Anar Ulikpan, EV 2010 & 2012 from Mongolia, currently PhD Candidate at the School of Population Health, The University of Queensland, Australia
Nadira Muratova, MHA, MD, PhD, Public Health coordinator in UNDP/GF project, Uzbekistan.
Akbar Suvanbekov, MD, PhD, Associate professor of International School of Medicine, Kyrgyzstan, currently Research student at Graduate School of Medicine, Nagoya University, Japan.
A week ago, I (AU) received an email from a colleague at the Institute of Tropical Medicine (ITM), Antwerp informing me and other young researchers about a call for implementation research focusing on maternal, newborn and child health in Low and Middle Income Countries (LMIC) issued by WHO’s Alliance for Health Policy and Systems Research and UNICEF. It is an appealing call as it intends to address issues affecting maternal, new born and child health, still a huge problem in many developing countries (including Post-Soviet countries, where we come from). Yet, our initial excitement about this very relevant call disappeared as we read through the Eligibility Criteria.
The excerpt is as follows:
The Principal Investigator must be an individual in a low or middle income country directly or indirectly involved in the implementation of health interventions for maternal, newborn and child health. Program Managers, District Health Officers, front line health workers are typical examples of such individuals. Please note that this condition must be met for the proposal to be eligible for funding.
These “Eligibility criteria” immediately sounded like “Elimination criteria” to us. Just looking at our respective country contexts (Mongolia, Uzbekistan, Kyrgyzstan), we could not think of any person who is working in the field, yet able to write a research proposal in English and work as a Principle Investigator to implement a US$100.000 research project within a period of 12 months. In reality these people are just too overwhelmed by their day-to-day work, both clinical and managerial tasks, seasonal outbreaks etc. Some do not even have the time, nor access or the skills and knowledge to use cyber technology. In most cases, practitioners in LMIC are not researchers and vice versa. We acknowledge the Call encouraged collaboration with local researchers: “Implementers, particularly if they are not trained in research methods, are encouraged to collaborate with researchers from an academic institution or research institute based in the study country.” However, ultimately it is the principal investigator who is expected to run the research, NOT the collaborator. The fact that there will be expert facilitators and a protocol development workshop to help research teams is very encouraging, too. But again, the earlier stages of the process are very challenging, at least for practitioners from post-Soviet countries (before they get to these stages where more support is foreseen).
As mentioned above, I (AU) received the Call announcement from the Emerging Voices email network run by ITM and shared it with my colleagues from the same region. It made me and my colleagues question other issues (especially related to logistic and infrastructure capabilities) as well. How many of the District Health Officers (DHO) or front line health workers in LMIC have access to a Research call announcement? And even if they have access, how many of those from non-English speaking countries will be able to understand English and be able to work as a Principal Investigator? If the Call announcement were disseminated through the local offices of UNICEF and WHO, translated into the local languages, the right people would be able to gain access to it and could respond to the Call in a timely manner.
However, as already mentioned, we acknowledge the Alliance’s intention to promote collaboration between practitioners on the field and research institutions. Moreover, the condition stating “..not more than 25% of the total grant value can go to individuals or organizations based in high-income countries” further supports home-grown research capacity building. But the Call’s rather prescriptive approach in “appointing’’ a Principal Investigator somewhat limits many potential research opportunities for Post-Soviet countries. And anyhow, selection and appointment of team members should be an in-country issue, we feel, as local experts know the competences and areas of expertise of their own people better. Instead of being prescriptive about ‘who should do what’, the call should thus have focused more on the content and quality of the research proposal, also with a view on addressing broader system problems such as financing, organising and delivering of MCH services.
The Call may be more applicable to a number of African countries, where the British colonial and educational influence is obvious in the language and ways of operation of the health sector. It is very unlikely, though, that practitioners working in Post-Soviet countries such as Mongolia, Kyrgyzstan and Uzbekistan would succeed to receive a grant from the call. And this is a pity, as these countries definitely have many experiences to offer and lessons to be shared for more effective implementation of existing maternal and child health programs. Unfortunately, as often is the case in health systems research (HSR), these countries will remain ignored. When it comes to HSR, the Post-Soviet region is extremely underrepresented and often overlooked. Hoffman et al confirmed that HSR in the Post-Soviet countries is heavily neglected, by and large. All Central Asian Post-Soviet countries (Kazakhstan, Kyrgyzstan, Mongolia, Tajikistan, Turkmenistan and Uzbekistan) are included in the list of 25 countries with the fewest (0.16-1.71 publications/100.000 population) number of publications in health over the past 15 years (McKee et al., 2012). However, not knowing about the problem does not mean that the problem does not exist.
As we said before, it would be a pity if research calls from the Alliance/UNICEF or any other health systems research related initiatives left our challenges and experiences unheard, due to a lack of in-depth understanding of the reality on the ground. Post-Soviet countries are part of the (health systems research) world!