Brics partners can show SA how to fix health system
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South Africa hosts the fifth summit of the Brics alliance of Brazil, Russia, India, China and South Africa in Durban tomorrow and Wednesday. The five Brics countries represent about 43 percent of the world’s population and account for 25 percent of the gross global 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 the Brics countries’ heads of states and governments.
In January health ministers from the five countries met in New Delhi. They issued a communique and made resolutions that they hope will be endorsed by the summit in Durban.
The health ministers “resolved to collaborate and co-operate for development of capacity and infrastructure to reduce the prevalence and incidence of tuberculosis through innovation for new drugs or 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 (R&D) 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 with 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 UN agency Unesco, in 2008 South Africa produced about 1 450 peer-reviewed scientific publications in clinical research compared with 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 percent 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 that indicate an intention to spend at least 2 percent of national health budgets on research.
South Africa’s annual gross expenditure on R&D in general is less than 1 percent of gross domestic product (GDP). This is in comparison with Brazil’s expenditure of 1.10 percent of GDP and China’s 1.5 percent of GDP.
More than 50 percent of the funding for research on HIV/Aids, malaria and tuberculosis is from external or foreign sources particularly the US, the EU and the Bill and Melinda Gates Foundation.
This raises the question of whether current research initiatives are well aligned to the country’s health priorities.
South Africa’s capabilities for turning research outputs into innovations – products such as medicines and vaccines – need 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 by the government may be a step towards addressing the challenge of turning health research results into medicines, diagnostics and vaccines. However, it is taking this agency a relatively long time to get a sharp focus on innovation.
The country has policies, regulations and legislation for promoting health research and innovation. 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.
Policy instruments include the National Health Research Policy and the National Health Act. According to these instruments, the government is expected to allocate at least 2 percent of total public sector health expenditure to priority research and the Department of Health was meant to increase its allocation to R&D from 0.5 percent to 1.5 percent of its total budget within three years from 2001. Currently the department spends less than 1 percent of its budget on research.
The challenge facing the government is to ensure the effectiveness of policies, regulation and legislation through their implementation. The government’s record on policy implementation is not good. This is manifested in long delays in approval of clinical trials. It takes about a year to obtain such approvals 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 half those in South Africa.
South Africa can reap substantial gains by learning from and collaborating with Brazil, China and India on ways of strengthening 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 created world-class laboratories, promoted the creation of local pharmaceutical companies, improved the regulatory infrastructure and reduced costs of conducting clinical trials. They have innovation-based health research policies and programmes.
South Africa should benchmark its investments in health research and innovation to those 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 percent of national health expenditure to health research. External funding accounts for less than 5 percent of the budget for national health research.
South Africa will host the next Brics health ministerial meeting in January. It would serve better if the meeting was dedicated to exploring specific ways and means by which the bloc can support South Africa in strengthening its 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 co-operation with the other Brics countries.
John Ouma Mugabe is a professor of science and innovation policy at the University of Pretoria’s Graduate School of Technology Management. Views expressed in this article are personal.