Sinergia Project: African contributions to global health – Circulating knowledge and innovations

Julia Tischler opens the workshop with a reference to a New York Times article from 2018 titled ‘What we can learn from “S-Hole Countries" as a response to Trump’s reported call to reject immigrants from countries that he refers to as such.  Among other examples, the article mentions Sierra Leone, whose president committed to provide free healthcare for children under five and pregnant women or Rwanda, who is vaccinating girls against HPV throughout the country and is therefore more likely to eliminate cervical cancer than the US. The article illustrates how little such developments are known, and how strong the preconception is that innovations are created in the Global North, while the South is at the receiving end. Indeed, as Julia points out, African contributions to global health have not been studied yet from a broad interdisciplinary perspective. The Sinergia project is motivated by present-day challenges in global health and will thereby examine three central areas of health: 1. drug development, 2.  healthcare systems and 3. environmental health and holistic approaches to healthcare. Each of the modules is divided into two sub-projects which interact with each other and across modules. The project also relies on a dense network of experts based in Basel, including Christian Burri, Günther Fink, and Jakob Zinsstag, as well as at universities and research institutions in Abidjan, Lusaka, Nairobi, and Dar es Salaam.

Module 1: Drug Development (Julia Tischler / Department of History) 
Subproject 1.1: Tanja Hammel, Postdoctorial Researcher / Department of History, University of Basel
Subproject 1.2: Eric Ipyn Nebie, PhD Student / Swiss TPH

The module led by Julia Tischler focuses on new forms of partnerships in the field of drug development. Drug development for neglected tropical diseases (NTDs) differs from conventional drug development mainly because there is no profitable market for NTDs, which makes the development of such drugs of little interest for the pharmaceutical industry. This has led to the formation of non-profit partnerships, so called "Product Development Partnerships" (PDPs), involving Universities, governments, the philanthropic sector and the pharmaceutical industry. Given that the development of a drug using such models costs about 20 percent of the expense incurred by conventional pharmaceutical processes, it is not surprising that PDPs receive more and more attention also in high-income countries. The first subproject is a historical case study on the development of the antimalarial drug “Mefloquine”. The drug was developed by the Walter Reed Army Institute of Research (WRAIR) during the time of the Vietnam war and was then transferred to Hoffmann La-Roche for Phase I and II studies, which were conducted in Zambia. The project aims to provide important insights into the mechanisms of knowledge generation in transcontinental, public-private partnerships but also addresses the ethical issues that may arise from power asymmetries between partners. The second subproject compares contemporary clinical trial processes in high-income countries with models applied by PDPs and academic drug research and thereby aims to identify cost-saving mechanisms and potential sources of over-expenditure respectively, but also to point out possible shortcomings in academic and PDP trials. In both cases, the Swiss TPH's excellent connections to Basel’s pharmaceutical industry opens doors that would otherwise remain closed.

Module 2: Health Care Systems (Jürg Utzinger / Swiss TPH)
Subproject 2.1: Doris Osei Afriyie, PhD Student / Swiss TPH
Suproject 2.2: Vitor Pessoa Colombo, PhD Student / Urban Planning EPFL

Creating a fair, high-quality and affordable health care system for all is certainly one of the most important challenges facing society, but also one of the most complex. Even in high-income countries such as Switzerland, the rising costs for health insurance are subject of ongoing and heated debates. In Africa, despite severely limited resources and an increase in population of almost 100 percent, child mortality has been reduced by over 50 percent between 1990 and 2015. These remarkable developments have been achieved not least through a number of innovative health reforms implemented in many African countries over the last two decades. The first subproject of the module led by Jürg Utzinger will systematically review these reforms and investigate their implications for OECD countries. Among the reforms assessed is the so-called "Result-Based Financing" (RBF) scheme, which was introduced with the support of the World Bank in several African countries over the past decade. Under RBF schemes, governments pay financial rewards to health centers and individual providers for achieving pre-determined results, such as for example vaccinating a certain number of children. The second subproject will analyse health facilities and health-related infrastructure in the cities of Nairobi and Abidjan and thereby starts with a look back at the colonial era. At that time, urban planning was motivated by providing a ‘safe’ environment for a white colonial elite and little importance was placed on infrastructure that would benefit public health. Still today, more emphasis seems to be placed on access to health facilities than on preventive infrastructures. The aim of this project is to investigate the influence of the structures formed during the colonial period on contemporary city planning and to gain insights into the motives and effects of current policies.

Module 3: Urban planning, health and agriculture (Jérôme Chenal / Urban Planning EPFL)

Subproject 2.1: Akuto Akpedze Konou, PhD Student / Urban Planning EPFL
Suproject 2.2: Danelle van Zyl-Hermann, Postdoctoral researcher / Department of History, University of Basel

People in Africa care for their wellbeing and health in numerous ways. Urban agriculture is widespread, and modern health centres exist side by side with traditional healers. The module led by Jérôme Chenal investigates how such knowledge and practices are incorporated in city planning and health policies. The first subproject of the module evaluates the complex relationship between urban agriculture, health and spatial planning. While urban agriculture has become an important source of food and income for city dwellers, it is also associated with a number of health risks. For example, wastewater is frequently used for irrigating crops and animals are kept without appropriate drainage systems. City planners, however, have so far largely ignored urban agriculture and there is also little support from government officials. One of the main reason for this, the project assumes, is the lack of understanding of the complex value chains related to urban agriculture. With the aim to identify the most effective ways to include urban and peri-urban agriculture into current urban planning, the project investigates how different practices are integrated into policy and urban planning approaches and how agriculture-related health risks differ between urban and rural areas.  The second subproject of the module has again a strong historical perspective analyising how traditional knowledge was incorporated in the emerging public health sector in late- and postcolonial Kenya and Côte d’Ivoire. It focuses on the links between human, veterinary and environmental health and aims to provide important insights in how traditional practices in Africa have influenced global health concepts such as for example the "One Health" movement.