Nuffield Centre for International Health and Development

Governance and Stewardship of National Health Research Systems

Analysis and synthesis of survey results

Dr Erica Gadsby

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

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

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.)

However, data enables an important and useful descriptive overview of functions related to stewardship

Stewardship and the health research system

VisionPriorities

Ethical standards

Monitoring & evaluation

Articulating a vision for health research

National health policy 84%

Strategic health plan 84%

National health research policy 28%

Strategic health research plan 16%

Three quarters of those without an existing health research policy expressed interest in developing one – this indicates a lack of capacity, rather than willingness!

Prioritising health research

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

Ethical standards

Functional ERC 72%

(but ¼ of these have no written terms of ref)

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

Monitoring and evaluating the NHRS

Only 35% of countries have functional NHRS

National Scientific Review Committee 51%

Policy which includes vision for assessment of NHRS 16%

43% of institutions have explicit or written requirement for the institution to undergo independent evaluation

29% of institutions have SRC that meets regularly

A rich and varied research culture

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 methodsHigh level of applied research (75%)

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.