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Change of government: health reforms inevitable – Part VI

[By Brian Kabika]

Introduction

Today’s discussion centres on the role and scientific achievements of the Tropical Diseases Research Centre (hereinafter called ‘TDRC’), which was established by the Tropical Diseases Research Centre Act, Chapter 301 of the Laws of Zambia (hereinafter called ‘TDRC Act’).

The article will also talk about the underfunding the TDRC has endured in the last 40 years of its existence, thereby making its work challenging.

The role of TDRC in national research, training and development

As alluded to in the previous article, TDRC’s main stay is public health research, training and development. According to TDRC Act, TDRC was established by the Zambian government in 1981, as a national research and training centre.

According to the TDRC, the organisation also provides training to other health personnel in areas such as Project Management, Research Ethics, Good Clinical and Laboratory Practice and such trainings are meant to equip health personnel with knowledge to enable them respond to emerging health problems. The malaria training focuses on the following:

1. Laboratory diagnosis of malaria: microscopy using giemsa stain, rapid diagnostic test, and molecular biology-based techniques.

2. Recent pathogenesis and epidemiology of malaria.

3. Drugs for malaria treatment.

4. Global distribution of drug resistant malaria parasites.

5. General principles of laboratory management following internationally recognised standards.

Some scientific achievements of TDRC – expanding choices of malaria treatment in pregnancy

The TDRC has achieved a lot in health research. Due to space limitation, this article will only look at one study in malaria, titled: “Safety and efficacy of four artemisinin-based combination treatments in African pregnant women with malaria.” This study was conducted by TDRC in collaboration with the Institute of Medicine in Belgium. It was conducted in four countries, namely; Burkina Faso, Ghana, Malawi and Zambia and a total of 3,423 pregnant women were recruited as participants. The study was the largest trial on artemisinin-based combination treatments (ACT) use during pregnancy, which was ever done in sub-Saharan Africa. The duration of the study was five years.

The study revealed that dihydroartemisinin-piperaquine was efficient and stayed long in the blood to kill the malaria parasite and prevent re-occurring of the infection in pregnant women than the other drugs. Further, considering its findings, the Tropical Diseases Research Center (TDRC) recommended that dihydroartemisinin-piperaquine should be used as a new malaria treatment drug and be added to the malaria treatment policy for pregnant women.

The study also showed that the new drug had a good cure rate, safe in terms of drug-related resistance and that it was easier to administer to patients because of the dosage. In this regard, the TDRC proposed to the Ministry of Health to adopt euratesim instead of quinine for the routine management of malaria in pregnant women and that quinine could be reserved for severe malaria cases in hospitals.

The TRDC further established that apart from being cost-effective, the new drug had a good cure rate, safe in terms of drug-related resistance and was easier to administer to patients because of its low dosage.

Funding of TDRC and research financing

The TDRC has an expanded research mandate from the initial one. It has embraced research on all health problems of national importance. According to TDRC, the institution conducts research in diseases of public health importance, which include malaria, HIV/AIDS, TB, diarrhoea diseases, schistosomiasis, human African trypanosomiasis, micronutrient deficiency diseases and sexually transmitted diseases.

Research requires huge financing from both the government and well-wishers. However, TDRC is not adequately funded by the government. Most of the funding for research is received from external funding agencies and this has made the institution vulnerable to externally driven research.

According to TDRC, some notable funders to the institution are WHO, UNAIDS, Sight and Life, SIDA, ITM, CIHD, CIDA, USAID, CDC and Population Council. Although the government does give intermittent monthly grants to TDRC mainly for operational costs, this funding has not been adequate to meet the capacity needed for the institution to carry out the research mandate.

The TDRC mainly survives on source funding from relevant international research and development funding agencies through grant applications for medium to long-term programmes.

It is the view of this author that some of the money that the national health insurance scheme (hereinafter called “scheme”) collects from employees and employers can be used to finance TDRC. Further, the government must reform the scheme so that the money it collects is used for all health matters. There is no need for the scheme to participate in private insurance business when the country has private insurance companies that offer health insurance. With the advent of COVID-19, the country cannot afford to neglect scientific research. Health research requires substantial investment and part of the money that the scheme collects from employers and employees should be used for this purpose, among other health needs such as building modern hospitals, training specialists, equipping all hospitals with modern equipment.

The scheme money can also be used to finance the combating of coronavirus pandemic (hereinafter called “COVID-19”), including setting up of oxygen plants in all the 10 provinces of Zambia, establishing compensation fund for health personnel that may demise from COVID-19 while on duty and increasing their risk allowance during the pick months or periods of the disease.

It is shameful that over 50 years after independence, some health facilities lack certain specialists and equipment. Patients are sometimes referred to the University Teaching Hospital or Cancer Diseases Hospital in Lusaka where they are made to wait for months to seek treatment. What is even more sad is that for one to seek medical attention (booking) from these referral hospitals, one should be prepared to spend almost the whole day, sitting on hard surface pews before being attended to. The government must take advantage of the huge amounts that the scheme collects from subscribers and decide how well it must be used to benefit the greater good of the public.

Conclusion

Today’s article wraps up the discussion on TDRC. It is the hope of this author that government will abolish the Zambia National Public Health Institute and transfer its functions to TDRC so that all health research matters in the country can be handled by TDRC. The author is reliably informed that the TDRC Act is in the process of being reviewed. Therefore, the government is advised to take advantage of this process and repeal the Zambia National Public Health Institute Act No. 19 of 2020. This author proposes that TDRC should also be renamed as ‘Centre for Infectious Diseases’, in addition to incorporating its expanded new mandate, whose objectives are to:

1. Develop and evaluate tools, technologies and strategies for the prevention and control of diseases and related conditions.

2. Collect and disseminate scientific information including the publication of scientific reports, journals and other such documents and literature relating to the work of the Centre.

3. Serve as a Regional Research and Training Center in Africa.

4. Strengthen research and product development in malaria through design and implementation of epidemiological studies aimed at understanding better the burden of malaria including its socio-economic impact.

5. Evaluate new tools including candidate vaccines for prevention and control of malaria.

6. Develop new ways of utilising current and new drugs, traditional medicines and technologies for malaria prevention and control.

7. Strengthen the technical capacity of the Center to conduct research and product development activities that will contribute to national, regional and global prevention and control of HIV infection.

8. Development and evaluation of new methods of utilising current and new drugs, traditional remedies, vaccines, technologies and tools for HIV/AIDS and STI prevention and control.

9. Build capacity for detection of drug resistant tuberculosis, validation of molecular techniques for detection and surveillance of drug resistant strains, and devise ways of utilising current and new drugs and strategies for prevention and control of TB.

10. Develop capacity for conducting priority research in micronutrients aimed at creating a national database, improving current public health interventions, and assessment of impact of interventions.

11. Provide epidemiological data necessary for defining the place of schistosomiasis on the national health agenda, and to formulate a national strategy for control.

12. Strengthen and sustain proven ways of trypanosomiasis transmission reduction, early detection and treatment of cases to expand tsetse fly free areas and hence enable socio-economic development.

13. Establish a sentinel surveillance system, develop and evaluate existing and new tools, technologies and strategies for the prevention and control of diarrheal disease.

This is the time that the new dawn government must empower TDRC to achieve its intended purpose. This institution must also be used to develop world class good disease surveillance system that can be recognised and respected globally. The need for good disease surveillance system cannot be over emphasised. According to WHO, disease surveillance is important in helping countries monitor and evaluate emerging patterns and trends of diseases. It is crucial because it contributes to better prevention and management of diseases and through the data collected, countries are able to set their priorities and develop targeted interventions to reverse disease epidemic.

For comments, please email: muwanei.kabika@gmail.com.

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