Intended for healthcare professionals

Rapid response to:

Education And Debate

Moving to research partnerships in developing countries

BMJ 2000; 321 doi: (Published 30 September 2000) Cite this as: BMJ 2000;321:827

Rapid Response:

Nature of research influences co-operative partnerships

It was encouraging to read Costello and Zumla’s article advocating
the need for truly co-operative research partnerships in developing
countries.1 We believe the research area and topic will influence the way
research is conducted and ‘partnerships’ are nurtured. In particular, we
believe that research projects that investigate or test approaches to
deliver care (often called "implementation research") encourage
partnerships in a way that laboratory science does not.

This is because such research requires an understanding of how things
work, tackled by qualitative methods, with investigation of how the
various participants-be they health workers or the public-relate to the
service provided. Through ‘in-depth’ approaches, and communicating with
health professionals, users of services, and community members, one is
able to delve beneath proven statistical benefits and learn how these are
interpreted locally, and how relevant an intervention is to a given
community. There is little possibility of ‘semi-colonial’ dominance when
local knowledge, influential academics, and other local stakeholders are
the cornerstone of successful implementation.

For example, we have been seeking change towards more evidence-based
maternity care through the ‘Better Births Initiative3. We have conducted
applied studies to encourage the use of obstetric procedures for which
there is good evidence of benefit. Changing practice requires that all
stakeholders are involved – women as users of state maternity services,
health workers, and academics. Links with local experts and government
health authorities, who are able to influence national policymaking, are
also essential for successful implementation, and this is beginning to
happen in South Africa and China.4 5

Helen Smith - Research Assistant, International Health Division,
Liverpool School of Tropical Medicine, UK.

Heather Brown – Obstetrician/Gynaecologist, Chris Hani Baragwanath
Hospital, Johannesburg, South Africa.

Justus Hofmeyr – Obstetrician/Gynaecologist, Cecilia Makiwane and Frere
Hospitals, East London 5200, Eastern Cape, South Africa.

Qian Xu – Associate Professor, Department of Maternal and Child Health,
Shanghai Medical University, Shanghai, P.R.China.

(on behalf of the Better Births Initiative)


1 Costello A, Zumla A. Moving to research partnerships in developing
countries. BMJ 2000;321:827-829. (30 September.)

2 Gulmezoglu M, Villar J, Hofmeyr J, Duley L, Belizan JM. Randomised
trials of maternal and perinatal medicine; global partnerships are the way
forward. Br J Obs Gynae 1998;105:1244-47.


4 Qian Xu, Smith H, Zhou Li, Liang Ji, Garner P. Current status of
obstetric care in Shanghai and options for change [abstract]. Proceedings
of the 7th World International Association for Maternal and Neonatal
Health; 2000 April 2-5; CapeTown, South Africa.

5 Hofmeyr J, Brown H, Nikodem C, Garner P. Childbirth companionship
implementation: a randomised trial [abstract]. Proceedings of the 7th
World International Association for Maternal and Neonatal Health; 2000
April 2-5; CapeTown, South Africa.

Competing interests: No competing interests

17 November 2000
Helen Smith
Research Assistant
Liverpool School of Tropical Medicine