Managing health care research and development: How we can hit at cancer
Health care personnel are often not aware of their participatory role in health care research and development. We are often content to leave such deliberations to our colleagues in the laboratories. With a population of over 140 million people, less than fifty thousand practising doctors and ten thousand practising pharmacists, Nigeria cannot afford this observatory posture.
The term “research and development” connotes a systemic inquiry geared at creating something of worth or of improving the value of something in existence. In health care, this something could be of a preventive, diagnostic, therapeutic or palliative nature. It also includes the development of reliable data that would help in the management of health.
Our failure at research and development is evidenced by our low input in the nature and manner of health care interventions employed in our unique settings. In cancer management, this negligence, though not surprising, is very worrisome.
As the second common cause of death in developed nations and among the third leading cause of death in developing countries, cancer deserves special attention. In Nigeria, the most common cancers are breast, cervical, prostate, colorectal, liver and childhood cancers.
Data from the six cancer registries in Nigeria (which by the way, are poorly funded and hospital-based) show an increase in the incidence of these cancers. One of our major limits is that we are yet to fully understand that health care research and management is a discipline by itself. This point is important because our university system has made it such that we must do health care research; the next step is to manage these efforts effectively.
Research management embraces anything that health care providers, research institutions and universities can do to maximise the impact of their research activity. It includes presenting research findings in a manner that its application is visible, assistance in identifying new sources of funding, the development of efficient frameworks for costing projects and negotiating contracts with external sponsors. It incorporates project management and financial control systems. It also involves help in exploiting research results – through commercialisation, knowledge exchange and dissemination to the wider society.
Though there are no perfect solutions to the problems of research management, this article however seeks to present some thoughts for consideration. These would be within the ambits of the following:
- World View
- Capacity and
It is easier to do nothing about Nigeria’s health challenges until one is affected personally. One need not have a relative with cancer to dedicate skills and time to research. One should not also believe that we can contribute nothing of significance.
It is in the opinion of this writer that the most beneficial medications in use in Nigeria today were developed with the same level of skill and technology that are currently at our disposal. Drugs like Metformin, Paracetamol, Sulfonylureas, Digoxin, Artemisinine, Quinine, Chloroquine and Sulphadoxine did not require the kind of ultra equipment that we are yet to have in Nigeria. Yet, these common medications are the main stay of therapy in Nigeria. Research has shown that newer generations of medications are not necessarily more effective than these old warriors. The point is that we need not think that our inadequacies are sufficient to rob us of any capacity to make meaningful contributions, especially to cancer management. It is my personal submission that we have all it takes to make breakthrough findings in Nigeria.
It is such an attitude that would persevere against odds to seek models and strategic partnership for an effective output. Such attitude, it is believed, would drive collaboration and foster result-oriented research. This becomes even more important if we should consider that the most effective preventive and therapeutic medications for cancer were plant-derived.
Central to a researcher’s theorem is his view of the world and his role in it. A world view that sees man as a product of chance and matter, or of soil and blood as the Nazis put it, as opposed to that of a created being, would propose different questions and expect different kinds of help. A researcher that believes in an Adamic mandate of rulership and dominion, and of the goodness of the Creator, should believe that the Creator has not kept the answers to the questions too far from man. The problem is that in Africa, we don’t carry our beliefs to the laboratory or even to work; unfortunately, the African believer has been made apathetic, rather than ardent by the things which he believes.
To drive an effective cancer management research and development initiative, we need to believe that the forces of good are in our favour and are ready to help us. We would need to also question some standard approaches, with respect to their coherence with that which we believe to be true.
Like we mentioned earlier, the few health care professionals in Nigeria who are practising are so overwhelmed with work that few have the time or the wherewithal to design and implement an effective research strategy – considering that the rewards for such commitments are long in coming. The universities and other research institutions have therefore become the only hope for an intervention. These institutions, which are mainly public in nature, have also suffered from the same problems that have hoodwinked the Nigerian economy. The paucity of strategic vision and funding is such that these institutions have been unable to contribute much.
In a shrinking funding-market where everything is going private, health care personnel in private and public institutions who have the right attitude and world view must adopt certain frameworks to drive research management.
The first framework, I believe, is in the purposefulness of a research undertaking. The prevailing research for research’s sake cannot take us anywhere. Of course, there is need for basic research; but in Nigeria, what we have is mediocre. I have seen many research ventures that, though may have bogus “rationales” will make no meaningful contribution in practice, especially when compared to the opportunity cost of performing such. Take, for an example, a research to evaluate the effects of trace metals on the antimicrobial effect of chloramphenicol may sound quite nice, but in reality, it could be a mediocre effort to obtain a degree.
In practice, a post-primary clinical setting that does not inculcate a system of research and development is quite inadequate. My point is that health care providers must inculcate systems that allow them to ask certain questions, evaluate certain assumptions and contribute to the body of knowledge. A teaching hospital, for example, must create a robust knowledge building and sharing system that is both daring and ethical. We cannot afford to leave this onerous task to traditional research institutions alone. The private sector is more adept at finding and managing finance. She must rise to the challenge of cancer research and development. These would involve seeking and getting approvals for clinical trials; driving Public-Private Partnerships; soliciting to increase the willingness of hospital administrators to conduct clinical trials on herbal remedies; commitment of huge funds to research and development; and active collaboration between research and industry.
Nelson Okwonna (B.Pharm)