1. EXPENDITURES ON HEALTH RESEARCH IN AFRICAN COUNTRIES, 2005 Prepared for the Algiers Ministerial Summit on Health Research June 2008

2. Monitoring financing for health research: Current status? –US$125.8 billion -- world spending in 2003 –US$4.1 billion -- low- and middle- income countries (LMIC) spending in 2003 – Very limited data on African countries Why track financial flows? –At institutional level – to apply knowledge on flow of funds, to enhance negotiations and research management –At country level – to better influence the level and use of funds, to obtain the best impact from health research, to document within National Health Accounts –At global level – to advocate support for research that impacts on the health of LMIC

3. This presentation reports on findings: Health research expenditures estimate, Africa 2005 Health research funding by source Research expenditures by expense item Research expenditures by research topic Other findings Main data source: Health Research System Institution Survey in 44 African Countries (WHO 2007)

4. SAMPLES OF HEALTH RESEARCH INSTITUTIONS WITH EXP.DATA SAMPLES OF HEALTH RESEARCH INSTITUTIONS BUT NO EXP. DATA Location of Sample Institutions: Health Research Systems Institution Survey, 2007

5. Finding 1: At a minimum, spending for health research in Africa in 2005 is estimated at US$517.5 million. Represents roughly 13% of the 2003 total spending in Low- and Middle- Income Countries for health research –US$4.1 billion – 2003 spending in LMICs (estimate by the Global Forum for Health Research) Represents about 1.3% of the combined Total Health Expenditures (THE) of the 36 African countries covered

6. Estimate of Health Research Expenditures in African Countries, 2005 Type of Estimate and Estimation Approaches Health Research Institutions 2005 Estimated Health Research Expenditures (in million US$) Total in the countries indicated Number with 2005 spending data Relatively Complete (based on combined information from NHA and survey) -- 11 countries (includes Ethiopia, Kenya, Malawi, Mali, Namibia, Nigeria, South Africa, Uganda plus Burkina Faso, Tanzania and Zimbabwe) 60784408.7 Partial (based only on data from the survey) -- 25 countries (includes Algeria, Benin, Botswana, Burundi, Cote dIvoire, Cameroon, Central Africa, Chad, Comoros, Congo, Democratic Republic of Congo, Eritrea, Gabon, Ghana, Guinea, Liberia, Mauritania, Mauritius, Mozambique, Niger, Senegal, Seychelles, Swaziland, Togo, Zambia) 72182108.8 No Estimate (no NHA and survey data missing) -- 8 countries 16800 ESTIMATED TOTAL 1,496166 US$517.5M

7. Finding 2: Funding sources for research institution activities reflect functions and operational structures. Medical schools and hospitals research are partly funded by own internally generated funds. –These institutions, as service providers, receive fees for services rendered. Government agencies research expectedly rely on government budgets Hospitals, medical schools, independent research institutions and NGOs rely heavily on rest-of-the-world (row) or donor funds

8. 71.3% 88.5% 71.1%

9. Analysis perspective: by type of institution across the region Government agencies Hospitals Independent research institutions Medical schools Other institutions – NGOs, Charities Other – universities, other business firms, pharmaceutical companies

10. Finding 3: Most research institutions do research activities in-house and through contracts to individual persons. NGOs and other institutions spend more than 1/3rd of their resources on research contracts to individual persons Only independent research institutions report significant contracting of research work to other research institutions Management cost to total research spending: –about 2 percent (government agencies and hospitals) –11 percent (independent research institutions)

11. 71.2% 77.9% 65.3% 96.8% 61.7% 47.1% 45.4%

12. 71.2% 77.9% 65.3% 96.8% 61.7% 47.1% 45.4%

13. Finding 4: Most research topics are given funding by at least one type of health research institution. Research on conditions, prevention and treatment of TB, HIV/AIDS and malaria accounts for significant shares of expenditures of most institutions –Shares range from 1/10 of hospital expenditures to 1/3 of expenditures of government agencies, medical schools and other/NGOs Research on innovative practices and product development is getting the least funding (only in hospitals)

15. Other Findings: As a first-time effort, the conduct of the institution survey served two purposes –Provide new information, set "minimum" baseline and fill some data gaps –Provide insight and lessons about what needs to be improved in similar future surveys Next steps –Further analysis to provide estimates at country level where sample appropriate –Inputs within a NHA sub-guide on estimating health research funding in LMIC

16. Other Findings: Issues that need to be addressed to improve data quality and response rate particularly to the Financial Module of the survey –Respondent issues Are institutions in fact keeping track of what they do in financial terms? Are institutions willing to share financial data? How can sharing of financial data be promoted? –Questionnaire design issues How can the design of the Financial Module questionnaire be improved to encourage and facilitate its accomplishment & integration within NHA tools? Is there a better or simpler way to track health research performer expenditures by research topic?

17. Thank you! Merci! Obrigada!