Sustainable Health Programs: Any Role of Universities?

Bernt Lindtjørn

Status in Africa

Population: approaching 1 billion Less than 30,000 African-born PhD-level scientists work in

Africa Independent scientific academies only in ten of 53

countries Health challenges

……… ………

Nature 2004

My experience as a ”country physician”

Work in rural Ethiopia

Visits by”high ranking visitors” Government International organizations Universities

Results (long-term)

?

”Research and Development”

Research at Universities

Done in isolation? Do they have the freedom and the means to

participate?

Are the ”large donors” also working in isolation? As viewed from the Universities As seen from the regional/ local authorities As seen from the patients and from the communities

A message from young physicians eager to mix research with medicine:

“We know what we wish to do. So please: do not tell us what you think we ought to do.

Work with us not only to deliver the medicine we need, but also to create the research programme that will support it”

Lancet 2001

Does DOTS work?

Yes! WHO, IUATLD, ……… ”Over 80% of patients are cured”

No April 2004: 50% of patients with AFB+ tuberculosis refused DOTS in

Ujjain (India). The prevalence of tuberculosis is unknown, but higher than expected In Addis Ababa only 10% of patients identified in the community were

on treatment

Alternatives? Should the “No” participate on defining the research research

agenda (and ”tomorrows” development agenda)?

The mission of the EDCTP is

to accelerate the development of new clinical interventions to fight HIV/AIDS, malaria and tuberculosis particularly sub-Saharan Africa

to improve the quality of research in relation to these diseases.

The activities of the EDCTP include: ensuring that research effectively addresses the needs and

priorities of DCs to develop and strengthen capacities in the DCs, including the

promotion of technology transfer ……

? How do you do this?

Emphasis on the developing countries’ own responsibility

Co-ordination of measures … the UN and the World Bank …. greater synergistic effect.

Focus on research on diseases that affect the poor.

……

New white paper on Norwegian development policy

Can we define what is relevant health research in developing countries?

Research on inherently global health issues that reduce the burden of disease, and vice versa

Research that represents concerns or questions defined by developing countries

Research that increases equity in health outcomes between groups within nations

Research that engages civil society

Research that increases equity in knowledge capacities between developed and developing countries

BMJ 2001

the challenge is …..

To modernize Africa's universities To transform Universities and Research institution from

"clubs for old men" to younger, more active and inclusive bodies

To build scientific capacity and address the continent's problems

But, governments must use Universities/ Research institutions

African scientists need to influence their countries' policies on

Public health Agriculture Environment Research priorities ……

Barriers to information exchange between North and South Research

Lack of resources Poor laboratory facilities Limited technical support Little available training Few tutors or mentors

No career structure Weak peer networks Diffuse relation between research and academic reward Research biased to Northern interests

Publication Editorial bias Information access

Lancet 2001

Countries need to enable their universities to

Teach Do relevant research Apply their research findings Participate in defining policies Participate as partners in international

collaborations ...

“The politics of knowledge”