organized curiosity

Improving health care through research

MicroResearch: Addressing Barriers to Improved Community Health in East Africa

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Submitted by Dr. Noni MacDonald and Dr. Robert Bortolussi, September 2014

“Knowledge is not enough, we must apply. Willing is not enough, we must do.” (Goethe).

In 2000, 189 countries made a promise to help citizens in the world’s poorest countries to achieve a better life by the year 2015. This promise, the Millennium Development Goals (MDGs), lead to greater funding from wealthy countries to support programs that would increase literacy, reduce poverty, and improve maternal, newborn and child health in the poorest Low Income Countries (LICs). By 2013, Ban Ki-moon, the director general of the United Nations, called the overall MDGs the most successful global anti-poverty push in history.

But improving health for mothers, newborns and children is proving to be more difficult, then the other MDG’s. For often in Africa, new knowledge gained from health research that could improve conditions has fail to be implemented in the community. The reasons are many, but chief among them is that the changes often conflict with local beliefs and culture. To paraphrase Goethe: Knowledge and good intentions are not enough, we need effective action.

One serious barrier to improving the health outcomes for mothers, newborns and children has been inadequate implementation of health knowledge at the community level. Although African health care professionals are excellent clinicians, they lack training and skills to identify critical community health problems, and to use research methods to find local sustainable solutions. Research support for health care professionals to develop and carry out their own community focused research has been neglected, since much of the donor-funded research has focused on diagnostics/treatments for infectious diseases in these LICs. For example, investigators from LICs are principal authors on only 4% of research publications dealing with health policy in LICs .

Yet health care professionals from LICs have the greatest potential to impact their own country’s health practices and policies. They understand the local culture, local languages and the local barriers to better health practices. Top down implementation has failed unless it is context and culturally appropriate. Local African health care professionals, embedded in their communities, can identify critical community problems, and apply research methods to find solutions and are in the best position to then implement change and improve health outcomes.

In 2008, Drs. Robert Bortolussi, and Noni MacDoanld from the IWK Health Centre teamed with Dr. Jerome Kabakyenga from Uganda, to develop an innovative East African-Canadian collaboration, called MicroResearch ( .  MicroResearch helps to build local African healthcare professional capacity to find local solutions for local maternal and child community health problems. MicroResearch uses five integrated components to ensure the research fits the local context, culture, and resources, is scientifically valid and is shared with local communities and local health professionals:

  • Trains multidisciplinary healthcare professional teams to identify local maternal and child health problems needing solution,
  • Coaches these MicroResearch teams to develop their research questions into scientifically valid internationally peer reviewed proposals,
  • Funds the teams to undertake these projects that will find solutions to local health problem with ongoing coaching.
  • Helps to translate the findings into action that will improve community health outcomes for mothers, newborns and children with ongoing coaching.
  • Supports sharing of research findings across an East African MicroResearch Network, through East African MicroResearch Forums.

In fact, for the past 6 years MicroResearch has already implemented the principles recently advocated by the World Health Organization as the best way to strengthen research capacity in low and middle-income countries .

The MicroResearch program has achieved remarkable success with incredibly small financial support. Between 2008 and 2013, 5 East African sites have invited MicroResearch trainers to help them increase the research capacity of local health care professionals. More than 15 workshops have been held and about 400 participants trained. Of 29 funded MicroResearch team projects ($2000 CAD each), 22 are ongoing and 7 completed . This was all done with less than $300,000. Knowledge gained from these projects has already influenced several health programs and/or government policy. For instance MicroResearch teams found that traditional umbilical cord care practices in Ugandan rural villages carry risks for sepsis; over 40% of neonatal deaths were attributable to cord related sepsis. Although we know that antiseptics may dramatically improve newborn survival, these researchers showed that WHO recommended procedures were not being followed in rural areas, and identified the root cultural barriers. As a result of their work, they are working with the Ugandan Ministry of Health, to pilot the implementiation of a chlorhexadine cord care program in rural villages in Uganda as a demonstration project and case study.

Noni & Bob









~Dr. Robert Bortolussi and Dr. Noni MacDonald



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