Poor countries striving to improve their health systems deserve better than the unexplained implosion of the Global Forum for Health Research, argues Beverly Peterson Stearns.
Barely a year ago nearly 1,000 people from 80 countries gathered enthusiastically at the Palacio de Convenciones in Havana, Cuba, under the banner 'Innovating for the health of all'. More than half came from low- and middle-income countries. They were attending the annual meeting of the non-profit organisation the Global Forum for Health Research (GFHR), eager to hear about inventive and effective ways to conduct research, and urgently seeking to improve health in their countries.
Now, less than a year after taking office, the forum's executive director, Anthony Mbewu, has resigned, and the forum itself is in failing health. The prognosis is poor. Very few remain in its Geneva secretariat. Many employees have quit, been fired, or have retired early.
Time for explanations
Why did this international organisation, set up in 1998, founder so spectacularly and so quickly when the need for health research remains so great? More importantly, what now are the prospects for ordinary people in developing countries? They pinned their hopes on local leaders in health and research who, in turn, sought guidance from experts at the annual forums.
South Africa's Sunday Times, which reported Mbewu's resignation on 31 October, said that his appointment as head of the forum had drawn criticism from HIV/AIDS activists. They had charged Mbewu, the former president of South Africa's Medical Research Council, with supporting the Mbeki government's denial of HIV and AIDS.
But in Havana the controversy was largely unrecognised. Mbewu responded to a reporter's question about the criticisms saying, "I'm a researcher, not an activist." At the time, that seemed a sufficient answer for his fellow health researchers too. They seemed satisfied that Mbewu's appointment by the forum — a respected organisation originally set up under the auspices of the WHO — meant his qualifications had been well-vetted.
A year on, many of the health leaders and researchers who gathered in Havana will convene in Montreux, Switzerland, at the First Global Symposium on Health Systems Research (16–19 November). Will any of them probe the GFHR's collapse — or will they politely not mention it?
The Foundation Council, the forum's policy- and decision-making body, should bear responsibility for explaining what has happened to this small but once-vibrant organisation, to which so many from developing countries looked for guidance. But the responsibility is not theirs alone. The entire health research community has a duty to not turn a blind eye to the forum's failure.
A betrayal of trust?
I was in Havana as a freelance writer drafting a report on that meeting, similar to others I wrote for the Forum about previous meetings in Mexico City (2004), Mumbai (2005), Cairo, (2006), Beijing (2007) and Bamako (2008). The great strength of these annual meetings was making well-known health researchers, public health experts, economists and innovators accessible to the people who need their help the most.
The meetings were moved each year to a new venue. That allowed field workers, students, community physicians and academics in some of the world's poorest countries to attend. There were a few large plenary sessions and many small group sessions that encouraged interaction. Even people without computers could be part of this network.
Impressive young people from poor countries sat in discussion groups next to rich entrepreneurs, respected academics and government decision-makers, all talking about problems held in common. I listened with growing optimism that progress in global health could come through collaboration that reached across the divides of poverty, borders, and politics.
The meetings' official programmes highlighted the Millennium Development Goals; combating disease and poverty; equitable access; capacity building and health systems; and innovation.
But discussions ranged much further and deeper, covering subjects some countries would rather not have highlighted: an obesity epidemic in Mexico, crushing poverty in India, female genital mutilation in Egypt, HIV/AIDS in China, counterfeit drugs in Africa, and embargoes and naturopathic medicines in Cuba. Each annual meeting was, in the fullest sense of the word, a forum.
I was astonished by how quickly and quietly the health of the GFHR deteriorated. I heard reports as the staff diminished. I read that employees were bringing lawsuits alleging unfair dismissal. Gill Samuels, chair of the forum's 20-member foundation council, confirmed in an email to me that Mbewu had resigned. But she denied that there are legal cases pending. "Nothing else to add at the moment," she wrote in answer to my query.
Nothing to add? I hope there will soon be a considerable amount to add. Samuels, who comes from the pharmaceutical industry, and the others who sit on the council and come from foundations, universities, governments and institutes, are responsible for appointing the director and overseeing the forum's budget and plan of action.
Their explanations — or lack of them — will affect the credibility not only of the forum, but of any existing or future organisation seeking the trust of researchers and of those depending on them.
Beverly Peterson Stearns is a freelance writer and author. She lives in the United States.