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The Algiers Declaration: ‘a unique opportunity’ for Africa’s health ministers

30 Jun 2008

Paul Chinnock

Source: TropIKA.net

The recent meeting of Africa’s health ministers in Algiers, Algeria was almost totally neglected by the world’s media, even though the decisions taken could ultimately have major benefits for the health of many of the world’s poorest people, if the measures agreed upon are indeed implemented.

TropIKA.net has provided a detailed account of the 2008 Algiers Ministerial Conference on Research for Health in the African Region. It is one of our ‘Featured Meetings’ – an exciting new initiative on our web portal – and we would value your feedback on what we have achieved with our daily reports, news and blogs from the conference. One delegate at the meeting said, ‘The daily reports have enabled thousands of those not here in Algiers to share the experience of what we’ve been going through. TropIKA is a great idea!’ If you have found our coverage helpful, or if you have criticisms to make, please let us know.

But what of the meeting itself and its achievements? Most discussions about health research in Africa have till now been dominated by one theme – money. So great, and so unmet, is the need for adequate funding that it has generally skewed the debate, but it is not only money that is needed. A focus on money, to the exclusion of other issues, leaves the locus of control with the donor nations, and it has so often been said that it is the donors who set the research agenda and set it according to their own priorities. The discussions at Algiers gave hope that African governments are breaking free from the culture of learned helplessness. No longer is it enough to blame the North for not providing enough cash and for taking all the decisions on health research. The need for African health ministries to be pro-active in order to set the research agenda is at last being accepted. As one of our interviewees Hannah Akuffo commented in Algiers: ‘The onus is on African countries to be clear about where they want to go in terms of research directions.’ This would be health governance at work – with very little extra cost involved in terms of budget, but considerable investment in terms of clarity of purpose and social and political commitment.

Each African nation must define its individual priorities for health care and for health research. Where on the priority list should be placed infectious diseases, non-communicable diseases, trauma.... ? Ultimately, it is the health ministers who must decide but every effort must be made, at community level, to find out what people themselves regarded as their most pressing health concerns. Sometimes the answers that communities give, on the rare occasions that they are asked, can surprise us all.

Identifying priorities and drawing up national health policies is not of course a straightforward business but some delegates expressed the view that many governments have yet to put in the required effort. There is now more data available, despite the many gaps, and today’s policy makers do have more to guide them than did their predecessors.

The full Algiers Declaration, which was signed at the end of the meeting, may be seen here but, as always with such declarations , what the signatories have ‘noted’ and what they have ‘called upon’ others to do is of less significance than the actions they have themselves pledged to undertake. We reproduce below the core of the Declaration – the 22 measures that the ministers have agreed they will launch by 2009. The list is worth careful study; it will be a matter of personal preference as to which of the 22 are potentially the most far reaching. Highlights, however, must surely include the decisions to establish governance structures to promote ethics and increase public trust in research; to address the broad and multidimensional determinants of health; and to support the development of human resources for research. The inclusion of a specific deadline (2009) for the beginning the actions specified is most welcome.

The latter point was much discussed during the conference. As the Director of the US National Institutes of Health, Elias Zerhouni, said in an interview for TropIKA.net, ‘You cannot do health research without health researchers.’ Perhaps the biggest challenge facing African science is that of increasing the number of trained researchers, and then keeping them in their own country rather than see them join the brain drain to wealthier nations.

The brain drain issue is an example of an issue that has been with us for a long time but, sadly, it is still relevant and deserves a place in any discussion on health research in Africa. Other ‘old friends’ that figured, with good reason, in Algiers included the need for intersectoral collaboration and the advantages of various forms of partnership in research programmes.

The inadequate communication of research findings arose as a topic during many conference discussions. It is clear, in particular, that health researchers and health policy makers rarely speak to each other! The breaking down of barriers between all the stakeholders in infectious disease research is at the centre of the mission of TropIKA.net. We hope that by making the Algiers gathering one of our Featured Meetings we have made a further step towards that goal.

As for what this meeting has actually accomplished, we must wait and see how many of those 22 resolutions are put into practice, and in how many countries. The delegates interviewed by TropIKA.net varied in their level of optimism. Some predicted that the Declaration would simply ‘gather dust’ but let us end with the words of the anonymous delegate who told us that: ‘The onus is now on the ministers attending this meeting to use their considerable powers and influence to steer the implementation of this Declaration and prove the sceptics wrong. They have the unique opportunity to make this Declaration come live.’

Paul Chinnock
Editor-in-Chief, TropIKA.net

Africa health ministers have committed to launching the following actions before 2009

Strengthen coordination within the health sector and among all ministries contributing to the development of science and technology, including health, and establish governance structures to promote ethics and increase public trust in research;
Develop or strengthen comprehensive national health research policies and strategic frameworks that are based on systematic and standardized assessments of existing health research and knowledge systems.
Expand the health research agenda to include broad and multidimensional determinants of health.
Create and strengthen South-South and North-South cooperation and collaboration including technology transfer;
Link health research and development efforts with health needs and explore partnerships between governments, academic institutions, private sector entities and civil society organizations;
Create sub regional centres of excellence to promote research and generate evidence for better decisions; the principal activities of the aforesaid centres shall focus on disease surveillance, public health laboratories and quality control of food and drugs;
Support the development of human resources for research through initial and further training and promotion of access to scientific information;
Establish appropriate mechanisms for scientific and ethical oversight of health research, including clinical trial, regulation, sensitization of the people on their roles, rights and obligations in matters of health research;
Monitor and systematically evaluate and review health research systems by developing appropriate health research registries and indicators;
Allocate at least 2% of national health expenditures and at least 5% of health external project and programme aid to research and research capacity building; and invest more on research aimed at improving health systems.
Create and strengthen an environment that attracts the best minds, for example, by providing attractive career structures and incentives, by facilitating access to information and by offering the persons concerned opportunities to teach, do research and participate in communities of practice;
Develop a critical m various disciplines and areas of health research, including ethics and regulation;
Support the translation of research results into policy and action by creating appropriate mechanisms and structures, including promoting networks of researchers, decision-makers and policy-makers for evidence-based public health action;
Continue to promote innovative research directed towards discoveries in basic knowledge and its transformation into new tools such as drugs, vaccines and diagnostics;
Implement operational research to assess how discoveries might be optimally utilized and strategically implemented to ensure enhanced access;
Develop and strengthen the national health information system by instituting procedures that ensure the generation and availability of information that conforms to international norms and standards and by defining clear relations between the various sub-systems, as well as the mechanisms needed for regular sub-system evaluation;
Identify and integrate the various sources of information into national information systems taking into account the private sector so as to generate accurate and reliable information;
Acquire information and communication technologies and make them accessible to all sources and potential users of information, in order to have up-to-date evidence for health research development.
Prepare national strategic directions for knowledge management, including e-health, ensuring that they are integrated as a priority into national health policies and plans;
Establish norms and standards, including ethical ones, taking into account new technologies and approaches to knowledge management;
Strengthen national capacity in knowledge management;
Adopt policies that promote the application of intellectual property rights in favour of the public in North-South and public-private research partnerships so as to enhance accessibility of research results.

Note: The Algiers meeting was a regional preparation for the Global Ministerial Forum on Research for Health will be held in Bamako, Mali, 17-19 November 2008. It will bring together up to 1000 policy-makers and researchers to focus on the key linkages between the health sector and research, science and technology, higher education, and the global innovation system. Preparatory meetings have also taken place in Europe and in the Asia-Pacific region.