Four years ago, Penn demographer Iliana V. Kohler and Fabrice Kämpfen, a former Penn postdoc now at University College Dublin, received a grant from Research for Development (r4d), a program of the Swiss Agency for Development and Cooperation and the Swiss National Science Foundation, to create a workshop in Malawi focused on the future of health-related research there.
As an organization, r4d works on many multi-country public health projects, and through this initiative Kohler, Kämpfen, and colleagues would aim to create a process that could effectively translate r4d’s research findings into policy in sub-Saharan Africa. Beyond that, the researchers intended to synthesize key outcomes that pertained explicitly to Malawi, engaging with stakeholders on the ground to develop and disseminate specific, actionable recommendations.
The organizers envisioned an open forum for the country’s policymakers, researchers, and a variety of other stakeholders. Then the pandemic hit, pausing the project.
After a two-year hiatus, Kohler, Kämpfen, and colleagues resumed planning, and, in conjunction with the Kamuzu University of Health Sciences (KUHeS), the Young Researchers Forum (YRF) in Malawi and the Invest in Knowledge Initiative, they held a one-day conference this past November in Blantyre, Malawi. It focused on a trio of subjects: the double burden of non-communicable and infectious diseases, assistive technology and disability, and the use of technology in public health.
“We had this mixture of people, from the local, traditional authority level to high up in the Ministry of Health, as well as international researchers who were part of the r4d program and whose research findings in other sub-Saharan African countries were highly relevant to health policy in Malawi,” says Kohler, associate director of Penn’s Population Studies Center and an associate practice professor in the Department of Sociology. “The goal was to provide a space to talk about these topics, to understand how the different stakeholders see them and how they might be addressed in Malawi.”
Partners in Malawi
For the past decade, the Malawi government has been working to highlight the country’s health research priorities, according to Benson Chilima, who, until his retirement in December, was director of the Public Health Institute of Malawi. A national survey looking at 45 years of research found that institutions outside of Malawi commissioned, conducted, or funded most of the nation’s scientific investigations which, more often than not, focused on HIV, tuberculosis, and malaria.
Recognizing that the disease burden was evolving beyond malaria and other infectious diseases, which had been the traditional focus, the 2012 Malawi National Health Research Agenda (NHRA) suggested a research pivot to put greater emphasis on non-communicable diseases, mental health, and trauma and rehabilitation. “It was also designed to encourage researchers and policymakers to interact amicably,” Chilima says.
Chilima had previously collaborated with Kohler on work pertaining to high-priority public health interventions in Malawi. So, when she invited him to participate in a conference aimed at discussing at least one of these new research priorities, he felt it was a good opportunity to reinforce the ideas of the original NHRA and understand what holes a new version—slated to publish in early 2023—might fill. “The workshop aligned well with the spirit of the NHRA,” he says.
Kohler and Kämpfen also invited Kondwani Katundu, a physician researcher at KUHeS and current chair of YRF, to join as a planning partner. “It’s imperative to have avenues where this kind of topic is synthesized and discussed among researchers, policymakers, and community representatives,” he says. “It creates an intersection between knowledge and policy.”
With partners in place, Kohler and Kämpfen put together an agenda. Their aim was to break down prior research findings generated by r4d-funded public health projects, determining which were most relevant in the context of public health in Malawi. “For instance, the government is committed to universal health care, but important gaps in the service provision for non-communicable diseases remain,” Kohler says. “It was our job to help identify these gaps and possible solutions.”
The group decided first to look at the challenges posed by the “double burden” of infectious diseases like malaria and HIV and non-communicable diseases like heart disease. “Traditionally, research in Malawi has focused almost singly on infectious diseases,” Chilima says. Non-communicable diseases, on the other hand, he says, are “poorly attended to, making Malawi’s preparation to achieve global targets difficult or impossible to calculate.”
He uses the example of heart health, explaining that even though the daily routine of many rural Malawians includes work akin to heavy exercise, that doesn’t always translate into improved health outcomes. Yet no research has focused on why that’s true for this population. Given how interrelated such issues are, Chilima says, “government policy and research priorities on health must reflect this.”
The other conference centerpiece focused on use of technology in public health and for people with disabilities. On this front, Kohler says that for the past decade or so there’s been a significant effort in Malawi to digitize the health care system through electronic health records and by using media and technology to educate health care providers. “Technology is an important tool that can enhance health care,” Katundu says. “Yet its use requires further research and harnessing to optimize health benefits in key populations, including people living with disabilities.”
To that end, Chilima says the workshop exposed gaps at the policy level around access to facilities, waste management, and training. “It challenged the current understanding of and even national policy on disability, including the positioning of disability departments in government,” he says.
The organizers say the workshop was a big success. For Chilima, highlights included hearing different regional perspectives and the interactions he witnessed between young scientists and more established researchers, from Malawi and elsewhere. Katundu called the roundtable discussion the “apex” of the workshop. “That’s where much of the real, frank discussion among researchers, program implementers, the private sector, policymakers, and the community representatives took place,” he says.
Kohler and Kämpfen say the workshop achieved what they hoped it would: It provided a space for open dialogue and debate between Malawian and international researchers, high-level policymakers, NGOs representatives, and local traditional leaders. “It was also important that international r4d speakers were able to present best practices and research evidence from other sub-Saharan African countries,” Kämpfen says, “in particular how these can help inform policy responses to mitigate present and future public health challenges in Malawi.”
For Kohler, the active engagement of junior scholars felt particularly unique. “Given the limited resources of many academic institutions in low-income countries, it’s often difficult for junior scholars to network with more senior researchers in their field,” she says. “Our workshop employed the YRF as a local co-organizer, created ample opportunities for networking, prominently featured poster presentations by junior scholars, and gave out awards to the two best posters.” This enriched the experience for researchers at all levels, she says.
After the workshop, the organizing team prepared policy briefs on each of the three main topics and is currently working on a white paper outlining recommendations from the meeting.
Benson Chilima is former chairman of the National Health Research and Ethics Review Committee in Malawi and was the first director of the Public Health Institute of Malawi in the Ministry of Health until his retirement at the end of 2022.
Kondwani Katundu is a physician researcher at Kamuzu University of Health Sciences and current chair of the Young Researcher Forum in Malawi.
Iliana Kohler is an associate practice professor in the Department of Sociology and associate director of the Population Studies Center in the School of Arts & Sciences at the University of Pennsylvania.
Funding for the workshop came from the r4d program of the Swiss Agency for Development and Cooperation and the Swiss National Science Foundation.