50% of their time in research activities. However, fewer than half of previous fellows had published a scientific paper in an international or national journal after their training period. Research-capacity building is the logical and much-needed first step, but to avoid frustration and failure among researchers in developing countries measures must go far beyond that one simple objective. Without functioning infrastructures, access to information, and positive feed-back—in the form of publications, grant allocation, or policy changes—research-capacity building is a futile exercise. Can outcomes measured every 10 years by methods that are to be reviewed at the Bangkok conference guide global priorities for future research? Too large a step and too high a goal are likely to be dispiriting rather than encouraging. Vague aims and agendas set by large organisations can cause anger rather than gratitude. The focus must be small-scale progress and individual collaborations at the same time as striving for global institutional solutions to the challenge of health research for development.