Boosting research capabilities in the South

8 Sep 2009

Tatum Anderson

Source: TropIKA.net

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Dr Jimmy Whitworth, the Wellcome Trust’s Head of International Activities.

One of the world’s large-scale philanthropic funders for global health, the Wellcome Trust, is embarking on a series of suitably large strategies to boost dramatically the numbers of global health specialists in developing countries.

The Trust has launched a US$30m-project called the African Institutions Initiative – see TropIKA.net News. It will create seven consortia among higher education and research institutions located within Africa, the UK and other rich countries. Over 70 universities and research institutions are involved, including 50 in Africa alone.

The idea behind the plan is to share resources as much as possible so that African universities are able to train more researchers, and ultimately carry out more research.

“It’s huge,” says Dr Jimmy Whitworth, who is spearheading the project at the Wellcome Trust. “We hope more African universities are able to compete internationally for funding, hold grants and support research.”

Plans under way will help established African universities to develop other promising institutions. Collaborating institutions might, for instance, create modular training courses, so that one institution could provide training in one area, while a partner provides training on another aspect, in which it has more expertise. The consortia will not only link Southern institutions but match Northern institutions and universities with African universities too.

India’s new public health institutes

Concurrently, and a continent away, the Trust is participating in one of the largest public health projects in the world.

It is playing a key role in an ambitious plan by the Indian government to launch around seven public health institutes with a view to training 10,000 people every year in all aspects of public health, from PhD researchers to health officials.

It’s a resource that is desperately needed, says Whitworth. “Public health has been a neglected area in India,” he says. “You have this huge dichotomy between world-class, cutting-edge basic biomedical research and side-by-side you have poverty-stricken urban slums and rural villages that are the equal of anything in Africa.”

As part of that plan, the trust is linking the Public Health Foundation of India with several UK universities, including the London School of Hygiene & Tropical Medicine, to develop a programme to train the first faculty that will teach within the newly-founded institutes.

Bigger thinking

Both projects are enormous (although rather eclipsed by projects funded by the other major philanthropic organization, the Bill & Melinda Gates Foundation). But they demonstrate that big thinking is necessary to have any lasting impact on diseases of poverty.

Bigger thinking – beyond grants to individuals – is certainly necessary to make up for years of neglect, says Dr Whitworth. That’s especially true in Africa, where high-level universities and researchers, who are able to conduct research into the problems that most affect the continent, are in short supply. “African universities have been bypassed for research for a generation or two and they really have to be part of any long-term solution,” he says. “There is little point in supporting individuals if they don’t have a system all good institutions to go to.”

More ambitious projects are required, he says, to develop a desperately-needed generation of high-level senior African researchers: professors who can represent the requirements of their countries amongst the legions of northern voices and views within multinational research groups.

The issue has always been about playing odds. The fact is that many PhD students must be trained so that a handful might choose eventually to become leading career researchers. The problem in Africa has been that not nearly enough PhD students have been trained in the first place, to create the critical mass that will produce the professors of the future. “Our efforts to develop more African scientists in the past have been inadequate,” he says. “In retrospect, I think we’ve underestimated by an order of magnitude or two what we need to do to actually train enough.”

Whitworth’s mission is to oversee the Trust’s strategy and policy of funding science outside the UK. About 90% of this philanthropic organization’s money goes into projects in the UK – $755 million last year – the rest was spent overseas. (Many of Wellcome’s UK programmes – and beyond Whitworth’s remit – focus on diseases that disproportionately affect such countries too. The Wellcome Trust Sanger Institute, for instance, has sequenced the genomes of pathogenic organisms that cause malaria, tuberculosis and typhoid fever.)

With a pick of projects around the world, he has chosen to focus on lower and middle-income countries, especially developing scientists, institutions and research specific to those countries.

“Solving problems that are important for all of us”

Whitworth’s long career in tropical medicine has certainly influenced Wellcome’s policies since he was appointed Head of International Activities at the Trust in 2004. He has worked in The Gambia, Sierra Leone and directed the Medical Research Council Programme on AIDS in Uganda at the turning point in the course of the epidemic there.

“Global health is all about multinational teams solving problems that are important for all of us,” says Whitworth.

The Wellcome Trust has of course supported joint research programmes on diseases that cause high levels of mortality for many years; its partnership with the Kenyan Medical Research Institute (KEMRI) is a good example. It supports other programmes in Malawi, South Africa and South Asia too, often through British scientists working in the field. It also makes “strategic awards”, prestigious funds to establish new research initiatives in endemic countries.

Last year, strategic awards were given to establish a Centre for Clinical Infectious Disease Research at the University of Cape Town. The KEMRI–Wellcome Trust Research Programme also received $14m to train researchers in the specific areas of translational research, social science research and clinical trials.

And in September, the Trust and the Indian government announced a $130m, five-year project to fill a uniquely Indian research gap. Beyond PhD level, scientists are often expected to pursue their careers abroad, only returning later to fill professorships. As a result, bright minds at a level between PhD and professorships are few and far between. The project will therefore create a series of fellowships to help at least some researchers develop their careers at home.

“Let African scientists do something for themselves”

Lessons from Whitworth’s career in Africa have helped direct policy in a novel way. While working in Africa he witnessed a procession of Western experts trundle in and out of the country for a few days at a time and then going on to set policy.

“They would go away thinking that they understood what was going on, sit in darkened rooms in Seattle and Washington or London and develop research programmes,” he says “They would say, ‘This is what you need for Africa’ and I thought that was completely wrongheaded.”

So Whitworth earlier this year launched a project to encourage more African decision-making in research. Together with the UK government’s Department for International Development (DFID) and Canada’s International Development Research Centre (IDRC), they have established two African bodies that will be in charge of awarding grants to researchers.

These national bodies will be responsible for setting the research agenda according to the needs of the country, decide how much money should be spent on projects and monitor those who receive it, not Northern funders.

Under this project, dubbed the Health Research Capacity Strengthening (HRCS), grants are dispersed by a new non-governmental organization, the Consortium for National Health Research (CNHR) in Kenya. And in Malawi, grants will be issued in the existing National Research Council of Malawi (NRCM).

Whitworth predicts that as a result, decision makers will increase the amount of research going into health systems, including studies on scaling up existing small-scale pilot projects and how to best to create efficient health systems in on a small national budget.

And long term, it is hoped that more funding decisions will be placed in the hands of African decision makers. Zambia has expressed an interest in following Malawi and Kenya’s lead, for instance.

But Whitworth fires a warning shot at northern funders who succumb to the temptation to take the reins.

“There is a real willingness at the moment between different funding agencies and development agencies to work together and are trying to address this problem,” he says. “But part of what we’ve all got to do is to take hands off and let African scientists and policymakers do something for themselves. That’s going to be very important to the future.”

Key questions

Briefly, what are the priority concerns of your organization?
To foster research to improve animal and human health.
And, more precisely, what goals have you set?
To focus on support for improving research, researchers and institutions in low and middle-income countries.
What progress has been made so far?
Health Research Capacity Strengthening (HRCS) initiative, a project with the Alliance for Health Policy and Systems to promote the use of research evidence in developing health policy, the African Institutes Initiative, the Indian public health projects, strategic awards to Africa and India.
Which other organizations will you be working with most closely?
A selection includes the four main programmes: Africa Centre for Health and Population Studies is embedded in the University of KwaZulu-Natal with academic and strategic support also provided by the South African Medical Research Council. The Wellcome Trust South-east Asia (SEA) Programmes are based in Thailand Faculty of Tropical Medicine, Mahidol University, Bangkok, and research sites across Thailand in Mae Sot (Shoklo Malaria Research Unit), Ubon Ratchatani, Udon Thani and also in Vientiane Lao PDR The Vietnamese Programme is located at the Hospital for Tropical Diseases, Ho Chi Minh City. Malawi-Liverpool-Wellcome Trust Programme for Research in Tropical Medicine works in collaboration and partnership with the University of Malawi College of Medicine, the University of Liverpool and the Liverpool School of Tropical Medicine. KEMRI-Wellcome Trust Research Programme works in collaboration with KEMRI, and is part of KEMRI’s Centre for Geographic Medicine Research, Coast, headed by Dr Norbert Peshu. The Programme also collaborates and works closely with the Kenyan Ministry of Health and has direct collaborative links with the University of Oxford, the Institute of Child Health (London), Liverpool University and School of Tropical Medicine and London School of Hygiene and Tropical Medicine. Wellcome Trust Centres for Research in Clinical Tropical Medicine, Department for International Development (DFID) in the UK, and the International Development Research Centre (IDRC).