Lessons from (human) development research: Case studies from Mozambique By Prof. Baltazar Chilundo (MD, PhD) Department of Community Health, Faculty of Medicine, UEM

2May 11th 2009 IAP for Research Capacity Building Background: Mozambique Profile ParametersValue Population (in millions)*20(52% ♀, 50% <18y) % People living below the poverty line*54 HDI 2006 position (value)175/179 (0.366) Under-five mortality rate/1,000 live births*:152 Maternal Mortality Ratio/1,000 live births (DHS 03)408 % National HIV prevalence rate (pregnant women years old, 2007) 16 % Malaria prevalence children 2-9 yrs40-80 TB incidence rate (per 100,000)436 % Literacy*37 ♀ & 67 ♂ Life expectancy (years)*:37 Health sector financing (proportion/source)**~70% by partners Source: *Childhood Poverty: A Situation and Trends, ** MISAU 2007 Analysis, UNICEF, 2006 other: UNDP Mozambique 2006

Background Focus on Human Development (Sen, 1999) Better health is an essential ingredient and consequence of development Research as a central and indispensable component of improving health and hence for achieving MDGs – Bridging the “know-do gap” – Conducting more research May 11th 20093IAP for Research Capacity Building

The spectrum of health research in Mozambique Clinical & Biomedical research ++++ Operational research ++ Public Health Epidemiological research + Social sciences and behavioral research + Health policy and systems research +/- Environmental health research +/- May 11th 20094IAP for Research Capacity Building

Institutions conducting health research National Institute of Health – MoH – Research… – National Bioethics Committee Faculties of Medicine/Health Sciences: – UEM ++; Higher Institute of Health Sciences; Catholic University; UniLurio; UniZambeze and Higher Institute of Science/Technology Research Centres – Manhica Health Research Centre – Beira Operational Health Research Centre May 11th 20095IAP for Research Capacity Building

Mapping urinary bilharzias and intestinal parasitosis in Mozambique Know – do Gap By: National Institute of Health/MoH (2007) on deglected diseases May 11th 20096IAP for Research Capacity Building Bilharzias Prevalence at districts Intestinal Parasitosis Prevalence at districts

“mapping lymphatic Filariasis in Moçambique” By: Know – do Gap By: National Institute of Health/MoH (2007) on deglected diseases Nampula Province with 54% of filariasis May 11th 20097IAP for Research Capacity Building

Some ongoing research projects in the Community Health Department/UEM – Routine Iron Prophylaxis during Pregnancy - Effects on Maternal and Child Health in Maputo City and Maputo Province Mozambique (2 countries) – Experience of African Countries with GHIs (8 countries: 4 south) – HRH development in Tete Province (2 countries) – Health Systems Strengthening for Equity: The Power and Potential of mid-level healthcare providers in Mozambique (5 countries: 3 south) – Country Situation on Child Maltreatment Prevention in Mozambique (w/ WHO) – Strengthening Integrated Primary Health Care in Sofala Province, Mozambique May 11th 20098IAP for Research Capacity Building

9 Manhi ç a health Research Centre at a glance The biomedical rural-based research centre’s agenda is based on the main causes of disease and death in children less than 5 years and pregnant women: malaria, HIV/AIDS, pneumonia and diarrhoea Age groups 0–27 Days 28 d – 11 months 12–59 months 6-14 years 1st Prematurit y (31%) Malaria (22.6%) Malaria (31.4%) Malaria (18.2%) 2ndBirth asphyxia (16.3%) Pneumoni a (19.1%) Malnutr. (20.1%) Traumatis m (10.4%) 3rd Septicaemia (14.6%) Malnutr. (10.0%) Pneumonia (10.4%) Traumatism (10.4%) 4th Pneumonia (10.6%) Diarrhea (8.0%) Diarrhea (6.0%) Pneumonia (9.1%) 5thNo consensus (7.3%) Meningitis (7.5%) No consensus (5.7%) Meningitis (9.1%) Causes of paediatric death in the community Some examples: Clinical trials for malaria vaccine Clinical development of new antimalarial drugs Evaluation of the impact of the Haemophilus influenzae type b vaccine Feasibility studies for clinical trials of microbicides and for HIV vaccines May 11th 2009IAP for Research Capacity Building

Some lessons/challenges to remark (1/2) The hiatus between policy and practice – 2025 agenda; 5y Government Plan; Science and Technology Policy and Strategy, UEM strategic and Research plans… Many publications available but the recommendations are hardly known by decision makers = Know-Do Gap – Lack of national research open access warehouse – The process of sharing health research based only on a few national mechanisms: (i) quarterly medical journal with quality problems although is a peer-review based (ii) health journey held every 4 years… May 11th IAP for Research Capacity Building

Some lessons/challenges to remark (2/2) Research conducted in ad hoc manner Lack of tracking system after approval by the only existing national bioethics committee Lack of specific health research agenda undermining informed based decisions Research mainly conducted as per donor request and fashion not primarily as part of implementing organization’s agenda External aid is needed to support local research capacity building May 11th IAP for Research Capacity Building

12 ObrigadoNabhongaKanimamboAsanteThanksMerciGracias May 11th 2009IAP for Research Capacity Building