Is donor dependency stifling African health research?

In the early days following the declaration of COVID-19 as a pandemic, opinions painted a gloomy picture of how the virus would ravage Africa — a continent whose health systems are the poorest globally.

The World Health Organization warned that 190,000 people on the continent could die in one year if containment measures failed. But almost a year later, a policy paper by the Africa Centres for Disease Control and Prevention, WHO, and other partners found that though the outbreak had devastated parts of Asia, Europe, and the United States, data from Africa showed “remarkably low numbers of reported COVID-19 deaths despite high levels of disease transmission.”

The paper called for more research and development investments that are “focused, timely, and unique to various geographies” to respond to the impacts of the pandemic. But African scientists and researchers say a lack of local funding and overreliance on donor-driven research has led to limited expertise in health research disciplines in Africa, which consequently has affected the continent’s ability to respond to the pandemic.

Catherine Kyobutungi, executive director at African Population & Health Research, or APHRC, said that there were no institutions in Africa that had money or people who could start doing modeling when the pandemic struck.

The lack of financial support for researchers in Africa has created an environment where important areas of health research do not have experts and resources, she added, which has affected the preparedness for epidemics and pandemics like COVID-19.

“There are very few institutions which have modelers just sitting there idle or money which can be repurposed,” she said.

Dependency on donor funding

A 2020 study found that Africa comprises 15% of the world’s population but bears 25% of the global disease burden and produces only 2% of the world’s research output. The study concluded that though African-led research has the potential to lead to health improvement and economic transformation, it needs to overcome significant challenges such as poor funding and research infrastructure.

Many countries in the continent are yet to ensure that health research or even research, in general, is budgeted for, and only a few countries such as Kenya allocate a certain percentage of their annual health expenditure to health research, Kyobutungi said. 

“There is still a lot to be done for African governments to realize that there is value in investing in research and development and not just tokenistic funding,” she said. “It has to be significant and sufficient.”

Because of poor funding from governments, universities and research institutions such as APHRC depend on donor funding. This leads to a high percentage of the funding being retained abroad despite research being done in Africa, according to Uzma Alam, who leads the biomedical and health sciences portfolio for the program known as Developing Excellence in Leadership, Training and Science in Africa.

As a result, the “science and development agenda for the continent has been defined from outside instead of within,” she said.

Kyobutungi agrees that the majority of funding is retained in the countries where the funding is coming from.

“You don’t give someone a million dollars, and 70% of it remains in the U.K., and yet the work is being done in three African countries. Those kinds of things are happening,” she said.

“It all boils down to donor funding,” said Henry Zakumumpa, a health researcher based in Makerere University, Uganda, who collaborates with scientists from the U.S. and Europe in his work.

“More often than not, big universities of the West, especially [those from the] U.S. and U.K. have a huge footprint in Africa through collaborations with local universities. It is easier for them to attract funding to conduct research here in Africa,” he said.

Expertise in health research disciplines in Africa is now limited to areas that can attract donor funding, Zakumumpa said. Adding that African researchers are reduced to data collectors and not principal investigators, and opportunities to collaborate with peers in Africa are scarce.

In recent times, however, Kyobutungi said there have been shifts towards ensuring that more funding gets to the countries where research is being conducted. Adding that more institutions are now measuring the strength of a research grant design on both science and equity.

“When a research grant is designed, the strength of the grant is not just how good the science is, but also how equitable the partnerships are, how much of the funding is actually going to the country where the data is being collected, and what role do the African or the Asian researchers play,” she said.

Local researchers have a greater understanding of the context of their country and cannot be compared to someone who has studied the country, Kyobutungi added.

“There are those things that are unwritten. There is the understanding that you grew up knowing the cultures, the barriers, what accountability exists, how the systems work, the bureaucracy,” she said.

Update, June 24, 2021: This article has been updated to clarify the attribution of a quote from Uzma Alam and the title of the Developing Excellence in Leadership, Training and Science in Africa program.