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.