Guidelines for Research in Partnership with Developing Countries

The Swiss Commission for Research Partnership with Developing Countries (KFPE), a Commission of the Conference of the Swiss Academies of Sciences (CASS), will shortly publish the Guidelines that are introduced here. Looking at the summary (in the box ) may raise questions in the mind of the reader, some of which we shall try to answer.

What do the Guidelines have to do with health in developing countries?

The Guidelines are not exclusively or even mainly for research on health matters. They do include health research, but also apply to all scientific disciplines, because we have come to recognise that sustainable development can only be achieved as the result of holistic, interdisciplinary efforts. Like any other research directed towards development, health research does not only need specialised medical knowledge but must also involve the other disciplines, for example environmental science, social sciences, economics or law.

In recent times, more and more health problems have been tackled by participatory research . This means that as far as possible all those affected, from the community at the grassroots to the staff of the Ministry of Health, are involved in the research work. This participation begins with formulating the research question to be tackled and the planning of the activities, and continues into the evaluation of the results and their practical application in everyday life.

Projects using an interdisciplinary and participatory approach do already exist. They are mainly in developing countries with very limited resources, where this approach is seen as an important element in ensuring sustainability. In view of the rapid increase in the costs of health services in industrialised countries, we must also consider new strategies, and there is much that we could learn from the experience of countries in the South (1). Even if the experience is not immediately applicable here, feedback is most necessary. The large and varied experience acquired by people from Switzerland who have worked in the Third World should be systematically evaluated and made use of, far more than it has been up to now.

Is research still necessary at all? Is research in partnership the right direction?

As an answer to this question I should like to offer the first paragraphs of the summary of a lecture given in 1997 (2):

As far as it is humanly possible to tell, the survival of the human race and indeed of much life on earth is under threat. Research is of major importance in finding means to prevent and overcome the dangers that confront us. However, if research is to achieve its full potential, the capacity to carry it out must be distributed evenly around the globe. Building up research capacity in developing countries, and ensuring that it is firmly established, is not only demanded by ideals of solidarity but is also a matter of commonsense.

The "Swiss Strategy for the Promotion of Research in Developing Countries" considers that an effective way of achieving an increase of research capacity is through research partnership. The aim is to set up groups with an equal representation from North and South, which can carry out long-term, interdisciplinary work on matters of common concern, accompanied by the continuous further education and training of all participants....

Is research in partnership feasible?

The answer is yes . Recently I returned from a visit to Tanzania. It was the first time I had been there for 10 years, and I wanted to see what the small Swiss Tropical Institute Field Laboratory (STIFL) opened in Ifakara in 1957 by the Swiss Tropical Institute (STI) in Basel had grown into. I found to my great satisfaction that Ifakara is an example of how research partnership really can be put into practice and bear fruit.

To help in understanding the situation I should point out that when the STIFL was founded, medical parasitology was in the forefront of the activities there, with work on sleeping sickness, African relapsing fever, malaria, schistosomiasis and onchocerciasis. Young Swiss scientists were given an opportunity to go to the tropics and to carry out research that could yield practically useful results. Today, the Field Laboratory has developed into the Ifakara Health Research and Development Centre (IHRDC). It is no longer the property of the Swiss Tropical Institute, but is supported by a joint Foundation, set up by Switzerland and Tanzania together, in whose Board the STI is represented. The IHRDC is linked to the Tanzanian National Institute of Medical Research (NIMR) and its task is to promote health in the widest sense, in close cooperation with the local community and with the local and national health authorities. It is evident that the people living in and around the Centre have indeed become more health-conscious. It is an advantage for all concerned that the research activities are closely linked with courses at the Clinical Officers’ Training Centre (previously the Medical Assistants’ Training Centre, MATC), also in Ifakara, and with the St Francis Designated District Hospital and the government health services.

The present Director of the IHRDC is the biochemist Hassan Mshinda, a competent Tanzanian scientist. Major projects running at the IHRDC include several on malaria and its control. These include the second major trial of the malaria vaccine SPf66 to be carried out in Ifakara. The first trial showed that the vaccine did provide some protection, and the second is looking at its effectiveness in infants. It is overseen by the WHO, and involves an international research team and the collaboration of many different institutions. A second major project is KINET , in which the aim is not only to distribute insecticide-impregnated mosquito nets on a large scale, but to examine how a marketing and distribution system can be set up which will ensure that nets continue to be available. In association with this, molecular biological studies are looking at the long-term effects of the use of mosquito nets on the development of immunity to malaria. The IHRDC is also associated with a project to map malaria risks in Africa.

The Director of the IHRDC is of course responsible for the running of the Centre, its administration and its finances. What is new in the situation in Ifakara, compared with that 10 years ago,is that a Tanzanian colleague is not only running the IHRDC, but also coordinating a wide variety of research projects, involving not only Tanzanian colleagues but also scientists from Switzerland, other parts of Europe, Canada and Latin America. That he is doing it successfully is evident from the fact that the different projects are maintained by funds from a great variety of international sources. The greatest financial problem is assuring sufficient funding for the core budget, needed to keep the Centre running and maintain a stable minimum of staff independently of limited-term projects. Perhaps in this connection the Swiss side should show a little more flexibility than theorists would approve of.

"Ifakara" shows that research partnerships can indeed contribute to capacity building and to the general development of the host country. Research in partnership is demanding and needs staying-power. Nevertheless, it is possible. And Ifakara is not the only scientific institution in tropical Africa with Swiss origins. In the Côte d'Ivoire there is a comparable and also successful research station, the Centre Suisse de recherches scientifiques (CSRS) of the Swiss Academy of Science (SANW). Scientific activities in this Centre also emphasise the principles of partnership, and the only reason for not discussing them in detail here is that there is less emphasis on health services there than in Ifakara.

Are we in Switzerland adequately prepared for research in partnership?

The answer is as unambiguous as the answer to the previous question - but this time it is no . The reasons for this have been discussed in detail elsewhere (3). Basically, they lie in a deeply-rooted feeling of superiority, and in the spirit in which research and teaching are carried out in the industrialised countries. There are signs of a change of attitude - but all good things take their time ...

Thierry A. Freyvogel planned and constructed the Field Laboratory in Ifakara, and continued his work there with frequent visits until 1987, when he retired as Director of the STI . He is at present Chairman of the KFPE.