IHI Historical Background
Ifakara Health Institute (IHI) was first established as a field research station of the Swiss Tropical Institute (Basel) in 1956. In 1996 the organisation was registered as an independent, non-profit entity in Tanzania. IHI is led and managed by Tanzanians. The last decade has witnessed a period of rapid growth. In 2009 the organisation has more than 500 staff, over 100 research scientists, annual turnover of $15 million and six branches country-wide. IHI has partnerships with numerous international centres of excellence in health research including local and international universities. In 2008, Dr. Salim Abdulla took over as Director of IHI from Dr. Hassan Mshinda who was appointed by the President of the United Republic of Tanzania to head the Tanzania Commission for Science and Technology (COSTEC). However Dr. Mshinda continues to serve on IHI’s Board of Trustees.
IHI as WHO Collaborating Centre
Ifakara Health Institute (IHI) is the WHO collaborating centre since 2006. WHO and its partners (IHI inclusive) established a network of malaria specimen banks that has been used to test and conduct a quality control of malaria Rapid Diagnosis Test (RDT) kits that are newly developed and those procured by ministries of health and other agencies for routine use in malaria endemic populations. Hence, the objective of the specimen bank network is to facilitate the development, evaluation and quality assurance of malaria diagnostics by providing standards for: 1) the WHO pre-qualification/product evaluation of RDTs for malaria and 2) quality assurance of malaria RDTs, including post-purchase lot testing.
This briefing note focuses particularly on IHI’s malaria research – although IHI also conducts research into other important health challenges, including HIV/AIDS, TB, maternal & neonatal health and health systems.

Strategic objectives

In contributing to the National Strategy for Growth and Reduction of Poverty (NSGRP) and the Millennium Development Goals (MDGs), IHI pursues the following objectives:

To develop and evaluate health system interventions to improve the coverage, quality, equity and efficiency and effectiveness.
To evaluate interventions against diseases of public health importance.
To understand health determinants of the leading public health problems.
To monitor and evaluate the impact of national and global initiatives in improving population health.
To promote evidence-based policy formulation and translate research results into public health action.
To strengthen human resource capacity through executing joint training programmes with universities.
To strengthen institutional capacity to ensure sustainability.

Malaria Research at IHI

IHI has a rich and diverse research portfolio. Within this, malaria continues to be a major area of focus, covering the full spectrum from basic science, through efficacy and effectiveness studies, to policy implementation and monitoring. A few examples of recent malaria-related research are provided below.

Basic Science

Discovery & optimisation of synthetic odours to attract malaria-carrying mosquitoes. The project has found a blend that proves to be four time more attractive than humans. This important development has potential application as a bait to lure and kill mosquitoes.
Design, testing and development of a new trap to catch mosquitoes in the natural environment. The Ifakara Tent Trap-B has proved superior to other trap techniques and correlates closely with the gold-standard “human-landing catch”. This new methodology provides an ethical, sensitive, cost-effective approach to monitor the intensity of malaria transmission across a range of intensity and ecological conditions. The tool may play a key role in monitoring the impact of control efforts on malaria transmission.
Studies of malaria transmission epidemiology, including mathematical modelling have demonstrated the community-wide impact of ITNs, beyond individual users. The findings spurred the global policy shift from targeting vulnerable groups to universal ITN coverage in endemic countries. Mathematical modelling has tremendous potential for forecasting as well as intervention optimisation.
Studying the behavioural determinants of mosquito gene flow and the population genetics of insecticide resistance. This provides essential intelligence for planning insecticide resistance monitoring and future vector control strategies.
Testing of rapid micro-array method for monitoring parasite resistance to anti-malarial drugs. The technique increases the speed, efficiency and accuracy of monitoring drug resistance.

Efficacy Studies

Phase 2 testing of the safety & efficacy of GSK Biological’s RTSS malaria vaccine in infants found a promising safety profile, no interference with co-administered EPI vaccines and protective efficacy over 6 months’ of 65%.
IHI was the first of several centres to launch international Phase 3 trials of RTSS at Bagamoyo in 2009.
Phase 1 assessment of viral vectored malaria vaccine showed that it was safe in adults and children.
Isolation and efficacy demonstration of novel-fungi to kill Anopheles mosquitoes and reduce transmission of malaria parasites.
Habitat targeting for controlling aquatic-stage mosquitoes. In Dar es Salaam IHI demonstrated the efficacy and cost-effectiveness of community-based identification, monitoring and larviciding of mosquito breeding areas. The experiment achieved a dramatic reduction in malaria transmission intensity.
Development & testing of new spatial repellents to replace DDT.
Safety & efficacy of the new paediatric formulation of Coartem â as a flavoured, dispersible tablet.
Safety and efficacy of novel synthetic peroxidise (synthetic artemisinin) in the treatment of malaria.

Effectiveness & Intervention Application

Landmark study of ITN effectiveness that demonstrated 27% reduction in under-five mortality.
Effectiveness of artemisinin combination therapy in routine public health setting. This work facilitated the adoption of ACT as first line therapy in Tanzania.
New studies that demonstrated the community-impact of nets on users and non-users
The first study of IPTi at Ifakara demonstrated its effectiveness in prevention of clinical malaria and anaemia in infants. The study gave rise to the creation of the IPTi Consortium. IHI contributed a suite of studies on IPTi feasibility, acceptability, cost-effectiveness and sensitivity to SP resistance.
IHI demonstrated the feasibility and acceptability of Rapid Diagnostic Tests for malaria at primary health facilities, showing improved diagnostic accuracy and appropriate treatment of fevers.
Availability, quality and rational use of over-the-counter anti-malarial drugs. A high proportion of fevers are “self-treated”. These studies shed light on treatment effectiveness in the retail sector.
Understanding and improving access to prompt and effective malaria treatment & care. This project monitors health-seeking behaviour, barriers to treatment access and the clinical management of malaria in health facilities.
Over a four-year period IHI has been monitoring impact of the Tanzania national voucher scheme (TNVS) on ITN coverage. This has provided the national malaria control programme (NMCP) vital data for planning and for operational improvements in the management of the scheme.

Getting Research into Policy and Practice

IHI senior staff serves on a number of technical groups –to provide advice directly to decision-makers at the Ministry of Health and Social Welfare. On the international stage, IHI research is represented at major scientific conferences and informs global policy formulation – for example on malaria eradication. IHI senior scientists serve on the Medicines for Malaria Venture Scientific Advisory Committee (MMV-ESAC)
IHI’ senior researchers are frequently called upon by the MOHSW and donors to undertake commissioned evaluations and reviews as well as to participate in planning of new malaria interventions. Over the past four years IHI staff have authored or co-authored nearly 100 publications in international peer-reviewed journals. The volume and impact factor of published outputs continues to grow year-on-year. IHI staff also produces annual progress reports for government to measure progress in the health sector against key indicators and targets.
IHI places a special emphasis on bringing research knowledge to a broader audience in Tanzania and beyond. An electronic dissemination system was initiated in 2008 and already reaches 1,000 people. An electronic library of Tanzania-specific health literature has also been established, providing easy remote access for all stakeholders to published research, official reports and grey literature. IHI’s Resource Centre also produces Policy Briefs, to present new knowledge and research findings to a broader audience in a readily digestible form. A research monitoring service is in the pipeline, as is a Newsletter and an Annual Scientific Health Policy Symposium. In addition, the resource centre provides regular briefings and interviews to the national and international media.

Future Plans

A new Strategic Plan has been launched to guide IHI’s work over the period 2008-2013. The Strategy assures that IHI’s research output is aligned closely to Tanzania’s policies, priorities and health environment. We anticipate a period of continued growth in the scope and scale of IHI’s research. Most importantly, we aim to consolidate our organisational effectiveness to provide a sound basis for the future.
Under the new strategy, new strands of research (including HIV/AIDS and non-communicable disease) will be expanded. A key part of the strategy is to make full use of existing data sets and to improve third-party access to IHI’s data for secondary analysis. In addition, IHI plans to set up a “sentinel panel of districts” which will have dual use as a research platform as well as a basis for monitoring the effectiveness and impact of health policies and programmes.
IHI is presently mobilising resources to support implementation of the new Strategy. This includes funds to consolidate our research infrastructure and to attract and retain key personnel. Throughout the period, IHI will continue to invest in the development of young researchers through doctoral and post-doctoral programmes. The institute will also launch a series of short courses open to non-IHI staff in collaboration with higher learning institutions, to become a focal place for malaria-related skills transfer in the country and sub-region.

Challenges

It is a paradox that as IHI is more and more successful in attracting research funding, it is chronically under-funded. This is because research grants only fund the research activities, making only a minor contribution to essential overheads. As a part of the new strategy, IHI is proactively seeking “core” funding to support its infrastructure and core personnel as well as to improve its internal organisation and effectiveness.
Related to this is the challenge of attracting and retaining personnel with rare skill sets. After developing their expertise at IHI, some highly-qualified staff wish to move on to greener pastures. IHI is now putting in place human resource policies that will encourage overseas Tanzanians to return home and that will retain the key personnel who are essential for leading, managing and mentoring others.
A third challenge is to position IHI as a think tank that can serve as an independent “monitor” for the performance of the health sector . We have put forward an ambitious proposal for service-based and population-based monitoring of health care access, delivery and outcomes in a representative sample of districts across the country. This is a major logistical and data management undertaking that will require a major investment of financial and human resources, as well as close collaboration with the Ministry of Health and Social Welfare and the National Bureau of Statistics.

Bio-sketch of IHI Personnel

Dr. Salim Abdulla is the Director of Ifakara Health Institute. He obtained his medical training at Muhimbili University College of Health Science, and later pursued a Master of Science in Epidemiology at the London School of Hygiene and Tropical Medicine. He holds a PhD in Epidemiology. Abdulla joined IHI in 1996 and has managed large-scale malaria intervention evaluation programs. He founded and led the Bagamoyo Research and Training Centre, the branch of IHI responsible for biomedical and clinical research and training. Dr. Abdulla has published extensively on malaria intervention strategies. He has received international awards including the centenary medal of the Royal Society of Tropical Medicine and Hygiene in the United Kingdom.

Dr. Flora L. Kessy joined Ifakara Health Institute (IHI) in December 2006 as a Senior Social Research Scientist. She holds a PhD in Agricultural and Consumer Economics. She has researched and published widely on issues related to gender and development and reproductive health, in particular on family planning and HIV and AIDS. She is currently the head of the ACCESS project which looks into ways to improve access to effective malaria treatment and care through strengthened healthcare services and patients’ resources.

Dr. Tanya Louise Russell is a Research Fellow for the University of Durham. She is a research scientist trained in Mosquito Ecology and Control as well as Environmental Ecology. She is managing the Public Health Entomology Unit of IHI in Ifakara. She has researched widely on affordable, effective and environmentally sound mosquito control interventions. Tanya is currently developing fungi which are efficacious, long-lasting, and capable of suppressing malaria transmission in entire African communities.

Dr. Sarah J. Moore joined IHI in 2006 as a Research Fellow and is based full-time in Ifakara. She works on the chemical ecology of mosquitoes, finding ways to prevent them from biting humans with repellents and insecticides, and luring mosquitoes into traps with chemical baits. Sarah has three PhD students enrolled at LSHTM who are working hard to find new, cost-effective and acceptable ways of protecting people from mosquito vectors of malaria and filariasis. They are currently conducting operational research on insecticides in experimental huts, working on new assays to improve repellent and insecticide testing methodology and conducting a clinical trial on the efficacy of topical repellents.

Dr. Fatuma Manzi joined IHI in 2000 a research scientist specialized in health economics. She holds a PhD in Epidemiology & Public Health from the Swiss Tropical Institute. Fatuma has published extensively on topics related to the field of costing, economic evaluation, effectiveness evaluations, and public health.

Dr. Eveline L.P.E. Geubbels holds a PhD in Epidemiology. She worked as a consultant for DANIDA in the field of Health Management Information Systems. Eveline also did consultancy assignments with the Royal Tropical Institute where she was responsible for course content development, facilitation, teaching, logistical support and evaluation of a diploma course in applied clinical research for Rwandan and Ugandan PhD / MSc students. She joined IHI I n January 2009. Dr. Eveline now works in the field of HIV, reproductive health and research capacity-building within IHI.

Dr. Godfrey Michael Mbaruku holds a doctor of medicine degree from the University of Dar es Salaam and a master of medicine in obstetrics/gynaecology. He has also attended many short courses including the clinical trials and critical evaluation of clinical research. Dr Mbaruku is the Deputy Director of IHI.

Paul Smithson holds a Masters in Health Policy and Planning and Masters of Business Administration. He first worked in Tanzania in 1986 in Rufiji District. After 15 years work in other parts of Africa with Save the Children and DFID, he returned to Tanzania in 1999 as DFID’s Health Adviser. Paul joined IHI in 2006 to re-establish the Resource Centre, with a focus on “research translation” and getting evidence into health policy.

Dr Rose Nathan holds a PhD in Demography from the University of London (2001). She has extensive experience in population and public health research with emphasis on equity perspectives. The experience ranges from designing studies, supervising data collection, processing, and analysis to writing papers for publications. She is a member in the Research and Analysis Working group for the National Strategy for Growth and Reduction of Poverty (NSGRP). Dr Rose has done consultancy work for several local and international Non-Governmental Organizations and government agencies. She is an honorary lecturer at the University of Witwatersrand.

Dr Honorati Masanja is a statistician/research scientist with experience in data management and analysis of clinical trials and in evaluation of large maternal and child health effectiveness programs. Has experience in using database software (Visual Foxpro, CSPro) and standard Microsoft office products. He also lectures at the University of Dar es Salaam in health information module and supervises students during their MSc dissertation. Dr Masanja has published extensively in internationally renowned journals, and one of his recent publications is on child survival gains in Tanzania. He joined IHI in 1997 and participated in the establishment of the Rufiji Health and Demographic Surveillance System (RHDSS). The RHDSS documents vital events including pregnancy follow-up, births, deaths and migration in a population of 80,000 people.

Dr. Ahmed Hingora is a senior Public Health Physician trained in Tanzania and at the Liverpool School of Tropical Medicine. He has participated in numerous short term specialized trainings in Primary Health Care, Health reforms, Management and Health financing in the UK, Europe and the USA. He has extensive working experience within the different levels of the Tanzania national health system and has also worked in Namibia, Ethiopia, Zimbabwe, Uganda, Mauritius and Swaziland. He joined IHI following his retirement from the Department of Health Policy and Planning of the Ministry of Health and Social Welfare in May, 2009. His main interest and expertise is in health systems strengthening, having worked for some 10 years implementing reforms of the health sector in Tanzania.

Abdunoor Mulokozi Kabanywanyi joined IHI in 2002 as a research scientist. He is a clinical epidemiologist and is currently a PhD candidate at Basel University, Switzerland. His main expertise is in Malaria in Pregnancy and has published in this area. He is also a member of the Global Malaria in Pregnancy Consortium. He is coordinating ALIVE study within the Ifakara Demographic Surveillance System.