Int Urogynecol J (2005) 16: 174–175
DOI 10.1007/s00192-004-1278-x
C U R RE N T O P I N I O N / U P D A T E
Fikri M. Abu-Zidan Æ Diaa E. E. Rizk
Research in developing countries: problems and solutions
Received: 30 October 2004 / Accepted: 7 December 2004 / Published online: 8 February 2005
Ó International Urogynecology Journal 2005
Biomedical researchers from developing countries who
have been trained for a reasonable time in developed
countries may decide to work in their own countries for
different social, financial or scientific reasons. They will
directly realise the huge task ahead if they want to
pursue their research career. The problems that hinder
biomedical and health care research in developing
countries are complex, interrelated and often poorly
understood. These include lack of research education
and training for health professionals, lack of apprecia-
tion for the value of health care research as an important
tool for progress, shortage of funding and research re-
sources, special bioethical standards and concerns, lim-
ited access to health informatics and individualism and
inability to work within groups [1, 2].
Teaching research principles, methodology and skills
is the major component required for building the bio-
medical research infrastructure. This should be imple-
mented on all levels of undergraduate, postgraduate and
continuous medical education programmes. The relative
lack of scientists in developing countries makes this a
difficult endeavour. Trained biomedical researchers,
however, have an obligation to promote research and
train health professionals so they can at least evaluate
the results of health care research. Critical thinking
should also be nurtured to promote research synthesis.
In this evidence-based medicine era, physicians are more
aware that basic research skills are essential to critically
evaluate the medical literature. Academic clinical
researchers should seize this opportunity and educate
F. M. Abu-Zidan (&)
Department of Surgery, Faculty of Medicine and Health Sciences,
UAE University, PO Box 17666, Al Ain, United Arab Emirates,
E-mail: fabuzidan@uaeu.ac.ae
Tel.: +971-3-7672000
Fax: +971-3-7672067
D. E. E. Rizk
Department of Obstetrics and Gynaecology,
Faculty of Medicine and Health Sciences,
UAE University, PO Box 17666, Al Ain,
United Arab Emirates
clinicians, nurses and other health professionals to crit-
ically appraise the medical literature using such simple
tools as journal clubs and case presentations. Any
experienced academician knows that formulating the
research question is the most important part of the re-
search process. This is relatively lacking in the devel-
oping world, but developed countries can play an
important role by training scientists to acquire these
skills. One of the major challenges is to maintain the
competence and activity of these scientists after return-
ing to their own countries. The change of scientific cul-
ture and lack of support may drive them to go back
where they have been trained or to change their scientific
career. Regular and short-term training visits to
advanced or parent academic institutions, however, may
help these young researchers to retain interest in their
areas of expertise and raise their morale.
Scientific research including health care and bio-
medical research is an important tool for social devel-
opment and economic progress of any country. This has
to be well appreciated both by the society and the
individual researchers. Developing countries should not
follow the research models that led to the scientific
enterprise in developed countries [3]. Instead, they
should develop their own models that stem from their
understanding of their own needs, goals and surround-
ing environment and devise methods to reach these
goals.
Health care research in the developing world raises
specific ethical questions driven by the different cultural,
economic and socio-political factors [4–6]. Participants
in internationally funded projects, usually with a very
serious and grossly unequal burden of disease, receive
the standard of health care available in the funding
country, the moral principle of ‘‘universal standard of
care’’. However, improvements in health care as a result
of these studies may not be maintained after the trial.
Study subjects do not often truly understand the nature
of the intervention, accept the placebo concept and en-
joy individual autonomy to give ‘‘informed consent’’.
The balance of equity between physicians and patients in

developed countries is also different. Therefore, im-
proved access to medical services as a result of research
enrolment may constitute an inappropriate incentive
that compromises the consent procedures. Health care
researchers in academic health centres usually focus on
their primary mission of research and their perception of
their professional role as service providers versus inves-
tigators is not clearly understood. Hence, the extent of
their obligation to improve the health care, service
development and quality of life in their country and their
social responsibility to help their community is not fully
appreciated. Academic clinicians with special expertise
and who are heavily involved in research projects may
find it difficult morally and psychologically to turn down
requests to participate in daily health care that is not
directly related to their own area of research or exper-
tise. Guidelines defining moral and professional
responsibilities have to be established to protect these
experts from being ‘‘burned out’’ in health services
routine. Only those who practise in such circumstances
will understand the continuous ethical conflict of aca-
demic clinicians between the needs of their own patients
and their commitment to research progress.
Scientific research is never complete unless the results
are published and made public. It may be difficult to
publish those results in prestigious journals simply be-
cause these results are irrelevant to the developed
countries. Hence, there should be a forum to propagate
this biomedical knowledge in developing countries that
increases the value of local journals and their ability to
publish relevant health care research that targets their
own population [7]. Furthermore, free web-based bio-
medical journals are now an excellent, quick and rela-
tively cheap tool to disseminate biomedical knowledge
and share information among these researchers in
developing countries. This method can assist in bridging
the gap of access to health informatics in developing
countries more than attempts to purchase printed
expensive biomedical journals.
The lack of collaboration between individual bio-
medical scientists and academic health units within
developing countries forces local researchers to collab-
orate with those in developed countries to survive as
scientists. The priority setting is usually decided by the
fund donators and may serve the national health plans
of the developed countries. In fact, 10% of the funds
spent on health research globally cover 90% of the dis-
ease burden that is centred mainly in developing coun-
tries [2]. Health care researchers in developing countries,
175
however, must be confident that they will be capable of
solving their local health problems only if they collab-
orate with each other and are devoted to their cause. It is
our experience that funding can be raised from the local
community if the importance of the research project and
its impact on the health of the local population is clearly
understood. Local understanding of health problems
and setting priorities is of paramount importance.
Bringing packed solutions from abroad may not be the
best remedy. The contribution of ‘‘parachuting’’ con-
sultants who land for a short period and rehash local
wisdom into a hick report will not solve the problems of
developing countries [2].
The real impact of biomedical and health care re-
search in developing countries stems from its ability to
generate possible solutions for local health problems
that are usually numerous. This can be achieved by
promoting research education and training of health
professionals, raising societal appreciation of the value
of research as an important tool for progress, enlisting
community participation in funding and provision of
research resources, increasing health care researchers’
awareness of their social and philanthropic mission and
their need to adopt strict ethical guidelines in collabo-
rative research protocols, improving access to biomedi-
cal knowledge and information and encouraging a
paradigm shift in the prevailing research culture towards
more positive collaboration and pedagogy.
References
1. Selman M, Perez-Padilla R, Pardo A (1998) Problems encoun-
tered in high-level research in developing countries. Chest
114:610–613
2. Edejer TT (1999) North–South research partnerships: the ethics
of carrying out research in developing countries. BMJ 319:438–
441
3. Goldemberg J (1998) What is the role of science in developing
countries? Science 279:1140–1141
4. Rizk DEE (2002) Ethics of clinical research in the developing
world. Saudi J Obstet Gynecol 2:62–65
5. Belsky L, Richardson HS (2004) Medical researchers’ ancillary
clinical care responsibilities. BMJ 328:1494–1496
6. Kent DM, Mwamburi DM, Bennish ML, Kupelnick B, Ioan-
nidis JP (2004) Clinical trials in sub-Saharan Africa and estab-
lished standards of care: systematic review of HIV, tuberculosis,
and malaria trials. JAMA 292:237–242
7. Abu-Zidan F, Deleu D, Northway MG, Hanssens Y (2001)
Quantity and quality of research from the Gulf Corporation
Council countries. Saudi Med J 22:1040–1041