Sustainable Health Programs: Any Role of Universities?

1. Sustainable Health Programs: Any Role of Universities? Bernt Lindtjørn

2. 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

3. My experience as a ”country physician” • Work in rural Ethiopia • Visits by”high ranking visitors” • Government • International organizations • Universities • Results (long-term) • ?

4. ”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

5. 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

6. 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)?

7. 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?

8. New white paper on Norwegian development policy • 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. • ……

9. 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

10. 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

11. African scientists need to influence their countries' policies on • Public health • Agriculture • Environment • Research priorities • ……

12. 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

13. 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”