Lancet Global Health
Mar 2018 Volume 6 Number 3 e229-e350
Local research in Africa: a glimpse at possibilities in Niger
The Lancet Global Health
At the core of the conclusions reached by the Lancet Commission on the future of health in sub-Saharan Africa published last September is a sense of possibility for what Africans can and must accomplish to level their populations’ health with the rest of the world’s by 2030. Among the key requirements are the home-bred, tailored solutions that a greater local research capacity and leadership would produce to respond to the challenges ahead. At the first Epicentre Niger Scientific Day held in Niamey on January 25, there were signs that the message is on point and the optimism justified.
Epicentre, an offshoot of Médecins Sans Frontières (MSF) created in 1988, conducts field epidemiology, research, and training activities that encompass the span of MSF’s areas of intervention. This connection to the medical humanitarian organisation makes it a unique research institution, with solid operational know-how, deep roots in the field, and strong ties to local communities. While its nerve centre is located in Paris, France, its heart clearly beats to the rhythm of two research facilities located in Maradi, Niger, and Mbarara, Uganda. Both are the scene for locally-led innovative research on issues ranging from infectious diseases and malnutrition to antimicrobial resistance, mental health, and child development. In Niger, the local staff of around 250 researchers, communicators, laboratory technicians, and administrators, run projects under the careful mentorship of international experts with knowledge of the realities of the field and a keen understanding of the importance of local knowledge and talent development.
Scientific days showcasing Epicentre’s research have been held in Paris for the last 27 years and for the first time in Kampala in 2017. But the day in Niamey, organised with the support of the Elsevier Foundation, carries some particular significance. A vast, landlocked country mostly covered by desert, Niger is by traditional indicators one of the poorest and least developed countries in the world. It is prone to chronic food insecurity, natural disasters, and infectious disease outbreaks, which included hepatitis E and meningitis in 2017. Diarrhoea is still a leading cause of death in children, as is malaria. Against such a backdrop, the research presented during the conference stands out: studies on malaria treatments highlighting the challenges of seasonal malaria chemoprevention, nutritional interventions underlining the difficulties in preventing severe acute malnutrition, and work around the heat stable and therefore highly adapted Rotasiil rotavirus vaccine, with impact beyond Niger, to only name a few. A francophone forum for these presentations is to be valued. As for many French-speaking countries, Niger faces challenges of another order that need to be acknowledged: the predominance of English as the language of communication in science undeniably represents a limiting factor for many francophone African researchers, adding significant hurdles to the exchange of knowledge and dissemination of research generated locally, as well as hindering the rise of local talent able to champion the country on the international scene.
But there was no shortage of talent present in Niamey, both on stage and in the audience. It is fair to say that the rigour of the research, clarity of the presentations, and depth of the discussions on topics of direct importance to the local context made an impression. Familiar difficulties were evoked during a plenary session expanding beyond Epicentre’s work, on the priorities for research in Niger: the pressing need for locally-adapted tools, the shortage of researchers, and the obstacles encountered in research activities—including accessing information—because of infrastructural limitations. Participants to a round table on how to move from research to policy also identified the misalignment of the donor-researcher-policymaker triad and the need for a stronger link between the protagonists of research and policy. These are all quasi-universal issues and they must be addressed. Yet opportunities seem to exist, many driven by the researcher’s knowledge and membership of the local context: the proximity to the Ministry of Health as a natural and close partner, the understanding of the local oral tradition to overcome research dissemination barriers, or even the inherent trust of the local population in the conduct of research. A sense of possibility was definitely glimpsed at in Niger, and with collaborations between Epicentre, local universities and research institutes such as CERMES, NGOs and other partners, Nigeriens involved in local research can play their part in leading Africa towards her health goals.