Blog “Issues Relating to Healthcare Research in Sub-Saharan Africa: How Can Research Capabilities be Enhanced Through Development Cooperation?”

Researchers at the JICA Ogata Sadako Research Institute for Peace and Development (JICA Ogata Research Institute) have wide-ranging experience and diverse backgrounds, and they are forging partnerships with varied stakeholders and partners. This series of blog posts shares the knowledge and perspectives they have acquired through their research activities. This blog post was written by Isono Mitsuo, an advisor to JICA’s Human Development Department. He participated in the JICA Ogata Research Institute’s project titled “Situation Analysis on SARS-CoV-2 Infection Using a Seroprevalence Survey in Democratic Republic of Congo.”

Author: Isono Mitsuo
Advisor to JICA’s Human Development Department

Every country must appropriately develop healthcare policies based on its own disease burden, epidemiological characteristics, racial and ethnic factors, and other aspects to aptly and effectively provide healthcare services to its citizens. Research-based evidence creation and evaluation are vital for the achievement of these objectives. This applies to all countries, including developing nations. However, the volume of health-related research has been extremely limited in developing countries. In the 1990s, developing countries reported 90% of the global mortalities from preventable diseases but received only 10% of the overall international funding for healthcare research (Franzen, 2017). Much of the research-related insufficiencies could be attributed to the lack of interest of developed nations in public health-related issues or diseases specific to developing countries, especially infectious diseases. Therefore, the paucity of existing research does not entirely reflect the insufficient research capabilities of developing countries, but the importance of enhancing the research capabilities of developing countries has been highlighted for years. The problem is not merely technical; it encompasses diverse issues such as the lack of research personnel with sufficient research abilities to occupy leadership positions, a dearth of research systems in the state (including funding and regulatory systems), and the absence of administrative abilities required to manage the implementation of research activities. Diverse cooperation efforts have been undertaken to address these issues and reinforce the healthcare research capabilities of developing nations with a particular focus on personnel development, especially in Sub-Saharan Africa (Franzen, 2017; Kasprowicz et al., 2020).

The methodologies utilized to enhance research capabilities in general are listed below along with some examples of their deployment by JICA:
(1) The so-called “vertical approach” of researching specific diseases is used to provide single target disease support. For instance, this would include JICA’s technical cooperation grounds research activities that form part of the agency’s vertical programs.
(2) Joint research is undertaken by different research institutions. One example would be the ongoing Science and Technology Research Partnership for Sustainable Development (SATREPS).
(3) Research facilities are upgraded to centers of excellence. Some examples include the improvement of national and community research sites such as the Kenya Medical Research Institute (KEMRI), the Noguchi Memorial Institute for Medical Research in Ghana, and the Institut National de Recherche Biomédicale (INRB) in the Democratic Republic of the Congo. The JICA Ogata Research Institute also conducted a COVID-19 research project titled “Situation Analysis on SARS-CoV-2 Infection Using a Seroprevalence Survey in the Democratic Republic of Congo.”
(4) Personnel are developed through international student programs (Franzen, 2017; Kasprowicz et al., 2020). To cite an example, JICA’s foreign student program focusing on infectious disease countermeasures provides training opportunities for disease control experts. A growing number of students can leverage diverse opportunities presented by national governments and private sector foundations such as the Partnership for Building Resilience against Public Health Emergencies through Advanced Research and Education (PREPARE). They can obtain degrees from national universities and research institutions in the West and other developed countries.

Consequently, some progress is also evident in human resource development. The research capabilities of developing countries are improving, to some extent because of such efforts, and the number of research papers is rising dramatically (Scimago Journal and country ranking).

However, these initiatives have also produced certain serious negative effects. In particular, the vertical approach and joint research programs listed above as the first two categories encompass diverse strategies. For instance, development cooperation agencies can become directly involved in collaborative initiatives, or research institutions such as universities can conduct scholarly investigations with purely academic objectives and without directly linking research projects to development-related cooperation. Normally, research activities performed using any of the mentioned approaches are conducted in conjunction with local research institutions. In certain cases, research institutions in developed countries can undertake research projects entirely on their own. However, such solo initiatives do not help to enhance the capabilities of local institutions in developing countries. Thus, the involvement of local institutions is often stipulated for the approval of research projects. The donor institution decides on the content of the research program and takes the initiative in joint research projects. However, local institutions can rarely control the planning, management, and implementation of research projects even when they secure the funding and lead the studies. Therefore, the projects do not reflect local needs in many cases. Further, local institutions must often surrender all intellectual property rights to the results of joint research projects. I have worked in collaboration with KEMRI, INRB, and other research institutions in Nigeria and Guinea. The local research leaders in each of these institutions share the sentiment that they cannot engage in the research projects they would like to prioritize when they undertake joint research programs with overseas partners.

It is sometimes difficult to apply research results to policies because studies do not address the issues that are of high priority to the concerned developing nation. However, there are also numerous other difficulties relating to feedback. For example, two new medicines were approved for use in the treatment of Ebola virus disease after joint clinical trials performed in collaboration with INRB. However, neither of these products is commonly used in the Democratic Republic of the Congo, where the clinical trials were performed, or anywhere in Africa, because of business reasons. Instead, the U.S. is stockpiling these drugs for emergency use (Torreele et al., 2023).

Although there is some variation among countries, research capabilities have advanced to some extent, primarily through personnel development. The progress made in recent years necessitates the development of a system that would allow African nations to take the initiative in conducting research that serves their national and community needs. The need for such a system is becoming even more urgent given the recent inequalities noted in the distribution of vaccines to African nations during the COVID-19 pandemic (Adepoju, 2022; Titanji & Pai, 2023).

A project titled “Situation Analysis on SARS-CoV-2 Infection Using a Seroprevalence Survey in the Democratic Republic of Congo” was conducted as a part of the COVID-19 research conducted by the JICA Ogata Research Institute and the INRB of the Democratic Republic of Congo. This project aimed to deliver data essential for the adoption of COVID-19 countermeasures in the Democratic Republic of Congo. The INRB did not hold enough funds to conduct the research project on its own despite the dire need for this information. The INRB was, on the other hand, able to develop research protocols, conduct research, analyze data, and write research papers. The institution also possessed the requisite capabilities to arrange research content based on its needs and interests and could conduct sample-based collaborative research projects with other research institutions.

This project represents just one example. However, developing countries still cannot perform research based on their needs or apply their research findings despite the substantial progress that has been made. This inability is largely the product of financial rather than technical difficulties. The reality is that the governments of developing countries can allocate only 0.42% of their GDP to all research and development fields, which is far below the world average of 1.7% (as of 2019) (Adepoju, 2022). Therefore, the funds available for healthcare-related research are correspondingly restricted, and domestic research institutions depend on joint research with foreign partners. For example, Kenya is second only to South Africa among all African nations in terms of the percentage of GDP utilized for research and development (Index mundi). However, KEMRI, Kenya’s most advanced medical research institution, has long received support from Japan. In fact, it depends on foreign institutions for 90% of its funding. In such cases, the overseas research institutions that provide funding can also claim the right to select research themes and contents. Therefore, the research conducted is often a poor match for the priorities and needs of the respective developing countries.

The governments of developing countries must designate sufficient funds for research to address such problems. However, realistically, this goal will not be achieved for quite some time. Meanwhile, research institutions must strive to acquire proposal-based competitive research funding if they desire to conduct autonomous research based on their requirements. This task is not always easy and entails three steps: (1) building a track record of collaborative research with overseas research institutions, (2) acquiring competitive research funding in conjunction with overseas research institutions, and (3) acquiring competitive research funding entirely on their own. This is a long process, and even KEMRI, which does a high level of research compared to other institutions in the Sub-Saharan region, is only now advancing from step (1) to step (2). INRB remains on step (1).

The need to continuously develop personnel who stay up-to-date with the rapid advances in research technologies represents another difficulty. Foreign student programs operated by various nations and support organizations enable many students to receive degrees in other countries such as Japan. However, overseas study is currently primarily handled on an ad hoc basis, with individuals making personal applications, including applications for scholarships. Support funds and scholarships apply their own restrictions, so research institutions cannot systematically send students abroad at the organizational level to study to update their research technologies. Further, students must obtain degrees and engage in postdoctoral work or advance their careers overseas if they aim to learn state-of-the-art research technologies and then lead research projects in their home countries. The researchers I met who had leadership positions in Africa and displayed advanced research abilities previously held postdoctoral or higher positions overseas, but very few people fit this profile. Organizations that generally implement overseas study programs and those applying for such programs to develop their careers do not adequately recognize the importance of postdoctoral work. Moreover, postdoctoral positions are very limited, and it is not easy to secure one. Only 20%–30% of the students from KEMRI who earn doctoral degrees from overseas institutions progress to postdoctoral work.

What actions should development cooperation agencies adopt to help developing countries continually cultivate research personnel and acquire competitive research funding?

The healthcare-related research conducted or supported by development cooperation agencies is focused on practical issues, not on specific academic interests (unlike academic institutions such as universities). Therefore, the outcomes of research funded in this way are relevant to the healthcare policy formulation and implementation of the respective funding countries. To become more effective, when supporting research, organizations must determine high-priority local needs and ensure the utilization of the research results in advance to the responsible authorities, such as health ministries. In addition, a track record of research output (such as academic papers) must be created when research is conducted or supported by a development organization. Also, a research protocol must be applied to include improvements in research capabilities as an aspect of the research outcomes.

Specifically, personnel development can be focused on acquiring new research skills by conducting research, but this approach presents certain drawbacks. Significant monetary investment is needed to develop researchers capable of conducting scholarly investigations that include the development of vaccines and new drugs using advanced technologies, which is an especially high-priority area for developing countries. Development cooperation agencies must coordinate with universities and research institutions to implement scholarship programs for developing countries in accordance with the needs of individual developing nations and establish programs that extend to postdoctoral work.

Such steady activities are needed, and the Sub-Saharan African countries (including the African Union) are also beginning to make their own individual efforts. Hopefully, these endeavors will function organically and enable African nations to conduct independent research projects that will improve health indicators and contribute to the reduction of poverty in this region of the world.

Adepoju, P., 2022. Africa’s future depends on government-funded R&D, https://www.nature.com/articles/d44148-022-00134-4 (accessed September 18, 2023)

Franzen, S.R.P., Chandler, C., Lang, T., 2017. Health research capacity development in low- and middle-income countries: reality or rhetoric? A systematic meta-narrative review of the qualitative literature. BMJ Open, 7, e012332.

Index mundi, Research and development expenditure (% of GDP) - Country Ranking: https://www.indexmundi.com/facts/indicators/GB.XPD.RSDV.GD.ZS/rankings (accessed September 18, 2023)

Kasprowicz, V.O., Chopera1, D., Waddilove, K.D., Brockman, M.A., Gilmour, J., Hunter, E., Kilembe, W., Karita, E., Gaseitsiwe, S., Sanders, E.J., Ndung’u1, N., 2020. African-led health research and capacity building- is it working? BMC Public health, 20, 1004-114.

Scimago journal and country ranking., Country ranking. https://www.scimagojr.com/countryrank.php, (accessed October 1, 2023)

Titanji, B.K., Pai, M., 2023. Leveraging the positives from the pandemic to strengthen infectious disease care in low-income and middle-income countries. Lancet Infectious Disease, 23, 354-357.

Torreele, E., Boum II, Y., Adjaho, I., Biaou Alé, F.G., Issoufou, S. H., Harczi, G., Okonta, C., Olliaro, `P., 2023. Breakthrough treatments for Ebola virus disease, but no access—what went wrong, and how can we do better? Lancet Infect Di, 23, e253–58.

Note: This blog expresses the individual views of the author, not the views of JICA nor of the JICA Ogata Sadako Research Institute for Peace and Development.

About the Author:
Isono Mitsuo is an advisor to the Human Development Department at JICA. He worked as a clinician in a university hospital, where he was engaged in medical practice, education, and research before assuming his current position in 2009. He participates in planning and monitoring healthcare-related projects.