Low- and middle-income countries, especially in sub-Saharan Africa, bear the highest burden of poverty-related, neglected infectious diseases (PRNIDs) worldwide, yet health research originating from these regions remains very low. In addition to the devastating disease burden faced by many of these countries, the lack of public expenditure on health and the fragility of some health systems (as highlighted by the recent Ebola outbreak in West Africa) call for this gap to be addressed in order to provide a better evidence base for the treatment of infectious diseases in sub-Saharan Africa. In recent years, there has been a substantial influx of funding for clinical research and control programmes by many donor and research agencies, but there is a need for greater understanding of the challenges faced in creating research capacity in sub-Saharan Africa.
Ensuring the development of health research that meets the needs of people who live in countries most affected by PRNIDs is integral to alleviating their burden. The European & Developing Countries Clinical Trials Partnership (EDCTP), funded by the European Commission and established in 2003, has sought to address this through the development of new or improved drugs, vaccines, microbicides and diagnostics against HIV/AIDS, malaria and TB, with a focus on phase II and III clinical trials in sub-Saharan Africa. EDCTP aims to give African researchers the opportunity to “learn by doing”, to foster sustainable clinical research capacity through international collaboration between African partners, Europe and the United States, and regional collaboration, between African research institutes.
A recent study by RAND Europe, in collaboration with Bairds CMC and supported by EDCTP, mapped the landscape of PRNID research funding across sub-Saharan Africa through a review of the literature and interviews with policy makers, NGOs and researchers in 46 countries. As part of these interviews, respondents were asked to rank barriers to the development of clinical research in their country. Issues highlighted through the literature review and interviews included a lack of:
- funding,
- policymaker appreciation for the importance of research,
- human resources,
- research infrastructure,
- long term collaboration, and
- local peer-reviewed journals.
While a lack of funding for clinical research was cited as a major issue in the literature review and the primary barrier in our interviews, interview respondents often explicitly tied funding to the second most important barrier, a lack of policymaker appreciation for the importance of research. Interestingly, over 50 percent of respondents in over 60 percent of countries considered lack of policymaker understanding as an important barrier to the development of clinical research. A number of respondents highlighted that it was this lack of understanding which led to money being either unallocated or funds being allocated but not spent, and therefore associated with other barriers. Our report calls for training aimed at improving policymakers' ability to understand research findings, with the long-term aim of enabling them to make informed decisions when prioritising spending.
It is evident that equitable research collaborations between African and non-African partners hold the potential to have a significant impact on the development of clinical research capacity in sub-Saharan Africa. Nevertheless, we believe that developing clinical research in sub-Saharan Africa requires a more holistic approach that considers not only individuals and institutions concerned with clinical research but also the wider health and research systems in these countries. Efforts to strengthen capacity that encourages the active engagement of local policymakers, community-based organisations and other key stakeholders from different areas of the value chain, will be crucial to their sustainability. International donors to health research have a role to play in helping to improve the engagement of national policymakers in developing clinical trial capacity in their countries, particularly given the importance allocated to this barrier by many respondents.
Gavin Cochrane is an analyst at RAND Europe, focusing on innovation in a developing country context. His research specialties include health research capacity strengthening and research funding. Catriona Manville is a senior analyst at RAND Europe. Her research specialities include the implementation of research to address and improve societal challenges in the health and education sector.
Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.
