Why India and Africa need aligned health research strategies
doi:10.1038/nindia.2016.112 Published online 31 August 2016
Similar demographics and disease burden, and a visible shift from communicable to non-communicable diseases in both India and Africa present a strong case for ramping up south-south collaborations in health research, argue Shahid Jameel1, Tom Kariuki2 and Simon Kay3.
In early September 2016, health care professionals, scientists and policy makers from India and Africa will meet at a health science summit in New Delhi to take stock of ongoing partnerships between the two regions and forge new ones. The meeting follows the India-Africa Forum Summit of October 2015, hosted by India and attended by over 30 African leaders, committing to work together to address shared global challenges, including those in the health sector.
Why have the two regions come together and what global challenges are they seeking to tackle jointly? What can we expect of these India-Africa efforts? What drives the agenda of this health science summit?
Answers to these questions lie in the mirror image that India and Africa present in terms of demographics, disease burden, problems and their solutions. Together, the two regions constitute about a quarter of the world’s land area, a third of its population and half of its disease burden. There is a visible shift in both regions from communicable to non-communicable diseases, but HIV/AIDS, tuberculosis, malaria, childhood diarrhea and respiratory infections remain stubborn and important challenges.
Shared burdens, shared assets
The greatest shared asset between India and Africa is their young people – about half of the population in each region is under 25 years of age1,2, aspiring for a share in the economic growth. Armed with knowledge and technical skills to solve local problems, these young people have an opportunity to learn from each other’s experiences. Science and technology, therefore, must become the centerpiece of public discourse for sustainable solutions in all spheres – health and wellbeing, food security and nutrition, energy, climate change, water and sanitation.
The Indian health care industry has made considerable progress in the recent years, the effects of which are also seen in Africa by way of affordable healthcare and low cost medicines. In 2014, Indian companies exported about $3.5 billion worth of bulk drugs and formulations to Africa and made an investment of $67.4 million in the continent3. Generic anti-retrovirals from India have improved the quality of life of people living with HIV/AIDS in Africa and other parts of the world. Many Africans are now seeking treatment for cancer and other ailments in Indian hospitals. In 2013 about 14% of African visitors to India came for medical treatment3.
Despite the disease burden and other challenges, Africa and India spend less than 1% of their GDP on science and technology, against a world average of 1.77%. each contributes only 2% to global research output4. The number of researchers in Africa and India are 70 and 137 per million of population, respectively, compared to Europe and USA that have 1990 and 26405. Poor funding, insufficiently trained human resource and low capacity to generate new knowledge stand in the way of science-led development for both geographies.
At the India-Africa Summit 2015, Indian Prime Minister Narendra Modi announced a health fund of $10 million. Apart from harnessing India’s expertise in healthcare and affordable medicines to fight against many common diseases, the funds are expected to help give newborns a better chance to survive. Under this grant, new collaborations will try to develop Indian and African traditional knowledge and medicines.
International research funding can be a driver for knowledge generation, cooperation and innovation, and bring management best practices to local funding. However, since decisions made locally tend to be more informed and impactful, the research, policy planning and decision-making must largely be local.
Towards this end, UK-based charity Wellcome Trust (WT) has invested significantly in India and Africa, supporting high achievers in biomedical research through research fellowships that mentor younger researchers and improve research productivity. India’s Department of Biotechnology (DBT), partnered with the charity to set up the Wellcome Trust/DBT India Alliance that builds excellence in the Indian biomedical scientific community.
The WT in partnership with the UK’s Department for International Development and the Bill & Melinda Gates Foundation (BMGF) aims to build high quality scientific leadership in Africa. This has led to the creation of the think tank Alliance for Accelerating Excellence in Science in Africa (AESA). Its first initiative – Developing Excellence in Leadership, Training, and Science has awarded over £60 million over the next 5 years to programmes in Ghana, Kenya, Mali, South Africa, Uganda, Senegal, Cote D’Ivoire and Zimbabwe.
Among other top initiatives are the BMGF-supported Grand Challenges that use science and technology to solve development problems. Grand Challenges India, set up through DBT’s Biotechnology Industry Research Assistance Council in 2012; and Grand Challenges Africa, a programme of AESA was launched by the African Academy of Sciences and the New Partnership for African Development in 2015 to support key areas of health research and innovation6, 7.
Way forward for south-south partnerships
Africa and India should learn from each other on research capacity, programmes, translation and innovation.
A good starting point is to build infrastructure. Translation of ideas and innovations into commercial products through the ‘Discovery, Development, Delivery’ (3D) mode needs sound infrastructure. India has done well in this area either through small ‘cottage’ biotechnology companies or large manufacturing firms – both models that Africa could adopt. India’s experience in building innovation-driven small and medium biotech enterprises can be seamlessly transferred to Africa.
A three-fold strategy for a winning south-south partnership among low and middle income countries (LMICs) should include: sound contributions from the regional economies; a robust and communicative science leadership that can convey the importance of such partnerships to political establishments; and international funders who bring in technical expertise, management experience and funds.
Alongside the $10 million India-Africa Health Fund last year, India committed $100 million towards an India-Africa Development Fund and 50,000 scholarships for African students to study at Indian universities. This provides an opportunity to enhance health research and build health systems capacity in Africa through the Indian experience.
Competition for resources could hamper long-term planning in LMICs for science and technology based solutions. Vocal leaders with scientific credibility are needed to convince the political leadership and the public of its importance. The development of such leadership should be the focus of south-south cooperation in science and technology.
And lastly, funders should join hands to scale up the India-Africa model and create regional partnerships, following the successful example of AESA. Creating strong research collaborations and advocacy to secure government support will be key elements of future partnerships.
1CEO, Wellcome Trust/DBT India Alliance, New Delhi, India; 2Director, Alliance for Accelerating Excellence in Science in Africa, Nairobi, Kenya; 3Head, International Operations and Partnerships, Wellcome Trust, London, UK.
1. The World Fact Book: India. CIA, USA
2. Mariam, M. The young continent. The Economist (2015) Article
3. James, T. C. et al. India-Africa partnership in healthcare – accomplishments and prospects.Research and Information System for Developing Countries (2015) Article
4. Research and development expenditure, Science and technology. The World Bank (2015)
5. A global perspective on science, technology and innovation (STI). UNESCO (2014)
6. Grand Challenges India. BIRAC (2014)
7. Grand Challenges Africa. BMGF (2015)