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Objective To describe human capacity and staff movement in national health research institutions in 42 sub-Saharan African countries. Design A structured questionnaire was used to solicit information on governance and stewardship from health research institutions. Setting Eight hundred and forty-seven health research institutions in 42 sub-Saharan African countries. Participants Key informants from 847 health research institutions. Main outcome measures The availability, mix and quality of human resources in health research institutions. Results On average, there were 122 females employed per respondent health research institution, compared with 159 males. For researchers, the equivalent figures were nine females to 17 males. The average annual gross salary of researchers varied between US$ 12,260 for staff with 5–10 years of experience and US$ 14,772 for the institution head. Of those researchers who had joined the institution in the previous 12 months, 55% were employed on a full-time basis. Of the researchers who left the institutions in the same period, 71% had a full-time contract. Among all those who left, those who left to a non-research sector and to another country accounted for two-thirds. Conclusions The study revealed significant gaps in the area of human capacity development for research in Africa. The results showed a serious shortage of qualified staff engaged in health research, with a dearth of staff that held at least a master’s degree or doctoral degree. Major efforts will be required to strengthen human resource capacity, including addressing the lack of motivation or time for research on the part of existing capable staff.

Objective To identify key data sources of health information and describe their availability in countries of the World Health Organization (WHO) African Region. Methods An analytical review on the availability and quality of health information data sources in countries; from experience, observations, literature and contributions from countries. Setting Forty-six Member States of the WHO African Region. Participants No participants. Main outcome measures The state of data sources, including censuses, surveys, vital registration and health care facility-based sources. Results In almost all countries of the Region, there is a heavy reliance on household surveys for most indicators, with more than 121 household surveys having been conducted in the Region since 2000. Few countries have civil registration systems that permit adequate and regular tracking of mortality and causes of death. Demographic surveillance sites function in several countries, but the data generated are not integrated into the national health information system because of concerns about representativeness. Health management information systems generate considerable data, but the information is rarely used because of concerns about bias, quality and timeliness. To date, 43 countries in the Region have initiated Integrated Disease Surveillance and Response. Conclusions A multitude of data sources are used to track progress towards health-related goals in the Region, with heavy reliance on household surveys for most indicators. Countries need to develop comprehensive national plans for health information that address the full range of data needs and data sources and that include provision for building national capacities for data generation, analysis, dissemination and use.

Objective To assess the state of national health research systems of countries in the World Health Organization (WHO) African Region. Design A questionnaire-based survey Methods Structured questionnaires were used to solicit health research systems’ relevant information from key informants in each country. Setting Forty-six Member States of the WHO African Region. Participants Key informants from the ministry of health in each country, with the support of WHO Country Offices. Main outcome measures Presence of national health research policy or strategy, priority setting and ethical review of research. Results Of the 44 responding countries, 39 (89%) reportedly had an official national health policy and 37 (84%) had a strategic health plan. A total of 16 (36%) countries reportedly had a functional national health research governance mechanism, nine of which had clear terms of reference; nine (20%) countries had a functional national health research management forum. Functional ethical review committees were reported in 33 countries (75%). Conclusions National health research systems were weak in the countries assessed. Significantly more resources should be allocated to strengthening these systems.

Objective To describe the state of research ethics policies and practices in health research institutions in sub-Saharan African countries. Design A structured questionnaire was used to solicit information on research ethics from health research institutions. Setting Forty-two sub-Saharan African countries. Participants Key informants from the health research institutions. Main outcome measures Existence of institutional ethics review policies and mechanisms. Results About half (51%) of respondent institutions reported having policies on research ethics and 58% had written policies requiring that researchers obtain informed consent of research participants. About one-third of respondent institutions (34%) had established ethics review committees, 42% required that studies went through ethics review committees and 46% had linkages with national or regional ethics organisations. Regarding operating procedures for ethics review committees, 53% had adopted standard operating procedures. Less than one-quarter of respondent institutions reported having policies in place to monitor ongoing research. Of the institutions that monitored ongoing research, 34% did an annual ethical review and 74% required a periodic written report. Only 36% provided any type of ethics training for staff, including those conducting health research and those who were not members of the ethics review committee. Conclusions There are substantial gaps in the capacity of health research institutions in the WHO African Region to undertake ethical review of studies before, during and after studies conducted. There is a need to strengthen such capacity in order to ensure the wellbeing of individuals enrolled in studies and that of communities that host these studies.

Objective To describe the mechanisms and systems of knowledge acquisition, creation, diffusion, application and improvement of knowledge in two layers of the health system: health policy formulation and the provision of clinical services. Design A questionnaire-based survey. Setting Health research institutions in 46 countries of the World Health Organization (WHO) African Region. Participants Key informants in ministries of health and health care institutions in 39 countries of the Region. Main outcome measures Existence of knowledge management infrastructure or components of infrastructure in the countries of the Region. Results Central national bodies are always cited as having a major role in policy-setting. Non-national bodies most frequently provide advice and act in monitoring and evaluation, while decentralised entities are strongly involved in dissemination, implementation, and monitoring and evaluation. In general, ministries tend not to have an explicit knowledge management framework and do not map knowledge sources and flows for policy-making. The main sources of evidence are guidelines or recommendations from international or national agencies, although systematic reviews are rarely used. Routine monitoring and evaluation of quality and effectiveness of the process of policy development and its implementation was reported in 19 of the 39 respondent countries. In most respondent countries, electronic medical records were rarely used. Conclusions As systematic reviews are rarely utilised as a source of evidence in policy development and few mechanisms exist to assess the performance of the policies, there are significant opportunities for improving policy development.

Objective To describe and analyse research output from surveyed national health research institutions in Africa. Design The survey used a structured questionnaire to solicit information from 847 health research institutions in 42 countries of the World Health Organization African Region. Setting Eight hundred and forty-seven health research institutions in 42 sub-Saharan African countries. Participants Key informants from the health research institutions. Main outcome measures Volume, type and medium of publications, and distribution of research outputs. Results Books or chapters for books accounted for the highest number of information products published (on average 16.7 per respondent institution), followed by patents registered in country (8.2), discussion or working papers (6.5) and conference proceedings (6.4). Publication in a peer-reviewed journal constituted only a minor part of research output (on average about 1 paper per institution). Radio and TV broadcasts on health research accounted for the highest number of products issued by institution staff (on average 5.5 per institution), followed by peer-reviewed journals indexed internationally (3.8) or nationally (3.1). There were, on average, 1.5 press releases, 1.5 newspaper or magazine articles, and 1.4 policy briefs per institution. Over half of respondent institutions (52%) developed briefs and summaries of articles to share with their target audiences, 43% developed briefs for possible actions and 37% provided articles and reports upon request. Only a small proportion of information products produced were available in institutional databases. Conclusions The research output of health research institutions in the Region is significant, but more effort is needed to strengthen research capacity, including human and financial resources.

Objective To describe in detail the methods followed in each of the qualitative and quantitative surveys of national health information, research and knowledge systems and research institutions. Design Cross-sectional surveys. Setting National health information and research systems, and 847 health research institutions in 42 countries in the World Health Organization (WHO) African Region. Participants Key informants from health research institutions, ministries of health and statistical offices. Main outcome measures Stewardship, financing, ethics, human and material resources and output of health information and research systems. Results Key informants were used to collect data to assess national research systems in 44 countries in the Region. The same method was followed in assessing national information systems in 17 countries and knowledge systems for health in 44 countries. These assessments included a detailed review of the state of data sources in the Region and their effect on measuring progress on the health-related Millennium Development Goals. A concurrent survey employed a structured questionnaire (the WHO Health Research Systems Analysis Questionnaire) to assess the capacity of 847 health research institutions in 42 countries. Stewardship, financing, ethics, human and material resources and research output were assessed. Conclusions The logistics and resources involved in surveying the knowledge landscape in the 42 countries were substantial. However, the investment was worthwhile as the results of the surveys can be used to inform policy-making and decision-making, as well as to establish a regional database of national health information, research and knowledge systems.

Summary Objective: To describe governance and stewardship of research in health research institutions in the World Health Organization (WHO) African Region. Design: A structured questionnaire was used to solicit information on governance and stewardship from health research institutions. Setting: Forty-two Member States of the WHO African Region. Participants: Key informants from the respondent health research institutions in the respondent sub-Saharan African countries. Main outcome measures: Institutions’ participation in setting the national health research agenda. Institutional research priorities, scientific reviews and governance structure. Results: During the previous 12 months, the heads of 49% of respondent health research institutions participated in the setting or coordination of national research priorities. The most frequently cited priorities for contributing to or performing research were improving health programmes, producing new knowledge, influencing health policies and conducting operational research. For 78% of respondent institutions, scientific review was required for research funded directly by the institution, and for 73% of respondent institutions, scientific review was required for research not funded by the institution. However, most respondent institutions did not have written policies or guidelines, either for the scientific review of proposals (70%) or regarding conflict of interest on scientific review committees (80%). Conclusions: Some health research institutions demonstrate good practice in terms of the establishment of structures and processes for governance and stewardship, many others do not. There is a need for the strengthening of the stewardship capacity of research institutions in the Region.

Objective To estimate the sources of funds for health research (revenue) and the uses of these funds (expenditure). Design A structured questionnaire was used to solicit financial information from health research institutions. Setting Forty-two sub-Saharan African countries. Participants Key informants in 847 health research institutions in the 42 sub-Saharan African countries. Main outcome measures Expenditure on health research by institutions, funders and subject areas. Results An estimated total of US$ 302 million was spent on health research by institutions that responded to the survey in the World Health Organization (WHO) African Region for the biennium 2005–2006. The most notable funders for health research activities were external funding, ministries of health, other government ministries, own funds and non-profit institutions. Most types of health research performers spent significant portions of their resources on in-house research, with medical schools spending 82% and government agencies 62%. Hospitals spent 38% of their resources on management, and other institutions (universities, firms, etc.) spent 87% of their resources on capital investment. Research on human immunodeficiency virus/tuberculosis and malaria accounted for 30% of funds, followed by research on other communicable diseases and maternal, perinatal and nutritional conditions (23%). Conclusions Research on major health problems of the Region, such as communicable diseases, accounts for most of the research expenditures. However, the total expenditure is very low compared with other WHO regions.

Objective To describe the status of health information systems in 14 sub-Saharan African countries of the World Health Organization African Region. Design A questionnaire-based survey. Setting Fourteen sub-Saharan African countries of the African Region. Participants Key informants in the ministries of health, national statistics offices, health programmes, donors and technical agencies. Main outcome measures State of resources, indicators, data sources, data management, information products, dissemination and use of health information. Results The highest average score was in the identification and harmonisation of indicators (73%), reflecting successful efforts to identify priority indicators and reach international consensus on indicators for several diseases. This was followed by information products (63%), which indicated the availability of accurate and reliable data. The lowest score (41%) was in data management, the ability to collect, store, analyse and distribute data, followed by resources – policy and planning, human and financial resources, and infrastructure (53%). Data sources (e.g. censuses, surveys) were on average inadequate with a score of 56%. The average score for dissemination and use of health information was 57%, which indicated limited or inadequate use of data for advocacy, planning and decision-making. Conclusions National health information systems are weak in the surveyed countries and much more needs to be done to improve the quality and relevance of data, and their management, sharing and use for policy-making and decision-making.

Objective To describe the current status of institutional facilities and the supporting research infrastructure of surveyed health research institutions in Africa, including information on communication technologies and connectivity, library resources, and laboratory operations and resources. Design A structured questionnaire was used to solicit information on institutional facilities at health research institutions. Setting Health research institutions in 42 sub-Saharan African countries. Participants Key informants from 847 health research institutions. Main outcome measures The availability of laboratory, information and communication, and library facilities in health research institutions. Results Less than half of the respondent health research institutions had computer laboratories (49%), network computers (50%) and information technology support (38%). More than two-thirds (67%) had a library. Electronic subscriptions to international journals were observed to be very low, with an average of three subscriptions per institution. Almost two-thirds of the surveyed institutions (69%) reported having laboratories, about half of which (55%) were accredited nationally. Linkages and research collaborations were generally weak, particularly those with other laboratories in the Region. Challenges included financial and human resource constraints and the inability to communicate effectively with partners. Conclusions Health research institutions in the Region have insufficient access to essential facilities such as laboratories, libraries, computers and the Internet to generate, access and share information.

Gaps in health knowledge, where essential answers on how to improve the health of the people in the Region are missing. This is an issue related to the generation of health information or evidence. . Failure to apply all existing knowledge to improve people’s health, which is often referred to as the ‘know-do gap’. This is related to the issue of sharing and translation of health information, research evidence or knowledge.

Whether global health interventions target diseases (vertical), systems (horizontal) or both (diagonal), they must address the challenge of delivering services in very remote areas of poor countries with inadequate infrastructure. The primacy of this challenge has been underscored by persistent service-delivery difficulties despite several large financial commitments – the latest, US $363 million in the January 2012 London Declaration. Community-driven approaches, pioneered in river blindness control, show that engaging communities can maximise access and performance. This experience should inform a paradigm shift in disease control whereby communities are empowered to extend health service access themselves.