Need of health research policy in Bangladesh
Research is a term attached with something very much academic. It is not affordable in poor countries like ours — is the usual notion amongst most health professionals in our country.
We have a large number of various health professionals. Very few of them are concerned about research for many reasons including less incentives, appreciation of research and scientists and so on.
The utilisation of research findings was also limited to produce a good number of publications which should have been an essential pre-requisite for promotion in the academic positions in medical institutions in the country.
Recently there are some small funds available for conducting health research in Bangladesh. Despite many faceted limitations, a large number of heath research was conducted by the local medical scientists.
Those who are involved in policy planning and implementation hardly ever consult those research findings. It is an usual practice to seek advice from consultants many times from abroad to solve the local health related problems.
The failure of attaining the previously fixed targets of various world bodies by the member states is exemplified by the 'Health for all by the year 2000' as declared in Alma Ata which could not be achieved. Similarly target detection rate of 80 percent sputum positive pulmonary tuberculosis cases by 2005, reduction of malaria related mortality rate by 25 percent by 2000 were not achieved. All these undermines the cherished objectives of the major important health targets of the poor countries which are reasons for developing lack of confidence among the public on the health service and system of the country.
Meanwhile the much acclaimed 'Millennium Development Goal (MDG)' was formulated and approved by the member states. Four targets of the MDG are related with the heath of the population which has a time bound targets to be achieved. We have information about various indicators of health, but many times we do not believe on those parameters rightly due to the weak mechanism of getting the baseline data for the indicators.
Bangladesh is beset with two prong health problems: diseases of the poverty (mostly infectious and tropical diseases) and emerging diseases of the affluent (cardiovascular, metabolic and malignant diseases).
Thanks to our government to give due importance to tropical and infectious diseases. We have fixed the time bound target of achievement for several illness e.g. elimination of Kala-Azar by the year 2015, elimination of filariasis by 2015, reduction of malaria morbidity and mortality by 50 percent by 2010.
Now we have better and simple preventive, diagnostic and treatment options for majority of the commonly prevalent diseases of the poor in this country. Due to poor implementation of such strategies we could not achieve the target in time.
Availability of knowledge does not mean that they will be utilisable by the poor countries justifies the implementation research in real life situation. The glorious example is about malaria: an important health problem of the poor causing sufferings and deaths in relatively inaccessible areas of five districts of the country, prevention by using insecticide treated mosquito net is possible, simple rapid diagnostic tests by simple immuno chromatographic test is available, effective artemisinin combination treatment (ACT) is recommended by the government and very effective drug for the treatment of severe malaria is available in the market.
Despite all these know-how an large number of patients suffer and die with official morbidilty of ~60,000 and death of ~500 per year due to malaria. To implement the known technology of disease management we need to have our locally adaptable strategy by operational research to be conducted by our people in our community.
It is a sorry statement to be given that we do not have reliable data of the majority of the commonly prevalent health conditions of the country to properly estimate the disease burden. Piece meal information given by various sources may mislead the health and policy planners. The reasons for lack of reliability of data is multi-faceted but all should agree that we do not know the proportion of sick people seeking advice from the public sector which is the main source of data.
In poor countries like Bangladesh people seek advice from non-formal health sectors like traditional healers like Polly chikitshak, medicine dispensary shop, Homeopathy, Aurvedi, Unani, religion based therapy, for example. The proportion or number of this population is not known and as such disease burden remains speculative.
It is now high time to know the disease burden by scientific manner so that we can say that disease burden is not by speculation. In absence of such reliable statistics, how can we calculate our parameters of achievements of MDG related to health sector.
Stories related to other important diseases or health conditions of the poor are also applicable like malaria; e.g. Kala-Azar, rabies following dog bite, snake bite, various poisoning particularly fatal organophosphorus pesticide poisoning, viral hepatitis, typhoid, dengue, leptospirosis, amoebiasis, soil transmitted helminthes.
Early diagnosis and providing effective treatment in many tropical conditions can provide cure, prevent relapse and even transmission. Income lost during and due to disease and seeking treatment may lead to debt and loss of properties perpetuating the economic status of the individual. Implementation of research in health sector may improve the outcome of the illness by reducing all these factors.
Developing a health research policy on the basis of priorities of the nation is a dire need of the time along with the development and implementation of health policy.
The poverty alleviation is linked with the MDGs. So pro-poor strategy will lead to improvement of markers of MDG. A sound health research policy will lead to creation of environment of employment creation, enhance the quality of life, develop human resource, and promote an informed society by promoting ethical health research.
If research environment is created in the country by a sound realistic policy, then doctors in training will also be able to learn the steps of conducting research.
In order to better utilise the grant of the health budget committed for health research, it is time to formulate a need driven health research policy for the country.
The operation research should get a priority in such planning. Most of the disease conditions of the poor are prevailing in the villages where we have a relatively reasonable infrastructure for conducting community based research. Most of the health manpower working in public sectors in rural areas either do not have enough knowledge or time to conduct fruitful research for our health sector.
We are in a better position of having medical institutes under the Ministry of Health and Family Welfare as we have medical colleges and institutions throughout the country under the same ministry to oversee. These institutes also enroll post graduate students of different discipline. Responsibility may be given to those institutes to develop a basic research infrastructure and environment in a rural Upazila health complex of their own catchment area. A good amount of initial funds earmarked for research funding may be used for developing the infrastructure in these rural health complexes.
Involvement of the community from the very beginning of such study will give additional value. The transformation of knowledge for utilisation for delivery at user level in developing countries is a new area of health research in a number of fields. Many countries developed their own approach of translational research. We have to fix up our own such research agenda.
Once the capability is developed for solving locally identified priority health problem by our scientists, the reliability towards public health sector will also be improved.
Over the period of time, these medical institutes can develop these stations as their outreach research stations. We can conduct on a number of priority health research essential for our country concurrently. Collaboration from throughout the country and outside will be opened up through this type of initiative.
Recent interest in community involvement in disease control could get a priority in planning such type of research. The same centres may also be utilised for the community based teaching programme in place for the medical students in 4th year and for the internee doctors as a part of their training.
Similarly as a part of our basic academic requirement in MBBS course, all private medical colleges should have a community based teaching programme through their own initiatives which may be planned spreading all over the country.
Development of a country is dependent on healthy population. Indeed development in any sector is not possible without a healthy population and workforce.
Recently concluded High-level Health Ministerial meeting in Accra, Ghana on 'Health Research and Development' gave due importance to health research for evidence-based disease control and public health. 'Needs driven use-inspired research' may lead to achieve many goals of such research policy including retention of medical scientists in the poor countries.
The writer is the Director General of the DGHS under the Ministry of Health and Family Welfare of Bangladesh. E-mail: [email protected]; [email protected]