Health research in the developing world: a gastroenterological view from Bangladesh

Ill health is a serious impediment to progress in most poor countries, yet health is not a high priority on foreign aid agendas. Health research, which provides the essential base for sustainable progressive health programs, is barely visible in developing countries. For example, in Bangladesh, one finds unacceptably high morbidity and mortality rates among infants and children, health programs that are struggling and a rudimentary health research establishment; for the huge foreign donor community in that country, health programs and research do not appear to warrant major investments. Diarrheal diseases are at the top of the list of killers in many poor nations including Bangladesh. Recent advances in our understanding of diarrhea suggest that when prevention may not be possible soon, improved active treatment can evolve from an aggressive research effort centered in a developing country and linked to appropriate international partners. Global agencies such as the World Health Organization have demonstrated a declining interest in health research, as reflected in the policies of their Diarrhoeal Disease Control Programme. Major donors to the developing world, the Canadian International Development Agency for example, have had a relatively minor involvement in health and little commitment to health research. University links with the west, private enterprises and specially targeted programs are involved in developing world health research but they have not been able to foster and leave behind sustainable, high quality research programs. The problem should be attacked directly by supporting focused, relevant health research centres in regions of the world where the burden of disease continues to impede progress and where the environment is conducive to high quality research that is well integrated with care delivery programs. An instructive model of this approach is the International Centre for Diarrhoeal Disease Research in Dhaka, Bangladesh.