Time to turn words into deeds on health research
African ministers have committed themselves to a set of actions to boost health research in their countries. Now they must implement them.
There is much encouragement to be gained from the commitment to health research demonstrated by Africa's health and science ministers at a meeting in Algeria this week (23–26 June). At the meeting, ministers from 17 African countries announced a collective commitment to ensuring a higher priority for health research at both a national and regional level, and across the continent.
Improving health in the developing world is one of the key Millennium Development Goals (MDGs). These include, for example, reducing the mortality rate among children under five by two-thirds and maternal mortality by three-quarters, and making a significant impact on malaria and other tropical diseases. None of these targets will be achieved without extensive research into new methods of diagnosis and treatment.
The Algiers meeting was organised as a preparatory meeting for the Global Ministerial Forum on Research for Health that takes place in Bamako, Mali, in November 2008.
Its key outcome was the 'Algiers Declaration', a commendable list of 22 actions that ministers agreed to implement before the end of 2009, and intended to ensure that the potential contribution of health research to achieving the MDGs is delivered.
The actions include increasing funding for health research and research capacity-building by African governments, and boosting mechanisms for scientific and ethical oversight of all such activity. The ministers also agreed to "support the translation of research results into policy and action by creating appropriate mechanisms and structures, including promoting networks of researchers, decision-makers and policymakers for evidence-based public health action".
Provided these commitments are met, Africa's health will receive a significant boost. But it became clear from the discussions in Algiers that there are several key issues that must be tackled urgently if this is to happen.
One is the need for better information about the health priorities of the continent — and a clearer idea within African countries themselves about how these priorities can best be addressed through research.
Donor agencies from the developed world — who provide much of the funding for such research — are frequently criticised by African stakeholders for seeking to impose an agenda that reflects the donor's own priorities. But many of these agencies insist that they would be delighted to engage in a more informed, two-way dialogue on what their research priorities should be.
This means that African nations need to develop their own capacity for setting research priorities. Two essential components of this are adequate information about current research efforts and the development of professional skills among both research administrators and government officials — part of a broader need to develop a robust research infrastructure.
Another necessity is the development of stronger networks to ensure that African researchers and politicians — including particular ministers — communicate with each other more effectively. Far too often, gaps remain between scientists' understanding of what is needed for health research to be put into practice, and the willingness of decision-makers to implement the steps that make this possible.
An additional need is to boost national capacities to address the ethical dimensions of health research — particularly at a time when the activities of researchers from the developed world, including those carrying out large-scale clinical trials for pharmaceutical companies, are under closer scrutiny.
A survey of capacity to conduct ethical reviews in 634 research institutes in 43 countries was presented at the Algiers meeting by a WHO team. They found that half of those who have a "high research activity" don't have written policies requiring researchers to obtain informed consent from trial participants.
There is still much debate to be had about how the situation can be improved. Nevertheless, it is clear that health research in Africa needs to be conducted in a more ethical manner than in the past. And building the capacity to achieve this must form an integral part of future plans.
A third priority to emerge from the meeting was the need to encourage more research collaboration. The final declaration calls for promotion of equitable cooperation, technology transfer and collaboration, emphasising that this requires both North–South and South–South dimensions.
But it became clear at the meeting that delegates — mostly African ministers and researchers — had a greater interest in the second of those. They were more interested in how African countries could transfer knowledge between themselves than in receiving knowledge from Northern institutions, a sentiment echoed by Elias Zerhouni, the director of the US National Institutes of Health.
Finally there was general acceptance among the Algiers delegates that none of these aims could be achieved without adequate funding.
Participants broadly agreed that not only should African countries seek to boost their spending on research and development to at least one per cent of their gross domestic product — a target endorsed by last year's African Union summit — but that at least ten per cent of research spending should be dedicated to health research.
But, as science ministers are already aware, there is a large step between putting forward a wish list and ensuring that those who control the purse strings are prepared to listen and act. The Algiers Declaration has provided a framework within which action can occur. What is now required is the political commitment within individual African countries to turn those words into deeds.
David Dickson, Director, SciDev.Net