Chapter 5: Essential National Health Research
White Paper for the Transformation of the Health System in South Africa

1. Background and Introduction

Historically, health research, as an integral component of the apartheid health system, has been fragmented, unco-ordinated and devoid of a clear research strategy. As a result health research has not been used for the development of an effective health system.

In keeping with the transformation of the health system, the Department of Health has introduced the concept of Essential National Health Research (ENHR), an integrated strategy for organising and managing health-related research. Using the full range of health research methodologies, its goal is to promote health and development in order to achieve equity and social justice.

2. Guiding principles

The strategy for ENHR will be based on three major principles, namely:

• The development of a research agenda that will address the country’s health problems, involving all major roleplayers as equal partners.
• The full range of health research methodologies, including epidemiology, health systems and policy analysis, must be used to address health problems. In addition, research priorities must be set by the stakeholders involved.
• Research must be relevant to health needs. It should aim at informing health planning, effective delivery, management and policy development.

3. Implementation Strategies

3.1. The development of a process for identifying a research agenda to address the country's major health problems

The process of setting research priorities must include all roleplayers, including community researchers and health service providers. Research agendas must be responsive to the country’s health needs.

3.1.1. The following guidelines will be used to set priorities:

• consideration of the overall impact, including the physical and psychological costs of disease on the individual, the family and the community at large;
• cost-effectiveness of interventions aimed at relieving the impact of disease;
• development of human resources to intervene at the community level;
• health priorities which reflect the communities' needs;
• health profiles.

3.1.2. The research agenda should:

• be goal oriented, and relevant to the country’s health problems;
• be cost-effective and aimed at improving the efficiency of health services;
• develop effective, high quality health delivery, planning, management and policy.

3.1.3. A task force will be formed to promote and facilitate the development of the ENHR process, in conjunction with the Chief Directorate: Health Information, Evaluation and Research.

3.1.4. Stakeholders must be identified and intersectoral functional networks developed.

3.1.5. A central information centre for health should be established to collect and collate data from all available sources inside and outside the country.

3.1.6. The Department of Health should co-ordinate public health research activities, to ensure that results and recommendations are disseminated and implemented.

3.2. Capacity development

Health research will aim at identifying mechanisms for improving health delivery, quality of care, and policy development. A culture of information-based decision making will be encouraged.

To achieve these goals, emphasis will be put on the following:

• The development of skills in the collection, compilation, interpretation and effective use of information. All major roleplayers, including health service providers, must be equipped with the necessary skills to help shape research agendas.
• The development of a culture of research and technology. To this end, government must ensure maintenance of the present research infrastructure, thereby contributing to the training of scientists and research technologists.
• The promotion of mentorship and modelling programmes.In addition, linkages must be established between historically advantaged and disadvantaged institutions to ensure the optimal development of research capacity.

3.3. Funding

Public health research activities will be co-ordinated by the Department of Health. This is to ensure that research results and recommendations are disseminated and implemented. Additional funding strategies will include:

• The implementation of a system of tendering for research which has been identified as a priority. The intention is to allow for a speedier redistribution of resources for health research.
• The development of an incentive-driven process to encourage more public health research.

4. Indicators of success

The successful implementation of the ENHR will be measured at the national, provincial and district levels. Result indicators will include:

• The existence of health systems research at all levels;
• Increased number of completed or ongoing health systems research projects;
• The existence of procedures to co-ordinate health research and policy implementation;
• A functional ENHR co-ordinating committe; and
• Functional research committees at provincial level.

5. Issues Raised in this Chapter

• One of the primary aims of the ENHR strategy is to develop relevant, responsive public health research agendas. It is unclear how key roleplayers will be identified. How, for example, will NGOs be able to contribute their analysis of grassroots issues? Will the necessary capacity be built in small organisations?
• It is unclear how communities themselves will be able to help shape research agendas. Community researchers and health service providers have been identified in the chapter as key roleplayers. No mention is made of the direct role and contribution of the communities themselves. To what extent will the ENHR strategy address the historical power imbalances between the researcher and the researched? What strategies are envisaged to allow communities to articulate their own research needs? Will communities have a say in, for example, the research methodology or research implementation strategies?
• How does the Department intend interacting with other departments involved in research, for example, Education; Arts, Culture, Science and Technology, the universities and other research institutions such as HSRC?

For more information, please contact Jane Mathieson or Bea Abrahams by telephone @ 021 - 6964954 or by fax @ 021 - 6969308 or by e-mail at philaw@wn.apc.org . The PHILA programme is funded by a grant from the Henry J. Kaiser Family Foundation.

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