Kristin Palitza

BAMAKO, Nov 19 2008 (IPS) – Health experts and activists have heavily criticised African governments for failing to collaborate with civil society organisations (CSOs) on health research and health policy development.
Governments tend to perceive CSOs as a threat because they are independent, often critical of government and see their role as holding politicians accountable, health activists said during the World Health Organisation (WHO) Global Ministerial Forum for Health Research in Bamako, Mali. As a result, many governments ignore calls for public participation.

Civil societies are a missing voice in health research, said Thelma Narayan, public health consultant at the Centre for Public Health and Equity in India. Without inclusion of CSOs, African governments efforts to create sustainable health systems would fail, she said.

Working with CSOs plays a crucial role in making research relevant to communities.

With increased partnerships between researchers, governments and CSOs, the health agenda could be taken forward more efficiently and in a more equitable way, Narayan added.

Health activists believe that CSOs can increase the skills and capacity of local researchers and politicians by providing social and cultural perspectives on health research and systems. CSOs are also well positioned to translate research into action.
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In South Africa, for example, activist group Treatment Action Campaign (TAC) showed the impact that CSOs can have on research agendas when they pressured the South African government to halt its ethically questionable research pilot programme on nevirapine in pregnant, HIV-positive mothers at designated research sites in 2004, obliging the health department to provide the drug to HIV-positive, pregnant mothers nationwide.

Moreover, civil society can play a crucial role in communicating research to communities while at the same time ensuring that researchers will be in the know about communities needs and struggles.

Civil society should therefore inform and be involved in all levels of the health research process, including research design, identification of health issues, data collection, analysis of findings and advocacy, said Samuel Anya, deputy director of the Public Health Research and Development Centre (PHRDC) in Gambia. CSOs are ideally positioned to identify the gaps between research, policy and implementation [because they work closely with communities on the ground].

We need truly participatory processes. Research needs to be brought closer to communities and there should be no tokenism, he added, referring to governments who agree to public consultations with civil society but later ignore their inputs when drafting health policies.

According to Shyama Kuruvilla, researcher at London-based Overseas Development Institute (ODI), governments, especially in resource-strapped countries, can benefit from CSO participation in decision-making and there are legal obligations and human rights standards on the same.

The far-ranging determinants of health and societal development require collaboration across a range of societal actors [ ] and sectors in policy-making, said Kuruvilla, adding that much health policy is wrongly focused on the content of reform and neglects actors, such as CSOs, that could be useful to be involved in policy reform and inform the context in which policy is developed.

CSOs are indispensable when it comes to successfully implementing research and policies, especially on a grassroots level, agreed Ayo Palmer, director of the PHRDC.

However, in many African countries, research, policy-making and civil society initiatives remained separate sectors of society. A major concern is that in most countries, there is no clarity about how health research translates into national policies, she said.

It was also important that countries took control of their own research, rather than rely on international studies, to get outcomes and recommendations that can be locally implemented. Health experts agreed that for health and research systems to be sustainable in the long term, they needed to be nationally owned.

We need to develop local capacity for health research, with CSOs ensuring that governments keep the promises they make and forcing governments to take action, said Sam Kinyanjui, head of training of the Kenya Medical Research Institute. To date, Africa has the highest burden of infectious disease, yet the lowest [health research] capacity.

Unfortunately, African governments continue to rely on international research to make decisions on how to build and improve national health systems.

African governments commit less than ten percent to health research and tend not to meet many [national and international] commitments they make because these are not legally binding, lamented Ruth Oniang o, founder of the Rural Outreach Programme in Kenya.

Moreover, the public was not often enough informed about research initiatives and there was not enough transparency with regards to spending and what targets were being met. There is too little interest from government in public participation and civil society inputs are often ignored, she said.