Biomedical research support project (386-0492) : project assistance completion report

Initial progress was slow due to structural problems and bureaucratic delays, although good work was done by WHO consultants in developing a basic epidemiological curriculum, procuring laboratory equipment (including AIDS equipment), and upgrading laboratory procedures; USAID should seek where appropriate to involve WHO in future efforts, especially those involving equipment procurement. In 1988, the project was thoroughly revised: the field epidemiology and laboratory support components were combined into one; the management information system for malaria component was dropped; and the quality control of biologicals component eventually evolved into the Quality Control of Health Technologies project. The revised project made remarkable progress in its last 2 years, accomplishing 80% of its original objectives, most of them in a sustainable manner. Under the aegis of the U.S. Centers for Disease Control (CDC), the field epidemiology and laboratory component created a 3-tiered (central-state-district) laboratory-based epidemiological service in the pilot States of Rajasthan and Uttar Pradesh. In addition, the process for nationwide epidemiological service was initiated, with the Indian National Institute of Communicable Diseases (NICD) as lead agency. Training provided under this component constituted the principal output of the project and included: visits to CDC/Atlanta for 6 senior officials; short U.S. courses for 6 senior medical faculty, 16 senior epidemiology trainers, and 12 mid-level managers; and in-country training for 24 microbiologists and pathologists, 22 district health officers, 34 primary health care officers, 14 district pathologists, and 12 laboratory technicians. In addition, 5 district health centers were established, and, together with the 2 State medical colleges and NICD, are now functioning as an integrated health laboratory service, with coordination between field epidemiologists and microbiologists/pathologists being of particular note. Important linkages between U.S. and Indian health institutions and professionals were also established. In addition, 5 Clinical Epidemiology Units (CEUs) (vs. 3 targeted) have been established at: All India Institute of Medical Sciences; King George Medical College; Government Medical College, Nagpur; Christian Medical College, Vellore; and Medical College, Trivandrum. The CEUs, which have been designated as International Clinical Epidemiological Network (INCLEN) centers, are staffed with clinical epidemiologists, social scientists, and biostatisticians. Project support included long-term U.S. training for 34 persons (vs. 45 targeted), research grants and institutional (core) support, and opportunities for exchange in international fora. By project completion, a functioning INCLEN system with over 100 members had been organized in India. Postproject support for the INCLEN program in India has been provided through the centrally funded Data Decision Making project. The sustainability of most components is likely. NICD has a mandate to continue the field epidemiology and laboratory support program in the 2 pilot States until 1995, and it is expected that activities will be expanded to other districts in these States. As for the CEUs, their establishment has been a milestone in the process of building Indian capacity for epidemiological research. They are expected to become centers of excellence and to serve as regional research and training centers; steps in this direction have already been taken.