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Daily report - 23 June 2008

Source: TropIKA.net editorial team

The opening ceremony of the Ministerial Conference on Research for Health in the African Region was characterised by an appeal for delegates to use all their efforts to do research in Africa, for Africa.

The Algerian Health Minister, Mr Amar Tou, acknowledged that there were shortcomings in the indicators which emerged from the massive 2007 AFRO/WHO survey that mapped health research capacity in Africa, but that the equation between health, economics and development was simple.

“Resources need to be used to save people from diseases. If they are sick, they cannot work, meet their debts, or contribute to economies. At the same time, we recognise that the approach is not simple, given other parameters in Africa,” he said.

He stressed that the political will needed to be strengthened. “It is obvious that we should make greater efforts at policy and infrastructure levels; we need to increase our budgets and tighten up public health laws,” he concluded.

Governance and stewardship was the theme running through Day 1. Participants agreed that these issues would determine not only the effectiveness and sustainability of health research, but also its relevance and ultimately the ability to deliver better health to the people of Africa.

Collaboration and ethics were two other major policy and institutional issues, for health research systems, discussed in later technical sessions on Day 1.

In all discussion groups, capacity-building, infrastructure, funding requirements, and bargaining power (at national, intersectoral and global level) recurred as major areas of interest and need.

As keynote speaker on Governance and Stewardship, Dr Tikki Pang gave advice on how to approach the main functions and skills involved. It’s all about “getting the balance right”, he said, between different types of research and researchers; between national, regional and global priorities; between publications and practice, professorships and policy, patents and people. He stressed the role of tacit knowledge and the need to explore the ways in which this can be captured, systematized and disseminated. His plea was for “out of the box” thinking and contextualized strategy. (Dr Tikki Pang’s presentation).

Funding was an area of concern common to all. The need for political commitment and increased and sustainable funding for health research was repeatedly emphasized. Several discussants referred to pressure and bias on the part of donors in their selection of health research priorities for funding. Others, like Nigeria and Burundi, pointed out that “the best strategy to convince donors is to have a national health plan”. This point was reinforced by the Namibian delegate who said that unless countries can show specific budget lines for research, it would be impossible to talk about research priorities.

Dr Erica Gadsby’s analysis of governance found that many countries lack a formal, articulated vision for health research – “policies, plans and strategies are frequently either absent or out of date.” (Dr Erica Gadsby’s presentation).

The absence of official health research policies in many countries means most will not have identified health research priorities.

There is good news, however: the broad range and types of research institutions, and of the research activities they contribute to, shows a good basis for the strengthening of research capacity in Africa.

The session on collaboration stated that capacity-building and training should be developed specifically to enable countries to negotiate with partners. Negotiation and communication skills will be valuable tools for researchers in all cases, at national, intersectoral, and global levels. Being part of a multinational network adds leverage. One crucial determinant of success, as stressed by Dr Kitua in a panel discussion, is when partners share common goals, no matter which sector, geographic or economic group they belong to.

The theme was echoed by many participants. Every collaboration must be able to define from the outset whose problem is being tackled and what strategies will be used to solve the problem at hand, with a mutually agreed mechanism to be put in place defining the code of conduct of collaborators. Pr Muyembe highlighted the importance of network collaborations between countries to reach a better understanding of new and emerging diseases, such as avian flu.

Points of agreement included the need for equity in partnerships, balanced collaboration with a view to both groups gaining from the relationship. The point was made about defining the legal issues involved in collaboration so as to protect intellectual property rights.

Trust between research collaborators is key. Another decisive factor would be to balance allocation of resources to collaborating partners and institutions. Better remuneration of African researchers would go some way to encourage them to pursue research in their own countries rather than abroad. The questions delegates raised were: how do you know where your potential research partners are, and how do you go about seeking out partners and collaboration.

The session on ethics centred on clinical trials, guidelines, regulatory framework, and the institutional environment for health research ethics. Limiting factors are the lack of legislation and supporting institutional policies. Too often, ethics review committees are not functioning properly. They tend to be added on to the structure, but lack institutional support, have no written terms of reference, and meet sporadically.

In the absence of centralized oversight, Pr Sonali Johnson reported, fragmentation was a big risk, along with neglect of and lack of compliance with established guidelines and good practices. The surveys on which the ethics presentation was based showed that lack of training was a key constraint. (Pr Sonali Johnson’s presentation). Not only where researchers are concerned, but also the ethics review committee members themselves may not have been formally trained in ethics issues. One option proposed was to set up an Ethics Review Council at the central level, which could accommodate intersectoral representation.

Some cautioned against reinventing the wheel and advised that experience be identified and shared across the Region. Zimbabwe gave the example of an institutional review board that was being set up with EDCTP support, at provincial level, to serve various areas and sectors of activity.

In the final plenary session, in the run up to the Bamako meeting in 2008, delegates called for the technical reports to be posted on the web so that countries could update and feed in information thus turning the surveys into a dynamic process.

Participants also called for the setting up of a research observatory for the African Region.

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