Africa needs stronger institutions: what is making it happen?

An outstanding malaria researcher in his own right, Professor Abdoulaye Djimdé has also been instrumental in strengthening research capacity both in Mali and in surrounding countries. During the plenary session on 9 November, he outlined his philosophy on the best ways to strengthen institutional research capacity.

Under the leadership of Professor Abdoulaye Djimdé, the Malaria Research and Training Centre (MRTC) in Mali has become one of Africa’s leading malaria research institutions. As well as its own ground-breaking studies, it has also had a major impact on capacity building in surrounding countries with less well-developed research bases, including Guinea and Niger, under the umbrella of the West African Network for Clinical Trials of Antimalarial drugs (WANECAM), which Prof. Djimdé also leads.

The MRTC is one of three international centres of excellence in research recognised by the US National Institutes of Health (NIH). This designation reflects a long-standing partnership with the US – connections that Prof Djimdé suggests are crucial to capacity building: “In Africa we say it takes a village to raise a child. It also takes the world to build a strong institution.”

Prof. Djimdé’s approach to institutional capacity building focuses on people, just as the origins of parasitological research in Mali hark back to Philippe Ranque’s identification of Malian researchers as central to the future of research in Mali. Allied to this, the most promising people need the space and equipment to carry out their studies when they return form training abroad– something Prof. Djimdé was grateful for when he returned to his homeland after his PhD in the US: “When I went back to Mali, the lab where I used to work resembled exactly the lab I lived in in Baltimore.”

Now, he suggests, African researchers can conduct international quality research without having to leave the country. “Over 98% of those who went for training abroad came back to Mali to work.”

Neighbours

Having had a significant impact in Mali, Prof. Djimdé has also had a regional focus, and was keen to build research capabilities in neighbouring countries, through the WANECAM Network. The first target was Guinea, which required capacity building from a very basic level, as Prof. Djimdé discovered when he was shown the space allocated for a new research site: “It was a place where donkeys were sleeping,” he recalled.

Lack of a reliable electricity supply for fridges and freezers was another challenge: “The only place where we could find steady cold chain was in a fish factory.”

Undaunted, he and his colleagues from Mali and researchers in Guinea set about equipping the new site and training workers, flying back and forth between Mali and Guinea. An epidemiological study was organised, in preparation for participation in a clinical trial. These efforts had a remarkable impact: “From having no working microscope, in a few months, they were able to contribute to a GCP-compliant phase III clinical trial and recruited up to 700 patients.”

The Guinea site is thriving. It made important contributions during the Ebola outbreak in Guinea, has attracted significant additional US funding and is at the forefront of research on infections of epidemic potential. It hosts a professor and PhD students. For CANTAM II, Prof. Djimdé and colleagues adopted a similar approach, helping to strengthen a clinical research site in Niger.

Beyond the research team

Prof. Djimdé highlighted other critical aspects of capacity building, including strengthening the capabilities of a wide range of research support functions. He also stressed the importance of EDCTP’s work on enhancing national regulatory and ethics capabilities: “Unfortunately, there are not many funders that look in that direction,” he suggested. “We salute the EDCTP initiatives that target funds to training, ethics and regulatory bodies.”

Another area that should not be overlooked, he added, is community engagement.  “The community should be at the beginning, in the middle and end of everything we do,” he argued. This must include communicating the results of studies: “If you don’t feed back to the community, when you come back with your product, they will say, ‘We don’t know what you have been doing. We see you with your white coats, but we don’t know what you’ve been up to.’ So it is critical to have the community at the heart when you are working.”

Also critical is engagement with policymakers and health authorities, who will be the ones acting on the evidence generated by clinical studies: “It is critical – they need to know from the beginning what you are going to do. And, if possible, involve them in the teams. Otherwise, when the product comes out, they won’t know about it.”

A wise investment

In conclusion, Prof. Djimdé argued that investment in research capabilities would ultimately pay off handsomely: “Building research and training capacities in the least-developed countries is one of the most cost-effective and sustainable ways to advance health and development.”

He stressed the need for increased domestic investment in the research base, as well as for continuing development of regional research networks and collaboration, including in key areas such as pathogen genomics and antimicrobial resistance.

In the meantime, EDCTP remains a vital source of funds for institutional capacity building: “Really, this impact of EDCTP – it’s just amazing.”

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