Global research organisations, foreign funding and absent states: the health research agenda in Peru
In the academic world, little attention has been paid to how the priorities and agendas of global research organisations, along with their funding mechanisms, affect research projects in developing countries where there is a lack of state interest in research. Globalized Research and ‘‘National Science’’: The Case of Peru, by Carlos F. Caceres and Walter Mendoza, is an article published in the Academic Journal of Public Health in 2009 that tries to remedy this void. Using Peru as a case study to analyse how the state and the academic community react to funding sources and develop research policy processes, it found that research policy development and evaluation processes are inadequate, as there were few activities in the areas of promotion, planning and identification of needs, as well as of development of institutional capacities. Most academic research related to health is published in English, and researchers’ access to funds is limited. There might be many researchers in Peru but no national science agenda, as there are no debates on research priorities, little use of research for policy formulation, and no investment policies that involve local funding (either private or governmental).
The lack of locally formulated research agendas that focus on nationally determined priorities is not exclusive to this country. Two non-local factors influence the relationship between the state, academic institutions and researchers in low to middle-income countries: the concept of academic centers and peripheries and globalized research. According to the authors, academic centres are defined as more developed members of a network of research institutions that represent the state of the art in science. In peripheral countries such as Peru, the primary publications of a given discipline use the language of these centers; academics form their networks around them; and since they have access to funding sources, they can define what topics are relevant and should be researched. A well-known example is neglected tropical diseases in African countries: even though they are not costly to cure, these have been overshadowed by the global health agenda on HIV/AIDS, malaria and tuberculosis.
Since there are a limited number of nationally defined priorities, researchers are almost obligated to align themselves with these academic centers in order to safeguard their careers and their livelihood. This begs the question of whether globalized academic centers, where many of the peripheral countries’ best academics are trained, actually teach their students to think independently and in a way that fits with their local contexts.
There is a chronic lack state interest and sponsorship of research on health in Peru: a 2004 – 2005 study that analysed the status of public health research found that the Ministry of Health had severe limitations which greatly hindered public health research. These limitations included poor communication and synchronicity between researchers and public health officials, which in turn results in inadequate cooperation schemes. Additionally, the amount of state funding allocated to research is not enough. Thus, dependence on foreign funding leads to research agendas being driven by foreign interests, and so national debates on what research topics should be prioritised do not happen.
Since there is no identifiable governmental research program, universities often fill the research void – in developing countries, they can help in providing much needed health research in a context of limited state resources. For instance, Cayetano Heredia University, the institution with the leading biomedical research program in Peru, has been successful in tempting faculty members who have obtained advanced degrees in developed countries, mostly in the north.
Nevertheless, universities cannot always compete with foreign funding and foreign networks; in terms of access to resources and salaries, for example. Local researchers might privilege their relationship with international research centres or pharmaceutical companies as they can guarantee access to funding and to more fruitful networks. This in turn can influence the issues they focus on and the questions they generate. For example, a worrying fact is that around 90% of clinical trials in Peru since 1995 have been sponsored by pharmaceutical companies.
When taking the education system into consideration, even more problems arise. Many local health studies are undergraduate or graduate theses. Unfortunately, they are usually of little utility as research is considered a general rather than specialised skill within Peru’s higher education programs. This means that students are inadequately trained in research, and so research questions are often wrongly formulated or the methodology is flawed.
The article proposes a myriad of steps and solutions for the implementation of a national health research agenda. First, the role of the state is crucial – it should develop a policy that invests in health research and uses it. Important institutions are the Ministry of Education, the Ministry of Health and the National Council of Science and Technology; they should establish stronger connections with the health sector and formulate research priorities, as well as secure funding. This is not an impossible feat: Malawi has implemented a national health research agenda, launched by the country’s National Commission for Science and Technology and done in collaboration with the Ministry of Health. It consists of a five-year agenda of nationally-driven priorities which would also enhance institutional capacity to carry out high quality research and the formulation of national health policy and programmes. Nevertheless, Malawi’s efforts in developing a health research agenda is still mainly funded by international agencies and donors.
On the other hand, Cuba has been successful in developing a self-determined and self-funded research agenda, perhaps because of the lack of support from international donors and programmes. Health research in Cuba is supported in the highest levels of government and primarily state-funded.
Second, it is important that the state establish mechanisms that allow collaboration with universities and research centers, and promote capacity development in management and research implementation. For instance, the Philippines’ National Unified Health Research Agenda for 2011-2016 was elaborated in consultation not only with key state institutions but also with the University of Philippines – Manila. University initiatives should also be taken advantage of: in Tanzania, the Muhimbili University of Health and Allied Sciences published a university-wide research agenda, drawing on research expertise from its five health professional schools and two institutes, national development priorities and published literature. The research agenda was distributed to ministry officials, but there are still problems in its implementation due to a lack of infrastructure and local funds.
Finally, the article suggests that research as a skill should be improved in higher education programs. Improving tertiary education in developing countries is key not only to ensure high quality research but to promote development both in policy and industry pertinent to local interests.