The National Health Research Strategy Priority Framework Workshop was held online as a Webinar on the 19th of October 2022. The main objective of the workshop was to conduct a retrospective explanatory analysis to examine the policy determination that is how the policy got to be on the agenda, how it was initiated and formulated, what the policy consists of (content) and also to know if it has achieved its goals through evaluation and monitoring of the policy. We also sought how as SAHTAC we can influence its implementation to advance its goals of accelerated access to health technologies.
Spearheading the session was Yolanda Moyo. She is head of Govt Affairs Africa at Illumina, based in Johannesburg South Africa. Yolanda is passionate about access to life saving health technologies by those who need them the most, she has spent most of her career advocating for equitable access to health and health technologies in Africa, inclusion of patients and civil society in policy making processes. She is a member SAHTAC and is currently leading the Positioning & Capacity Building Task Team.
The National Health Research Strategy Framework is a policy document that the Dept of Health has put together. This is a very key policy document that will assist us understand the prioritization of what govt considers as priority for research in SA and to understand from them how this policy document is being implemented. We also sought to understand how SAHTAC can play an influential role in shaping the document and its implementation. This was part 1 of the workshop. We intend to have a part 2 where we wish to invite the committee members of this policy to come through and further elaborate more on the policy.
Yolanda used a concept called, The Retrospective Policy Analysis. This is a policy triangle or framework used to dissect a very complex policy. It is a strategic way for us to understand how the policy was formulated, who the actors were, what the actual content and the process was. She spent time looking at the key areas of the NHRSPF policy to see how we will have a deeper dive with the committee members to understand if there’s things that need to be revisited and whether this policy is still relevant looking at the current situation.
As we analyse policies, there are a number of factors that we consider. Like context, content, process and the actors. Context is the situational positioning in the country, what is happening politically, for example lately there is a lot of frustration among citizens around loadshedding and water supply. In the last two years it was the covid19 pandemic. Structural factors are things that cannot change, like political structures or political parties. Cultural factors are people’s different cultural values in the country and lastly exogenous factors involves issues that are global/international that affect us as a country, e.g the war in Russia. This all shapes what the context is in terms of policy formulation.
How was the policy formulated and how did we come up with the content? Is there an implementation plan? What was the policy design and were there any specific objectives that they were trying to address through the particular policy.
The process has been well documented in terms of how the committee members and all the stakeholders came together to deal with some of the process issues, making sure that the provinces were consulted and making sure that various stakeholders had the opportunity not only to review the draft but also to add to what the priorities were going to be. It also follows the global trends in terms of how other countries have gone through this process.
There are a number of actors who are influential in terms of what goes into the policies. You find that there might be technocrats,’ people who come from academia, people who are well known researchers, policy makers are in charge of health research policy, these have a lot of influence and power. There are power dynamics that come into play as well.
The above is the process/framework in terms of policy determination. Researchers and policy makers became interested in priority setting for health research partly because of advocacy but also because in 1990, the commission on health research for development report was published. In this report they recommended and emphasised that each country should develop a strong national plan to conduct research that is responsive to the needs of its population. Before that all the research was really being determined by the agenda of the West though being done in Africa. This is the advocacy that has brought us to where we are now. This just gives us a little background of how we came to have this policy and how the discussions over the years came about.
As we looked at the document, we focussed on the national and provincial priorities. Here there seems to be a bit of a disconnect and we want to make sure that when we meet with the officials, we are asking questions that will help us understand this document better. We cannot have one provincial health plan to cater for all the 9 provinces in the country. The document listed the priorities for the country at national level looking at the feasibility and equity. We spent time looking at the COVID19 section. The covid19 section speaks mainly to what was happening at the time and was a national priority. But given where we are is this still a priority area for research? We had a discussion getting the thoughts of others in terms of prioritising some of these research areas considering where we are now with the pandemic.
HIV & TB
Besides COVID19, there is also HIV and TB. These are still priorities and we also need to make sure there is linkages between NSP and what is here in terms of research focus. Non-communicable diseases have also been put as priorities at national level.
The session was very interactive as members had questions that were answered and discussed. Below are some of the questions and this continued until end of the session:
Q Neetha Morar: Thanks Yolanda for the overview on policy analysis. Please also consider that research in SA is within the international context and often regulators and ethicists work in collaboration with colleagues in Africa. Does the policy and strategy address the benefit sharing from research?
- Sizwe Nombasa: If the policy will be updated at some point, rather than looking at COVID19, maybe if we can refocus on pandemic preparedness?
- A. Yolanda: At the time of the policy formulation, these were burning issues but now the pandemic is now at a management phase, therefore going forward there are other pathogens that are problematic that will need investment in.
Nomsa Mnisi: I agree with Nombasa as well. Currently in South Sudan the country is preparing and getting ready for Ebola virus. So important not to be diseases specific.
Q Neetha: A policy is an alive document, already the research is focused on the upcoming variant. The COVID vaccine platform is now being used to spearhead the HIV vaccine research and lastly focus is now on creating a local laboratory, a manufacturing skills plant. The policy has already moved the research in a different way.
A Yolanda: This is a very fluid document and is subject to change. Five years maybe too much of a gap as a lot happens during this time. If we can change the cycle of the document to three years perhaps. A constant periodic review of the policy is required as this is a document that is guarding a lot of things including funding and donors will fund according to your country priorities. But if the priorities are no longer relevant, then this will impact negatively.
Q Sakhile: How do we overcome donor-imposed priorities over our own priorities especially now that the funds are scarce?
A Yolanda: Donors come with their own agendas. It is important indeed that we have these priorities set. Donors should also fund what the country has determined as a priority. Our researchers will apply for funding everywhere, it is important however that we remain relevant. The pandemic has also helped in terms of investing locally in terms of manufacturing and the capacity for science, how our scientists can develop these vaccines themselves. They can even influence the global level.
Q Kevin Vollenhoven: Agree that we need to look at a strategy shift looking at leveraging research outcomes such as diagnostics dashboards, mRNA platforms and energy to address other disease
Q Neetha: How does this policy link to the Science Council in the country?
A Yolanda: One of the things a country should do is to make sure that it has a document that prioritises health research. There has to be infrastructure that should make sure these priorities are implemented. MRC and CSR, Academic Institutions, NGOs and Donors have a big role and are focused in helping the government achieve.
Q Kelvin Vollenhoven: But also think a lot of work needs to go into Basic research before we will realise these. e.g., for TB, from the SA Tb conference it’s clear that our understanding of disease construct has shifted from the 2nd stage, either active or latent, has broadened to multiple stages which affects our vaccine profiles. From SA TB prev study, 6 out of 10 people, who were asymptomatic tested positive for bacteriological confirmed TB which means that there are many people out there who miss out on diagnosis and effect treatment. We need to lobby for greater community voices in disease and research strategies.
The session ended with a lot of questions, some of which Yolanda attempted to answer but the rest we are hoping the second part of the workshop session will answer most of these unanswered questions. We are hoping the committee member coming through will address most of these raised issues about the policy. Yolanda attempted to break down the NHRSPF policy but it is clear that this remains a very difficult subject hence the need for the second session.