Improving Health in Developing Countries: Building In-Country Research Capacity Is Critical to Staving off Epidemics and Finding Long-Term Solutions to Critical Health Needs
Csaszar, Michael, Lal, Bhavya, Issues in Science and Technology
International initiatives to combat diseases have proliferated, in some cases dramatically, during the past decade. For example, world spending on HIV/AIDS has increased from $300 million in 1996 to about $5 billion in 2003. President Bush's Emergency Plan for AIDS Relief alone has promised to deliver $15 billion during the next five years to combat the epidemic.
Initiatives such as the president's plan are valuable in the fight against HIV/AIDS in that they support and build in-country health infrastructures for prevention, care, and treatment. However, there is an additional and equally important piece of the puzzle that is largely missing: a scientific infrastructure in emerging and developing countries that provides in-country capabilities to respond to health crises.
In many global programs, it is generally assumed that the efforts of donor countries to improve health outcomes in emerging and developing countries will rely heavily, if not exclusively, on the ability of researchers in the industrialized world to identify local, regional, and national needs and to devise strategic plans for implementation. Jeffrey Sachs, director of Columbia University's Earth Institute, has proposed a global health research facility, akin to a global National Institutes of Health (NIH), to conduct research on high-burden diseases such as HIV/AIDS, malaria, and tuberculosis. However, as with President Bush's plan, there has been little discussion of the specific need to build in-house research capacity in the emerging and developing countries themselves. It is implied that outside sources would supply the researchers, be able to understand indigenous conditions, and enact appropriate steps to achieve goals.
Supporting emerging and developing country health challenges through science is important. Just as important, though, is to support indigenous empowerment through science. Based on our evaluation experience, we believe that it is primarily through in-country research capacity development that emerging and developing countries can attain long-term solutions to critical health needs. There are several advantages to this strategy.
First, with appropriate in-house capacity, emerging and developing country researchers, especially when they have effective partnerships with user communities in clinics, government, or elsewhere, can eventually address many of their public health challenges faster, better, and more cost effectively than if they were addressed from the outside. This is because diseases manifest themselves differently in different countries, and their cultural contexts are best understood in the countries themselves. For example, in Thailand, it makes sense to focus research on the sex trade, which is a significant cause of the spread of HIV/AIDS. In Russia, on the other hand, research needs to be focused on issues relating to intravenous drug use, which is the single most important factor in the spread of the disease. Additionally, researchers in the industrialized world cannot understand the sociopolitical conditions as clearly as do researchers in the developing world. Social stigmas, discrimination, and government policies alter the best practices for combating these diseases in different countries. Therefore, having research led by in-country scientists makes it possible to incorporate local, regional, state, and national factors in how resources are best spent.
A second reason for supporting indigenous research capacity is that having such capacity enables researchers to better interact with their counterparts in the industrialized world. This is not a particularly new idea. Experts have recommended systems in which recipient countries submit proposals for actions to combat diseases of interest, rather than having outside entities set priorities and actions. The rationale behind this system is that it would help overcome social and political variability and ensure that actions are most relevant to local conditions and needs. …