Health research has a key role in the development of low-income and middle-income
countries. There are several current initiatives that have greatly contributed to
capacity strengthening of health research in sub-Saharan Africa, including those supported
by WHO and Tropical Disease Research (TDR), the Swedish International Development
Agency (SIDA) and Department for Research Cooperation (SAREC), the European Union,
the Bill & Melinda Gates Foundation, the International Clinical Epidemiology Network
(INCLEN), the Fogarty International Centre, the National Institutes of Health (NIH),
and the Wellcome Trust. However, enormous challenges remain for sub-Saharan Africa
to establish a common framework for sustainable research capacity strengthening.
The Global Ministerial Forum on Research for Health in Bamako will give emphasis to
the challenges of research for development and health, the need for more health-system
research, and a greater intersectoral approach to science, technology, and health.
That health research is indispensable for improving health, equity, and development
is now widely accepted,
1
yet how sub-Saharan African countries can develop their fragile health systems and
their own capacity to do health research is rarely discussed.
2
A recent African-led initiative—the Initiative to Strengthen Health Research Capacity
in Africa (ISHReCA)—has identified nine key requirements to strengthening health-research
capacity in Africa (panel 1). We focus on these requirements and suggest practical
strategies for sustainable capacity strengthening in African institutions.
In many sub-Saharan African countries there is a non-conducive environment for research:
the legislative framework has not kept pace with new trends in research, such as genetics
research, ethical conduct of clinical trials, material exchange, and intellectual
property rights. These legislative gaps hamper multi-institutional research such as
clinical trials. Governments must appreciate the need to make greater commitments
to provide strategic planning, legislative reforms, and funding for effective management
of research activities. The recently launched International Centre for South–South
Co-operation in Science, Technology and Innovation—under the auspices of the United
Nations Educational, Scientific and Cultural Organization (UNESCO) in Kuala Lumpur,
Malaysia—can provide policy advice and ease the exchange of experiences with policy
makers.
3
Science is a global activity, and some of the best African researchers move to countries
where their efforts are better rewarded and appreciated. High-profile advocates are
needed to promote science within African society, to ensure that research gets its
share of the national budgetary allocation and attracts additional external funding.
This could be done by national academies of science—the African Academy of Sciences
and the African Union. Politicians and policy makers need to consider how science
and technology can contribute to development, including achievement of the Millennium
Development Goals. African governments should recognise that funds allocated for research
are a good investment. More appreciation of the benefits of research might lead to
greater commitment to providing dedicated funding to national research budgets. Science
can also contribute directly to wealth creation, through product development partnerships
with industry and entrepreneurs. Strong and sustained advocacy is needed, similar
to that undertaken for the provision of AIDS treatment at affordable cost.
One example of an institution able to support such advocacy is ISHReCA, created after
meetings in 2007 in Kilifi, Kenya, and Cape Town, South Africa, which brought together
health researchers in Africa and international health-research funders. ISHReCA aims
to promote self-sustaining research groups that can initiate and carry out high-quality
health research in Africa. Its mission also includes helping the translation of research
products into policy and practice through better integrated approaches to capacity
development at individual, institutional, and system levels.
4
ISHReCA aims to promote African-led plans, leading to better negotiations with funders
and partners, increased commitment of national governments and civil society, and
national and international reinforcement of the urgency for networking and building
African capacity for health research.
The current population of African researchers is ageing, and young talented researchers
need to be identified early on in their careers. Thus, promotion of secondary-school
science education and training of science teachers are needed. Also, key centres of
research excellence on which to concentrate available resources for research capacity
strengthening should be identified at a regional and national level. Some such centres,
such as those in Ifakara, Fajara, Navrongo, Kintampo, Kilifi, Manhiça, Makerere, and
Bamako already exist, but many more are needed. These centres can offer leadership
in research, provide mentorship programmes for interns, and collaborations with other
teaching and research institutions for high-quality training of the next generation
of research leaders.
The lack of career paths to attract and retain good researchers is the most serious
impediment to health research. The development of attractive career pathways is key
to bringing research in sub-Saharan Africa to international standards of excellence.
We propose starting attractive research-focused career pathways within key African
institutions to address this issue. These should open new career opportunities at
every level, starting with a broad base of junior interns, continuing with competitive
PhD or postdoctoral programmes combined with equivalent clinical research fellowship
and MD schemes. Most individuals should have the opportunity to progress beyond a
PhD, if they are competitive. Africa simply cannot afford to lose more trained health
researchers both within and outside the continent. Therefore, attractive packages
should be available, including appropriate salaries for internationally competitive
candidates, career posts, and opportunities for training and travel for postdoctoral
researchers. Crucial elements frequently missing in African universities are programmes
to recruit women into science, promotion of good mentoring, and empowerment of junior
scientists. At Makerere University in Uganda, well-funded junior clinical scholarship
positions have been put into place to attract, mentor, and retain junior researchers,
and a fast-track promotion pathway, based mainly on outstanding research productivity,
has been created.
In most African institutions, junior researchers develop their careers on their own.
A strategy to identify and support research group leaders, who can help to mentor
young researchers through the career pipeline, could be more productive. Such individuals
would feed the scientific passion of junior researchers and help their careers. This
plan would lead to identification and support of existing and potential research leaders
within the country, and attract those who have moved to work abroad to return. Secure,
long-term funding is needed for these individuals if they are to build national research
capacity, for example through endowed positions or guaranteed, long-term career funding.
Sources of such funding could be diversified and expanded beyond the usual sponsors
and foundations, with grants raised from national governments, private donations,
charities, and corporations.
Schemes that are run through and include contributions from African governments are
needed to sustain promising young scientists. The management of such government-driven
schemes needs to be carefully structured to ensure that they are non-bureaucratic
and flexible. National grant awards should be made in open, transparent competition
to institutions and individuals to promote cross-institutional, multidisciplinary
research, which develops South–South linkages. Promising young scientists should get
support, including training in scientific-writing skills and translating research
results into policy, to help them to develop competitive proposals. Substantial re-entry
grants are needed to attract scientists who have moved abroad. For example, the Health
Research Capacity Strengthening Initiative partnership between the UK Department for
International Development (DFID), the International Development and Research Centre
(IDRC) Canada, and the Wellcome Trust has lent support to develop nationally available
research grant funding, awarded and administered locally, in Kenya and Malawi.
5
African governments should provide the basic infrastructure for health research. Although
initiatives, such as those of SIDA and SAREC, have made substantial contributions
in helping infrastructure upgrading at African institutions, such activities should
be in addition to national governments' central role. African governments and funders
should work together to create appropriate ways to ensure the full costs of research
are provided. This effort might include the cost of upgrading infrastructure and improving
support services, such as research management and governance, accounting and financial
reporting, information technology, and library services. Research institutions and
universities with a real potential for success should have priority, so resources
can be focused to drive national or sub-national research programmes. For research
to flourish, requisite organisational frameworks, adequate human resources, and access
to appropriate skills are needed. SIDA and SAREC have set a positive trend, and the
Wellcome Trust has recently launched an African Institutions Initiative, which aims
to build a critical mass of sustainable local research capacity across Africa, by
strengthening African universities and research institutions.
6
Initiatives might fail to achieve aims because of no coordination and duplication
of effort. With close harmonisation between development agency donors and health-research
sponsors, and increased alignment with national health-research priorities, sustainable
progress can be made in research capacity strengthening in Africa. An interagency
working group for Enhancing Support for Effective National Capacity Efforts (ESSENCE)
has been created with relevant international funders of health research to maintain
contact and promote coordination.
7
These initiatives that help research capacity strengthening (including ISHReCA and
ESSENCE), relevant United Nations agencies, and the African Union should find a common
platform that enables creation of complementary networks and partnerships to make
space for African institutions to articulate their needs to develop health research
further.
8
Sponsors can encourage Northern research institutions and universities to develop
long-term sustainable partnerships with their counterparts in low-income and middle-income
countries through appropriate funding mechanisms. Increased support for South–South
networks, whereby established universities and research institutions can assist the
development of emerging institutions, will also be essential. African research centres
need long-term support to be able to grow organically over time. A good example of
this development is Ifakara Health Institute in Tanzania, which has developed from
a site that relied on the Swiss Tropical Institute for scientific and administrative
drive to an independent research centre based on a Trust governance structure with
a scientific board, which derives core funding from several grants giving long-term
stability and independence. International sponsors should consider providing core
funds to assist the development of research centres that can address national and
international research priorities through an appropriate balance of research, training,
and service provision (figure).
9
There is increasing interest in and recognition of the crucial importance of strengthening
the capacity for research for health in Africa.
10
A similar approach has been proposed in the context of health-systems research
11
and in the social sciences and humanities.
12,13
Lessons from other sectors, such as agriculture and education, need to be sought and
discussed. Several initiatives and schemes have recently been established or are under
development (panel 2).
African academics and researchers are best placed to identify what is needed to strengthen
their academic institutions. ISHReCA is already raising the profile of African views
on capacity strengthening and ensuring that these views are heard. ESSENCE is one
group of development donors and health-research funders willing to engage in such
discussions.
To assist coordination in this area, knowledge platforms should be developed, maintained,
and updated to provide high-quality information on national health-research systems,
funders' strategies, and activities in relation to health research. Examples include
the Health Research Web from the Council on Health Research for Development (COHRED),
14
and other platforms.
Measurement of success of capacity strengthening initiatives is not straightforward
and new methods are being developed to assist with this (eg, the outcome mapping techniques
used by IDRC).
15
These can complement useful assessments that have already been done by development
agencies including the Danish International Development Agency (DANIDA),
16
Swiss Commission for Research Partnerships with Developing Countries (KFPE),
17
and SIDA and SAREC.
18,19
However, improved learning from such initiatives and wider dissemination of case studies
remain important issues.
Improved research communication and learning will assist in the implementation of
the 2005 Paris Declaration on Aid Effectiveness,
20
which aims to foster targeted investments to help developing countries. The challenge
remains to improve harmonisation of the efforts of research funders and donors where
these are complementary, while retaining diversity of opportunities and increasing
alignment with countries' own priorities.
Research for health, as articulated in the objectives of the Global Ministerial Forum,
is not a luxury; on the contrary, it is essential for developing future interventions
and improving delivery of existing interventions.