Bipin Adhikari: Community engagement for malaria elimination

My name is Bipin Adhikari. I'm a research physician and a social scientist. I work at the Malaria Department of Mahidol Oxford Tropical Medicine Research Unit in Bangkok.

Most of my research is around social aspects of infectious diseases, mostly around malaria. And the recent works that I've done are around the community engagement; designing community engagement, and executing it around community-based anti-malarial mass administration. That was one of the recent projects we did in Laos. I'm also involved in some other research projects which are mostly community-based in Cambodia, and one in Tanzania, and another one in Bangladesh.

There are many questions related to community engagement. Since community engagement is a very complex undertaking, the fundamental stereotypes around community engagement, that it is necessary to facilitate the research, is an understatement, in my opinion. Because it's not just to facilitate the research, but it is to conduct ethical research. “Ethical” meaning community engagement can help understand the vulnerabilities of the population, and it serves the interests of community members, not just researchers. And it helps us to find out, as it does, priorities and concerns of community members. These are the questions often overlooked, or even if they are emphasised, not adequately emphasised, I guess. The other questions are related to evaluating community engagement itself, how it works in different contexts, and what are the processes and mechanisms which helps to get the outcomes, or make changes in the interventions, or the ethical conduct of research.

There are a lot of other ways in which my work makes a difference. As you know, community engagement is essentially a very translational research, a very fundamental and integral aspect of all the health research, including interventions and trials. With community engagement, we create a platform between researchers and community members. It's directly related to translational aspects of the trials or the research, which offers a sort of platform for community voices to be heard, their priorities to be heard, their agendas and concerns. At the same time, it offers researchers and, in general, community engagement personnel, to explain their agendas as well. The aspirational goals of community engagement are to set the agendas and priorities based on what community members think are important for them, which may be hard to reconcile when the priorities of the institutions, researchers, and funders are different to community members. My research obviously helps to ensure that community members’ interests are articulated or prioritised.

It is extremely essential if we want to do ethical research, if we want to save resources, if we want to prevent wasting of resources. You've heard from different clinical trials in different parts of the world how clinical trials experience failure because of lack of community engagement or thorough community engagement. And you've recently seen the COVID-19 pandemic where vaccine was not a problem. Availability of vaccine was not a problem. But cover has become, is still very low, especially in high-income countries, USA, UK, France, for example. So that already explains why community engagement is really essential, why it is necessary to hear the voice of community members. What are their concerns?

It is extremely essential. In my personal opinion, community engagement should be understood as an integral part of the health research. And we want to move from top-down approach to bottom-up approach in future. Although there are challenges, for example, inherent challenges are the power differences between researchers, funders, institutions and the community members. We question whether community members can really authentically raise their voices because there are inherent power differences. These are the areas where we need more investment to ensure there is authentic dialogue between community members and researchers. Hopefully, the power differences are mitigated in the future. These are aspirational goals, but we want to make sure that community members’ priorities are aligned with researchers’ in future.

This interview was recorded in January 2024