How scientists can bridge missing link with policy makers in TZ health sector

Dar es Salaam. As the government inches closer to laying groundwork for the 2016/17 national budget, Tanzanian health scientists believe it’s the right time to begin influencing policy makers to prioritise research and development (R&D).

At least 1 per cent of the country’s GDP is committed to R&D but health scientists believe there is a large communication gap between them and the government.

This, they believe, deters the efforts of young and ambitious research scientists who would have wished to utilise a proportion of the research budget to improve health systems and the quality of life through evidence-based solutions.

Over the past ten years, local scientists have been attracted to the research field—more so, after the government established a new salary scheme that boosted the morale of many young scientists.

But a myriad of challenges ensued, when most of the work done by the researchers always ended up being shared among the scientists themselves at forums—but not necessarily being translated into solutions for development.

This week, the scientists engaged some policy makers at a one-day Policy Dialogue in Dar es Salaam, themed: “Setting Health Policy Agenda for 2016 and Beyond.” The dialogue aimed at stressing the need to transform research findings into policies.

There was a moment of soul-searching among the scientists themselves during the dialogue—especially when some of them hinted on the need for the experts “to master the basics of communicating research evidence to the policy makers, who are mainly the politicians.’’

“I would suggest that we, the researchers, learn the simplest ways to approach the government from the lowest level,’’ urged one of the researchers at the meeting in Dar es Salaam.

For many years, it has been the belief of most local scientists that, perhaps, organizing major round-table talks between them and government officials could help to raise the profile of research in the country and bridge the gaps.

At times, a section of the researchers have criticised the government for being reluctant to make use of most of the findings from their research studies—with most of the scientists’ work ending up in academic journals.

Others alluded to earlier experiences where government officials had been notorious for being absent when invited at most forums aimed at discussing important research evidence from the researchers.

However, during this week’s meeting, the Member of Parliament for Kigamboni, Dr Faustine Ndungulile--who took part in the dialogue—challenged the scientists on how they should be approaching policy makers.

Dr Ndungulile, also a medic, told the scientists that the best way to make their case strong to policy makers was by setting their priorities correctly and learning how to lobby for support.

For instance, the lawmaker suggested that researchers can achieve their goal by undertaking studies which aim at helping the government to solve problems that are directly affecting the society.

Drawing experience from his recent tour in upcountry regions, he said, “I recently took a tour to Rukwa and found that 60-75 per cent of patients at public health facilities were receiving healthcare under the exception policy.”

With only only 25 per cent of the people being able to contribute for healthcare, he argued, it was important for the researchers to come up with innovative studies on how to streamline the healthcare financing system.

The Kigamboni MP also expressed his concern over the sources of funding for most of healthcare studies done in the country—criticizing the over reliance of the researchers on donor support.

Funding for science has changed with the times. Historically, science has been largely supported through private patronage--from the backing of a prominent person or family--church sponsorship, or simply paying for the research yourself.

The work of Galileo Galilei, a famous scientist in the 16th and 17th centuries, for example, was supported mainly by wealthy individuals, including the Pope.

Charles Darwin’s Beagle voyage in the 19th century was, on the other hand, funded by the British government — the vessel was testing clocks and drawing maps for the navy — and his family’s private assets financed the rest of his scientific work.

Today, researchers are likely to be funded by a mix of grants from various government agencies, institutions, and foundations. In African countries, most of the studies are funded by foreign donor agencies or foundations.

If the world was perfect, money wouldn’t matter in this sense, as all scientific studies (regardless of funding source) would be completely objective. But we live in an imperfect world—in fact a real world, where funding may introduce biases — for example, when the funder has a stake in the study’s outcome. Take an example of a pharmaceutical company paying for a study of a new medication in Tanzania. This might influence the study’s design or interpretation in ways that subtly favor the drug that they’d like to market. There is much evidence that some biases like this do occur in this real world. Drug research sponsored by the pharmaceutical industry is more likely to end up favouring the drug under consideration than studies sponsored by government grants or charitable organisations.

In similar circumstances, a nutrition research sponsored by the food industry is more likely to end up favoring the food under consideration than independently funded research. It’s here that Dr Ndungulile said, “You see, when the donors give their financial support for studies, you can be sure that they expect their interests to be given an upper hand.’’ He asked the scientists to start contemplating about new ways of bridging the communication gap between them and policymakers and seek better funding options, among other things. Although the position of the scientists was to stick to the existing frameworks of interacting with the government, Dr Ndungulile asked them to go a notch higher—even if it meant applying skills that are beyond their science field.

The MP’s message to the scientists seemed to sink down well—especially when the Director General of the National Institute for Medical Research (NIMR), Dr Mwele Malecela, urged her fellow researchers to “be bold enough to face the policy makers’’ and lobby for support.

“Until now, it means that we can’t wait any longer for the policy makers to come to us and take our research findings and turn them into policies. We’ve got to find ways to face them,’’ she said during the meeting.

She added: “Most times, we blame the policy makers for not understanding what we publish and the cycle of—who knows and who doesn’t know—continues. Should we still go ahead with that system?”

Early last year, the then Ministry of Health and Social Welfare said it would launch a new strategic plan that envisions consistent engagement between policymakers and researchers.

It was said that the plan would address the health sector’s research priorities and the need for turning research evidence into actual solutions to problems. It’s not clear if the plan was implemented.

Dr Malecela admitted, though, that currently, not all research findings can be turned into national policies. She made reference to Dr Ndungulile’s suggestion that researchers must be producing studies which can solve pressing issues that affect the society.

“For example, studies have suggested that distribution of insecticide treated nets in malaria-endemic areas cuts down the cases of malaria. But there is evidence of people using the nets for fishing instead of preventing vectors. Studies need to be done to find out why,’’ she suggested.

According to the Permanent Secretary in the Ministry of Health, Community Development, Gender, Children and the Elderly, Dr Mpoki Ulisubisya, Tanzania needs research-driven solutions, especially in the health sector.

As a participant in the recent dialogue with scientists, Dr Ulisubisya noted that the country has been rated among nations which best-utilized research findings on vaccines and immunization.

“Today, Tanzania is listed among ten countries with the highest coverage of immunization. This is partly attributed to the readiness of the government to make use of studies done on immunisation development,’’ he said. But he gave real-life experiences which need to be researched on to improve public health and well being of the society. He cited out issues to do with antibiotic resistance.

“There are scenarios where a person develops a fever and when the diagnosis and lab tests are done, it is found out that the person has no malaria or commonest bacterial diseases,’’ he noted.

In most cases, he said, such people have ended up being given antibiotics but without relief. “The fact that a person is given several antibiotics and the fever seems not to go down, it means that the doctor might not be hitting the right enemy with the right bullet,’’ he explained.

“Studies on the extent of antibiotic resistance and how to deal with the menace are important at this point in time,” he said.

As s country with a weak economy, Tanzania needed cost-effective solutions to problems facing its health system, mostly the problems emanating from the rapidly changing global health trends.

Taking an example of the threat of Non-Communicable Diseases (NCDs), it requires a team of scientists who are well-equipped and who can think big in trying to curb such a public health challenge.

Now as the world embarks on the new global development agenda under the Sustainable Development Goals (SDGs), the need for extensive research on the challenges facing Tanzania and other countries is very crucial.