Robert zavuga
17 December 2008
opinion
Kampala — Contrary to common belief, the existence of many non-governmental organisations (NGOs) in our health sector does not necessarily imply healthcare promotion.
Most of the NGOs are donor-funded which means they target specific diseases. Secondly, they are research-based and in most cases such research is unethical.
Although such projects advance international health research, they do not improve our staggering health sector. The reason is simple. Since these projects usually target specific diseases, most of the forgotten and "unpopular" diseases continue killing our people silently.
Theoretically, local researchers gain from participating in multi-national or international research trials conducted by the NGOs. They gain knowledge of hitherto unknown research methodologies, get higher income and academic credit. However, they seldom gain sufficient understanding of the research methods to enable them independently emulate the methods, report or publish the research findings locally, or offer any direct benefit to the participants.
This dilemma comes from the funders. Even for those "privileged" diseases where extensive funding and research has been channelled, the methods of funding lead to conflict between health research and health promotion.
Grants are awarded to researchers to evaluate the benefits of a health intervention, but no funding is provided for implementing the research findings. If the results prove positive, its benefits are not applied for the benefit of the study population. Similarly, if they prove detrimental, neither is the intervention withdrawn from the experimental population.
Most researchers who have worked in a multi-national capacity agree with me about the existence of different standards of research ethics across the globe. Selection of willing participants in studies or those whose characteristics best meet criteria for selection; providing respect for autonomy and anonymity of the respondent.
Others request participants to participate rather than requiring them to collaborate in order to receive health care; to provide informed consent; and avoidance of coercion of participants.
These concepts are frequently and literally foreign to many of our local researchers working with NGOs. To conduct international health research that meets international standards, it must become both an educational process in research methodology, ethical and a fact-finding mission.
Researchers in multi-national studies should also be brave and ask some hard questions: To whom does the data belong? Does it belong to the local researchers or the international team? How will local ownership of data be recognised? Ideally, data collected in a country will remain theirs even if the coordinating research team 'owns' the collated data.
Authorship and publication should be shared based on agreed procedures before participation in the study, or at least, before data collection. Publication in local journals and the international literature should receive equal priority. I also suggest that translation of international publications into local languages for local publication should be encouraged, especially for the study population.
Conflicts between the goals and methods of research and health promotion are unending despite the attempts to improve international research standards and health care. The only way to promote healthcare while standing at the front line of research is to centrally mobilise all the donor health funds.
This gives the Government leeway to prioritise according to the burden of disease rather than leaving NGOs to manage its funds and activities independently. This way, we shall abolish many duplicate activities done by most NGOs and make our health sector better.
The writer is the executive director of the Science Foundation for Livelihoods and Development
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