Strengthening HealthResearch intheDevelopingWorld ...Africa to tackle the major and increasing...

Strengthening Health Researchin the DevelopingWorld

MalariaResearchCapacity inAfrica

Pauline Beattie

Melanie Renshaw

Catherine S Davies*

Prepared by the Wellcome Trust

for the Multilateral Initiative on Malaria

*Corresponding author

PREFACE 6

ACKNOWLEDGEMENTS 7

GLOSSARY OF ABBREVIATIONS AND ACRONYMS 8

EXECUTIVE SUMMARY 9

Introduction 9Main elements of the study 9Main findings 9Recommendations for the way forward 13

1 INTRODUCTION 17

1.1 Approaches to the study 171.2 Background 171.3 Health research in developing countries 181.4 Public health significance of malaria 191.5 The Multilateral Initiative on Malaria 20

2 TRAINING OPPORTUNITIES 23

2.1 Methods 232.1.1 Survey of funding agencies 232.1.2 Data analysis 232.2 Results 242.2.1 USA and Canada 242.2.2 Europe 292.2.3 Asia and Australia 402.2.4 International organizations 402.2.5 Developing countries 422.3 Overview of awards and discussion 442.3.1 Investors in training 452.3.2 Expenditure 462.3.3 Training level of awards 482.3.4 Geographical distribution of awards 492.3.5 Training mechanisms 502.4 Conclusions 51

3 OUTPUTS OF MALARIA RESEARCH 53

3.1 Background 533.2 Methods 543.2.1 Overview of bibliometric analyses 543.2.2 Databases and search strategy 543.2.3 National outputs and collaboration patterns 543.2.4 Research categories 553.2.5 Funding acknowledgements 553.2.6 Impact of research 553.2.7 Malaria guidelines and policies 55

CONTENTS

3 OUTPUTS OF MALARIA RESEARCH (cont.)

3.3 Results 553.3.1 Global and African malaria research outputs 553.3.2 International collaboration in malaria research 593.3.3 Research categories 623.3.4 Funding acknowledgements 633.3.5 Characterization of top research institutes in Africa 653.3.6 Impact of research 683.3.7 Malaria guidelines and policies 693.4 Summary and discussion 69

4 MALARIA RESEARCH CAPACITY IN AFRICA 73

4.1 Methods 734.2 Results 744.2.1 Overview of research groups 744.2.2 Profile of malaria researchers 804.2.3 Training needs and solutions: an African perspective 824.3 Summary and discussion 85

5 OVERVIEW AND POLICY ISSUES 89

5.1 Introduction 895.2 Policy issues 895.3 Reflections on methodologies 94

REFERENCES 96

ANNEXES 97

1 Contributions to the UNDP/World Bank/WHO 99Special Programme for Research and Training in Tropical Diseases (TDR) 1989–98

2 Contact details of funding organizations 1003 Search strategy to identify malaria papers using the SCI 102

and MEDLINE databases4 African publication output in SCI and MEDLINE 103

databases (1995–97)5 Malaria control guidelines and policies 1036 Malaria research classification system 1047 Acknowledgements by funding body for papers 106

(international and African) from 1995–978 Questionnaire for the survey of African malaria 108

research laboratories 9 Survey respondents 11110 Funding sources listed by respondents to a survey of 112

African malaria research laboratories11 Funding acknowledgements for Master’s and PhD training 113

in a survey of African malaria research laboratories12 African malaria research groups contact details 114

CONTENTS

6 Strengthening Health Research in the Developing Wor ld Malar ia Research Capacity in Afr ica

Despite nearly a century of research, malaria has yet to be conquered in its bastion, Africa south of theSahara, where the majority of the world’s cases are to be found. Nevertheless, the tremendous effort tounderstand the disease and develop effective methods of control has removed the disease from signifi-cant parts of the world.

A major component of the research effort against malaria is the capacity of scientists based in Africato study the disease on the ground. This report identifies existing centres of excellence as well as high-lighting areas of remaining need. As is typical of reports of this kind, in which new data are brought tothe fore, interesting phenomena are uncovered which, when revealed, suggest obvious solutions.Perhaps the best example of this is that the majority of collaborations that individual scientists in Africahave are with laboratories outside the continent, mainly Europe and the USA. Surprisingly, there isminimal collaboration within Africa. Therefore, funds need to be made available to foster collabora-tions on the continent and maximize the impact of existing knowledge and experiences.

Although the objective of this report was to provide evidence to guide the development of theMultilateral Initiative on Malaria, its findings can probably be generalized to many areas of healthresearch. Clearly, further coordination of the multitude of agencies supporting health research is calledfor, but perhaps more importantly there needs to be a closer link between these agencies and scientiststo identify local needs as well as with governments to ensure the long-term sustainability of theresearch infrastructure. It is very much hoped that this report will stimulate such activities in an analo-gous manner to an earlier report on malaria research from the same stable.

Richard LaneHead of the Wellcome Trust’s International Programmes

October 1999

Preface

Strengthening Health Research in the Developing Wor ld Malar ia Research Capacity in Afr ica 7

The authors would like to extend their sincere thanks to colleagues at the Wellcome Trust for theirsupport, advice and direction during the preparation of this report: Elizabeth Allen, Graham Dawson,Grant Lewison and David Seemungal of the Wellcome Trust’s Policy Unit provided invaluable adviceand assistance in carrying out bibliometric analyses and survey work.

Individuals who provided constructive input on the draft report are also gratefully acknowledged:Peter Billingsley (University of Aberdeen, UK), Joel Breman and Gerald Keusch (Fogarty InternationalCenter, NIH, USA), John Claxton (Wellcome Trust), Brian Greenwood (London School of Hygieneand Tropical Medicine, UK), Kevin Marsh (Wellcome–KEMRI, Kenya), Ayoade Oduola (Universityof Ibadan, Nigeria), Odile Puijalon (Institut Pasteur, Paris), Robert Snow (Wellcome–KEMRI,Kenya) and Fabio Zicker (TDR, Geneva).

The authors are particularly indebted to those responsible for the African Malaria Vaccine TestingNetwork (AMVTN), especially Wenceslaus Kilama, for allowing inclusion of information from theAMVTN Directory in analyses presented in this report. Similarly, the Fogarty International Center ofthe US National Institutes of Health is gratefully acknowledged for permitting use of informationcontained in the Inventory prepared for the meeting held in Dakar, Senegal, in January 1997.

Finally, the authors would like to express special thanks to representatives of funding agencies whotook time to provide data on training activities, and to all those individuals from African research lab-oratories who participated in the MIM survey and provided so much important information.

This study was funded in full by the Wellcome Trust (registered charity, no. 210183).

The Trust’s sole Trustee is The Wellcome Trust Limited, a company registered in England, no. 2711000,whose registered office is 183 Euston Road, London NW1 2BE.

Acknowledgements


AusAID Australian Agency for International Development

BADC Belgian Administration for Development Cooperation(Administration Générale de la Coopération auDéveloppement)

BMZ Ministry of Economic Cooperation and Development

BWF Burroughs Wellcome Fund,USA

CDC Centers for Disease Control and Prevention (USA)

CIDA Canadian International Development Agency

CNPq Conselho Nacional de Desenvolvimento Cientifíco eTecnológico,Brazil (National Council for theDevelopment of Science and Technology)

COHRED Council on Health Research for Development

DAAD Deutscher Akademischer Austauschdienst (GermanAcademic Exchange Service)

DANIDA Danish International Development Assistance

DBL Danish Bilharziasis Laboratory

DEA Diplome d’Études Approfondies

DFG Deutsche Forschungsgemeinschaft

DFID UK Department for International Development(formerly ODA)

DOD US Department of Defense

DG XII Directorate General XII, European Commission

EIS Epidemic Intelligence Service

ENRECA Enhancement of Research Capacity in DevelopingCountries,DANIDA

FCS Federal Commission for Scholarships for foreignstudents, Switzerland

FIC Fogarty International Center,US National Institutes ofHealth

FINEP Financiadora de Estudos e Projectos (Brazilian Agencyfor the Funding of Studies and Projects)

GTZ Deutsche Gesellschaft für Technische Zusammenarbeit(German Agency for Technical Cooperation)

HRP UNDP/UNFPA/WHO Special Programme forResearch,Development and Research Training inHuman Reproduction

IAEA International Atomic Energy Agency

IDRC International Development Research Centre,Canada

IHTM Institute of Hygiene and Tropical Medicine,Portugal

INCLEN International Clinical Epidemiology Network

INCO-DC International Cooperation with Developing Countriesprogramme,European Commission

INPA Instituto Nacional de Pesquisas da Amazonia (NationalAmazon Research Institute),Brazil

INSERM Institut National de la Santé Recherche Médicale(French Institute of Health and Medical Research)

IRD Institut de Recherche pour le Développment (formerlyORSTOM),France

IRTC WHO Immunology Research and Training Centre,Lausanne, Switzerland

JICA Japan International Cooperation Agency

KEMRI Kenyan Medical Research Institute

MCT Ministerio da Ciencia e Tecnologia (Ministry of Scienceand Technology),Brazil

MIM Multilateral Initiative on Malaria

MRC Medical Research Council (UK or South Africa)

NGO Non-governmental organization

NIAID National Institute of Allergy and Infectious Diseases (USA)

NIH National Institutes of Health,USA

NORAD Norwegian Agency for Development Cooperation

NRF National Research Foundation, South Africa

OCEAC L’Organisation de Coordination pour la Lutte contre lesEndémies en Afrique

PAHO Pan American Health Organization Regional Office ofthe World Health Organisation

RCS Research Capability Strengthening

RTG Research Training Grants

SAREC Swedish Agency for Research Cooperation withDeveloping Countries

SCI Science Citation Index

SDC Swiss Agency for Development and Cooperation

SEAMEO– South East Asian Ministers of Education Organization TROPMED Regional Tropical Medicine and Public Health Network

Sida Swedish International Development Cooperation Agency

SNSF Swiss National Science Foundation

STI Swiss Tropical Insitute,Basle

TCP Technical Cooperation Projects

TDR UNDP/World Bank/WHO Special Programme forResearch and Training in Tropical Diseases

UNDP United Nations Development Programme

UNFPA United Nations Population Fund

UNICEF United Nations Children’s Fund

USAID US Agency for International Development

WHO World Health Organization

WRAIR Walter Reed Army Institute of Research,US Department of Defense

Glossary of abbreviations and acronyms


INTRODUCTION

Experiences during the last century have shownthat the returns from well-targeted healthresearch can be immense. Vaccines and diseasetreatments, for example, together with newknowledge to enable people to maintain theirown health, have averted disease, reduced suffer-ing and enabled greater productivity in manyregions. However, the research bases in mostdeveloping countries require significant strength-ening to enable effective responses to the chal-lenges of local health problems.

The Multilateral Initiative on Malaria(MIM) is a global initiative that is particularlyconcerned with building research capacity inAfrica to tackle the major and increasing prob-lem posed by malaria. This study was undertak-en by the Wellcome Trust as part of the activitiesof MIM. The purpose was to generate soundanalytical data that could inform discussions onstrategies for strengthening research bases inAfrica and enable future monitoring of progress.

The study included a unique survey of train-ing opportunities in health and biomedicalresearch offered by high-income countries to sci-entists in developing regions. It also examinedthe current status of malaria research capacityand training in Africa using a number ofapproaches. Research outputs, infrastructure,availability of trained personnel, training path-ways and funding sources were assessed, and theopinions of African scientists on training needsand solutions were sought.

The findings of the review represent aresource for funding organizations and govern-ments in both developed and developing countries to assist evidence-based approaches toresearch training activities. In addition, the reportis intended to raise awareness amongst Africanscientists of current research training opportuni-ties and the characteristics of leading malariaresearch centres across sub-Saharan Africa.Although the review has a particular focus onmalaria research in Africa, many of the conclu-sions are more broadly applicable to capacitydevelopment in other research areas and otherdeveloping regions.

MAIN ELEMENTS OF THE STUDY

The study comprised the following analyticalapproaches:1. A survey of training opportunities for devel-

oping-country scientists in biomedical sci-ences and health offered by funding organi-zations internationally (1995–98).

2. An assessment of research capacity and trainingactivities in African malaria research through:• analysis of malaria publication outputs in

MEDLINE and Science Citation Index(SCI) databases (1995–97) to identify themost productive countries and centres, col-laboration patterns, funding sources, sub-field specializations and citation impact;

• analysis of research literature cited inAfrican national malaria treatment guide-lines and policies;

• a questionnaire-based survey of 54 malariaresearch centres across Africa to assess facili-ties, expertise and training pathways, and togather opinions on research training needsand solutions.

MAIN FINDINGS

Broad indicators of malaria research capabilityAnalysis of malaria publications in the SCI data-base for 1995–97 showed that African scientistsand institutes make a major contribution tointernational malaria research: 17.2 per cent ofglobal publications included an address inAfrica. By comparison, the contribution ofAfrica to overall research in health and biomedi-cine, stands at just 1.2 per cent of the world’soutput. The highest contributing individualcountries in malaria research were the USA, UKand France which participated in 30.0, 17.8 and9.6 per cent of publications respectively in thethree-year period assessed.

Malaria research is a strong component of allresearch relevant to health or disease in develop-ing countries, representing an estimated 21 percent of worldwide publications in tropical medi-cine. However, the absolute level of malariaresearch activity is low relative to other areas ofbiomedical research and in relation to the globalburden of malaria disease: publications num-bered approximately 1000 a year and accounted

Executive summary


for just 0.3 per cent of all outputs in SCI annu-ally. By comparison, cardiology accounted for10.2 per cent, and arthritis and rheumatism 2.4per cent of world SCI publications in 1995.The low publishing activity in internationalmalaria research reflects the relatively smallglobal investment, which stood at aboutUS$100 million in 1998.

Kenya, Tanzania, Nigeria and The Gambiawere the highest publishing African countries inmalaria research in 1995–97, each producingmore than 50 papers. The most productive indi-vidual research programmes were located at theUK Medical Research Council Laboratories,Fajara, The Gambia; the KEMRI–WellcomeTrust collaborative programme in Kilifi andNairobi, Kenya; and the University of Ibadan,Nigeria. Seven centres published more than 20papers in the three-year period assessed.

Overall, African malaria research publica-tions show extensive international co-author-ship: 79 per cent of papers were found to involvecollaboration outside Africa, particularly withEurope and the USA, and few linkages acrossAfrica were observed. While this high degree ofcollaboration indicates productive links betweenlaboratory research in ‘Northern’ laboratories,and field and clinical studies in Africa, it alsoreflects dependence on foreign funding sourcesand on external expertise.

Direct survey of African malaria research lab-oratories provided a more detailed impression ofthe availability of human resources for researchand revealed the presence of a core of trained sci-entists currently engaged in malaria research. Atotal of 752 malaria researchers trained to atleast first degree level were identified in 54research centres across sub-Saharan Africa. Ahigh proportion (35 per cent) were trained toMaster’s level, while postdoctoral scientists andclinicians were also well represented (26 and 22per cent respectively). The majority of PhDgraduates held Master’s degrees and nearly halfof clinical researchers also held higher degrees.However, the 192 postdoctoral and 168 clinicalscientists identified were dispersed across 22countries so that the numbers of trainedresearchers per country were small. In addition,about one-third of research groups were led bynon-national scientists. Of the 313 individualquestionnaire respondents, 15 per cent werenon-African. The results, therefore, indicate a

strong need for additional African scientificleaders who are able to conduct innovative andindependent research, and play a key role incapacity-building efforts.

While numbers of trained personnel andpublications provide an indication of the level ofresearch activity, they are unable to measure theimpact and usefulness of that research. Citationindices of publications are commonly usedmeasures of research impact, which indicate theinfluence of published results on the scientificcommunity. African malaria research papers for1995–97 had a lower potential citation impactthan the international set of malaria papers forthe same period. However, the result primarilyreflects the highly clinical and applied nature ofAfrican research, as this type of research isknown to attract fewer citations than more fun-damental studies. Citations, therefore, do notprovide an accurate measure of the value of moreapplied research, and alternative methods arerequired.

Literature cited in national guidelines andpolicies for the treatment and control of malariafrom 11 African countries were examined toassess links between research and policies. Theresults indicated that it is clinical and in-countryresearch, often recorded in grey literature, thatinfluences policies rather than basic research.These observations would support investment inthe local research bases in developing countries,particularly in clinical and applied sciences.Analysis of national policies and guidelines is animportant potential method of demonstratingspecific outcomes from clinical and appliedresearch. However, there was a lack of a system-atic approach to citing scientific literature in thedocuments examined, and more widespread useof this approach would be dependent on coun-tries including full bibliographies in their policydocuments.

Investments in research and training indeveloping regionsA diverse set of funding organizations in indus-trialized countries support research and trainingin Africa, Asia and South America, as revealed bysurveys of funding agencies and of malariaresearch laboratories in Africa, and by analysis offunding acknowledgements on malaria publica-tions. These include governmental, non-govern-mental and commercial sources.

Executive summary


The most frequently acknowledged funderson African malaria research publications were theUNDP/World Bank/WHO Special Programmefor Research and Training in Tropical Diseases(TDR), the Wellcome Trust, the Kenyan Med-ical Research Institute (KEMRI) and the UKMedical Research Council. Commercial fundingsources for African malaria research were notprominent: only Hoffman La Roche registeredmore than ten acknowledgements on publica-tions over a three-year period. Fourteen commer-cial companies were listed in the survey ofAfrican research centres as providing grants, butfunding was generally on a small scale.

Survey of funding organizations and ofAfrican malaria research laboratories indicatedthat training opportunities for developing-coun-try scientists are widely dispersed across manyorganizations from high-income countries.However, only a few funders provide substantiallevels of support, notably the Japan InternationalCooperation Agency (JICA), the EuropeanCommission (INCO-DC), the US NationalInstitutes of Health (NIH), and TDR. Otherrelatively prominent direct supporters of train-ing (excluding multilateral contributions)include Australian, Belgian, Danish, French,Swedish, Swiss Government agencies, theInternational Clinical Epidemiology Network(INCLEN) and the Wellcome Trust.

An aggregate expenditure by industrializedcountries of US$261 million for training devel-oping-country scientists in biomedical scienceand health was identified for the three-year peri-od 1995–97. This figure is low when comparedwith the figure of US$145 million invested in asingle year (1997) in developing biomedicalresearch expertise in the UK. Nevertheless, thereappears to be a growing international commit-ment to strengthening research capacity indeveloping countries: a 41 per cent increase inexpenditure by high-income countries wasobserved over the three-year period assessed.

Contributions to training by governments indeveloping regions were not broadly surveyed,but data were obtained from Brazil and SouthAfrica, which are by far the highest investors inresearch in their regions. The figures obtainedsuggest that expenditures by other countries inSouth America and sub-Saharan Africa are likelyto be very low.

The research base in Africa is stronglydependent on external investment: 88 per centof malaria research grants to African laboratoriesfor 1993–98 were from organizations outsideAfrica. For PhD training, 65 per cent of fundingacknowledgements were to agencies from devel-oped regions, and 17 per cent to African govern-mental or local sources. Many researchersreported funding their own degree studies.African governments contribute significantly tosupport for Bachelor’s degrees (over half in thegroup analysed), and to salaries of nationalresearchers (68 per cent of survey group). Localgovernment sources were also the highest indi-vidual category acknowledged for PhD andMaster’s training.

Career progression opportunities inbiomedical researchSurvey responses from 39 funding organzationsrevealed the broad range of training schemes inhealth and biomedical research offered by higher-income countries to scientists in developingcountries. However, these training opportunitiesare generally dispersed, with many funders pro-viding small numbers of awards annually.Training is often associated with specific pro-grammes and is not offered openly, thus limitingoptions for individuals seeking to identifysources of funding. Relatively small numbers oforganizations actively monitor the numbers andsuccess of training awards, illustrating the lack ofa coherent international approach to trainingscientists. Despite the large number of trainingschemes overall, there are few opportunities forscientists to develop their careers through thefunding schemes of a single organization, asmany funders target training at one level.

Most agencies focus their resources on partic-ular regions, and available data suggested thatAfrica and Asia are slightly favoured over SouthAmerica in terms of training opportunities.

The availability of international awards fordeveloping-country scientists at different stages ofcareer progression was assessed. It was found that:• Training attachments in overseas laboratories

and short courses are the most frequent typesof support provided by organizations in devel-oped countries, and accounted for a large pro-portion of overall identified expenditure.

• Very few organizations in high-income coun-tries provide support for Bachelor’s degrees.

Executive summary


• A large proportion (74 per cent) of organiza-tions surveyed provides support for Master’straining, although many provide only smallnumbers of awards annually. Over half of theidentified Master’s awards came fromINCLEN and the Belgian Agency forDevelopment Cooperation, and these awardswere focused in the areas of clinical epidemi-ology, public health and related disciplines,indicating that the availability of Master’straining in other disciplines is more limited.

• A smaller proportion of funders offers PhDtraining (just over half of those surveyed),but over 90 per cent of identified awardswere provided by the European Commission,TDR, US National Institutes of Health(NIH) and DANIDA. AusAID is an impor-tant supporter of training for Asian scientists,although available data were incomplete.Survey of African research centres also identi-fied L’Institut de Recherche pour leDéveloppement (IRD) and the FrenchMinistry of Cooperation as notable fundersof PhD training.

• Postdoctoral training is often provided inassociation with larger research programmesand few agencies provide opportunities forindividual postdoctoral scientists to apply forindependent research support. The US NIHand the Wellcome Trust were the mostprominent supporters of postdoctoral train-ing identified in the survey. African scientistscommented on the lack of availability ofresearch awards to develop the careers ofpostdoctoral scientists.

The survey of funders from high-incomecountries identified a total of 684 PhD awardsand 821 Master’s awards for 1995–98. By com-parison, in a single year (1997) there were an esti-mated 2101 PhD awards directed towards build-ing biomedical research expertise in the UK, acountry with a population of about one-seventy-fifth of the developing-country regions com-bined. This is equivalent to nearly 1000 timesmore PhD opportunities in the UK than in thedeveloping regions, relative to population size. Inview of the dependence of many developingcountries on external funding sources for post-graduate training, the overall conclusion is thatprovision of research training opportunities fordeveloping-country scientists is low relative to

opportunities in industrialized countries.These figures must of course be considered in

the light of the more limited availability of grad-uates to absorb training at higher-degree levelsin developing countries. However, comparativefigures for numbers of tertiary students and PhDawards per unit population in developing anddeveloped countries support the view that cur-rent PhD training in many developing countriesis restricted. In addition, three-quarters of scien-tists in Africa responding to the MIM surveyhighlighted the need for additional opportuni-ties at Master’s and PhD level.

Training mechanisms and infrastructureMost funding organizations link training tomajor research programmes that have receivedsupport through a competitive, peer-reviewedprocess, thus providing some assurance thattraining will take place in a strong intellectualenvironment. Funders also tend to focusresources on specific centres to develop facilitiesand a critical mass of people that will encouragehigh-quality science to flourish.

The survey of African malaria researchersrevealed that 90 per cent of Bachelor’s degreeshad been completed within Africa (81 per centlocally or self-funded), but just over half of post-graduate qualifications had been obtained whol-ly or partially outside the home country. Exter-nal training occurred most frequently in Europefollowed by the USA. The extent of overseastraining varied among countries, with moreresearchers receiving PhD training at home inNigeria, South Africa, Cameroon and Senegal.

Patterns of African scientific partnershipsand training sites are strongly moulded by fund-ing mechanisms, which reflect historical andlanguage associations and geographical proximi-ty. In many cases training is offered in the coun-try in which the donor organization is based.There are few funding mechanisms that supportlinkages between countries within developingregions. For example, France and the UK focustheir resources primarily on centres in Franc-ophone and Anglophone Africa respectively,contributing to a lack of interaction betweeninstitutes in these regions.

African survey respondents recognized thevalue of international partnerships as a mecha-nism for training and for technology transfer.They considered overseas training attachments to

Executive summary


be important in exposing developing-countryscientists to the scientific culture and facilities ofoverseas centres of excellence. However, they alsonoted that overseas training is not always relevantto the home research base, is expensive, and mayresult in researchers being attracted permanentlyaway from their home countries to locationswhere the facilities and career prospects areadvantageous. It was considered that local train-ing opportunities within Africa are not beingfully exploited, and further investment in Africantraining centres would be valuable to allowregional technology transfer and sharing ofresources. Funding agencies are increasingly rec-ognizing the benefits of using local and regionaltraining facilities, combined with shorter train-ing attachments in European or US laboratories,to develop sustainable and locally relevantresearch expertise.

Many of the most productive malariaresearch centres in Africa receive long-term sup-port from external funders and are relatively wellequipped, thus underscoring the importance ofa stable foundation from which to develop aneffective research programme. Over 90 per centof all African malaria laboratories surveyed hadcore laboratory facilities (freezers, centrifuges,incubators and microscopes). However, a highproportion of individual survey respondentscited lack of research funds or poor infrastruc-ture and laboratory facilities as major obstaclesto developing a research career in Africa. Africanresearchers also emphasized the critical impor-tance of good communication links in allowingthem to participate effectively in internationalresearch activities. The survey results indicatethat the communications revolution is success-fully reaching Africa as 90 per cent of laboratorieshad e-mail connections. The quality of electroniccommunications, however, was not assessed.

Adequate remuneration is a major factor insuccessfully retaining scientists in developingcountries. Nearly 70 per cent of African scien-tists surveyed received their salaries from localsources, but many commented that these salarieswere insufficient.

The present study identified the location andspecializations of a number of strong malaria

research centres across sub-Saharan Africa.Primary funding sources of these centres andinternational scientific partnerships have alsobeen analysed. This information should assistboth researchers and funders in identifying cen-tres which might be further developed for localand regional training, and for multicentre studies.

Research specializations: diseases and disciplinesResearch training schemes must aim to buildcapacity that is appropriate to national healthneeds and priorities. Many funding agencies tar-get resources on particular diseases or disciplines.For example, INCLEN focuses on developingexpertise in clinical epidemiology, and related dis-ciplines, while WHO/TDR focuses on eight tar-get tropical diseases. Training is also often linkedto larger research programmes, whose researchfocus will strongly influence the balance ofexpertise generated by training activities. There isa need for overarching mechanisms to matchcapacity development to research priorities.

The major focus of current malaria researchin Africa is on clinical studies, epidemiology,intervention trials and health services research.Only 3 per cent of African malaria publicationsin SCI and MEDLINE (1995–97) related tobasic science studies of the malarial parasite, and7 per cent to fundamental studies of mosquitovectors, or vector taxonomy, ecology or behav-iour. Eighty-one per cent of African publicationsreported studies involving human subjects, com-pared with 46 per cent for malaria papers inter-nationally. Direct survey of malaria research lab-oratories in Africa confirmed the strong presenceof expertise in clinical and field-based research:for example 132 scientists trained in publichealth and 88 in epidemiology were identified.The results also suggested that facilities andexpertise in molecular biology, biochemistry andimmunology are increasing (gel electrophoresisand PCR equipment was present in 76 and 58per cent of laboratories respectively). Thereappeared to be a lack of expertise in biostatistics,sociology and economics: 37, 36 and 12 individ-uals, respectively, were identified with trainingin these disciplines.

Executive summary


RECOMMENDATIONS FORTHE WAY FORWARD

This report has gathered information from dif-ferent perspectives on the availability of trainingopportunities for scientists in developing coun-tries, and on the current status of human andinfrastructural resources for malaria research inAfrica. In view of the enormity of the challengein strengthening research capacity in developingcountries, funding organizations and govern-ments face some difficult decisions on wherebest to direct their resources for maximal effect.The results of this review point to a number ofareas of weakness in current international researchtraining activities and to specific conclusionsrelating to malaria research in Africa. The keypoints are summarized here together with recom-mendations for consideration by the MultilateralInitiative on Malaria, by other coordinating bod-ies such as the Roll Back Malaria Project ofWHO, and by individual funding organizationsin the developed and developing worlds.

International investment and coordinationin research training➤ The research bases in many developing coun-tries are currently heavily dependent on foreigninvestment, but the success of any capacity-building activities is ultimately dependent onlocal commitment to scientific research. Fundingorganizations internationally and governments ofdeveloping countries must, therefore, worktogether to build sustainable research expertise toaddress clearly identified national health researchpriorities. Coordinated and long-term invest-ment by both national governments and externalfunders is needed to improve infrastructure andfacilities. More formalized, overt partnershipsmay be required for maximal effect.

➤ Current training offered by higher-incomecountries to developing-country scientists isgenerally fragmented and inadequately moni-tored. Greater efforts are required to coordinateactivities internationally and to monitor theeffectiveness of training programmes in order tomaximize the impact of resources in building acore of appropriately skilled scientists. Thiscoordination role is one that might be played bythe Multilateral Initiative on Malaria.

➤ Science is a global activity and the migrationof scientists to high-income countries is a prob-lem that must be addressed in order to build sus-tainable research bases in developing countries.National research institutes must be able com-pete successfully to retain scientists against bothoverseas institutes and the local private sector.Serious consideration must be given by localgovernments to the provision of adequate salarystructures to reward productive scientists. Moreexternal funders might also consider provision ofsalary supplements to scientists who competesuccessfully for research awards.

➤ The aggregate expenditure by industrializedcountries in training scientists in developingregions appears low relative to population inthese regions, and relative to expenditure ontraining scientists in industrialized countries.This is particularly significant in view of theobserved dependence of developing countries onforeign investment in research training. A smallincrease in the proportion of overall budgetscommitted by larger research and developmentorganizations to research training could poten-tially have a substantial overall impact.

➤ Accurate measures of the impact of clinical andapplied research are required to provide data tosupport investment in this type of research. Theanalysis of research cited in health policy docu-ments is a potentially effective method of assess-ing the influence of research in informing clinicalpractice or disease control strategies, but effectiveimplementation is dependent upon the inclusionof full bibliographies in policy documents.

Career progression opportunities inbiomedical research➤ The majority of African scientists completeBachelor’s degrees in their home countries.Universities in developing regions, therefore,have the responsibility of ensuring thatBachelor’s degree curricula are of high quality,reflect national scientific needs and generate aninterest in scientific research.

➤ Current availability of awards for PhD andMaster’s training in many developing countriesfrom both local and international sources is verylimited, even after taking into consideration thelower numbers of graduates in developing as

Executive summary


compared with developed countries. Greateropportunities are likely to be beneficial in devel-oping a critical mass of independent scientists.

➤ The wider availability of grants and fellowshipsto support the research projects of individual sci-entists would provide an incentive for scientists todevelop careers in research and may contribute tothe development of key scientific leaders.

➤ There is a relatively large overall investmentby high-income countries in providing shorttraining attachments in overseas countries,workshops and short courses. These trainingmechanisms are potentially important, but theymust be appropriately targeted and monitoredfor maximal effect. There is a need for a moredetailed analysis of the nature of current activi-ties of this type.

Training mechanisms and infrastructure➤ Training patterns are strongly influenced byrigid funding mechanisms that often involvecollaborations between specific high- and low-income countries. The establishment of morevaried funding formats would enable greaterdiversity in international scientific partnershipsfor more effective use of top-class training cen-tres, irrespective of their location. Mechanismsto support linkages within developing regionsare also required to allow sharing of regionalresources and expertise, perhaps through moreformalized research and training networks andmulticentre approaches.

➤ A high proportion of scientists from lower-income countries is currently trained overseas.Greater investment in developing countries isrequired to establish top-quality local andregional training centres, which can play a rolein building sustainable and relevant nationalresearch expertise. This approach would assist inbuilding productive collaborations betweenneighbouring countries and may also prove to bemore cost-effective in the long-term.

➤ The balance of expertise generated by trainingis determined primarily by funding policies ofindividual agencies that target particular diseasesor disciplines, and by the focus of large researchprogrammes with which training is associated.There is a need for mechanisms, at national andinternational levels, to assess the overall distribu-tion of training across different research areasand hence assist in mapping capacity develop-ment to national research priorities.

➤ Stronger links between the research and con-trol communities are required to facilitate orien-tation of research agendas to practical healthneeds, and to promote rapid uptake of researchresults into policy and practice.

Malaria research capacity in Africa➤ Malaria research is a particular strength ofsub-Saharan Africa and the current study hasidentified and characterized the most productiveresearch centres. These centres represent a strongbase for the development of a network of sitesfor training and for multicentre studies.

➤ A core of training African scientists engagedin malaria research has been established, but thenumbers of trained scientists are relatively smalloverall and there appears to be substantialdependence on external expertise from Europeand North America. Continuing efforts arerequired to train African scientific leaders forthe future.

➤ African centres appear to lack expertise inhealth economics, social sciences, and biostatis-tics, and these disciplines may require specificstrengthening in view of their importance inoptimizing the delivery of healthcare and diseasecontrol interventions.

➤ This review has provided baseline data onresearch activity, infrastructure and trained personnel which can be used to measureprogress in strengthening malaria research capa-bility in Africa.

Executive summary


1

1.1 APPROACHES TO THE STUDY

The MIM review includes the following analyti-cal approaches:1. A survey of training opportunities in health

and biomedical research offered by interna-tional funding organizations to scientists inAfrica, Asia and South America.

2. An assessment of current malaria researchcapacity and training in Africa including:• analysis of African malaria research

publications, in the context of globalpublications, to assess relative outputs ofcountries and institutes, collaborationlinks, subfield strengths and weaknesses,and funding sources;

• analysis of journal impact factors forAfrican malaria research publications toassess the potential influence of the report-ed research on the scientific community;

• analysis of literature cited in African nationalmalaria treatment policies to elucidate theresearch guiding policy formulation;

• a survey of African malaria research labora-tories to assess current research expertise,facilities and training pathways, and toobtain opinions on needs and solutions incapacity development in Africa.

Where possible, the study made use of pre-existing information contained within theDirectory of the African Malaria Vaccine TestingNetwork (AMVTN)1 and the ‘Inventory ofresources and activities’ produced for theInternational Conference on Malaria, held in

Dakar, Senegal, in 1997. However, the majorpart of the review presents novel bibliometricand survey information.

1.2 BACKGROUND

The quality and productivity of scientificresearch in the lower-income countries of theworld currently lags far behind that ofindustrialized nations, and the lack of localresearch capacity has seriously hindered progressagainst health problems in developing regions.Estimates from the United Nations Educat-ional, Scientific and Cultural Organization(UNESCO, 1996) suggest that Africa, LatinAmerica and the Middle East together accountfor only 13 per cent of the world’s scientists,with the majority being concentrated in theWestern industrialized nations. There is,however, growing awareness of the need tostrengthen indigenous research capacity toenable developing countries to respond to theirown health challenges in a more effective and sustainable way (e.g. COHRED, 1990).Scientific research has had a dramatic impact inimproving health this century in many regionsof the world, through the development of newtreatments and control interventions, andthrough providing knowledge to enable peopleto maintain their own health. Research has alsobrought economic benefits through avertingdisease and decreasing healthcare costs.

It has been estimated that about half of allfunds for research relevant to developing coun-tries comes from local governments, with the

This report has been prepared by the Wellcome Trust as part of the activities of theMultilateral Initiative on Malaria (MIM). A major objective of this initiative is tostrengthen and sustain malaria research in African countries through partnershipswith scientists internationally. However, it was recognized early in the establishmentof the initiative that very little information is available on current research capabilityin developing countries. Organizations involved in MIM agreed that such data werecrucial to inform discussions on potential options for strengthening long-termresearch capability. Hence, it was decided that a review of current research trainingschemes should be carried out, together with an assessment of human andinfrastructural resources for malaria research in Africa. The Wellcome Trust, as thecoordinator of MIM during 1998 and a major funder of malaria research, undertookto carry out this study, drawing on experience from a previous review of internationalmalaria research (Anderson et al., 1996).

Introduction

1 www.amvtn.org


remainder coming from external sources(Michaud and Murray, 1996). Successfulstrengthening of the science base in developingcountries is therefore heavily dependent uponexternal investment. In view of the enormity ofthe challenge and limitations in resources, it isevident that inputs from organizations interna-tionally need to be focused and coordinated inorder to achieve maximal effect.

On a broad level there has been a recentmove towards evidence-based approaches toresearch investments. Individual organizationsare placing greater emphasis on evaluating theirfunding policies and assessing how their contri-butions integrate into an international context.There are also ongoing activities to analyse glob-al resource flows into health research, that willfacilitate rational investment in relation to dis-ease burden estimates (e.g. the WHO Ad HocCommittee on Health Research, 1996; and theGlobal Forum for Health Research, Geneva). Inaddition, initiatives such as the MultilateralInitiative on Malaria are providing a structuralframework for coordinated international invest-ments by scientific funding organizations.

Analytical data to inform decision-makingon strengthening research in developing coun-tries are not readily available. Comparative fig-ures on human resources in different regions aredifficult to obtain and highly incomplete(UNESCO, 1998). Some data specifically relat-ing to malaria research capacity have been gath-ered previously, but these have not been subjectto detailed analysis (e.g. AMVTN Directory andan Inventory produced for the InternationalConference on Malaria, Dakar, Senegal, 1997).Reviews focusing on research training have beenlimited in scope and have tended to focus onspecific issues or schemes (e.g. Doumbo andKrogstad, 1998; TDR, 1999; INCLEN InternalReview, 1999). What is lacking is overviewinformation on the extent and nature of interna-tional training schemes for scientists in develop-ing countries, and the degree to which they pro-vide a coherent training framework.

This study aimed to complement existinganalytical efforts and to fill some of the gaps incurrently available information. A large body oforiginal data has been gathered and analysed, andthe main findings are being published in thisreport as a resource for funding agencies interna-tionally. While a major part of the report focuses

on malaria research in Africa, many of the con-clusions are of broader relevance to buildingresearch capacity in the poorer countries of theworld. The data on current malaria research pro-ductivity also provide indicators to enable futuremonitoring of the success of programmes to trainscientists in developing countries. Finally, andimportantly, the report is directed towards devel-oping country scientists themselves to raiseawareness of current training opportunities andof the location of centres of malaria researchexpertise across the African continent.

1.3 HEALTH RESEARCH IN DEVELOPINGCOUNTRIES

Health problems in Africa and in other low- andmedium-income regions remain a significantchallenge: with the persisting burden of avoid-able childhood and maternal diseases, a diverseand changing threat from infectious diseases,and a rapidly emerging epidemic from noncom-municable diseases and injury. Malaria is onedisease in particular that continues to be a majorproblem, despite previous eradication cam-paigns (see below).

Overall, it is estimated that more than 90 percent of the world’s burden of preventable mor-tality occurs in low- and middle-income coun-tries. Nevertheless, these health problems ofdeveloping countries receive relatively littleattention, with most global resources beingdirected towards diseases of higher-incomecountries. Of the global investment in healthresearch and development (about US$55 billionannually), only 5–10 per cent is thought to bedevoted to health problems in low- and middle-income countries, (Michaud and Murray,1996). There is a strong need, therefore, for arational, coordinated international response todiseases of lower-income countries, which willcontribute towards redressing this imbalance.

Within the context of international researchactivity, scientists working in developing coun-tries have a critical contribution to make. Astrong indigenous science base is required forcountries to define and address their own healthresearch priorities, thereby contributing towardsimproving health and towards social and eco-nomic development.

Introduction1


Investment in science in developing coun-tries over the last 50 years has been successful inbeginning to establish national scientific com-munities with internationally recognized scien-tific leaders. For example, financing of researchin sub-Saharan Africa increased sevenfold in1970–85 and the number of people engaged inresearch by a factor of ten (Gaillard and Waast,1993). Despite this progress, developing coun-tries still contribute only a small fraction of theworld scientific publications: an estimated 6.5per cent of the total (OST, 1997).

Across the developing nations there areregional and country-specific patterns andtrends in scientific research. Figures derivedfrom the Science Citation Index (SCI) andCompumath databases provide some indicatorsof scientific activity (UNESCO, 1998). LatinAmerica accounts for about 1.5 per cent of sci-entific outputs in all disciplines, while sub-Saharan Africa accounts for 0.8 per cent, China1.6 per cent, India and Central Asia 2.1 per centand South-East Asia just 0.1 per cent. The worldshare of publications outputs from sub-SaharanAfrica dropped by 19 per cent between 1990and 1995, while the outputs from China andLatin America increased substantially (+38 and+17 per cent respectively) and the outputs fromAsia remained relatively steady.

The different regions also have different dis-ciplinary specializations: sub-Saharan Africa isstrongest in applied biology/ecology and weak-est in basic biology, chemistry, physics and engi-neering. Conversely chemistry, physics and engi-neering are relative strengths of China, India andCentral Asia. Latin America is strongest inapplied biology and ecology. It should be noted,however, that the databases used for these analy-ses are biased towards English-language journalsand do not take into account local and regionaljournals that are particularly prominent inChina and Latin America, and which might pro-vide more accurate insight into locally relevantresearch capacity. The results, however, do give afair representation of the broad international sci-entific visibility of the different regions.

Public investment in research and develop-ment (R&D) by developing countries is the low-est in the world, illustrating the lack of localresources to sustain scientific activity. Similarly,the available figures for trained scientific person-nel in developing regions are also very low relative

to industrialized countries.The above data on scientific activity in devel-

oping countries are a strong indication that theseregions remain ill-equipped to respond to themajor challenges posed by local health problemssuch as malaria, tuberculosis, HIV/AIDS andupper respiratory tract infections.

1.4 PUBLIC HEALTHSIGNIFICANCE OFMALARIA

Malaria is a major and increasing cause of diseaseburden globally and is estimated to be responsi-ble for more than one million deaths and almost300 million clinical cases annually worldwide(See ‘Rolling Back Malaria’ in the WHO WorldHealth Report, 1999). The disease has its greatestimpact in sub-Saharan African where an estimat-ed 90 per cent of cases occur, often in young chil-dren. The economic impact of malaria in Africais substantial. Despite successes in controllingmalaria in the 1950s and 1960s, recent yearshave seen a resurgence due to a combination offactors. There is growing resistance to currentantimalarial drugs in many areas, includingmultidrug resistance. Increasing insecticideresistance, environmental changes and humanmigration, often the result of political instabilityand wars, are further contributory factors. Areduced commitment to control programmes insome regions has also had the serious conse-quence of exposing populations with decreasedimmunity to the threat of malaria.

Over the past few years there has been agrowing momentum to address the problem ofmalaria. Strong international commitment hasdeveloped, and action has taken place in a rangeof different sectors. For example in Amsterdamin 1992, a Revised Global Malaria Strategy wasapproved by the health ministers of severalmalarious countries (WHO, 1993). This wasfollowed in 1996 by discussions between theWHO Regional Office for Africa (AFRO) andthe World Bank, leading to plans for a malariacontrol programme to be targeted at malariousareas across the African continent. At the sametime, discussions were under way in the researcharena to develop a more cohesive and coordinat-ed international approach to scientific researchagainst malaria, leading to the establishment of

Introduction 1


the Multilateral Initiative on Malaria. Mostrecently, WHO, has recognized the impact ofescalating mortality from malaria andannounced a major new programme to ‘RollBack Malaria’ (Nabarro and Tayler, 1998),which is global and aims to add value to andcoordinate all efforts to control malaria.

1.5 THE MULTILATERALINITIATIVE ON MALARIA

Origins and objectivesThe Multilateral Initiative on Malaria (MIM) isan international alliance of organizations andindividuals that aims to maximize the impact ofscientific research against malaria. Enhancingcoordination and collaboration, mobilizingresources, promoting capacity building inAfrica, and encouraging research and controlcommunities to engage in fruitful dialogues aremajor emphases of MIM.

The origins of MIM go back to a meeting held in 1995 between a number oforganizations supporting scientific research inthe developing world. From these discussionsemerged a recognition that ongoing activitieswere fragmented with different organizationsindependently supporting research activities atvarious locations across the developing world.There was agreement that a mechanism wasrequired to orchestrate these individual activitiesinto a more coherent approach, which wouldhave a stronger and more sustainable impact.Malaria in Africa was selected as an importantfocus to develop a mechanism to promotegreater coordination amongst the range ofdifferent players; and so the concept of the Multilateral Initiative on Malaria (MIM)came into being. The original overarching goalwas defined as “to strengthen and sustainthrough collaborative research and training, thecapability of malaria-endemic countries inAfrica to carry out research required to developand improve tools for malaria control”.

A defining step in the evolution of MIM wasa congress convened in Dakar, Senegal, inJanuary 1997 where the scientific communitywas asked to identify the major research ques-tions that must be answered in order for theproblem of malaria to be addressed effectively(Butler, 1997a; Mons et al., 1998). The meeting

was successful in highlighting specific researchpriorities, as well as some broad recurring needsthat cut across different subject areas. The recommendations arising from this meetinghave played a crucial role in guiding the activities of MIM. Follow up meetings during1997 in The Hague (Butler, 1997b; Gallagher,1997) and London (Butler, 1997c; Williams,1997) then defined more clearly the areas forconcerted action and set out the strategies foraddressing priorities. At the London meeting,the Wellcome Trust accepted the nomination toact as a coordinator of the activities of MIM foran initial period of 12 months. One of the keypriorities set at this meeting was to carry out areview of malaria research capacity in Africa.This priority, amongst others, was actively pursued by the Wellcome Trust, leading to thepreparation of this report.

Key outcomes and future directionsMIM has been involved in a diverse range ofactivities since its establishment in 1997 (Davies,1999). Importantly, the Initiative has played asignificant role in drawing additional funds intomalaria research: overall funds committed tomalaria research increased from an estimatedUS$85 million in 1995 (Anderson et al., 1996)to a figure of well over US$100 million in 1999.

MIM is particularly concerned with promot-ing global coordination and collaboration in themalaria research community to address scientificneeds and opportunities. To this end, it has facil-itated links not only between scientists, but alsobetween the funding organizations supportingthem. MIM meetings, newsletters and websites2

have been important channels for enhancingcommunication amongst partners. Furthermore,the Malaria Foundation International has playeda prominent role in raising awareness of theimmense health and economic impacts of malaria.

There have also been unprecedented oppor-tunities for interactions between scientists acrossAfrica. The Dakar Conference in 1997 was a sig-nificant event in bringing together scientistsfrom all regions of sub-Saharan Africa and, fol-lowing the success of this meeting, MIM made acommitment to establish a regular forum of thiskind. The first MIM African MalariaConference took place in Durban, South Africa,in March 1999 and was attended by over 850delegates. It was made possible through the gen-

Introduction1


erous sponsorship of a broad range of fundingorganizations and commercial companies. TheConference was successful not only in facilitat-ing scientific collaborations across Africa andinternationally, but also in strengthening linksbetween the research and control communities.

MIM has also catalysed the establishment offormalized collaborations across Africa.Multicentre approaches can make a particularcontribution by linking fragmented and isolatedresources into networks which have the poten-tial for much greater impact on malaria.Furthermore, single sites are not sufficient toobtain definitive answers in certain types ofstudies where large sample sizes are required,necessitating instead that standardized reagentsand methodologies are applied at multiple sites.For example, a network linking five sites acrossAfrica has been established to study severemalaria in children and particularly to evaluatenovel treatments and develop new interventions.

To fulfil the need for standardized and well-characterized malaria research reagents identi-fied in Dakar, a Malaria Research and ReferenceReagent Repository has been established withfunding from NIAID. This facility will maintainand distribute reagents such as parasite strains,mosquitoes, genetic material (e.g. DNA probes)and antibodies.

The immense opportunities offered to Africanscientists by electronic communications technol-ogy and the Internet have been recognized byMIM, and the US National Library for Medicinewas nominated to lead an initiative in this area.Much improved connectivity has been achievedin Mali, and at two sites in Kenya, while plans forsites in Tanzania and Cameroon are advancing.

As part of its commitment towards buildingresearch expertise in Africa, MIM was responsi-ble for the establishment of the new Task Forcefor Malaria Research Capability Strengtheningin Africa, which is administered by theUNDP/World Bank/WHO Special Programmefor Research and Training in Tropical Diseases(TDR) and is funded from several differentsources. This Task Force provides support forresearch training in association with large multi-centre studies across Africa.

Overall, MIM has helped to energize a newphase to improve approaches to internationalmalaria research through creating new partner-ships, and through providing a practical frame-

work and point of reference to guide the activi-ties of the international research community.The new working relationships establishedbetween the major funders are also having aninfluence in improving coordination in thebroader field of biomedical and health researchin the tropics. In the future MIM will continueto tackle key priorities, as well as bottlenecksimpeding progress. It is also committed to work-ing with the WHO Roll Back Malaria Project toensure smooth integration of malaria researchand control activities.

Introduction 1

2www.wellcome.ac.uk/mim

and www.malaria.org/mim

www.mimcom.net


2

2.1 METHODS

2.1.1 Survey of funding agenciesFunding agencies providing support for devel-oping-country scientists were identified throughliterature searches, Internet searches and directo-ries of grant-making organizations. The studyfocused primarily on funding organizationsbased in established market economies. Someinformation was obtained from governments oflower-income countries, although these sourcesof support were not broadly surveyed.

A questionnaire was sent to organizationsrequesting details of award schemes throughwhich individuals from developing countriesmight receive funding. Information for the peri-od 1995–98 was requested on:• numbers of awards to developing-

country scientists;• expenditure on awards;• training level of awards;• the regional breakdown of awards into

Africa, Asia and South America;• proportion of awards for malaria

research training.

As the questionnaire format was not neces-sarily compatible with the records kept, organi-zations were encouraged to submit as much rele-vant data as possible in a format convenient fortheir records. All organizations that contributeddata were given an opportunity to check theaccuracy of the presentation of their data in thereport prior to its publication.

The following points should be noted:• Although every effort was made to obtain

comparable data, it cannot be assumed thatall funding agencies classify their awards inthe same way.

• Accurate figures for expenditure on trainingwere sometimes difficult to identify wheretraining was provided as part of a larger

research or development programme.• The review focused on organizations that

administer training schemes and consequent-ly funding agencies that contribute funds tosecondary organizations for training may beless well represented in the review. Wherepossible, contributions from one organiza-tion to another are specifically stated anddouble counting of the funds avoided.

2.1.2 Data analysisExpenditure totals were converted to US dollarequivalents using annual average exchange rates1

for each of the years 1995 to 1997. Figures for1998 were converted according to the exchangerate for June 30 1998. Expenditure was classifiedaccording to the financial year of the particularorganization contacted. The specific time periodcovered in a financial year varies between organi-zations. Where the financial year spans morethan one calendar year, the year assigned wasthat containing the greater proportion of thefinancial year. For example, the financial year ofthe Wellcome Trust runs from 1 October to 30September, therefore FY 1995 refers to the peri-od from 1 October 1994 to 30 September 1995.

Awards were classified according to the fol-lowing categories:• Bachelor’s: undergraduate studies,• Master’s: postgraduate degree or studies,

including Diplôme d’Études Approfondies;• PhD: doctorate awarded for original research

in a subject;• postdoctoral: studies, research or professional

work above the level of doctorate;• training attachment: specific skills or techni-

cal training not necessarily leading to theaward of a formal certificate. Training isoften, but not always, provided at a researchinstitute in a developed country;

• diploma: courses and specializations where acertificate is awarded.

This chapter presents the results of a survey of international research trainingopportunities in biomedical sciences and health for researchers in developing countries.The aim was to obtain an analytical overview of existing training schemes in order toassess the availability of support at different levels of training, in various disciplines,and across different geographical regions. Such data are essential to guide futuredirections in strengthening research capability in developing countries. The informationshould also be a valuable resource for scientists seeking support for research training.

Training opportunities

1International Monetary Fund

(1997) International Financial

Statistics Yearbook,Vol. 50.


Training opportunities2

Awards were classified into three geographi-cal regions: Africa, Asia and South America.Although several organizations supportedresearch projects and training in Eastern Europeas part of their international programmes inhealth, these awards were excluded from theanalysis. The review focused on research trainingopportunities and career progression in biomed-icine and health. It should be noted, however,that in some instances it was difficult to separateresearch training from other more general typesof training in health. The term ‘developing-country scientist’ is used broadly in this report torefer to laboratory and field-based researchers,health professionals, clinicians, sociologists,economists etc.

2.2 RESULTS

A total of 54 funding organizations wereapproached in the MIM survey and 39 organiza-tions (74 per cent) responded with relevant infor-mation on research training activities for develop-ing-country scientists in biomedicine and health.Of the responding organizations, 13 provided fulldata, 16 provided partial data and ten providedqualitative information. Respondents includedgovernmental and non-governmental organiza-tions, private foundations and internationalorganizations (see Annex 2 for contact details).

The results are presented according to the geo-graphical location of the organizations surveyed:

2.2.1 USA and Canada2.2.2 Europe2.2.3 Asia and Australia2.2.4 International organizations2.2.5 Developing countries

Within each section, organizations are classi-fied as governmental or non-governmental. Asfar as possible, information is presented in astandardized format, although there is somevariation according to the type of informationprovided by individual organizations. The head-ers in brown indicate the direct expenditure ontraining developing-country scientists unlessotherwise stated.

2.2.1 USA and Canada

US Government

The Department of Health and Human Services(HHS) is the US Government’s principal agencyfor protecting the health of all Americans andproviding essential human services. There areeight Public Health Service Operating Divisionswithin the HHS. Two of the divisions, theNational Institutes of Health (NIH) and theCenters for Disease Control and Prevention(CDC), have schemes of support for developing-country scientists.

US National Institutes of Health (NIH)US$69.8 million in FYs 1995–98The National Institutes of Health is the world’spremier medical research organization whosemission is to uncover new knowledge that willlead to better health for everyone. The NIHbudget for 1999 was US$15.7 billion. WithinNIH, the Fogarty International Center (FIC)and the National Institute of Allergy andInfectious Diseases (NIAID) develop andadminister research training programmesfocused on developing countries. These pro-grammes support research and training in a widerange of subjects including infectious diseases(with emphasis on HIV/AIDS, tuberculosis andmalaria), environmental/occupational health,population-related issues, drug discovery andmedical informatics. Table 2.1 shows theschemes of support offered by the FIC andNIAID that are open to scientists in developingcountries and the expenditure per scheme in1995–98. As well as these targeted schemes,NIH offers open grant programs to US sndnon-US citizens.

Expenditure by the FIC and NIAID ontraining developing-country scientists increasedby 80 per cent in FYs 1995–98 (Figure 1).Within these training programmes, US$1.4 mil-lion (2 per cent of total) was devoted to malaria.The FIC and NIAID support training at allstages of career progression, but particularly atPhD and postdoctoral levels, and via trainingattachments (Figure 2). In general, academic

FY1995 FY1996 FY1997 FY1998


Training opportunities 2

Table 2.1 The Fogarty International Center (FIC) and National Institute of Allergy and Infectious Diseases (NIAID) award schemes forscientists in developing countries.

Award scheme Remit Expenditure in Year began1995–98 (US$ million)

1 AIDS International Training and Laboratory, clinical, epidemiological 37.6 1988Research Program (AITRP) and public health aspects of HIV/AIDS

2 International Cooperative Identification of novel therapeutics from 10.4 1993Biodiversity Groups indigenous flora and fauna;

preservation of biodiversity

3 International Training and Research Emerging infectious diseases 8.1 1997Program in Emerging Infectious (non-HIV/AIDS research)Diseases (ITREID)

4 International Training and Research Reproductive biology, and social and 4.9 1995Program in Population and Health demographic correlates of fertility

5 International Training and Research Pollution (air, land and water) 6.2 1995Program in Environmental and and occupational hazardsOccupational Health

6 Tuberculosis Training and TB training (supplement to the ITREID 1.1 1998Research Program and AITRP schemes) (1998 only)

7 International Training in Medical Computer-assisted information processing 0.6 1998Informatics and communications (focus on Africa) (1998 only)

8 Tropical Medicine Research Awards to institutions in disease-endemic 6 1990Centre (TMRC)* areas to support interdisciplinary research

programmes on parasitic and other tropical infectious diseases

9 International Collaborations Awards to support research partnerships 14 1979in Infectious Diseases between institutions in USA andResearch (ICIDR)* disease-endemic countries

10 Actions for Building Capacity Research training in the context of specific Awards to be 1999scientific themes made in 1999

11 Malaria research training Malaria training (supplements to ITREID, Awards to be 1999AITRP and NIAID grants) made in 1999

Fogarty International Center

NIAID

25

20

15

10

5

0

Figure 2.1 Fogarty International Center (FIC) and National Institute of Allergy and Infectious Diseases

(NIAID) expenditure on research training for developing-country scientists.

US$ million

* NIAID administered schemes that primarily focus on research programmes, but include a training component (approximately 20 per cent of the programme budget).Programmes 1, 3, 5 and 6 have some activities in Eastern European countries, including the former Soviet Union.

Total expenditure in FYs 1995–98 was US$69.8

million.These figures are restricted to training

costs and exclude expenditure on major

programmes of research through the ICIDR and

TMRC awards (see Table 2.1)


training is conducted in USA and field researchin disease-endemic areas. The FIC and NIAIDalso conduct training workshops in developingcountries. In FYs 1995–98 nearly 400 workshopswere organized, with over 28 000 participantsfrom Africa, Asia and South America (Table 2.2).

Centers for Disease Control and Prevention (CDC)CDC’s mission is to promote health and qualityof life by preventing and controlling disease,injury and disability. Its budget for 1999 wasUS$2.7 billion. CDC supports developing-country scientists in two ways:• The Epidemic Intelligence Service (EIS). The

EIS is a two-year postgraduate fellowship pro-gramme run by CDC for health professionalsinterested in the practice of epidemiology.During 1996–98, 17 developing-country sci-entists participated in the programme (Africa5, Asia 5, South America 7).

• Training as part of CDC internationalresearch projects, principally at the field sta-

tions in Kenya (CDC/KEMRI) andGuatemala (MERTU/G). In Kenya, studentsmay receive training at Master’s and PhDlevel while working on CDC research proj-ects. In Guatemala, the field station is anintegral part of the Universidade del Valle deGuatemala. Undergraduates participate inresearch projects, and opportunities for train-ing at Master’s and PhD level exist. CDC hasno dedicated award schemes for developing-country scientists and consequently expendi-ture on training varies according to the avail-ability of research projects and the level offunding per project.

The US Agency for InternationalDevelopment (USAID)USAID is the foreign assistance arm of the USGovernment. USAID supports applied researchwhich includes biomedical, epidemiological,behavioural, economic and clinical research. Themajority of research (80–90 per cent) is conductedin developing countries by national researchers.


Postdoctoral 216 (21.8%)

PhD 174 (17.6%)

Master’s 33 (3.3%)

Bachelor’s 6 (0.6%)

Training attachment

560 (56.6%)

Figure 2.2 Fogarty International Center (FIC) and National Institute of Allergy and Infectious Diseases

(NIAID): Classification of support in FYs 1995–98 by training level and region.

Number of individuals trained = 989 (data for FY 1998 is provisional)

Table 2.2 The Fogarty International Center (FIC) and National Institute of Allergy and InfectiousDiseases (NIAID) workshops in FYs 1995–98. (1998 data are provisional)

Region Number of Number of workshops participants

Africa 103 2735

Asia 50 1488

South America 244 23 838

Number of individuals supported

Africa 322 (32%)

Asia 284 (29%)

South America 383 (39%)


USAID funds some developing-country institu-tions directly (e.g. the International Centre forDiarrhoeal Diseases Research, Bangladesh), butthe majority of research is managed by a granteeinstitution which is usually US based, or byWHO. These institutions in essence operatesmall grants programmes. The cost and durationof support varies according to the research pro-gramme. The US-based funder normally playsthe role of technical adviser and only participatesin the research in a limited number of cases.

Capacity building is an important componentof the research programmes with efforts focusedon proposal development, workshops, short-termtraining in new methodologies and technologies,training in data analysis, and on developing skillsfor translating research results into policy andprogrammes. Networking and effective commu-nication are also considered important compo-nents of the research. Both in-country and inter-national networks have been fostered, the lattermainly through multi-country/multi-site inter-vention trials. Almost all research training at thepostgraduate level is accomplished within thecontext of a research project. USAID expendi-ture on health research in total in 1995–98 wasapproximately US$158 million.

US Department of Defense – Walter ReedArmy Institute of Research (WRAIR)The WRAIR is the largest of six medical researchlaboratories under the US Army’s MedicalResearch and Material Command. It is the USDepartment of Defense’s lead agency for infectiousdisease research and a major source of researchsupport for medical product development.

Training of developing-country scientists byWRAIR has an emphasis on antimalarial drug

discovery and drug resistance, and vaccine devel-opment. Support is predominantly at postdoc-toral level, through the National ResearchCouncil Associateship awards (funded byWRAIR) and funds from NIAID/FIC andWHO. Short research training attachments inmalaria drug and vaccine development are alsosupported. In general, training is conducted atthe WRAIR unit in Washington DC, USA,although opportunities for local training alsoexist in the six overseas laboratories in Brazil,Peru, Thailand, Indonesia, Egypt and Kenya.Table 2.3 shows the number of developing-coun-try scientists trained by WRAIR in 1995–98.

US non-governmental organizations

The Burroughs Wellcome FundUS$1.8 million on New Initiatives in Malariaawards in FYs 1996–98The Burroughs Wellcome Fund (BWF) is anindependent private foundation in the USA thatwas established in 1955 as a US extension of theUK-based Wellcome Trust. Its mission is toadvance the medical sciences by supportingresearch and other scientific and educationalactivities, with emphasis on the career develop-ment of biomedical scientists and on advancingareas in the basic medical sciences that areunder-funded or that have a shortage of quali-fied researchers. BWF spends US$30 million ingrants annually in the USA and Canada.Opportunities for developing-country scientistsexist through the New Initiatives in Malariaaward scheme, although the majority of theUS$1.8 million spent in FYs 1996–98 wasdirected to US-based researchers.


Table 2.3 WRAIR: Classification of support for 1995–98 by training level and region.

Postdoctoral Training Totalattachment

Africa 8 8 16 (17%)

Asia 58 8 66 (72%)

South America 2 8 10 (11%)

Total 68 (74%) 24 (26%) 92

These figures exclude trainees at WRAIR supported by fellowships from WHO and FIC/NIAID.


International Clinical EpidemiologyNetwork (INCLEN)US$4.9 million in FYs 1995–98INCLEN is an independent non-profit organiza-tion established in 1980 which is dedicated toimproving public health, by promoting clinicalpractice based on the best evidence of effective-ness and the efficient use of resources. INCLEN’scentral funding is primarily from two donors, theRockefeller Foundation and USAID, with addi-tional support from various sources. INCLENhas training centres in Canada, USA andAustralia, and regional clinical epidemiologytraining centres in Latin America, China, SouthAsia and India. INCLEN’s total expenditure inFYs 1995–98 was US$17.6 million (the financialyear of INCLEN runs from 1 July to 30 June andFY 1995 was used to refer to the period 1 July1994 to 30 June 1995). Expenditure on trainingin FYs 1995–98 was US$4.9 million. This figureis restricted to the expenditure on personal sup-port and training of developing-country scien-tists and excludes core support for INCLEN’straining centres. The majority of INCLEN’straining is at Master’s level (Figure 2.3) in the dis-ciplines of clinical epidemiology, biostatistics,health social science and clinical economics.

Takemi Program in International Health,Harvard School of Public Health, USAThe Takemi Program is a ten-month researchprogramme that focuses on the problems ofmobilizing, allocating, and managing limitedresources to improve health. Financial supportfor the Program comes from various sources:

• the Japan Foundation for the Promotion ofInternational Medical Research Cooperation,in collaboration with the Japan Ministry ofHealth and Welfare, the Japan MedicalAssociation, and the Japan PharmaceuticalManufacturers Association;

• the Carnegie Corporation of New York;• the Merck Company Foundation.

Takemi Fellows are mid-career professionalsfrom around the world, particularly from devel-oping countries. Fellows carry out their researchprojects at Harvard, generally using data theybring with them. Projects are closely linked toaction programmes and to the work of Fellows intheir home country. During 1995–97, 22 Fellowsfrom developing countries completed the TakemiProgram (Africa 8, Asia 10, South America 4).

Canadian Government

Canadian International DevelopmentAgency (CIDA)US$0.6 million in 1995–97CIDA is the main organization involved indelivering Canada’s official development assis-tance programme. Working with private andpublic sector partners in Canada and in develop-ing countries, and with international organiza-tions and agencies, it supports aid projects indeveloping countries. CIDA has no dedicatedaward schemes, but supports training as part of its international projects. CIDA’s expenditureon health sector training in 1995–97 wasUS$0.6 million. This figure is restricted to


Training attachment 41 (16.1%)

Master’s 209 (82%)

Postdoctoral 5 (2.0%) Number of individuals supported

Africa 53 (21%)

Asia 98 (38%)


Figure 2.3 INCLEN: classification of support in FYs 1995–98 by training level and region.

Expenditure on training was US$4.9 million.

Number of individuals trained = 255


expenditure on training developing-country scientists and excludes project costs and thesalaries of trainers, advisers and other health professionals working on CIDA’s projects indeveloping countries.

During 1995–97, CIDA trained 76 individ-uals, mainly via training attachments in Canada(Figure 2.4). CIDA provides training for a vari-ety of health professionals, including counsel-lors, nurses, clinicians and scientists.

International Development Research Centre (IDRC)US$0.23 million in FYs 1995–98The International Development ResearchCentre is a public corporation created by theCanadian Government to help communities inthe developing world find solutions to social,economic and environmental problems throughresearch. Developing-country scientists receivetraining as part of IDRC projects. In FYs1995–98, IDRC supported three Master’s stu-dents and three PhD students in biomedicineand health (Africa 5, South America 1). Trainingwas conducted in Canada.

2.2.2 Europe

The Commission of the European UnionThe European Union is composed of 15European member states. Within the Union, theEuropean Commission is the main executivebody, with responsibility for three areas:• initiating proposals for legislation;• guardian of the treaties;• management and execution of Union poli-

cies and of international trade relationships.

The Commission is divided into 26 direc-torates-general (DGs) with an additional 15 orso specialized services. Information on trainingwas obtained from DG XII.

Directorate General XII (DG XII)US$71.6 million on the INCO–DC Healthprogramme in FYs 1995–98DG XII has responsibility for Science, Researchand Development. Within DG XII, scientistsfrom developing countries receive trainingthrough the International Cooperation withDeveloping Countries programme (INCO-DC).



Master’s 9 (11.5%)


Africa 24 (32%)

Asia 3 (4%)


Figure 2.4 CIDA: Classification of support in FYs 1995–97 by training level and region.

Expenditure on training was US$0.6 million excluding project costs


PhD 12 (15.4%)


This programme covers three main areas: natu-ral resources, agriculture, and health. The totalbudget of the programme for 1995–98 was anestimated US$273 million. Each of the threeareas receives similar levels of funding.

The programme promotes technologicalresearch and development in fields of relevanceto developing countries through joint researchactivities with Europe, and aims to maintain andstrengthen the research capacity of developingcountries. Awards are partnership based andmust include researchers from a minimum oftwo separate European member states (or associ-ated countries) and at least one partner from adeveloping country. Training is an integral partof the programme and may be conducted indeveloping countries and/or Europe. During1995–98, expenditure on the health programmeincreased fourfold (Figure 2.5). A total of 668scientists from developing countries receivedtraining, mainly at PhD level and via trainingattachments (Figure 2.6).

Belgian Government

Belgian Administration for DevelopmentCooperation (BADC)Administration Générale de la Coopérationau Développement, BelgiumUS$8.8 million on scholarships and support toinstitutes in 1995–98BADC supports development cooperationthrough governmental, non-governmental andmultilateral mechanisms. Funds are allocated toseveral institutions for health research training:• US$0.8 million per annum supports 44

scholarships for developing-country scien-tists to attend Master’s courses in DiseaseControl, and Public Health at the AntwerpInstitute for Tropical Medicine, Belgium;

• an annual award of US$0.5 million supports20 scholarships for Master’s courses in PublicHealth, and Health and Development at theFree University of Brussels, Belgium;


Training attachment240 (35.9%)


PhD 238(35.6%)

Master’s 100 (15.0%)

Fig.2.5 European Commission INCO-DC:Annual

expenditure on the health programme.

Total expenditure in 1995–98 was

US$71.6 million (not restricted to

training). US$15.3 million (21 per cent of

total) was on malaria

Fig.2.6 European Commission INCO–DC Health

programme: Classification of training in

1995–98 according to level.


FY1995 FY1996 FY1997 FY1998

30

25

20

15

10

5

0

US$ million



• the International Centre for DiarrhoealDiseases Research, Bangladesh, receives anannual award of US$0.6 million for corefinancial support and research projects;

• the National Centre for Tropical Diseases,Bolivia receives an annual award of US$ 0.3 million for health projects and training.

The total number of master’s awards in1995–98 was 256. In addition, BADC fundstraining through its health projects in Africa,Asia and South America. Courses on a range oftropical diseases, including malaria and tubercu-losis, are held regularly in developing countries.

Danish Government

Danish International DevelopmentAssistance (DANIDA)DANIDA supports collaborative research withdeveloping countries and training of develop-ing-country scientists through several channels:• The programme for Enhancement of

Research Capacity in Developing Countries(ENRECA) aims to strengthen researchcapacity in developing countries throughpartnerships between Danish universitiesand research institutions, and institutions indeveloping countries. The programme coversa range of disciplines in agriculture, medicineand health, technology, social and naturalsciences. Projects have a duration of 10–15years and typically include postgraduatetraining of developing-country researchers,exchanges of research staff, provision ofresearch equipment, and improvement ofresearch infrastructure and communications.There have been four ENRECA-supportedmalaria projects in Africa since theprogramme’s inception in 1988: Ghana,Mozambique, Tanzania and Sudan.

• The Danish Bilharziasis Laboratory (DBL) isa private institution involved in training,research and technical cooperation. It receives

the majority of its funding from DANIDA.African researchers receive support through aCollaborative Award scheme for definedresearch or research training projects conduct-ed in the home country with collaborativeassistance and training from DBL. During1995–98, 43 Master’s and 92 PhD studentswere trained via the scheme, which has anannual budget of US$1.5 million.

• The Danish Council for DevelopmentResearch supports three- to four-year collaborative projects with developing countries, where part of the research is conducted in the developing country.

• Contributions to TDR. The Danish govern-ment is a major contributor to the TDR pro-gramme, having donated US$26.3 millionduring 1989–98 (see Annex 1).

French Government

The French Government, in addition to itsdirect support to Institut de Recherche pour leDéveloppement (IRD), Institut National de laSanté et de la Recherche Médicale (INSERM)and Institut Pasteur, provides funds via theMinistry of Cooperation for French–Africancollaborative malaria research.

French Ministry of CooperationEstimated US$3.4 million per annum on malariaresearch in AfricaExpenditure by the Ministry of Cooperation onmalaria research in Africa is via three main channels:• financial support to institutions and malaria

research programmes in Senegal,Madagascar, Cameroon, Congo, Burkina-Faso and Gabon;

• support of French scientists working onFrench Cooperation assignments in thehealth research sector in Africa;

• re-entry grants (three-year awards) to African researchers trained in France toenable them to establish a research career in their home country.


2 In November 1998, ORSTOM

became l’Institut de

Recherche pour le

Développement (IRD).


Training of developing-country scientists isconducted as part of the Ministry’s research pro-grammes. Table 2.4 shows training supported viamalaria research programmes in 1996–98.

French Institute of Health and Medical ResearchInstitut National de la Santé et de laRecherche Médicale (INSERM)US$7 million in support of developing-countryscientists and collaborative awards in FYs1995–98INSERM is a public scientific and technologicalorganization overseen by the French Ministriesof Health and Research, whose vocation is topromote health for all. INSERM’s annual budg-et is approximately US$488 million. INSERMsupports training of developing-country scien-tists through several schemes:• Poste Vert awards support non-French post-

doctoral researchers at INSERM units inFrance. During 1995–98, 50 awardstotalling US$3.9 million were made to scien-tists from developing countries (Africa 14,Asia 24, South America 12).

• Cooperative Agreements support collabora-tions between INSERM units in France andresearch laboratories in developing countriesby providing funds for travel and researchattachments in the partner laboratory.Expenditure on Cooperative Agreements inFYs 1995–98 was US$2.1 million.

• North–South networks are partnership-based awards that promote collaborationsbetween French and foreign laboratories (atleast two on each side). In 1995–97, 13awards totalling US$1 million supported col-laborations with developing countries. Thescheme was discontinued in 1998.

• Workshops organized by INSERM scientistsare held in developing countries.Expenditure on workshops in 1995–98 wasUS$80 000.

Institut de Recherche pour le Développe-ment (IRD) (formerly ORSTOM) 2

IRD is a state-owned public service agencyunder the joint authority of the French researchand overseas development ministries. It offers arange of consultancy services and is involved ininternational research programmes through itscollaborations with scientific institutes inFrance, Europe and developing countries. Amajor objective of IRD is to strengthen the sci-entific capabilities of developing countriesthrough research training and specific assistance.IRD trains junior scientists through multidisci-plinary research programmes in the field, in theInstitute’s own laboratories, or in the laborato-ries of its research partners. IRD also providessupport for scientific networks and communitiesin developing countries.

IRD scientists work in research institutions inmore than 15 countries in Africa. Malariaresearch and training programmes are based in Senegal, Ivory Coast, Cameroon andMadagascar. Data on training were obtainedfrom the Malaria and Medical ZoologyLaboratories in IRD-Dakar, Senegal. During1995–98, 84 scientists (technicians, nurses, fielddoctors as well as laboratory-based researchers)received training as part of ongoing malariaresearch projects (Figure 2.7). IRD has similartraining schemes in other countries where it sup-ports research programmes, but figures were notavailable for these other programmes.


Table 2.4 French Ministry of Cooperation:Training on African malaria projects in 1996–98.

Level Number of awards Remit of scheme

Postdoctoral 4 Two-year award held in the home country or in France

Master’s 3 One-year award held in the home country or in France

Training course 50 Technical skills training held locally or regionally (duration two weeks to three months)

Total 57


French non-governmentalorganizations

Institut PasteurInstitut Pasteur is a private, non-profit researchorganization founded in 1887. It is not a fund-ing agency per se and has no specific schemes of support for developing-country scientists.However, it has a history of malaria research duein part to its network of daughter institutions inmalaria-endemic regions, and it supports train-ing through its research programmes. Currently,Institut Pasteur has an integrated research pro-gramme on malaria, with emphasis on vaccinedevelopment, at four main centres:• Institut Pasteur, Paris, France, has malaria

research programmes focused on parasitebiology, vaccine development and entomolo-gy. The institute conducts postgraduate train-ing courses in infectious diseases and studentsworking in other institutes of the networkreceive training in Paris towards the Diplômed’Études Approfondies (DEA) and PhD.

• Institut Pasteur, Dakar, Senegal, has malariaresearch programmes in epidemiology,immunology and human genetics. The insti-tute has research and training links with theUniversity of Cheikh Anta Diop, Dakar, andacts as a consultant for the national malariacontrol programme.

• Institut Pasteur, Antananarivo, Madagascar,is an integral part of the Ministry of Healthof the Malagasy Republic and contributes tonational control programmes. It has collabo-rative and training links with the Universityof Antananarivo.

• Institut Pasteur, Cayenne, French Guyana,conducts research on the Saimiri sciureusmonkey malaria model and provides a drugsensitivity screening service.

Institut Pasteur provides a small number oftraining grants to developing-country scientistsleading to tenure in one of the institutes of itsnetwork. Approximately ten training grants havebeen awarded for malaria research in Senegaland Madagascar during 1995–97.

German Government

German Agency for Technical CooperationDeutsche Gesellschaft für TechnischeZusammenarbeit (GTZ)Technical and financial development coopera-tion in Germany is the responsibility of theMinistry of Economic Cooperation andDevelopment (BMZ). The implementation ofresearch and health projects is subcontracted toGTZ. This agency has been coordinating malar-ia projects since 1992 in Mali, Mauritania,Uganda and Vietnam. Training has been sup-ported as part of these projects, although thereare no dedicated award schemes for scientists.No figures were available on the number of indi-viduals trained or the expenditure on training.

German Academic Exchange ServiceDeutscher Akademischer Austauschdienst(DAAD)DAAD promotes international academic ex-changes; acts as an intermediary for the imple-mentation of foreign, cultural and academic



Master’s 9 (11.0%)

Figure 2.7 Malaria Research Laboratories, IRD-Dakar, Senegal: Classification of support in 1995–98

by training level.

82 African researchers received training

PhD 13 (15.9%)



policy; and is involved in educational coopera-tion with developing countries. Funding for indi-viduals from developing countries is provided bythe Ministry of Economic Cooperation andDevelopment (BMZ), but programmes areadministered by DAAD. Programmes range fromshort-term exchanges to full doctoral scholar-ships. Several Master’s courses have been designedspecifically for participants from developingcountries. The Master’s course in CommunityHealth and Health Management in DevelopingCountries at the University of Heidelberg is aWHO collaborating centre for health systemsresearch in developing countries. DAAD awardsapproximately ten scholarships per annum todeveloping-country scientists worldwide.

German non-governmentalorganizations

Alexander von Humboldt FoundationUS$0.9 million in FYs 1995–98The Alexander von Humboldt foundation is anon-profit organization which is largely sup-ported by the German Government through itsForeign Ministry. It supports highly qualifiednon-German postdoctoral scholars to carry outresearch projects in Germany. Research may beundertaken in any subject field. In 1995–98, 22scientists from developing countries receivedfunding for research in biomedicine and healththrough the Humboldt Research Fellowship and

George Forster Fellowship schemes (Africa 5,Asia 10, South America 7). Expenditure on fel-lowship awards was US$0.9 million.

The Netherlands Government

Ministry of Foreign AffairsInternational development programmes in TheNetherlands are administered by the DirectorateGeneral for Development Cooperation, part ofthe Ministry of Foreign Affairs. In the majorityof programmes there is cooperation between aDutch institution (usually a university faculty ordepartment) and an institution in the partnercountry. In 1995–98, 17 scientists from develop-ing countries were trained at the Department ofMedical Microbiology, University of Nijmegen(Figure 2.8).

Norwegian Government

The Norwegian government supports training ofdeveloping-country scientists through contribu-tions to multilateral development schemes(including the TDR programme, to whichNorway is a major contributor), and bilateraldevelopment schemes. The Ministry of ForeignAffairs’ bilateral department is responsible for sup-port to the Norwegian Agency for Developmentand other Norwegian institutions that carry outcooperation and development research.


Training attachment

8 (47.0%)

Master’s 3 (17.6%)


Africa 16 (94%)


Figure 2.8 University of Nijmegen,The Netherlands: Classification of support by training level and

region in 1995–98.


PhD 4 (23.5%)



The Norwegian Agency for DevelopmentCooperation (NORAD)The NORAD Fellowship programme providesscholarships for International Diploma andMaster’s courses in Norway that are designed forparticipants from developing countries. Theprogramme aims to support capacity buildingwithin key institutions in prioritized countriesfor Norwegian development cooperation.Scholarships in the field of biomedicine andhealth are available for the Master’s in HealthSciences (International Health) course at theUniversity of Bergen and the Master’s inInternational Community Health course at theUniversity of Oslo.

Portuguese Government

Training of developing-country scientists is sup-ported by various government agencies and non-governmental organizations in Portugal. TheMinistries of Science and Technology, ForeignAffairs, and Health fund training through bilat-eral agreements or individual research projects.

Institute of Hygiene and Tropical Medicine,New University of Lisbon, PortugalThe Institute of Hygiene and Tropical Medicine(IHTM) in Lisbon conducts postgraduate coursesof relevance to developing-country scientists andhas research links with several African countries.The Centre for Studies on Malaria and other

Tropical Diseases, which is based within theIHTM and funded directly from the Ministry ofScience and Technology, is also involved intraining, predominantly through its researchcollaborations with African countries. The datapresented in this report reflect training carried outby the IHTM and the Centre for Malaria Studies,excluding clinical training activities. In 1995–98,82 scientists received training, mainly via attach-ments and diploma courses (Figure 2.9).

Swedish Government

The Swedish International DevelopmentCooperation Agency (Sida)Sida administers Swedish aid programmes.Within Sida, the Department of ResearchCooperation, SAREC, supports research andstrengthening of research capacity in developingcountries. The data presented in this report referto years 1996 and 1997. SAREC supports bio-medical/health research via three main channels:• Country-based and Regional Research

Cooperation. SAREC expenditure for 1996and 1997 was US$10.2 million. Examples inthe field of parasitic research include aTanzania–Sweden collaborative project onmanagement of childhood malaria inprimary healthcare institutions and a studyof the impact of land use change on socio-economic status and incidence of malariaand schistosomiasis in Ethiopia.



Master’s 5 (61.0%)


Africa 78 (95%)


Figure 2.9 Institute of Hygiene and Tropical Medicine, Portugal: Classification of support by training level

and region in 1995–98.


Diploma 36 (43.9%)



• International research programmes and otherspecial programmes and projects, including theTDR programme to which Sida/SAREC is amajor contributor (Annex 1). SAREC expen-diture in 1996 and 1997 was US$9.3 million.

• Research grants to Swedish institutions onapplication. Expenditure in 1996 and 1997was US$2.5 million. The research projectsmust be of relevance to developing countriesand are often carried out in collaborationwith institutions in developing countries.

SAREC has no fixed budget for training:expenditure varies on a project or needs basis,although, in general, a high proportion of theprogramme budget is devoted to training.Training may be conducted locally, or via the‘sandwich’ model where students combine workin their own university departments with studiesat a Swedish institution.

Swiss Government

The Swiss Government supports training andresearch cooperation with developing countriesthrough a variety of channels. The figures pre-sented in this report are underestimates of thetotal expenditure, due to difficulties in tracingcontributions from the various sources.

Swiss Agency for Development andCooperation (SDC)The SDC is responsible for bilateral develop-ment cooperation, which is concentrated on 16target countries in Africa, Asia and SouthAmerica. SDC supports training in a range ofsubjects, with emphasis on management of pub-lic affairs, the environment, agriculture andhealth. The majority of health research trainingis conducted at two Swiss institutions: theWHO Immunology Research and TrainingCentre (IRTC), Lausanne, and the SwissTropical Institute (STI), Basle.

The IRTC runs a seven-week Immunology,Vaccinology and Biotechnology Applied toInfectious Diseases course (in English andFrench) for health professionals from developingcountries. Refresher courses are held in develop-ing countries for previous course attendees.

SDC provides an annual award of US$0.4 mil-lion to WHO to cover training costs.

The STI offers a range of courses of interestto health professionals working in developingcountries, and it is a partner in developmentprojects that are largely financed by SDC. Forexample, more than half of the participants onthe Health Care and Management in TropicalCountries (HCMTC) are from developingcountries. A high proportion receives scholar-ship support from SDC.

SDC expenditure in FYs 1995–97 on schol-arships in health was US$3 million. A total of135 scholarships was awarded, mainly for cours-es and training attachments (Africa 81, Asia 37,South America 17). It should be noted that thesefigures do not include training conducted as partof research programmes and development proj-ects, for example on STI collaborative projectswith developing countries.

Swiss National Science Foundation (SNSF)The SNSF was established in 1952 to promotebasic scientific research at Swiss universities andother scientific institutions. Research grantsconstitute about 75 per cent of the budget of theSNSF, and are distributed in all areas of science(Humanities and Social Sciences, Mathematics,Natural and Engineering Sciences, Biology andMedicine). Fellowships and research grants areawarded mainly to Swiss researchers, but SNSFalso supports efforts to encourage collaborationsbetween Swiss scientists and researchers in developing countries. The SNSF, in conjunctionwith the SDC, supports specific projects onEnvironment and Development, which are conducted by researchers in developing coun-tries working in collaboration with Swissresearch groups.

Federal Commission for Scholarships forforeign students (FCS), SwitzerlandThe Swiss Government offers scholarships viathe FCS to foreign postgraduate students whowish to study or undertake research work in anysubject field at Swiss universities. The scholar-ships are offered to governments of developingcountries on a unilateral basis. During 1995–98,55 students from developing countries received



scholarship support for studies in biomedicineand health. In the last few years, an annualscholarship support of approximately US$2.2million has been awarded to students fromdeveloping countries.

UK Government

UK Department for InternationalDevelopment (DFID)DFID is the government department responsi-ble for promoting development and the reduc-tion of poverty. It manages Britain’s bilateral andmultilateral development programmes. DFIDhas no specific award schemes for developing-country scientists, but provides training as partof its bilateral programmes. It also allocatesfunds to support training administered by theUK Medical Research Council and the BritishCouncil, and it is a major donor to the TDRprogramme (Annex 1). DFID does not holdcentral records on training conducted throughits development projects, therefore the Africanregional offices were contacted for further infor-mation. A total of 30 students received trainingas part of DFID projects in Uganda, Zambiaand Kenya during 1994–98 (Master’s 18, train-ing attachments 12). Training is not normallyprovided beyond Master’s level.

The British CouncilThe British Council promotes educational, cul-tural and technical cooperation between Britainand other countries. The Council’s work isdesigned to establish long-term and worldwidepartnerships, and to improve internationalunderstanding. Schemes managed by the BritishCouncil in 1995–98 supported 70 studentsfrom developing countries in studies in biomed-icine and health. The majority of awards were atMaster’s level (Figure 2.10). Training was con-ducted in the UK.

UK Medical Research Council (MRC)The MRC is a UK governmental research organi-zation. Its mission is to improve health by pro-moting research into all areas of medical andrelated science. It supports medical research inthree main ways: through its research establish-ments; grants to individual scientists; and sup-port for postgraduate students. The MRC totalannual budget in FY 1997 was US$485 million.

The MRC supports major research pro-grammes in Africa (The Gambia and Uganda)and Jamaica. Training of local researchers in TheGambia occurs through several mechanisms. TheMRC Laboratories in The Gambia are recog-nized by the UK Open University as a sponsor-ing establishment for research degrees, and sever-



Master’s 47 (67.1%)


Africa 21 (30%)

Asia 28 (40%)


Figure 2.10 The British Council: Classification of support by training level and region in FYs 1995–98.


Diploma 1 (1.4%)

PhD 6 (8.6%)


al students have undertaken studies through theOpen University. Study at local or overseas uni-versities is also supported. In Uganda, the MRCreceives an annual allocation from DFID forvocational and technical training of Ugandanstaff. In Jamaica, the MRC Laboratories willshortly be transferred to the University of theWest Indies. Collaborations and interchanges ofscientists between UK and Jamaica are encour-aged. Under the recently re-launched RogersFund, local researchers and technicians in TheGambia, Uganda and Jamaica may undertake astructured training programme usually lastingone year in an MRC research establishment.

UK non-governmental organizations

The Wellcome TrustUS$17.7 million in FYs 1995–98The Wellcome Trust is an independent, privatecharity that funds research in the biomedical sci-ences and the history of medicine. Established in1936 under the will of Sir Henry Wellcome, asuccessful industrialist and philanthropist, theTrust is currently the world’s largest medicalresearch charity. Total expenditure on researchawards in FY 1998 was US$345 million.Although the greater part of the Trust’s incomesupports the work of researchers in UK and theRepublic of Ireland, its international activitiesare currently being expanded. The Trust has ahistory of providing support for tropical medi-cine research. Major research programmes out-side the UK are currently funded in Kenya,Malawi, Thailand, Vietnam and South Africa.

A range of award schemes is open to scien-tists internationally; several have a focus ondeveloping countries. In FYs 1995–98, theTrust’s expenditure on awards to developing-country scientists increased 16-fold and totalledUS$17.7 million (Figure 2.11). These figures aregenerally restricted to individual training andcareer development awards, and exclude expen-diture on major programmes of research indeveloping countries. The majority of the Trust’sprogrammes are aimed at postdoctoral scientistsand medical or veterinary researchers (Figure

2.12), with fewer awards at earlier career stages.Awards are normally available for all research rel-evant to health or disease in developing coun-tries. In addition, a number of specific schemesare offered to encourage research on noncom-municable diseases, population studies andreproductive health, health services research andclinical epidemiology. Postdoctoral awards rele-vant to this survey are:• Travelling fellowships: awards to individual

scientists to travel to another country (usual-ly the UK) to carry out a research project.Awards include project costs, travel and astipend for the period spent overseas.

• Training fellowships: up to four years’ supportfor a study focusing on a health problem ofrelevance to the trainee’s home country.Training (including Master’s training whereappropriate) may be in centres of excellencein the developing world or the UK, but a sub-stantial part of the trainee’s time should bespent in the home institute.

• Collaborative awards: support for a researchproject in a developing country led by oneprincipal investigator, with scientific supportfrom a developed country. Awards are avail-able to postdoctoral researchers returninghome after a period of training in the UK aswell as for more senior researchers.Collaborations may link the UK and anydeveloping country; South Africa and sub-Saharan Africa; or Australia/New Zealandand South-East Asia.

• Project and programme grants: three- to five-year awards to scientists in their home country that provide the full directcosts of research projects focusing on health problems of local significance.

Training at Master’s and PhD level is provid-ed mainly in association with large overseasresearch programmes such as those in Kenya,Thailand and Malawi, rather than through dedi-cated award schemes. However, a ResearchTraining Fellowship at Master’s Level inPopulation Studies has been introduced recently.




Figure 2.11 Wellcome Trust: Expenditure on training of developing-country scientists.

Total expenditure in FYs 1995–98 was US$17.7 million

FY1995 FY1996 FY1997 FY1998

10

9

8

7

6

5

4

3

2

1

0

US$ million

* Excludes major project and programme grants to UKinvestigators based in developng countries that may includesupport for training of local scientists

†Postdoctoral awards

Travelling/Training fellowships†

66 (37.3%)


PhD 3 (1.7%)

Master’s 7 (4.0%)

Diploma 4 (2.3%)

Project and Programme grants*†

14 (7.9%)Collaborative awards *†

75 (42.4%)


Africa 76 (43%)

Asia 65 (37%)


Figure 2.12 Wellcome Trust: Classification of support by training level and region in FYs 1995–98.

Expenditure on training was US$17.7 million

Number of individuals supported = 177


Figures exclude expenditure

on major research

programmes led by UK

investigators. However,

the 1998 figure includes

one large award to a

developing-country

institute (US$2.2 million)


2.2.3 Asia and Australia

Japanese Government

Japan International Cooperation Agency(JICA)Estimated US$89 million on health training inFYs 1995–97Japan’s Development Assistance programmecomprises three main categories: bilateral grants,bilateral loans, and contributions to multilateraldonor organizations. JICA administers approxi-mately 60 per cent of the bilateral grants. Trainingprogrammes delivered through bilateral grantsare of three types:• training programmes conducted in Japan;• training programmes in a developing coun-

try for local participants;• training programmes in a developing coun-

try for local and regional participants.

The data presented in this report are limitedto training programmes conducted in Japan.(Expenditure on training in health was estimat-ed from the mean expenditure per person ontraining in all sectors.) All training was in theform of short courses on a wide range of subjectsin health and medicine, including infectious dis-eases, public health, oncology and occupationalhealth. More than half of the trainees were fromAsia (Table 2.5).

Australian Government

Australian Agency for InternationalDevelopment (AusAID)AusAID manages Australia’s development coop-eration programmes. Education and trainingconstitutes around 20 per cent of the total devel-opment cooperation budget. Support is provid-ed for technical and further education training,

undergraduate and postgraduate studies, andtraining can take place in Australia, in the homecountry, or in another developing country. Cur-rently, the majority of training is conducted inAustralia through the Australian DevelopmentScholarships scheme. A recent review of trainingawards showed that as at March 1998 there were3851 AusAID-funded students, mainly fromAsia and the Pacific Islands, engaged in highereducation and technical and further education.3

Of these, 10 per cent were engaged in Healthand Community Services training. The overallbreakdown of awards in all subject areas wasapproximately 1400 awards at Bachelor’s level,1400 at Master’s, and 600 at PhD level.

2.2.4 International organizations

The UNDP/World Bank/WHO SpecialProgramme for Research and Training inTropical Diseases (TDR)Estimated US$22 million on Research CapabilityStrengthening Grants 1995–98The Special Programme for Research andTraining in Tropical Diseases (TDR) is co-spon-sored by the United Nations DevelopmentProgramme (UNDP), the World Bank and theWorld Health Organization (WHO). TDR issupported by voluntary contributions from gov-ernments, international organizations, charitiesand other non-governmental bodies (see Annex 1for contributions to the programme in 1989–98).

The programme has two objectives: toresearch and develop new tools to control TDRtarget tropical diseases (malaria, schistosomiasis,leishmaniasis, lymphatic filariasis, onchocercia-sis, African trypanosomiasis, Chagas disease andleprosy) and to increase the research capability indeveloping countries through training of indi-viduals and strengthening of institutions. Thetotal annual TDR grants budget [ResearchCapability Strengthening (RCS) and Researchand Development] is US$18.5 million, of whichUS$5.5 million is devoted to RCS for institu-tional and training support).

Within RCS, training support to developing-country scientists is via Research Training Grants(RTG) and Re-entry Grants. RTGs are awardedon a competitive basis for studies at Master’s,PhD or postdoctoral level, or for acquiring spe-cialized skills. Studies are restricted to one ormore of the TDR target diseases in any of


Table 2.5 JICA: Participants on Healthtraining courses in Japan FYs 1995–97.

Africa 787 (22%)

Asia 1871 (51%)


3 Australian Agency for

International Development

‘Snapshot of Training’ as of

31 March 1998.


the laboratory, clinical or applied field researchdisciplines. Preference is given to applicants from countries with lesser developed researchcapacities, and to those who wish to pursue studies in their own country or within their own region. TDR expenditure on RTGs in1995–98 was US$8.3 million. In the same period, TDR Research Training Grants supported193 researchers, predominantly at Master’s andPhD level. The majority of awards were directedto scientists in Africa (Figure 2.13).

Re-entry Grants provide support forresearchers, who have recently completed post-graduate training, to establish an independentresearch programme or laboratory in the homecountry. In 1995–98, 43 Re-entry Grants wereawarded. TDR expenditure on Re-entry Grantsaverages US$0.5 million per year.

The TDR Multilateral Initiative on MalariaTask Force is a time-limited programme to sup-port malaria research capability strengthening inAfrica. Awards support collaborative projectsbetween partners in developed and developingcountries. Projects must include at least twoAfrican research institutions (one establishedand one emerging) and at least one internationalpartner. Training is an integral element of theprogramme. Fifteen awards were made inFebruary 1998 at a cost of US$2.5 million.

Within TDR’s other grant formats, trainingopportunities are available and encouraged. Inaddition to training administered through dedi-cated award schemes, TDR conducts short-termtraining courses in specialist areas.

The International Atomic Energy Agency(IAEA)The IAEA serves as the world’s central intergov-ernmental forum for scientific and technicalcooperation in the nuclear field. The Agencyseeks to enhance the capabilities of developingMember States to address important health prob-lems through the development and applicationof nuclear and related techniques. Human healthactivities focus on methods for curative and pal-liative treatment of cancer and the establishmentof comprehensive quality assurance programmesfor radiation dosimetry, on techniques for earlydiagnosis of diseases such as tuberculosis, andeffective nutritional studies. Assistance to devel-oping countries is made via two principal mecha-nisms: Technical Cooperation Projects (TCP)and Co-ordinated Research Projects (CRP).

TCP awards have a problem-solving orienta-tion. They seek to contribute, in a cost-effectivemanner through the provision of experts, train-ing and equipment, to activities addressing highdevelopment priorities relating to health servicesin Member States.

CRP awards provide support for three yearsfor networks of research institutions workingtogether on a specific topic. The aim of the CRPis to promote high-quality research in developingand developed countries (the latter provide cost-free expertise to the projects). The Agency’sexpenditure during 1997–98 on malaria researchand associated training was US$1.0 million. In addition, the Agency convenes and sponsorsseminars, symposia and international confer-ences, and disseminates information throughcost-free publications.



Master’s 38 (19.7%) Number of individuals supported

Africa 120 (62%)

Asia 38 (20%)


Figure 2.13 TDR: Classification of support by training level and region in FYs 1995–98.These figures are

restricted to training via the Research Training Grant Scheme.



PhD 136 (70.5%)

Medical and basic health research grants 722 (11.9%)

Medical and basic health scholarships

overseas 181 (3.0%) Master’s 15 (38.5%)


2.2.5 Developing Countries

Brazilian Government

Ministry of Science and TechnologyMinisterio da Ciencia e Tecnologia (MCT)US$71.5 million on research and training throughFINEP, CNPq and INPA in FYs 1995–97MCT is responsible for the planning, coordina-tion, supervision and control of all activities relat-ing to science and technology in Brazil. WithinMCT, there are three collegiate bodies, four secre-tariats, two funding agencies and four researchinstitutes (for further information see Brazil: a sci-ence and technology profile, Bogliolo, 1998). Thetwo funding agencies are the National Councilfor the Development of Science and Technology(Conselho Nacional de Desenvolvimento Cientí-fico e Tecnológico, CNPq) and the BrazilianAgency for the Funding of Studies and Projects(Financiadora de Estudos e Projectos, FINEP).

CNPq is mainly concerned with the trainingand qualification of human resources, and withsupport for research. Its funding activities aredivided into Basic Programmes for traditionalfields of knowledge and Special Programmes forstrategic areas and multidisciplinary projects.CNPq expenditure on scholarships and research

grants in biomedicine and health in FYs1995–97 was US$65.6 million (Figure 2.14).

FINEP is a state-owned company attached toMCT, with responsibility for financing Brazil’stechnological development. FINEP providessupport in the form of loans for public and pri-vate enterprises, and universities and researchcentres. FINEP expenditure on research projectsin biomedicine in FYs 1995–98 was US$4.2million. An additional US$72 000 providedsupport for scientific meetings and publicationson health sciences.

The National Amazon Research InstituteInstituto Nacional de Pesquisas da Amazonia(INPA)INPA is one of the four research institutesattached to MCT. It was established in 1952 toundertake scientific research of the physicalenvironment and living conditions in theAmazon region. It also trains personnel to carryout research in the region by means of Master’sand doctoral courses. Biomedical research andtraining at INPA is focused on studies of the vec-tors of malaria and leishmaniasis. Expenditureon 40 training awards made during FYs1995–98 was US$1.7 million (Figure 2.15).


Fig.2.15 INPA: Classification of awards by

training level FYs 1995–98.

Expenditure on training was US$1.7 million


Medical and basic health scholarships in Brazil 5169 (85.1%)


PhD 2 (5.1%)Postdoctoral 6 (15.4%)

Fig.2.14 CNPq: Classification of awards in

FYs 1995–97.

Expenditure was US$65.6 million



South African Government

South African Medical Research CouncilUS$10.7 million on health research in FYs1995–98The South African Medical Research Council isthe main government funding agency for healthresearch in South Africa. It has several awardschemes open to South African researchers:• research unit and centre awards support the

creation of a research unit around an interna-tionally recognized leader;

• research group awards enable establishmentof a group in a strategic area to develophealth research capacity;

• research development planning grants pro-vide support to historically disadvantagedinstitutions in South Africa;

• self-initiated research awards provideresearch grants to independent researchers;

• fellowships and postgraduate scholarships.

MRC expenditure on awards was US$10.7million in FYs 1995–98. Figure 2.16 shows thebreakdown of awards.

National Research Foundation (NRF)US$3.2 million on training in FYs 1997–98The NRF is a newly created institution in SouthAfrica that combines the functions of the formerFoundation for Research Development and theCentre for Science Development. The objectiveof the NRF is to support and promote researchthrough funding, human resource development,innovation and development in all fields of sci-ence and technology. In so doing, it contributes tothe improvement of the quality of life of all thepeople of the country. The NRF has severalmechanisms of support in the fields of the naturaland applied sciences, engineering and technologywithin its various programmes, including:• free-standing bursaries, scholarships and fel-

lowships (awarded to students directly in thisprogramme, based on merit and potential);

• grant holder bursaries (awarded by principalgrant-holders funded in the Open ResearchProgramme and programmes in the directed themes);

• institutional student support awardedthrough programmes to develop institutionalresearch culture at historically disadvantageduniversities and technikons.


Figure 2.16 South African MRC: Classification of awards in FYs 1995–98.

Expenditure was US$10.7 million

Master’s and PhD scholarships (188)

Postdoctoral scholarships (8)

Self-initiated research awards (863)

Research development planning awards (3)

Research unit and centre awards (65)

Research group awards (8)

All awards were made to

South African citizens or

permanent residents.

Figure 2.17 South African NRF: Classification of awards in FYs 1997–98.

Expenditure was US$3.2 million. Number of individuals trained = 1105



Expenditure on Master’s, PhD and postdoc-toral awards in health and biomedical sciences in1997 and 1998 totalled US$3.32 million. Figure2.17 shows the breakdown of these awards.

A limited number of awards is offered toSouth African researchers in health sciencesthrough the Open Research Programme. In FY1998, 38 awards totalling US$0.5 million weremade to scientists in the field of biochemistry. Fourawards (US$40 000) were for malaria research.

South-East Asia

SouthEast Asian Ministers of EducationOrganization Regional Tropical Medicineand Public Health Network (SEAMEO-TROPMED)US$2.3 million on training and special projectsFYs 1995–97SEAMEO-TROPMED’s mission is to developthe capacity of individuals and institutions todeliver quality healthcare through training andresearch. The network offers academic degreeprogrammes and a range of short-term coursesand workshops, including distance learningmodules. Its four regional health centres con-duct research and offer training in the followingfields of speciality:• TROPMED/Indonesia at the University of

Indonesia, Jakarta is the Regional Centre forCommunity Nutrition;

• TROPMED/Malaysia at the Institute ofMedical Research, Kuala Lumpur is theRegional Centre for Microbiology,Parasitology and Entomology;

• TROPMED/The Philippines at theUniversity of The Philippines, Manila is the Regional Centre for Public Health;

• TROPMED/Thailand at MahidolUniversity, Bangkok, is the Regional Centrefor Tropical Medicine.

Expenditure on training courses, scholar-ships and special projects was US$2.3 million inFYs 1995–97. A proportion of SEAMEO’sfunding is provided by partner organizationswith whom SEAMEO organizes special projectsand courses. These include the GTZ-supportedHIV/AIDS/STD Partnership project in the Asiaregion, and the SEAMEO–France CooperationProgramme on Control of CommunicableDiseases. During FY 1997, 424 students, mainlyfrom Asia, received scholarship support fromSEAMEO (Figure 2.18).

2.3 OVERVIEW OF AWARDSAND DISCUSSION

The present survey gathered comparative datafrom a range of funding organizations onresearch training opportunities in health and thebiomedical sciences in developing countries.Previous reviews of have tended to be qualitativein nature or limited in their scope, whereas thepresent study provides a much broader analyticaloverview of the availability of training opportu-nities at the various stages of career progression,in different disciplines and in different regions.This study, however, has not attempted to assessthe success of training schemes, either individu-ally or collectively, in building sustainable andproductive research capacity in developingcountries. Data are therefore limited to numbersof trainees, expenditure figures and descriptiveinformation on training mechanisms. Some


PhD 330 (29.9%)

Master’s 566 (51.2%)



indicators of the current levels of research activi-ty in developing countries and of the effective-ness of training schemes are presented in laterchapters. However, more detailed assessments byindividual organizations are needed to yieldanswers on optimal training mechanisms.

Collecting comparable and reliable data oninternational support for training developing-country scientists represented a significant chal-lenge. The quality and quantity of data collectedfrom individual organizations varied, andinevitably there were omissions in the overallinternational data obtained. A particular diffi-culty was in obtaining details of training thatwas delivered as part of a larger research or devel-opment programme, as this training was oftennot recorded separately or monitored.Nevertheless, a substantial body of data was col-lected and an overview is presented here. Thisresource of information should be of value bothto funding agencies considering their contribu-tions to training, and to researchers seekingfinancial support. Contact details for funderssurveyed are provided in Annex 2.

2.3.1 Investors in trainingThe 39 organizations that participated in the sur-vey included governmental and non-governmen-tal organizations, private foundations and inter-national organizations. Information from gov-ernmental agencies in two lower-income coun-tries (Brazil and South Africa) was also obtained.

Resources from governments in developedregions principally flow to low- or middle-income countries through specialized researchcouncils or agencies, bilateral programmes of

foreign assistance agencies or ministries, or con-tributions to multilateral institutes or organiza-tions such as the UNDP/World Bank/WHOSpecial Programme for Research and Training inTropical Diseases (TDR). Most private founda-tions and non-governmental organizationsadminister their own funding schemes, butsome also contribute to other agencies. Wherepossible, this report has given due credit toorganizations providing funds to secondaryagencies, but the principal focus is on the pointof administration of training schemes. Trainingprovided through bilateral resources was oftendifficult to identify through survey of fundingorganizations, due to decentralization of records.Further information on organizations for whichdata were incomplete was in some cases obtainedby direct survey of malaria research laboratories(see Chapter 4).

The results of the survey clearly showed theimmense number and variety of schemes offeredby the international funding community, eachindividual scheme having its own aim and remit.The majority of funding organizations providerelatively small numbers of training awards each year, and only a few funders operate larger-scale training schemes: namely the JapaneseInter-national Cooperation Agency (JICA), theEuropean Commission INCO-DC programmein DG XII, the US National Institutes of Healthand WHO/TDR. Other more prominent directsupporters of training include Australian,French, Swedish, Swiss, Danish and BelgianGovernment agencies, the International ClinicalEpidemiology Network (INCLEN) and theWellcome Trust.

Figure 2.18 SEAMEO scholarship recipients in FY 1997.

The figures exclude course participants who received support from other sources


Short course 342 (80.7%)

Master’s 52 (12.3%)

PhD 1 (0.2%)

Diploma 29 (6.8%)


2.3.2 ExpenditureTable 2.6 summarizes the expenditure on train-ing identified in this survey. Although everyeffort was made to present only the direct expen-diture on training, this was not always possible,and the footnotes to the table provide additionalinformation.

Aggregate identified expenditure on trainingof developing-country scientists in biomedicineand health by organizations in higher-incomecountries was US$261 million (FYs 1995–97),with nearly a third of this from JICA. This figurerepresents a minimum estimate of expendituredue to the incompleteness of informationreceived from a number of organizations, anddifficulties in achieving comprehensive surveycoverage of all relevant funders. For example, thesurvey focused on TDR as the largest WHOprogramme providing research training for sci-

entists in developing countries, and does notinclude other WHO programmes such as thatfor Training in Human Reproduction (HRP);nor other multilateral institutes or agencies suchas PAHO and UNICEF. In addition, responseswere not obtained from a number of privatefoundations. Nevertheless, the survey almostcertainly captured the majority of larger contrib-utors from the established market economies(for an overview of investors in health researchin general, see Michaud and Murray, 1996).

The trend in investment in research trainingin developing countries was upwards, with anincrease of 41 per cent during the three-yearperiod 1995–97 (data not adjusted for inflation;Figure 2.19). Several organizations reported further increases in 1998. Those organizationsshowing the most notable increases in trainingexpenditure were the US National Institutes of


Table 2.6 Summary of identified support for training developing-country scientists in FYs 1995–97.

Funder Expenditure in FYs 1995–97 (US$million)

Japan International Cooperation Agency (JICA) 1 89.4

Brazilian Government and associated agencies 2 71.5

European Commission DG XII 3 46.9

US National Institutes of Health: Fogarty International Center and National 46.7Institute of Allergy and Infectious Diseases

UNDP/World Bank/WHO Special Programme for Research and Training in 16.5Tropical Diseases (TDR) 4

South African MRCand NRF 5 11.9

Swedish International Development Cooperation Agency (Sida) 6 10.2

French Ministry of Cooperation 7 10.2

Wellcome Trust 8.2

Federal Commission for Scholarships for foreign students Switzerland 6.6

Belgian Administration for Development Cooperation 8 6.6

Institut National de la Santé et de la Recherche Médicale (INSERM) 9 6.3

Danish Bilharziasis Laboratory 4.5

International Clinical Epidemiology Network (INCLEN) 4.4

Swiss Agency for Development and Cooperation 10 3.0

SEAMEO-TROPMED 11 2.3

Others 2.4

1 Estimated expenditure on training courses held in Japan, one partof Japan’s training activities

2 Research programmes and scholarships3 Expenditure on the INCO-DC Health programme (not restricted

to training)4 Research capability strengthening and institutional support 5 Health research grants from MRC. NRF figures are for 1997–98 only6 Expenditure on country-based research cooperation and special

projects for 1996 and 1997

7 Estimated expenditure on French–African collaborative malariaresearch

8 Scholarships and support to institutions in developing countries9 Expenditure on collaborative schemes with developing countries

and training awards10 Expenditure on scholarships to developing-country scientists, one

part of SDC training activities11 Expenditure on scholarships, courses and special projects for

1995–97

All available figures for expenditure on training developing-country scientists are included in the above table, but it should be noted that:(a) Some organizations are not listed as they only provided qualitative information on training; (b) Figures listed for some organizationsrepresent only a portion of their training activities; (c) Organizations providing training funds via another agency are not listed here.

Health, the Wellcome Trust and the EuropeanCommission DG XII INCO-DC programme.

Data were available from some organizationson the significance of their investment in train-ing of developing-country scientists in relationto overall expenditure. In 1998, the US NationalInstitutes of Health (NIH) committed US$24million to training scientists in developingregions (dedicated training schemes only), repre-senting 0.15 per cent of the total NIH budgetand an estimated 6 per cent of expenditure onresearch relevant to developing countries(Michaud and Murray, 1996). The WellcomeTrust’s expenditure on training of developing-country scientists increased from 0.17 per centof the total research funding in 1995 to 1.5 percent in 1997. Overall, approximately 10 percent of the Trust’s total grants expenditure goesto research relevant to developing regions and,in 1997, 15 per cent of this was for training. Theabove figures show that training of scientists inlower-income countries represents a small pro-portion of overall activities for NIH and theWellcome Trust. These two organizations areleading international funders of research intodiseases that predominantly afflict developingcountries, and a small increase in the proportionof their budgets allocated to training has thepotential to make a large global impact. In fact,the expenditures of both the Wellcome Trustand NIH on training overseas scientists havealready increased over the last few years. It

should be noted that the US Government, inaddition to contributing through NIH, also pro-vides training through CDC and USAID, andvia WHO/TDR.

The review focused primarily on trainingsupport from organizations based in higher-income countries and did not attempt to obtaincomprehensive data from developing countries.Estimates of financial investment in research anddevelopment by governments in lower-incomeregions are generally very low, although there issubstantial variation between countries(UNESCO, 1998). Information was obtainedin the current study from the governments oftwo lower-income countries: Brazil madeimportant contributions to training of local sci-entists and research projects (US$71.5 millionin 1995–97), while South Africa made moremodest contributions (about US$8.6 million in1997–98). Brazil and South Africa have thehighest levels of research and developmentexpenditure for their respective regions and thefigures from these two countries therefore prob-ably represent the upper levels of governmentcommitment to training. The figures fromSouth Africa in particular suggest that invest-ments by other countries in sub-Saharan Africaare extremely low, and these countries are there-fore likely to be heavily dependent on externalfunding resources to maintain research activities.

Data were also requested from organizationson training of developing-country scientists in



Figure 2.19 Expenditure in FYs 1995–97 on training scientists in developing countries.

Restricted to organizations in developed countries

FY1995 FY1996 FY1997

Others

Wellcome Trust

UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR) Research Capability Strengthening grants budget

US National Institutes of Health: Fogarty International Center and National Institute of Allergy and Infectious Diseases

European Commission DG XII INCO-DC programme

Japan International Cooperation Agency

120

100

80

60

40

20

0

US$ million


malaria research. The US National Institutes ofHealth and the Wellcome Trust devoted approxi-mately 2 per cent of their training expenditure tomalaria in 1995–98, reflecting the broad remit oftheir training schemes.4 In contrast, 20 per centof the INCO-DC Health budget was devoted tomalaria during 1995–98 and a recent review ofTDR Research Training Grants revealed that 42per cent of PhD awards in 1991–97 supportedprojects on malaria (TDR, 1999).

2.3.3 Training level of awardsThe availability of support at different stages ofcareer progression was assessed by analysing thenumber of awards and the principal contributingorganizations at each training level (Figure 2.20).

Training attachments and short courses werethe predominant forms of support identified inthe survey, accounting for 5010 awards (70 percent of total identified awards). Many organiza-tions support this type of training, althoughJICA provided the greatest number, particularlyto Asian countries. Detailed information on thenature of training attachments, such as the stageof scientific career where they were most often

directed, was not available. Many organizationsalso provide support for training workshops andthe US NIH was notable in this respect.

At undergraduate level there were very fewopportunities for support from agencies interna-tionally: only 1 per cent of all identified awardswere for Bachelor’s studies. Available data indi-cated that the European Commission INCO-DC programme and AusAID provided the high-est numbers of awards at this level.

Postgraduate training identified in the study(excluding training attachments) comprised 821Master’s awards (40 per cent of total), 684 PhDawards (33 per cent) and 564 postdoctoralawards (27 per cent) for the period 1995–98.Again, these are likely to be underestimates dueto the incompleteness of data. For example, thelarge numbers of AusAID awards to scientists inAsia and the Pacific islands were not included inoverview analyses due to a lack of precise data.Similarly, data from French agencies wereincomplete. Nevertheless, the aggregate figuresinclude the majority of larger funders and pro-vide an indication of the order of magnitude ofpostgraduate training opportunities.


4Malaria represents about a

third of Wellcome Trust

expenditure on tropical

medicine research activities

overall.

Figure 2.20 Availability of training at different levels in FYs 1995–98.

Postdoctoral

PhD

Master’s

Bachelor’s

[Training attachment,short course and

diploma] x 10

(n = 564)

(n = 684)

(n = 821)

(n = 77)

(n = 5 010)

Japan International Cooperation Agency

European Commission DG XII INCO-DC programme

US National Institutes of Health: Fogarty InternationalCenter and National Institute of Allergy andInfectious Disease

UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR)

Wellcome Trust

Belgian Administration for Development Cooperation

INCLEN

DANIDA

Others

0 200 400 600 800 1000 Number of awards FYs 1995–98

Notes:• Figures exclude local support within developing countries (South Africa and Brazil)• TDR figures include Research Training Grants only (excludes Re-entry Grants and Postdoctoral project grants)• DANIDA training was supported through the Danish Bilharziasis Laboratory• AusAID provide large numbers of awards at Bachelor’s, Master’s and PhD level to scientists in Asia and the Pacific islands,

but directly comparable figures were not available


Many of the organizations that participatedin the survey (74 per cent of the total) offeredMaster’s training, although the majority provid-ed only small numbers of awards each year. Afew organizations provided substantial supportat Master’s level: the Belgian Agency forDevelopment Cooperation (BADC) and theInternational Clinical Epidemiology Network(INCLEN) provided 256 and 209 awards in1995–98 respectively, accounting for over halfof the total Master’s awards identified. Otherprominent supporters of Master’s training during1995–98 were the INCO-DC programme (100awards), the British Council and DANIDA(40–50 awards each). The awards provided byINCLEN and BADC were focused in the areas ofclinical epidemiology and public health respec-tively, so that the availability of Master’s trainingin other research disciplines was more limited.

Support at PhD level was available from justover half of funding organizations surveyed, but94 per cent of the identified awards came fromfour organizations: the European Commission,NIH, TDR and DANIDA (through the DanishBilharziasis Laboratory). Partial data providedby AusAID, IRD, Sida/SAREC and the SwissAgency for Development and Cooperation sug-gested that these agencies may also make impor-tant contributions to training at PhD level.Contributions from some of these agencies wereconfirmed by direct survey of African laborato-ries (Chapter 4).

Identification of opportunities for postdoc-toral scientists to extend their scientific skills andconsolidate their PhD training was complicatedby the differing definitions and perceptions of‘training’ and the lack of formalized qualifica-tions at this level. It is likely that a proportion ofthe identified large number of training attach-ments and workshops are aimed at postdoctoralscientists, although insufficient information wasavailable to confirm this. Postdoctoral scientistscan also extend their experience by working inassociation with ongoing research projects, andthere are a number of bilateral awards to supportexchange of scientists between high- and low-income countries. Accurate assessment of theextent of these types of postdoctoral training wasdifficult as they are often an integral part of alarger programme.

Few opportunities were identified for post-doctoral scientists to apply for research funds to

develop their own individual careers; the majori-ty of support going to larger-scale programmes.TDR, NIH, and the Wellcome Trust appear tooffer the most extensive possibilities for supportin this respect, although most TDR grantopportunities are focused on strategic priorityareas or linked to institutional strengtheninggrants. TDR also provides small one- to two-year Re-entry Grants to researchers upon returnto their home institution after a period of train-ing. The Wellcome Trust offers schemes todevelop the expertise of junior postdoctoralresearchers, including opportunities to train inor collaborate with centres of excellence indeveloping countries or in the UK, as well asawards for more senior scientists. NIH offersinternational research fellowships to supportpostdoctoral training of foreign scientists in theUSA and in addition, unsolicited grant applica-tions are accepted from non-US citizens.

2.3.4 Geographical distribution of awards

Geographical information was available for justover half of the agencies contacted and 89 percent of the specific awards identified in the sur-vey (local support from Brazil and South Africawas excluded from the analysis). Overall, theregional distribution of awards in FY 1995–98was Asia 41 per cent, Africa 32 per cent andSouth America 27 per cent, but the distributionwas strongly skewed by the very large number ofawards to Asian researchers from JICA. The dis-tribution would further favour Asia if awardsfrom AusAID were included in the analysis(accurate figures not available). When trainingattachment awards from JICA were excluded,the distribution of awards moved towardsAfrica: Asia 27 per cent, Africa 46 per cent andSouth America 27 per cent. Many of the largerfunders were included in this analysis, but itshould be noted that geographical informationfor the awards of the European Commission andBADC were not available.

Geographical proximity and historical linksbetween countries, as well as a common lan-guage, appeared to be important influences onthe focus of support by an organization. In somecases, distribution of awards was determined bya funding strategy to support particular coun-tries or diseases. For example, TDR focuses itsresearch capability strengthening grants mainly



on Africa and in least developed countries: 62per cent of TDR Research Training Grants wereawarded to African researchers (1995–98).Awards from JICA and AusAID were directedmainly to researchers in South Asia; support toLatin America was derived mainly from fundingorganizations based in the USA and Canada;and French and UK organizations tended tofocus on specific countries in Africa (Franco-phone and Anglophone). Other factors likely toinfluence the distribution of awards include theexistence of established collaborations, the abili-ty of researchers to compete for funds, the avail-ability of alternative local funds to supportresearch, and the efficiency of advertising media.

2.3.5 Training mechanismsThe survey revealed that a variety of strategies areemployed by funding agencies to deliver trainingto scientists in developing countries, althoughtraining is often linked to ongoing research pro-grammes. Some agencies focus long-term sup-port on a small number of centres in developingcountries and train local scientists associated withthese centres (e.g. IRD, the UK MRC, WellcomeTrust, CDC). Other agencies link training tocompetitively awarded larger scale programmesat a variety (but usually small number) of sites(e.g. NIAID, DANIDA, EC INCO-DC).Relatively few funders offer research trainingawards that are not restricted to specific sites orlinked to other awards. The Wellcome Trust andTDR offer some possibilities in this respect,although many of their awards are also restricted.

Linking training to research projects thathave received support through a competitive,peer-reviewed process provides some assurancethat training will be in an appropriate intellectu-al environment. Concentrating resources at alimited number of centres also assists in buildingresearch facilities and a critical mass of peoplewhere high-quality science can flourish; avoid-ing wasteful dispersion of resources acrossunproductive sites. However, the selection ofcentres at which resources are focused is critical-ly important and a number of key elements arerequired for successful research and training; forexample the presence of talented scientific lead-ers, efficient administration, and local commit-ment to research (for a fuller discussion of effec-tive research programmes and institutions seeWHO, 1996, Chapter 7).

Many organizations target support forresearch and training on particular diseases, spe-cific research disciplines or even individual train-ing courses. For example, TDR programmesfocus on eight target diseases, while the govern-ments of Belgium, Norway and Germany sup-port Master’s training on selected courses specifi-cally for participants from developing countries.NIAID and FIC offer some schemes that areopen to all areas of biomedical sciences, whileothers aim to encourage research on particulardiseases (e.g. tuberculosis) or in specific disci-plines (e.g. reproductive biology, medical infor-matics). Similarly, the Wellcome Trust encouragesresearch in specific areas (e.g. population studies,health services research and noncommunicablediseases), whilst also offering open schemes.

Many funding agencies support training in adeveloped country, usually in the country wherethe agency itself is based. A significant problemassociated with overseas training of developing-country scientists is that trainees are often drawnaway from their home countries to regionswhere the laboratory facilities and careerprospects are far superior. For this reason fun-ders often require an assurance from the home-country institute that a post will be available to atrainee following completion of an overseastraining attachment. A recent internal reviewcarried out by TDR (TDR, 1999) showed thatonly 4.5 per cent (6/131) of PhD graduatestrained between 1991 and 1997 failed to returnto their home country following training, thusindicating the success of the TDR approach.

There is also growing recognition that over-seas institutes often cannot provide training thataddresses a research problem of relevance to thestudent’s home country or that is appropriate tothe facilities and equipment in the home insti-tute. The higher cost of training abroad is anoth-er factor that would favour exploring local orregional training options. Nevertheless, exposureof developing-country scientists to the researchculture and high-quality training environmentsof laboratories abroad is still considered to beextremely valuable in training internationallycompetitive researchers. In the light of theseissues, several funders support training in homeinstitutes with attachments in a developed coun-try (e.g. TDR, SAREC, DANIDA) and fundersare beginning to make more use of local orregional training facilities where possible (TDR,



INCLEN and the Wellcome Trust for example).There are currently few mechanisms that can

link sites together within developing regions formulticentre studies or regional training net-works. The European Commission INCO-DCprogramme, the MIM/TDR awards, SEAMEO-TROPMED and INCLEN are the most promi-nent in this respect.

2.4 CONCLUSIONS

The survey results showed the complex array ofresearch training opportunities offered to devel-oping countries by a broad range of fundingorganizations. This diversity of schemes presentsdifficulties to potential trainees attempting toidentify and secure sources of funding. In addi-tion, training opportunities are in many caseslinked to larger research programmes and arenot offered openly.

In general, training schemes are dispersedand fragmented with the majority of fundersproviding relatively few awards annually andonly a small number of organizations providinglarger-scale training programmes. Few devel-oped countries include a strong commitment toresearch capacity building as an integral elementof their overseas development programmes.Furthermore, there appear to be few opportuni-ties for scientists to develop their research careersthrough the funding schemes of a single organi-zation, as support from most organizations tendsto be targeted at one particular level.

Available data suggest that Africa and Asia areslightly favoured over South America in terms ofthe availability of training awards. Overall, it wasevident that the location of training is stronglyinfluenced by mechanisms of bilateral support,and by historical and language associationsbetween countries. The majority of training isoffered overseas, often in the country of thedonor organization, and training partnershipstend to link specific developed countries to par-ticular regions or countries. The establishment offunding mechanisms that can support morediverse training links would assist in optimizingthe use of the best training centres globally and inpromoting greater diversity in collaborations, forexample amongst Francophone and AnglophoneAfrican countries. Additional funding mecha-nisms to support networks and multicentre stud-

ies are also required to allow regional technologytransfer and sharing of resources. This is an issuethat has been recognized by the MultilateralInitiative on Malaria, and some progress hasalready been made in establishing schemes tosupport multi-centre studies and networks acrossAfrica (e.g. the MIM/TDR awards).

Training attachments and short courses are thepredominant type of training provided by organi-zations in developed countries. Very few organiza-tions provide support for undergraduate training.Nearly three-quarters of organizations surveyedprovide Master’s awards and just over half offerPhD training. However, over 50 per cent ofMaster’s awards came from two organizations andover 90 per cent of identified PhD awards camefrom four organizations. Postdoctoral training isoften provided in association with larger researchprogrammes and few agencies provide opportuni-ties for individual scientists to apply for inde-pendent research support.

Training offered by funders is often linked tolarge research programmes or targeted at partic-ular diseases, disciplines or courses. The balanceof research expertise generated in different sub-ject areas will obviously be strongly influencedby these approaches to training. There is there-fore a need for a mechanism that allows a strate-gic overview of ongoing activities, which willassist in matching research efforts to actualhealth needs and disease burden.

Even after taking into consideration theinevitable underestimation in the survey results,the data suggest that investment by higher-income countries in training biomedical scien-tists in developing countries is low relative totraining activities in industrialized countries. In1997, the UK spent US$145 million5 on train-ing and fellowships to develop UK expertise inbiomedical research, compared with a figure inthe present study of about US$100 million inthe same year for training scientists across Africa,Asia and South America; regions with an aggre-gate population of about 75 times that of theUK. Similarly, the 684 PhD awards to develop-ing-country scientists identified for the fouryears 1995–98 compares with at least 2101 PhDawards in biomedicine and health in the UK in asingle year (1995, supported by the UKGovernment-funded Medical Research Counciland the Biotechnology and Biological SciencesResearch Council). Despite the small overall


5In 1997 UK Medical Research

Council expenditure on train-

ing awards and fellowships

(Master’s and PhD

studentships; junior to senior

fellowships) was approximate-

ly US$52 million;

Biotechnology and Biological

Sciences Research Council

expenditure on studentships

and fellowships was US$37.8

million;Wellcome Trust

expenditure on postdoctoral

fellowships (mid-level and

training) was US$45 million

and approximately US$10 mil-

lion was spent on PhD

studentships.


investment, there was a marked increase inexpenditure over the survey period, suggesting agrowing commitment by organizations in high-income countries to support training of scien-tists from developing countries.

The above figures need to be considered inthe light of the more limited educational basesin developing countries at undergraduate level,and hence the availability of individuals toabsorb training at doctoral level. The extent ofhigher education varies considerably betweencountries. For example in Africa the number oftertiary students per 10 000 population in 1991ranged from two to four for Ethiopia, Malawi,Tanzania and Uganda, through 30–50 forCongo, Kenya, Nigeria and Zimbabwe, and upto 80 for South Africa. By comparison, theequivalent figures for China and Japan were 19and 238 respectively (African DevelopmentBank, 1994). Thus, it might be approximatedthat there are 10–100 times more tertiary stu-dents per unit population in industrializedcountries as compared with developing coun-tries. The figures for PhD awards obtained in thepresent study indicate that there are approaching1000 times more awards per unit population inthe UK than in the developing regions com-bined. Although these figures encompass a rangeof different educational systems across the devel-oping world and involve a lack of precision, theydo indicate the disparity in the numbers of sci-entists trained in high- and low-income coun-tries in relation to population sizes; particularlyif the dependence of developing countries onexternal support for postgraduate training istaken into consideration. The figures on num-bers of tertiary students relative to numbers ofPhD awards also suggest that there is additionalcapacity to absorb PhD training in some lower-income countries.

An important observation in the presentstudy is that relatively few organizations activelytrack the levels of training that they provide andthe success of their schemes: only 13 out of the39 organizations that responded to the surveywere able to provide full data. Many do notmaintain accurate central records, particularlywhen training is provided as part of largeresearch programmes. This observation under-scores the fragmented nature of currentapproaches to training scientists in developingcountries and the need for a more concerted

approach. The results of this study would sup-port a call for greater international effort tomonitor and review the effectiveness of currentschemes in building productive scientificresearch capability in lower-income regions ofthe world.

In view of the enormity of the challenge inbuilding research capacity in developing coun-tries, funding organizations face some difficultdecisions concerning where best to direct theirresources for maximal effect. The data gatheredin the present survey provides essential informa-tion on the international context against whichsuch decisions can be made.



3

3.1 BACKGROUND

Evaluation of the results of biomedical researchcan be approached in a number of different waysand each approach is able to provide a specificinsight into scientific activity. Methodologytherefore needs to be tailored to the particularassessment being carried out. The limited scopeof current indicators, however, means that acombination of approaches is required to obtaina more complete view of scientific activity andits social, economic and cultural impacts.

Analysis of publication outputs in interna-tional databases (bibliometrics) or analysis ofcommercial patents are standard approaches toassess direct output from scientific activity(Narin, 1994; Dawson et al., 1998). Publishedpapers represent relatively accessible and con-venient measures of research activity whichbroadly equate with advances in knowledge.Although numbers of papers provide measuresof the volume of research outputs, they cannotindicate the quality of these outputs or the ulti-mate impact of research on policy developmentand on health. Patents are another accessiblemeasure which provide indicators of technologi-cal potential at the frontiers of knowledge.

The present study selected bibliometricapproaches to assess the current status of malariaresearch activity in Africa. The results, however,necessarily reflect the databases used for theanalyses. Currently available databases concen-trate on papers published in international, peer-reviewed journals, and cannot capture informa-

tion published in local sources, the so-called ‘greyliterature’ (e.g. ministry of health publications,technical memoranda or conference proceed-ings). The omission of this grey literature is amajor constraint, particularly when evaluatingresearch of relevance to malaria-endemic coun-tries, and when examining links between researchand implementation. This chapter therefore givesan insight only into publication performance asrepresented in the international, predominantlyEnglish-language scientific literature.

Assessments of longer-term outcomes ofresearch, such as the development of new prod-ucts to fight disease or improvements in health-care, require more complex approaches. In thisstudy, references cited in malaria guidelines andpolicies in African countries were examined tomake a more direct assessment of the degree towhich both published and unpublished papershave been incorporated into policy and practice.Policies and guidelines are resources aimed athealth professionals and disease control person-nel which are intended to influence or direct clin-ical practice and approaches to preventing dis-ease. Reference to a scientific paper in a policy orguideline therefore demonstrates a link betweena research study and policy development, andprovides an indication of the practical utility ofthe research results reported in the paper.

The number of published papers is an indicator of research output that can provide aproxy measure of research activity in a particular field. More detailed characterizationof publications yields information on key research centres, international collaborationpatterns and strengths and weaknesses in different subfields of research. The presentchapter uses this approach to assess the current status of African malaria researchactivity, set against the background of international activity. Publication analyses are,however, limited in their scope and this chapter therefore also explores the use ofnational malaria treatment guidelines and policies to make an assessment of theinfluence of malaria research in developing policies for disease treatment and control.Similar future analyses of these indicators will enable changes in research status to bemonitored, providing mechanisms for evaluation of the broad success of schemesaimed at strengthening research capability in Africa.

Outputs of malaria research


3.2 METHODS

3.2.1 Overview of bibliometricanalyses

The current assessment of malaria research inAfrica employed a number of different biblio-metric approaches.1. Numbers of publications were used as a

quantitative measure of research activity atdifferent levels: internationally, withinAfrica, at individual country level and at spe-cific research centres.

2. Author addresses were used to explore pat-terns of international collaboration.

3. Classification of papers into defined subfieldsof malaria research provided information onthe balance of global and African activityacross different disciplines, and on theresearch focus of individual research centres.

4. Funding acknowledgements quoted in publi-cations were used to analyse sources of finan-cial support for research.

5. Journal impact factors were used to assess thepotential impact of publications.

The combination of approaches aimed toprovide a detailed insight into the characteristicsof research ongoing in Africa in the context ofinternational activity.

3.2.2 Databases and search strategyThe databases used for the bibliometric analysiswere the Science Citation Index (SCI) producedby the Institute for Scientific Information inPhiladelphia, and MEDLINE, produced by theUS National Library of Medicine. MEDLINEcovers a more comprehensive set of journalsrelating to medical research, particularly jour-nals reporting on clinical and epidemiologicalstudies. It also has better coverage of local,regional and non-English language journals. SCIhas greater coverage of basic chemistry and drugdevelopment studies, but is primarily based onEnglish language journals and therefore is biasedtowards the USA and Europe (Sancho, 1992).This bias will have particular significance in thefield of malaria, which predominantly affectsdeveloping countries and is of local interest toresearchers in those countries. A major advan-tage of SCI is that it provides multiple authoraddresses, enabling analysis of international col-laboration patterns. MEDLINE records only the

address of the first author, precluding its use inanalysis of co-authorship on publications.However, MEDLINE includes abstracts thatassist in assessment of the specific research focusof publications.

The search strategy employed was that used ina previous review of malaria research activity(Anderson et al., 1996)(Annex 3). Specific key-words relating to malaria were used to search thetitles of publications in SCI and MEDLINE data-bases for the three-year period 1995–97. Thistime period was chosen in order to obtain themost up-to-date information on malaria researchactivity. Articles, notes and reviews were includedin the analysis as these are generally considered tocontain substantial scientific material, but letters(apart from those to Nature), meeting reports,news and editorials were excluded.

The broader field of tropical medicine wasdefined by a similar process (Lewison, 1996).The definition aimed to capture all publicationsrelevant to health and disease in developingcountries. Publications were retrieved from SCIfor the period 1995–97 in order to compare theoutputs in the field of malaria with the widerfield of tropical medicine.

3.2.3 National outputs andcollaboration patterns

Author addresses on malaria publications wereused to determine the outputs of individualcountries and to identify the most prolificresearch institutes in Africa. For publicationsrecorded in the SCI database, addresses of allauthors were used. For MEDLINE, however,only first author addresses were available – a lim-itation which means that the contribution ofcountries and institutions not associated withfirst authors is missed. Addresses were analysedusing integer counts, such that one count wasassigned for each paper with at least one addressfrom a specific country. Thus, the figures repre-sent the numbers of publications in which acountry has participated, rather than the num-ber exclusively produced by that country.Author addresses on SCI publications were alsoused to examine co-authorship on malaria publi-cations and hence patterns of international col-laboration. Collaboration patterns were exam-ined for the highest publishing countries world-wide and countries in Africa.

Outputs of malaria research3


3.2.4 Research categoriesTo examine the levels of research activity in dif-ferent areas of malaria research, and to identifyregional, country- and institute-specific researchstrengths, publications retrieved from SCI andMEDLINE were classified into a series of sub-field categories. The classification systememployed was that developed for a previousreview (Anderson et al., 1996) and is shown inAnnex 6. Malaria research publications were cat-egorized by inspection of the title, and wherepossible, on the basis of information in theabstract. Precise definition of research categoriesreduced the number of papers spanning morethan one category, although separation of small-er categories of biology, biochemistry and genet-ics of Plasmodium was difficult. Each paper wasalso classified as either ‘human’ if it involvedstudies of malaria in humans, or ‘non-human’ ifit described studies in animals or in vitro models.

3.2.5 Funding acknowledgementsFinancial support for published research wasanalysed using acknowledgements to fundingbodies on papers and institute addresses (toidentify intramural support e.g. from govern-ment or industry). Acknowledgements and/orinstitute addresses for each malaria publicationwere obtained by examining individual papers inlibraries.

3.2.6 Impact of researchThe potential impact of a paper (W), based onrecent average citation impact data for journals,was calculated using the methodology outlinedby Dawson et al. (1998) for both the internation-al and African data sets. High W values reflect ahigher potential impact; the range is from 1 to 4.

Papers were also assigned a research levelvalue (RL) determined by the clinical or basicnature of the journals in which they were pub-lished. RL1 journals describe clinical observa-tion, whilst RL4 journals report basic science.

3.2.7 Malaria guidelines and policiesThe references in ministry of health guidelinesand policies from selected countries in Africawere examined to assess the types of data onwhich they were based, for example, whetherthey incorporated information from recentmalaria research publications and publicationsemanating from the specific country concerned.

3.3 RESULTS

Unless otherwise stated all results are based onpublications in both SCI and MEDLINE.

3.3.1 Global and African malariaresearch outputs

A total of 3672 malaria papers were retrievedfrom the SCI and MEDLINE databases for theyears 1995–97. There was an increase in thenumber of malaria papers published interna-tionally, from 1121 in 1995 to 1295 in 1997.However, there does not appear to be a steadyupward trend as the equivalent 1994 figure was1302 (Anderson et al., 1996).

There was a considerable degree of overlap inpublications in the MEDLINE and SCI data-bases. Malaria research papers were published ina total of 568 journals across the two databases,with 119 journal titles specific to SCI and 153titles specific to MEDLINE. A greater numberof non-English language and local journalsappeared in MEDLINE (e.g. Santé, CentralAfrican Journal of Medicine, West African Journalof Medicine, Tropical Doctor). Of the 3672malaria papers identified, 2869 (78 per cent)papers were included in SCI and 3211 (87 percent) in the MEDLINE database.

Over the same period, 13 815 papers in thefield of tropical medicine were identified inter-nationally in the SCI database, with malariapapers constituting 20.8 per cent of the totaloutput in tropical medicine.

Outputs of malaria research 3

A total of 633 malaria research papers pub-lished between 1995 and 1997 included at leastone author address in Africa. This represents17.2 per cent of the global malaria research out-put over the three-year period. In 329 papers (52per cent), the first author address was in Africa.Of the African output, 121 papers were foundonly in SCI, while 112 papers were found onlyin MEDLINE. Malaria research output fromAfrica remained fairly constant, with 201 paperspublished in 1995 and 215 papers in 1997.

Analysis of address information recorded onmalaria papers from both SCI and MEDLINErevealed the leading publishers over the period1995–97 (Figure 3.1). The USA participated inthe greatest number of malaria publications, fol-lowed by the UK and France. Although the USAremains the top malaria-publishing country, itsshare of international outputs has decreased from37 per cent for the years 1984, 1989 and 1994(Anderson et al., 1996) to 30 per cent in 1995–97(SCI database only). The UK and French contri-butions to malaria publications have remainedsteady since 1994. The malaria-endemic coun-tries India, Thailand and Kenya have a notablyhigh share of global malaria publications.

Table 3.1 illustrates country contributions tointernational malaria research relative to perform-ance in the overall field of biomedicine. All of thetop ten publishing countries, with the exceptionof the USA and Germany, contribute relativelymore to international malaria research than tooverall biomedical research. Thailand and Kenyahave particularly high commitments to malariaresearch, as does Africa as a whole. AlthoughAfrica contributes 17.2 per cent of world malariapublications, it participates in only 1.2 per cent ofall biomedical publications.

Figure 3.2 shows sub-Saharan African coun-tries that published 14 or more malaria researchpapers over the three-year period. A completelist of publication output by African country isgiven in Annex 4. These data include all publica-tions with an address in Africa and no attemptwas made to separate African and expatriateresearchers.



Figure 3.1 Top publishing countries in malaria research 1995–97.

0 100 200 300 400 500 600 700 800 900 1000

USA

UK

France

India

Australia

Thailand

Switzerland

Netherlands

Germany

Kenya

Africa (pooled)

Number of publications



Table 3.1 Country contributions to international publication outputs.

Country Percentage (%) of world Percentage (%) of world Share of world malariamalaria publications biomedical publications publications relative to1995–97 1995–97 share of world biomedical

(Dawson et al., 1998) publications*

USA 30.0 41.7 0.7

UK 17.8 10.5 1.7

France 9.6 6.2 1.5

Australia 7.3 2.6 2.8

Thailand 5.5 0.2 27.5

Switzerland 5.2 2.0 2.6

India 4.6 1.0 4.6

Netherlands 4.6 3.4 1.4

Germany 4.0 7.8 0.5

Kenya 3.2 0.1 32.0

Africa (pooled) 17.2 1.2 14.3

Figure 3.2 Top African countries publishing in malaria research 1995–97.

SCI only

SCI and MEDLINE

MEDLINE only

0 20 40 60 80 100 120

Kenya

Tanzania

Nigeria

The Gambia

Cameroon

Senegal

Gabon

Malawi

South Africa

Burkina Faso

Zimbabwe

Ivory Coast

Ghana

Mali


* A value greater than 1 indicates a greater contribution to world malaria research publications relative to overall biomedical research



Figure 3.3 Highest publishing malaria research centres in Africa, 1995–97.

0 10 20 30 40 50 60

KEMRI–WT Collaborative Programme (Kilifi and Nairobi), Kenya

UK MRC, Fajara,The Gambia

University of Ibadan, Nigeria

OCEAC, Cameroon

Institut Pasteur, Senegal

KEMRI, Nairobi, Kenya

Muhimbili University,Tanzania

NIMR, Ifakara,Tanzania

IRD, Senegal

College of Medicine, Blantyre, Malawi

Albert Schweitzer Hospital, Gabon

Ministry of Health, Malawi

KEMRI, Kisumu, Kenya

University of Abidjan, Ivory Coast

ENMP, Mali

University of Witwatersrand,South Africa

CNLP, Burkina-Faso

University of Khartoum, Sudan


CNLP Centre National de Lutte contre le Paludisme

ENMP École Nationale de Médecine et de Pharmacie etd’Ontosomatologie

IRD Institut de Recherche pour le Développement (formerly ORSTOM)

KEMRI Kenyan Medical Research Institute

MRC Medical Research Council

NIMR National Institute for Medical Research

OCEAC Organization de Coordination pour la Lutte contre les Endémies en Afrique Centrale

WT Wellcome Trust

Address details are provided in Annex 12

Figure 3.4 Regional collaborations in malaria research 1995–97 (SCI).

70

60

50

40

30

20

10

0Perc

enta

ge o

f pap

ers

co-a

utho

red

wit

h an

oth

er r

egio

n

USA (n = 863)

Afr

ica

Oth

er

Euro

pe

USA

Afr

ica

Oth

er

Euro

pe

Afr

ica

Oth

er

Euro

pe

USA

Oth

er

Euro

pe

USA

UK (n = 510) France (n = 276) Africa (n = 519)


Further examination of author addressesidentified the individual institutes in Africa withthe highest publication outputs (Figure 3.3).Eighteen African centres published ten or moremalaria papers in the three-year period analysed.The joint highest publishing institutes were TheUK Medical Research Council Laboratories,Fajara, The Gambia, and the Kenyan MedicalResearch Institute (KEMRI)–Wellcome TrustCollaborative Programme (Kilifi and Nairobi),Kenya, followed by the University of Ibadan,Nigeria, and Organization de Coordinationpour la Lutte contre les Endémies en AfriqueCentrale (OCEAC), Yaoundé, Cameroon. Mostof the institutes collaborated extensively outsidetheir own country, with the exception of theUniversities of Ibadan and Witwatersrand.

3.3.2 International collaboration in malaria research

Analysis of co-authorship on SCI malaria publi-cations revealed that 40 per cent of publicationscontaining USA author addresses involved a col-laboration with another country, compared with

figures of 55 per cent for the UK and 53 per centfor France. African papers showed a high level ofinternational co-authorship, with 79 per centinvolving a collaboration outside Africa.

Africa has particularly strong collaborativelinks with Europe: 68 per cent of its publicationswere co-authored with a European country and22 per cent with the USA (Figure 3.4).However, collaborations between African coun-tries were rare, with only 34 publications (6.5per cent) containing more than one Africanaddress. The actual level of collaboration acrossAfrica may be higher, however, as this co-author-ship analysis was restricted to SCI, which focuseson European and US journals and omits mostlocal and regional journals from Africa. UK andFrance both collaborated more frequently withAfrica than with other European countries,while the USA collaborated more extensivelywith Europe than with Africa.

Analysis of the countries with which Africacollaborates revealed that the UK, followed bythe USA and France are the most frequent col-laborators (Figure 3.5).


Figure 3.5 Leading collaborators with Africa in malaria research, 1995–97 (SCI).

Total number of publications with an African address = 519

UK

USA

France

Switzerland

Netherlands

Germany

Denmark

Sweden

Austria

Belgium

Africa

0 20 40 60 80 100 120 140 160

Number of publications co-authored with Africa



(a) USA (n = 863)

0

1

2

3

4

5

6

Tha

iland UK

Fran

ce

Aus

tral

ia

Switz

erla

nd

Braz

il

Ken

ya

Mal

awi

Mal

i

Tan

zani

a

Sout

h A

fric

a

Perc

enta

ge o

f pap

ers

co-a

utho

red

wit

h a

part

icul

ar c

ount

ry

(c) France (n = 276)

0

1

2

3

4

5

6

7

8

9

USA UK

Net

herl

ands

Isra

el

Tha

iland

Switz

erla

nd

Sene

gal

Cam

eroo

n

Ivor

y C

oast

Mad

agas

car

Gab

on

(b) UK (n = 510)

0

1

2

3

4

5

6

7

8

9

10

Tha

iland

USA

Net

herl

ands

Fran

ce

Aus

tral

ia

Vie

tnam

Ken

ya

Gam

bia

Tan

zani

a

Nig

eria

Gha

na

Perc

enta

ge o

f pap

ers

co-a

utho

red

wit

h a

part

icul

ar c

ount

ryPe

rcen

tage

of p

aper

s co

-aut

hore

d w

ith

a pa

rtic

ular

cou

ntry

Figure 3.6 Collaboration patterns of top malaria publishing countries, 1995–97 (SCI).

Non-African and African countries collaborating most frequently with the USA, UK and France


Figure 3.6 shows the country-wise collabora-tion patterns of the top three publishing coun-tries in malaria research: the USA, UK andFrance. There was little overlap in the principalAfrican collaborating partners of these countriesindicating that a common language, as well ashistorical links, are important determinants ofpatterns of collaboration.

Examination of co-authorship patterns forindividual African countries confirmed thatmost countries participated in a high level of col-laboration outside Africa, with few collabora-tions across Africa (Figure 3.7). However, coun-try-specific variations in collaboration patternswere observed: Nigeria and South Africa pro-duced a higher proportion of papers without anyexternal collaborations.


Kenya

Tanzania

Gambia

Nigeria

Senegal

Cameroon

Malawi

South Africa

Gabon

Ivory Coast

Ghana

Mali

Burkina-Faso

Zimbabwe

Figure 3.7 Collaborations of African countries in malaria research 1995–97 (SCI).

0 20 40 60 80 100


Collaborations outside Africa

African collaboration

No external collaboration


3.3.3 Research categoriesThe distributions of both international andAfrican papers across broad categories of malariaresearch are shown in Figure 3.8. Only 0.7 percent of papers were judged to span more thanone discipline. Internationally, the category withthe greatest number of publications was clinicalmedicine, drug trials and pathophysiology with23 per cent of publications, followed bybiology, biochemistry and genetics ofPlasmodium with 17 per cent. Comparison ofthe international output in 1995–97 with aprevious review of papers published in 1984,1989 and 1994 (Anderson et al., 1996) revealedthat there has been very little change in therelative activity of the different subfields.

The emphasis of research in Africa was onclinical and field studies: publications were mostnumerous in the category clinical medicine, drug trials and pathophysiology (33 per cent),followed by epidemiology (20 per cent) andintervention trials and health services research (14 per cent). Studies of the biology, biochem-istry and genetics of Plasmodium accounted foronly 3 per cent of total output. Similarly, funda-mental studies of mosquito vectors or vector taxonomy, ecology or behaviour accounted for 7 per cent of African papers, compared with 12 per cent for the international set. About aquarter of African epidemiological studiesfocused on mosquitoes (5 per cent of the totalset). Nine per cent of papers described studies on


Figure 3.8 Malaria research publications (1995–97) by major research category (SCI and MEDLINE).

(a) International malaria publications (n = 3672)

(b) African malaria research publications (n = 633)

Intervention trials and health services

research 14%

Mosquito vector studies 7%

Drug discovery anddevelopment 9%

Immunology andvaccines 11%

Clinical medicine,drug trials andpathophysiology 33%

Biology,biochemistry

and genetics of Plasmodium 3%

Epidemiology 20%

Diagnostic tests 3%

Intervention trials and health services

research 7%

Mosquito vector studies 12%

Drug discovery anddevelopment 15%

Immunology andvaccines 12%

Clinical medicine,drug trials andpathophysiology 23%

Biology,biochemistry

and genetics of Plasmodium 17%

Epidemiology 12%

Diagnostic tests 2%


drug discovery and development in animal modelsor in vitro; the majority of these relating to test-ing of natural products for antimalarial activity.

The category of intervention trials and healthservices research was well represented in theAfrican set of papers (14 per cent of the total),but was less significant in the international set (7 per cent of total). About half of the Africanpapers in this category focused on social, culturalor economic aspects of malaria treatment or con-trol measures. It should be noted, however, thatnot all research relevant to these areas will havebeen captured by the databases employed, andthe use of the Social Sciences Citation Indexdatabase might have extended coverage.

Internationally, 46 per cent of papers des-cribed studies of malaria in humans, whereas theequivalent figure for Africa was 81 per cent.

In drawing conclusions from these results itshould be borne in mind that the research effortrepresented by a single paper varies between sub-fields due to differences in experimentalapproaches and techniques. In addition, theextent of the subfield, which is determined bythe definition employed to describe it, will alsoaffect the absolute number of publications persubfield. Finally, the overall field of malariaresearch is relatively small and individualresearch groups may substantially influence out-put in a particular subfield and hence the bal-ance between subfields.

3.3.4 Funding acknowledgementsTable 3.2 shows the number of malaria papers inthe SCI and MEDLINE databases that wereretrieved from UK libraries and examined forfunding acknowledgements. Of the 2724 inter-national papers examined, 75 per cent acknowl-edged at least one funding agency. In the Africandata subset, 82.2 per cent of the papers locatedhad at least one funding acknowledgement.

As the search was restricted to UK libraries, itis possible that journals published in Englishwere more readily available than those in otherlanguages, resulting in a bias towards funders ofEnglish-speaking researchers. Furthermore, ininterpreting funding acknowledgements data, itshould be noted that the results can only serve asan indicator of support provided by fundingbodies, and they do not necessarily reflect theactual expenditure. The numbers of acknowl-edgements will be influenced by the degree ofemphasis placed on researchers acknowledgingtheir funders, and the specific funding strategiesemployed by organizations. A funding bodymay, for example, choose to provide partialfunding for a project, or to provide the full costsas far as possible. Moreover, some agencies pro-vide infrastructure costs for research institutes,whereas others do not. Counts of fundingacknowledgements do not take into accountthese differing levels of support, nor do they rec-ognize funders that have contributed throughother agencies.


Table 3.2 Number of funding acknowledgements on malaria publications 1995–97.

Total malaria papers in SCI Papers located during Papers with fundingand MEDLINE searches physical search of libraries acknowledgements

International 3672 2724 2034malaria papers

African 633 499 410malaria papers


Table 3.3 shows the funding organizationsmost frequently acknowledged in the interna-tional and African sets of malaria papers (Annex7 gives additional details). Internationally, TDRreceived the highest number of fundingacknowledgements, followed by the WellcomeTrust, the US Department of Defense andNIAID. In the African papers, TDR was againthe most frequently acknowledged funder, with24 per cent of all papers containing at least oneacknowledgement, followed by the WellcomeTrust (19 per cent), KEMRI (17 per cent) andthe UK Medical Research Council (15 per cent).

TDR was also the most frequently acknowl-edged funder in a previous analysis of interna-tional malaria publications from 1984, 1989 and1994 (Anderson et al., 1996) accounting for 23per cent of all acknowledgements. However, theTDR share of acknowledgements decreased to19 per cent in the current analysis. NIAID, thesecond ranked funder in terms of acknowledge-ments in the earlier survey also appears to havedecreased its share from 17 per cent to 9 per cent.

These figures may, however, be influenced by theacknowledgement practices of authors in the useof NIH and NIAID (NIAID being one of theinstitutes of NIH). NIH received only 2 per centof acknowledgements in the earlier survey com-pared with 8 per cent in the current survey. Over-all, 353 papers (17 per cent) acknowledged eitherNIH or NIAID. The Wellcome Trust and theEuropean Commission both increased their per-centage share over the period of the two surveys.Funding from French sources was noted to bedistributed across a range of organizations, par-ticularly governmental agencies. The number ofpapers with an acknowledgement to at least oneof these agencies totalled 221 for the internation-al set and 64 for Africa, thus confirming the sub-stantial support from France overall. One Africangovernmental source, the Kenyan MedicalResearch Institute, featured strongly as a funderin the African set of papers. The governments ofCameroon, Tanzania, Burkina-Faso, The Gam-bia, Ethiopia and Malawi received smaller num-bers of acknowledgements.


Table 3.3 Acknowledgements to funding bodies, 1995–97.

International AfricanFunding body Number of papers with at least one Funding body Number of papers with at least one

acknowledgement (% of total) acknowledgement (% of total)

UNDP/World Bank/WHO 388 (19%) Special Programme for 97 (24%)Special Programme for Research Research and Trainingand Training in Tropical in Tropical Diseases (TDR)Diseases (TDR)*

Wellcome Trust 234 (12%) Wellcome Trust 79 (19%)

US Department of Defense 231 (11%) Kenya Medical Research 71 (17%)Institute (KEMRI)

National Institute of Allergy and 184 (9%) UK Medical Research Council 63 (15%)Infectious Diseases (NIAID)

National Institutes of Health (NIH) 169 (8%) Centers for Disease Control 39 (10%)and Prevention (CDC USA)

UK Medical Research Council 160 (8%) Institut de Recherche pour le 35 (9%)Développement (IRD) formerly ORSTOM

European Commission 141 (7%) US Agency for International 33 (8%)Development (USAID)

Centers for Disease Control 115 (6%) World Health Organization 33 (8%)and Prevention (CDC USA) (WHO)

US Agency for International 107 (5%) Swiss Tropical Institute 31 (8%)Development (USAID)

Institut Pasteur 103 (5%) US Department of Defense 28 (7%)

*Many funders contribute to TDR and these are not acknowledged individually (see Annex 1 for details of contributions to TDR in 1989–98)


Only two commercial sources of support, Hoff-man La Roche and SmithKline Beecham, wereprominent in the three-year period analysed (58and 29 papers respectively). Similar earlier analy-sis (Anderson et al., 1990) had shown involve-ment of the Wellcome pharmaceutical company(now Glaxo Wellcome plc), but their activities inmalaria research have now been reduced.

3.3.5 Characterization of topresearch institutes in Africa

The top publishing institutes across Africa arewell balanced in their distribution between Eastand West Africa, but the published output fromsouthern (excluding South Africa) and particu-larly central Africa is low (Figure 3.9).

Table 3.4 summarizes the major research spe-cializations and primary sources of funding forthe top publishing African malaria research insti-tutes in 1995–97.

Subfield analysis indicated that many insti-tutes conduct multidisciplinary research pro-grammes: four institutes publish research in fiveor more malaria research subfields, and themajority of institutes publish research in at leastthree subfields, with the exception of theMinistry of Health, Malawi; University ofAbidjan, Ivory Coast, and CNLP, Burkina-Fasowhere research publications are predominantlyfocused on a single subfield. In reflection of theoverall publications portfolio of Africa, ten of the14 top publishing institutes and research centres


Figure 3.9 Location of malaria research centres in Africa publishing more than ten papers in 1995–97.

Medical Research Council, Fajara, The Gambia

Institut Pasteur and IRD/ORSTOM, Dakar, Senegal

OCEAC, Antenne,IRD/ORSTOM, Yaoundé, Cameroon

Universityof Ibadan,Nigeria

Albert SchweitzerHospital, Lambaréné, Gabon

University of Abidjan,Ivory Coast

National School of Medicine and Pharmacology (ENMP), Bamako, Mali

Kenya Government MedicalResearch Centres, Nairobi,Kisumu and Kilifi

University of Khartoum,Sudan

CNLP, Ouagadougou,Burkina-Faso

College of Medicine, University of Malawi, Blantyre and Community Health Sciences Unit, Lilongwe, Malawi

University of Witwatersrand,South Africa

Muhimbili University,Dar es Salaam,Tanzania

KEMRI–Wellcome Trust Collaborative Programme,Nairobi and Kilifi, Kenya

NIMR,Ifakara,Tanzania



Table 3.4 Research specializations and funding acknowledgements at top publishing African malaria research centres.

Centre Specialities Three most frequently acknowledgedn = number of malaria publications sources of funding (ranked by number in SCI and MEDLINE (1995–97) of acknowledgements)*

KEMRI–Wellcome Trust Collaborative Antimalarial drug trials: Lapdap; artemether; KEMRIProgramme,Kilifi/Nairobi,Kenya (n = 55) quinine;pharmacokinetics and pharmacology Wellcome Trust

Pathophysiology: severe malaria symptoms TDRand clinical observations Epidemiology: link between transmission and diseaseIntervention trials: bed net trials, and reduction of morbidity and mortalityMolecular biologyHealth services research/social sciences

MRC Laboratories, Fajara,The Gambia Immunology and vaccine development: UK MRC(n = 55) characterization of immune response to parasite Wellcome Trust

antigens; SPf66 vaccine trials TDRClinical management of malaria and antimalarial drug trials: iron therapy studies;drug trials in humansEpidemiology: human genetics in relation to malarial diseaseIntervention trials: insecticide-treated nets (ITNs)Pathophysiology: parasite adhesion, clinical markersand disease outcomes

University of Ibadan,Nigeria Clinical management and antimalarial drug TDR(n = 38) trials:pharmacokinetics and disposition of Wellcome Trust

antimalarials in humans; artemether,mefloquine, Swedish MRC/ Swedish Institutequinine drug trialsPathophysiology and disease symptoms of malaria:clinical diagnosis and observationImmunology: longitudinal seroreactivity studiesin humans

Organization de Coordination pour la Immunology and vaccine development: ORSTOM (IRD)Lutte contre les Endémies en Afrique humoral and cellular immune responses to French Ministry of Cooperation(OCEAC),Yaoundé,Cameroon (n = 35) parasite antigens Cameroon Government

Epidemiology: mosquito behaviour in relation to transmission and mosquito–parasite interactionsStudies of malaria mosquito vectorsMalaria in pregnancy: intervention trials and immunologyAntimalarial drug trials: including phospholipid metabolism inhibitors

Institut Pasteur,Dakar, Senegal (n = 26) Immunology: immune responses in human communities Institut PasteurStudies of malaria mosquito vectors: mosquito genetics ORSTOM (IRD)Epidemiology:clinical presentation and incidence under French Ministry of Cooperation different transmission levels; population genetics of Plasmodium falciparum

KEMRI,Nairobi,Kenya (n = 22) Clinical management of malaria and antimalarial KEMRIdrug trials: field trials; screening plant compounds CDCIntervention trials: mosquito vector control TDR(repellents; ITNs) US DODStudies of malaria mosquito vectors:population genetics and gene flow in Anopheles gambiae

Muhimbili University,Dar es Salaam, Health services research:role of traditional healers; USAIDTanzania (n = 22) community treatment practices; community perception Sida/SAREC

of malaria, particularly in pregnant women US DODClinical management of malaria and antimalarial drug trials:biochemical predictors of severe disease;artemesinin drug trials



Table 3.4 Research specializations and funding acknowledgements at top publishing African malaria research centres (cont.).

Centre Specialities Three most frequently acknowledgedn = number of malaria publications sources of funding (ranked by number in SCI and MEDLINE (1995–97) of acknowledgements)*

National Institute for Medical Research Epidemiology:malaria transmission by mosquitoes, Swiss Tropical Institute(NIMR), Ifakara,Tanzania (n = 22) particularly infectivity. Studies of malaria mosquito Swiss Directorate for Technical

vectors: biology and ecology Cooperation and Humanitarian AidImmunology and vaccine trials:field trials of SPf66; TDRimmunological markers of fevers in humans

Institut de Recherche pour le Epidemiology:malaria transmission intensity and clinical ORSTOM (IRD)Développement (IRD) (Formerly incidence;population genetics of P. falciparum; vector Institut PasteurORSTOM) Dakar, Senegal (n = 21) behaviour and transmission French Ministry of Cooperation

Studies of malaria mosquito vectors:ecology and population genetics

College of Medicine,University of Clinical management of malaria and antimalarial WHOMalawi,Blantyre,Malawi (n = 20) drug trials CDC

Intervention trials and health services research: USAIDeconomics of malaria controlMalaria in pregnancy:epidemiology of infection;intervention trials, health services research, including maternal practices

Albert Schweitzer Hospital, Antimalarial drug trials: combination chemotherapy TDRLambarene,Gabon (n = 18) using antimalarials with antibiotics DAAD

Pathophysiology:TNF and nitrogen oxides with severe German Academy of Sciencessymptoms and rapid clearance

Ministry of Health, Lilongwe/Blantyre, Intervention trials and CDC,USAIDMalawi (n = 18) health services research Malawian Government

KEMRI,Kisumu,Kenya (n = 17) Epidemiology: mosquito behaviour and ecology in KEMRIrelation to malaria transmission CDCIntervention trials:mosquito vector control US DOD(repellents; ITNs) TDRMolecular biologyStudies of malaria mosquito vectorsClinical management of malaria and antimalarial drug trialsImmunology: immune responses to and characterization of P. falciparum antigens

University of Abidjan, Ivory Coast (n = 15) Antimalarial drug discovery and development: testing TDRof plant extracts and evaluation of naphthylisoquinoline DFGalkaloids in vitro and in animal models Fonds der Chemischen Industrie

Prince Leopold Institute

Ecole Nationale de Medecine et de Epidemiology: seasonality and intensity of transmission, NIAIDPharmacie (ENMP),Bamako,Mali (n = 14) including vector studies;drug resistance USAID

Health services research:prophylaxis CIBA-GeigyStudies of mosquito vectors of malaria:vector population geneticsDrug resistance studies:epidemiology and genetics

University of Witwatersrand, Antimalarial drug discovery and development: iron South African MRCJohannesburg, South Africa (n = 12) chelators in malaria therapy and pharmacokinetics of Food and Drug Administration (FDA)

antimalarial drugs CIBA-GeigyStudies of malaria mosquito vectors: mosquito genetics

Centre National de Lutte contre le Studies of malaria mosquito vectors:molecular biology Burkina-Faso GovernmentPaludisme (CNLP),Ouagadougou, and genetics; characterization of mosquito behaviour TDRBurkina-Faso (n = 11) European Commission

University of Khartoum,Sudan (n = 10) Epidemiology:parasite population genetics and TDRepidemiology of unstable malaria transmission DANIDAImmunology:antibody responses to parasite antigens Sudan Governmentand links with disease symptomsDiagnostic tests: infection markers

*See page 8 for key to abbreviations for funding organizations


were actively engaged in epidemiological stud-ies, intervention trials or health services research.A high proportion of centres was also involvedin mosquito vector studies although the overallpublication output in this area was relatively low(7 per cent of total). Half of the centres pub-lished in clinical management of malaria andantimalarial drug trials, while two centres pub-lished basic studies of biochemistry, genetics andmolecular biology.

Analysis of sources of funding for the toppublishing institutes illustrated the substantialinvolvement of external funds in supportingproductive research programmes. Many fundingagencies focus support on specific centres. Forexample, French funding bodies (IRD, InstitutPasteur and the French Ministry of Coopera-tion) focus primarily on centres in FrancophoneAfrica, and tend not to co-fund with organiza-tions from other European countries or theUSA. USAID and CDC tend to fund institutesconcerned primarily with health servicesresearch and intervention trials, reflecting theirmore applied missions.

3.3.6 Impact of researchAfrican malaria research publications have alower mean potential impact (W = 1.67) com-pared with the international set of publications(W = 1.92). This is not unexpected, however, inview of the significantly more clinical nature ofAfrican malaria research compared to interna-tional research and the observation that clinicaljournals generate fewer citations (Dawson et al.,1998). The clinical nature of African malariaresearch is evidenced by two types of data.Firstly, the set of African papers was published inmore clinical journals, having a mean researchlevel value (RL) of 2.24 compared with a valueof 2.89 for the international set (RL1 = mostclinical, RL4 = basic science). Secondly, subfieldanalysis showed that 81 per cent of Africanpapers describe studies of malaria in humans,whereas the equivalent figure internationally was46 per cent.


Table 3.5 References in national malaria guidelines and policies.

Country Title Total no. of No. of published References to in- References to References references papers* country research WHO publications < 5 years old

Kenya National guidelines for 7 0 4 (57%) 2 (29%) 6 (86%)diagnosis, treatment and prevention of malaria for health workers

South Africa Guidelines for the 13 6 (46%) 5 (28%) 1 (8%) 10 (77%)prophylaxis of malaria

South Africa Guidelines for the 25 13 (52%) 6 (24%) 6 (24%) 19 (76%)treatment of malaria

Senegal Programme de lutte 62 0 62 (100%) 1 (2%) 17 (27%)contre le paludisme du Senegal

Zimbabwe National malaria control 5 0 4 (80%) 1 (20%) 2 (40%)programme five year plan (1994–1998)

Nigeria National malaria control 5 0 4 (80%) 1 (20%)programme plan of action 1996–2001

Tanzania Plan of action 11 0 10 (91%) 1 (9%) 11 (100%)1997–2000 of the National Malaria Control Programme

*Scientific papers in peer-reviewed literature


3.3.7 Malaria guidelines and policiesIn order to assess the degree to which researchstudies influence policy and practice in malariatreatment and control, ministry of health guide-lines and policies for malaria from 11 Africancountries were examined.

Table 3.5 summarizes the studies cited inthese policies and guidelines (see Annex 5 forfull titles). Only two countries, Kenya andSouth Africa, included a comprehensive refer-ences list in their guidelines. Senegal includedspecific references in the text of guidelines, butno bibliography; whereas guidelines fromNigeria, Tanzania and Zimbabwe referred tostudies and research, without citing specific ref-erences. Policies from Namibia, Ghana, Zambia,Uganda and Malawi included non-specific refer-ences to in-country operational research studiesand projects, mainly relating to drug resistancetesting and epidemiological studies. Grey litera-ture and local research featured prominently inthe malaria guidelines examined. Of the 45 ref-erences in the Kenyan and South African malar-ia guidelines, only 20 (42 per cent) were publica-tions in peer-reviewed research journals, and 15(33 per cent) referred to local research. WhenSenegal, Zimbabwe, Nigeria and Tanzania areincluded in the analysis, 85 of the 128 references(66 per cent) cited in guidelines and policieswere to research papers and studies of local ori-gin. Fifty-one percent of the references were topapers and studies less than five years old andWHO publications constituted 10 per cent ofthe references in the guidelines and policies.

Despite the lack of a formal references sec-tion, the Malawi guidelines clearly refer to oper-ational research which has affected policy. Theexperience of Malawi in changing from chloro-quine to sulphadoxine-pyrimethamine for firstline treatment of malaria has become a ‘bench-mark’ in the development of malaria treatmentpolicies for other countries in the region.Similarly, the references in the South Africanguidelines reflect the close working relationshipbetween the South African Medical ResearchCouncil and the Ministry of Health.

The clinical or basic nature of the 45 refer-enced papers was characterized by analysing thedistribution of the papers across different jour-nal types. The average research level (RL) of thecited papers in the African guidelines was 1.6,with over half in level 1 (clinical) journals, indi-

cating the strongly clinical nature of the citedpapers. This is significantly lower than the meanRL for African malaria papers 1995–97 at 2.24.Similar analysis of available WHO malaria pub-lications referenced in the guidelines revealedthat the majority of cited papers were also pub-lished in clinical journals.

3.4 SUMMARY ANDDISCUSSION

Bibliometric analyses were based on publica-tions recorded in MEDLINE and SCI between1995 and 1997. These analyses provided insightinto the publications performance of Africancountries in malaria research in the context ofworldwide productivity, based largely on inter-national peer-reviewed journals. The use ofMEDLINE in addition to SCI allowed greatercoverage of clinical and field-based research, andalso of non-English language journals and jour-nals from malaria-endemic regions. It should benoted, however, that the contribution of localgrey literature could not be accurately assessed,as this literature is not recorded comprehensivelyin any current database. To gain some insightinto local research that might be influencingclinical practice in malaria-endemic countries, acomplementary analysis of African malaria guide-lines and policies was carried out.

Publication outputsThe number of malaria publications worldwidewas small relative to other areas of biomedicalresearch and in relation to the high global bur-den of disease from malaria. On average 1070papers were produced per year between 1995 and1997 (SCI and MEDLINE), with no markedtrend in output apparent over the time periodassessed. By comparison, publications relating totuberculosis increased from 1078 in 1991 to1521 in 1998 (MEDLINE), thus overtakingmalaria research outputs.

Malaria research represented an importantproportion of tropical medicine research (21 percent of global output), but did not competestrongly with other areas of biomedical research,accounting for just 0.3 per cent of all publica-tions recorded in SCI. By comparison, a recentreview indicated that publications on arthritisand rheumatism accounted for 2.4 per cent of



world biomedical publications in 1995, and car-diology research papers constituted 10.2 percent of the world biomedical total in 1995 (SCIdatabase, Dawson et al., 1998).

The USA followed by the UK and Francewere the highest contributors to global malariapublications, although the influence of the USAhas decreased in recent years. African scientistsand research institutes make a major contributionto the field of malaria research, participating in17.2 per cent of the world publications output.This figure is particularly striking when com-pared with the very low overall African biomed-ical research output (1.2 per cent of world total).

Analysis of author addresses allowed identifi-cation of the highest publishing countries andinstitutes in Africa. Nine countries producedmore than 25 publications in 1995–97, whileseven research centres published more than 20papers. The most active malaria research centreswere based in East and West Africa, but very lit-tle research activity was found in Central andSouthern Africa, apart from South Africa.

The distribution of active research centresacross Africa may reflect differences in malariaendemicity and transmission intensity, withfewer resources being committed to malariaresearch in areas of lower transmission.However, investment by external funding organ-izations, national government commitment toscience and education, and political stability arealso likely to be major factors influencing levelsof research activity. South Africa, Nigeria andKenya train the highest absolute numbers of stu-dents at universities and polytechnics of all theAfrican countries (for which data are available),and also rank in the top five for the numbers oftertiary students per 10 000 population (1991figures, UNESCO, 1998). These figures indi-cate that educational base is probably an impor-tant factor contributing to the observed researchstrengths in these countries. Conversely, verylow numbers of students from Malawi andTanzania are trained at university level suggest-ing other factors are likely to be important inbuilding successful research programmes inthese countries.

Analysis of funding acknowledgements onpublications clearly demonstrates the majorinput from external funders in supportingresearch at the top publishing research centres.Many funders focus their support on specific

centres over a long time period: for example theUK Medical Research Council has supportedthe MRC Laboratories in The Gambia for over50 years, the Wellcome Trust supports pro-grammes in collaboration with KEMRI inNairobi and Kilifi, IRD supports institutes inSenegal and Cameroon, and the Swiss TropicalInstitute has provided long-term support for theNational Institute for Medical Research inIfakara, Tanzania. This sustained funding fromexternal sources undoubtedly has an importantimpact on the productivity of research pro-grammes, but country-specific factors such asexisting commitment to research and politicalstability are important criteria in the selection ofsites for investment of resources.

Collaboration patternsAfrican malaria publications have a very highlevel of international co-authorship. Links withresearchers in Europe are most common, whilecollaborations between African countries arerare. Collaborations tend to be polarized betweenspecific countries: for example there is little over-lap in the African countries collaborating withthe UK and with France. The low co-authorshipacross Africa is likely to be a reflection of poorcommunication links, language barriers and alack of funding mechanisms to support trans-African collaborations.

International scientific partnerships betweenAfrican researchers and colleagues international-ly play an important role in maximizing the pro-ductivity of global research and buildingresearch expertise in Africa. Tropical medicineresearch in general exhibits a high level of inter-national collaboration, probably reflecting theneed for strong links between basic research in‘Northern’ laboratories and applied clinical andfield studies in disease-endemic countries.Nevertheless, the particularly extensive interna-tional co-authorship observed for African malar-ia research publications also reflects a depend-ence on external funding sources and substantialinvolvement of external scientists in designingand executing research programmes in someAfrican institutes.

The present study did not attempt to assesssystematically the relative contributions ofAfrican nationals and expatriate scientists toAfrican publication outputs, for example throughcounting the proportion of papers with African



first authors. However, superficial inspection ofauthor names confirmed that many Africanaddresses were associated with expatriate scien-tists. A recent study found that 28 per cent of theresident scientists working on malaria in Kenya in1998 were non-African nationals (Snow et al.,1998), while in the present study 15 per cent ofscientists surveyed in malaria research laboratoriesacross Africa were non-African (Chapter 4). Theproportion of expatriate scientists, however, variesconsiderably in different countries and institutes,and again this was evident from inspection ofauthor names on publications from a variety ofinstitutes. Nigeria and South Africa, particularlythe Universities of Ibadan and Witwatersrand,were notable in producing a large proportion ofpapers that did not involve any external collabora-tions or input from expatriate scientists. This highdegree of self-reliance is likely to be linked in partto the fact that South Africa and Nigeria not onlyhave the highest number of students trained totertiary level, but over 98 per cent of these aretrained at home. By comparison, Tanzania, Kenyaand Cameroon respectively train 42, 20 and 25per cent of tertiary students overseas (1985–92figures, UNESCO, 1998). Enforced isolation dur-ing apartheid is likely to be another contribtoryfactor to South Africa’s lower collaboration rate.

Funding sourcesAnalysis of funding acknowledgements on publi-cations revealed that a broad range of organiza-tions support malaria research, with some beingmore prominent in the international set ofpapers and others featuring more strongly in theAfrican papers. The results were able to indicateimportant contributors to malaria research fund-ing, although they could not provide an accuratemeasure of the magnitude of financial support.

TDR followed by the Wellcome Trust werethe two organizations most commonly cited assources of funding for both the internationaland African sets of papers. The percentage shareof TDR has, however, decreased since an earliersurvey of 1984, 1989 and 1994 papers, whilethe shares of the Wellcome Trust and theEuropean Commission have both increased.Some African government agencies featured inthe funding of malaria research, most notablythe Kenyan Medical Research Institute. Onlytwo commercial companies were identified assupporting malaria research in Africa.

Research subfieldsSubfield analysis demonstrated that research inAfrica focuses primarily on clinical and fieldstudies with practical applications in Africa.Outputs from basic science studies of the malari-al parasite were very low. Examination of thepublications of individual institutes across Africaprovided an important insight into the researchspecializations of these centres. The results, how-ever, reflect research carried out prior to 1997and as such are not necessarily an accurate viewof current studies.

Impact of malaria researchAfrican publications had a lower potential cita-tion impact than the international set of papers.However, standard citation indices are measuresof the impact of research on the scientific com-munity and they are positively correlated withresearch that is more basic in nature. Africanmalaria research is therefore intrinsically disad-vantaged in this type of assessment due to itshighly clinical character. Alternative approachesare required to assess the impact of medicalresearch, particularly more applied and clinicalresearch, on health policy and practice, or onpopulation health status.

The current study examined national malariaguidelines and policies for the treatment andcontrol of malaria from a sample of Africancountries to assess links between scientificresearch and policies. The usefulness of thisapproach was, however, limited by the lack of asystematic approach to citing scientific literaturein the documents examined. Nevertheless, sometentative conclusions can be drawn on the basisof the limited information obtained. Firstly, justover half of the references in guidelines were tostudies less than five years old, indicating thatpolicies are being informed by recent research.Furthermore, in-country research, often record-ed in grey literature, was most frequentlyreferred to, and references to international stud-ies in peer-reviewed journals were less promi-nent. The influence of local research on healthpolicies was also observed in a study of 15British clinical guidelines, where 33 per cent ofthe cited papers were published by UK authors,over three times the British share of internation-al biomedicine publications (Grant, 1999).However, 96 per cent of papers cited in bibli-ographies in the UK clinical guidelines were



from research journals, contrasting with the situ-ation in Africa where references to grey literaturewere more common. The studies referenced inAfrican guidelines tended to be clinical innature, with few references to basic science, andthis was also the case for the UK clinical guide-lines. WHO documents constituted 10 per centof the references in African guidelines and poli-cies, indicating the importance of WHO as asource of high-quality and readily available tech-nical material.

The observed significant role of local andclinical research in determining health policyformulation in Africa and elsewhere is an argu-ment that might favour investment in the localresearch base in individual countries, and main-tenance of strong clinical science research inorder to achieve a direct impact on health.

The development of health policies and guide-lines is a complex process requiring the involve-ment of many different individuals and organiza-tions. A range of factors will therefore influencethe choice of information sources used in policyformulation. The observed dependence on localand grey literature in Africa may in part reflect thelack of availability of international scientific liter-ature to policy makers. However, a more signifi-cant factor may be the importance assigned tolocally relevant studies, and perhaps the difficultyin publishing this type of research in internationaljournals. A substantial amount of scientific mate-rial is contained in local conference and meetingreports, non-governmental organization (NGO)survey material and ministry of health reportswhich are not recorded in any major databases,and are therefore not easily accessible to theworldwide scientific community. These sourcesare often not subject to peer review, but neverthe-less comprise a significant body of knowledge,which is likely to be important in the develop-ment of local policies.

The infrequent use of peer-reviewed litera-ture in policy formulation in African healthguidelines may also reflect a lack of a strongresearch culture in the circles responsible for pol-icy development, and a broader need for moreopen dialogue between research and controlcommunities. Early involvement of ministries ofhealth in research programmes can informresearch design and objectives, and is more likelyto lead to prompt and efficient incorporation ofresults into policy. Greater access of ministries of

health to internationally published researchresults would facilitate the process by whichresearch results influence practice. The use ofnon-peer-reviewed literature in policy formula-tion raises potential concerns regarding the lackof a mechanism to assure the quality of theresearch results.

With the limited availability of resources forsupport of scientific research activities there is anincreasing need to measure the productivity ofscientists and the impact of their research.Standard bibliometric citation techniques aremore suited to measuring the impact of basicresearch in advancing scientific knowledge andare less appropriate for assessment of the impactof more clinical and applied research. Despitethis, there is a dependence of funding organiza-tions on high-profile publications for evaluatingresearch productivity in all fields. This approachwill tend to favour basic scientists in competi-tion for funds and potentially discourageresearchers from working in more appliedresearch areas, even though these areas are essen-tial to achieve an ultimate impact on health.Alternative methodologies are therefore requiredthat can provide a rational basis for investmentin research that has the potential to influenceevidence-based medicine and approaches to dis-ease control.

Assessment of the degree of incorporation ofscientific research into national health policiesand guidelines could potentially provide an effec-tive and important method of evaluating researchimpact on healthcare and disease control prac-tices. However, the format of national guidelinesmust include detailed bibliographies for accurateanalysis of the information guiding policies.



4

4.1 METHODS

A questionnaire was designed for the MIM sur-vey concerning research capacity in Africanmalaria research centres. In developing the ques-tionnaire, two pre-existing sources of informa-tion were taken into account:• the 1997 Directory of the African Malaria

Vaccine Testing Network (AMVTN),1 whichpresents information on 30 malaria researchinstitutions from 20 African countries;

• the ‘Inventory of Resources and Activities’,produced for the International Conferenceon Malaria in Africa, held in Dakar, Senegal,1997,2 which presents summary informationon 41 research groups in Africa.

The MIM survey aimed to build upon andextend these two reports, rather than to dupli-cate them. Some elements of the AMVTNDirectory were incorporated into the MIM sur-vey to increase coverage of data. In addition,some analyses were not restricted to MIM surveyresults, but were based on data from the two pre-existing reports.

The questionnaire comprised two sections(Annex 8). The director of the research programmewas asked to complete section A of the question-naire, and to distribute section B to all membersof staff educated to at least first-degree level.

Section A requested summary informationon the research group:• the number of researchers in the group;

• the proportion of time spent on malariaresearch;

• the research expertise within the group,including the number and qualifications ofindividuals trained in different disciplines;

• the research grants held by the group during1993–98.

Section B sought information on the careerpaths of individual researchers and the opinionsof these researchers on effective approaches todevelop research capacity in Africa. Details wererequested from researchers on:• current employment position, including

sources of support for salary and research;• all scientific training undertaken, including

location and source of funding;• difficulties experienced during their research

careers and potential solutions to identifieddifficulties;

• optimal mechanisms to build research capacity.

Malaria research laboratories in Africa wereidentified from the AMVTN and Dakar directo-ries, analysis of malaria publications (Chapter3), and lists of African delegates at recent malariaconferences. Questionnaires were sent by post,fax and e-mail, depending on the availablemodes of communication, to 52 senior scientistsleading malaria research programmes at 45 insti-tutions in Africa. Questionnaires were sent inEnglish or French according to the predominantlanguage of the research programme.

In the previous chapter, analysis of publications outputs provided a powerful andrelatively straightforward method to characterize a range of different aspects ofmalaria research activity in Africa. This approach, however, is necessarily retrospectiveas it generally reflects research carried out in the few years prior to the publicationdate. It also cannot provide more detailed insight into the human resources andinfrastructure in African research centres. This chapter therefore takes an alternativeapproach, a questionnaire-based survey, to obtain information directly from malariaresearch groups currently active in Africa. The survey gathered information onongoing and past research projects, the expertise and training paths of African malariaresearchers, field and laboratory facilities and sources of funding. It also provided anopportunity for African scientists to express their opinions and experiences ondifficulties in pursuing a career in science and on potential solutions to buildingsustainable research activity in Africa. The bibliometric analysis and the survey ofresearch centres are complementary approaches, which together provide a detailedpicture of the current status of malaria research capacity in Africa.

Malaria research capacity in Africa

1www.amvtn.org

2www.niaid.nih.gov/

dmid/malafr/default.htm


4.2 RESULTS

The results presented in this chapter are derivedfrom the data collected during the MIM survey,with three exceptions. The analysis of researchexpertise used data collected from the MIM sur-vey combined with data from the AMVTNdirectory; the analysis of laboratory facilities wasbased on data from the AMVTN and Dakardirectories; while the analysis of the epidemio-logical conditions at field research sites used datafrom the AMVTN Directory.

Contact details for malaria research groupsare shown in Annex 12.

4.2.1 Overview of research groups

Survey respondentsMore than three-quarters of the research pro-gramme leaders contacted participated in theMIM survey. The respondents comprised 48research groups based at 40 institutes in 19African countries, mainly in East and WestAfrica (Figure 4.1, Annex 9). Information onadditional groups was obtained from theAMVTN Directory, such that the total data setincluded 54 groups in 22 countries.

The sample group included 13 of the 18 toppublishing African malaria research centres iden-tified from the bibliometric analysis (Chapter 3).It should be noted that the concept of a ‘researchgroup’ or ‘centre’ was difficult to define due tothe widely varying situations in different researchinstitutes and the added complication of collabo-rations or formalized links between institutes(e.g. a university and the Ministry of Health).Interpretation of results was standardized as far aspossible, but some variation is inevitable. In gen-eral, the returned questionnaires were completedin full by researchers, although there were somegaps and omissions.

The questionnaire responses confirmed thatmalaria was the major topic of investigation: 34of the 48 groups devoted more than 50 per centof their time to malaria research.

Laboratory facilitiesA summary of the equipment and facilities inAfrican laboratories was produced using datafrom the AMVTN and Dakar directories. Thisanalysis provides an overview of the facilitiespresent in African research institutions at thetime of survey (1996–97), although it cannotindicate the quality or functionality of equip-ment. Owing to variation in the response ratesto individual questions, the sample size for thisanalysis ranged from 35 to 39 research groupsand institutes. All research institutions thatresponded had access to telephone, fax and com-puting facilities, with 91 per cent reporting e-mail connections. Core laboratory facilities(freezers, centrifuges, incubators and micro-scopes) were present in over 90 per cent ofresearch laboratories, and around 80 per centwere equipped with ELISA readers and laminarflow hoods. More specialized facilities such as gelelectrophoresis equipment and PCR machineswere present in 76 per cent and 58 per cent oflaboratories respectively. All laboratories thatresponded had at least one four-wheel drivevehicle for field work.

Malaria research capacity in Africa4


Malaria research capacity in Africa 4

Figure 4.1 Malaria research groups participating in the MIM survey or included in the AMVTN directory.

Groups from the AMVTN directory are shown in brown

(n) = Number of responding scientists per country

Senegal: 6 groups (32)

The Gambia: 1 group (10)

Burkina-Faso: 2 groups (12)

Ivory Coast: 2 groups (22)

Ghana: 3 groups (25)

Benin: 1 group (2)

Cameroon: 5 groups (47)

Gabon: 2 groups (5)

South Africa: 4 groups (15)

Madagascar: 2 groups (11)

Malawi: 2 groups (7)

Zambia: 1 group

Tanzania: 3 groups (15) 1 group

Kenya: 4 groups (36) 1 group

Uganda: 1 group (8)

Ethiopia: 2 groups (11)

Sudan: 2 groups (9) 1 group

Nigeria: 4 groups (27)

Niger: 1 group (8)

Mozambique: 1 group

Zimbabwe: 1 group (9)

Togo: 1 group

Additional data on six

research groups from the

AMVTN directory (shown in

brown) were included in the

analysis of research expertise

(Annex 9).Two questionnaires

were completed by African

researchers working overseas.



Table 4.1 Malaria epidemiology at African research sites (summarized from AMVTN Directory).

Country Institution Seasonality (1–4 % Anopheles Infective bites year age group) Prevalence vectors per person per year

Benin Regional Center for Entomological 12/12 67 gambiae s.s. 51–100Research of Cotonou melas

Burkina-Faso Centre National de Lutte contre 12/12 92 gambiae s.l. 101–300le Paludisme,Ouagadougou funestus

Burkina-Faso Centre MURAZ,Bobo Dioulasso 12/12 gambiae s.l. >300funestus

Cameroon L’Organisation de Coordination pour la Lutte 12/12 90 gambiae s.l. 51–300contre des Endémies en Afrique Centrale funestus(OCEAC),Yaoundé

Ivory Coast Pierre Richet Institute,Bouaké >6/12 10 gambiae s.l.funestus

Ethiopia Jimma Institute of Health Sciences >6/12 6 gambiae s.l.Gabon Centre International de Recherches 12/12 gambiae s.l. 51–100

Medicales de Franceville funestusThe Gambia UK MRC laboratories:Basse field station >3–6/12 30 gambiae s.l.The Gambia UK MRC laboratories: Fajara >3–6/12 34 gambiae s.l. <1Ghana Navrongo Health Research Centre 12/12 85 gambiae s.l. >300

funestusGhana Noguchi Memorial Institute for Medical 12/12 50 gambiae s.l.

Research,Legon pharoensismelas

Kenya Division of Vector Borne Diseases,Nairobi 12/12>6/12

3–6/12Kenya KEMRI–Wellcome Trust Collaborative 12/12 47 gambiae s.l. 21–50 (2 district zones)

Programme,Kilifi funestus 51–100Kenya Vector Biology and Control Research Centre 12/12 90 gambiae s.s.

Kisumu arabiensis funestus

Mozambique Instituto Nacional de Saude,Maputo 12/12 70 gambiae s.l. 6–20funestus

Niger Research Center for Meningitis 12/12 74 gambiae s.l.and Schistosomiasis,Niamey

Nigeria Cellular Parasitology Programme, 6/12 >300University of Ibadan

Senegal Institut de Recherche pour le <3/12 90 gambiae s.s. 6–20Développement-Dakar arabiensis

Senegal Institut Pasteur de Dakar 12/12 95 gambiae, 101–300funestus

South Africa National Malaria Research Programme, arabiensis <1 (due to low incidence)Medical Research Council,Durban

Sudan Faculty of Medicine,University of Khartoum 3–6/12 16 arabiensis <1Sudan Blue Nile Research and Training Institute <3/12 arabiensisTanzania Amani Medical Research Centre 12/12 90 gambiae s.s. >300

funestusTanzania Ifakara Health Research and Development Centre 12/12 92 gambiae s.l. >300

funestusTanzania Institute of Public Health,Dar es Salaam 12/12 80 gambiae s.s. >300

gambiae s.l.funestus

Togo National Malaria Control Programme (MOH), 12/12 gambiae s.l.Lomé melas

funestusUganda Med Biotech Laboratories,Kampala 12/12 85 gambiae s.l.

funestusZambia Tropical Diseases Research Centre,Ndola 12/12 78 gambiae s.l.

funestusZimbabwe Blair Research Institute,Harare 12/12 10 gambiae s.s.

arabiensisfunestus


Malaria epidemiology characteristicsData from the AMVTN Directory were analysedto characterize malaria epidemiology at differentfield research sites. The results are summarized inTable 4.1. Data were available for 29 centres(which covered 14 of the top 18 publishing cen-tres identified in Chapter 3), and encompassed32 different field study areas. The sites cover abroad spectrum of malaria endemicities and vec-tor systems. Plasmodium falciparum is the princi-pal human parasite at all sites although varyinglevels of other parasites were also reported. Forexample, P. vivax is prominent in Ethiopia.

Research fundingResearch funding was investigated by analysis oftwo types of data collected from the question-naire: research grants held by programme direc-tors during 1993–98 (Section A), and fundingacknowledgements for current research supportlisted by individual respondents (Section B).Summaries of both sets of data are presented inTable 4.2. The data provide an indication of thelevel of support from different funding organiza-tions for malaria research in Africa, althoughseveral points should be noted:• The analysis of research grants does not pro-

vide information on the magnitude of thevarious awards, which may vary considerably.For example, a single grant to provide majorsupport for a research institute would not beadequately represented when compared to alarge number of smaller awards to a variety ofinstitutes.

• Although the coverage of laboratories acrossAfrica was generally high, gaps in data mayhave led to under-representation of somefunding organizations, particularly if fundsare directed to a specific centre that did notparticipate in the survey.

A total of 284 grants were reported by thedirectors of 46 research groups in the responsesto Section A of the questionnaire, and 225researchers (African and non-African) provideddetails of their research funding in Section B.The research topics listed on awards were consis-tent with the malaria publications output fromAfrica (Chapter 3), with the majority of grantssupporting studies in clinical medicine, epi-demiology, intervention trials and health servic-es research. Sixteen per cent of awards supportedresearch on subjects other than malaria.

The sources of support for African malariaresearch were many and diverse (Table 4.2,Annex 10). The majority of research fundingcame from organizations based outside Africa,particularly from European sources, with only 9per cent of research grants and 21 per cent ofindividual funding acknowledgements listing anAfrican governmental or other local source.Nevertheless, local funding was still the mostfrequently acknowledged single category of sup-port for individual researchers. In terms ofresearch grants, TDR emerged as the most fre-quently acknowledged funder, accounting for 20per cent of all grants. A third of awards overallwere from a WHO programme. Commercialcompanies made a relatively low, but significantcombined contribution, accounting for 6 percent of research grants. Although the numbers ofgrants and funding acknowledgements cannotgive an accurate measure of the relative levels ofinvestment by different organizations, the resultsclearly identify those organizations makingmajor contributions towards supporting themalaria research base in Africa.



Research collaborationsInformation on the research links of Africanlaboratories was obtained by analysis of statedcollaborations on research grants. One-third ofawards involved a research collaboration, withEuropean countries being the most frequentcollaborators (Table 4.3). Collaborations acrossAfrica accounted for 16 per cent of the total.

Research expertiseOverview data of research groups completed inSection A of the MIM questionnaire wereanalysed together with AMVTN data to assessthe number of individuals trained to differentdegree levels in particular disciplines (Figure4.2). In total, 752 individuals qualified to atleast first-degree level were identified as beingactively involved in research programmes in thegroups surveyed (AMVTN and MIM survey):


Table 4.2 Sources of funding for African malaria research laboratories.

Funder Research grants held Funding acknowledgementsby African laboratories for current research from(1993–98) individual respondents

UNDP/World Bank/WHO 61 80Special Programme for Research and Training in Tropical Diseases (TDR)*

French Ministry of 33 26Cooperation

World Health Organization (WHO)* 25 31

Local sources† 24 94

Wellcome Trust 20 20

European Commission 17 25

Pharmaceutical companies/ 16 13industrial sources

Agence universitaire de la Francophonie 9 8(AUPELF–UREF)

Institut Pasteur 8 15

Danish International Development 7 14Agency (DANIDA)

International Development 6 6Research Center,Canada

UK Department for International 5 4Development

US National Institutes of Health§ 5 17

Institut de Recherche pour le 1 22Développement (IRD)

Others 47 78

Total 284 453

*Research grants specifically acknowledging the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases(TDR) were analysed separately from other acknowledgements to the World Health Organization (WHO)

† Awards from governments of developing countries and other local sources were classified together under the heading ‘Local sources’

§ Awards from the various institutes of the US National Institutes of Health were pooled for analysis


26 per cent to PhD level, 35 per cent to Master’slevel and 17 per cent to Bachelor’s degree level.Clinically qualified individuals accounted for 22per cent of the total. Full differentiation ofAfrican and non-African scientists was not possi-ble, but available data showed that there wassubstantial representation of expatriate scientistsin some centres, while others were entirely com-posed of African nationals. About a third ofresearch groups were led by overseas scientists.

The majority of research groups appeared tobe multidisciplinary, with expertise in a range ofdifferent research skills. The broad research areasof parasitology and public health were moststrongly represented, with more than 130 trainedpersonnel in each category. The disciplines ofepidemiology, immunology, entomology andbiochemistry also showed relatively high levels ofoverall expertise. In contrast, few individualsreported training in biostatistics, sociology and


Table 4.3 Regional breakdown of stated collaborations on research grants.

Geographical region Number of collaborations on research awards

Europe 81

Same African country 39

Other African country 25

USA 11

Asia 1

Figure 4.2 Research expertise in African malaria research laboratories and institutions.

Number of individuals per

discipline identified from the

MIM survey and AMVTN

Directory.Total number of

individuals identified = 752. 0 10 20 30 40 50 60

Bachelor’s (n = 127)

Master’s (n = 265)

PhD (n = 192)

Clinician (n = 168)

Parasitology

Public health

Epidemiology

Immunology

Entomology

Biochemistry

Molecular biology

Biostatistics

Sociology

Economics

(n = 145)

(n = 132)

(n = 88)

(n = 88)

(n = 87)

(n = 75)

(n = 52)

(n = 37)

(n = 36)

(n = 12)

Number of awards that listed collaborations = 99 Total number of collaborations listed = 157

Number of individuals


economics. Postdoctoral scientists were mostnumerous in parasitology, immunology, ento-mology and biochemistry, with each categoryhaving 30–40 researchers trained to PhD level.More than 50 scientists with expertise in molec-ular biology were also identified, a high propor-tion of these at postdoctoral level. Master’s qual-ifications predominated in parasitology, whereasclinically qualified researchers were most com-mon in public health and epidemiology.

4.2.2 Profile of malaria researchers

Research qualificationsA total of 313 scientists, of whom 85 per centwere African nationals, completed individualSection B questionnaires. This number is lessthan half the number of researchers reported bygroup leaders to be engaged in research in thecentres surveyed (see Figure 4.2). Hence, thecoverage in this survey was not comprehensive.In certain cases, individuals were unable to com-plete questionnaires as they were undergoingtraining outside their home institute. Neverthe-less the data provide some important insightsinto existing research capability and the trainingpaths of scientists in African research centres.

Researchers at all stages of career progressionwere represented in the sample of respondents,with postdoctoral researchers and PhD studentsconstituting the largest group of Africanresearchers: 37 per cent in total (Table 4.4). A

large proportion of respondents held more thanone higher degree for example 84 per cent ofpostdoctoral researchers also held a Master’sdegree, and 44 per cent of clinicians held addi-tional PhD, MD or Master’s qualifications.

Current positionSixty-four per cent of African survey respondentsheld a permanent position of employment.Researchers employed on temporary contractswere predominantly junior scientists. Salary pro-vision was mainly from within Africa: 68 percent of African researchers received a salary fromthe national government or other local source.Salary provision from external sources tended tocome from organizations providing substantialsupport to specific research centres in Africa,namely Institut de Recherche pour leDéveloppement (IRD), the Wellcome Trust,Institut Pasteur, the US Centers for DiseaseControl and the UK Medical Research Council(Figure 4.3).

Training paths of African researchersThe majority of African scientists (90 per cent)completed their Bachelor’s degree in Africa, with52 per cent funded by national governments, 29per cent self-financed and 3 per cent funded byan organization based outside Africa. Manymore researchers (54 per cent in total) complet-ed postgraduate training outside their homecountry (Figure 4.4): 28 per cent in Europe, 11


Table 4.4 Survey respondents according to nationality and highest qualification obtained.

Research level Number of respondents (% of total for each group)

African non-African

Bachelor’s 42 (16%) 2 (4%)

Master’s students 12 (5%) 0

Master’s 50 (19%) 4 (9%)

PhD student 24 (9%) 2 (4%)

Postdoctoral 74 (28%) 16 (34%)

Clinician* 59 (22%) 23 (49%)

Diploma/certificate 2 (1%) 0

Total 263 (100%) 47 (100%)

*Clinicians with higher degrees (44 per cent of total) are included in this categoryThree additional African respondents could not be classified due to incomplete information

per cent in another African country, 10 per centin the USA or Asia, and 5 per cent in a combina-tion of their home country and a second location(usually Europe or the USA). However, varia-tions in patterns of training were evident for dif-ferent countries. For example, more than 80 percent of respondents in Nigeria and South Africaconducted postgraduate training in the homecountry. Similarly, a high proportion of respon-

dents in Cameroon and Senegal conducted train-ing in Africa (in the home country or anotherAfrican country). In contrast, the majority ofTanzanian respondents completed postgraduatetraining outside the home country, mainly inEurope or in another African country. These dif-ferences may reflect the educational facilitiespresent in each country, and/or established linkswith researchers or institutes outside Africa.



Home government

Not specified

Institut de Recherche pour le Développement (IRD)

Wellcome Trust

Institut Pasteur

Self

US Centers for Disease Control and Prevention (CDC)

UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR)

US National Institutes of Health (NIH)

Others*

0 50 100 150

Number of respondents

Figure 4.3 Salary/stipend provider for African researchers (n = 278).

Figure 4.4 Location of training for African scientists.

Bachelor’s (n = 241) Master’s (n = 164) PhD (n = 104)

90

80

70

60

50

40

30

20

10

0

Home country

Other African country

Europe

USA

Asia

Home country and second location

*Organizations that received

fewer than five

acknowledgements are

classified as ‘Others’.

Percentage of total


Funding for postgraduate training was main-ly from external sources, particularly wheretraining was conducted outside Africa: 65 percent of funding acknowledgements were toorganizations based in developed countries atPhD level and the equivalent figure at Master’slevel was 46 per cent. African governmentalsources were still the highest single contributorto postgraduate training, accounting for 23 percent of funding acknowledgements in total(Table 4.5). TDR was the second most frequent-ly acknowledged funder, while IRD and theFrench Ministry of Cooperation were alsoprominent supporters of postgraduate studies inthe sample analysed. However, it was evidentthat there were many diverse funding organiza-tions that contributed to research capacity build-ing in Africa (Annex 11). It was also observedthat a high proportion of African scientists fund-ed their own studies at all levels of training.

4.2.3 Training needs and solutions:an African perspective

A total of 244 researchers (African and non-African) completed the opinion survey inSection B of the questionnaire. The responsesrepresent the personal views of a diverse group ofmalaria researchers in Africa on research capacitystrengthening. The following section presentsthe questions posed to researchers and theresponses received.

Please identify any specific difficulties that you mayhave experienced in developing and maintaining aresearch career in tropical medicine. How mightthese difficulties be overcome in the future?Not unexpectedly, the most frequent response tothis question was lack of funds. However,respondents identified the key areas that, in theiropinion, required greater financial investment asfollows.


Table 4.5 Sources of funding for Master’s and PhD training of African malaria researchers.

Funder PhD Master’s

Home government 23 50

UNDP/World Bank/WHO Special 23 26Programme for Research and Training in Tropical Diseases (TDR)

Self 15 37

Institut de Recherche pour 10 12le Développement (IRD)

Not specified 10 11

French Ministry of Cooperation 6 5

Wellcome Trust 5 3


Danish International Development 4 1Assistance (DANIDA)*

Agence Universitaire de la Francophonie 4 0

Swedish International Development 4 0Assistance (Sida/SAREC)

US National Institutes of Health 3 2

Others 25 31

Total number of acknowledgements 134 180

* Includes acknowledgements to the Danish Bilharziasis Laboratory


Research fundingThirty-six per cent of respondents indicated thatthey experienced difficulties in obtainingresearch grants due to limited funding opportu-nities, intense competition, and lack of aware-ness about potential sources of funding. Overall,respondents wanted a general increase inresearch funding from both local and interna-tional sources, particularly schemes to enablejunior researchers to develop their careers inAfrica. Training in grant application writing toenhance the competitiveness of Africanresearchers; reservation of a quota of awards forjunior researchers (without compromising stan-dards); and efforts to increase awareness amongthe research community about potential fundingsources were proposed as solutions to this problem.

Laboratory facilitiesPoor laboratory facilities, together with the highcost of reagents and lack of efficient systems forobtaining reagents were cited as problems by 26per cent of respondents. The general view heldwas that long-term and large-scale investment bynational governments and international fundingorganizations is needed to improve infrastruc-ture, as the short-term nature of science fundingfails to address this problem. Respondents alsosuggested provision within research grants forequipment, and the creation of funding schemesto support upgrading of facilities. Establishmentof distribution networks in Africa for laboratoryreagents, equipment spares and repair facilitieswas proposed by respondents as a practical solu-tion to counteract the costs and delays associatedwith the purchase of reagents and maintenanceof laboratory equipment.

CommunicationsPoor telecommunications, computing andlibrary facilities were viewed as an obstacle to thedevelopment of viable research partnershipswithin Africa and internationally by 18 per centof respondents. Respondents proposed long-term commitment and concerted action by gov-ernments and international funding agencies toimprove telecommunications. To address theimmediate problem, respondents proposedstrengthening of existing facilities in order toestablish a network of laboratories, to whichsatellite groups might link up in future. It wasrecognized that the increasing availability of

journals over the Internet might circumvent theneed for a well-stocked library, but would inturn require improvements in computing andtelecommunication facilities. Respondents alsosuggested the introduction of a reduced journalsubscription rate for developing countries.

Salary provision and career developmentPoor salary and limited career developmentopportunities were cited as difficulties by 17 percent of respondents, who considered that thesefactors contributed to the exodus of researchersfrom Africa. Respondents recommended thatnational governments increase salaries and takeaction to standardize pay and working condi-tions to enable researchers to focus full-time onresearch. Respondents observed that a lack oflocal employment opportunities deters juniorresearchers from pursuing their career in Africafollowing completion of training abroad andthat researchers without a local position are usu-ally ineligible to apply for international sourcesof research funds. To overcome this difficulty,respondents proposed that African institutes cre-ate honorary positions for researchers and thatresearch grants from international organizationsshould include full salary costs, or at least a sup-plement to the local salary.

Respondents also highlighted the difficultiesencountered by senior researchers, such as aninability to keep up to date with scientificadvances due to lack of on going training; inexpe-rience in running a research programme, particu-larly managing staff and budgets; lack of technicalsupport; and scientific isolation in Africa. To tackle these problems, respondents recommendedprovision within research grants for trainingattachments; management and financial training;funds to support technical staff; and funds toattend meetings and conferences.

Other difficulties (< 10 per cent of respondents)In addition to the main issues outlined above, anumber of other difficulties were identified inthe questionnaire responses.• Poor participation by the local population in

studies and trials. Respondents felt thataction should be taken by governments andresearchers to raise public awareness aboutresearch and its potential benefits to thecommunity.



• Lack of government cooperation and supportfor research. Respondents reported a generallack of government support, and highlightedthe failure of governments to make use ofresearch findings, and government bureau-cracy that hinders the process of obtainingtravel visas and the transport of researchmaterials as particular problems.Respondents recommended greater dialoguebetween scientists and government officials.

• Inadequate resources for conducting field trials. Investigators conducting field studiesin remote areas reported problems due topoor road conditions and a lack of suitablevehicles. Respondents proposed that researchawards should include provision for purchaseof vehicles and maintenance costs, wherenecessary.

• Lack of trained technical support staff. Thisproblem was deemed to put a considerableburden on the principal investigator, who hasto contend with the demands of a researchcareer, teaching or hospital commitments,and all the other activities connected withrunning a laboratory. It was also observedthat training of junior and technical staffwould boost staff morale.

• Funds to attend meetings and conferences.Researchers reported difficulties in obtainingfunds to attend meetings and conferences.They recommended provision withinresearch grants for travel to meetings andconferences to enable researchers to presentresults and establish contacts and collabora-tions, as well as the establishment ofnetworks of researchers locally and interna-tionally to ensure that scientists have oppor-tunities to discuss research findings.

• French–English language barrier. Researchersfrom French-speaking African countriescited the French–English language barrier as a difficulty in communicating researchresults and establishing collaborations.

What types of schemes (e.g. collaborative, training,funding etc.) do you consider, are or would be, par-ticularly beneficial in developing research capacityin African universities, research institutions andministries of health? Please give details of level oftraining (MSc, PhD etc.), mechanism, location etc.

TrainingThe overall availability of training opportunitiesand financial support for training was of concernto most respondents, and 77 per cent of respon-dents highlighted a need for additional opportu-nities at Master’s and PhD level. Respondentsidentified the following as elements of a success-ful training scheme:• training as a component of a local research

project to ensure relevance to the particularhealth problems of a country;

• exposure of students to the high-qualityresearch environment in external centres of excellence;

• application in Africa of techniques learntabroad to ensure technology transfer.

In general, respondents considered that allavailable mechanisms for training should be uti-lized, whether in Africa or in developed coun-tries, although there was some variation in thepreferred location of training. For example, pro-ponents of local training considered that train-ing abroad was ineffective as researchers may notreturn home following training; “techniqueslearnt abroad fail to be applied in Africa due todifferences in the conditions of the differentenvironments (i.e. laboratories)”; and the costsof training abroad are prohibitively expensive.Furthermore, respondents observed that oppor-tunities for training in Africa are under-utilizeddue to lack of funds, as international fundingorganizations tend to support training in devel-oped countries. Respondents proposed greaterinvestment in developing African centres ofexcellence as this would contribute to buildingsustainable research capacity and enable themajority of training to be conducted in Africa.Nevertheless, many respondents recognized theimportance of training links with developedcountries in building research expertise inAfrica. The ‘sandwich’ format of training wasconsidered a useful mechanism to allow “stu-dents from Africa to undertake training in devel-oped countries and then return home to do their



project work. In this way they would obtainexpertise from abroad and be able to use it tosolve problems on the ground.”

Although postgraduate training was identi-fied as a priority, all stages in the career develop-ment of scientists were considered to requireadditional attention. The career development ofpostdoctoral scientists was considered importantby respondents, who proposed provision withinresearch grants for training attachments, andregular training workshops on specialist skillsand topics to keep researchers up to date withscientific advances. Respondents also felt that“training at junior and technical levels wouldimprove and motivate staff and help to createthe next scientific generation”. Similarly, inclu-sion of a stronger research component in under-graduate degrees would encourage a ‘researchculture’ in developing countries and contributeto research capacity strengthening.

CollaborationsCollaborations within Africa and with col-leagues internationally were cited by 55 per centof respondents as an important means ofstrengthening research capacity in Africa.Respondents envisaged the principal benefits ofcollaborations to be:• opportunities for training;• coordination of research activities and the

ability to participate in multidisciplinaryresearch projects conducted at different sites;

• sharing of knowledge and experiences, result-ing in technology transfer between researchinstitutions.

The value of training provided by visitingoverseas scientists was also recognized. Further-more, respondents wanted greater researchcooperation within Africa, citing the TDR Mul-tilateral Initiative on Malaria (MIM) awardsscheme as a model that should be extended toenable the development of research collabora-tions and networks in Africa.

The need to promote greater interactionsbetween researchers and ministries of health wasraised by respondents.

4.3 SUMMARY ANDDISCUSSION

The present study used a questionnaire-basedapproach to gather data on the current humanand infrastructural resources in African malariaresearch laboratories. Detailed information wasobtained on the career paths of Africanresearchers and on sources of funding forresearch and training. The opinions of Africanresearchers on difficulties experienced andpotential routes to building effective researchcapacity in Africa were also obtained. Overall,the response rate to the survey was high (>80 percent), particularly in view of the communicationdifficulties usually associated with Africa.Researchers in 19 countries, the majority basedin East and West Africa, took part in the surveyand the distribution of questionnaires in Englishand French was successful in ensuring participa-tion from researchers in both Anglophone andFrancophone Africa. However, five of the 18highest publishing research centres (see Chapter3) did not respond to the survey, thus illustrat-ing the difficulty in obtaining complete coverageusing a survey approach. Data from the MIMsurvey were supplemented with informationfrom the AMVTN Directory such that the totaldata set encompassed 54 groups in 22 countriesacross Africa.

There is a lack of reliable national data onpersonnel in science and technology, and henceof meaningful regional figures for humanresources in sub-Saharan Africa. Available infor-mation suggests that the numbers of trainedAfrican scientists are low. Figures from theObservatoire des Sciences et Techniques (Paris)(UNESCO, 1996) indicate that there are in theregion of 0.4 scientists per 1000 population inAfrica, compared with 1.8 and 2.7 for theEuropean Union and the USA respectively.However, other data suggest a very much greaterdisparity in human resources for scientificresearch between Africa and the established mar-ket economies. The current MIM survey hasgathered important data on the training andexpertise of African scientists engaged in onefocused area of biomedical research: malariaresearch. It should be noted, however, that thisfield probably represents one of the strongestareas of biomedical research in Africa: 21 percent of global ‘tropical medicine’ publications



are devoted to malaria research and 17.2 percent of these malaria publications involveAfrican scientists (Chapter 3).

Research expertise: qualifications Overall, the survey results are encouraging asthey indicate that a core of trained Africanmalaria researchers has been established. Datafrom 54 research groups identified 752 re-searchers engaged in malaria research who weretrained to at least first-degree level. A large pro-portion of these researchers had higher qualifica-tions: personnel trained to Master’s level weremost numerous, although postdoctoral and clin-ical scientists were also well represented. Nearlyhalf of clinical scientists held higher degrees.There is a culture within Africa to progressthrough Master’s training before proceeding to aPhD and the majority of postdoctoralresearchers held Master’s degrees.

However, the 192 postdoctoral scientists and165 clinical scientists identified were dispersedacross 22 African countries so that the numbersper country are generally small. In addition,many of the most productive research centresinvolved substantial input from senior expatriatescientists. The results therefore indicate a strongneed for additional African scientific leaderswho are able to conduct innovative and inde-pendent research.

To put the numbers of trained malariaresearchers into context requires comparisonwith figures for the numbers of scientistsengaged in health research in Africa. Data in thisrespect are limited and subject to inaccuraciesand incompleteness. Figures for 1995 estimatethat researchers in national research centres in38 African countries totalled 13 174, with aquarter of these centres focusing on health andnutrition, basic sciences or social and human sci-ences (Gerring, 1995). These figures do notencompass all research institutes or countries,but they nevertheless support bibliometrics dataindicating that malaria research is a strong com-ponent of African biomedical research. Hence, itis likely that the trained malaria scientists identi-fied in this survey represent one of the strongestsets of health researchers in Africa. Expertise inmost other diseases prevalent in Africa willalmost certainly be considerably less.

Research expertise: scientific disciplinesThe ongoing research programmes reported byAfrican research groups in the current surveylargely reflected the research strengths identifiedby analysis of malaria publications (Chapter 3),with a focus on clinical and field studies. Thismore applied focus was also reflected in the spe-cializations of trained personnel in the samplegroup. However, expertise in the more basic sci-ence categories also showed a notable presence. Inview of the low publication outputs from Africain basic studies of Plasmodium (1995–97,Chapter 3), the present results suggest thatAfrican researchers are increasingly training inbasic laboratory disciplines. The majority ofresearch centres incorporated expertise in multi-ple research disciplines, rather than focusing onone approach, and this was also noted previouslyin publication outputs from individual centres.

Three disciplines of biostatistics, sociologyand economics were less well represented, withfewer than 40 individuals in total identified foreach category. This may reflect the tendency forresearchers in these areas to be associated withinstitutions other than those surveyed (e.g. spe-cific social science or economics institutes)and/or to work on a range of health problemsrather than focusing only on malaria. However,consensus opinions from researchers expressedduring MIM meetings and the relatively lowpublication outputs in these areas (Chapter 3)suggest that there is indeed a current lack ofexpertise in these areas. In view of the impor-tance of biostatistics, sociology and economicsin studies to optimize the delivery of healthcareand disease control interventions, these disci-plines may require specific encouragement andstrengthening through targeted schemes.

Funding sourcesSurvey data showed that a diverse set of funderscontributes towards sustaining malaria researchactivity in Africa. These included governmental,non-governmental and commercial sources, par-ticularly from Europe. Funds from outsideAfrica predominated both for research grants(88 per cent of acknowledgements) and for post-graduate studies (54 per cent). Nevertheless,African governmental and local sources account-ed for just over half of funding acknowledge-ments for first degrees and nearly a quarter ofPhD and Master’s degrees. Local governments



also contribute to sustaining research capacitythrough the provision of salaries for researchers(68 per cent of acknowledgements) and coresupport to institutions. Government commit-ments to scientific research vary considerablybetween African countries, although currentsurvey data were too limited to establish anyclear patterns in this respect.

The observed funding patterns reflect esti-mates of expenditures on research and develop-ment in sub-Saharan Africa, which are amongstthe lowest in the world relative to gross domesticproduct and in absolute terms (UNESCO,1998). In addition, the current results are con-sistent with previous studies which estimatedthat up to 70 per cent of funds for research insome low- and middle-income countries comesfrom external sources (UNESCO, 1998).

The survey identified the agencies that sup-port the African research base, although datacould not provide an accurate measure of rela-tive levels of investment. The World HealthOrganization and in particular the UNDP/WHO/World Bank Special Programme forResearch and Training in Tropical Diseases(TDR),3 received the highest number ofacknowledgements both for research pro-grammes and for Master’s and PhD training.French sources (IRD and the Ministry ofCooperation), the European Commission andScandinavian sources (DANIDA and Sida/SAREC) were other notable contributors topostgraduate training. Figures obtained directlyfrom French agencies (Chapter 2) were incom-plete, but the results of the survey of laboratoriesdemonstrate the significant training contribu-tion of these agencies. Although 14 commercialcompanies were identified as providing researchgrants, their aggregate contribution accountedfor only 6 per cent of the total.

TDR’s particular impact in this survey is areflection of the success of its training schemes,but also in part reflects its major focus on malar-ia and on least developed countries (Chapter 2).Other substantial supporters of training may notbe so visible in this survey due to their particularresearch subject or geographical remits. Alterna-tively, a lower-than-expected profile in this sur-vey, may suggest a lack of success in contributingtowards a sustainable pool of researchers inAfrica. Assessment of individual schemes isrequired to ascertain the true situation.

Despite the range of varied organizationscontributing towards research and training inAfrica, over three-quarters of survey respondentsexpressed the view that there were too fewopportunities for Master’s and PhD level train-ing. Researchers also felt that opportunities forpostdoctoral scientists to obtain independentresearch grants were very limited. These perspec-tives are generally supported by the results of thereview of training opportunities presented inChapter 2.

InfrastructureThe survey results indicate that the majority ofAfrican malaria research institutions (>90 percent) are equipped with core facilities, includingfreezers, centrifuges, incubators and micro-scopes. In addition, over half of the institutionshave access to PCR equipment, suggesting thatmolecular biology techniques are increasinglybecoming standard in African laboratories.However, the views expressed in the opinion sur-vey suggest that current facilities are often inade-quate to maintain competitive research pro-grammes: a quarter of respondents highlightedpoor infrastructure and laboratory facilities asmajor obstacles to developing a research careerin Africa. Respondents considered that greaterand long-term financial investment was essentialto tackle this problem. Although 90 per cent oflaboratories reported e-mail connections, manysurvey respondents specified poor telecommuni-cations, computing and library facilities asobstacles to the development of productiveinternational collaborations. The opportunitiesoffered by new electronic communication facili-ties for dramatically reducing the isolation ofAfrican scientists have been recognized by MIMand are being actively pursued.

Field research sites surveyed encompass arange of malaria endemicities and malaria mos-quito vector systems. These sites provide anopportunity for coordinated, multi-centre inter-vention studies, such as vaccine trials or clinicalstudies, under different transmission intensityconditions. Development of any further fieldmalaria research sites should take into considera-tion the balance of expertise and epidemiologi-cal characteristics at existing sites.

The majority of African scientists surveyedreceive their salaries from local sources, but theinadequacy of these salaries was highlighted in


3The TDR programme is

supported by voluntary

contributions from

governments, international

organizations, charities, other

non-governmental bodies and

the three co-sponsors of the

programme- the World Health

Organization (WHO), the

World Bank and the United

Nations Development

Programme (UNDP).


the opinion survey as a major problem thatdeterred junior scientists from pursuing researchcareers in Africa. The provision of enhancedsalaries, by local or external funders, would pro-vide an incentive to encourage junior researchersto remain in their home countries, and wouldalso allow African researchers to focus on theirresearch without the necessity of seeking addi-tional employment to raise their income to anacceptable level. Salary supplements are in factprovided by a number of organizations, includ-ing MIM/TDR awards, and the survey resultswould support this practice being extendedacross other organizations.

Training mechanisms and collaborativepartnershipsMost African students (90 per cent) completedtheir first degrees within Africa and this is con-sistent with the lack of opportunities forBachelor’s training offered by internationalorganizations (Chapter 2). A high proportion(43 per cent) of African scientists carried outtheir postgraduate training wholly or partlyoverseas, reflecting a dependence on externalfunding and the training mechanisms offered bythese funders (Chapter 2). This was of concernto respondents in the opinion survey who con-sidered that greater investment in African train-ing centres was necessary to develop sustainableresearch capacity. Marked variation wasobserved in the proportion of researchers trainedoverseas from different countries. For example, ahigh proportion of researchers in Nigeria andSouth Africa completed their postgraduate stud-ies in Africa, a factor that is likely to be impor-tant in the observed lower international co-authorship in publications for these countries(Chapter 3).

However, African scientists also recognizedthe critical importance of international partner-ships to facilitate effective training of scientists,and sharing of expertise and resources. The exis-tence of mechanisms to support internationalcollaborations was therefore considered a highpriority. Training mechanisms that are largelybased in the trainee’s home country, but allowoverseas training attachments were favoured.This approach combines the benefits of bothsites, ensuring that the training is relevant to thehealth problems, facilities and available tech-nologies in the home country, but allowing

exposure to leading overseas laboratories.African scientists further suggested the value

of continuing training at postdoctoral level, toallow updating of skills and to maintain linkswith collaborating laboratories. Improved mech-anisms to raise awareness of existing research andtraining opportunities, and workshops in grantapplication writing skills were also called for.

Stated collaborations on research grantsshowed that African researchers collaborateextensively, particularly with researchers inEurope. This was consistent with the results ofbibliometric analysis, although the overall extentof collaborations on research grants was lowerthan on publications (Chapter 3). This lower col-laboration rate may be due to the omission ofawards held by scientists outside Africa in thesurvey responses, but it may also indicate that theresults of African research activities without anexternal collaborator are published less frequent-ly in international journals recorded in SCI.

Collaborations across Africa were mainlysupported by TDR/MIM awards or grants fromthe European Commission INCO-DC pro-gramme. A slightly higher level of collaborationacross Africa was observed from research grants,as compared with publications analysis, but thenewly introduced TDR/MIM awards would nothave had an impact in the publication yearsanalysed (1995–97).



5

5.1 INTRODUCTION

Data collected by UNESCO (1996) clearlyillustrate the deep divide between establishedmarket economies and developing-countryregions in terms of their research capacity andproductivity: four-fifths of the world’s scientistsare estimated to reside in Western industrializednations, Japan and to a lesser extent other largeAsian countries. Furthermore, in 1994, develop-ing-country regions together contributed only6.5 per cent of the world’s scientific publications(OST, 1997).

Indigenous research expertise in developingregions is essential for an ultimate impact onhealth: locally relevant studies are needed to linkinternational research into a national frameworkof disease epidemiology, health services and pop-ulation-specific clinical, behavioural and socialdata. However, resource constraints demandthat support for science in developing countriesis focused effectively according to policies basedon sound analytical data. The present studyobtained information on research trainingopportunities across developing-country regions,and on a number of indicators of malaria researchcapacity in Africa. Data were derived from ques-tionnaire surveys of funding organizations and ofmalaria research laboratories in Africa, and alsofrom analyses of malaria publications.

The conclusions and key issues are summa-rized here together with recommendations forconsideration by the Multilateral Initiative onMalaria, by funding organizations and govern-ments in developed and developing regions, andby other coordinating bodies such as the RollBack Malaria Project of the World HealthOrganization.

5.2 POLICY ISSUES

International investment and coordinationScientific research in many developing countriesis heavily dependent on foreign investment: thesurvey of African malaria research laboratories inthe present study found that 88 per cent ofresearch grants and 68 per cent of PhD fundingacknowledgements were to external sources.These figures indicate the current degree ofinfluence exerted by the policies of foreigninvestors on research training in Africa, andpotentially in other developing regions. How-ever, any capacity-building efforts are ultimatelydependent upon local commitment and theestablishment of a culture in which science haslegitimacy and status.

➤ Funding organizations internationally andgovernments of developing countries must worktogether to build sustainable and locally relevantresearch expertise and facilities. This may requirethe establishment of formalized, longer-termpartnership arrangements.

The results of the survey of funding organiza-tions indicate that research training offered byhigher-income countries to developing regions isgenerally fragmented and does not represent acoherent international approach to generatingscientists to meet health research priorities.

➤ Greater efforts are required to coordinate ration-al allocation of resources to training activitiesinternationally and to monitor the effectiveness oftraining programmes. Such a coordination rolemight be played by a body that involves partner-ships between funding organizations internation-ally, such as the Multilateral Initiative on Malaria(MIM).

This study has combined a variety of approaches to obtain information on the trainingopportunities in health and biomedical research in developing regions, and on thestatus of malaria research capability in Africa. The current chapter aims to drawtogether the information derived from these different sources and to set out some keyissues for consideration in developing strategies to enhance the research bases indeveloping regions and particularly to strengthen malaria research capacity in Africa.

Overview and policy issues


➤ Despite the significance of foreign investmentin training scientists in developing countries, theoverall expenditure is low relative to trainingactivities in developed regions and represents a small percentage of the activities of some of the larger investors. A slight increase in theproportion of the budgets of larger research ordevelopment funders committed to training inlower-income countries could therefore have asubstantial overall impact.

Science is now indisputably a global activity andthe issue of retaining developing-country scien-tists in their home countries, so that their skillscan bring benefit locally, must be addressed. Inan international market, incentives are requiredto encourage researchers to remain in their homeinstitutes: national research institutes must com-pete to retain scientists against overseas centres,as well as with the local private sector. This studyshowed that nearly 70 per cent of scientists inAfrican malaria research laboratories receivetheir salaries from local sources, but thesesalaries were often considered inadequate for areasonable standard of living.

➤ Governments of developing countries shouldgive serious consideration to the potential largegains of investing in well-targeted research andproviding adequate salary structures to rewardproductive scientists.

➤ More external funders might also considerprovision of salary supplements to scientists whocompete successfully for research awards.

Training mechanismsInternational scientific partnerships are animportant mechanism for training. The currentstudy has shown that collaborative training linksfor developing countries are driven substantiallyby the format of schemes offered by high-income countries. Funding mechanisms tend tolink specific countries, with training often beingprovided in the donor country. Whilst countriesmust focus their resources in some way, the cur-rent situation does not permit optimal use of sci-entific training opportunities globally and dis-courages interactions between countries within aregion. For example, co-authorships on malariapublications clearly showed the lack of overlapin the African countries with which France and

the UK collaborate and the rarity of linkagesbetween Anglophone and Francophone regionsof Africa.

➤ There is a need for a greater variety of fundingformats to allow diversification of collaborationsand more efficient use of scientific strengthsirrespective of location.

➤ Mechanisms to support linkages and networkswithin developing regions are also required toenable sharing of resources and expertise, andexploitation of local and regional trainingopportunities. This problem has been recognizedby MIM and progress is being made inestablishing multi-centre studies within Africa.Additional mechanisms are, however, needed.

➤ Funding mechanisms that facilitate commun-ication and collaboration with scientists who havemigrated overseas will also bring benefit to thehome research base.

In view of the relatively weak research bases inmany developing countries, training in high-income countries is still considered to be impor-tant in generating internationally competitivescientists. The survey of malaria research centresin Africa showed that half of the scientists inthese centres had undertaken their PhD trainingwholly or partially outside Africa, although therewas considerable variation in the extent of over-seas training in different African countries.

A consequence of overseas training, however,is that developing-country scientists are oftenattracted away from their home countries tolocations where facilities and career prospects arepreferable. In the long-term, therefore, they maybe less likely to contribute to the home sciencebase. Moreover, overseas training is expensiveand may not be relevant or readily transferableto the home country. Thus, local and regionaltraining is likely to represent an importantapproach to building sustainable and relevantnational research expertise.

➤ The provision of training opportunities indeveloped countries should be maintained toallow exposure of scientists to internationallycompetitive laboratories. This might be in theform of shorter overseas training attachments,combined with local and regional training.

Overview and policy issues5


➤ Greater investment in developing countries isrequired to create ‘centres of excellence’ that canserve as local and regional training bases.Selection of appropriate centres for developmentwill be essential for efficient use of funds formaximal impact. These centres should be ofinternational scientific standing, and this willrequire focusing of resources to build top qualityfacilities and a critical mass of intellectualcapacity, preferably in multiple disciplines.

➤ Regional training is also potentially an impor-tant mechanism for building productive researchlinks between neighbouring countries.

➤ Mechanisms to allow input of teaching andresearch expertise from overseas scientists atundergraduate through to postdoctoral levels areimportant in contributing to high-quality train-ing in developing countries.

➤ Another approach to combining the benefits of local and overseas training is for developing-country centres to register for training throughdistance learning schemes such as the ‘OpenUniversity’, leading to the award of an overseas degree.

Analysis of the most productive malaria researchcentres in Africa, revealed that many of thesereceived sustained and high-level support fromexternal funders, thus illustrating the impor-tance of a stable foundation from which todevelop an effective research programme. Mostfunding organizations link training to majorresearch programmes that have received supportthrough a competitive, peer-reviewed process,an approach that associates training with topquality research studies. In addition, funds areconcentrated at specific sites to establish an envi-ronment where productive research programmesare more likely to flourish.

An important difficulty is that scientists indeveloping countries are frequently compelledto undertake major teaching and administrativeresponsibilities before they have had an opportu-nity to consolidate their postdoctoral researchtraining. Furthermore, absence of academic andministry of health staff for training, whether thisbe locally or overseas, often leaves home insti-tutes short-staffed and increases the burden onremaining staff.

➤ A commitment to research activities by localinstitutes, for example by ensuring that staff areable to devote adequate time to research activities,is essential for the development of productiveresearch programmes.

➤ The provision of research fellowships, whichinclude salaries and research expenses, wouldenable scientists to focus primarily on theirresearch. Such relatively stable funding would alsoprovide a significant incentive for them to pursuea career in research.

Malaria research is a particular strength of sub-Saharan Africa and data obtained in the presentstudy have shown that a cadre of trained malariascientists has been established in Africanresearch institutes. However, about one-third ofidentified research groups were led by non-national scientists.

➤ There is a need to develop additional African sci-entific leaders, but in the interim, the input of com-mitted and able expatriate scientists into training oflocal scientists should be maximally exploited.

➤ The information obtained on the location,research specializations and primary sources offunding for malaria research centres should assistboth researchers and funders in making optimaluse of these centres for further development ofresearch capacity in Africa.

Career progression opportunitiesVery little support from foreign investors is direct-ed at the Bachelor’s degree level and the majorityof African scientists surveyed in the study com-pleted their first degrees in their home countries.

➤ This observation underscores the responsibilityof governments in developing countries to supporttertiary education in order to generate a supply ofgood-quality candidates for research training. Uni-versities in developing regions must also establishdegree curricula that reflect the scientific needs ofthe country and which begin to instil an apprecia-tion of the importance of scientific research.

Survey of funding agencies and of African malariaresearch laboratories suggested that current avail-ability of awards for PhD and Master’s training,from both local and international sources, is very

Overview and policy issues 5


restricted. Only 684 PhD awards to scientistsacross the developing world were identified fromthe major funders in high-income countries, and65 per cent of African scientists surveyed indi-cated that their PhD funding was from an over-seas rather than a local government source. Bycomparison, the opportunities for PhD trainingper unit population in the UK are nearly 1000times greater than those in developing countries.Even after taking into account underestimates inthe survey figures and the more limited availabil-ity of graduates in developing countries, thenumbers of PhD awards appear low.

➤ The creation of more opportunities for PhDand Master’s training is likely to be beneficial ingenerating a core of scientific leaders for thefuture, although adequate support must also beprovided for research at the postdoctoral level.

There is a large overall investment by high-income countries in training attachments, shortcourses and workshops. This type of training canfulfil an important role but it must be appropri-ately targeted and monitored for maximal effect.

➤ Further analysis of the nature of current train-ing attachments, short courses and workshopswould be valuable to assess the effectiveness ofcurrent activities.

Only a small number of organizations provideopportunities for scientists in developing countriesto apply for independent research funds. Localsources of funding are extremely limited and for-eign investors tend to provide larger-scale supportto groups of researchers, often involving partner-ships with external scientists. While this approachcan use resources effectively to develop productiveresearch programmes, it is less effective in encour-aging individual innovation of local scientists.

➤ The wider availability of individual grants topostdoctoral scientists would provide importantcareer development incentives and may facilitatethe emergence of key scientific leaders. Fellow-ships might involve honorary academic positionsto ensure formalized association with localresearch institutes, and opportunities to inputinto teaching. Awards might also be linked tolarger research grants to ensure that trained indi-viduals are focused together.

Research specializationsMost countries in the developing world faceimmense economic and health problems, and itwould be inappropriate to advocate increasedexpenditure across all areas of research, or to aimto duplicate existing major strengths elsewherein the world. In view of the globalization of sci-ence, it is feasible to establish strategies that willallow developing countries to tap into the resultsof science internationally and build upon thesefor local benefit. Thus, strategic research priori-ties for lower-income countries might focus onrelevant health problems or aim to exploitunique opportunities.

➤ Mechanisms, at national and international lev-els, are required to assess the overall distributionof training across different research areas andhence assist in mapping capacity development toresearch priorities.

➤ Progress is being made in establishing essentialnational health research priorities in developingcountries, and effective publicizing of these scien-tific strategies would enable external funders totarget research resources more effectively.

➤ Strengthening of research and control interac-tions would assist in ensuring that research agen-das generate data required to underpin treat-ment and control strategies, and facilitate rapiduptake of research results into policy and prac-tice. This might require research training experi-ence for public health personnel for example, orinvolvement of laboratory scientists in servicedelivery activities.

African malaria research is currently stronglyfocused on clinical and field studies, which canyield practical solutions to local problems andthese studies are often linked to basic researchongoing in Europe and the USA. Nevertheless,there is growing expertise and facilities withinAfrica in more fundamental disciplines, show-ing that many basic science techniques aretransferable to Africa where they can comple-ment ongoing clinical and field studies. Basicscience is important for innovation and tech-nological breakthroughs and the ongoinggrowth in these disciplines in developing coun-tries should therefore be encouraged. However,initial targeting should preferably be towards



technologies that are more readily transferable,rather than those requiring major investmentin facilities.

➤ Results from the current study suggest thatsocial sciences, health economics and biostatisticsare areas that lack expertise in Africa. In view ofthe importance of these disciplines in optimizingimplementation of health interventions andinforming policy development, they may requirespecific strengthening.

The extent to which the subfield strengths andweaknesses observed for malaria research inAfrica can be extrapolated to other researchfields or developing regions is difficult to assess.However, broad publications outputs indicatethat fundamental biology is a weak field acrosssub-Saharan Africa, in China and South-EastAsia, but is slightly stronger in India and CentralAsia and in Latin America. It is estimated thatonly 8 per cent of research and developmentexpenditure in Africa goes to basic sciences andengineering, as compared with 40 per cent forindustrialized countries (OST, 1997).

Measuring progressGreater efforts to monitor the effectiveness ofcurrent research training schemes, at both indi-vidual and collective levels, are important toensure that resources are being used to best effect.Numbers of trained scientists and publicationoutputs are broad measures of human resourcesand research productivity. However, researchtraining and capacity-strengthening programmesmust be targeted so that they are appropriate tonational and regional needs, and assessmentsshould therefore also evaluate the type of expert-ise generated (disease and disciplinary specializa-tions) and the success of research in producingrelevant knowledge. More detailed monitoring ofindividual capacity-strengthening schemes canalso assess indicators such as numbers of grantssuccessfully obtained by trainees, numbers ofpresentations at conferences, and availability ofinfrastructure in research institutes.

➤ This report provides valuable baseline data bywhich to monitor the progress of capacity build-ing efforts in malaria research.

Effective local and national systems are requiredto harness the results of scientific research forindigenous development. Early dialogue betweenexternal funders, researchers and local govern-ments will assist the effective translation ofresearch results into policy and practice.Clinical and applied research are essential toachieve an impact on health, and accurate meas-ures of the outcomes of these types of researchare needed to provide a rationale and justifica-tion for investment of resources, by both localand foreign contributors.

➤ The examination of research cited in healthpolicy documents is a potentially effective methodof assessing the influence of research in determin-ing clinical practice or disease control strategies.However, in order for this approach to be imple-mented effectively, policy documents from devel-oping countries must include full bibliographies.

Local research, often recorded in non-peer-reviewed grey literature, appears to influencenational policies for malaria treatment and control.

➤ Greater effort to record grey literature in cen-tral, accessible databases, and/or more extensivepublication of locally relevant research in peer-reviewed journals would be beneficial.

The futureThere remains a major challenge to buildresearch bases in developing countries that canhave a significant impact on health. Fundingorganizations in developed and developingcountries must prioritize and coordinate theiractivities to use limited resources efficiently intraining productive, independent scientists andestablishing competitive research facilities. Thisreview provides data on the background contextagainst which funding decisions must be madeand it is hoped that it will facilitate an evidence-based approach to capacity building. Partner-ships between scientists as well as between fund-ing organizations may be required to achievesignificant progress. While there are commonthemes that are applicable across developingregions, it is clear that there is considerablediversity between individual countries in termsof their educational bases, existing trainingactivities and research facilities. Training strate-gies will therefore need to be responsive to coun-



try-specific circumstances and opportunities.Despite the scale of the task ahead, there are

positive signs for the future as lower-incomecountries increasingly recognize the importanceof scientific research. For example, countries inthe Latin American region have been reformingtheir science policies (see Macilwain, 1998), anda chain of regional centres of excellence has beenproposed to share resources and expertise. Chinais also an emerging success story, its research pro-ductivity having increased very significantly overthe last decade under directed governmentalpolicies. Further major reforms have recentlybeen announced (Normile and Lei, 1999),including a threefold increase in salary for scien-tists, aimed at retaining scientists in China andencouraging those working overseas to return.

There are also positive signs from Africa withan innovative proposal emerging from the WorldConference on Science in June 1999. This pro-posal, which was supported by ministers of sci-ence and education from Africa, was to create ascience fund for poor countries from the debtrelief agreed upon by G8 nations for the world’sleast-developed countries (Masood, 1999).

5.3 REFLECTIONS ONMETHODOLOGIES

This study combined a number of differentmethods to generate data relevant to interna-tional training opportunities for researchers indeveloping countries, and to malaria researchcapacity in Africa. These approaches provideddifferent perspectives on the same issue andoffered relative advantages and disadvantages. Anumber of points concerning the techniquesemployed in the study are set out below toinform future studies.

Assessing funding inputsInformation on funding inputs into malariaresearch and training was obtained in a numberof different ways: from data obtained directlyfrom funding organizations; from fundingacknowledgements on research publications andfrom direct survey of research centres in Africa.Survey approaches in general are time consum-ing and limited by the extent of coverage of thetarget population, as well as response rates.Conversely, analysis of publications has the

advantage of relative rapidity and can generallyachieve systematic coverage of a field. A majoradvantage of direct survey of funders is thatinformation can be obtained on actual expendi-ture, whereas numbers of funding acknowledge-ments on publications do not give an accuratemeasure of magnitude of funding. The survey oflaboratories was not effective in this particularstudy in obtaining information on levels offinancial support, probably due to confidentialityconsiderations.

The format of records kept by fundingorganizations is an important factor influencingthe success in obtaining relevant data, for exam-ple in a specific subject area. Organizations thatprovide block grants to other institutes or organ-izations, often do not have centralized records ofhow this expenditure has been allocated. In thissituation, the direct survey of malaria researchlaboratories was successful in identifying funderswhich make significant contributions to post-graduate training, but which did not registerhighly in the funding survey due to incompletedata. The survey of African centres was also ableto provide an indication of the relative contribu-tions of local and foreign investors in supportingresearch and training.

Analysing research outputsBibliometrics is a convenient means of measur-ing research activity in a particular field.However, databases must be selected accordingto the particular analysis being carried out. Forexample, MEDLINE has better coverage of clini-cal research and of non-English language jour-nals compared with the Science Citation Index(SCI), but does not include full details of authoraddresses, precluding its use in co-authorshipanalyses. A significant disadvantage of commer-cially available databases is that they are biasedtowards research in industrialized countries, asthey do not have comprehensive coverage of localand non-English language journals in developingcountries or of other types of grey literature.

Standard bibliometric citation techniques formeasuring research impact and quality arerestricted in their application, since citationindices primarily reflect the influence of researchon the scientific community. Research of a moreclinical or applied nature is intrinsically disad-vantaged in this type of analysis as it receivesfewer citations than more basic research.



Alternative approaches are required to assess thesuccess of research in generating new diseaseinterventions or influencing disease treatment orcontrol. Examination of literature cited inmalaria treatment and control guidelines couldpotentially provide a valuable method to assesslinks between research and policy. However, inthe present study it was noted that nationalguidelines often did not include full referencesto research results that had guided the develop-ment of recommendations. A more systematicapproach to citing literature would thereforehave to be adopted by countries to allow thisapproach to be employed more generally.

Assessing human and infrastructuralresourcesPublications analyses rapidly identified the mostproductive countries and research centres inAfrica, and showed their research specializationsand collaboration patterns. However, despitebasing analyses on the most recent research out-puts, the information was retrospective as itreflected research carried out in the few yearsprior to publication.

In contrast, the direct survey of active malariaresearch laboratories gave a current view of

research focus and expertise, and identified areasof growth. The survey also provided a moredetailed insight into research capacity, includinglaboratory facilities and the training paths of researchers. Furthermore, the questionnairegathered the opinions of African scientists withfirst-hand experience of performing research inAfrica. The responses raised issues relating tocapacity development that were not evidentfrom the other approaches employed in thestudy. The breadth of response from researchgroups was a key feature of this study and thedistribution of questionnaires in both Englishand French was likely to have contributed to thesuccess in obtaining high response rates fromboth Anglophone and Francophone Africa.

The survey of funding organizations was ableto give an overview of the types of awards avail-able in Africa and in other developing regions,and of the numbers of scientists trained annuallyat different levels. It also provided more detailedinformation on the strategies of funders in sup-porting training. However, the survey of Africancentres was able to give a clear impression of therelative contributions of these schemes towardsdeveloping the core of malaria researchers whoare currently active in Africa.


References


Anderson J, Maclean M, Davies C (1996) MalariaResearch: An audit of international activity. PRISMReport Number 7. London: The Wellcome Trust.

African Development Bank (ADB) (1994) AfricanDevelopment Report. ADB, Abidjan: Côte d’Ivoire.

Bogliolo A R (1998) Brazil: A science and technologyprofile. The British Council and the Department ofTrade and Industry.

Butler D (1997a) Time to put malaria control onthe global agenda. Nature 386: 535–540.

Butler D (1997b) Malaria meeting charts rockypath ahead. Nature 388: 219.

Butler D (1997c) Wellcome Trust to coordinatedrive against malaria. Nature 386: 535–540.

COHRED (Commission on Health Research forDevelopment) (1990) Health Research: Essentiallink to equity and development. Oxford: OxfordUniversity Press.

Davies C (1999) The Multilateral Initiative onMalaria: co-ordination and co-operation in inter-national malaria research. Parassitologia 41(in press).

Dawson G, Lucocq B, Cottrell R, Lewison G(1998) Mapping the Landscape: National biomedicaloutputs 1988–1995. London: The Wellcome Trust.

Doumbo O, Krogstad D J (1998) Doctoral train-ing of African scientists. American Journal ofTropical Medicine and Hygiene 58(2): 127–132.

Gaillard J, Waast R (1993) The uphill emergenceof scientific communities in Africa. Journal ofAfrican and Asian Studies. 27(1–2): 41–68.

Gallagher R (1997) Global initiative takes shapeslowly. Science 277: 309.

Gerring A L (ed.) (1995) International ResearchCenters Directory 1996–97. Detroit USA: GaleResearch Inc.

Grant J (1999) Evaluating the outcomes ofbiomedical research on healthcare. ResearchEvaluation 8(1): 33–38.

INCLEN (International Clinical EpidemiologyNetwork) (1999) Internal Review of INCLENSchemes.

Lewison G (1996) The definition of biomedicalresearch subfields with title keywords and applica-tion to the analysis of research outputs. ResearchEvaluation 6: 25–36.

Macilwain C (1998) Latin America steps up its sci-ence tempo. Nature 391: 524–525.

Masood E (1999) Debt relief cash ‘should be spenton fund for science’. Nature 400: 8.

Michaud C, Murray C J L (1996) Resources forhealth research and development in 1992: a globaloverview. Annex 5 Investing in Health Researchand Development. Report of the Ad Hoc Committeeon Health Research Relating to Future InterventionOptions. Geneva: WHO.

Mons B, Klasen E, Van Kessel R, Nchinda T(1998) Partnership between South and North crys-tallizes around malaria. Science 279: 498–499.

Nabarro D, Tayler E (1998) The “Roll BackMalaria” Campaign. Science 280: 2067–2068.

Narin F (1994) Patent bibliometrics. Scientometrics30: 147–155.

Normile D, Lei X (1999) China’s ScienceReforms: the view from the top. Science 283:1252–1253.

OST (Obervatoire des Sciences et des Techniques)(1997). Les Chiffres-Clès de la science et de la tech-nologie. Economica. Paris.

Sancho R (1992) Misjudgements and shortcom-ings in the measurement of scientific activities inless developed countries. Scientometrics 28: 61–77.

Snow R, Mwenesi H, Rapuoda B (1998) Malaria:A situation analysis for Kenya.

TDR (1999) UNDP/World Bank/WHO SpecialProgramme for Research and Training in TropicalDiseases. Research Capability Strengthening: Indepth review 1990–97, Interim Report. Draft docu-ment presented at the 22nd meeting of the JointCoordinating Board, Geneva, 24–25 June 1999.

UNESCO (1996) World Science Report, 1996.Paris.

UNESCO (1998) World Science Report, 1998.Paris.

Williams N (1997) Consensus on African ResearchProjects. Science 278: 1393–1394.

WHO (1993) A Global Strategy for MalariaControl. Geneva.

WHO (1996) Investing in Health Research andDevelopment. Report of the Ad Hoc Committee onHealth Research Relating to Future InterventionOptions. Geneva: (Document TDR/Gen/96.1)

WHO (1999) The World Health Report 1999.Geneva.

Annexes


Annexes

Contributor Contribution 1989–98 (US $million)

Norway 42.7

World Bank 40.6

Denmark 26.3

Sweden 25.4

United Nations Development Programme 23.6

USA 22.2

UK 18.6

The Netherlands 17.6

Canada 13.0

Germany 12.3

World Health Organization 11.3

Switzerland 10.6

Belgium 7.8

Australia 6.9

France 3.3

Luxembourg 2.6

Italy 2.0

Japan 2.0

Rockefeller Foundation 1.9

International Development Research Center (Canada) 1.9

Others 11.7

Total 304.3

1 CONTRIBUTIONS TO THE UNDP/WORLD BANK/WHO SPECIAL PROGRAMME FOR RESEARCH AND TRAINING IN TROPICAL DISEASES (TDR) 1989–98


Annexes

Agence Universitaire de la Francophonie (AUF)4,Pl. de la Sorbonne,75005 Paris, FranceTel:+33 1 44 41 18 18; Fax:+33 1 44 41 18 19E-mail: [email protected]; [email protected]:www.aupelf-uref.org

Alexander von Humboldt FoundationEnquiries to:Dr Klaus Manderla,Alexander von Humboldt-StiftungAuswahlabteilung, Jean-Paul-Strasse 12,D-53173 Bonn,GermanyTel:+49 228 833 139;Fax:+49 228 833 212 E-mail: [email protected]; Web: www.avh.de

Australian Agency for International Development (AusAID)GPO Box 887,Canberra ACT 2601, AustraliaTel:+2 (0)6206 4000;Fax:+2 (0)6206 4880Web:www.ausaid.gov.au

Belgian Agency for Development Cooperation (BADC)Candidates for Master’s scholarships are proposed by the Ministry ofHealth of the developing country. Final selection is by a panel of experts,including a BADC representative.Rue Bréderode,6–1000,Brussels,BelgiumTel:+32 2 519 0211;Fax:+32 2 519 0570

The British CouncilBridgewater House,58 Whitworth Street,Manchester M1 6BB,UKTel:+ 44 (0)161 957 7000;Fax:+44 (0)161 957 7111Web:www.britcoun.org

Burroughs Wellcome Fund P.O.Box 13901, 21,T W Alexander Drive,Research Triangle Park,NC 27709-3901,USATel:+1 919 991 5100;Fax:+1 919 941 5884E-mail: [email protected]; Web: www.bwfund.org/

Canadian International Development Agency200 Promenade du Portage,Hull,Quebec,Canada K1A 0G4Web:w3.acdi-cida.gc.ca

Centers for Disease Control and Prevention There are no dedicated awards schemes for developing-country scientists.For information on the Epidemic Intelligence Service (EIS) Program,contact:EIS Program,Epidemiology Programme Office,MS-D 18 CDC,600 Clifton Road,NE Atlanta,GA 30333,USAE-mail: [email protected] Web:www.cdc.gov.epo/dapht/eis/index.htm

Deutscher Akademischer Austauschdienst (DAAD) Enquiries to:Deutscher Akademischer Austauschdienst Kennedyallee 50,53175 Bonn,GermanyFax:+49 228 882 444 E-mail: [email protected]; Web:www.daad.deAlternatively, enquiries may be made to the German Embassy within the country.

DANIDA:The ENRECA programme The ENRECA Health Network,Department of International Health,Institute of Public Health,Pavillonen 42.1.04.Panuminstituttet,Blegdamvej 3A,DK-2200,Copenhagen N,DenmarkTel:+45 35 32 76 27; Fax:+45 35 32 76 29E-mail: [email protected]:www.um.dk

European CommissionEnquiries to:Dr Mamadou Traoré,DG XII: INCO-DC programme.Rue de la Loi 200,1049 Bruxelles, SDME 11150,BelgiumTel:+32 2 295 92 71; Fax:+32 2 296 62 52E-mail:[email protected]; Web:www.cordis.lu

Federal Commission for Scholarships for Foreign Students,SwitzerlandApplications to the Swiss diplomatic representative in the country oforigin.

Fogarty International CenterDivision of International Training and ResearchFogarty International Center,National Institutes of Health,Building 3131 Center Drive,MSC 2220,Bethesda,MD 20892-2220Tel:+1 301 496 1653;Fax:+1 301 402 2056E-mail: jbreman.nih.gov Web:www.nih.gov/fic/opportunities

Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ)GmbHDag-Hammarskjold-Weg 1-5,65760 Eschborn,GermanyTel:+49 6196 79 0; Fax:+49 6196 79 1115Web:www.gtz.de/

INCLEN INCLEN, Inc.Executive Office,3600 Market St,Suite 380,Philadelphia, PA 9104-2644,USATel:+1 215 222 7700;Fax:+1 215 222 7741E-mail: [email protected]; Web:www.inclen.org

Institut de Recherche pour le Développement (IRD, formerly ORSTOM)209–213 rue La Fayette,75480 Paris Cedex 10, FranceTel:+33 (0)1 48 03 77 77; Fax:+33 (0)1 48 03 08 29 Web:www.ird.fr;www.orstom.fr

International Atomic Energy Agency (IAEA) International Atomic Energy Agency,PO Box 100,Wagramer, Strasse 5,A-1400 Vienna,AustriaTel:+43 1 26000;Fax:+43 1 26007E-mail: [email protected]:www.iaea.org

INSERM Enquiries on Poste Vert awards to:Catherine Schatz,Département desRelations Internationales INSERM,101 rue de Tolbiac, 75654 Paris Cedex 13, France Tel:+33 1 44 23 61 81; Fax:+33 1 45.85.14.67E-mail: [email protected]:www.inserm.fr

Institut Pasteur25-28 Rue du Docteur Roux,75724 Paris Cedex 15, FranceTel:+33 (0)1 45 68 80 01; Fax:+33 (0)1 45 68 81 86Web:www.pasteur.fr

2 CONTACT DETAILS OF FUNDING ORGANIZATIONSNot all of the organizations listed here offer research training schemes that are open to application.

Refer to Chapter 2 for details of support provided.


Annexes

2 CONTACT DETAILS OF FUNDING ORGANIZATIONS (cont.)

International Development Research Centre (IDRC),CanadaIDRC has no dedicated award schemes for scientists. Enquiries regardingresearch in health should be directed to:Dr Enis Baris, Senior ScientificAdviser,HealthTel:+613 236 6163 ext. 2270;Fax:+613 567 7748E-mail: [email protected]; Web:www.idrc.ca

Japan International Cooperation Agency (JICA)Central Office, Shinjuku Mines Tower,2-1-1,Yoyogi, Shibuya-ku,Tokyo, JapanTel:+3 (5352) 5311/5314Web:www.jica.go.jp

National Institute of Allergy and Infectious Disease (NIAID) Enquiries to:Elizabeth Higgs,MD,Program Officer, International TropicalDiseases Research Program,NIAID (Solar Building) 6003 ExecutiveBoulevard,Bethesda,MD 20892,USA Tel:+1 301 496 2544;Fax:+1 301 402 0659E-mail: [email protected]; Web:www.niaid.nih.gov

Norwegian Agency for Development Co-operation (NORAD)Applications for NORAD Fellowships for International Diploma andMaster’s courses to the Norwegian Embassy or Consulate in the countryof origin. Fellowships for basic studies are not provided.Web:www.sui.no

SEAMEO–TROPMED Enquiries to:The Secretary-General/Coordinator, SEAMEO-TROPMEDNetwork.420/6 Rajvithi Road,Bangkok 10400,ThailandTel:+662 644 4331;Fax:+662 247 7721E-mail: [email protected] Web:www.seameo.org; www.mahidol.ac.th/mahidol/tm/

Sida/SAREC Enquiries to: Sida, S-105 25 Stockholm,SwedenTel:+46 8 698 5000;Fax:+46 8 20 8864Web:www.sida.se

South African Medical Research Council (MRC) The MRC is only able to fund researchers who are citizens or permanentresidents of South Africa.Researchers in other developing countries who wish to form collaborative ties with South African researchers in relevantfields, should contact MRC programme leaders.PO Box 19070,Tygerburg 7505, South AfricaTel:+27 21 938 0911;Fax:+27 21 938 0200Web:www.mrc.ac.za

South African National Research Foundation (NRF)PO Box 2600,001 Pretoria, South AfricaTel:+27 12 481 4067;Fax:+27 12 481 4010Web:www.frd.ac.za

Swiss Agency for Development and Co-operation (SADC)CH-3003,Bern, SwitzerlandWeb:www.sdc-gov.ch

Swiss National Science FoundationWildhainweg 20,Postfach 8232,CH-3001 Bern, SwitzerlandTel:+41 31 308 2222Web:www.snf.ch

Takemi Program in International HealthEnquiries to:The Takemi Program in International Health,665 HuntingdonAvenue,Building 1–1104,Boston,MA 02115-6021,USATel:+1 617 432 0686;Fax:+1 617 432 1251E-mail: [email protected] Web:www.hsph.harvard.edu/takemi.html

UNDP/World Bank/WHO Special Programme for Researchand Training in Tropical Diseases(TDR) Special Programme for Research and Training in Tropical Diseases,World Health Organization,1211 Geneva 27, SwitzerlandEnquiries on training grants: Steven Wayling.Tel:+41 22 791 3909;Fax:+41 22 791 4854 E-mail:[email protected] Other Information:Communications Office.Tel:+41 22 791 3725;Fax:+41 22 791 4854 E-mail: [email protected];Web:www.int/tdr/index

UK Department for International Development94 Victoria Street, London SW1E 5JL,UKTel:+44 (0)20 7917 7000;Fax:+44 (0)20 7917 0019Web:www.dfid.gov.uk

UK Medical Research Council20 Park Crescent, London W1N 4AL,UKTel:+44 (0)20 7636 5422;Fax:+44 (0)20 7636 6179Web:www.mrc.ac.uk

USAID Enquiries to:Dr Caryn Miller,Research Policy Adviser,RRB 6.7.31,USAID,Washington DC 20008,USATel:+1 202 712 4667;Fax:+1 202 216 3394E-mail: [email protected]: info.usaid.gov

Walter Reed Army Insitute of Research (WRAIR)Washington DC 20307-5100,USATel:+1 301 295 7788;Fax:+1 301 295 7755Web:wrair-www.army.mil

The Wellcome Trust Enquiries to the Tropical, International or Population Studies Programmes:The Wellcome Trust, 183 Euston Road,London NW1 2BE,UKTel:+44 (0)20 7611 8888;Fax:+44 (0)20 7611 7288E-mail: [email protected]; [email protected] or [email protected]; Web:www.wellcome.ac.uk


Annexes

Set Field

1 Title(ANTIMALARIA* OR MALARI* OR PLASMODIUM OR PLASMODIA*) NOT PHYSARUM

2 TitlePROGUANIL OR QUINGHAOSU OR HALOFANTRINE OR AMINOQUINOLINE ORPRIMAQUINE OR ARTESUNATE OR ARTEETHER OR DARAPRIM OR FANSIDAR ORNIVAQUINE OR FANSIMEF OR CAMOQUINE OR CHLORPROGUANIL OR ARTEMETHEROR ARTEMISIN* OR QUININE OR CHLOROQUINE

3 TitleMOSQUITOES OR PYRIMETHAMINE OR MEFLOQUINE OR MOSQUITO OR MOSQUITOSOR MOSQUITOCID* OR ANOPHEL*

4 TitleAEDES OR SCHISTOSOM* OR ONCHOCERC* OR BRUGIA OR CULEX OR HIV ORLEISHMAN* OR TRYPANOSOM* OR WUCHERERIA OR FILARIA* OR ARBOVIRUS* ORDENGUE OR (YELLOW AND FEVER) OR VIRAL OR VIRUS

5 Set:Article (2 or 3) not (1 or 4)

6 Set:Note (2 or 3) not (1 or 4)

7 Set:Review (2 or 3) not (1 or 4)

8 Set:Article 1

9 Set:Note 1

10 Set:Review 1

11 Set 8 thru 10

12 Set 5 thru 7

Unconditional set 11

Conditional set 12

3 SEARCH STRATEGY TO IDENTIFY MALARIA PAPERS USINGTHE SCI AND MEDLINE DATABASES


Annexes

Country Number of malaria publications

Kenya 103

Tanzania 74

Nigeria 68

Gambia 56

Cameroon 46

Senegal 44

Gabon 30

Malawi 29

South Africa 29

Burkina-Faso 19

Zimbabwe 19

Ghana 18

Ivory Coast 18

Mali 14

Ethiopia 12

Madagascar 12

Country Number of malaria publications

Sudan 11

Niger 8

Uganda 8

Burundi 7

Zambia 7

Democratic Republic 6of Congo (Zaire)

Sierra Leone 6

Congo 5

Benin 4

Togo 4

Guinea-Bissau 2

Equatorial Guinea 1

Liberia 1

Somalia 1

Swaziland 1

4 AFRICAN PUBLICATION OUTPUT IN SCI AND MEDLINEDATABASES (1995–97)

Country Title Authors Year ofpublication

Malawi Guide for the management of malaria (for physicians, Malaria Control Programme, 1997clinical officers,medical assistants and nurses Ministry of Health and Population

Kenya National guidelines for diagnosis, treatment and prevention Ministry of Health 1998of malaria for health workers

Namibia National policy and strategy for malaria control Ministry of Health and Social Services 1995

Zimbabwe National malaria control programme five year plan (1994–1998) Disease Control Unit,Ministry of Health 1993and Child Welfare

Ghana Malaria Action Plan – 1993–1997 Ministry of Health 1991

Nigeria National malaria control programme plan of action 1996–2001 Malaria and Vector Control Division, 1995Federal Ministry of Health

South Africa Guidelines for the prophylaxis of malaria Department of Health 1996

South Africa Guidelines for the treatment of malaria Department of Health 1996

Zambia Malaria control programme 1995

Senegal Programme de lutte contre le paludisme du Senegal Ministère de la Santé et de l’Action Sociale 1994 (version provisoire)

Tanzania Plan of Action 1997–2000 of the National Ministry of Health 1997 Malaria Control Programme

5 MALARIA CONTROL GUIDELINES AND POLICIES


Annexes

(A) 1,2 Antimalarial drug discovery and developmentin vitro and in animal models, and the biochemistry ofdrug action

1.Antimalarial drug discovery and development in vitro and

in animal models

Measurement of the activity of potential antimalarial drugs in animal

models and in vitro models of malaria. Antimalarial drug pharmaco-

kinetic, toxicity and metabolism studies in vitro and in animal models.

Chemistry and synthesis of antimalarial drugs. Analytical tests for

assaying antimalarial drugs.

Excluding: Antimalarial drug pharmacokinetic, toxicity and metabolism

studies in humans, trials of antimalarial drugs and combinations of

drugs in human malaria patients to establish efficacy (8). Effects of

drugs on immune status (3).

2.Mechanisms of drug addition

The biochemistry of drug action on Plasmodium. The mechanisms of

parasite resistance to antimalarial drugs.Analysis of genes involved in

drug resistance. Characterization of drug-resistant strains of

Plasmodium.Tests for drug susceptibility of parasites.

Excluding: Epidemiology of drug resistance (11).

(B) 3,4 Immunology, vaccine development and vaccine trials

3. Immunology and vaccine development

In vivo and in vitro studies on the protective immune response (cellular

and humoral) of the mammalian host to malaria. Immune response to

particular antigens, including variable antigens. Population studies of

human immunity to malaria and the effects of antimalarial drug treat-

ment on immune status.Vaccine development studies and studies of

adjuvants for malaria vaccines. Studies on the genetics of the immune

response to malaria.

Excluding: Vaccine trials (4). Studies of the pathology of malaria (9).

Cloning of candidate vaccine antigens (7). Epidemiology studies of the

effects of specific host genotypes on malaria transmission and prevalence

(11). Biochemical characterization of vaccine candidate proteins (6).

4.Human vaccine trials and vaccine review articles.

Trials of antimalarial vaccines in humans to establish safety and effica-

cy.Reviews on the status of antimalarial vaccine development.

Excluding: Preliminary studies of malaria morbidity and mortality in

vaccine study area (11).

(C) 5,6, 7 Biology,biochemistry and genetics ofPlasmodium

5.Biology of Plasmodium

Structure and morphology of different developmental stages.

Host–parasite interactions. Biology of invasion of host cells.

Localization of parasite proteins or antigens. Culture of parasites.

Purification of parasites of parasite stages. Descriptions of species of

Plasmodium and characterization of malaria strains in animal models

(course of infection, susceptibility of different hosts). Studies of roset-

ting, sequestration and adhesion of infected erythrocytes in which

pathological consequences are not examined. In vitro studies of inter-

actions between Plasmodium and other infectious agents (e.g. EBV).

Excluding: Studies whose primary focus if the pathology of malaria (9).

Studies of the molecular basis of host-cell invasion, rosetting and

sequestration (6).

6.Biochemistry of Plasmodium

Metabolism and nutrition. Enzymology. Translation, processing and

export of proteins. Protein sequences, protein and enzyme character-

ization (including antigen analysis). Glycosylation, GPI anchors, trans-

porters, ion channels, mitochondrial metabolism, electrophysiology

studies. Influence of parasite on host-cell biochemistry.Characterization

of antigen/protein diversity in strains of Plasmodium. Characterization

of proteins involved in sequestration and rosetting of infected ery-

throcytes and of molecular basis for host-cell invasion.

Excluding: Papers primarily on mechanisms of antimalarial drug action

(2). Immune response to particular antigens (3). Pathological conse-

quences of parasite sequestration (9).

7.Genetics of Plasmodium

Studies on chromosomes. Genomic maps. Genetic crosses. Cloning

and sequencing of genes/cDNAs for functional plasmodial proteins

(including drug targets and vaccine candidates). Expression of proteins

from cloned genes. RNA analyses. Control and timing of expression of

genes. Post-transcriptional processing. Genetics of antigenic variability.

Techniques for the genetic transformation of Plasmodium. Studies of

genetic diversity and phylogeny.Tests for genotyping Plasmodium.

Excluding: Analysis of the genetics of parasite resistance to anti-

malarials (2). Epidemiology of antigenic variability (11). Diagnostic

tests for detection of malarial parasites (13).

(D) 8,9,10 Clinical treatment and prophylaxis of malaria,and pathophysiology of malaria

8.Clinical management of malaria and antimalarial drug trials

Antimalarial drug pharmacokinetic, toxicity and metabolism studies in

humans. Trials of antimalarial drugs and combinations of drugs in

human malaria patients to establish efficacy. Drug treatment and pro-

phylaxis recommendations.Development of drug treatment regimens

for particular clinical presentations of malaria (e.g. severe malaria,

cerebral malaria or malaria during pregnancy, drug-resistant malaria).

Case history reports and studies of antimalarial drug side-effects.

Excluding: Malaria prophylaxis recommendations for non-immune

travellers to endemic countries (10). Diagnosis and treatment of

malaria in non-endemic countries. Studies of social factors influencing

drug treatment and compliance.Assessment of long-term prophylaxis

in communities in endemic areas. Health services research (12).

Reports on drug-resistant strains of Plasmodium (11).

6 MALARIA RESEARCH CLASSIFICATION SYSTEM


Annexes

9.Pathophysiology and disease symptoms of malaria

Clinical diagnosis of malaria and clinical observations of the disease

presentation and pathophysiology of malaria in humans and in ani-

mals (e.g. observations on cerebral malaria, malaria during pregnancy,

mild malaria). Interactions between malaria and other concurrent

infections.The role of nutritional status in determining disease severity.

Histopathology of malaria in humans and in animals.The mechanisms

of pathology in malaria, including the role of the host immune system,

expression of adhesion molecules etc. Studies of the mechanisms by

which particular susceptible/resistant mammalian host genotypes

exert their effect.

Excluding: Epidemiological studies of malaria prevalence in relation to

human genotype (11). Studies linking immunity to malaria to specific

genotypes (3).

10.Malaria treatment and prophylaxis in travellers and migrants

Malaria prophylaxis recommendations specifically for short-term visi-

tors to malaria-endemic areas. Diagnosis and treatment of malaria in

individuals in non-endemic countries. Case reports of malaria in non-

immune travellers to endemic regions. Import of malaria by migrants

to non-endemic areas. Prophylaxis in army personnel deployed to

endemic areas.

(E) 11.Epidemiology of malaria prevalence and severtiy,and mathematical modelling

Epidemiology of the distribution of species of malarial parasites and

mosquito vectors, and of the prevalence of morbidity and mortality

due to malaria. Studies of the biological, environmental, social and

economic determinants of malaria transmission dynamics and of

malaria prevalence (e.g. roles of human behaviour; vector behaviour,

ecology and epidemiology; inoculation rates, host genetic factors,

Plasmosdium strain variation etc.). Epidemiological studies of genetic

factors influencing the prevalence of malaria, including sickle cell

genes, thalassaemia, HLA type etc.The impact of malaria on selection

for particular host genotypes. Epidemiology of resistant/susceptible

strains of Plasmodium to antimalarial drugs and of mosquito vectors

to insecticides. Mathematical modelling of malaria (e.g. of malaria

transmission and of human immune response to malaria).

Excluding: Studies of the effects of control interventions on malaria

transmission. Morbidity and mortality as a result of malaria (12).

Studies on the mechanisms by which specific mammalian host geno-

types influence host immunity (3) or pathology (9). Studies of vector

ecology and behaviour which are not in the context of transmission

(14).Cases of malaria imported to non-endemic areas (10).

(F) 12. Intervention trials and health services researchTrials to test measures for the control of mosquito vectors (bed-

nets, environmental and biological control measures, insecticides

etc.) and to test other interventions, administered through health

care services etc. For the control of malaria morbidity and mortality

in communities (e.g. drug treatment and prophylaxis). Studies of com-

munity attitudes, knowledge and practice in relation to malaria treat-

ment and control programmes. Healthcare service studies in relation

to delivery of malaria treatment and control measures. Design of

treatment and control programmes appropriate to local prevailing

conditions. Implementation and evaluation of large-scale malaria

treatment and control programmes operated through healthcare

services, government ministries, non-governmental organizations etc.

Operational research. Economic impact of malaria morbidity and

mortality on communities and the economics of malaria control

measures.

Excluding: Clinical trials of drugs or vaccines to establish safety and

efficacy (8 or 4).

(G) 13.Development of diagnostic tests for malariaDiagnostic tests for the detection and identification of malarial para-

sites in humans: ELISAs, DNA probes, PCR tests, novel microscopy

tests etc.

Excluding: Application of these tests in epidemiology studies (11).

Tests for genotyping parasites (7).

(H) 14. Studies of mosquito vectors of malariaVector biology, biochemistry and genetics. Including studies of vector

susceptibility to infection by Plasmodium, genetic transformation of

vectors, insect transposable elements, genetics of insecticide resist-

ance, tests for vector identification, taxonomy and systematics.

Development of tests for the identification of Plasmodium-infected

mosquitoes. Characterization of mosquito behaviour and ecology.

Laboratory-based studies to develop mosquito control measures.

Studies of parasites and pathogens of mosquitoes, including those

which might be applied as biological control agents.

Excluding: Studies primarily on biology of parasite interaction with

mosquito host (5). Studies in which the epidemiology and behaviour

of vectors is specifically related to the transmission of malaria (11).

Field testing of mosquito control measures (12).

Definition of ‘human’ and ‘non-human’ researchPublications or grant awards were classified as ‘human’ if they includ-

ed within them studies of malaria in humans. For example: clinical

management and clinical observations of malaria in humans, the

human immune response to malaria, human genetic susceptibility to

malaria, the prevalence of morbidity and mortality due to malaria,

malaria control and treatment studies in populations (including mos-

quito control programmes), epidemiology of antimalarial drug resist-

ance,health services research.

All research into animal species of Plasmodium and studies of

human parasites in vitro were classified as ‘non-human’.This category

also included basic science studies of mosquito vectors of malaria,

studies of clinical disease or pathology in animals, theoretical mathe-

matical modelling of malaria, studies of the epidemiology of mosquito

vectors and vector behaviour studies.


Annexes

International (total number of papers with funding acknowledgements = 2034)

Funding body Papers

UNDP/World Bank/WHO Special Programme for Research and 388 (19%)Training in Tropical Diseases (TDR)Wellcome Trust,London,UK 234 (12%)US Department of Defense (DoD) 231 (11%)US National Institute of Allergy and Infectious Diseases (NIAID) 184 (9%)US National Institutes of Health (NIH) 169 (8%)UK Medical Research Council 160 (8%)European Commission 141 (7%)Centers for Disease Control and Prevention (CDC USA) 115 (6%)US Agency for International Development (USAID) 107 (5%)Institut Pasteur,Paris 103 (5%)Australian National Health and Medical Research Council 91 (4%)World Health Organization (WHO) 90 (4%)Institut National de la Santé et de la Recherche Médicale (INSERM) 75 (4%)Kenya Medical Research Institute (KEMRI) 71 (4%)Centre Nationale de la Recherche Scientifique (C N R S) 75 (4%)Hoffmann-La Roche 58 (3%)John D and Catherine T MacArthur Foundation 49 (2%)Indian Council of Science and Industrial Research 49 (2%)Swiss Tropical Institute (STI) 47 (2%)Fonds National Suisse de la Recherche Scientifique (FNSRS) 43 (2%)L’Institut de Recherche pour le Développement (IRD) formerly ORSTOM 43 (2%)Deutsche Forschungsgemeinschaft (DFG) 37 (2%)Japanese Ministry of Education,Science and Culture 37 (2%)National Research Council,Brazil 35 (2%)Swedish Medical Research Council 32 (2%)Howard Hughes Medical Institute 31 (2%)SmithKline Beecham plc 29 (1%)Foundation for the Advancement of Science,Denmark 28 (1%)Papua New Guinea Government 24 (1%)Swedish Agency for Research Development with Other Countries (SAREC) 23 (1%)Rockefeller Foundation,New York 22 (1%)Pan-American Health Organization 20 (1%)Danish Agency for International Development (DANIDA) 19 (1%) Recherche et L’Espace,Ministère de la France 18 (1%)Ministère de Cooperation et du Développement,France 18 (1%)Thai Government 18 (1%)Colombian Government 18 (1%)Burroughs Wellcome Fund,USA 17 (1%)US Public Health Service,Rockville MD 17 (1%)Ministère de Recherche et de la Technologique,France 17 (1%)Medical Research Council,Canada 16 (1%)UK Department of Health 15 (1%)Oswaldo Cruz Foundation,Brazil 15 (1%)Brazillian Agency for the Funding of Studies and projects 14 (1%)Tanzanian Government 14 (1%)Biotechnology and Biological Sciences Research Council (BBSRC),UK 13 (1%)Royal Society,London 13 (1%)Cameroon Government 13 (1%)Canadian National/Natural Science and Engineering Research Council (NSERC) 13 (1%)National Science Foundation,USA 12 (1%)Fonds der Chemischen Industrie,Frankfurt am Main 12 (1%)Indonesian Government 12 (1%)Queensland Institute for Medical Research 12 (1%)

7 ACKNOWLEDGEMENTS BY FUNDING BODY FOR PAPERS (INTERNATIONAL AND AFRICAN) FROM 1995–97Number of papers with at least one acknowledgement to a funding body (Percentage of all papers with funding acknowledgements)


Annexes

African (total number of papers with funding acknowledgements = 410)

Funding body Papers

UNDP/World Bank/WHOSpecial Programme for Research and Training in 97 (24%)Tropical Diseases (TDR)Wellcome Trust 79 (19%)Kenya Medical Research Institute (KEMRI) 71 (17%)UK Medical Research Council 63 (15%)Centers for Disease Control and Prevention (CDC USA) 39 (10%)L’Institut de Recherche pour le Développement (IRD) (formerly ORSTOM) 35 (9%)US Agency for International Development (USAID) 33 (8%)World Health Organization (WHO) 33 (8%)Swiss Tropical Institute (STI) 31 (8%)US Department of Defense (DoD) 28 (7%)European Commission 25 (6%)Institut National de la Santé et de la Recherche Médicale (INSERM) 22 (6%)Institut Pasteur (IP) 22 (5%)Ministère de Cooperation et du Développement,France 18 (4%)Danish Agency for International Development (DANIDA) 14 (3%)Swedish Medical Research Council 14 (3%)US National Institutes of Health (NIH) 13 (3%)Cameroon Government 13 (3%)Swedish Agency for Research Development with Other Countries (SAREC) 12 (3%)Tanzanian Government 12 (3%)US National Institute of Allergy and Infectious Diseases (NIAID) 11 (3%)Hoffmann-La Roche 10 (2%) Rockefeller Foundation 10 (2%)South African Medical Research Council 9 (2%)Danish Medical Research Council 7 (2%)US Government 7 (2%)Centre Nationale de la Recherche Scientifique (CNRS) 6 (2%)Ministère de Recherche et L’Espace,France 6 (1%)Swiss Directorate for Technical Cooperation and Humanitarian Aid 6 (1%)Fonds National Suisse de la Recherche Scientifique (FNSRS) 6 (1%)Deutsche Forschungsgemeinschaft (DFG) 6 (1%)SmithKline Beecham plc 6 (1%)Burkina-Faso Government 6 (1%)Gambian Government 5 (1%)Swedish National Board for Laboratory Animals 5 (1%)Swedish International Development Cooperation Agency (Sida) 5 (1%)UK Department of Health 5 (1%)Ethiopian Government 5 (1%)Foreign Affairs,Ministry of The Netherlands 5 (1%)Ministère de Recherche et de la Technologique,France 4 (1%)Netherlands Foundation for Advancement of Tropical Research (WOTRO) 4 (1%)Swedish Institute 4 (1%)Japan International Co-operation Agency (JICA) 4 (1%)Malawian Government 4 (1%)UNICEF 4 (1%)Fonds der Chemischen Industrie,Frankfurt am Main 4 (1%)


Annexes

8 QUESTIONNAIRE FOR THE SURVEY OF AFRICAN MALARIARESEARCH LABORATORIES

Section A:Completed by leaders of research groups

Section A: (i) About your research group

(a) Name of head of research group. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(b) Title of research group. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(c) Address of institute . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(d) What proportion of the group’s time is currently spent on malaria research?

0–25% 26–50%

51–75% 76–100%

(e) Please give details of all grants (including sources of local funding) that have supportedresearch in your group over the last 5 years (1993 to date) in any subject.

All data will be treated in strict confidence. Data will not be attributed to individuals and will be used in aggregate.

1. Funding body/source . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Award title . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dates of award (from/to). . . . . . . . . . . . . . . . Amount*. . . . . . . . . . . . . . . . . . . .

Other collaborating institutes involved in research project (if applicable): . . . . . . . . . . . . .


Award title . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dates of award (from/to) . . . . . . . . . . . . . . . Amount*. . . . . . . . . . . . . . . . . . . .

Other collaborating institutes involved in research project (if applicable): . . . . . . . . . . . . .


Award title . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dates of award (from/to). . . . . . . . . . . . . . . . Amount*. . . . . . . . . . . . . . . . . . . .

Other collaborating institutes involved in research project ( if applicable): . . . . . . . . . . . . .

* “Amount of funding” need not be completed, but approximate figures would be very useful.


Annexes

Section A: (ii) Your staff

(a) How many RESEARCH STAFF? (Number)

i) Currently work in your research group? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ii) Are involved in malaria related research? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(b) Please complete or update the information in the following chart taken from the Directoryof the African Malaria Vaccine Testing Network.

Number of employees in each of the following specialities:

Specialities MD Diploma 1st Master’s PhD African Non-African TOTALDegree National National

Public HealthEpidemiologyParasitologyEntomologyImmunologyBiochemistryMolecular BiologyBiostatisticsSociologyEconomicsDemographyOther discipline (please specify)Number of technical staffTOTAL

Section B:Completed by individual researchers

Section B: Staff details: To be completed by individual researchers, who are qualified to at leastfirst degree level.

Please complete the following questions giving details of all academic and training qualificationsyou hold and return to the head of your research group.

The purpose of the questionnaire is to gather information on research funding and training oppor-tunities in tropical medicine, with a particular focus on malaria in Africa. All data will be treated instrict confidence. Data will not be attributed to individuals and will be used in aggregate. You neednot indicate your name on this form if preferred.

(a) Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(b) Department/Institute . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(c) Current job title . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(d) Nationality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(e) Current employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8 QUESTIONNAIRE FOR THE SURVEY OF AFRICAN MALARIARESEARCH LABORATORIES (cont.)


Annexes

(i) Do you have a permanent position? Yes No If no, please answer Question (ii)

(ii) For how long is your employment contract? months

(iii) Who funds your salary? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(iv) Who funds your research? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(f ) What proportion of your time is currently spent working on malaria?

0–25% 26–50%

51–75% 76–100%

(g) Academic qualifications (e.g. undergraduate, higher degrees and diplomas, Postdoctoralresearch experience and research training attachments). MOST RECENT FIRST

Qualification and subject title: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Dates of study/training attachment: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Location(s) of study/training (Institute, country): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Source of funding: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amount of funding*: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

From: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

To: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

* “Amount of funding” may be left blank if preferred, but approximate figures would provide valuable information for the MIM survey.Please copy this sheet if necessary

(h) Do you have any collaborative or training links with other institutions or organizationsinvolved in malaria research or control activities? If yes, please give full details (e.g. locationof collaborating institute, nature of link). Please mention any local opportunities for malariaresearch training that currently exist or are under consideration.

(i) What types of schemes (e.g. collaborative, training, funding etc.) do you consider, are orwould be, particularly beneficial in developing research capacity in African universities,research institutions and ministries of health? Please give details of level of training (MSc,PhD etc.), mechanism, location etc.

(j) Please identify any specific difficulties that you may have experienced in developing andmaintaining a research career in tropical medicine. How might these difficulties be over-come in the future?

Please continue on additional sheet if more space is required.

Thank you for your co-operation in completing this questionnaire

8 QUESTIONNAIRE FOR THE SURVEY OF AFRICAN MALARIARESEARCH LABORATORIES (cont.)


Annexes

Country Institute Research Section B groups (n) respondents (n)

Benin Regional Centre for Epidemiological Research of Cotonou 1 2

Burkina-Faso Centre National de Lutte contre le Paludisme,Ouogadougou 1 7

Burkina-Faso Centre Muraz,Bobo Dioulasso 1 5

Cameroon Georgetown University,University of Yaoundé 1 18

Cameroon Institute of Medical Research and Studies of Medicinal Plants,Yaoundé 1 9

Cameroon University of Buea 1 13

Cameroon L’Organisation de Coordination pour la Lutte contre les Endémies en Afrique (OCEAC),Yaoundé 2 7

Ethiopia Jimma Institute of Health Sciences 1 7

Ethiopia Ethiopian Health and Nutrition Research Institute 1 4

Gabon Albert Schweitzer Hospital, Lambaréné 1 3

Gabon Centre International de Recherches Médicales de Franceville 1 2

The Gambia UK Medical Research Council Laboratories, Fajara 1 10

Ghana Navrongo Health Research Centre 1 15

Ghana Noguchi Memorial Institute, Legon 2 10

Ivory Coast Institut Pasteur de Côte d’Ivoire 1 4

Ivory Coast Institut Pierre Richet,Bouaké 1 18

Kenya KEMRI Vector Biology and Control Research Centre,Kisumu 1 11

Kenya KEMRI–Wellcome Trust collaborative programme,Kilifi and Nairobi 3 25

Madagascar Institut Pasteur de Madagascar 2 11

Malawi Community Health Sciences Unit,Ministry of Health, Lilongwe 1 4

Malawi Wellcome Trust Research Laboratories,College of Medicine,Blantyre 1 3

Niger Centre de Recherche sur les Meningites et les Schistosomoses (CERMES),Niamey 1 8

Nigeria University of Ibadan 2 15

Nigeria College of Medicine,University of Lagos 1 6

Nigeria University of Nigeria,Nsukka 1 6

Senegal Institut Pasteur de Dakar 4 14

Senegal Institut de Recherche pour le Développement,Dakar 1 12

Senegal Faculty of Medicine and Pharmacy,Dakar 1 6

South Africa National Malaria Research Programme,Durban 1 7

South Africa South African Institute of Medical Research, Johannesburg 1 4

South Africa University of Cape Town 1 1

South Africa University of Natal 1 2

Sudan Institute of Endemic Diseases,University of Khartoum 1 9

Tanzania Amani Medical Research Centre 1 10

Tanzania Muhimbili College of Health Sciences 1 1

Tanzania National Institute for Medical Research,Dar es Salaam 1 3

Uganda Med Biotech Laboratories,Kampala 1 8

Zimbabwe Blair Research Institute,Harare 1 9

Individual questionnaires from African researchers working abroad 0 2

Additional data from AMVTN Directory included in analysis of research expertise

Kenya Division of Vector Borne Diseases,KEMRI,Nairobi

Mozambique Instituto Nacional de Saude,Maputo

Sudan The Blue Nile Research and Training Institute

Tanzania Ifakara Health Research and Development Centre

Togo National Malaria Control Programme,Ministry of Health, Lomé

Zambia Tropical Diseases Research Centre,Ndola

9 SURVEY RESPONDENTS


Annexes6

Funder Research grants Funding acknowledgements1993–98 for current research

UNDP/World Bank/WHO Special Programme for Research and Training 61 80in Tropical Diseases (TDR)1

French Ministry of Cooperation 33 26World Health Organization (WHO)1 25 31Home government 24 94Wellcome Trust 20 20European Commission 17 25Agence Universitaire de la Francophonie (AUPELF-UREF) 9 8Unidentified funding bodies 9 11Institut Pasteur 8 15Danish International Development Agency (DANIDA)2 7 14International Development Research Center,Canada 6 6US National Institutes of Health 5 17UK Department for International Development (DFID) 5 4Swedish International Development Cooperation Agency (Sida/SAREC) 4 1Roche 4 1United Nations Children’s Fund (UNICEF) 4 0US Agency for International Development (USAID) 3 8US Department of Defense 3 3Rockefeller Foundation 3 3Italian Government 3 3World Bank 2 4International Atomic Energy Agency 2 3SmithKline Beecham 2 2International Center for Genetic Engineering and Biotechnology (ICGEB) 2 2Centre National de la Recherche Scientifique (CNRS) 2 2Japan International Cooperation Agency (JICA) 2 1Agr Evo 2 0UK Medical Research Council 1 9The Netherlands Government 1 3Pasteur Merieux Connaught 1 3Sumitomo 1 1Glaxo Wellcome 1 1Rhône Poulenc 1 0Parke Davis 1 0Old Mutual 1 0Medicus Mundi 1 0Laboratoire Innotech International 1 0L’Institut de Recherche pour le Développement (IRD)3 1 22Institut National de la Santé et de la Recherche Médicale (INSERM) 1 0Hoffman-La Roche 1 0German Government 1 0Belgian Government 1 0Bayer 1 0Water Aid 1 0US Centers for Disease Control and Prevention (CDC) 0 8Self 0 8University of Tubingen,Germany 0 3Swiss Agency for Development Cooperation (SDC)4 0 3Inter-church Medical Assistance 0 2Association pour le Développement de la Riziculture en Afrique de l’Ouest (ADRAO) 0 1Canadian International Development Agency (CIDA) 0 1German Government 0 1Norwegian Government 0 1Volkswagen 0 1Zeneca 0 1

10 FUNDING SOURCES LISTED BY RESPONDENTS TO ASURVEY OF AFRICAN MALARIA RESEARCH LABORATORIES

1 Research grants specifically acknowledging the UNDP/World Bank/WHO SpecialProgramme for Research and Training in Tropical Diseases (TDR) were analysed separatelyfrom other acknowledgements to the World Health Organization

2 Includes acknowledgements to the Danish Bilharziasis Laboratory 3 Formerly ORSTOM4 Includes acknowledgements to Swiss Tropical Institute


Annexes

Funder PhD Master’s

Home government 23 50

UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR)1 23 26

Self 15 37

Institut de Recherche pour le Développement (IRD)2 10 12

French Ministry of Cooperation 6 5


Wellcome Trust 5 3

Agence Universitaire de la Francophonie 4 0

Danish International Development Assistance (DANIDA)3 4 1

Swedish International Development Assistance (Sida/SAREC) 4 0

US National Institutes of Health 3 2

IDRC 2 1

Swiss Agency for Development and Cooperation (SDC)4 2 4

US Centers for Disease Control and Prevention 2 3

US university scholarships 2 2

USAID 2 1

British Council 1 1

CIDA 1 2

Deutscher Akademischer Austauschdienst (DAAD) 1 2

Edna McConnell Clark Foundation 1 0

Institut Pasteur 1 2

International Atomic Energy Agency 1 0

Italian Government 1 0

Japanese Government 1 1

Netherlands Government 1 0

Rudolf Geigy Foundation 1 0

UK Medical Research Council 1 0

United Nations 1 1

Chinese Government 0 1

Government of the former Soviet Union 0 2

Indonesian Government 0 1

NORAD 0 1

UK Department for International Development 0 3

Unknown/not specified 10 13

11 FUNDING ACKNOWLEDGEMENTS FOR MASTER’S ANDPHD TRAINING IN A SURVEY OF AFRICAN MALARIARESEARCH LABORATORIES

1 Research grants specifically acknowledging the UNDP/World Bank/WHO SpecialProgramme for Research and Training in Tropical Diseases (TDR) were analysedseparately from other acknowledgements to the World Health Organization

2 Formerly ORSTOM 3 Includes acknowledgements to the Danish Bilharziasis Laboratory4 Includes acknowledgements to Swiss Tropical Institute


BENINDr Martin Akogbeto,Regional Centre for Epidemiological Research ofCotonou,OCCGE – Malaria Institute,06 BP 2604,Cotonou,Republic of BeninTel:+229 330825;Fax:+229 330825/229 334 241

BURKINA-FASODr Diadier A Diallo,Centre National de Lutte Contre le Paludisme(CNLP),BP 2208,Ougadougou 01,Burkina-FasoTel:+226 32 4695/6; Fax:+222 31 0477E-mail: [email protected]

BURKINA-FASOProfessor Tinga R Guiguemde,Centre Muraz,01 BP 153 Bobo Dioulasso,01 Burkina-FasoTel:+226 97 0102;Fax:+226 97 0457/226 972824E-mail: [email protected]

CAMEROONDr Rose G F Leke,University of Yaoundé I,Biotechnology Centre,Nkolbison,Yaoundé,CameroonTel:+237 23 74 29; Fax:+237 23 44 51

CAMEROONDr Roger Moyou-Somo, Institute of Medical Research and Studies ofMedicinal Plants,BP 193,Yaoundé,CameroonTel/Fax:+237 22 45 29

CAMEROONDr Eric Achidi,Malaria Research Group,Department of Life Sciences,University of Buea,PO Box 63,Buea, SW Province,CameroonTel:+237 32 2134;Fax:+237 43 2508

CAMEROONDr Pascal Ringwald,Division of Biology and Epidemiology,Organisationde Coordination pour la Lutte contre les Endémies en Afrique (OCEAC),BP 288 Yaoundé,CameroonTel:+237 23 2232;Fax:+237 23 0061

CAMEROONDr Christian Boudin,Vector Host Parasite Division,Organisation deCoordination pour la Lutte contre les Endémies en Afrique (OCEAC),BP 288 Yaoundé,CameroonTel:+237 23 2232;Fax:+237 23 0061

ETHIOPIADr Haile Y Lechebo, Jimma Institute of Health Sciences,PO Box 378, Jimma,EthiopiaTel:+251 7 11 1458 60; Fax:+251 7 11 1450E-mail: [email protected]

ETHIOPIADr Tilahun Woldemichael,Malaria Research Team, Infectious and Non-infectious Research Department,Ethiopian Health and NutritionResearch Institute,PO Box 1242,Addis Ababa,EthiopiaTel:+251 175 3470/ 175 1522;Fax:+251 1 75 47 44E-mail: [email protected]

GABONDr Peter Kremsner,Research Unit,Albert Schweitzer Hospital,BP 118,Lambaréné,GabonTel:+241 58 1095;Fax:+241 58 1196

GABONDr Philippe Deloron,Medical Parasitology Unit,Centre International deRecherches Médicales de Franceville (CIRMF),BP 769Franceville,GabonTel:+241 677092/96; Fax:+241 677259/95

THE GAMBIADr Margaret Pinder,UK Medical Research Council Laboratories, Fajara,PO Box 273,Banjul,The GambiaTel:+220 495442/6; Fax:+220 496513

GHANADr Fred Binka,Navrongo Health Research Centre,PO Box 114Navrongo,GhanaTel/Fax:+233 21 666 005 E-mail: [email protected]

GHANADr Kwadwo Koram,Epidemiology Unit,Noguchi Memorial Institute forMedical Research,University of Ghana,PO Box LG581,Legon,GhanaTel:+233 21 500374;Fax:+233 21 502182E-mail: [email protected]

GHANADr Francis K Nkrumah,Noguchi Memorial Institute for MedicalResearch,University of Ghana,PO Box 25,Legon,GhanaTel:+233 21 500374;Fax:+233 21 502182E-mail: [email protected]

IVORY COAST Dr Louis K Penali, Institut Pasteur de Côte d’Ivoire,Unité d’Étude et deRecherche sur le Paludisme,01 BP 490,Abidjan,Côte d’IvoireTel:+225 08 7906;Fax:+225 48 7405/7623

IVORY COAST Dr Pierre Carnevale, Institut Pierre Richet, 01 BP1500,Bouake 01,Abidjan,Côte d’IvoireTel:+225 63 37 46; Fax:+225 63 2738

KENYADr Aggrey Oloo,KEMRIVector Biology and Control Research Centre,PO Box 1578,Kisumu,KenyaTel/Fax:+254 35 41031/22924

KENYA (AMVTN) Dr John Ouma,Division of Vector Borne Diseases,Ministry of Health,PO Box 20750,Nairobi,KenyaTel:+254 27 24302;Fax:+254 27 11673/25624E-mail: [email protected]

KENYADr William Watkins,KEMRI–Wellcome Trust Collaborative Programme,PO Box 43640,Nairobi,KenyaTel:+254 2 725390/8; Fax:+254 2 711673

KENYADr Robert Snow,KEMRI–Wellcome Trust Collaborative Programme,PO Box 43640,Nairobi,KenyaTel:+254 2 710672/715160;Fax:+254 2 711673

KENYAProfessor Kevin Marsh,KEMRI–Wellcome Trust CollaborativeProgramme,PO Box 230,Kilifi,KenyaTel:+254 125 22063;Fax:+254 125 22390

MADAGASCARDr Ronan Jambou, Institut Pasteur de Madagascar, Laboratoire dePaludisme,BP1274,Antananarivo 101,MadagascarTel:+ 261 20 22 401 64; Fax:+ 261 20 22 415 34

MADAGASCARDr Jean-Bernard Duchemin, Institut Pasteur de Madagascar, Laboratoirede Paludisme,BP1274,Antananarivo 101,MadagascarTel:+ 261 20 22 401 64; Fax:+ 261 20 22 415 34

MALAWIProfessor Malcolm Molyneux,Wellcome Trust Laboratories,College ofMedicine,University of Malawi,Box 30096,Chichiri,Blantyre 3,MalawiTel:+265 676 444;Fax:+265 675 774

Annexes

12 AFRICAN MALARIA RESEARCH GROUPS: CONTACT DETAILSGroups that responded to the MIM survey or were included in the AMVTN Directory


Annexes

MALAWIDr Allan Macheso,Malaria Control Programme,Community HealthSciences Unit, Private Bag 62,Ministry of Health, Lilongwe,Malawi Tel:+ 265 744 177;Fax:+ 265 744 882E-mail:[email protected]

MOZAMBIQUE (AMVTN) Dr Martinho Dgedge, Instituto Nacional de Saude,PO Box 264,Maputo,MozambiqueTel:+2581 431103;Fax:+2581 423726

NIGER Dr Jean Philippe Chippaux,Centre de Recherche sur les Meningites etles Schistosomoses (CERMES),BP 10887,Niamey,NigerTel:+227 572 045;Fax:+227 753 180

NIGERIAProfessor Mark Nwagwu,Malaria Immunology,Cellular ParasitologyProgramme,Dept of Zoology,University of Ibadan,NigeriaTel:+234 2810 1430;Fax:+234 2810 3118

NIGERIAProfessor Ayoade Oduola,Pharmacology and Therapeutics,Postgraduate Institute for Medical Research,University of Ibadan,Ibadan PMB 5116 NigeriaTel:+234 22 41 0588;Fax:+234 22 41 0403E-mail:[email protected]

NIGERIADr Bolaji N Thomas, Dept of Medical Microbiology and Parasitology,College of Medicine,University of Lagos,Lagos,PMB 12003,NigeriaTel:+234 1 54 53 76074;Fax:+234 1 58 51432E-mail: [email protected]

NIGERIADr Peter N Uzoegwu,Tropical Diseases Research Group,Dept ofBiochemistry,University of Nigeria,Nsukka,NigeriaFax:+234 42 253 223E-mail:[email protected]

SENEGALDr Alioune Dieye,Molecular Immunogenetics Laboratory, InstitutPasteur de Dakar,36 Avenue Pasteur,BP220,Dakar, SenegalTel:+221 839 93 42; Fax:+221 839 9210

SENEGALDr Laurence Lochouarn,Medical Entomology, Institut Pasteur de Dakar,36 Avenue Pasteur,BP220,Dakar, SenegalTel:+221 823 4874;Fax:+221 839 9210

SENEGALDr André Spiegel, Epidemiology Unit, Institut Pasteur de Dakar,36 Avenue Pasteur,BP 220,Dakar, SenegalTel:+221 833 9249;Fax:+221 839 9210

SENEGALDr Jean François Trape,ORSTOM-IRD,Laboratoire du Paludologie,BP 1386,Dakar, Senegal,Tel:+221 832 0962;Fax:+221 832 1675

SENEGALDr Samba Diallo,Parasitology Service, Faculty of Medicine and Pharmacy,University Chiekh Anta Diop,Dakar, SenegalTel:+221 24 5588/25 19 98; Fax:+221 25 29 52

SENEGALDr Ronald Perraut, Immunology Unit, Institut Pasteur de Dakar,36Avenue Pasteur,BP220,Dakar, SenegalTel:+221 839 92 45; Fax:+221 839 92 10

SOUTH AFRICADr J P D Goldring,Dept of Biochemistry,University of Natal,Box X01,Scottsville 3209, South AfricaTel:+27 331 260 5466;Fax:+27 331 260 5462

SOUTH AFRICAProfessor Maureen Coetzee,Dept of Medical Entomology, South AfricanInstitute for Medical Research (SAIMR),PO Box 1038, Johannesburg2000, South AfricaTel:+27 11 489 9393;Fax:+27 11 489 9399E-mail: [email protected]

SOUTH AFRICADr Brian Sharp,National Malaria Research Programme,PO Box 17120,Congella,Durban 4013, South AfricaTel:+27 31 205 1481;Fax:+27 31 205 1498

SOUTH AFRICAProfessor B Ryffel,Medical School,University of Cape Town,Departmentof Immunology,Observatory 7925, South AfricaTel:+21 406 6147;Fax:+21 448 6116

SUDAN (AMVTN)Dr Ahmed Awad Adeel,Blue Nile Research and Training Institute,PO Box 101,Wad Medani, Sudan

SUDANDr Maowia M Mukhtar,Malaria Research Group, Institute of EndemicDiseases,University of Khartoum,PO Box 11463,Khartoum,SudanTel/Fax:+24 911 779712

TANZANIADr Andrew Kitua,National Institute for Medical Research,Ocean Road,PO Box 9653,Dar es Salaam,Amani,TanzaniaTel:+255 51 130770/131864;Fax:+255 51 130660/131864E-mail: [email protected];[email protected]

TANZANIADr Zul Premji,Department of Parasitology,Muhimbili UniversityCollege,PO Box 65011,Dar es Salaam,TanzaniaTel:+255 51 151644;Fax:+255 51 150563E-mail: [email protected]

TANZANIADr Martha Lemnge,National Institute for Medical Research,AmaniMedical Research Centre,PO Box 4, Amani,TanzaniaTel:+255 812 781332; Fax:+255 53 43869E-mail: [email protected]

TANZANIA (AMVTN)Dr Hassan Mshinda, Ifakara Health Institute,PO Box 53, Ifakara,TanzaniaTel:+255 56 3566;Fax:+255 56 3566E-mail: [email protected]

TOGO (AMVTN)Dr Gayibor Anani Hila,National Malaria Research Programme,Ministryof Health,BP 518 Lomé,TogoTel:+228 21 3227

UGANDADr Thomas Egwang,Medical Parasitology and Tropical Medicine,Medical Biotech Laboratories,PO Box 9364,Kampala,UgandaTel:+256 41 268252/266445;Fax:+256 41 268 251

ZAMBIA (AMVTN)Dr Thomas Sukwa,Tropical Diseases Research Centre,PO Box 71769,Ndola,ZambiaTel:+260 2 610961/4; Fax:+260 2 612837E-mail: [email protected]

ZIMBABWEDr Stephen K Chandiwana,Blair Research Institute, Josiah TongogaraAvenue,Mazoe Streeet,PO Box CY 573,Causeway,Harare,ZimbabweTel:+263 4 792 747/9; Fax:+263 4 792480

12 AFRICAN MALARIA RESEARCH GROUPS: CONTACT DETAILSGroups that responded to the MIM survey or were included in the AMVTN Directory

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