Preventing and Mitigating AIDS in Sub-Saharan Africa Research and Data Priorities for the Social and Behavioral Sciences (1996) / Chapter Skim
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7 BUILDING CAPACITY FOR AIDS-RELATED RESEARCH
7 BUILDING CAPACITY FOR AIDS-RELATED RESEARCH
Pages 251-270
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From page 251... ...
It is worth noting that although the focus of this chapter is on capacity building for HIV/AIDS-related research, many of the obstacles identified here are also hindrances to optimal management and implementation of AIDS prevention and mitigation efforts.) For further discussion of the obstacles to implementing successful AIDS-prevention programs, see N-Galy et al.
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Data Sources This chapter draws on two types of information: (1) existing documents, including evaluations of national AIDS control programs conducted in the late 1980s and early l990s; and (2)
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Within each country, the panel interviewed individual researchers and representatives of various research units, nongovernmental organizations, donor agencies, and government offices. The panel acknowledges that this fieldwork does not provide an exhaustive assessment of the state of AIDS research and prevention and control programs throughout subSaharan Africa, but it does provide some indications of the pertinent problems.
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Furthermore, social and behavioral research has received a relatively small share of the available resources, despite the fact that experts both within and outside the behavioral sciences agree that traditional health education messages are insufficient to induce widespread behavior changes (Mann et al., 19929. A recent review of all HIV/AIDS-related research cataloged on MEDLINE over the period 1983-1989 identified more than 20,000 papers on HIV/AIDS-related research, of which only 2,299 (11 percent)
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Second, AIDS research priorities in subSaharan Africa must now compete with similar demands for funding created by emerging AIDS epidemics in other parts of the world, particularly Latin America and Asia. Third, the priorities of foreign donors may be inconsistent with those of a country's national AIDS control program, so that research priorities established in a country are either underfunded or not funded at all.
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256 PREVENTING AND MITIGATING AIDS IN SUB-SAHARAN AFRICA TABLE 7-1 Research and Data Collection Priorities in Tanzania Level of Priority Tanzania National AIDS Washington AIDS Area Control Program (AIDSCAP) Project Research Innovative behavior change and N H H communication interventions Links between prevention and care N H H Workplace structure and interventions N H H Women in stable relationships: N H L approaches to sexual safety Male responsibility in sexuality and family N N H Social and economic factors in HIV risk H H L Behavioral consequences of policy (e.g., N H H medical barriers to STD care)
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However, research projects that had been funded were established outside Tanzania rather than in collaboration with Tanzanians, and their objectives were not always consistent with the priorities established by the national AIDS control program in 1991. In Uganda, the Uganda AIDS Commission recently complained that funding of donor-driven priorities has led to an overemphasis on large-scale studies and an excessive concentration of resources in a small area of the country, leaving many other districts, cultures, and target groups understudied (Uganda AIDS Commission, 1992J.
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The lack of manpower results, in part, from the lack of emphasis placed on training AIDS researchers by national AIDS control programs and other Sunders, - low wages, and a decline in the quality and availability of higher education in the decades preceding the epidemic (as discussed further below)
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Some African government officials view such donor policies as "biased towards the use of costly external technical assistance with little or no consideration of local capacity building to ensure sustainability of programs" (Msiska, 1994:161. Moreover, persistent reliance on expatriate technical assistance personnel is extremely expensive compared with the cost of hiring local nationals; thus it drives up the cost of conducting research in Africa and leaves fewer resources for other purposes.
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Thus, there is an urgent need to change work practices and standards on international collaboration research projects and to reestablish a social contract that links pay to productivity. With the knowledge that AIDS will continue to plague sub-Saharan Africa for many years into the future, it becomes clear that donor agencies would maximize the return on their investment in AIDS research in sub-Saharan Africa by placing greater emphasis on developing an indigenous research capacity relative to utilizing foreign expertise.
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In a small number of countries, such as Uganda and Zimbabwe, there have been recent efforts to develop annotated bibliographies, specifically on published social and behavioral research results (Olowo-Freers and Barton, 1992; Bylmakers, 1992~. In Tanza 3A total of 559 AIDS-related research projects were identified in 35 sub-Saharan African countries.
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Lack of Research-Needs Assessment and Difficulty of Coordinating Funding from Multiple Sources Few African countries have undertaken a needs assessment for social and behavioral research or established research review boards to prioritize and coordinate research proposals. Consequently, the potential for inefficient use of resources and overlap of activities is considerable.
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Among these sources are (1) national AIDS control programs, which allocate small percentages of their annual budgets to AIDS research (Mann et al., 1992)
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Furthermore, given the many problems facing sub-Saharan African governments, the problem of AIDS may not appear as immediate as other social issues, a perception that may, in part, explain their attitude toward the disease. In Zaire, the government did not establish a national AIDS control program until 1987 or report AIDS cases to WHO/GPA until 1988, even though a well-known research team in Kinshasa had been presenting papers at international AIDS conferences as early as 1985 that showed hundreds of confirmed cases of AIDS in the country (Mann et al., 1992~.
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Since independence, the priority of sub-Saharan African governments has been to expand the number and size of universities without sufficient regard to their quality. Consequently, the growth in the number of university graduates has been spectacular, but the quality of education offered has fallen dramatically (World Bank, 1988~.
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These measures have seriously impaired the ability of sub-Saharan African health ministries and national AIDS control programs to function effi
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In 1985, the average per capita expenditure for health care by sub-Saharan African governments equalled US $5.32, as compared with per capita expenditures of US $1,340 in developed countries and US $323 for the world as a whole (World Bank, 1994~. Low Value Placed on Social and Behavioral Research An appreciation of the multifaceted cultural, social, and behavioral contexts throughout sub-Saharan Africa and how they are changing in the face of the AIDS epidemic is essential for understanding the spread of the epidemic and for evaluating the potential effect of intervention programs (see Chapter 2~.
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Linkages with international organizations, especially if built on an evolving and well-defined research agenda, can help local institutions develop and assist local researchers by providing relatively secure long-term funding, offering support for the preparation of data and manuscripts for publication and dissemination, and providing in-country technical assistance and research training. Experience in a number of settings has demonstrated that such long-term collaboration, in addition to contributing significantly to understanding of the HIV/AIDS epidemic, is mutually beneficial to all institutions involved; it could be very successful in providing highly skilled African researchers with support and the possibility of remaining in their country of origin.
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They should also have AIDS databases available on CD-ROM. (CD-ROM equipped computers are available in most national AIDS control program offices.)
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Not only is there an urgent need to increase indigenous capacity to conduct research, but there is also a need to better synthesize and translate research findings into effective prevention and control programs and policies. Otherwise, prevention programs will be only marginally based on local needs or tailored to local conditions, and research will be even more undervalued and underfunded.
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