Martin Okechukwu C Ota* and Joses Muthuri Kirigia
Research, Publications and Library Services Programme, Health Systems and Services Cluster, World Health Organization Regional Office for Africa, Brazzaville, Congo
Received date: June 07, 2016; Accepted date: June 22, 2016; Published date: June 25, 2016
Citation: Ota MOC, Kirigia JM. Research for Health Strategy to Buttress Pursuit of the Sustainable Development Goals in the African Region. Health Syst Policy Res. 2016, 3:2. doi:10.21767/2254-9137.100036
Evidence from scientific research is one of the major factors required to progressing toward the goal of ensuring that everyone, everywhere, can access quality health services needed without being forced into poverty (i.e., Universal Health Coverage). However, research is yet to be given the required high priority in addressing the health needs by many countries in the African Region. To guide countries in establishing the fundamental elements that facilitate health research, a new research for health strategy for the African Region that was developed by the World Health Organization was adopted in 2015. The aim of the strategy is to strengthen the National Health Research Systems(NHRS) that create an enabling policy environment for conduct and utilization of research. This strategy will not only guide countries in strengthening their NHRS but will also help partners in identifying areas requiring their support.
Functional national health research systems; Universal health coverage; Health strategy
African region has invested substantive political and financial resources into the achievement of health-related Millennium Development Goals (MDGs). As a result, some progress has been realized in the reduction of HIV incidence, a marked increase in measles vaccination in children less than one year old and a reduction in tuberculosis mortality rates at the regional level 1. However, many MDG targets were not achieved in most countries, and no country achieved all the targets by the end of 2015.1 Moreover, the progress within and between individual countries was highly variable.
The challenges that hindered the achievement of the MDGs include fragmentation of interventions; weak health systems (inadequate health infrastructure and medical devises, health workforce, essential medicines and vaccines, health financing, and information systems); inequities in access to effective services; weak health security; political conflicts; and weak multi-sectorial responses among others [1-3]. It is important to note that proven cost-effective interventions exist that would have facilitated the achievement of the MDGs. However, these were poorly utilized as result of a dearth of evidence from research to guide policy, planning and decision-making in countries. Priority is not given to research as a tool for solving the health needs by many countries in the African region, and consequently investments in health research are insufficient to facilitate research commensurate to the burden of the health needs. Much of the research activities, are at best driven by external partners, but often with agenda that focus on vertical disease programmes rather than investing in approaches that address health research systems and national health priorities.
Furthermore, the world has moved on and reached a consensus on the post-2015 global development agenda, as articulated in the United Nations Secretary-General’s Synthesis Report . The road to dignity by 2030. This envisions a 15-year programme of work in pursuit of the 17 sustainable development goals (SDGs), with health as the goal #3 (i.e. Ensure healthy lives and promote wellbeing for all at all ages). There are nine targets on health: three are related to non-communicable diseases and injuries; three are cross-cutting health areas including universal health coverage (UHC); and three are the critical MDGs and targets that were not achieved, the “MDG unfinished and expanded agenda”, which are to “reduce maternal mortality; end preventable newborn and child deaths; end the epidemics of HIV, tuberculosis, malaria, neglected tropical diseases and combat hepatitis, waterborne and other communicable diseases, and; ensure universal access to sexual and reproductive health-care.
UHC is the desired outcome of health systems strengthening and performance. A health system is functional and UHC attained when all people receive quality and equitable health services (promotion, prevention, treatment, rehabilitative and palliative) without financial hardship. Progress towards the UHC can be facilitated by circumventing the challenges that militated against the MDGs as well as increased deployment of research to guide the health systems in the design and implementation of health policies . Indeed, research evidence has been shown to improve the health policy-making process by identifying new issues for the policy agenda, informing decisions about policy content and direction, and evaluating the impact of policy [6,7]. There is global recognition that evidence-based operations are the main prerequisite for effective health systems strengthening that is crucial for continuous improvement in health outcomes in an efficient and equitable manner .
A recent assessment by the funding bodies for higher education in the United Kingdom demonstrated the enormous benefits from health research, including the development of new treatments and screening programmes that resulted in considerable reduction in morbidity and mortality . The African region is yet to realize such significant benefits partly because priority is not given to research as a tool for solutions to the health needs of the region, leading to lack of enabling environment for research. For instance, Africa’s contribution to global health research output, in terms of publications in journals, is currently only 1.3%, an indication of a relatively very low research activity given that it has 24% of the global burden of disease and 37% of the world population . This is evidence that the National Health Research Systems (NHRS) in the African region are very weak.
NHRS is defined as the people, institutions, and activities whose primary purpose is to generate and promote utilization of highquality scientific knowledge to promote, restore and/or maintain the health status of populations. The NHRS functions include the following: (a) governance; (b) developing and sustaining research capacities; (c) producing, and using research knowledge; and (d) resource mobilization and financing of research . NHRS are vital for research generation, dissemination and utilization in addressing the health needs of the population. Therefore, there is an urgent need to strengthen NHRS in the African region.
An earlier call for countries to address the growing inequities in health through research was in 1990 by the Commission on Health Research for Development. The recommended strategies included among others, for countries to focus on their own health research priorities, even when in partnership with more developed countries . There had been a previous regional strategy that expired in 2003, and other significant events to enhance health research in the region. However, some of these efforts were either not of immediate priority, fragmented or not oriented towards country ownership, and their full implementation was not accomplished. Therefore, WHO in the African region led the initiative to develop a health research strategy that focuses on reinforcing the performance of the NHRS in countries . Consultations on ways of strengthening NHRS took place with WHO headquarters in Geneva, the African Advisory Committee for Health Research and Development (AACHRD), the African Union Commission and among WHO Member States in the region.
The New African Region Health Research Strategy
The goal of the strategy is to provide guidance to member states for strengthening their NHRS in order to optimize research production and utilization. The major aim of the strategy is to foster the development of functional NHRS that generate scientific knowledge for developing technologies, as well as health systems and services needed to achieve UHC. The targets of the strategy are derived from the functions of the NHRS and relevant initiatives in health research system that should be implemented by 2025.
The strategy proposes a number of interventions for bolstering performance of NHRS. These include: (1) strengthening health research governance to create an enabling environment for the conduct of research such as development and implementation of national health research policy, plans, and priorities, and having functional national ethics committees; (2) building immediate and sustained human and infrastructural resources of academic and public research organizations. This entails establishment and strengthening of health research units, creation of clear research career development paths, and provision of incentives, that would attract and retain professionals in health research; (3) producing and using health research results through establishment of knowledge translation platforms such as Evidence Informed Policy Networks (EVIPNet). Such a platform has the capacity to undertake stakeholder analysis and disease priority mapping, stimulate demand-driven research, and provide evidencebased policy briefs to policy-makers; (4) ensuring adequate and sustained funding of health research through innovative funding mechanisms such as taxation schemes, pooled funds, precompetitive research platforms and milestone prizes, among others; and (5) establishing mechanisms for tracking research investments to strengthen research coordination and capacity building. Such may entail having a mechanism that registers, profiles and monitors all health research activities in the country .
This new strategy highlights the placement of relevant NHRS elements for the improvement of organizational effectiveness for development of appropriate policy framework for health research for health and generation of appropriate research outputs. Thus, to achieve the goal of the strategy, the following principles must underpin the process: there should be country ownership to ensure that governance of health research processes are led and owned by governments; the health research processes must be harmonized and aligned to ensure that all activities address national health needs; there should be adherence to international ethical principles to ensure that dignity, integrity and safety of research participants are guaranteed; evidence must be the basis for decision-making for policy, planning and practice related to service delivery, health workforce, information, medical products, vaccines and technologies, financing, and leadership and governance in order to make the desired impact; all health research resources must be allocated and used optimally to maximize production and use of scientifically valid research outputs; and there must be effective partnership among all health-related sectors and disciplines, including the private sector, international development organizations, nongovernmental organizations, civil society and communities in order to strengthen National Health Research Systems.
Health ministers from all the 47 member states of the WHO African region discussed and adopted this new strategy on 25 November 2015 during the 64th session of the Regional Committee that held at N’Djamena, Republic of Chad. They agreed that health research is critical in providing evidence-based solutions for the much-needed improvement in health and development. They recognized that the NHRS in the region – required to facilitate the conduct and use of research and are currently weak due to a number of reasons. Investments in health research by most countries in the African region are insufficient, and most research activities are driven by external partners.
Many countries are facing significant challenges in training and retaining researchers because the training curriculum of health professionals is weak in research, the career paths for researchers are ill-defined, and incentives for researchers are poor. Only a small proportion of graduates express interest in having health research as a career, which has also contributed to an inadequate base of qualified human resources for health research. These factors taken together have led to the region’s low contribution to global research output, 10 and insufficient tools and products against diseases that disproportionately affect the African region.
As a region bearing a high burden of communicable and noncommunicable diseases and injuries, and facing health systems challenges, the African region is in need of strong NHRS to propel it towards achievement of UHC. Full implementation of this new health research strategy will contribute to the development and strengthening of functional NHRS that facilitate the generation and use of research to provide solutions to the health needs of the region. The health ministers recognized that the full implementation of this strategy will require a multi-sectoral (education, health, science and technology, research and development) and an integrated approach aligned to regional and country health priorities. They endorsed the strategy and the associated resolution for immediate implementation by countries.
A major reason why countries in the African region did not achieve the health-MDGs was due to dearth of evidence to guide policy, planning and decision-making. Such evidence is lacking (or not used where it exists) due to weak NHRS. The African region has adopted a research strategy that will guide countries and partners in the strengthening of the NHRS that provide the basic infrastructure that create an enabling environment for conducting and utilizing research to address the enormous health needs. The implementation of the strategy would be monitored periodically to enable countries identify existing gaps to be bridged, tracking of progress in strengthening of NHRS whilst guiding WHO to tailor technical support to the NHRS needs of each country.
The authors declare that they have no competing interests.
MOCO and JMK participated in the development of the research for health: A strategy for the African region, 2016-2025, and the writing of this manuscript. All authors read and approved the final manuscript.
We owe profound gratitude to “Jehovah Shalom” for granting us peace in the process of writing this manuscript. We are grateful to AACHRD members and partners for their suggestions that guided the development of the strategy. The article contains the perceptions and views of the authors only and does not represent decisions or stated policies of the institutions/organizations that they work for.