Governance and Stewardship of National Health Research Systems

1. Governance and Stewardship of National Health Research Systems Analysis and synthesis of survey results Dr Erica Gadsby

2. Stewardship – knowing where you are going, monitoring progress, and getting there safely

3. Methods • National level survey • Questions on policies, legislation, plans, coordination mechanisms, etc. • Responses from 43 countries • Institutional level survey • Mod 1000: questions on institutions’ history, sector, operational level, functions, leadership, etc. • Mod 2000: questions on institutions’ types and approaches to research, their scientific review policies & criteria, monitoring & evaluation, and collaboration. • Responses from up to 825 institutions in 44 countries

4. However, data enables an important and useful descriptive overview of functions related to stewardship Analysis and limitations • Basic descriptive and comparative analysis using SPSS. • Analysis complicated/limited because: • Data entered as string rather than numeric variables, and not disaggregated • Numerous gaps in the data (particularly in national survey) • Questionnaire sometimes answered incorrectly (missed skip patterns, etc.)

5. Stewardship and the health research system Priorities Vision Ethical standards Monitoring & evaluation

6. National health policy 84% • Strategic health plan 84% • National health research policy 28% • Strategic health research plan 16% Articulating a vision for health research Three quarters of those without an existing health research policy expressed interest in developing one – this indicates a lack of capacity, rather than willingness!

7. Communication and coordination is weak: Only 35% of countries have functional NHRS 1/5 have a functional HR management forum Level of stakeholder involvement is low Little evidence of planning External (foreign) influence on priorities is high Prioritising health research

8. Functional ERC 72% (but ¼ of these have no written terms of ref) Ethical standards 35% of countries have hospitals with ERCs to review all clinical research proposals 22% of institutions have written criteria for scientific review of proposals that address ethical review

9. Only 35% of countries have functional NHRS • National Scientific Review Committee 51% • Policy which includes vision for assessment of NHRS 16% Monitoring and evaluating the NHRS 43% of institutions have explicit or written requirement for the institution to undergo independent evaluation 29% of institutions have SRC that meets regularly

10. Range of institutions govt (30%); hospitals (18%); independent (13%); med schools (13%) Majority (64%) at national level Range of activities Submitting proposals (48%) Conducting health research (48%) Research priority setting (43%) Preparing scientific outputs (43%) Wide range of research topics and methods High level of applied research (75%) A rich and varied research culture

11. Conclusions • In many countries, there is no formal, articulated vision for health research – policies, plans and strategies are frequently either absent or out of date. • Absence of official health research policies in many countries means most will not have identified health research priorities. Stakeholder collaboration in policy development is rare. • The setting and monitoring of ethical standards appears to be a woefully neglected function. • Monitoring and evaluation is also neglected, both at country level and institutional level. • The broad range & types of research institutions, and of the research activities they contribute to, shows a good basis for the strengthening of research capacity in the African region.