Research ethics policies and practices in health research institutions in sub-saharan African sountries: results of a questionnaire-based survey

Objective To describe the state of research ethics policies and practices in health research institutions in sub-Saharan African countries. Design A structured questionnaire was used to solicit information on research ethics from health research institutions. Setting Forty-two sub-Saharan African countries. Participants Key informants from the health research institutions. Main outcome measures Existence of institutional ethics review policies and mechanisms. Results About half (51) of respondent institutions reported having policies on research ethics and 58 had written policies requiring that researchers obtain informed consent of research participants. About one-third of respondent institutions (34) had established ethics review committees; 42 required that studies went through ethics review committees and 46 had linkages with national or regional ethics organisations. Regarding operating procedures for ethics review committees; 53 had adopted standard operating procedures. Less than one-quarter of respondent institutions reported having policies in place to monitor ongoing research. Of the institutions that monitored ongoing research; 34 did an annual ethical review and 74 required a periodic written report. Only 36 provided any type of ethics training for staff; including those conducting health research and those who were not members of the ethics review committee. Conclusions There are substantial gaps in the capacity of health research institutions in the WHO African Region to undertake ethical review of studies before; during and after studies conducted. There is a need to strengthen such capacity in order to ensure the well-being of individuals enrolled in studies and that of communities that host these studies

Surveying the knowledge landscape in Sub-Saharan Africa: Methodology

Objective To describe in detail the methods followed in each of the qualitative and quantitative surveys of national health information; research and knowledge systems and research institutions. Design Cross-sectional surveys. Setting National health information and research systems; and 847 health research institutions in 42 countries in the World Health Organization (WHO) African Region. Participants Key informants from health research institutions; ministries of health and statistical offices. Main outcome measures Stewardship; financing; ethics; human and material resources and output of health information and research systems. Results Key informants were used to collect data to assess national research systems in 44 countries in the Region. The same method was followed in assessing national information systems in 17 countries and knowledge systems for health in 44 countries. These assessments included a detailed review of the state of data sources in the Region and their effect on measuring progress on the health-related Millennium Development Goals. A concurrent survey employed a structured questionnaire (the WHO Health Research Systems Analysis Questionnaire) to assess the capacity of 847 health research institutions in 42 countries. Stewardship; financing; ethics; human and material resources and research output were assessed. Conclusions The logistics and resources involved in surveying the knowledge landscape in the 42 countries were substantial. However; the investment was worthwhile as the results of the surveys can be used to inform policy-making and decision-making; as well as to establish a regional database of national health information; research and knowledge systems

Resources, indicators, data management, dissemination and use in health information systems in Sub-Saharan Africa: results of a questionnaire-based survey

OBJECTIVE:To describe the status of health information systems in 14 sub-Saharan African countries of the World Health Organization African Region.DESIGN:A questionnaire-based survey.SETTING:Fourteen sub-Saharan African countries of the African Region.PARTICIPANTS:Key informants in the ministries of health, national statistics offices, health programmes, donors and technical agencies.MAIN OUTCOME MEASURES:State of resources, indicators, data sources, data management, information products, dissemination and use of health information.RESULTS:The highest average score was in the identification and harmonisation of indicators (73%), reflecting successful efforts to identify priority indicators and reach international consensus on indicators for several diseases. This was followed by information products (63%), which indicated the availability of accurate and reliable data. The lowest score (41%) was in data management, the ability to collect, store, analyse and distribute data, followed by resources - policy and planning, human and financial resources, and infrastructure (53%). Data sources (e.g. censuses, surveys) were on average inadequate with a score of 56%. The average score for dissemination and use of health information was 57%, which indicated limited or inadequate use of data for advocacy, planning and decision-making. CONCLUSIONS:National health information systems are weak in the surveyed countries and much more needs to be done to improve the quality and relevance of data, and their management, sharing and use for policy-making and decision-making

Expenditures on health research in sub-Saharan African countries: results of a questionnaire-based survey

Objective To estimate the sources of funds for health research (revenue) and the uses of these funds (expenditure). Design A structured questionnaire was used to solicit financial information from health research institutions. Setting Forty-two sub-Saharan African countries. Participants Key informants in 847 health research institutions in the 42 sub-Saharan African countries. Main outcome measures Expenditure on health research by institutions; funders and subject areas. Results An estimated total of US$ 302 million was spent on health research by institutions that responded to the survey in the World Health Organization (WHO) African Region for the biennium 2005-2006. The most notable funders for health research activities were external funding; ministries of health; other government ministries; own funds and non-profit institutions. Most types of health research performers spent significant portions of their resources on in-house research; with medical schools spending 82 and government agencies 62. Hospitals spent 38 of their resources on management; and other institutions (universities; firms; etc.) spent 87 of their resources on capital investment. Research on human immunodeficiency virus/tuberculosis and malaria accounted for 30 of funds; followed by research on other communicable diseases and maternal; perinatal and nutritional conditions (23). Conclusions Research on major health problems of the Region; such as communicable diseases; accounts for most of the research expenditures. However; the total expenditure is very low compared with other WHO regions

Research and its governance in health research institutions in Sub-Saharan African countries: results of a questionnaire-based survey

Objective:To describe governance and stewardship of research in health research institutions in the World Health Organization (WHO) African Region. Design: A structured questionnaire was used to solicit information on governance and stewardship from health research institutions. Setting: Forty-two Member States of the WHO African Region. Participants: Key informants from the respondent health research institutions in the respondent sub-Saharan African countries. Main outcome measures: Institutions' participation in setting the national health research agenda. Institutional research priorities; scientific reviews and governance structure. Results: During the previous 12 months; the heads of 49 of respondent health research institutions participated in the setting or coordination of national research priorities. The most frequently cited priorities for contributing to or performing research were improving health programmes; producing new knowledge; influencing health policies and conducting operational research. For 78 of respondent institutions; scientific review was required for research funded directly by the institution; and for 73 of respondent institutions; scientific review was required for research not funded by the institution. However; most respondent institutions did not have written policies or guidelines; either for the scientific review of proposals (70) or regarding conflict of interest on scientific review committees (80). Conclusions: Some health research institutions demonstrate good practice in terms of the establishment of structures and processes for governance and stewardship; many others do not. There is a need for the strengthening of the stewardship capacity of research institutions in the Region

The background to the Algiers Declaration and the Framework for its Implementation to Improve Health Systems

The Algiers Declaration on Narrowing the Knowledge Gap to Improve Africa's Health was adopted during a Conference held in Algiers; Algeria; in June 2008. The Conference; which brought Ministers from the African Region together with researchers; nongovernmental organizations; donors; and the private sector; renewed commitments to narrow the knowledge gap in order to improve health development and health equity in the Region. This paper describes the background to the Algiers Declaration and the Framework for its implementation and their signifi cance in assisting countries' eff orts to strengthen health systems in the Region