Developing Honduras’ health research system
Dr. Jackeline Alger is a Parasitologist working in Parasitology Service in the Department of Clinical Laboratories, Hospital Escuela and faculty member of the Scientific Research Unit, Faculty of Medical Sciences in Universidad Nacional Autónoma de Honduras. In this interview she discusses the challenges of developing a health research agenda, priorities and a system in the country.
What challenges does Honduras face with the development of its systems for health research?
Although the necessity of a national health research system in Honduras was implicit, its creation was not the direct responsibility of any institution. This was reflected in the fact that the different institutions doing health research in the country were working independently in most of the cases. Also, the Ministry of Health (MOH), the institution that could organize the research for health done in the country, was not aware of its regulatory role. The MOH’s lack of awareness largely stems from the fact that within MOH there was little research being done and not much collaboration with institutions doing research. In many cases research was driven by individuals or groups of researchers, some connected to international academic institutions where these groups were formed. Recently however, more research is done within the MOH. The Ministry is also collaborating more with academic institutions conducting research nationally and internationally.
What needs are essential for developing the national health research system in Honduras? Who should take action immediately?
The MOH has already taken this action. It is taking the lead in coordinating with the main institutions carrying out research for health in Honduras. This is an important element needed to build the system. As a first step in building the research for health system, an inter-institutional committee for health research was created. The MOH presides over this committee. A wide range of institutions from the health and non-health sectors, public and private arena are members. Other members include international organisations that help with technical cooperation and assistance, such as the Pan American Health Organisation (PAHO) and the Council on Health Research for Development (COHRED).
You were one of the participants of the First Latin America conference on research for health in Rio de Janeiro in 2008. What was your take home message from that conference? How different is it from the one you attended in 2001 in Geneva?
Prior to this I attended two international meetings of the Global forum for Health Research. At Forum 5 (Geneva 2001) I was invited to present in a session named Research capacity development: perspectives from the south. I spoke on Research capacity development: perspectives from a researcher from Honduras, Central America.
At Forum 6 (Tanzania, 2002), a colleague from the peripheral health system and a collaborator in a Tropical Diseases Research (TDR) project, presented a paper on knowledge and practices on anti-malarial drugs in the northern coast of Honduras. In these two previous experiences, our participation was more as individual researchers struggling to do research in an unfriendly environment. On my return from Geneva, I published a paper describing Forum 5 in the Revista Médica Hondureña (http://www.bvs.hn/RMH75/pdf/2002/pdf/Vol70-1-2002-11.pdf).
In the Latin America meeting (Brazil 2008) I was a member of a country group. It included participants from the MOH, University (Universidad Nacional Autónoma de Honduras, UNAH) and Private Foundation (Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal,http://www.bvs.hn/php/level.php?lang= es&component=35&item=28). A representative from the Science and Technology sector (Consejo Hondureño de Ciencia, Innovación y Tecnología, COHCIT), was not able to participate in the conference. Participating as an inter-institutional group allowed me to value my contribution beyond individual research. The First Conference had plenary sessions, working groups and country background papers, and its programme focus was on developing national health research systems in the participants’ countries of Latin-America, identifying strengths, weaknesses and opportunities. For the Brazil conference I was more prepared to identify with and support other members of the Honduras group, what contributions we could make as a group in order to emerge as part of the regional initiative with local impact.
My take home message from the Latin American group was a need to reunite the persons and institutions conducting health research in Honduras, to build the national health research system. This experience was also published in the Revista Médica Hondureña
Some countries in Central America have established competitive national funds to provide grants for scientific research. Honduras is not one of these countries. Why has this not happened in Honduras? What should the government do?
This has not probably happened because the government has not adopted scientific research as a development tool. Financial resources have always been scarce. Basic operative well-defined and prioritized research, describing national health problems and evaluating interventions, has not been understood as a cost-effective strategy to solve local problems.
Honduras is now in the process of organizing its national health research system and it is crucial that we identify national and international funding that is aligned to health research that fits national priorities. Several years ago the Honduran Council for Science, Technology and Innovation (COHCIT,http://www.cohcit.gob.hn/), started an initiative to create a database of Honduran scientific researchers and to establish competitive funding for research.
A national research and training programme (PRIDE) was established with the help of Canada’s IDRC and United Nations Development Programme (UNDP). What role does PRIDE play? How can it contribute to enhancing research for health?
The aim of PRIDE (Proyecto Piloto del Porgrama Nacional de Investigación para el Desarrollo, http://foprideh.org/cms/index.php?option=com_ content&task=view&id= 71&Itemid=110) is to create a competitive national fund to provide grants for scientific research. It started with an initial study to describe the actual situation of scientific research in Honduras. This was followed by a proposal to operate and institutionalize the funds.
The PRIDE study concluded that:
- There is little research information and knowledge in Honduras and its contribution as evidence to solving problems is marginal. Few institutions or persons are using the information and knowledge in their applicability. Adequate human and institutional capacity is needed to generate information and knowledge and use it, especially in other more advanced scientific contexts.
- A national mechanism should be established to build capacity among individuals, institutions and different sectors, to generate knowledge that is applicable to development.
- Inter-institutional and inter-sectoral coordination will make it necessary to improve governance of research. This will inevitably lead to the creation of a national health research system.
After the study, there was a proposal to operate and institutionalize the PRIDE project. The proposal includes an analysis of challenges that lead to the poor generation of information and knowledge. Strategies on how to overcome these challenges are also proposed in the document.
In Honduras, researchers have joined forces with communities to fight Chagas Disease. This is a rare partnership especially in low and middle income countries. How was it possible to achieve this in Honduras?
The Chagas Disease vector was already identified by communities as a local problem. Through education, the vector was related to the chagas disease. The communities were aware of how it manifests with symptoms such as cardiac failure, sudden death, abortion, neonatal infections, among others. Through institutional organization and collaboration with local authorities (municipalities, schools, community leaders), the people understood the problem and participated in the solution. It took a high commitment from the MOH.
This drive was led by people in charge of the National Program for Chagas Disease Prevention and Control, a team that has good academic qualifications. They conducted the operational research in an open and transparent way. They were able to construct and harmonize their technical and financial relationship with a variety of actors in academia, such as the National University of Honduras and Tulane University. The program is also working with NGOs such as the World Vision and the Instituto de Enfermedades Infecciosas y Parasitología Antonio Vidal. Bilateral cooperation with CIDA, JICA and PAHO/WHO has also been essential in making this programme a success. Local information, scientific papers and educational material on Chagas Disease is available at http://www.bvs.hn/E/chagas.html.
What advice do you have for researchers in other countries about working with communities?
I recommend the implementation of participatory action research. Countries should prioritize health problems together with the community and harmonize them with national and international collaborations. After this is done, the community can be approached to discuss a proposal for initial integration. When the community participates in the identification of the problem and its solution, they value the institutional commitment and partnerships. The communities will do their part!