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Where there is despair, hope

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7374.1194 (Published 23 November 2002) Cite this as: BMJ 2002;325:1194

Three initiatives to improve health research and health care in the South were announced at the Global Forum for Health Research meeting. Annabel Ferriman reports from Tanzania

Three initiatives designed to change the face of health research and health care in Africa and other developing countries were announced at the sixth meeting of the Global Forum for Health Research in Tanzania last week.

Three new organisations are being set up: an African forum for health research, to be led by African scientists; a programme to develop drugs for neglected diseases, an initiative of Médecins Sans Frontiàres; and a centre to train health researchers to understand and navigate the complex laws on the patenting of drugs, being set up with money from the Rockefeller Foundation.

On the setting up of the African health research forum, Tanzania's minister of health, Anna Abdallah, said: “Africa has long waited for this important development. At long last the dream has come true.”

African scientists decided to set up the forum to address the continent's low contribution to research. Health spending in most African countries is usually less than 1% of gross domestic product, and only about 0.2% of the health budget goes on research—compared with about 1.7% of the health budget in some other low and middle income countries, such as Brazil and Cuba.

No money for research

“Research has received little policy attention and insignificant investments in post-colonial Africa,” said Mutuma Mugambi, principal vice chancellor of Kenya Methodist University and secretary of the new forum.

Seed funding for the forum has come from the International Development Research Centre in Canada and the Council on Health Research for Development, Switzerland. A steering committee has proposed a programme of activities, including projects on research ethics, leadership development, and a communications system for sharing information throughout Africa.

It is hoped that the forum will go some way to closing what is known as the “10/90 gap,” in which less than 10% of total global spending on health research is devoted to diseases that account for 90% of the global disease burden. The Global Forum for Health Research, an international non-governmental organisation, which hosted the meeting, is dedicated to addressing this problem.

The new organisation for promoting drugs for neglected diseases grew out of Médecins Sans Frontiàres' campaign for access to essential medicines and a recognition of the lack of treatment options for communicable diseases (BMJ 2002;325:176-7).

“Drug development for tropical diseases has ground to a halt,” said Bernard Pécoul, director of the campaign.

Drugs cupboard is bare

Of 1393 new drugs developed over the last 25 years, only 16 were for tropical diseases, Pécoul said. A working group of the new organisation conducted a survey in 2001 of 20 pharmaceutical companies to assess the level of research and development activity concerning five neglected diseases (sleeping sickness, leishmaniasis, Chagas' disease, malaria, and tuberculosis).

Eight of the 13 companies that responded had spent nothing at all in the previous year on research into these diseases, two reported spending research money on malaria, and five reported spending on tuberculosis (these included the two that were researching into malaria).

“The cupboard was bare,” said Pécoul. The founding partners of the Drugs for Neglected Diseases initiative, which is going to be formally launched next year, include the special programme for research and training in tropical diseases (a project of the World Health Organization, the World Bank, and the United Nations Development Programme), the Oswaldo Cruz Foundation in Brazil, the Indian Council of Medical Research, the Institut Pasteur in France, and Malaysia's ministry of health.

“The idea is simple—to harness cutting edge science and technology and collaborate with organisations and governments to produce drugs for neglected diseases and make them available to the poorer patients of the world,” Pécoul added.

The organisation intends to spend about $20m (£13m; €20m) to $25m a year over the next 10 years. Its first three projects, which are already under way, are into visceral leishmaniasis and malaria.

The third initiative was the inauguration of the Centre for the Management of Intellectual Property in Health, which received an initial $1.5m grant from the Rockefeller Foundation. It is committed to providing health researchers and their organisations in developing countries with expert training to build capacity in intellectual property management. It expects to initiate its training programme in South Africa in 2003 with a course oriented to staff in public sector product development groups.

While some participants at the meeting were optimistic that such initiatives were going to improve health research and health care in Africa, others painted a bleaker picture of Africa's future. Robert Hecht of the World Bank pointed out that of the bank's six regions sub-Saharan Africa was the only one in which none of the countries was on track to meet the millennium development goal of reducing child mortality by two thirds by 2015. That goal is one of several drawn up by the World Health Assembly in the year 2000, to improve global health by 2015.

Loss of trained staff

Another participant said that a major problem for Africa was that its health professionals were “demoralised, desperate, and demotivated,” while many participants complained that African and other developing countries were losing their trained staff to richer countries, who could offer higher salaries and better facilities.

Professor Nirmal Ganguly, director general of the Indian Council of Medical Research, said that in the 38 years he was a medical school professor he helped 147 graduates acquire their PhDs. Of these, 99 were now living in the United States.

Professor David Sanders of the University of the Western Cape, South Africa, thought that participants at the forum were being too polite and too muted in their criticism of the G7 donor countries, who saved money on training by recruiting trained staff from poorer countries.

He said, “The United States, with its 130000 foreign physicians, has saved an estimated $26bn in training costs for nationals. Africa loses approximately $4bn per annum through migration of an estimated 20000 professionals (not only health professionals), at a loss of $184000 per migrating African professional.”


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Footnotes

  • More information on the Drugs for Neglected Diseases initiative is available by email (java.banerji{at}geneva.msf.org, or the Centre for the Management of Intellectual Property in Health Research and Development at its website (http://www.mihr.org/).

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