the inevitable health reforms – Part VI – The Mast Online
[By Brian Kabika]
Today’s discussion focuses on the role and scientific achievements of the Tropical Diseases Research Center (hereinafter referred to as “TDRC”), which was established by the Tropical Diseases Research Center Act, Chapter 301 of the Laws of Zambia (hereinafter referred to as the “TDRC Law”).
The article will also talk about the underfunding that the TDRC has suffered over the past 40 years of its existence, making its work difficult.
The role of the TDRC in national research, training and development
As mentioned in the previous article, the main objective of the TDRC is research, training and development in public health. In accordance with the TDRC Act, the TDRC was established by the Zambian government in 1981 as a national research and training center.
According to the TDRC, the organization also provides training to other healthcare workers in areas such as project management, research ethics, good clinical and laboratory practices and these trainings are aimed at staffing staff. health knowledge necessary to enable it to respond to emerging health issues. Malaria training focuses on the following:
1. Laboratory diagnosis of malaria: microscopy using the giemsa stain, a rapid diagnostic test and techniques based on molecular biology.
2. Recent pathogenesis and epidemiology of malaria.
3. Drugs for the treatment of malaria.
4. Global distribution of drug resistant malaria parasites.
5. General principles of laboratory management according to internationally recognized standards.
Some Scientific Achievements of the TDRC – Expanding the Treatment Options for Malaria in Pregnancy
The CRTD has achieved a great deal in the area of health research. Due to space constraints, this article will consider only one study on malaria, titled: “Safety and Effectiveness of Four Combination Artemisinin Treatments in Pregnant African Women with Malaria”. This study was carried out by the TDRC in collaboration with the Belgian Institute of Medicine. It was carried out 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 of the use of artemisinin-based combination therapy (ACT) during pregnancy ever conducted in sub-Saharan Africa. The duration of the study was five years.
The study found that dihydroartemisinin-piperaquine was effective and stayed in the blood for a long time to kill the malaria parasite and prevent the infection from coming back in pregnant women than other drugs. In addition, in view of its findings, the Tropical Diseases Research Center (TDRC) recommended that dihydroartemisinin-piperaquine be used as a new drug for the treatment of malaria and that it be added to the malaria treatment policy. for pregnant women.
The study also showed that the new drug had a good cure rate, was safe in terms of drug resistance, and was easier to administer to patients due to 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 in addition to being cost effective, the new drug had a good cure rate, was safe in terms of drug resistance, and was easier to administer to patients due to of its low dose.
TDRC funding and research funding
The TDRC has an expanded research mandate compared to the initial mandate. It encompassed research on all health issues of national significance. According to the TDRC, the institution conducts research on diseases of public health importance, including malaria, HIV / AIDS, tuberculosis, diarrheal diseases, schistosomiasis, human African trypanosomiasis, diseases due to micronutrient deficiency and sexually transmitted diseases.
Research requires huge funding from government and supporters. However, the TDRC is not sufficiently funded by the government. Most of the research funding comes from external funding agencies, which has made the institution vulnerable to outside research.
According to the TDRC, some notable funders of the institution are WHO, UNAIDS, Sight and Life, SIDA, ITM, CIHD, CIDA, USAID, CDC and Population Council. Although the government provides intermittent monthly grants to the TDRC primarily for operational costs, this funding has not been sufficient to meet the capacity needed for the institution to carry out its research mandate.
The TDRC survives mainly through funding sources from international research and development funding agencies, through grant applications for medium and long term programs.
This author is of the opinion that part of the money that the National Health Insurance Scheme (hereafter referred to as “the scheme”) collects from employees and employers can be used to fund TDRC. In addition, the government must reform the regime so that the money it collects is used for all health issues. The scheme does not need to participate in private insurance activities 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 the program collects from employers and employees must be used for this purpose, among other health needs such as building modern hospitals, training specialists. , equipping all hospitals with modern equipment.
The money from the program can also be used to finance the fight against the coronavirus pandemic (hereinafter referred to as “COVID-19”), including the establishment of oxygen factories in the 10 provinces of Zambia, establishing an indemnity fund for healthcare workers who may die of COVID-19 while on duty and increasing their risk allowance during the months or periods of illness selection.
It is shameful that more than 50 years after independence, some health establishments lack certain specialists and equipment. Patients are sometimes referred to the University Hospital or Lusaka Cancer Hospital, where they have to wait months before seeking treatment. What is even sadder is that in order to seek medical care (reservation) at these referral hospitals, one must be prepared to spend most of the day, sitting on hard-surface benches before being treated. The government must take advantage of the huge sums the system collects from subscribers and decide how much it is to be used for the greater good of the public.
Today’s article concludes the discussion on TDRC. This author hopes that the government will abolish the National Institute of Public Health of Zambia and transfer its functions to the TDRC so that all health research issues in the country can be dealt with by the TDRC. The author is reliably informed that the TDRC law is under review. Therefore, the government is advised to take advantage of this process and repeal Law No. 19 of 2020 on the National Institute of Public Health of Zambia. This author proposes that the TDRC be also renamed “Center for Infectious Diseases”, in addition to incorporating its 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 documents and literature related to the work of the Center.
3. Serve as a regional research and training center in Africa.
4. Strengthen research and product development against malaria through the design and implementation of epidemiological studies aimed at better understanding the burden of malaria, including its socio-economic impact.
5. Evaluate new tools, including candidate vaccines for the prevention and control of malaria.
6. Develop new ways of using current and new drugs, traditional medicines and technologies for the prevention and control of malaria.
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 using current and new drugs, traditional remedies, vaccines, technologies and tools for the prevention and control of HIV / AIDS and STIs.
9. Build capacity for detection of drug-resistant tuberculosis, validation of molecular techniques for the detection and surveillance of drug-resistant strains, and design ways of using current and new drugs and strategies for the prevention and control of tuberculosis.
10. Develop the capacity to conduct priority micronutrient research aimed at building a national database, improving current public health interventions and evaluating the impact of interventions.
11. Provide the epidemiological data necessary to define the place of schistosomiasis in the national health agenda and formulate a national control strategy.
12. Strengthen and maintain proven means of reducing trypanosomiasis transmission, early detection and treatment of cases to expand tsetse-free areas and thereby 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 diseases.
This is the time when the new dawn government must empower the TDRC to achieve its goal. This institution should also be used to develop a good world-class disease surveillance system that can be recognized and respected globally. The need for a good disease surveillance system cannot be overstated. According to the WHO, disease surveillance is important to help countries monitor and assess emerging disease patterns and trends. It is crucial because it contributes to better disease prevention and management and thanks to the data collected, countries are able to define their priorities and develop targeted interventions to reverse the disease epidemic.
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