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Beating the brain drain: West African research centre shows it can be done
3 Jun 2009
Tatum Anderson
Source: TropIKA.net
The brain drain is a term that fails to convey the staggering number of trained professionals who leave developing countries every year. In Africa, estimates in recent years have put the number at 20,000 annually. Ethiopia lost 75 per cent of its skilled workforce between 1980 and 1991.
Such a massive exodus of qualified Africans is widely seen as stifling both economic and human development. But an innovative strategy embarked upon by a research institution in the West African state of Mali has managed, at least in a small way, to reverse the tide.
The Malaria Research Training Centre
(MRTC) runs a scheme, with international collaborators, that has created a critical mass of African scientists able to study malaria and provide evidence to influence control strategies in a country where malaria kills more children under five than any other disease.
These scientists embrace a multitude of specialist fields from epidemiology and microbiology to entomology. Between them, they have racked up an impressive number of papers. From 1992 to last year, staff at the centre published more than 240 peer-reviewed articles in top-tier journals. MRCT has about 50 researchers; most are Malian and all 12 MRTC research groups are led by Malians.
More importantly, MRTC has helped Mali put together an integrated malaria strategy, which includes bed nets, indoor residual spraying, access to artemesinin combination therapies and strategies to target areas where mosquitoes develop. The researchers recommend treatment protocols and carry out surveys to track changes in the disease, so that government policy can keep pace with reality.
One research group has been responsible for a full-scale randomized controlled trial (1) comparing chemoprophylaxis and intermittent preventive treatment for the prevention of malaria during pregnancy. It is now participating in studies to look at similar strategies for infants.
Professor Ogobara Doumbo.
MRTC’s work has resulted in a significant drop in malaria in many areas according to Professor Ogobara K Doumbo, director of MRTC and a co-founder. He recounts a story of a high-level government minister passing through one region of Mali where MRTC has a clinical site.
“The minister of health came to visit the [people] and they told him, “We haven’t had any deaths from malaria for years now,” says Doumbo, speaking from Bamako, the Malian capital. “He was so surprised.”
The scheme has been so successful that it is being exported to other francophone countries, including Senegal and Burkina Faso. And MRTC is also developing research groups to focus on diseases beyond malaria including HIV, leishmaniasis and lymphatic filariasis.
A simple scheme
The MRTC scheme is a simple one. It manages the way the country’s most promising scientists receive higher education around the world. Importantly, it relies on a compact of mutual understanding between MRTC and Malian scientists that recognizes both the needs of Mali as well as those of individual scientists, who unsurprisingly, want career progression, personal fulfilment, job security and a stimulating work environment.
So, MRTC chooses the top graduates from Mali’s university and medical schools and submits them for PhD and Masters qualifications at some of the world’s most prestigious universities.
But these promising graduates are not able to go just anywhere. They are restricted to a group of research institutions with which MRTC already has close ties. They include US and European institutions – from the London School of Hygiene & Tropical Medicine to the Universities of Maryland, Oxford, Marseille and Tulane. Swedish and Dutch institutions have become involved too.
Specifically, the groups to which Doumbo’s students are sent are part of close-knit research networks that are collaborating with MRTC on several projects; the genomic research network, MalariaGen, is an example. Indeed, many of these groups already send their own scientists to work on Malian projects at MRTC.
These institutions are considered appropriate places for Doumbo’s graduates, because they are likely to have a particular understanding of Mali and the needs there. “We are very rigorous in selecting those who should be included, before I send them my PhD students,” he says. “If I send a Malian to the US, I want to be sure he is in good hands, with a man who cares about the culture and returning [to Mali].”
Graduates must uphold their end of the deal too. Their contract stipulates that they must return to Mali to work, not only at the end of their studies, but during vacations. That way, they continuously transfer what they are learning abroad and not just after they return. The knowledge amassed at the centre means domestic PhDs and Masters are possible too. Scientists from Mali, as well as neighbouring countries, are now attending training courses at the centre.
A good working environment
For MRTC, the deal doesn’t end when students finish their studies. When they return to Mali, it pledges to provide a suitable working environment – including equipment and facilities they have worked with during their studies. “If a PhD student comes back and he is not able to perform molecular biology with PCR or genomics in Mali he won’t stay here,” says Doumbo.
Visitors have reported seeing state-of-the-art freezers, fume hoods, polymerase chain reaction machines and fully-networked computers that are linked to the National Library in the US. Even field sites 800km from the capital, Bamako, have access to the internet via satellite. That means scientists in the field have full access to journals and can continue their education through e-learning courses.
A good working environment includes the potential for career advancement. Many, for instance, are offered research groups and responsibility for research grants quite early on.
The compact appears to be attractive, judging from the number of graduates who have returned to Mali so far. In total, 40 postgraduates have returned to Mali, amounting to five generations of scientists since the scheme began.
Achieving a critical mass
Obviously, the work of MRTC and its partners is a drop in the ocean. Nevertheless, it is part of a greater movement to re-invigorate African research and higher education.
The absence of a critical mass of researchers has been devastating for years – especially in malaria. The last international malaria eradication plan failed in Africa in part because there were few African researchers to steer strategy on the continent, says Doumbo.
Even after the plan failed, for many years spending on higher education was slashed by international donors – partly on the basis that those receiving tertiary education were, by definition, elites and not part of the development effort.
In sub-Saharan Africa during the 1980s, average public expenditure plummeted to US$1500 from US$6300 per student according to the World Bank (2). This has had a knock on effect on research capacity in many countries. The dearth of funds has led to severe deterioration in many institutions that in turn has fed the brain drain.
In contrast, investments in educating a country’s professionals is seen as way to build a country’s self-reliance, as well as having a longer-term effect on development and health. As Doumbo put it, in a research paper (3): “We cannot imagine a greater tribute to the wisdom of a donor than the life-long commitment of a developing country investigator to health on-site in sub-Saharan Africa.”
As a result, many different strategies to educate and keep graduates are now under way in Africa; from regional collaborations and centres of excellence to tailor-made courses offered by universities abroad.
But more still needs to be done. As recently as 2005, a review by Harvard University (4) found most African countries had not included higher education in poverty-reduction strategies.
A model for replication
Against this background, the MRTC model is seen as one small model that, if replicated, could help reverse the brain drain in many countries.
Founded around 20 years ago, MRTC was the fruit of collaboration between the University of Bamako in Mali and the National Institutes of Health in the United States (NIH). Many other US and European organizations have since contributed. MRTC is housed within the University of Bamako’s Department of Epidemiology and Parasitic Diseases, located within the Faculty of Medicine, Pharmacy and Dentistry.
Doumbo, chairman of the Department of Epidemiology of Parasitic Diseases at the university, together with Professor Yeya Touré, a renowned entomologist, built MRTC. The centre is now co-managed by Doumbo and Sékou Fantamady Traoré.
The primary impetus for such a scheme came from the late Philippe Ranque, a parasitologist at the University of Marseille. Doumbo worked with Ranque, in Mali, on Phase II trials of ivermectin for the treatment of onchocerciasis (river blindness).
Ranque took a more visionary approach than perhaps had been seen in the past. Indeed he sponsored the first generation of Malian scientists – among them Doumbo. “He said Malian scientists can get a degree in Europe and come back to establish themselves,” remembers Doumbo. “Without him, we would not be here.”
If collaboration with Ranque was key to the start of the scheme, then long-term funding from the US NIH has been core to its continuation over such a long period. The NIH stands to gain from the collaboration too. MRTC has become a hub for its malaria research. One group is looking into the fact that people with high concentrations of haemoglobin C in their blood appear to be more resistant to the malaria parasite, and less likely to develop or die from serious disease; Another group, supported by funders including US space agency NASA, is using satellite technology to track the effect of climate change on malaria in the Sahel. This is a difficult link to make, especially because so many other factors might be responsible for changing the incidence of malaria – including Mali’s integrated malaria strategies. But, nevertheless work is continuing and results are due next year.
The symbiotic relationship between researchers has resulted in the development of 10 clinical trial sites throughout the country. To date, 10 clinical trials have been carried out including the most recently completed – in collaboration with the University of Maryland – on blood-stage vaccines targeting the AMA1 protein.
But another major collaborator, interestingly, is the Malian government. It has already played an important role in the helping limit the brain drain for MRTC. In addition to guaranteeing positions at the university or medical school to returning postgraduates, it now plays a key role in helping to smooth over the bureaucratic fug that regularly delays drug and vaccine research in many countries. Doumbo says it is much easier for visiting scientists to get hold of visas and bring vaccine candidates into the country nowadays.
The status quo appears to have been reached through painstaking negotiation. MRTC says that a strong bargaining position is vital. “We are always publishing science [in international journals], helped by the national malaria control programme and in our study areas where we have field [tested] we’ve reduced significantly the deaths due to malaria and people [in government] are seeing that,” says Doumbo.
Ultimately, the goal of the MRTC is malaria elimination. Amongst other projects, Professor Doumbo is participating in an international group, malERA, that is creating a white book – a kind of multinational strategy document for elimination. It will contain an in-depth analysis of all the available tools, research and lessons from history, to understand what is needed to eliminate malaria.
Lessons must be learnt from history to ensure that Africa is never again left behind in eradication efforts, says Doumbo.
Key questions
Briefly, what are the priority concerns of your organization?
Conducting laboratory and field research related to malaria. Units within MRTC include: Entomology and Molecular Biology, Vector Ecology, Malaria during Pregnancy, Transmission Blocking Vaccine Unit, GIS Unit, Parasite Epidemiology, Malaria Vaccine Development Unit, Biostatistics and Data Management, Drug Resistance/Molecular Biology, Parasite Immunology and Immunogenetics, Parasite Molecular Biology and Informatics.
And, more precisely, what goals have you set?
To educate Malian scientists to work in Mali, to create a world-class clinical trials environment, to work for malaria elimination at a national level regional level and international level.
What is it about your organization’s approach to these issues that distinguishes you from others in this field?
A unique compact that enables Malian scientists to return home to work.
What progress has been made so far?
40 PhD and Masters students have been trained abroad and have returned to work in Mali.
What are the main challenges outstanding?
To eliminate malaria.
Which other organizations will you be working with most closely?
The Rockefeller Foundation, France’s University of Marseille and Italy’s La Sapienza University. Doctoral trainees have been funded by the UN Special Programme for Research and Training in Tropical Diseases (TDR), the International Atomic Energy Agency, and by the National Security Educational Program of the US Department of Defense.
References
1. Kayentao K, Kodio M, Newman RD, Maiga H, Doumtabe D, Ongoiba A, Coulibaly D, Keita AS, Maiga B, Mungai M, Parise ME, Doumbo O (2005). Comparison of intermittent preventive treatment with chemoprophylaxis for the prevention of malaria during pregnancy in Mali. J Infect Dis; 191(1):109-116. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15593011
2. World Bank (1994). Higher Education: the lessons of experience. World Bank, Development in Practice series. PDF version.
3. Doumbo OK, Krogstad DJ (1998). Doctoral training of African scientists. Am J Trop Med Hyg; 58(2)127-132. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9502592
4. Bloom D, Canning D, Chan K (2006). Higher Education and Economic Development in Africa. Harvard University. PDF version.
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