Ministry of Health

NATIONAL HEALTH RESEARCH AGENDA

2012-2016

January, 2012

THE NATIONAL HEALTH RESEARCH AGENDA

Ministry of Health
P.O. Box 30377
Capital City
Lilongwe 3
Telephone Numbers: +265 1 789 400, 789 321
E-mail: doccentre@malawi.net

Table of Contents

ACRONYMS AND ABBREVIATIONS .................................................................................... i

FOREWORD ......................................................................... Error! Bookmark not defined.
ACKNOWLEDGEMENT ........................................................................................................ iii
1.0 INTRODUCTION............................................................................................................ 1
2.0 BACKGROUND ............................................................................................................. 2
3.0 GOAL AND OBJECTIVES OF THE NATIONAL HEALTH RESEARCH AGENDA .......... 3
3.1

Goal ........................................................................................................................ 3

3.2

Specific Objectives.................................................................................................. 3

4.0 GUIDING PRINCIPLES.................................................................................................. 4

4.1

Political Will and Commitment ................................................................................. 4

4.2

Demand Driven Research ....................................................................................... 4

4.3

Ethics, Human Rights and Law ............................................................................... 4

4.4

Networking, Public and Private Partnerships and Collaboration .............................. 4

4.5

Multidisciplinarity and Complementarity .................................................................. 4

4.6

Sensitivity to Gender Issues and Needs of Vulnerable Populations. ....................... 5

5.0 METHODOLOGY ........................................................................................................... 5

5.1

Approach and Process ............................................................................................ 5

5.2

Criteria for Setting Priorities .................................................................................... 6

6.0 RESEARCH AREAS ...................................................................................................... 6

6.1

Communicable Diseases ........................................................................................ 7

6.1.1

Research Priorities for HIV and AIDS .............................................................. 7

6.1.2

Research Priorities for Malaria ......................................................................... 9

6.1.3

Research Priorities for Tuberculosis .............................................................. 10

6.1.4

Research Priorities for Pneumonia................................................................. 10

6.1.5

Research Priorities for Diarrhoeal diseases ................................................... 11

6.1.6

Research Priorities for Neglected Tropical Diseases (NTDs) ......................... 11

6.2

Non-Communicable Diseases ............................................................................... 12

6.2.1

Research Priorities for Cardiovascular Disease (CVD) .................................. 12

6.2.2

Research Priorities for Cancer ....................................................................... 13

6.2.3

Research Priorities for Diabetes..................................................................... 13

6.2.4

Research Priorities in chronic and recurrent lung disorders ........................... 14

6.3

Sexual and Reproductive Health ......................................................................... 144

6.3.1

Epidemiology ............................................................................................... 144

6.3.2

Prevention ................................................................................................... 144

6.4

Trauma ............................................................................................................... 155

6.4.1

Epidemiology ............................................................................................... 155

6.4.2

Prevention ................................................................................................... 155

6.4.3

Diagnostics .................................................................................................. 155

6.4.4

Treatment ....................................................... Error! Bookmark not defined.5

6.5

Mental Health...................................................................................................... 155

6.5.1

Epidemiology ............................................................................................... 155

6.5.2

Prevention ................................................................................................... 166

6.5.3

Treatment .................................................................................................... 166

6.6

Environmental Health.......................................................................................... 166

6.6.1

Water and Sanitation ................................................................................... 166

6.6.2

Food Safety and Hygiene ............................................................................ 166

6.6.3

Pollution Control .......................................................................................... 177

6.6.4

Occupational Health and Safety ................................................................... 177

6.7

Nutrition .............................................................................................................. 177

6.7.1

Epidemiology ............................................................................................... 177

6.7.2

Prevention ..................................................................................................... 17

6.7.3

Treatment ...................................................................................................... 18

6.8

Health Systems..................................................................................................... 18

6.8.1

Governance/Stewardship ............................................................................... 18

6.8.2

Health Financing ............................................................................................ 18

6.8.3

Human Resource for Health........................................................................... 18

6.8.4

Healthcare Service Delivery ........................................................................... 19

6.8.5

Health Information System ............................................................................. 19

6.8.6

Medical Products and Technologies .............................................................. 19

6.9

Community System Strengthening ........................................................................ 19

7.0 IMPLEMENTATION OF THE RESEARCH AGENDA ................................................... 20

7.1

Stakeholders ......................................................................................................... 20

7.2

Coordinating Structures ........................................................................................ 20

7.3

Capacity Building, Transparency and Accountability ............................................. 21

8.0 FINANCING OF THE NATIONAL HEALTH RESEARCH AGENDA ............................. 21

8.1

Government Funding ............................................................................................ 21

8.2

Research Grant Scheme....................................................................................... 22

8.3

Public and Private Partnerships ............................................................................ 22

9.0 DISSEMINATION OF RESEARCH FINDINGS............................................................. 22

10.0 MONITORING AND EVALUATION OF THE AGENDA .............................................. 23
10.1

Tools for Tracking Adherence to the Agenda ........................................................ 23

10.1.1

Checklist for Submission of Review of Research Protocols............................ 23

10.1.2

Catalogue of Protocols Developed from the Priority Areas ............................. 23

10.1.3

Monitoring and Evaluation (M&E) Reports ..................................................... 23

10.1.4

Progress and Final Reports ......................................................................... 233

10.1.5

Database and Directory of Research Studies .............................................. 233

10.2

Review of the Agenda ........................................................................................... 23

11.0 LIST OF SOURCE MATERIALS.......24

Annex1: National Taskforce, Drafting Committee and the Secretariat..................................25
(a) National Taskforce25
(b) Drafting Committee.................26
(c) Advisors.26
(d) HRCSI Secretariat26

ACRONYMS AND ABBREVIATIONS

COMREC

College of Medicine Research and Ethics Committee

CSWs

Commercial Sex Workers

DFID

United Kingdom
Development

EHP

Essential Health Package

IDRC

International Development Research Centre

HSSP

Health Sector Strategic Plan

HRCSI

Health Research Capacity Strengthening Initiative

(Programme funded in Malawi by DFID and Wellcome
Trust)

GoM

Government of Malawi

IVDUs

Intravenous Drug Users

MGDS II

Malawi Growth Development Strategy II

MSMs

Males Having Sex with Males

MOH

Ministry of Health

NCDs

Non Communicable Diseases

NCST

National Commission for Science and Technology

NHRA

National Health Research Agenda

NHSRC

National Health Sciences Research Committee

NTDs

Neglected Tropical Diseases

IEC
MDA

Information, Education and Communication

Mass Drug Administration

BEmOC

Basic Emergency Obstetric Care

MDR

MultiDrug Resistance
i

Department

for

International

FOREWORD
The Government of the Republic of Malawi (GoM) subscribes and reaffirms its
commitment to the philosophy and ideals of the internationally agreed development
goals that include the Millennium Development Goals (MDGs). At a national level,
Malawi has her own national development strategy called the Malawi Growth and
Development Strategy II (MGDS II) that covers the period from 2011 to 2016. The
MGDS II is, in essence, a conduit through which GoM advocates her commitment
towards achieving the MDGs. While the MDGs 4, 5 and 6 directly relate to human
health that require national governments to make efforts in realizing them, the MGDS II
has equally isolated health sector as one of the key social development sub-theme
requiring the attention of the Government. As an area of focus within the MGDS II, the
health sub-theme (comprising of Public Health, Sanitation, Malaria, and HIV and AIDS
Management) was recognized and espoused as one of the nine key priority areas.
In contributing to the achievement of the health related goals of the MDGs and MGDS
II, Malawi through the Ministry of Health, developed the Health Sector Strategic Plan
(HSSP) covering the same period as the MGDS II. The success of the HSSP in
achieving better health service delivery depends on careful evidence-based policy and
decision making. Health research provides evidence based policy and decision making.
It is acknowledged world over that research requires enormous amount of resources
which are often limited. When operating in an environment of limited resources, it
becomes prudent to set priorities on which concerted effort could be targeted. The GoM
with support from its partners has, therefore, developed this National Health Research
Agenda, as a policy document, that directs priorities in health research covering the
period from 2012 to 2016 to be implemented in tandem with the MGDS II and HSSP.
While the Government of Malawi appreciates the diversity of needs and interests of
different stakeholders in health research, stakeholders are called upon to ensure that
research in Malawi is addressing the research priorities that have been outlined in this
document during the period of its implementation. It is, therefore, expected that
stakeholders will take deliberate steps to conduct and support research in the identified
priorities. The Government of Malawi will endeavor to channel resources to support
research in these priorities. A special appeal is being made to all co-operating partners,
both national and international, to support the undertaking of research in the identified
areas.

Honourable Dr Jean Kalilani, MP

MINISTER OF HEALTH
ii

ACKNOWLEDGEMENT
A National Taskforce was formed to oversee the development of the National Health
Research Agenda (NHRA). The National Commission for Science and Technology
(NCST) through its Health Research Capacity Strengthening Initiative (HRCSI)
programme, with the support of the National Taskforce, coordinated the development of
this agenda. Throughout the Agenda development process, the NCST worked jointly
with the Ministry of Health (MOH) as a relevant sectoral Ministry in matters of health
research. The Ministry provided sectoral policy oversight and quality assurance services
at every stage of the development process.
The Government of Malawi through the MOH would like to acknowledge the efforts of all
experts and stakeholders, too numerous to mention, that were engaged at different
stages of the Agenda development process. I would like to pay special tribute to the
following groups and individuals:
Dr Charles C.V. Mwansambo, the Principal Secretary for Health and Chairperson of
the National Taskforce for his leadership and guidance throughout the development
process. Profound thanks to the Taskforce members and members of the sub-groups
for their outstanding commitment and effort to the development process of this
Agenda. The composition of the taskforce appears on the last page of this document.
Professor J. J. Wirima who facilitated the first ever workshop of the National
Taskforce on the development of the NHRA. With his expertise, he led the
identification of the Thematic Priority Research Areas contained in this Agenda. The
identification of these areas provided the framework of the Agenda development
process.
Consultants who undertook gap analysis studies in the identified thematic priority
areas of research for their dedication, patience and hard work in coming up with
quality reports that informed the drafting of this Agenda. These reports are available
at the HRCSI pages on the NCST website.
NHRA Drafting Committee which drafted the Agenda document. This was a team of
experts that crafted the document in a logical fashion using the gap analysis reports
and a wide range of other source materials using their expertise and experience. The
drafting committee also served as an editorial team. It was composed of Dr Charles
V. Mwansambo (Chairman of the Drafting Committee); Dr Victor Mwapasa (Vice
Chairman of the Drafting Team); Dr Alister Munthali; Dr Kamija Phiri; Dr Damson D.
Kathyola; Dr Charles Chilimampunga and Mr Hudson Nkunika.

iii

 The drafting committee was backstopped by the following members of the

Secretariat: Dr Mathildah Chithila-Munthali (HRCSI Program Manager), Dr Tchaka
Ndhlovu, Mr Mike G. Kachedwa and Mr Andrew M. Mpesi.

All stakeholders who constructively critiqued and reshaped the document at the
stakeholders consultative meetings and whose inputs were duly incorporated.

Thanks also go to Dr Henderson M. Chimoyo, Director General of the National

Commission for Science and Technology, for his leadership and commitment to the
HRCSI mission and objectives. The work of the Health Research Capacity
Strengthening Initiative (HRCSI) staff and their counterparts who worked behind the
scenes and provided coordination remain commendable.
The National Health Research Agenda for 2012-2016 was developed as one of the
milestones of the HRCSI in Malawi, a programme under the joint funding of the UK
Department for International Development (DFID) and Wellcome Trust with technical
assistance of the International Development Research Centre (IDRC). As well as
funding the HRCSI implementation and the development of the NHRA, these
cooperating partners have also supported GoM and its health sector programs and
have presented an invaluable gift to the people of Malawi. Government of Malawi,
therefore, remains sincerely thankful to them.

W. Samute

SECRETARY FOR HEALTH

iv

1.0

INTRODUCTION

The conduct of health or biomedical research in Malawi dates back to preindependence era. Since then, the need for health research has been growing in order
to inform policy and health care service delivery. Most of the research has been
operations research commissioned by national disease control programmes on the one
hand, while basic health research has been influenced largely by the academic
community on the other hand, while a greater proportion of all health research
conducted in Malawi has been externally driven, thereby leaving little room, if any, for
Malawi to focus on conducting locally relevant priority research. Recognising this
growing need for health research, Malawi through the Health Research Capacity
Strengthening Initiative, a programme operating in Malawi with funding from the UK
Department for International Development (DFID) and Wellcome Trust, embarked on a
process of developing her own National Health Research Agenda that covers a period
of five years from 2012 to 2016.
This National Health Research Agenda represents nationally set and agreed priorities in
which research efforts for Malawi will be concentrated over the next five years. The
Agenda document itself is organized into eleven chapters or sections. These are:
Introduction; Background; Goal and Objectives; Guiding Principles; Methodology; Areas
of Research; Implementation of the Research Agenda; Financing of the National Health
Research Agenda; Dissemination of Research Findings; Monitoring and Evaluation of
the Agenda; and List of Source Materials.
This National Health Research Agenda finally represents the Government of Malawi
policy need and interest for research to be carried out in the identified priority areas.
Research in the identified priorities is geared towards obtaining evidence which is much
needed for policy and decision making. Government of Malawi, therefore, expects all
cadres of stakeholders to support the implementation of this National Health Research
Agenda.

2.0

BACKGROUND

The Government of Malawi (GoM) recognises the importance of health and health
research for socio-economic development. The Malawi Growth and Development
Strategy (MGDS II) which is an overall national development agenda acknowledges that
a healthy population is necessary if the country is to achieve sustainable economic
growth. It is against this background that the National Health Research Agenda has
been developed. This Agenda document will be implemented alongside the Health
Sector Strategic Plan (HSSP) and the National Health Policy (NHP) which will guide the
implementation of interventions in the health sector for the period 2011-2016. The
development of the NHRA has been in line with Malawis extended Essential Health
Package (EHP) which includes: HIV and AIDS; Acute Respiratory Infections (ARIs);
Malaria; Diarrhoeal Diseases; Perinatal Conditions; Non-Communicable Diseases
(NCDs) ; Tuberculosis; Malnutrition; Cancers; Vaccine preventable diseases; Mental
illness (including epilepsy); Neglected Tropical Diseases (NTDs); and Eye, Ear and Skin
infections.
Health indicators have generally improved over the last decade. The infant and under
five mortality rate has been decreasing from 76/1000 and 133/1000 to 66/1000 and
112/1000 live births in 2004 and 2010, respectively. The maternal mortality ratio (MMR)
has declined from 807 in 2006 to 675 per 100,000 live births in 2010. Despite the
improvement in these indicators, Malawi still faces major health challenges due to a
persisting high burden of preventable and treatable diseases, and significant limitations
of the health system to respond. The total fertility rate (TFR) is estimated at 5.2 and the
contraceptive prevalence rate (CPR) is at 43%. The number of tuberculosis case
notifications increased from 5,000 in 1985 to 25,000 cases in 2010. Malaria remains a
major cause of morbidity and mortality in Malawi. The number of presumptive cases of
malaria increased from 3.7 million in 2005 to 6.1 million in 2009. The burden of NCDs in
Malawi is an emerging problem and account for at least 12% of the Total Disability
Adjusted Life Years in Malawi which is fourth behind HIV and AIDS, other infections and
parasitic and respiratory diseases. NCDs are thought to be the second leading cause of
deaths in adults. A STEPS survey conducted in Malawi in 2009 clearly demonstrated
2

that NCDs and their risk factors are a significant public health problem and hence their
inclusion in the expanded EHP.
A lot of research is being done in Malawi. This research, however, is mostly
commissioned, conducted and funded externally and in most cases does not align with
the national health priorities including the EHP. In order to ensure that research
addresses Malawis health priorities this NHRA has been developed and will guide
investments in health research aimed at improving the health status of people in Malawi
and contribute to the overall goal of the MGDS II and the achievement of the Millennium
Development Goals.

3.0

GOAL AND OBJECTIVES OF THE NATIONAL HEALTH RESEARCH

AGENDA

3.1

Goal

The overall goal of the NHRA is to guide researchers, policy makers, program
implementers, academic institutions, health development partners and other
stakeholders on health research priorities for Malawi.

3.2

Specific Objectives

The specific objectives of the agenda are to:

Promote the conduct of health research responsive to the priority health needs of
Malawi.
Facilitate the mobilization of resources for the conduct of locally relevant health
research
Promote multidisciplinarity and collaboration in the conduct of research
Facilitate the coordination of health research conducted by various stakeholders.
Promote the strengthening of capacity for conducting research in Malawi.
Facilitate translation of research findings into policy and practice

4.0

GUIDING PRINCIPLES

The implementation of the National Health Research Agenda shall be guided by the
following principles:

4.1

Political Will and Commitment

Undertaking meaningful research that addresses priority needs of Malawi requires

adequate resources available through political will at all levels.

4.2

Demand Driven Research

Stakeholders shall be encouraged to conduct research responsive to priority health

needs of Malawi.

4.3

Ethics, Human Rights and Law

The dignity and rights of all research participants including vulnerable populations shall
be promoted and protected as enshrined in the bioethics principles, Constitution of the
Republic of Malawi and all relevant Malawi laws, national policies, regulations and
guidelines as well as in tandem with international law.

4.4

Networking, Public and Private Partnerships and Collaboration

Concerted efforts and strategic partnerships with public and private research institutions
and with a cross-section of other stakeholders shall be promoted.

4.5

Multidisciplinarity and Complementarity

Research studies that are multidisciplinary and/or complementary in nature shall be

promoted to enhance skills transfer, optimal usage of resources, and translation of
research findings into policy and programmes.

4.6

Sensitivity to Gender Issues and Needs of Vulnerable Populations

Encourage fair participation of both genders and vulnerable populations in research

taking into account their special needs, so as to reduce disparity in health care provision
based on individuals attributes.

5.0

METHODOLOGY

This section describes the approach and process that were followed in developing the
National Health Research Agenda.

5.1

Approach and Process

Essential National Health Research (ENHR) and Child Health and Nutrition (CHNI)
approaches were used to set research priorities. ENHR and CHNI are demand-driven
approaches focusing on the analysis of health needs, peoples expectations and
societal trends. Basing on these approaches, the setting of research priorities was
guided by principles of country-drivenness; analytical evidence; stakeholder
participation; transparency; iterativeness and value-drivenness.
The general process that was followed included the undertaking of the following key
activities;

Establishment of the National Task Force for the Development of the NHRA with
concrete terms of reference
National Taskforce Workshop for the Identification of the Thematic Priority
Research Areas. The identification was done using Delphi method
Recruitment and induction of consultants to undertake gap analysis studies in the
identified thematic priority areas of research to inform the drafting of the NHRA
Conducting gap analysis studies by the consultants using literature review, key
informant interviews and focus group discussions as data collection techniques.
Subgroup meetings for each thematic priority thematic area to review findings of
gap analysis studies
Revision of gap analysis reports by consultants
National Task Force Meeting to review revised gap analysis reports
Appointment of the NHRA Drafting Team by the Chairman of the National
Taskforce
Drafting of the NHRA using the gap analysis reports
5

5.2

Review of the Draft NHRA by a special team of advisors in health research

Incorporation of comments from a team of advisors
National stakeholders consultative meeting on the draft NHRA
Finalization of the NHRA document by incorporating comments from
stakeholders workshop

Criteria for Setting Priorities

Each of the identified specific priorities was analyzed according to five key criteria.
These criteria are:
1. Current and potential burden of disease;
2. Feasibility and deliverability of the research taking into consideration human,
financial and infrastructural resources and the acceptability of the research;
3. Expected impact of the research on policy/decision making/system changes,
disease burden reduction, health care delivery services, knowledge for further
research and design of interventions, direct and indirect effects, short and long
term effects;
4. Effects on equity and social justice to ensure the concerns of vulnerable groups
and disadvantage groups are considered; and
5. Contribution to research capacity strengthening in Malawi.
Each of the identified priorities was scored against the above mentioned criteria on a
scale of 1-5 and ranked accordingly.
6.0

RESEARCH AREAS

This section presents the key research priorities. The priorities are organized in nine
disease and non-disease thematic areas which were identified as key priority research
areas for Malawi. These areas are: Communicable diseases; Non-communicable
diseases; Sexual and reproductive health; Trauma; Mental health; Environmental
health; Nutrition; Health systems; and Community system strengthening.
Within each of these thematic priority areas, priorities are articulated in specific subthemes. An attempt has been made to outline these priorities within each sub-theme
under the following structure: Epidemiology, Prevention, Diagnostics and Treatment.
This structure has been followed for all disease-based thematic areas. The research
priorities are outlined in a reasonably broader sense with a view of allowing a
researcher to have discretionary opportunity and flexibility to design specific research
studies that address a particular identified topical area of priority research.

6.1 Communicable Diseases

The top six conditions are HIV and AIDS, Malaria, Tuberculosis (TB), Pneumonia,
Diarrhoeal diseases and Neglected Tropical Diseases (NTDs).

6.1.1

Research Priorities for HIV and AIDS

6.1.1.1

Acute HIV infection in adults

The burden and trends of blood borne infections associated with HIV, including
Hepatitis and human papilloma virus in Malawi
Impact of HIV and AIDS on cultural perceptions on disease, death and the dying
The role of high risk groups (CSWs, MSMs, IVDUs) in HIV and AIDS
transmission and prevention
Determinants of HIV and AIDS transmission among co-habiting couples
Trends and dynamics of HIV in the context of implementing various HIV
interventions
Impact of gender on HIV and AIDS prevention, care and support
Impact of existing macrolevel factors, such as structural adjustment
programmes, policy/legal frameworks and food security policies on HIV and AIDS
transmission, morbidity and mortality
Socioeconomic implications/impact of HIV interventions including ART in
Malawi
Trends and impact of HIV and AIDS on productivity of the private and public
sector
Trends and impact of stigma and discrimination on HIV and AIDS responses

6.1.1.2

Epidemiology

Prevention

Interventions to promote female condom use and HIV partner notification

Efficacy, effectiveness and feasibility of novel interventions for prevention of
heterosexual, homosexual and mother-to-child transmission of HIV
Factors that influence adoption of positive behavior towards HIV prevention
Effectiveness of various behavioural change interventions, especially among
young people
Cost-effectiveness of various HIV and AIDS prevention strategies
Explore known HIV status and new episodes of Sexually Transmitted Infections

Uptake of family planning methods in ART clients or People Living with HIV and
AIDS.

6.1.1.3 Diagnostics
Evaluate the efficiency and accuracy of the current whole blood rapid test
(WBRT) kits
Evaluate new candidates of WBRT kits
Explore new strategies for early infant HIV diagnosis
Role of point of care CD4+ testing
Strategies for HIV viral load testing

6.1.1.4

Treatment, Care and Support

Strategies for optimizing HIV treatment in infants and children in settings where
access to care continues to be limited
Strategies for detecting ART treatment failure in the context of limited ART
monitoring resources
Explore sustainable financing mechanisms for provision of antiretroviral drugs
Studies on causes of delay of the development of full blown AIDS after HIV
infection
The efficacy and effectiveness of traditional medicine in the treatment of
Opportunistic Infections (OIs)
Health seeking behavior practices and determinants among people with HIV and
AIDS and STIs
Efficacy, effectiveness and feasibility of novel HIV treatment interventions
Acceptability of the referral systems including home based care (HBC)
Cost-effectiveness of various HIV and AIDS treatment strategies
Levels and determinants of compliance and ART adherence
Impact of ART roll out services on HIV Testing and Counseling uptake
Challenges of HTC service provision
Impact of HIV and AIDS on health care delivery systems
Role of Youth in providing HIV care and support
Impact of existing strategies and programmes addressing orphans and
vulnerable children
Impact of Option B+ implementation on pediatric HIV
Assess models and challenges of integration of HIV and TB

6.1.2 Research Priorities for Malaria

6.1.2.1 Epidemiology
Biology, ecology and distribution of malaria vectors
Trends in burden and transmission of malaria.

6.1.2.2 Prevention
Insecticide resistance status and their operational significance to LLINs, IRS and
other vector control strategies
Evaluating drug resistance management strategies, including rotational or
mosaic approaches
Evaluation of alternative vector control strategies
Cost effectiveness of various vector management approaches
Feasibility and acceptability of dichlorodiphenyltrichlorethane (DDT) for IRS
Effect of various prevention strategies on malaria parasite biology, including
changes in predominant genotypes
Innovative strategies of expanding delivery of Intermittent Preventive Therapy in
pregnancy (IPTp) at community level
Factors causing poor uptake of malaria control interventions in the community
Innovative strategies for delivery of IEC for malaria prevention and treatment
Efficacy, effectiveness and feasibility of preventive interventions against malaria

6.1.2.3 Diagnostics
Validity and feasibility of new and available diagnostic tools

6.1.2.4 Treatment
Strategies to improve early treatment of malaria within the community
Factors affecting treatment of malaria by health workers in the context of
increased availability of diagnostic services
Parasite resistance to antimalarial drugs
Factors responsible for non compliance of health workers to national malaria
treatment guidelines
Post marketing surveillance of the quality of drugs at service delivery points
Trends in malaria drug efficacy
Efficacy, effectiveness and feasibility of therapeutic interventions against malaria

6.1.3 Research Priorities for Tuberculosis

6.1.3.1 Epidemiology
Assessment of burden of TB in the community
Role of bovine TB in human morbidity and mortality, including its transmission
and prevalence
Trends in MDR and XDRTB.

6.1.3.2 Prevention
Assessment of models for community and social mobilization towards TB control,
especially in the rural areas
Efficacy, effectiveness and feasibility of preventive interventions against TB
Strategies to improve access to high quality TB diagnostics in the community

6.1.3.3 Diagnostics
Strategies to improve diagnosis of TB, especially TB in HIV-infected individuals
and extrapulmonary TB.
Develop and assess new technologies for diagnosis of TB

6.1.3.4 Treatment
Efficacy, effectiveness and feasibility of new therapeutic interventions against TB

6.1.4 Research Priorities for Pneumonia

6.1.4.1 Epidemiology
Trends in burden and type of pneumonia

6.1.4.2 Prevention
Assessment of the efficacy of new preventive strategies.
Surveillance of pneumonia vaccines coverage and effectiveness.

6.1.4.3 Diagnostics
Assessing strategies for early clinical and laboratory-based diagnosis.

10

6.1.4.4

Treatment
Assess new treatment strategies for pneumonia

6.1.5 Research Priorities for Diarrhoeal diseases

6.1.5.1 Epidemiology
Assessment of burden and aetiology of diarrhoeal diseases in the community

6.1.5.2 Prevention
Strategies to improve coverage of hygiene and sanitation interventions
Assessment of models for community and social mobilization towards diarrhoea
disease control, especially in the rural and high density urban areas
Efficacy, effectiveness and feasibility of preventive interventions against
diarrhoeal disease

6.1.5.3 Diagnostics
Assess new strategies for diagnosis of diarrhoea-causing pathogens

6.1.5.4 Treatment
Efficacy, effectiveness and feasibility of new therapeutic interventions against
diarrhoea and its complications
Strategies to improve management of diarrhoea outbreaks

6.1.6 Research Priorities for Neglected Tropical Diseases (NTDs)

This sub-section focuses on five top NTDs which are considered to be of high priority in
Malawi, namely; Schistosomiasis, Trypnosomiasis, Onchocerciasis, lymphatic filariasis
and Trachoma, including Soil transmitted helminths.

6.1.6.1 Epidemiology
Characterize the determinants and distribution of NTDs
Assess long term complications of some NTDs

11

6.1.6.2 Prevention
Strategies for
onchocerciasis

prevention

of

NTDs

especially

lymphatic

filariasis

and

6.1.6.3 Diagnostics
Validity and feasibility of new and available diagnostic tools

6.1.6.4 Treatment
Assess new strategies for treatment of NTDs
Assess the efficacy and effectiveness of MDA campaigns

6.2 Non-Communicable Diseases

This thematic area focuses on four top non-communicable conditions which are
considered to be of high priority in Malawi, namely Cardiovascular disease (CVD);
Cancer; Diabetes; and Chronic and recurrent lung disorders.

6.2.1

Research Priorities for Cardiovascular Disease (CVD)

6.2.1.1 Epidemiology
Burden and trends of cardiovascular disease
Determinants of cardiovascular disease in HIV and AIDS patients

6.2.1.2 Prevention
Strategies that increase awareness of cardiovascular disease risk factors and
need for screening for hypertension

6.2.1.3 Diagnostics
Strategies for early screening and diagnosis of hypertension

6.2.1.4 Treatment
Assessment of Costeffective and evidencebased treatment protocols for
hypertension and other risk factors for cardiovascular disease

12

6.2.2 Research Priorities for Cancer

6.2.2.1 Epidemiology
Determinants, distribution and trends of common types of cancers.

6.2.2.2 Prevention
Cost-effectiveness of various strategies for prevention of cancers including
screening programmes
Barriers, levels and determinants of uptake of proven strategies for the
prevention of cancers and vaccination

6.2.2.3 Diagnostics
Diagnosis and access to screening for cancer.

6.2.2.4 Treatment
Treatment strategies for HIV and AIDS related malignancies
Cost-effectiveness and evidence-based treatment protocols for common types of
cancers
Levels and determinants of access to evidencebased treatment of cancers

6.2.3 Research Priorities for Diabetes

6.2.3.1 Epidemiology
Determinants and distribution of diabetes
Trends and burden of diabetes and its complications

6.2.3.2 Prevention
Feasibility of introducing screening programmes in the communities and clinics
Development of innovative strategies for prevention of diabetes

6.2.3.3 Diagnostics
Assessment of strategies for diagnosing diabetes and monitoring response to
treatment in the context of limited resources
Tools/techniques for early screening and diagnosis

13

6.2.3.4 Treatment
Develop and evaluate costeffective treatment protocols
Innovative approaches to improve access to diabetic treatment

6.2.4 Research Priorities in Chronic and recurrent lung disorders

6.2.4.1 Epidemiology
Magnitude, determinants and distribution of chronic and recurrent lung disorders,
especially asthma.

6.2.4.2 Prevention
Assessment of strategies for the prevention of exacerbations and treatment of
chronic and recurrent lung disorders, especially asthma.

6.2.4.3 Treatment
Development of innovative and cost-effective strategies for the treatment of
chronic and recurrent lung disorders.

6.3 Sexual and Reproductive Health

6.3.1 Epidemiology
Burden and trends of cancers affecting the reproductive system, including breast
cancer
Burden, trends and impact of STIs (including HIV), unplanned pregnancies and
unsafe abortions, especially among the youth.
Magnitude and trends of maternal and neonatal morbidity and mortality.
Determinants of early sexual behaviour
Sexuality patterns, trends and determinants among adolescents
Impact of early child bearing on the mother, baby and family
Determinants, extent and effects of sexual abuse

6.3.2 Prevention
Impact of strategies for promoting male involvement in SRH services.
Interventions and strategies to address stigma and discrimination resulting from
obstetric fistula
14

Impact of life skills education on adolescents

6.4 Trauma
6.4.1 Epidemiology
Causes, extent, and nature of trauma and type of injuries and their long term
outcome
Identification of minimum data sets and use of distributed data collection and
analyses procedures

6.4.2

Prevention
Characterizing life-styles that increase the likelihood of trauma and injury
Assessing effectiveness of technologies that prevent trauma and injury.
Public education strategies about road safety for road users
Outcome studies documenting the effectiveness of primary prevention

6.4.3 Diagnostics
Diagnosis using cost-effective imaging techniques
Evaluate innovative methods for diagnosis and localization of injuries

6.4.4 Treatment
Effective strategies for pre-hospital trauma care including preparedness studies
Treatment using safe and effective and inexpensive blood substitutes
Strategies for an effective accident response system allowing for identification
and management of high-risk groups

6.5 Mental Health

6.5.1 Epidemiology
Burden, trends, distribution and determinants of mental health disorders,
including psychological trauma
Impact of mental health disorders on psychosocial development
Understanding the link between mental and physical disorders, especially in
vulnerable groups.

15

Cultural and socioeconomic factors that may mediate knowledge of mental

illness among caregivers
Perception of public on mental disorders
Relationship between substance abuse and mental disorders

6.5.2 Prevention
Effective and culturally appropriate strategies to prevent substance abuse and
mental disorders

6.5.3

Treatment
Development of innovative and appropriate treatment strategies
Use of traditional medicine in treating mental illness
Adherence to drug treatment

6.6 Environmental Health

6.6.1 Water and Sanitation
Assess access to sustainable safe water and improved sanitation facilities in
Malawi
Determine the impact of climate change on water resources
Evaluate the impact of Community Led Total Sanitation (CLTS) on latrine
coverage
Determine the sustainability of operation and maintenance of water sources
Assess the effectiveness of water treatment options at household level
Assess the safety of EcoSan products (compost) from eco-toilets for agricultural
re-use
Assessment of appropriate sanitation technologies for congested and informal
settlements in urban areas.

6.6.2 Food Safety and Hygiene

Assess the safety of food in terms of microbiological and chemical contamination
Assess hygiene practices in commercial food premises
Assess the food safety management practices in commercial businesses

16

6.6.3 Pollution Control

Effect of radioactive substances

Management of solid waste

Impact of agriculture chemicals on human health

Characterize exposure to the general population from industrial processes and

industrial and consumer products containing pollutants

Characterize health of exposed populations and environment

Understand workplace processes and factors that determine exposure to

pollutants

6.6.4 Occupational Health and Safety

Characterizing accidents and injuries in the workplace.

Occupational disease prevalence, assessment, monitoring and reporting

Monitoring exposure to occupational hazards.

6.7 Nutrition
6.7.1 Epidemiology

6.7.2

Trends in nutritional status of population and its determinants

Determinants of chronic malnutrition
Determinants of micronutrient deficiencies, especially iron, iodine, Vitamin A and
zinc
Determinants of mortality rates in nutritional rehabilitation units.
Dietary habits (practices) in pregnant women that affect birth outcomes
Interactions between infection (including HIV) and nutrition, including estimation
of energy demands (requirements) in HIV+ children with malnutrition
Long term adverse effects of drugs and hormones used in enhancement of food
production on human health
Effects of high fibre diet on human health
Prevention
Assessing nutritional content of locally-produced foods, optimal food processing
methods and bioavailability of micronutrients
Strategies to improve micronutrient content of food, including bio-fortification.
Prevention of malnutrition in people living with HIV/AIDS
Prevention strategies for chronic malnutrition
17

6.7.3

Community strategies for preventing relapsing malnutrition after discharge

Impact of health education programmes on micronutrient (including zinc, iodine
and vitamin A) consumption
Treatment
Management of moderate and acute malnutrition, including relapsing malnutrition
following hospital discharge
Optimal treatment options in people living with HIV/AIDS with severe acute
malnutrition
Assessing the effectiveness of different multidisciplinary programs (models) for
reducing childhood malnutrition in the community.
Extent of and barriers in the infant and young child feeding practices
Barriers against use of optimal nutritional interventions in pregnant women

6.8 Health Systems

6.8.1 Governance/Stewardship

6.8.2

6.8.3

Impact of decentralization and other health reforms including SWAps on health

systems performance.
Cost-effectiveness studies of health programs.
Strategies for community engagement in implementation of health programs.
Utilisation of research evidence and community needs on health policy
formulation

Health Financing
Alternative financing mechanisms for financial sustainability.
Resource allocation mechanisms for heath equity and positive health outcomes.
Tracking studies for health financing
Cost-benefit and cost-effective analysis of health care interventions

Human Resource for Health

Strategies for HRH retention in the health sector.

Impediment to HRH policies and regulations
Impact of different models of task shifting on health sector performance.
Effective HRH deployment in the health sector.
Strategies for improving training for staff
18

6.8.4

Workload assessment and its impact on health worker performance

Healthcare Service Delivery

Equitable distribution of resources across different levels of the health care.

Effective strategies for delivering health services in the context of limited
resources.
Effective models of PPP in the health care services
Assessment of effectiveness and quality of services in the context of limited
resources.
Heath system factors responsible for the unmet need for health services

6.8.5 Health Information System

6.8.6

Strategies to enhance data collection mechanisms and utilization for program

planning and implementation.
Strategies for harmonization of HMIS and other data systems.

Medical Products and Technologies

Determinants of medical and pharmaceutical products stockouts
Assessment of supply chain management
Rational utilization of medical and pharmaceutical products.
Quality and content of medicines found in the formal and informal sector.
Development and use of appropriate technologies
Pharmacovigilance studies to monitor adverse drug reactions

6.9 Community System Strengthening

Research on social determinants of EHP conditions and other emerging health

issues;
Perception of community members on communicable and non-communicable
diseases and their impact on livelihood
Explore and evaluate appropriate strategies for information, education and
communication to influence positive behaviour change across diseases
The interface between traditional and modern medicine
The impact of immigration and emigration on health
The interrelationships and policy implications between health and other social
domains of human life.
19

7.0

Factors that determine access to health services, especially in marginalised

populations
Community barriers that impede access to health care
Effective strategies for increasing male involvement in women and child health
programmes

IMPLEMENTATION OF THE RESEARCH AGENDA

The NHRA is the overarching guiding instrument for generating evidence that will be
used in the health sector in order to inform the development of policies and health
interventions. To ensure full implementation of the Research Agenda, there is a need
for involvement of various stakeholders at both national and international levels in the
design and execution of research. With the support of the legal tutelage of the National
Commission for Science and Technology (NCST), the Ministry of Health as a sectoral
ministry responsible for health care delivery, in partnership with stakeholders and the
international community, will support and advance the objectives of the Agenda to
ensure promotion, facilitation, co-ordination, development and management of research
activities in Malawi with efforts geared towards addressing research activities in the
identified priority areas.
While Government of Malawi appreciates the diversity of needs and interests of different
stakeholders in health research, stakeholders are, however, called upon to ensure that
research in Malawi is geared towards addressing the research priorities that have been
outlined in this document during the period of the Agenda. It is therefore, expected that
stakeholders will make deliberate efforts in conducting and supporting research in the
identified priorities. Government resources will not be used in supporting research
outside these priorities.

7.1

Stakeholders
Key stakeholders that are being called upon for the implementation of the Agenda
include government Ministries with line functions that have bearing on determinants of
health; academic institutions and their research centres of excellence, and affiliates;
research institutions; the civil society organizations; private sector organizations; NGOs;
INGOs; and international co-operating partners.
7.2 Coordinating Structures
Key coordinatory and regulatory structures and mechanisms for health research review
and clearance in Malawi in the identified priorities shall remain the research and ethics
committees (i.e. National Health Sciences Research Committee and College of
Medicine Research and Ethics Committee that are existent in Malawi in respect of their
20

different jurisdictions and operating under the authority of the NCST). The Pharmacy
and Medicines Board shall continue providing regulatory aspects of trials involving
drugs and vaccines, while the NCST shall continue providing national co-ordinatory and
regulatory services of all forms and types of health research including clinical trials.
7.3 Capacity Building, Transparency and Accountability
To ensure ownership in the design and execution of the NHRA, stakeholders efforts
aimed at fostering capacity building in the conduct and dissemination of research results
by local researchers and research institutions will be promoted.
To mitigate implementation risks, any strategies or efforts by stakeholders geared
towards achieving successful operationalisation of the Agenda will be fostered. Such
efforts and strategies will revolve around the following;

8.0

Capacity risks: promoting covering issues of human and financial resources,

processes and systems in research;
Governance risks: targeting ownership, decision-making, accountability,
transparency and oversight in research;
Fraud and corruption risks: fostering efforts and controls that fraud and
corruption in health research.
FINANCING OF THE NATIONAL HEALTH RESEARCH AGENDA

Financing of research in the identified priority areas is critical for the realization of the
goal and objectives of this Agenda. Stakeholders are, therefore, implored to support the
financing of research geared towards addressing priorities outlined in this Agenda. The
following mechanisms of financing this Agenda shall be pursued:
8.1 Government Funding
Government shall commit direct resources at various levels to support the undertaking
of research in the identified priorities. The Ministry of Health shall be particularly
proactive in leveraging support for resourcing this Agenda.
Drawing on experiences from other countries, the Government of Malawi shall establish
a National Health Research Fund (NHRF). The NHRF shall be a pool of resources from
the government and co-operating partners. This will be a basket funding for research in
the identified priorities. The Fund shall be managed by the Ministry of Health with clear
guidelines. A key advantage of the NHRF is that it has some potential to ensure
sustainability of funding for research.

21

8.2 Research Grant Scheme

Researchers and all other stakeholders wanting to undertake research in the identified
priorities shall be encouraged to take advantage of the existing national and
international research grant schemes in health research. Several international grant
giving organizations exist. These include WHO Special Programme on Training and
Research on Tropical Diseases; National Institute for Health (NIH); Alliance for
Research on Health Policy and Health System Research, Wellcome Trust, etc.
8.3
Public and Private Partnerships
Public and private partnerships shall be an important vehicle for nurturing resource
mobilization for research in the priority areas. Researchers in public and private sectors
shall be encouraged to pursue a spirit of collaboration in undertaking research.
Deliberate efforts in cultivating corporate social responsibility to support the financing of
the Agenda shall be encouraged and sought after by researchers at various levels.
9.0

DISSEMINATION OF RESEARCH FINDINGS

Research dissemination entails popularization of research results. Researchers shall

ensure that scientific knowledge is communicated to a wider audience beyond the
research community. Reporting of research and its results shall be the responsibility of
every researcher and the research institution. The responsibility may be delegated to
either the sponsor or any individual upon mutual agreement. Research communication
shall entail expressed commitment to publish or disseminate the results within a
specified period.
It is incumbent upon research institutions to promote multifaceted and comprehensive
research communication to achieve high quality research dissemination. Institutions
conducting health research shall have a responsibility for dissemination of research
results to ensure that the results reach end-users. The researchers have a responsibility
of publishing and organizing events for dissemination of research results.
All approved research studies shall have a component on dissemination of results.
Institutions shall be required to establish budget lines for dissemination of research
results. Institutions shall establish research data banks and repositories and compile
annual directories of research in order to facilitate access and availability of research
data and information for use by end-users.
The Ministry of Health and other coordinating institutions including the National
Commission for Science and Technology shall ensure that Research Information is
available for utilization at the national level by policy makers, communities, target
populations, researchers and all other relevant stakeholders. It is, therefore, hoped that
22

the NHRA will stimulate interest that will generate research evidence in the identified
priority areas.
10.0

MONITORING AND EVALUATION OF THE AGENDA

The tracking of the stakeholders adherence to the Agenda shall be part and parcel of
monitoring the Agenda implementation. The tracking will be informed by some
tools/indicators as described below. This tracking shall benchmark the review of the
Agenda.

10.1 Tools for Tracking Adherence to the Agenda

10.1.1 Checklist for Submission of Review of Research Protocols
NHSRC and COMREC Checklists for submission of protocols for ethical review shall
contain an element of whether the study is addressing any of the priority areas.
10.1.2 Catalogue of Protocols Developed from the Priority Areas
Using the database of the NHSRC, COMREC and institutional databases, the MOH in
collaboration with the NCST shall compile catalogues of approved protocols of studies
addressing the priority areas.
10.1.3 Monitoring and Evaluation (M&E) Reports
NHSRC and COMREC shall be supported to be undertaking M+E visits to sites where
the approved studies are being conducted.
10.1.4 Progress and Final Reports
Progress and final reports shall be submitted to an ethics committee that approved the
study as per its stipulated guidelines and standard operating procedures. At the end of
the research study, final report shall be deposited with the ethics committee that
approved that study with copies submitted to NCST and MOH.
10.1.5 Database and Directory of Research Studies
Final reports of studies deposited with MOH, COMREC and NCST shall be used to
compile database and directories of approved research studies.

10.2 Review of the Agenda

This Agenda has a lifespan of five years in line with the HSSP. Informed by emerging
issues in health and the above stated indicators for tracking the stakeholders
adherence to the implementation of the Agenda, there would a midterm evaluation
followed by a final review of the Agenda after five years.
23

11.0 LIST OF SOURCE MATERIALS

In drafting this Agenda, the following documents were used as source materials:
1. SADC Regional HIV and AIDS Research Agenda-SADC/HM/1/2008/5
2. HIV/AIDS Research Strategy for Malawi (2005-2007)
3. Health Research Agenda for the 21st Century: Country Perspective (Indonesia)
4. National Unified Health Research Agenda for Philippines 2008-2010
5. Priority Areas for Research in Population and Development- September 2009
6. Consultancy Reports of the Gap Analysis Studies: NCST/HRCSI 2010
7. Health Sector Strategic Plan 2011-2016
8. Priority Setting for Health Research: Toward a management process for low and
middle income countries; Philippines, South Africa, Brazil, and Netherlands; Council
on Health Research Development (COHRED); Working Paper 1 (2006)
9. The Algiers Declaration: Ministerial Conference on Research for Health in the African
Region- Narrowing the knowledge gap to improve Africas health; 23-26 June 2008
10. National Health Sciences Research Committee General Guidelines on Health
Research- December 2007
11. The 10/90 Report on Health Research 2000: Global Forum for Health Research
(April 2000)
12. Systems Thinking for Health Systems Strengthening: Alliance for Health Policy and
Systems Research-WHO 2009
13. Health Systems: Improving Performance-World Health Report 2000 (WHO 2000)
14. National Health Priority Areas Report: Mental Health: A report focusing on
Depression: Commonwealth Department of Health and Aged Care- Australian
Institute of Health and Welfare-1998
15. Tanzania: National Health Research Priorities 2006-2010
16. 2nd National Conference on Priority Setting for Health Research Report.
Department of Health, 2006: Pretoria, South Africa
17. Monitoring the Building Blocks of Health Systems: A Handbook of Indicators and
their Measurement Strategies: WHO 2010
18. Draft Health Policy, Ministry of Health, 2010)
19. Malawi Growth and Development Strategy (1 & II)
20. Guidance Note on Operational Risk Assessment Framework (ORAF); Risk to
Achieving Results; World Bank 2010
21. The Millennium Development Goals for Health: Rising to the Challenges; IBRD/The
World Bank, 2004

24

ANNEX

1:

NATIONAL TASKFORCE,
SECRETARIAT

(a) National Taskforce

Dr Charles V. Mwansambo (Chairman)

Dr Ben Chilima (Vice Chairman)
Dr Damson Kathyola
Dr George Chithope-Mwale
Dr Storn Kabuluzi
Prof Joseph Mfutso-Bengo
Dr Bonus Makanani
Dr Kenneth Maleta
Dr Bagrey Ngwira
Mr Chris Moyo
Mr Francis Masiye
Dr Peter Kazembe
Prof Yohane Z. Nyasulu
Prof Chrissie Kaponda
Mr Blackson Matatiyo
Mrs Diana Jere
Dr George Kafulafula (deceased)
Mr Frade K Nyondo
Dr Kondwani Chalulu
Dr Austin Mnthambala
Mr Andrew Simwaka
Mr George Jabu
Dr Frank Taulo
Dr Sarah White
Dr Steve Taulo
Mr Harris Chilale
Dr Neil French
Dr Kamija Phiri
Dr Nellie Wadonda-Kabondo
Mrs Martha Kwataine
Dr Maureen Chirwa
Dr Beatrice Mtimuni
Dr Chiwoza Bandawe
Dr Bertha Simwaka
Dr Address Malata

25

DRAFTING

COMMITTEE

AND

THE

(b) Drafting Committee

Dr Charles V. Mwansambo (Chairman)
Dr Victor Mwapasa (Vice Chairman)
Dr Damson Kathyola
Dr Kamija Phiri
Dr Alister Munthali
Mr Hudson Nkunika
Dr Charles Chilimampunga

(c) Advisors
Prof Jack J Wirima
Dr Peter Kazembe
(d) HRCSI Secretariat
Dr Mathildah Chithila-Munthali (HRCSI Program Manager)
Dr Tchaka Ndhlovu
Dr Happy Phiri
Mr John Chipeta
Mr Alick Manda
Mr Mike G Kachedwa
Mr Andrew M Mpesi
Mrs Kamoza Chimungu

26