An overview of the Access meeting held in Kampala, Uganda, 28–30^th June 2010.

The discovery and development of new tools and interventions to combat infectious diseases of poverty is fundamental to improving health outcomes among affected communities. Yet just as important as the tool or intervention itself is the community’s ability to access it. Currently, lack of access to improved tools and interventions represents a major barrier to better health and healthcare. And until that barrier is removed, achievement of the Millennium Development Goals will remain out of reach.

In recognition of the need to expand access to new tools and interventions, TDR and the Ugandan Ministry of Health convened a meeting of researchers, implementers and scientists to discuss and finalize a comprehensive report identifying gaps and priorities in implementation research (IR) into diseases of poverty. With the title, “Implementation Research for Access and Delivery of New and Improved Tools, Strategies and Interventions for the Control of Diseases of Poverty”. The meeting took place in Kampala, 28–30^th June 2010 and was covered in a TropIKA.net Knowledge Hub.

Delegates included representatives of ministries of health, research institutions, product development companies, non-governmental organizations, funders and UN agencies.

The meeting was organized around the chapters of the planned report, with discussions focused on a framework for turning new and improved disease control tools, strategies and interventions into effective solutions; identification of solutions to challenges and current inadequacies in implementation research for access and delivery; and agreement on a roadmap demonstrating how implementation research will influence adoption and scale-up of tools and interventions.

While the definition of implementation research itself remains a matter of debate, delegates nonetheless agreed that strengthening IR is critical to reducing diseases of poverty. In order for new tools and interventions to be effective, they said, the strategies employed in introducing them into target populations must be informed by a sound body of evidence.

IR is under-valued

“For Implementation Research (IR) to achieve results, the global IR community must improve its co-ordination, strengthen partnerships with health systems, and create more opportunities for cross-learning and transparency,” Dr Jane Kengeya-Kayondo, TDR’s Coordinator of Strategic Alliances, told delegates. As it is, however, IR is undervalued by the public health community and underfunded by governments.

Indeed, as TDR’s Dr Soumya Swaminathan pointed out, the highest levels of government in many countries still do not recognize the value of implementation research. As a result, scientific advances have not translated into improved health outcomes for the most vulnerable sectors of society, namely women and children.

Moreover, many countries do not even regard implementation research as a genuine form of research, said Dr Walter Flores, director of the Center for the Study of Equity and Governance in Health Systems in Guatemala. Consequently, these countries provide little funding for IR, which results in most of this research being conducted by NGOs. There is an important need to advocate for IR with ministries of health and donors.

Community participation

Still, say delegates, a top-down approach to IR is not appropriate, community participation is vital to strengthening health systems research. And by actively participating in research, communities are better able to understand research findings.

In the course of conducting IR, researchers should be mindful of the people on the ground and the importance of getting research results to patients and health workers. Policy makers, providers and the community need to have knowledge of the new tools, strategies and interventions, and of their costs and implementation.

It is also important to remember that all members of the health workforce, and not only providers of care, play a part in communicating the benefits of health interventions and how to correctly implement them.

Integration into health systems

It was also noted that many interventions fail to be adopted by the communities that most need them because they have not been integrated into the local health system. By ensuring that interventions are integrated into a community’s health system, health officials can make new tools and interventions more widely available, acceptable, accessible and affordable, Speakers also stressed the inclusion of a range of health professionals such as lay providers, volunteer workers and traditional specialists to enhance the effectiveness of behavioural, household, and community-based interventions.

Pharmacovigilance and patient safety were the subject of debate as well. According to Dr Larizgotia, an estimated one in 10 patients in developed countries are harmed while receiving hospital care, and the majority of these incidents are preventable.

“In some countries, the proportion of injections given with syringes or needles reused without sterilization is as high as 70%. This exposes millions to infections,” he said, adding that each year unsafe injections caused 1.3 million deaths, primarily due to the transmission of blood-borne pathogens such as hepatitis B virus, hepatitis C virus and HIV.

Summing up: share IR knowledge and increase participation

At the conclusion of the meeting, participants agreed that some of the biggest problems facing IR are the failure to share knowledge, the dearth of IR activity, and the perception of IR as an unserious and needless endeavour. They agreed that the compilation of the report will promote multi-stakeholder engagement and help combat diseases of poverty by providing real-world examples of interventions that have succeeded.

The Report on Implementation Research for Access and Delivery of New and Improved Tools, Strategies and Interventions for the Control of Diseases of Poverty

This report will document existing and new IR methods to equip healthcare role players and decision makers with tools, strategies and interventions to effectively combat diseases of poverty. Importantly, it will provide evidence-based information to clarify where increased action and investments might make a difference in advancing research.

The final report will feed into the Global Symposium on Health Systems Research scheduled to take place in Montreux, Switzerland 16–19^th November 2010, and will also be used as a resource for TDR’s Global report for research on infectious diseases of poverty due for publication in June 2011.