Since its inception in 2001, the Global Fund to fight AIDS, TB and Malaria (The Global Fund) has saved approximately 5.7 million lives. Each day an additional 4000 deaths are averted, but in order to continue its existing programmes and rapidly scale up towards achieving the Millennium Development Goals (MDGs) in 2015, The Global Fund needs to invest resources in operational or applied research to confirm where it gets most value for its dollar, measured in terms of protecting human rights, saving lives and preventing infections.
For Dr Nevin Wilson, Director of the International Union Against Tuberculosis and Lung Disease (South East Asia), “After the directly observed treatment shortcourse (DOTS) model was developed by The Union) what new evidence has really been researched and put into practice. How is the Global Fund grant helping in implementing Principal Recipient (PR) to carry out the necessary operational research during the lifetime of their grant to provide the evidence that the intervention they have carried out works? This is especially true when we work with the community.”
The Union is a principal recipient (PR) of the Global Fund round 9 grant in India and is implementing one of the largest advocacy, communication and social mobilisation (ACSM) programmes in the world.
“The Global Fund round 9 grant is a very good opportunity to find and generate new evidence that some interventions work, some don’t. There can be some interventions which don’t work but still need to be funded to know that they don’t work. This is the opportunity,” adds Wilson.
He continues, “Sadly current technical review panel (TRP) mechanisms are such that if you just wrote a process to generate evidence you won’t get funded. So we just propose the intervention. Once the grant negotiation takes place we need an opportunity for the Global Fund to be flexible enough to allow PR with capacity, SR with capacity, SSR with capacity, CCM with capacity, to do the research around an intervention.”
Two third of the deaths in the world are from non-communicable diseases (NCDs). One of the common risk factors for deadly NCDs is tobacco use and diabetes, both of which increase the vulnerability of getting active TB disease. “This [operational research] involves very specific and important areas like high risk factors for TB like tobacco use in India. 300 million people in India use tobacco, their risk of acquiring TB goes up by half, risk of dying of TB goes up by half, and yet the Global Fund doesn’t do anything about tobacco. Huge populations are in India with high risk factors like diabetes, silicosis or tobacco use that collide with each other, but don’t have a coordinated response to address them,” said Wilson. To translate the knowledge around these risk factors into practice in implementation requires evidence from operational research.
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