International partnerships: View from the South…

1. www.globalhealthperu.org International partnerships: View from the South… Patricia J. Garcia MD MPH Universidad Peruana Cayetano Heredia (UPCH) Patricia J. Garcia MD MPH Universidad Peruana Cayetano Heredia (UPCH)

2. Outline • Definitions • Research models 3. Research capacity building and partnerships 4. Principles of Good Research Partnerships 5. Peru, UPCH and experience with international partnerships 6. Lessons learned 7. How to N-S and S-S relations compare? 8. Conclusions

3. 1. Definitions • Collaboration: the act of working “jointly” (whatever that means) • Partnership: a cooperative relationship between people or groups who agree to share responsibility for achieving some specific goal • International Research Relationship Models (RM): styles of research interaction seen between develop and developing countries’ researchers. Several times called collaborations.

4. 2.Research models • Semi colonial models: Quite common, unfortunately… • Postal research • Researcher requests a colleague from developing country to send biological samples • Parachute research • Researcher travels to developing country for short periods of time and take back biological samples • Annexed sites research: • Research site established at a developing country by a develop country researcher/institution, led an managed by expatriate staff. Independent from national institutions, attractive for promising national academics… • Partnership models: the ideal (at least for us in the south), challenging but possible…

6. 3. Research Capacity Building for development in the global community requires : +Good Research Partnerships Investment in Training Institutions Trained Individuals ++Trained Individuals Critical Mass Potter, 2004, modified

7. 4. Principles of Good Research Partnerships • Mutual trust and shared decision making • National ownership • Emphasis on getting research findings into policy and practice • Training, mentoring, exchange • Within the national research agenda

8. 5. Peru, UPCH and experience with International Partnerships • Population: 29 million • Geography: Broad diversity of climactic and different the Amazon basin to the Andean mountains. • 70% urban (mostly in Lima) • Inca culture outside of Lima (Cuzco) • Languages: Spanish, Quechua, Aymara • Peru’s food: lots of ethnic influences

9. Universidad Peruana Cayetano Heredia UPCH -1961 - 2000 students- 8 Schools- Research is a priority

10. Concrete example: Peru- UPCH as a Research Hub • Second country in NIH funding in Latin America ($6m), similar to Mexico ($6m), and after Brazil ($16 m). (source NIH , average FY 2004-2005) • Populations in Brazil, Mexico and Peru are 190m, 109m and 29m, respectively • The Universidad Peruana Cayetano (UPCH) is the largest research institution in the country

11. UPCH is investing in an enabling environment for research • Vice rector of Research • Well establish IRB • Office of Grants and contracts • Small grants to promote intramural research • Recognition of “Research professors” • Awards for research: • Within the university • Latin American Award • Scholarships for post doctoral re-entry support • Competitive, 1 per year • To fight against brain drain • National Council of science and technology, following the example

12. CASE STUDY: UNIVERSIDAD PERUANA CAYETANO HEREDIA AIDS Clin Res Train Clin Res Train Environ Health Inf Disease AIDS Informatics Framework Small grants (FIRCA) Research? Ecol Inf Diseases Biodiversity GRIP Minority Postdocs U. Alab. Birm. (15 y) Med Students U. Washington (16 y) Johns Hopkins (21 y) NMRCD* (23 y) FIC Grants TrainingResearchU.S. FellowshipsGlue grants * NMRCD = US Naval Medical Research Center Detachment

13. UPCH: Significant increase in competitive research funding* *All sources, national and international funding

14. Successful International partnerships Cysticercosis working Group Hector Garcia Armando G • Johns Hopkins • 25 y of collaboration • Training and research grants, Robert Gillman et al • 7 graduated PhDs, 10+ in training • U. Washington, Seattle • 20 y of collaboration • IATRP, King Holmes et al • 2 PhDs, 20+ MPHs, +60 and more in training • U. Alabama • Initial masters programs in Peru • Sten Vermund, now at Vanderbilt National and Global collaborations STI/HIV research Unit Patty Garcia CTU in Peru Jorge Sanchez National and Global Impact Gorgas Tropical Medicine Course Research in Tropical Diseases E. Gotuzzo

15. The Cysticercosis Working Group in Peru • Since 1987 as a true horizontal collaboration • UPCH-SM universities, CDC, and Johns Hopkins • Global collaborations • Belgium, Italy, Spain, UK, Japan, Korea, etc. • Ecuador, Honduras, Brazil, Bolivia, etc. • National Impact • Improve policies and official Dx and Tx guidelines • Global Impact • new diagnostics, treatments, vaccines, field control. • E.g. seizures associated with neurocysticercosis, impact in management of US Hispanic populations • Diversification in sources of funding (NIH, Gates, national, private)

16. STI and HIV Unit- School Public Health • Since 1999, as a true horizontal collaboration with the UW • Working with NMRCD, MOH, USAID, NGOs • Opportunities for training and research for local and US-UK , and LA students • Global collaborations • UK (Imperial College), China • National Impact • Improve policies and official Dx and Tx guidelines • Data produced is being used by the Ministry of Health, International agencies (USAID, UNAIDS), for Global Fund prop • Implementation of innovative interventions • GPS using PDA , mobile teams for reporting of medication adverse events, pharmacy training in STI, cell phones, Internet • Globalization • Sharing with countries in the region experiences in STI

17. Lessons learned • Research groups which operate in isolation limit the scope and success of their work • Research is essential for development and becomes a bridge between countries • Researchers trained abroad become diplomats in their regions • Opportunities for young researchers from abroad • Collaborators are important • Benefits in both ways • Expertise from the north • Collaborators understanding local needs and resources

18. Lessons learned • Good research partnerships require: • Huge investments of time from all participants, but they are hugely rewarding in return • Training and mentoring (in both ways), which help to establish long-lasting sustainable partnership • Changes in life perspectives for both sides

19. Lessons learned: Challenges • Heavy demands on participants, investments from both sides (time and effort) • Takes time • High quality projects may take longer • Start up phase can be long • Communication to avoid confusions • Informed decisions • Mutual respect • Equity, justice • Horizontal relationship

20. Need for balance, even in S-S , is important to keep N-S collaborations 7. How to N-S and S-S relations compare? South to south North to south • Needs good collaborators from North (twinning) • Can help to develop and nurture institutions • Higher investment • Problems: language, how to assure address local needs, who drives the agenda, brain drain • Advantage: expertise !!! • Horizontal, peer to peer relationship • Next level for more mature institutions in the south • Cost effective • Problems: assure expertise • Advantage: language, similar culture, less “fear to reach changes”, own driven agenda, less brain drain

21. 8.Conclusions • International partnerships are important for capacity development • Opportunities for both develop and developing countries • Principles of good partnerships • Challenges are real, but can be overcome • UPCH has established good international partnerships and has learned from the experience • Beyond science, lifelong friendship and mutual benefits

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