A Health Research Agenda for East Africa

Andrew Kitua
Former Director General, National Institute for Medical Research in Tanzania

Andrew Kitua is one of the people involved in shaping a health research agenda for East Africa. He explains how regional coordination and networking can substantially improve population health, how the region’s agenda should be set, and who should set it.

Why is it important that East Africa develops a health research agenda? Why now?

Because it helps us to focus our research. It sets the direction towards which we should direct our efforts and helps us allocate our limited resources better and measure our achievements. The end product will be clear. Now is the right time because the East African Community is being molded to form and allow innovations to its shape.

To what extent are countries in the region setting the agenda today?

With the establishment of the Regional East African Community, member countries are better positioned to set joint agendas. The East African Health Research Agenda, now in the process of being set up, is a good example. A proposal was circulated and shared among the countries. We witnessed that all countries agreed to the agenda, as we share the same problems and identify with the challenges that the agenda sets out to address. Before this, each country was setting its own agenda without consulting the neighbor. Now we are talking and putting issues on the table for discussion. The East Africa Health Research Commission is in the process of being established to coordinate all these efforts.

Today we have working examples of where we are cooperating and applying a common agenda in the area of integrated disease surveillance. The East African Health Desk coordinates these activities and we plan together and implement them together.

What are the ideal areas for cooperation between countries in the region on health research and ideal results of effective regional cooperation? How can regional cooperation solve problems in a better way than what is done at a country level?

Now that we have set the agenda, we must discuss together each agenda item and identify the common areas of interest, draw up a work plan with clear roles and responsibilities. To start with we are defining the priorities within each agenda items and planning together how to implement the plan and the resources required from each partner. For example: Agenda Item No. 1 is to establish a joint mechanism for research coordination, promotion and regulation. To act on this we have agreed to establish the East African Health Research Commission as the coordinating organ. This is an ongoing process. The partners have agreed and established two programmes under this mechanism: the Integrated Disease Surveillance and Regional East African Community Health Policy Initiative (REACH) and are working together to implement them.

We will discuss and prioritize actions under each of the seven items. For example, under Item 2 – Establish stronger collaboration in research and training – we will first identify research and training priorities. Then plan how we can do joint research and training.

The ideal results of this regional cooperation are:

  • Common policies and interventions in health
  • Greater impact in reducing the health and disease burden
  • Increased capacity to fight diseases and provide health services
  • Better health indicators of our populations like fewer deaths of mothers during delivery (Maternal mortality), fewer infant deaths and better nutrition status (indicating that that our populations are healthier)
  • The current level of stunted children is bad and we should aim to eliminate this condition so that we can have better performing citizens.

Regional cooperation will help us better solve common public health problems that we face. It pools resources and has greater impact. By harmonizing interventions, we can act concurrently – across countries – to prevent the spread of disease. As diseases know no borders, without coordination between countries, we allow disease to move freely across our regions, creating an endless battle. Regional cooperation gives us better strength to direct donor funding to our priorities and a stronger role in solving our public health problems.

What are the key issues to consider when developing a regional health research agenda?

Developing a research agenda involves discussion among member countries and prioritizing areas where we want to put our resources. We have limited resources to face a huge burden of disease. We cannot do everything, so need to define issues that can bring the maximum impact – then put our resources behind them. Combining resources across the region will bring a greater impact in a shorter time. For example, we can easily establish a high-level laboratory in one member country for joint use by members. Today, no member country alone has sufficient funds to establish such a facility. We can also increase the production of qualified health personnel by establishing joint training facilities where running costs are shared. Joint training also ensures harmonization of standards and practices across the region.

In your recent presentation to the first East African health and scientific conference you stressed networking. Why is it important for researchers in the East African community to network?

Networking is important because diseases don’t know borders. It helps us better inform our governments and policy and decision making processes, and reduces fragmentation or duplication of effort. Through networking we share knowledge and experience to develop common strategies and research activities. This transcends borders and national systems providing greater coverage of public health problems at regional level. A strategy based on networking and sharing of information ensures better control of diseases such as avian flu or the current rift valley fever. Without common activities and strategies we will create a situation where one country is controlling a disease and their neighbor is not, and it moves from border-to-border, dancing with us forever. With common strategies we solve the problem in a short time.

Are there examples of good networking that has made a difference in research in the East African region?

The East African Disease Surveillance Network is one good example. (www.eac.int/eaidsnet) In this network, by sharing information between countries, we learn of the occurrence of epidemics and take action more rapidly. Through another network, the East African Network for Monitoring Anti-malarial Treatment (www.eanmat.org) we have monitored malaria drug effectiveness in the region. When resistance occurs we informed policy makers immediately. The East African countries have been taking action based the results of research and information provided by these two networks.

What is your ideal scenario for networking, cooperation and science translation in the region?

It is one where we share ideas; formulate research questions and do research jointly between partner states. This approach can produce results that are strong, tangible and applicable in all our communities and the impact is felt throughout the region. This is what we should do.

Can you cite examples to make this idea come alive for our readers?

Yes. Artemether annua – the shrub from which the best anti-malaria treatment is made – grows in some East African countries such as Tanzania. However we have no local production of these drugs because it is very expensive to build these facilities. In East Africa we could easily join forces and contribute to the construction of such a facility in one of the member countries. This would produce cheaper drugs and enhance the agriculture sector for growing these shrubs as a cash crop and increase the income of our people.

How should donors better align to have health research focused on a research agenda in East Africa?

Currently each country has its own agenda and donors have theirs. If we do not have a common agenda and direction across the region we will definitely be pulled into the donor agenda, which is not necessarily the priority areas for our countries – and may not give us results we expect or societal benefits that our people would want to see. We should develop our agenda and request that donors put resources in what we believe is the best direction for our country and region.

What suggestions do you have for donors on how to better engage with countries so that their programmes in health research are more effective – individually and collectively – in their support of the national health research agenda?

Donors should respect the national and regional priorities and focus their funds to support these efforts. They should also make sure that they work within the established systems and involve local leadership in running any activities so that these activities are eventually integrated into the national and regional activities.

Who sets the research agenda?

The research agenda should be set by scientists and institutions in the East African community. This is our agenda! We know our problems, the challenges ahead and in which direction research should go. This is why we should jointly develop this agenda to support common regional research. By joining forces we will have better results than we are currently achieving.

Interview by Jennifer Bakyawa, COHRED, Kampala.

© Copyright Council on Health Research for Development (COHRED) and Andrew Kitua, Director General of the National Institute for Medical Research in Tanzania. Re-use and circulation of this text its current form, or referral to this text, is encouraged, provided the following credit is given: Interview published on www.cohred.org Perspectives on Research for Health. © Council on Health Research for Development (COHRED) and Andrew Kitua, Director General of the National Institute for Medical Research in Tanzania. For reuse in a publication, contact COHRED for permission. The Perspectives on Research for Health series is published in the interest of strengthening the voice of research for health in, by and for the ‘south’. The opinions expressed in these articles do not necessarily reflect the opinions or policies of COHRED. Interview by Jennifer Bakyawa, COHRED Kampala.