Revitalising clinical research in South Africa
Consensus Study Report
Clinical research in a developing country like South Africa contributes to health care at all levels by identifying the causes of problems, facilitating diagnosis, improving the efficiency and effectiveness of care, and promoting good policy-making. It also supports the training of competent health professionals of all kinds, and contributes to global knowledge about locally, as well as generally, prevalent diseases in terms of prevention and treatment. The key narrative of clinical research in South Africa over the last two decades has been that of a largely unplanned, but cumulative, disinvestment in publicly funded programmes, resulting from the withdrawal of the health departments of provincial governments from this sector (academic hospitals are now funded for service functions only), the absence of discounts for research tests from the business model of the National Health Laboratory Service (NHLS), chronic underfunding of the Medical Research Council (MRC) despite its obviously important mandate for maintaining and developing medical/ clinical research capacity in the country, and the lack of funding streams to universities that might in principle have been applied to meet the overall shortfall in support. These intersecting developments are a kind of ’elephant in the room’, well known to all participants, but very poorly documented. Tertiary service units struggle to remain active in research, and to translate their expertise into improved health service. As a result, many clinical researchers have been left with no option but to turn to the pharmaceutical industry for the funding of those clinical trials in which the companies concerned have an interest, or to international donors who conduct large-scale, short-to medium-term, projects in South Africa, with local researchers drawn into international teams, often led by outsiders. The pharmaceutical investment is directed predominantly at the profitable areas of chronic diseases of lifestyle, mental illness and allergy, while most of the external donor funding is directed at the serious local HIV and TB pandemics. Local and international clinical conference activity has accordingly begun to reflect the agendas of donors and industry. There is little likelihood that continuation of the present situation is compatible with rebuilding and sustaining solid research capacity in the clinical domain, nor can the ideal of well-coordinated state support for a health system, built on the ‘intelligence’ of good clinical research, ever be realised. The serious decline in clinical research activity and capacity has prompted this study by ASSAf (http://www.assaf.org.za) in order to make recommendations on the overall revitalisation of clinical research in the country within the broad paradigm of essential national health research. An additional stimulus is the emphasis of government in its ten-year science and technology plan on the development of new medicines and other biologically useful agents (‘farmer to pharma’).