Lessons from (human) development research:Case studies from Mozambique

By Prof. Baltazar Chilundo (MD, PhD)Department of Community Health, Faculty of Medicine, UEM

chilubal@uem.mz

2 May 11th 2009 IAP for Research Capacity Building

Background: Mozambique ProfileParameters Value

Population (in millions)* 20(52% , 50% <18y)♀

% People living below the poverty line* 54

HDI 2006 position (value) 175/179 (0.366)

Under-five mortality rate/1,000 live births*: 152

Maternal Mortality Ratio/1,000 live births (DHS 03) 408

% National HIV prevalence rate (pregnant women 15-49 years old, 2007)

16

% Malaria prevalence children 2-9 yrs 40-80

TB incidence rate (per 100,000) 436

% Literacy* 37 & 67♀ ♂

Life expectancy (years)*: 37

Health sector financing (proportion/source)** ~70% by partners

Source: *Childhood Poverty: A Situation and Trends, ** MISAU

2007 Analysis, U

NICEF, 2006 other: U

ND

P Mozam

bique 2006

Background• Focus on Human Development (Sen, 1999)• Better health is an essential ingredient and

consequence of development • Research as a central and indispensable

component of improving health and hence for achieving MDGs– Bridging the “know-do gap”– Conducting more research

May 11th 2009 3IAP for Research Capacity Building

The spectrum of health research in Mozambique

• Clinical & Biomedical research ++++• Operational research ++• Public Health Epidemiological research +• Social sciences and behavioral research +• Health policy and systems research +/-• Environmental health research +/-

May 11th 2009 4IAP for Research Capacity Building

Institutions conducting health research

• National Institute of Health – MoH– Research… – National Bioethics Committee

• Faculties of Medicine/Health Sciences: – UEM ++; Higher Institute of Health Sciences; Catholic

University; UniLurio; UniZambeze and Higher Institute of Science/Technology

• Research Centres– Manhica Health Research Centre– Beira Operational Health Research Centre

May 11th 2009 5IAP for Research Capacity Building

Mapping urinary bilharzias and intestinal parasitosis in MozambiqueKnow – do Gap

By: National Institute of Health/MoH (2007) on deglected diseases

May 11th 2009 6IAP for Research Capacity Building

Bilharzias Prevalence at districts

Intestinal Parasitosis Prevalence at districts

“mapping lymphatic Filariasis in Moçambique”By: Know – do Gap

By: National Institute of Health/MoH (2007) on deglected diseases

Nampula Province with 54% of filariasis

May 11th 2009 7IAP for Research Capacity Building

Some ongoing research projects in the Community Health Department/UEM

– Routine Iron Prophylaxis during Pregnancy - Effects on Maternal and Child Health in Maputo City and Maputo Province Mozambique (2 countries)

– Experience of African Countries with GHIs (8 countries: 4 south)

– HRH development in Tete Province (2 countries)

– Health Systems Strengthening for Equity: The Power and Potential of mid-level healthcare providers in Mozambique (5 countries: 3 south)

– Country Situation on Child Maltreatment Prevention in Mozambique (w/ WHO)

– Strengthening Integrated Primary Health Care in Sofala Province, Mozambique

May 11th 2009 8IAP for Research Capacity Building

9

ManhiManhiçça health Research Centre at a glancea health Research Centre at a glanceThe biomedical rural-based research centre’s agenda is based on the main causes of disease and death in children less than 5 years and pregnant women: malaria, HIV/AIDS, pneumonia and diarrhoea

Age groups

0–27 Days

 28 d – 11 months

12–59 months

6-14 years

1st          Prematurity (31%)

Malaria(22.6%)

Malaria (31.4%)

Malaria (18.2%)

2nd Birth asphyxia(16.3%)

Pneumonia(19.1%)

Malnutr. (20.1%)

Traumatism (10.4%)

3rd      Septicaemia(14.6%)

Malnutr. (10.0%)

Pneumonia (10.4%)

Traumatism(10.4%)

4th     Pneumonia(10.6%)

Diarrhea (8.0%)

Diarrhea (6.0%)

Pneumonia (9.1%)

5th No consensus(7.3%)

Meningitis (7.5%)

No consensus (5.7%)

Meningitis(9.1%)

Causes of paediatric death in the community

Some examples:

•Clinical trials for malaria vaccine•Clinical development of new antimalarial drugs•Evaluation of the impact of the Haemophilus influenzae type b vaccine•Feasibility studies for clinical trials of microbicides and for HIV vaccines

May 11th 2009 IAP for Research Capacity Building

• The hiatus between policy and practice

– 2025 agenda; 5y Government Plan; Science and Technology Policy and Strategy, UEM strategic and Research plans…

• Many publications available but the recommendations are hardly known by decision makers = Know-Do Gap

– Lack of national research open access warehouse

– The process of sharing health research based only on a few national mechanisms: (i) quarterly medical journal with quality problems although is a peer-review based (ii) health journey held every 4 years…

May 11th 2009 10IAP for Research Capacity Building

• Research conducted in ad hoc manner

• Lack of tracking system after approval by the only existing national bioethics committee

• Lack of specific health research agenda undermining informed based decisions

• Research mainly conducted as per donor request and fashion not primarily as part of implementing organization’s agenda

• External aid is needed to support local research capacity building

May 11th 2009 11IAP for Research Capacity Building

12May 11th 2009 IAP for Research Capacity Building