1. Nuffield Centre for International Health and Development Governance and Stewardship of National Health Research Systems Analysis and synthesis of survey results Dr Erica Gadsby

2. Stewardship – knowing where you are going, monitoring progress, and getting there safely

3. Methods National level survey Questions on policies, legislation, plans, coordination mechanisms, etc. Responses from 43 countries Institutional level survey Mod 1000: questions on institutions history, sector, operational level, functions, leadership, etc. Mod 2000: questions on institutions types and approaches to research, their scientific review policies & criteria, monitoring & evaluation, and collaboration. Responses from up to 825 institutions in 44 countries

4. Analysis and limitations Basic descriptive and comparative analysis using SPSS. Analysis complicated/limited because: Data entered as string rather than numeric variables, and not disaggregated Numerous gaps in the data (particularly in national survey) Questionnaire sometimes answered incorrectly (missed skip patterns, etc.) However, data enables an important and useful descriptive overview of functions related to stewardship

5. Stewardship and the health research system Vision Priorities Ethical standards Monitoring & evaluation

6. Articulating a vision for health research National health policy 84% Strategic health plan 84% National health research policy28% Strategic health research plan16% Three quarters of those without an existing health research policy expressed interest in developing one – this indicates a lack of capacity, rather than willingness!

7. Prioritising health research Communication and coordination is weak: Only 35% of countries have functional NHRS 1/5 have a functional HR management forum Level of stakeholder involvement is low Little evidence of planning External (foreign) influence on priorities is high

8. Ethical standards Functional ERC 72% (but ¼ of these have no written terms of ref) 35% of countries have hospitals with ERCs to review all clinical research proposals 22% of institutions have written criteria for scientific review of proposals that address ethical review

9. Monitoring and evaluating the NHRS Only 35% of countries have functional NHRS National Scientific Review Committee51% Policy which includes vision for assessment of NHRS 16% 43% of institutions have explicit or written requirement for the institution to undergo independent evaluation 29% of institutions have SRC that meets regularly

10. A rich and varied research culture Range of institutions govt (30%); hospitals (18%); independent (13%); med schools (13%) Majority (64%) at national level Range of activities Submitting proposals (48%) Conducting health research (48%) Research priority setting (43%) Preparing scientific outputs (43%) Wide range of research topics and methods High level of applied research (75%)

11. Conclusions In many countries, there is no formal, articulated vision for health research – policies, plans and strategies are frequently either absent or out of date. Absence of official health research policies in many countries means most will not have identified health research priorities. Stakeholder collaboration in policy development is rare. The setting and monitoring of ethical standards appears to be a woefully neglected function. Monitoring and evaluation is also neglected, both at country level and institutional level. The broad range & types of research institutions, and of the research activities they contribute to, shows a good basis for the strengthening of research capacity in the African region.