Decolonizing Health Research: Perspectives From 50 Years Of Practice – Health Policy Watch

Dr Amara Leno is one of thousands of people in low- and middle-income countries – including health programme implementers, physicians, policy-makers and scientists – that TDR has enabled to use the power of research to tackle health challenges in their countries. 

This is just one example of how TDR has been decolonizing health research over the past five decades. TDR is a global programme of scientific collaboration co-sponsored by the United Nations Children’s Fund (UNICEF), the United Nations Development Programme (UNDP), the World Bank and the World Health Organization (WHO). 

Throughout its 50-year history, TDR has had two intertwined missions – to build research capacity in the countries where infectious diseases burden so many, particularly the less advantaged, and to help prioritize and fund the research needed to address these diseases. 

Today, many scientists whose careers were jump-started by TDR are leading research institutions or setting health policies in disease-endemic countries.  

What was put in place by a resolution passed by the World Health Assembly in 1974 has made possible the development of 13 new drugs and five disease elimination campaigns. These have been powered by a growing number of researchers and institutions that are capable of identifying research priorities and carrying out a range of studies, from clinical trials to implementation research that informs health policies. 

Between 2018 and 2023, TDR-supported research and tools have influenced 115 health policies and guidelines around the world.

Prioritizing equity and inclusiveness in partnerships

Since its inception, TDR has forged pioneering partnerships and collaborations with leading research institutions in low- and middle-income countries (LMICs) that have led to remarkable achievements. 

For example, the WHO announced in October 2023 that Bangladesh is the first country in the world to eliminate visceral leishmaniasis (VL) as a public health problem. Since 2005, TDR has supported dozens of studies led by the International Centre for Diarrheal Disease Research (icddr,b) in Bangladesh on improving surveillance of VL through active case detection, new diagnostic tools, a new single-dose treatment and vector control tools such as indoor residual spraying.

The critical role of this locally driven research in this landmark achievement was acknowledged by Bangladesh’s Ministry of Health and Family Welfare, which benefited from the research evidence that helped policy-makers understand which interventions would be effective for elimination.

TDR has also moved the centre of gravity of its research training programmes to low- and middle-income countries. While in the past, TDR had funded scholarships for scientists to earn masters or doctoral degrees at institutions in high-income countries, it currently consciously targets training at competitively selected public health universities in the Global South. In this way, TDR helps to build the system at the same time as supporting the individual. 

Co-creating new training materials

Not only are these partnerships building a cadre of infectious disease experts across Africa, Asia and Latin America (having supported 486 master’s students since 2015), but they have also given TDR the opportunity to co-create innovative training materials and strengthen the quality and relevance of the training.

For example, over the past year, eight universities affiliated with TDR’s research capacity strengthening programmes have co-developed a new standardized curriculum on implementation research. This online lecture series, called “Foundations of implementation research” is designed for researchers, public health practitioners, and stakeholders involved in implementing proven interventions in low- and middle-income countries

TDR training partners, which include regional training centres in all six WHO regions, also play a key role in disseminating and promoting these research tools through their national and regional networks. 

In this way, the flagship Massive Open Online Course (MOOC) on implementation research, has reached more than 23,000 participants across the world. New modules for this MOOC, which show implementation research in action through case studies on topics such as Chagas disease in Ecuador and COVID-19 vaccine implementation in Ghana, are now available in four languages.

TDR is also supporting researchers to generate new knowledge and evidence on the intersection of sex and gender with other social stratifiers that affect access to health services and health outcomes. Research tools developed by TDR are allowing more researchers to address gender aspects of infectious diseases, thereby informing the development of more inclusive, gender-responsive health interventions to prevent and control infectious diseases of poverty.

Evolving with the changing landscape 

Over its 50-year history, TDR has evolved to meet changing needs. The largest shift has been from a focus on product development to a greater emphasis on research to implement effective health tools and strategies, so they reach those who need them most, including hard-to-reach populations.

The new TDR Strategy for 2024-2029 also reflects the changing landscape of global health by focusing on four major challenges affecting infectious diseases of poverty using a One Health approach: epidemics and outbreaks; control and elimination of diseases of poverty; climate change’s impact on health; and resistance to treatment and control agents. Together with funders, partners, grant recipients, and other stakeholders, TDR is committed to supporting efforts to overcome diseases of poverty in the context of this dynamic global health environment.

An inclusive, equitable global research partnership ecosystem requires consistent action and reflection. As TDR celebrates its 50th anniversary, it can take pride in the fundamental impact this cross-UN model has had on the global scientific community and on the leaders in countries who are pushing forward nationally owned agendas of health research.