Building Local Research Capacity: Key to Achieving Universal Health Coverage
The example of the KLE University’s success as a member of the Global Network for Women’s and Children’s Health
This blog post is by guest blogger, friend and colleague...Nora Kropp
As a midwife who later went into the field of public health research, I distinctly remember my first days at my ‘research job’. There were so many acronyms unknown to me. “What is an MOU?” But my overall goal remained clear. I wanted to affect a larger population – not just the women for whom I provided maternity care.
My first experience working in India was as a Health Analyst with RTI International from 2001-3 working with the Global Network for Women’s and Children’s Health Research. Funded by the US Government's National Institute for Child Health and Human Development, this partnership is committed to improving maternal and infant health outcomes and building health research capacity. The Global Network supports and conducts clinical trials in resource-limited countries by setting up partnerships between US-based and international researchers. The Global Network has eight research units in developing countries around the world. I was privileged to work with KLE University’s Jawaharlal Nehru Medical College, Belgaum (JNMC) in north Karnataka during their first community-based misprostol trial.
North Karnataka is an under-priveleged region that has not benefitted from the economic development the state has enjoyed. Many of its health indicators lag behind the rest of the South of India, instead hovering near those of Bihar. The researchers at JNMC work to evaluate low-cost, sustainable interventions to improve maternal and child health and simultaneously build local research capacity and infrastructure. Some of the big success stories are pioneering misprostal for community-based management of post-partum haemhorrage; the helping babies breathe initiative and the safe birth checklist.
The centrality of local research to achieve universal health coverage
Last year’s World Health Report highlighted the important role local health research plays in achieving universal health coverage. Research is important because there are many critical, unsolved questions on how to provide access to health services. Basic questions such as what ARE women and newborns dying of in different regions? How to effectively address the logistical obstacles driving maternal and newborn mortality? How to provide access to health services – whether it is through facilities, or community based care? Given the chronic shortage of health care staff in rural areas which provider should perform what role to deliver the best outcomes?
Currently most research is invested in one-size fits all new technologies rather than in making better use of existing knowledge, and figuring out how to address real-world constraints. Instead, more research is needed to turn existing knowledge into practical applications. For example, how do you prevent post-partum haemorrhage in the absence of a OBGYN, or even a functional health facility? Many questions in health require local answers.
A trip to Belgaum
Recently I had the opportunity to see the fruits of this dedication and commitment. I attended the “Interventions to Reduce Maternal and Infant Mortality” meeting at KLE ‘s JNMC in Belgaum on the 5th-7th September. This was a celebration of fourteen years of producing high-quality, ground breaking research.
I knew what to expect there, and was looking forward to seeing old friends and colleagues. But my colleague, Anna Schurmann, who accompanied me was wide-eyed with surprise: “who could have imagined world-class research like this in a remote corner of North Karnataka, I mean, I’d heard about this lot, but this is amazing…”.
The number of competent, capable, local lead investigators JNMC have nurtured is staggering. We listened to 24 presenters reporting on hospital and comnutiy based trials JNMC have been or are invloved in. The quality of the research and the presentations without exception met international standards.
How KLE is a model for the way forward
There are a number of ways in which JNMC demonstrates how to build capacity in local research:
Long term commitment
The accomplishements of KLE University’s JNMC over the past decade and a half demonstrate the importance of a long-term commitment of personnel and funding. In an era where people flit from job to job, and funding typically only lasts for a project cycle, it was great to see the same dedicated people at KLE after more than a decade.
Diversifying funding sources
Regarding sustainablitly they have moved from tow major funding sources 14 years ago to over 15 funding sources today.
Beyond their own research teams in Belgaum, senior researchers there are now mentoring new research teams in Bijapur and Nagpur.
Strong relationships with policy decision makers
KLE is well respected among policy-makers – and at the September dissemination meeting, the Minister for Health Education, Sharanprakash R. Patil was there the whole time, not just to receive his boquet at the opening ceremony. His comment on the proceedings was reported in the media – see article here.
Improving public health practice
Since their trial results showing misoprostol is effcteive in prevention of postpartum hemorrhage in resource poor communities, the Governemnt of India has added misoprostol to the essential drug list for use when oxytocin is not available. JNMC participates in maintaing the largest community based stillbirth registry in the world and will most likely change the way we understand and address stillbirth globally.