Challenges in communicating malaria reseach with the malaria knowledge programme discussion

Networks, participation, cross-disciplinary exchanges: all these make for more effective communication of health research.

The importance of communicating about malaria was an appropriate subject for a World Health Day aiming to ‘make every mother and child count’. Ninety per cent of the 3000 people who die of malaria every day are young children in Africa and pregnant women are another of the highest risk groups.

At the thirty-first Exchange lunchtime discussion, Imelda Bates and Rachel Tolhurst from the Malaria Knowledge Programme (MKP) at the Liverpool School of Tropical Medicine presented their analysis of the communication processes in four malaria research projects at district, institutional, national and international level.

An action research project in the Volta region of Ghana trained district level health workers in participatory research skills to look at gender roles in the community. Health workers and community members then worked together to identify ways to improve women’s access to healthcare services for malaria.

The communication processes in the second project – setting up a research programme at Komfo Anokye Teaching Hospital in Ghana – were surprisingly easy. Health workers, research advisors and institutional managers maintained their enthusiasm throughout the four years it has taken to establish a vibrant research community and programme.

However in the third project, which aims to strengthen laboratory services throughout Malawi, there have been communication difficulties. Despite support and funding from the highest government levels, laboratory workers on the ground have had only intermittent access to the resources they need to improve malaria testing.

At international level, the need for new anaemia tests is belatedly making it onto the agenda of the World Health Organization (WHO). Progress is slow even though research shows the existing anaemia tests – a key tool in malaria management – are inappropriate for rural areas.

Discussion focused on three topics:

How appropriate and sustainable is it to involve health (and other government sector) workers in research?

Rachel and Imelda noted that cross-disciplinary research made much more sense to people at district level. Health workers, project managers and researchers from different sectors know they need to work collaboratively to make the most of limited resources.

In the action research project in the Volta region there was a move towards greater equality between health workers, government officials and members of the district communities: “We sat down on the ground together” was one project participant’s comment. However, the bottom-up generation of ideas about improving women’s health has only had a marginal impact on government health plans.

The nucleus of the hospital research programme was the committed students. Doctors need to do their own research before they can become consultants. Before the research programme was set up, health workers at the hospital had been unable to access training and support for their own research. The research programme also built on a twenty-year relationship between Imelda and the hospital: “Everyone already knew each other and we were motivated by the same goal,” said Imelda.

How can the mechanisms from government for scaling up successful research be made more effective?

In the community action research programme, one of the participants has since been promoted to a government policy position. This has contributed to continued support for the project findings. However this outcome would have been difficult to predict or plan at the beginning.

Discussion participants were enthusiastic about a project team approach, rather than expecting each individual to have all the skills. But trust is needed between researchers, implementers and policy makers – and there are powerful cultural factors at work here as people are working with different timescales, constraints and purposes. Making sure the evidence is there before making research accessible was one key issue raised by participants. It is also difficult to communicate in advance what impact research will have when using participatory research processes.

So what do government policy makers base their decisions on? If policy makers believe that decisions should be evidence-based, research would flow more naturally into policy and practice: “They commission research but don’t want to believe it,” said one discussion participant.

Who is responsible for following the ‘research trail’ to make sure results get into practice?

Researchers get acclaim for academic outputs but the other components of research are just as important, noted Imelda, who emphasised that the key was using the process of research to make links between research, practice and policy.

A ten-year timescale for getting research into practice is realistic, said Imelda and Rachel. But making primary researchers responsible for the whole process is unrealistic. A participant from GlaxoSmithKline likened the process of getting research into practice to developing a new drug: “You wouldn’t make a molecular chemist responsible for launching a new drug,” he said.

HIV and AIDS communication has shown the effectiveness of community participation over time – the people who are affected by HIV and AIDS are the ones who maintain the pressure for change. Local people will also start to make changes while research is going on when they see what makes sense and what they can do.

Creating public debate is another route that has both direct and indirect influence on policy and practice. Exchange’s Andrew Chetley pointed out an example in the UK right now: TV-chef Jamie Oliver’s successful campaign for improved school meals for children. “Where’s his evidence?” asked Andrew, noting that money had been allocated to school meals by the UK government in response to public pressure and the issue had figured prominently in the media and in the election campaigns of all political parties in the UK.

Monitoring and evaluation – or more research – can make a difference. But the benefits of health research might not be health benefits, so monitoring and evaluation tools need to be able to cope with changes in the character of what is being delivered.

MKP’s communication plan developed along the way, and was refocused in response to changes in their work. A communication strategy from the beginning would have been helpful.

Imelda and Rachel emphasised the importance of networks of researchers - links between individuals and institutions are essential to sustain research and see it through into policy and practice.

Challenges in communicating about malaria