Day One

Policy and strategic plan

All the 17 countries responded to the questions investigating the existence of a national health policy and its dissemination, and health sector strategic plan and dissemination. All countries demonstrated the existence of both a national health sector policy and strategic plan, but one country (Nigeria) had not disseminated both documents, apparently due to lack of funds. All countries provided evidence for the existence of Research for Health (R4H) coordination and regulation mechanisms. The majority of the PS (12) reported the existence of the memorandum of understanding (MOU), between Ministry of Health (MOH) and universities conducting research, that covered development of human resources for health, providing technical advice, and undertaking R4H for MOH.  MOH in 13 PSs reported the existence of MOUs with National Health Research Institutions. Several countries including: Angola, Burkina Faso, Ethiopia, Gambia, Mali, Nigeria, Tanzania and Zambia, lacked national guidelines on the development of collaboration agreements (NGCA). 

Three countries (Angola, Ethiopia and Ghana) did not have a national health research policy to guide the development of NHRS; and eight countries (Angola, Congo, Ethiopia, Gabon, Ghana, Mozambique, Nigeria and Uganda) did not have health research strategic plans. Four countries (Angola, Gabon, Gambia, and Uganda) did not have a health research priority list or agenda, which may undermine alignment of the research activities with national health needs.

Figure 1: The existence of operational components of the NHRS functions in 17 EDCTP participating states in Africa

Legislation on R4H 

Two countries (Angola and Ethiopia) did not have a law for regulating health research. Two (Angola and Congo) of the 15 PS with a law governing research did not include articles addressing research ethics concerns. 

National R4H focal point (NRHFP)

Three countries (Ethiopia, Gabon and Senegal) reported the absence of a NRHFP within MOH.   

National research ethics review committee (NERC)

All 17 PSs reported the existence of functional NERC.

There was a budget line for research for health in 13 PSs. There were no budget lines for Angola, Congo, Ethiopia and Gabon.

Research for health programme

Out of 17 PS, 15 (88%) reported to have a health research programme (HRP) within MOH for coordination and oversight of R4H. Only Ethiopia and Gabon did not have such programme. The average number of technical and support staff in health Research Unit in respondent PS was 49.9. Out of 13 PS that answered the question asking where the HRP is housed, 10 (77%) indicated MOH and 3 Ministry of Research, Science, Technology and Innovation. In 11 (69%) out of 16 responding PS, the technical staff in HRP were reported to have a computer. In Cameroon, Ethiopia, Gambia, Mali and Nigeria not all technical staff in HRPR had computers. Four countries (Cameroon, Ethiopia, Gabon and Gambia) reported that their HRPR were not connected to the internet and email.

Health research institutes (public and private)/councils (NHRI/NHRC)

Sixteen (94%) of the EDCTP African PS reported to have a national health research institute or council (NHRI/NHRC). Only Gambia reported not to have a national NHRI/NHRC for addressing health development needs of the national population. There is a Medical Research Council funded by the UK in the Gambia, which does global health research.

In 14 PS that responded to the question, the average number of researchers working in NHRI/NHRC was 208 (SD±289) and median 61. The average number of administrative staff was 70 (SD±64) and the median was 43 among the 12 PS that responded to this question. The 15 PS responding had an average of 12 laboratories (SD±18) and a median of 8.  About 14 (82%) of the 17 respondent PS reported that all researchers in their NHRI/NHRC had access to the internet; and 12 (71%) of NHRI/NHRC had capacity to conduct clinical trials. The only PS reporting researchers in their NHRI/NHRC without access to the internet were Cameroon and Congo. The countries with some NHRI/NHRC that did not have human and physical capacities for clinical trials were Cameroon, Gabon, Mali and Uganda.

National public and private universities conducting R4H 

All PSs reported the existence of universities conducting R4H.

Non-governmental organizations (NGOs)

Sixteen (94%) of the 17 PS reported to have NGO(s) involved in conduct of R4H. Mozambique and Gabon were the only PS that reported not to have an NGO that undertakes R4H.

National Health Research Management Forum (NHRMF)

Seven PS (Congo, Ethiopia, Gabon, Gambia, Ghana, Nigeria and Senegal) reported not to have functional NHRMF. A NHRMF is an organ with representation of all key stakeholders and the Ministry of Health as its Secretariat. Some of its functions / terms of reference are to advise government national health research policies and priorities, and mechanisms and action plans for their implementation; develop a 5-year projection of the plans for health research and to prepare an annual national health research plan; conduct a mid-plan appraisal for reprogramming; promote the development of health research activities in a PS; review biomedical and health research management, and suggest strategies to overcome problems in implementation of policies; suggest mechanisms to nurture a scientific environment to attract talent and to develop human resources for biomedical and health research; and facilitate utilisation and dissemination of research results and advocacy for health research. Thus, PS without a functional NHRMF may have challenges in performing such roles effectively.

Knowledge Translation Platform (KTP)

Five (Angola, Burkina Faso, Congo, Gabon and Nigeria) of the 17 PS reported not to have an evidence collation mechanism (ECM) to systematically gather pertinent reliable R4H publications. Also eight (Burkina Faso, Gabon, Gambia, Mali, Nigeria, South Africa, Tanzania and Uganda) of 16 PS responding reported they did not have a knowledge translation platform for synthesising, translating and communicating R4H to inform health policy and planning, health system development, practice and innovation. 

R4H Publications per 100,000 population in 2017:  

Table 1 presents the EDCTP African PS total R4H publications, population, and publications per 100,000 population in 2017.

In 2017 there was a total of 18,192 R4H peer reviewed articles published among the 17 PS. The average number of R4H publications was 1,070 (SD±1,695) per PS and the median was 484. However, the average number of R4H publications per 100,000 was 2.9.

There was wide variation in publications per 100,000 population across the 17 countries. The publications per 100,000 population in 2017 were less than two in six PS; two to three publications in five PS; and 3.1 and above publications in six PS. Angola had the minimum number of publications at 0.3 per 100,000 population. South Africa had the highest number of publications at 12.5 per 100,000 population followed by Gambia with 11.7 publications per 100,000 population.

The health research institutions mainly disseminate their research through peer-reviewed publications in journals (16/17); national health research forums, conferences, professional association assemblies, international conferences, and seminars (15/17); institutional letters, posters and/or brochures in official and local languages (11/17); website (8/17); print and electronic mass media (7/17); and publication in annual progress report of the institution and/or MOH (7/17).

Overall NHRS barometer score for individual EDCTP African Participating State

Table 2 Comparison of EDCTP African Participating States overall NHRS barometer scores in 2018 and 2014 

The overall EDCTP African PS NHRS barometer score was greater than 50% in 14 out of the 17 EDCTP African PS. The NHRS barometer score was below 50% in three PS; 50-70% in six PS; and above 70% in eight PS in 2018. Eighty-two percent of PS had an average national NHRS barometer score of 50% and above. Comparatively, in the 2014 survey, the average NHRS barometer score was less than 50% in nine PS; 50-70% in four PS; and above 70% in four PS. In 2014, only 47% of PS had an average national NHRS barometer score of 50% and above.

Therefore, between 2014 and 2018 overall NHRS barometer scores improved in all EDCTP African PS; except in Uganda where there was a five-percentage point decrease in NHRS performance.

WHO-AFRO made a presentation about the incorporation of the NHRS into National Health Observatories.  The “health observatory” is a concept of gathering, analysing, synthesising and sharing of reliable and quality health information on population health and health services. In 2011, WHO-AFRO established the Africa Health Observatory  (AHO) to serve four core functions: storage and sharing of data and statistics that can be viewed and downloaded; monitoring of health situations and trends, including progress on internationally agreed targets such as the health MDGs/SDG; production and sharing of evidence and knowledge by analysis and synthesis of information; and support for networking and communities of practice for improved use of such evidence and knowledge for policy and decision-making. It also supports countries in establishing their own national health observatories to strengthen their national health observatories.

EDCTP committed to working with WHO-AFRO to incorporate the NHRS data into national health observatories.