A partnership between Bill & Melinda Gates Foundation and the Ministry of Health resulted in the initiative "Grand Challenges Brazil: Prevention and Management of Preterm Birth." The initiative is part of the global Grand Challenges program, supported by the American foundation, which aims to fund research and innovative ideas to address serious global problems in health, agriculture and development.

Fiotec,as a foundation to support Oswaldo Cruz Foundation (Fiocruz), was selected by Bill & Melinda Gates Foundation to manage the 12 projects chosen from 156 proposals received. As fiscal agent of Fiocruz,Fiotecwill be responsible for coordinating the transfer of funding to each institution. Fiocruz will be in charge of the technical management and will monitor the progress of projects, ensuring the achievement of targets over two years.

It is expected that the studies result in products and high-impact solutions in Brazil and the world for the prevention of preterm births and treatment of premature infants in the areas of biological research, medical technology and product development, service provision to premature infants and mechanisms for behavior change.

The twelve projects are from the following institutions: Fiocruz, Federal University of São Paulo (UNIFESP), Federal University of Minas Gerais (UFMG), University of São Paulo (USP), Pernambuco Faculty of Health (FPS / PE), Health Institute of São Paulo, Federal University of Rio de Janeiro (UFRJ), Federal University of Rio Grande do Sul (UFRGS) and the State University of Campinas (Unicamp). They will receive 8.4 million reais over two years to develop his studies, divided into two categories of funding: up to 500 thousand reais (seed) and up to 2 million reais (full). Under the agreement, the Ministry of Health, through the National Council of Scientific and Technological Development (CNPq), will finance half of such amount and the Gates Foundation will finance the the other half.

Studied areas

The projects can be divided into three major areas: biomedical research; service provision to premature infants and educational mechanisms for behavior change; and clinical trials. At first, the focus is on the discovery of biological markers of prematurity, such as, for example, mapping microorganisms of the vaginal flora during premature births and compare with the term delivery after 37 weeks.

In the area of ​​services and educational mechanisms, the projects aim to address the understanding that pregnant have about childbirth and the knowledge of health professionals to address the issue of natural childbirth and cesarean section. There will also be interactive exhibits and a solid study on the social, economic, cultural, ethnic/racial, psychological and behavioral factors that may influence the rate of premature births.

In the third case, therapeutic interventions for inhibiting preterm delivery will be studied, such as the use of progesterone vaginal ring, low-dose aspirin to prevent eclampsias (high blood pressure in pregnancy) and magnesium tablets, among others.

Fiocruz will be in charge of the coordination between research centers

Claude Pirmez, a researcher at Fiocruz, was appointed the project manager and is responsible for coordination between the researchers of the participating institutions, and for their dialogue with Fiotecand Bill & Melinda Gates Foundation. She explained how this innovative partnership works.

"The Grand Challenges Brazil in prematurity is a call in which half of the funding comes from the Ministry of Health and CNPq and the other half comes from Bill & Melinda Gates Foundation. The Gates Foundation needed a strong institution to manage its financing of Brazilian projects and therefore chose Fiocruz for this task. It is the first time we do this, and therefore we all have a lot to learn", said the researcher.

Claude explained that everything is being done in a very well-defined partnership, centered on Fiotec."Fiotec has an extremely important role of supporting the cooperation between Bill & Melinda Gates Foundation and the Ministry of Health. The structure of a support foundation is very important to support projects together, although the researches are different ".

Also according to her, all administrative procedures must occur cohesively between the two foundations. "As the legal, fiscal and other factors are quite different between countries, the role ofFiotec is fundamental for all to happen in a clear way," added Claude.

The executive director ofFiotec, Maurício Zuma, praised the challenge of the project. "I would say that this is another important challenge to be overcome. Besides all the results already detailed, which is an honor to be part of, there is the fact that the project model is new and complex. "

According to Maurício, the success of this project will prove the capacity of Fiotec to successfully deal with complex situations. "It will also be a way to new partnerships with Bill & Melinda Gates Foundation, which is a great institution."

The result should generate health intervention

Claude Pirmez stressed that the main result of this project goes beyond the delivery of a report or publication at the end of two years. "What we want is a practical result, assess how all these researches will impact the high prematurity rates in Brazil. None of these projects alone willsolve the problem, but all of them together can offer an intervention or solution to address this important issue not only in Brazil but in the world", she said.

Furthermore, Claude pointed out that the idea is to know the best way to reduce prematurity. "These researches will complement each other, which is part of my role, that is, to gather all these people, these data, integrate all actions. It is using science to support, with scientific data, a health intervention and a political decision-making in public health," she concluded. The project is scheduled for completion in 2016.