Africa Healthcare: Commitment and Research Required
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| A mother in a hospital ward Photo courtesy |
The EAC has lost on time since its tragic collapse. However, lost time can both be a cost as well as an opportunity; in our case, more of an opportunity to learn from our history of integration and to take advantage of ever becoming more in tune with current relevance as well as responding to new demands and challenges in a more unique and enabling environment. The EAC can build on its past and turn it into a force for good, for the present. Specifically in the field of health care and research for health, the Treaty establishing the EAC offers an institutional platform as well as the political framework to get this new challenge moving more robustly.
The EAC views the importance of putting effective health service delivery systems and health research at the heart of regional cooperation and integration. Article 117 and 118 of the Treaty recognise this imperative. These treaty provisions put emphasis on joint action towards the prevention and control of communicable and non-communicable diseases including pandemics and epidemics; the promotion of management of health delivery systems and their better planning; the harmonisation of health policies across the board; and the joint use of health research outputs.
One of the key drivers of Africa’s social and economic development, best realised through the vehicle of regional integration, is the reduction of the burden of disease. In his recent magisterial book, Common Wealth: Economics for a Crowded Planet, Jeffrey Sachs postulates, that amongst the four basic types of investment required to enable the poor world escape from poverty, is health, “including control of the main killers-infection, nutritional deficiencies, and unsafe child birth-through the provision of preventative and curative health services.”
In its Africa Health Strategy 2007-2015 policy document adopted by the African Ministers of health in Johannesburg in April, 2007, the African Union equally recognises this linkage. Whilst Africa’s population is 10% of the world population, Africa bears 25% of the global disease burden. Yet Africa has only 3% of the global health workforce. Moreover, only two out of the 53 AU Member States have been able to meet the 2007 Abuja Declaration (on HIV/AIDS, Tuberculosis and other related infectious diseases) benchmark of allocating at least 15% of national budgets to health care. Less than 10% of the African population is under social protection, whatever the form of health insurance.
Evidently, the burden of disease and its grave implications to the realisation of the Millennium Development Goals by 2015 is worrisome when viewed in the context of two troubling factors: first, the challenge of population growth in Sub-Saharan Africa. Whilst the world population has risen from 2.5 billion in 1950 to 6.6 billion in 2007, Sub-Saharan Africa’s population has quadrupled in the same period, from 180 million to 820 million. This population growth has not been in tandem with growth in people’s incomes. Second, the challenge of climate change which is wreaking havoc on food security because of frequent and unpredictable droughts and floods. In turn, malaria and infectious diseases, especially vector-borne, are hugely climate influenced and regulated, especially in the tropics. Thus, the challenge of tackling poverty could never have been more onerous and arduous.
Africa has to promote a strategic policy and approach that views the burden of disease from the context of underdevelopment and mal-development. It is not sufficient for political leaders and policy makers to deal with health issues as if they were isolated from the broad issues of economic growth, good governance, democracy and social stability.
Admittedly, Africa’s record in healthcare provision has not been satisfactory. Whilst commitments to addressing the broad development problematique and, in turn, the health burden, have been well propagated at policy level and declarations of intent, such proclamations have rarely found serious implementation on the ground. At the heart of the apparent quagmire has been the inadequacy of budgetary funds. It is difficult to doubt or question this state of affairs when many Sub-Saharan African countries remain stuck in dependency syndromes with at least 40% of their recurrent budgets, on average, being paid for by development partners! However, important as such funding deficit for better health care for all is, what now troubles many right thinking people in Africa is the new wave of a disease burden emerging. This is the burden that is imposed on African governments and, painfully, on the pockets of the poor by and through counterfeit generic drugs.
It estimated that in the East African Community region, as much as 70% of the generic drugs sold in the drug stores and pharmacies are counterfeit. The percentage may not be scientific; what is evidential, however, is that container loads of counterfeit Panadol Extra and Metakelfin drugs have been intercepted by the Food and Drugs Authorities in Kenya and Tanzania respectively in the past one year. Surely, at a time when free or insurance-based universal health care is yet to be fully realised in our region and ordinary folks have to rely on their meagre earnings and savings to buy essential and life saving medicines, the logic about State commitment to health care can be thrown overboard by a high propensity of counterfeit drugs in the marketplace.
This new challenge is diversionary in terms of better utilisation of scarce resources. In fact, it dovetails State capacities to earn optimum revenues necessary in enabling universal health care to become a reality. The resulting pertinent question, of course, is: how is the counterfeit menace being handled and tackled by the State authorities? Is it adequately realised that efforts at implementing the African Union Declaration that economic production of quality pharmaceutical products and drugs be promoted in Africa are, by default or omission, undermined by counterfeit drugs? How can commitment to scaling up health care delivery be realised in an environment where essential drugs are counterfeits? Where are the punitive laws to combat counterfeits? Is enforcement effective? These questions should form part of the measures Governments put in place in promoting health care for all. They are also questions of relevance to the private sector which is supposed to play a major role in the realisation of health care objectives in our societies.
At the level of the East African Community, efforts are underway in addressing the counterfeit menace. The problem has been well analysed, from a policy and practice angle, and the EAC is now at the stage of drafting a draconian law, to be passed by the East African legislative Assembly early next year, to curb counterfeits across the board.
Turning to health research or research for health, the picture, in so far as Africa’s commitment to health research is concerned, is not any different from that of health care generally. There is no African- wide health research as such. The African Union has merely called for multi-country collaboration in health research which is to be undertaken through the Regional Economic Communities (RECs, such as the EAC). The assumption is that the RECs have a policy framework for promoting such collaboration, which is not the case in many RECs as their policy focus and priorities differ.
The EAC is one of the few RECs in Africa that have a strong health research policy focus, that is well defined in its Treaty. Indeed, it has mainstreamed, in its calendar of activities, Annual Health Scientific Conferences which bring together policy makers, including Ministers of Health, and top researchers focusing on selected key health research projects under investigation and on research results thereof, as well as on health care systems and delivery challenges. These conferences have become a key source of information and knowledge sharing. The 4th such conference will be held in Kigali, Rwanda, from 31st March to 2nd April, 2010.
The African Union has recently engaged in advancing the translation of health research into policy and action, described as evidence informed policy network (EVIPNet-Africa). Launched in Brazzaville in March, 2006, this programme is the brainchild of eight AU member states. In the past three years, efforts have been made to scale up the policy network throughout Africa. Once operationalised on a continental scale, the network will form a strong basis for health research collaboration and exchange of health research outputs. However, what would be interesting to determine is how the programme would be funded.
Presently, Africa is yet to reflect serious commitment to allocating adequate resources to fund health and other scientific research. The African Union has set a benchmark of 2% of national recurrent budget expenditure and 5% of health development budget for health research at national levels. However, only few African countries have been able to fulfil such benchmark. Tanzania has recently scaled up state investment in research and development from 0.3% to 1.0% of GDP. This move should be hailed but it is yet to come close to the AU benchmark which is focused on research for health per se and not on R&D generally.
At the EAC, we have seen the importance of developing an institutional health research framework and capacity. Of course, this has been propelled by a strong history in collaborative health research. With the support mainly of the Canadian and Swedish Governments, the EAC started the East African Community Health Policy Initiative (REACH) five years ago to promote joint efforts in determining priority areas for health research. Through this mechanism, the idea of constituting a full fledged EAC Health Research Commission emerged. A Protocol was developed to enable the Commission be created and we are now at an advanced stage of enacting a law, through the EAC Legislative Assembly, which will outline the Commission’s mandate and institutional structure.
As the EAC proceeds to establish these institutional arrangements for health research, on a regional scale, there is much health research work that is on-going through the coordination of the EAC Secretariat and the Sectoral Council of Ministers of Health from all the five Partner States. Whilst funding at national levels has been an issue for health research, the EAC, on the other hand, has been well endowed in such funding, which partly attests to the confidence development partners have on collaborative work at regional level. In this context, the EAC is managing and co-ordinating a number of health research projects and programmes encompassing HIV/AIDS especially mobility-induced vulnerabilities and gaps in harmonised responses with focus on the Lake Victoria Basin region; cross-border human and animal disease prevention and control, strengthening capacities of the Partner States on Trade-related intellectual property rights in pharmaceutical production, sexual and reproductive health and rights, drugs regulation and harmonisation of pooled bulk procurement, e-health integrated disease surveillance and response, Avian influenza etc.
The EAC has a funding portfolio of over US$ 24 million over the next five years. Whilst we closely work and collaborate with a number of institutions such as University Medical Schools and Colleges, Research Centres, AMREF and the WHO, the critical challenge we face is one of co-ordinating capacity at the EAC secretariat level. This is why it is important and urgent that the East African Community Health Research Commission is soon established.
The EAC will be looking forward to working with the EDCTP and other partners in building the capacity of this Commission and supporting it in promoting clinical health research. Of concern, however, is the lifespan of EDCTP beyond 2010. It is hoped that the European Commission and other development partners will see the importance of extending EDCTP’s life span. Also important is for the African Union to find more sustainable ways of funding institutions of the calibre of EDCTP.
Africa’s commitment to health and research would be of little meaning if research is not translated to productive use. Africa faces a huge challenge in so far as its infrastructure is concerned for commercialisation of health research findings. To start with, our health researchers lack the right and modern laboratories to undertake advanced research. Indeed, one of the reasons for the brain drain involving the best and the brightest in the African health sector is this lack of state of the art facilities for clinical and health research work. These deficits partly explain why Africa only produces 1.5% of the world’s scientific knowledge measured by articles published in peer reviewed international journals. In turn, Africa produces even fewer of the world’s patents, which is the best measure of product innovation.
Based on patents for inventions registered with the US Patents Office, the patents coverage, between 2003 and 2007, shows that South Africa had 98 patents. This is the highest figure in Africa. But it only constitutes 0.06063% of the world’s total during the period. The average for selected 16 African countries, totalling 115.8 patents, including South Africa, was 0.07164% of the world’s total. This poor scientific performance is also explained by the weak links between African Universities, research centres and industry.Recently, the UN Economic Commission for Africa took up the challenge of addressing this weak link. In March, 2008, it organised an African Science to Business Challenge Initiative Conference in Addis Ababa specifically to seek solutions to it. The results would have to be awaited for.
Africa faces a number of challenges of a political, social, economic and, now, increasingly, of an environmental and climate change nature. One of these serious challenges is the health of millions of the world's poor. But it is a challenge that is part of a larger conundrum and should thus be addressed from a broader social and economic context.
Amb. Juma V. Mwapachu,
EAC Secretary General.