Wednesday, 30 December 2015

Building Capacity in Maternal Health

The example of the KLE University’s success in building local, community-based research capacity in maternal health

Nora Kropp

My first experience working in India was as a Maternal Health Researcher with RTI International from 2001-3 working with the Global Network for Women’s and Children’s Health Research.  Funded by the US Government's National Institute for Child Health and Human Development, this partnership is committed to improving maternal and infant health outcomes and building health research capacity. The Global Network supports and conducts clinical trials in resource-limited countries by setting up partnerships between US-based and international researchers. The Global Network has eight research units in developing countries around the world. I was privileged to work with KLE University’s Jawaharlal Nehru Medical College, Belgaum (JNMC) in north Karnataka during their first community-based misprostol trial.
North Karnataka is an under-privileged region that has not benefited from the economic development the rest of state has enjoyed. Many of its health indicators lag behind the rest of the South of India, instead hovering near those of Bihar. The researchers at JNMC work to evaluate low-cost, sustainable interventions to improve maternal and child health and simultaneously build local research capacity and infrastructure. Some of the big success stories are pioneering misprostal for community-based management of post-partum haemhorrage;the helping babies breathe initiative and the safebirth checklist.

The centrality of local research to achieve evidence based maternal health care that makes sense in India
Research conducted in India is important because there are many critical, unsolved questions on how to provide evidence based maternal health that services the specific needs of women in resource challenged environments. Basic questions such as what ARE women and newborns dying of in different regions?  How do we effectively address the logistical obstacles driving maternal and newborn mortality? How do we best provide access to health services – whether it is through facilities, or community based care? Given the chronic shortage of health care staff in rural areas which provider should perform what role to deliver the best outcomes?
Currently most research is invested in one-size fits all new technologies rather than in making better use of existing knowledge, and figuring out how to address real-world constraints. Instead, more research is needed to turn existing knowledge into practical applications. For example, how do you prevent post-partum haemorrhage in the absence of a OBGYN, or even a functional health facility? Many questions in health require local answers.
A trip to Belgaum
Recently I attended the “Interventions to Reduce Maternal and Infant Mortality”  meeting at KLE ‘s JNMC in Belgaum. This was a celebration of fourteen years of producing high-quality, ground breaking research at the institute.
I knew what to expect there, and was looking forward to seeing old friends and colleagues. But my colleague, Anna Schurmann, who accompanied me was wide-eyed with surprise: “who could have imagined world-class research like this in a remote corner of North Karnataka, I mean, I’d heard about this lot, but this is amazing…”.
The number of competent, capable, local lead investigators JNMC have nurtured is staggering. We listened to 24 presenters reporting on hospital and community based trials JNMC have been or are involved in. The quality of the research and the presentations without exception met international standards.

How KLE is a model for the way forward in building research capacity
There are a number of ways in which JNMC demonstrates how to build capacity in local research:
  • Long term commitment
The accomplishments of KLE University’s JNMC over the past decade and a half demonstrate the importance of a long-term commitment of personnel and funding to build expert research cultures of integrity. In an era where people flit from job to job, and funding typically only lasts for a project cycle, it was great to see the same dedicated people at KLE after more than a decade.
  • Diversifying funding sources
Regarding sustainability they have moved from two major funding sources 14 years ago to over 15 funding sources today.
  • Replicating success
Beyond their own extensive research teams in Belgaum, senior researchers there are now mentoring new research teams in Bijapur and Nagpur.
  • Strong relationships with policy decision makers
KLE is well respected among policy-makers – and at the September dissemination meeting, the Minister for Health Education, Sharanprakash R. Patil was there the whole time, not just to receive his bouquet at the opening ceremony. His comment on the proceedings was reported in the media – see article here.
  • Improving public health practice
Since their trial results showing misoprostol is effcteive in prevention of postpartum haemorrhage in resource poor communities, the Government of India has added misoprostol to the essential drug list for use when oxytocin is not available. JNMC participates in maintaning the largest community based stillbirth registry in the world and will most likely change the way we understand and address stillbirth globally.

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