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Daily report - 24 June 2008

Source: TropIKA.net editorial team

The opening plenary of Day 2 focused on financial flows and funding of national health systems. WHO’s Dr Bennett, manager of the Alliance for Health Policy and Systems Research presented on “Money, people and institutions: health research capacity in Africa.”

Although there have been significant increases in resources for health research worldwide over the past decade, gross imbalances still exist between regions and countries with respect to the allocation of resources. Just 5 per cent of global research spending addresses low-income and middle-income country needs, and Africa is particularly disadvantaged in this global context. Delegates were challenged to rethink funding assistance to enhance country ownership of health research, with funding models being tailored to countries’ needs.

“We need to look at health research capacity from a systems perspective. The brain drain is not only due to poor salaries; countries need to assess the lack of supportive environments as well,” urged Bennett, noting that capacity building for health research, as well as knowledge translation was sorely needed. “Africa has a clear opportunity to take the lead in proposing aid modalities and funding models that foster equitable North-South and South-South partnerships,” she added.

Delegates agreed that national stakeholders should determine their own country vision for capacity building, which should include sectors in addition to health. They proposed that the meeting in Bamako consider an African Research for Health funding body to manage funds from donors, and allocate research grants based on African health research priorities to promote health for all Africans.

Funding for research

How is money spent on research, and research and health systems in Africa? In a session on financial flows and donor priorities, Dr Sadana noted that less than 5% of the US$125 billion spent on health research worldwide was spent in low-income and middle-income countries (LMIC), mainly in Latin America and Asia. This presentation discussed data from WHO’s health research performer survey in 44 African countries (see the report/powerpoint slides for an explanation of how institutions were categorized). The information is vital to enhance donor negotiations and to facilitate better use of funds.

NGOs and similar organizations tend to fund individuals, and only research institutions regularly contract out work to other research institutions. Research in two areas are particularly neglected by all types of institutions: non-communicable diseases, and innovative practices and product development.

Challenges include: shifting of health research focus from disease to health; supporting development of sustainable systems for collection and analysis of statistics for R&D for health; and exploring the development of the economics concept of “purchasing power parities” for R&D in health.

Professor Akuffo, speaking on donors’ perspectives on financial flows noted the need for clarity of expression of terms such as “capacity building,” and “national research capacity,” as these could mean different things to different people. She added that African governments should be primarily responsible for paying health researchers, with funding agencies playing a supportive role.

Health Information Systems

The surveys of Health Information Systems (HIS) in 14 African countries, in a separate session, are not independent and not intra-comparable, but helpful in identifying gaps. . The challenge is to convince policy makers that data is important. The requirements of donors and the feedback mechanisms of the MDGs have helped to boost HIS, but it is critical for countries to have plans to strengthen HIS which are costed, in order to allocate resources appropriately.

In terms of barriers to creating better systems, inadequate policy frameworks were seen as the most important barrier, as well as the absence of strategic plans and a regulatory framework to ensure the private health sector is included. In addition, there are unclear procedures for collecting, analysing and using data; this in turn impacts on countries’ ability to plan and set priorities, and report on MDGs, for example. The poor quality of vital statistics is a major problem in most countries.

There are no quick fixes for improving HIS: while there have been noticeable improvements, national policy makers need to understand why data are important. Countries must have long term HIS plans that have been costed; Honduras, Sierra Leone and Paraguay are examples of where this forward-thinking pays off. Countries should integrate systems to save scarce resources, optimizing the use of data by strengthening networking. A key recommendation was to have a multi-year plan for HIS strengthening around which donors can align their resources and support.

The human capacity issue in HIS is critical: countries need to value their data collectors and improve capacity of health workers at different levels to boost the ability to collect, analyse and use the data, which should be based on plans and the needs of countries.

Human resources

Human resources was discussed in a separate session. Just 3% of the world’s health workers are in Africa - institutions for training researchers are not enough to train the number of staff needed to meet the continent’s health research needs. There are brain drain issues. Many researchers train abroad, but only a few return home; those who do can become frustrated because of poor salaries and infrastructure, and the prospects for career advancement. Though some African researchers work abroad, some would like to come back home to work if the working conditions back at home are improved Some of the brain drain is internal - most of the research institutions lose staff to other sectors within their home countries every year as well; though there is no documentation on the movement of staff into other sectors. African researchers in the Diaspora should contribute to training graduate students back at home during their spare time.

This paucity of workers is reflected in the numbers of African-authored publications in peer reviewed journals; and 60% of these are concentrated in three countries – Egypt, Nigeria and South Africa. Algeria is an exception in having equal numbers of female and male research staff - because many women are educated to a high level, there is an appreciable number in health research. Publications could be increased by helping researchers translate their findings for scientific papers, analyze data collected and write quality papers. The number of local journals also needs to be increased to widen the arena for publication.

Improving institutional facilities

In a session on improving institutional facilities, discussed towards the end of the day, Ms Motari used data provided by interviews of researchers from 42 African countries representing four major regions; Central, East, Southern and West Africa.

The high level of government institutions involved in research skewed interests to those of the government. Many Southern African researchers viewed the quality of research from their home institutions as inadequate; this was in contrast to those from West Africa who tended to view theirs as high quality. The lack of laboratory interactions within and between countries and regions is an impediment to successful health system research development.

The misuse rather than the lack of ICT infrastructure in knowledge gathering were also observed to limit growth in successful health system research development. A second presenter noted that most of the institutions studied lacked efficient electronic library facilities and that there was the need for the development of regional libraries and the linking of laboratories with shared goals within countries and within regions.

Key recommendations included: improving the supply of electricity and promoting the use of renewable energy; raising laboratory standards and supporting training of technicians and research personal; supporting career development for laboratory technicians; convincing governments that health research is a tool for development and linking it to other developmental needs; and strengthening South-South collaborations.

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