How Clinical Research Can Contribute to Strengthening Health Systems in Low Resource Countries

Abstract

Clinical research on neglected tropical diseases is a challenge in low-resource countries, and the contribution of clinical and operational research to health system strengthening is poorly documented. Developing new, simple, safe, and effective treatments may improve the effectiveness of health systems, and conducting research directly in health structures may have an additional impact. This study describes the process of conducting clinical trials in the Democratic Republic of Congo (DRC) in compliance with international standards, and the role of the trials in strengthening health system functions, including governance, human resources, health information, provision of care, and the equipping of health services with the necessary supplies and infrastructure. We conclude that conducting clinical trials in endemic areas has not only reinforced and supported the aim of conducting high-level clinical research in endemic countries, but has also brought lasting benefits to researchers, staff, and hospitals, as well as to broader health systems, which have positive knock-on effect on patients outside of the clinical trials and their communities. Sustainability, however, remains a challenge in an underfunded health system, especially with respect to specialized equipment. Clinical research in most of sub-Saharan Africa is highly dependent on international input and external technical support; there are areas of weaknesses in trial design and documentation, as well as in data management and analysis. Financing remains a critical issue, as African investigators have difficulties in directly accessing sources of international research funding.

Passive surveillance of human African trypanosomiasis in Côte d’Ivoire: Understanding prevalence, clinical symptoms and signs, and diagnostic test characteristics

“…Furthermore, the study allowed passive screening of 3433 individuals for HAT in the last 2 HAT endemic districts in Côte d'Ivoire and contributed to the elaboration of a WHO dossier for validation of HAT elimination as a public health problem in Côte d'Ivoire. This underlines again that participation to clinical research can contribute to strengthening of health systems, as previously described for DR Congo [58].…”

Development and Introduction of Fexinidazole into the Global Human African Trypanosomiasis Program

“…The main objective of the HAT platform was to facilitate the research environment by increasing technical capacity and to prepare for future access to the treatments developed through local research. 14 Funding provided through DND i enabled the HAT platform to organize training sessions, engage local authorities from Ministries of Health to facilitate access to the new treatment, and promote pharmacovigilance. Annual meetings were frequently combined with scientific events and were useful for sharing new research developments in the HAT field among the partners.…”

Barriers and facilitators to the conduct of critical care research in low and lower-middle income countries: A scoping review

“…While the health-related problems in these regions are often unique, locally led research solutions are either inadequate or non-existent [ 2 ]. Apart from describing epidemiology or developing diagnostic and prognostic tools or testing interventions, high quality research has been shown to strengthen health systems, especially in countries and settings where such systems are typically fragile [ 3 ]. And yet, across disciplines and specialities, the research contributions from low and lower-middle income settings are negligible or absent [ 4 – 6 ].…”