The African continent bears a disproportionately high burden of globally significant disease but lags in knowledge to address its health challenges.
Benefits of African-led efforts
Major international funders have started to understand and appreciate the importance of shifting internationally-led research and capacity-building efforts towards more African-led models. Two specific examples of recent African-led funding initiatives include:
- a US $135 million funding through the Medical Education Partnership Initiative (MEPI) from 2010 to 2015 (supported by the United States’ National Institutes of Health (NIH) and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)
- a further commitment of approximately $180 million through the Human Heredity and Health in Africa (H3Africa) initiative from 2011 to 2021 (supported by the NIH, the Wellcome Trust and the African Academy of Sciences).
The reality is that Africans are often best placed to identify and contextualise Africa’s most relevant and pressing problems and providing information for the development of national and international partnerships tasked with originating and leading research agendas. While external support and collaboration is vital, political will and not necessarily further research, is needed to solve issues such as insufficient childhood vaccinations, inclusive community engagement and affordable quality primary and secondary education. Experts believe that scientific health research efforts and capacity on the continent will not improve or become sustainable without Africans increasingly taking a leading role.
The immediate benefits for African researchers are enhanced local ownership of activities and new opportunities for steady and sustained skills building of staff and trainees. This will hopefully lead to improved research outputs, including African-led first and senior author publications and grants awarded to African researchers.
When research is led by African scientists, not only may more locally relevant topics be targeted, but it will enhance the sharing of study findings in a cultural and policy context, more accessible and relevant to local populations. Recommendations from African-led studies may resonate better and have better uptake among African policy makers, compared to research results produced by largely internationally-led teams. In addition, African-led research will further increase opportunities for senior African scientists to act as role models for junior scientists, increase visibility of African scientists, facilitate South-South collaborations and strengthen African institutions. While external collaboration, knowledge exchange and financial support are critical to capacity building in Africa, with many tangible immediate benefits to existing collaborations, sustainable scientific development efforts on the continent will only happen if research and capacity building are led, managed and owned by its citizens.
Initiatives and Collaborations
In 2015, the Wellcome Trust launched the DELTAS Africa initiative in collaboration with the UK Department for International Development (DFID) and the Bill & Melinda Gates Foundation. DELTAS Africa is currently supporting 11 research consortia across Africa with an investment of more than $100 million over an initial period from 2015 to 2020, making it one of the most ambitious initiatives by a major international donor in biomedical sciences to channel significant funding to African-led research teams.
The key innovation of this initiative is that the Wellcome Trust has handed control and ownership to the African Academy of Sciences (AAS)‘s Alliance for Accelerating Excellence in Science in Africa (AESA), headquartered in Nairobi, Kenya and is also supported by the African Union Development Agency (AUDA-NEPAD). The aim is to base all aspects of African science and capacity building efforts on the continent – from conceptualisation of ideas, the implementation of the grant, to evaluation and management of the programme in its entirety. The DELTAS Africa initiative is currently in its final year of a 5-year funding cycle and the Phase II call for proposals has been announced (for the 2021–2025 cycle).
From observations and feedback to date, it is clear that the DELTAS Africa initiative is likely to be one of the most impactful efforts ever in terms of African research production, numbers and quality of African trainees and strengthening of African institutions with regards to knowledge translation and community and public engagement (CPE).
Sub-Saharan African Network for TB/HIV Research Excellence (SANTHE)
SANTHE is an African-led HIV and TB research and capacity building consortium, based at five primary sites in South Africa, Botswana, Kenya, Rwanda and Zambia. These received an investment of about $11.2 million over 5 years to carry out cutting-edge HIV/TB research, train future leaders of African science, develop strong institutional networks to facilitate research on the continent and facilitate effective CPE to ensure meaningful research translation and maximum community impact.
The goals of institutional strengthening and CPE cannot be overemphasised. It is critical to long-term sustainability of the DELTAS-funded programmes. From 2015 to the present, SANTHE has established a strong foundation with 119 peer reviewed publications during the past 4 years. A good level of success had been experienced by supporting the organisation’s Fellows to convert their scientific findings into manuscripts with 42 of these publications first-authored by SANTHE Fellows.
Females Benefit from Funded Programmes
SANTHE recruited 105 trainees from 10 different African countries, including 15 graduate interns, 38 Masters Students, 38 PhD students and 14 post-doctoral researchers with 64% of these being females. To date, 42 have completed their Fellowships, including 17 Masters Graduates, 3 PhD graduates and 4 individuals who have upgraded from Masters to PhD. These Fellows have given 82 presentations at international conferences. This group of individuals met annually at the ACM consortium meeting and provided feedback on an ongoing basis. Furthermore, continuous and systematic monitoring and evaluation of the effectiveness of our interventions have been provided and data used to assist in proposing new solutions or amend existing ones.
A potential expansion to 3 new partner sites in Cameroon, Zimbabwe and Uganda are in the offing. The current tools used, were evaluated and plans to produce new tools are planned. These new tools include development of a leadership development curriculum, intensive and holistic supervisor training, incorporation of a panel of experts to help guide CPE efforts and provision of an advisory committee for post-doctoral researchers.
An increasing number of scientific projects identified and led by African-based researchers will lead to publications with African-based scientists as first and last authors and increasing numbers of grant applications with African-based scientists as principal investigators (PI’s). Expanded local grant funding, infrastructure development and investment in training of science support staff will lead to the development of local research environments optimally supporting ongoing science and the scientists based therein.
Sustained external funding support will initially be needed, providing time and stability to establish a functional and sustainable programme and need to be combined with scientific collaborative support from non-African based researchers and laboratories. Over time, increasing levels of African government and philanthropic financial support for research on the continent hold the key to unlocking Africa’s scientific potential.
African-based Researchers empowered
Directly empowering African-based researchers involve identification and the support of locally-initiated and led efforts. The scientific concept sheets for proposed studies funded by SANTHE were developed by supervisors mostly based in Africa and peer-vetted by a team of three scientists based at the consortium secretariat site in South Africa.
Trainees are identified to work on selected projects following innovative and competitive recruitment procedures such as panel interviews, critique of an assigned manuscript, a written scientific proposal assignment and online abstract and numerical reasoning tests. SANTHE makes stipend and consumable support available for these projects, thus benefiting trainees and their supervisors, particularly more junior supervisors with worthy ideas but limited grant funding support. Although SANTHE benefits from non-African collaborating partners for scientific input, collaboration and assistance with training of Fellows, projects are mainly conceived and executed by African-based supervisors. Research is performed primarily in Africa, with students enrolled in African institutions of higher learning and in universities in well-resourced countries affiliated with SANTHE (if local facilities are not yet adequate). The second step towards directly empowering African-based researchers involves the inclusion of all scientists to support scientific efforts. One advantage of holding such a large and diverse capacity building grant is that it makes it possible to support initiatives that would normally be difficult to fund on their own.
Awards are generally given to junior investigators and involve researchers from a total of 23 different African sites. SANTHE has also awarded five Path-to-Independence (PTI) awards which provide critical bridge funding to support young scientists establishing themselves as independent investigators (often a critical bottleneck in a scientist’s career development pathway).
As an example, one PTI award-enabled former SANTHE post-doctoral researcher returned to his home country of Cameroon after spending eight years training in South Africa. In addition to establishing his own research programme, this award facilitated new collaborations and expanded the SANTHE consortium to include a second site in Francophone Africa. Overall, the investment SANTHE received has directly benefited African-based researchers by raising their profiles and that of their institutions and enabling them to directly identify and address problems, set a research agenda, supervise students on these projects on site, promote their careers in the process and directly impact local and international stakeholders. Crucially, one demonstration of the scientific impact of these efforts is that important discovery and policy impacting research has been performed within a short period of time.
Instead of identifying single talented individuals, consortium-level funding is able to invest in providing student stipends and research support to enable recruitment of a cohort of trainees at a site, providing an opportunity for peer support and interactions critical to sustaining research interest, increasing the numbers of scientists at one site and helping to avoid the frequently encountered challenge of working in relative intellectual isolation.
One critical component of high-quality training is skills development. Training is provided by in-house value-adding courses or workshops and partnering with key collaborators, including academic supervisors and internal manuscript and grant writing workshops in partnership with institutions such as Simon Fraser University and the Ragon Institute of MGH, MIT and Harvard to offer specialised courses with international faculty and trainees. This has proved to be a cost-effective approach, facilitated exploration of cutting-edge topics and approaches.
Another such course took place in January 2019 when SANTHE co-hosted a workshop on HIV reservoirs and evolution, (in collaboration with the Max Planck Society and with additional financial support from the Victor Daitz Foundation, a South African philanthropy), which brought together leading researchers in the field of HIV cure research and treatment failure and provided scientists with an opportunity to learn about the latest developments in this area and engage with other leading scientists. Examples of other course topics include CPE, biostatistics, phylogenetics and immunology.
Information Exchange and Collaboration
A pervasive challenge to scientific excellence in Africa is the lack of opportunities to meaningfully engage with peers and experts in one’s field of research. It is vital for scientists to have opportunities to exchange ideas and information to obtain critical feedback on their work and to partner on projects to facilitate the ability to address cutting-edge issues.
Another step towards effective capacity building is the development of strong collaborations in key areas including science, training, science support and community and public engagement. Effective cross-site collaborations are vital to address scientific questions as a consortium and catalysing research synergies. To help with this, collaborative grants and travel scholarships are key tools. Other examples of interaction with the global scientific community include hosting symposia and satellite sessions at international conferences. This is an important component to support the promotion of African science.
However, despite the reported success there are many challenges, such as:
- running a large-sized consortium;
- difficulty in implementing interventions easily across all sites due to diversity in site capacity or ethos of institutions;
- non-electronic communication issues;
- balancing merit and equity in funding allocations and
- the sustainability of consortia-level funding.
Although these challenges can be frustrating, invaluable experiences had been gained. Although there had been efforts in the past, now more than ever there is a need to explore how the lessons learnt through health research capacity building initiatives can be shared and harnessed most effectively to improve the design, evaluation, cost effectiveness and overall impact.
This knowledge sharing could continue through interactive meetings or conference with representatives from key stakeholders in capacity building initiatives in Africa, where participants can present best practices, lessons learned and ways to allocate resources more efficiently for greater impact. A valuable contribution to this process will be the findings of the DELTAS Africa Learning Research Programme (LRP), which aims to produce research-based learning from the DELTAS Africa initiative and investigate how best to train and develop world-class researchers and promote research uptake.
It is believed that the following are key target areas required to support the pathway for successful capacity building in Africa:
- Directly empowering African-based researchers;
- Offering quality training to large numbers of junior African scientists and support staff;
- Effective information exchange and collaborationand
- Continued and sustainable funding support.
There is no doubt that many challenges still need to be overcome. Existing programmes need to be evaluated and assessed. However, it is important that a long-term view in support of sustaining these programmes be promoted. Alternative funding mechanisms, such as local tax and philanthropies, must also be encouraged. Although increased investment in science by African governments is being made, sub-Saharan Africa still lags behind other global regions with countries, on average, spending only 0.4% of GDP on research and experimental development (R&D), in contrast with 2.5% GDP spent by North America and Western Europe. A target of 1% of GDP invested on R&D was set by the African Union. Some countries, including South Africa and Kenya, are approaching this 2025 target and are currently investing around 0.8% of GDP.
Increased domestic investment in research is needed to accelerate the long-term health and development progress required to meet the Sustainable Development Goals by 2030 and realise a critical local capacity and to create and sustain world-class research hubs to address Africa’s intractable health challenges. African-led research must eventually translate into African-funded research.
Experience suggests that African-led research has the potential to overcome the vicious cycle of brain-drain and may ultimately lead to improvement of health and science-led economic transformation of Africa into a prosperous continent.