South Africa has a lot to learn about efficient and effective ways to approach health research and policy, suggests John Ouma-Mugabe.
South Africa hosts the fifth Summit of the alliance of Brics (Brazil, Russia, India, China and South Africa) on March 26 to 27 in Durban. The five Brics countries represent about 43% of the world’s population and account for 25% of the world’s gross domestic product. They also account for a significant and growing portion of global scientific productivity and technological innovation.
The Durban Summit will consider a wide range of policy issues and development programmes. Its theme is “Brics and Africa: Partnership for Development, Integration and Industrialisation”. It will focus on funding for infrastructure in Africa and the establishment of a Brics development bank, a scientific research centre and a think-tank for public policy and international affairs. Statements and communiques from various ministerial and technical working groups’ meetings will also be considered by heads of states and governments of the Brics countries.
In January health ministers from the five countries met in New Delhi. They issued a communique and made resolutions that may be endorsed by the Summit in Durban. The ministers “resolved to collaborate and cooperate for development of capacity and infrastructure to reduce the prevalence and incidence of tuberculosis through innovation for new drugs/vaccines, diagnostics and promotion of consortia of tuberculosis researchers to collaborate on clinical trial of drugs and vaccines, strengthening access to affordable medicines and delivery of quality care”.
They also committed to “focus on the unique strength of Brics countries such as capacity for research and development and manufacturing of affordable health products, and capability to conduct clinical trials”.
South Africa’s participation in Brics offers opportunities to strengthen its capacities for health research and innovation. Compared to the rest of the Brics members, the country’s health research and innovation system has gaps or weaknesses that undermine its ability to reduce its burden of disease.
The challenges include relatively low scientific productivity in biomedical and clinical research. According to the United Nations Educational, Scientific and Cultural Organisation, in 2008 South Africa produced about 1 450 peer reviewed scientific publications in clinical research compared to about 8 800 by Brazil, 13 600 by China and 7 500 by India.
The country’s relatively low scientific productivity in health fields is related to low investments in research. South Africa spends less than 2% of its national health budget on research despite its subscription to declarations such as the 2000 Bangkok Declaration on Health Research for Development and the 2008 Algiers Declaration of the Ministerial Conference on Research for Health in the African Region, which indicate an intention to spend 2% of national health budgets on research.
Its annual gross expenditure on research and development in general is less than 1% of its gross domestic product (GDP). This is in comparison to Brazil’s expenditure of 1.1% of GDP and China’s 1.5% of GDP.
More than 50% of the funding for research on HIV, malaria and tuberculosis is from external or foreign sources particularly the US, the European Union and the Bill and Melinda Gates Foundation. This raises the question as to whether current research initiatives are well aligned to the country’s health priorities.
South Africa’s capabilities for turning research outputs into innovations and products such as medicines and vaccines needs to be strengthened. There are weak links between research institutions and industry in general and pharmaceutical companies in particular. Findings of research projects are rarely translated into commercial products. There are many factors that account for this.
They include a weak entrepreneurial culture in research institutes and limited funding dedicated to commercialisation of health innovations. The creation in 2008 of the Technology Innovation Agency (TIA) by the South African government may be a right step in addressing the challenge of turning health research results into medicines, diagnostics and vaccines. However, it is taking TIA a relatively long period to have a sharp focus on innovation.
Right to research
The country has policies, regulations and legislation for promoting health research and innovation. The 1996 Constitution of South Africa has policies for promoting health research. Article 27(1a) of the Constitution states: “Everyone has the right to have access to health care services, including health care.”
The state is required to institute legislative and other measures to ensure that citizens’ health rights are realised. Such measures include ensuring that health research is conducted to generate products for reducing the country’s disease burden, and to make medicines available to citizens of the country.
Other policy instruments include the National Health Research Policy 2001 and the National Health Act, 2003. According to these instruments the government is expected to allocate at least 2% of total public sector health expenditure on priority research and the department of health was to increase its allocation to research and development from 0.5 to 1.5% of its total budget within three years from 2001. Currently the department spends less than 1% of its budget on research.
The challenge facing the government of South Africa is that of ensuring effectiveness of policies, regulation and legislation through their implementation. The government’s record of policy implementation is not good. Weak implementation of policies is manifested in long delays in approval of clinical trials. It takes about one year to obtain approval for a clinical trial in South Africa while it takes less than six months in Brazil and China. The costs of clinical trials in Brazil, China and India are at least half of costs incurred in South Africa.
In addition to benefits from trade and political cooperation with other members of Brics, South Africa can reap substantial gains by learning from and collaborating with Brazil, China and India on ways of strengthening its national health research and innovation capacities. It has health challenges of a relatively huge burden of disease, a national health system that needs strengthening, and high dependency on foreign sources of medicines, diagnostics and vaccines.
Brazil, India and China have been able to strengthen their capabilities to address similar challenges by increasing investments in scientific research. They have created world class laboratories, promoted the creation of local pharmaceutical companies, improved the regulatory infrastructure and reduced costs of conducting clinical trials. These countries have innovation-based health research policies and programmes.
South Africa should benchmark its investments in health research and innovation to that of the other Brics members and aim at experimenting with similar policy instruments for capacity building. Brazil’s experience demonstrates how important investment in health research is for the economy in general and for industrial production of medicines, vaccines, and diagnostics. The country devotes at least 3% of national expenditure on health research. External funding accounts for less than 5% of the budget for national health research.
South Africa will host the next Brics Health Ministerial meeting in January 2014. It would serve better if the meeting is dedicated to exploring specific ways and means by which Brics can support the country to strengthen its national health research and innovation capabilities. In preparation for the meeting the department of health, department of science and technology, the Medical Research Council and other agencies should conduct a comprehensive audit of the national health research and innovation system. The audit would identify specific areas of health research cooperation with the other Brics countries.
John Ouma-Mugabe is Professor of Science and Innovation Policy, Graduate School of Technology Management at the University of Pretoria.