Published: 23 November 2022
NIHR Chief Executive Professor Lucy Chappell writes about her recent visit to South Africa and Malawi, and the power of bidirectional learning.
It was a pleasure visiting colleagues in Malawi and South Africa recently. Given the many current issues that require a coordinated global response, from Covid to climate change and beyond, it was a timely reminder for me of the huge and enduring value of international collaboration.
The scope and scale of the work being done in these two countries to strengthen their health systems and develop dynamic research sectors is significant. Through the meetings I had with both established and early career researchers, in the roundtable conversations held with policy makers, and in the time I spent engaging with patients and staff on the front line I was left in no doubt that these two countries are at the forefront of what feels increasingly like a continent-wide momentum towards hugely impactful next-generation level skills and expertise.
Health systems - the bedrock of effective care
There was a real meeting of minds with colleagues in South Africa. It is a country with very strong underpinning science, and a voracious appetite for data-driven innovation.
There is real interest in developing the best innovative treatments, driven by the latest research, underpinned by a strong health system. The work being done in South Africa on establishing a national health insurance (NHI) system is hugely significant, as South Africa functions as both a science leader in its own right, and also as a regional hub across the southern continent.
Already in possession of a strong clinical trials sector, their focus on innovation in diagnostics (including point-of-care tests) and on cross-disciplinary funding is extremely impressive, as is their collaboration with the life sciences industry. And their work on genomics, supported by the DHSC Fleming Fund, shows that South Africa is a real player in this field.
Leapfrogging innovation
As colleagues in Malawi and South Africa know very well, patient care is at its best when research is embedded at the frontline. And with an innovative mindset, the results can be revolutionary.
An important issue in both countries, and one close to my heart, is that of maternity care. In Malawi, where I visited the Queen Elizabeth Central Hospital in Blantyre, I saw much work being done to improve maternity care in many respects.
For example, I was impressed by the really strong work being done to ensure respectful care in maternity. The multidisciplinary teams in maternity described how they developed strong community and stakeholder partnerships, with 'fit-for-purpose' research designs, to develop sustainable interventions that had been co-developed with front-line workers and women.
I believe we should start with the view that all healthcare professionals come to work to provide the best care possible, and that it is on all of us to develop systems and settings that will enable us to do that. These are common issues colleagues in all settings are confronting and considering, whether in Malawi or the UK, and there are clear opportunities for maternity professionals to learn from each other. As we know from the recent report into maternity care in East Kent, these are matters that impact us all, and are not particular to one country or continent.
Another inspiring example was the use of innovative technological solutions that enable staff on the ground to inventively provide good care, such as the handheld portable ultrasound used by midwives in Malawi. Its capacity to enable accurate gestational age dating, which is crucial to maternity care, is ground-breaking in this context. These innovations allow for rapid, treatment evolutions and help practitioners to leapfrog straight to the best and latest methods, and become part of the vanguard of medical treatment providing significantly improved outcomes for mothers and newborns.
More generally, we clearly heard that there was a strong need for sustainability and stability of the funding we provide. Knowing that programmes aren't going to be switched on and off is crucial if these sorts of projects are to succeed over the long term and deliver the real-world impact that we all aim to achieve.
AMR
Another issue that is increasingly at the forefront of my mind, and those of many of my colleagues at home and abroad, is antimicrobial resistance (AMR). It is not an exaggeration to say that it is, in the view of many (myself included), a looming global health crisis.
In the Ministry of Health in Lilongwe, we heard about much work being done to tackle AMR in Malawi, and it is clear that huge strides have been made toward taking a one-health approach. This includes incorporating regional veterinarians into the process, whose specialist work taking faecal matter from chickens only displays the depth of their determination. From a UK point of view, the Fleming Fund has been instrumental in supporting AMR work in laboratories around Malawi. The impact of the fund’s infrastructure grant is obvious, with 17,000 AMR samples processed since funding started.
However, there is clearly more work to do as AMR is still causing deaths around the world. The drug resistant index of 76% means that urgent action is required, particularly in terms of changing practice at clinician level. There is a clear need to pursue a test-to-treat approach, by which healthcare professionals, and patients, understand that appropriate diagnostic testing enables treatment that is tailored to the microbe in question. By adopting an approach that pursues point-of-care diagnostics - as so effectively used in Covid-19 - we will better underpin a "keep antibiotics working" ethos. It's not about being against the use of antibiotics in itself, but rather about avoiding the wrong ones being used for the wrong bug at the wrong time, which benefits no-one - least of all the patient.
Bidirectional
Global health impacts directly on UK health, both through specific examples such as infectious disease, which knows no borders, but also with positive opportunities for bidirectional innovation and translation.
We achieve this through a combination of utilising the UK's strength as a science superpower to support our peers and colleagues, and also through dialogue with partners such as those in Malawi and South Africa, where there is existing infrastructure and a strong willingness to partner.
This visit was undertaken jointly with colleagues with both global health research (Mike Batley) and global health security (Anna Wechsberg) colleagues, and it was strongly supported by Foreign, Commonwealth and Development Office teams at home and in-country, to incorporate their wider international strategies. It showed me that our global health focus on tackling the global burden of disease, strengthening health systems, and building resilience, underpinned by research capacity building, is exactly the right one at this time.
I was privileged to be part of an exchange of ideas and experiences that reaffirmed the importance of equitable partnerships. In the NIHR, we are proud to have championed these since the inception of our Global Health Research programme.
The NIHR Global Health Research Portfolio uses UK international development funding to fund high quality applied health research and training in areas of unmet need, for the direct and primary benefit of people in low and middle income countries (LMICs).