The second National Health Research Strategy Priority Framework webinar was held on the 25th of November 2022. This was a build-up session from the first one which was held only with the coalition members and other advocacy groups on the 19th of October 2022. This was aimed at increasing their understanding of NHRSPF. In this second session, we invited one of the committee members that drafted this policy to come through and enlighten the team on this policy document.
Our guest speaker was Professor Mushi Matjila. He is the Head of the Department of Obstetrics and Gynaecology, Groote Schuur Hospital, University of Cape Town. He has extensive experience as Consultant Obstetrician and Gynaecologist at tertiary level Groote Schuur Hospital and his clinical interests are embedded in High-Risk Obstetrics, Reproductive Medicine and Recurrent Pregnancy Loss. Professor Matjila’s research focuses on the molecular aspects of aberrant placentation, as well as maternal-fetal dialogue in placental-based disorders such as Preeclampsia, Recurrent Pregnancy Loss, Gestational Diabetes Mellitus and Assisted Reproduction. In particular, his research focuses on the reproductive roles of kisspeptin and angiogenic factors on trophoblast invasion and maternal immune tolerance. He is also a member of the Receptor Biology Unit at the Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town. Prof Matjila is current Chair of the Faculty of Health Sciences Research Equipment Committee (FEC), member of University Research Equipment Committee (UEC) and Senate member of the University of Cape Town. Prof Matjila is serving a second term on the National Health Research Committee (NHRC)- the Ministerial Advisory Committee on Research for Health and is current Chair of the Policy and Strategy Subcommittee of the NHRC.
Facilitating together with Professor Matjila was Sibusiso Hlatjwako. Sibusiso is PATH’s country representative for South Africa leading on advocacy and partnerships in the region, including serving as PATH’s liaison to the Africa Centre for Disease Control and Prevention (CDC).
Health Research priority setting is in itself a complex process but it does help researchers and policy makers in effectively targeting research that has the greatest potential for public health benefits. Like many countries South Africa has many health challenges and selecting ones that need to be addressed can be difficult. There are many different approaches that can be used for health prioritization, all of which have advantages and disadvantages. In September 2018 the NHRC held a National Health Research Summit, where they received input from different stakeholders and other important forum on priority setting for health. The policy was drawn up in 2001, and subsequently revised in 2011 and has just been revised again now in 2022. This has been submitted for review with the Minister of health and will be released soon. This SAHTAC second session was held to continue the discussion on priority setting for health.
Prof hence came through to reiterate and drive home the meeting’s main idea or theme. His talk outline was mainly to produce insights on the workings of the NHRC and the research for Health Priorities in the Republic. This included among other things he touched on:
- NHRC – Background
- NHRC Subcommittees & Workstreams
-Finances for Research for Health
-Capacity Building for Research for Health
- NHRC Summit Reports
- Health Research Priorities for South Africa
- Summary & Conclusion
NHRC – Background
There is a National Health Act 63 of 2003 and this act provides a framework for a structured uniform system within the Republic. It takes into account the obligations imposed by the constitution and other laws on the national, provincial and local governments in relation to health services, and all matters related to that. Within the Health Act, it prescribes that the Minister must establish a committee known as the National Health Research Committee (NHRC). The NHRC should consist of no more than 15 persons appointed by the Minister. This comprises of expertise across the health spectrum. The people appointed serve for a term of not more than three years but may be appointed for one or more terms. A member ceases to be a member upon resignation or when requested by the Minister to resign. The NHRC is an advisory committee to the Minister of Health, it makes recommendations and advises the ministry on direction. Their mandate is to determine the health research to be carried by the public health authorities; to ensure the health research agendas and focus research resources on priority health problems; to develop an integrated national strategy of health research and advise the minister on the application and the implementation thereof. Lastly, they co-ordinate the research activities of the public health authorities.
NHRC Subcommittees & Workstreams
There are 5 subcommittees within the NHRC, namely:
- Policy & Strategy: This has to do with revision of policies. Policies ought to be a dynamic process because the environment is changing, health challenges are changing e.g. we just had the impact of covid19. Thus, in drafting the policy, one needs to have a view of the national vision in terms of government vision around research and the legislative framework and also the global societies, for example the WHO policies and sustainable development. The policy should be broad enough to give us a broad guidance. Strategy looks at how to we achieve the vision. We can have both short term and long-term strategies in place.
- Priority Setting Committee: These deal with priority setting and the importance of it. They conduct and coordinate research that has an impact for the man on the street.
- Health Research Financing: This is important as it helps in the understanding of the funding landscape. It helps us understand how much we are spending on research; what we are spending on; what is being funded; whether what is being funded is a priority area or are we only funding areas of academic interest. Given that funding is external are we just doing research guided by who is funding? The health research financing committee looks at all these and works towards responding to the various aspects of finance.
- Health Research Resourcing: Health Research Resourcing talks to the human resource aspect, that is the people doing the research. The current landscape of who is doing research is largely academia that is aging. Capacity development then becomes an important focus for health research resourcing. What are we doing in terms of the future generation of researchers. It also talks about the infrastructural resource aspect, which is still a challenge, like the big laboratory equipment and administration needed to capacitate research.
- Monitoring and Evaluation: We need to monitor and evaluate what we do to see what we are focusing on and if is it being responsive to priority research needs.
Provincial Health Committee Structures (PHRCs)
The Provincial Health Research Committees are established in terms of the Health Research Policy in South Africa. PHRCs mandate is almost similar to that of the NHRC but operate at provincial level and thus work closely with the NHRC on research coordination and development of health research priorities. They coordinate health research by liaising with all research stakeholders conducting research within provinces, they manage the process of priority and assist in the development of health research priorities within the province and they review preliminary and final reports to give advice on policy implications of completed research projects. The PHRCs meet twice a year with NHRCs to present their activities, challenges and priorities.
NHRC Summit Reports
One of the key outputs of NHRC is to give direction. This direction is important, not only for the country but also when we have funders from outside the country who have no idea what to fund. These documents then come in handy to help give guidance on what needs financing. We get funders from the US, the grand challenge from Canada, funders from the UK etc.
Health Research Priorities for South Africa
The NHRC must identify and advise the Minister on health research priorities. In identifying health research priorities, the NHRC must take into consideration the following:
- Burden of Disease
- Cost-effectiveness of intervention aimed at reducing BOD
- Availability of human and institutional resources for implementation of intervention at levels closest to the affected communities. We need to ensure research is not concentrated withing the urban areas but are focused to where the communities are.
- Health needs of vulnerable groups (e.g. women, older persons, children and people with disabilities)
- Health needs of communities. The focus should be community health. Patience should not travel huge distances to access health facilities.
Priority setting exercises must consider the three pillars of process, tools, and context:
- The process of priority setting is not static, but should be continuous and cyclical, responsive to the changing health environment and local need; and involving a large number of stakeholders from both health and other sectors (including education, environmental affairs). The process should be objective, participative, and based on consensus. Appropriate preparation and planning is essential.
- Tools for priority setting include all the resources and instruments required to collect, organize, analyse the multiple information resources required to set priorities (including different metric for burden of disease measurement)
- The particular and complex sociopolitical, economic and cultural contexts within South Africa must be taken into account to ensure appropriate identification of priority areas. Results of priority setting exercises must be simple, clear and free of jargon in order for policy makers to fully understand the report, and therefore able to implement the results appropriately.
Summary & Conclusion
This looks at where we are going in terms of the previous policy. Below are the recommendations from the 2018 Summit:
- Prioritization of the social determinants for health, including the burden of disease for funding.
- Building capacity of health research human resources, along a pipeline, and inline with national transformation imperatives. This is imperative given the aging nature of the current academics. There is need to capacitate for young, black female researchers as well.
- Improving health research funding flows and quantification. The flows look at where the funding is going.
- Creating a national system of implementing health research with a national-provincial alignment of mandates including funding. Seeking to see a bottom-up approach with provinces understanding the nature of challenges within the provinces and that coming up filtering into NHRC.
- Creating an evidence-based system of health research information management through collation, monitoring, evaluation and translation of health research. What we do should really be directed by good evidence, evidence-based practices that impact on health, evidence-based information through collections and monitoring and evaluation. What is published should not be the end point. The end point should be what is the impact of what was published.
- Improving provision of and access to health research structure, especially in academic health complexes.
The session ended with a question-and-answer session which was guided by Sibusiso. Most of the questions and issues raised during the 1st session were answered during prof’s presentation and some he answered directly and also with the help of one the members of the Secretariate who was present in the session, Dr Malinga. Issues like donors pushing their agenda were resolved with the Prof stating that the summit reports give guidance as to what needs financing. The policy is not static and this was addressed. Policies ought to be a dynamic process because the environment is changing. The policy also comes to an end and a new policy will be implemented soon. There is however still a gap on the involvement of communities.