Funders of African health research are excluding Africans, say scientists

Illustration: Lisa Nelson

• African scientists have published a letter in Nature Medicine criticising the fact that funding for health interventions on the continent sidelines local institutions and scientists.
• They cite a new US$30 million (R430 million) project by the US President’s Malaria Initiative, which is being implemented by a US organisation called PATH.
• Asked to comment, PATH acknowledged the criticism as “fair” though it aims to include local “stakeholders”.

A group of African scientists are calling on the funders of Africa-focussed health interventions to change their approach, and make sure that African scientists are not excluded from scientific research, and Africans from healthcare decisions.

In January 2021, the US President’s Malaria Initiative (PMI) announced a five-year, US$30-million research project, called Insights for Malaria (INFORM). According to the press release, INFORM “will generate evidence and data to inform national malaria programs and the global malaria community of best practices, while strengthening research capacity in PMI-supported countries.”

The Seattle-based non-profit PATH (formerly known as the Program for Appropriate Technology in Health) was selected by PMI as the main partner in this initiative, leading a consortium of seven companies and institutions (Abt Associates; the Broad Institute of MIT and Harvard and the Harvard T.H. Chan School of Public Health; the MRC Centre for Global Infectious Disease Analysis at Imperial College London; the London School of Hygiene & Tropical Medicine; the Malaria Atlas Project of Telethon Kids Institute at Curtin University; the Center for Applied Malaria Research and Evaluation at Tulane University; and the University of California, San Francisco Malaria Elimination Initiative.)

Not one of these is based in Africa.

This decision prompted Ngozi A. Erondu, Ifeyinwa Aniebo, Catherine Kyobutungi, Janet Midega, Emelda Okiro, and Fredros Okumu, all African scholars and researchers at top universities and research institutions, to write an open letter. The letter, published in Nature Medicine — a leading scientific journal, is directed towards the major international funders of science and development in Africa. It calls for an overhaul of the dominant practices among funders which tends to exclude African scientists, and concentrates power over African healthcare in the hands of western NGOs.

The authors of the letter argue that INFORM decision is the rule, rather than the exception. A global funding model that massively favours western institutions is undermining the development of African research and healthcare systems.

The vast majority of funding purportedly for African health initiatives does not go to African institutions, say the authors. “In 2017, the USA, UK and Canada collectively spent US$1.1 billion on malaria development aid, which includes research funding … just 1% of malaria funding [went] to local in-country research institutions.”

“International funding … has substantially advanced the goal of improving people’s health and wellbeing in Africa and beyond. However, funding models such as that of the PATH-led initiative are among the reasons that after several decades and billions of dollars spent, the control of diseases such as malaria is still heavily donor dependent.”

According to the authors, “the predominant global health architecture and its business model enable Western institutions to gain more than, and sometimes at the expense of, the people and institutions in the countries where the actual problems are.”

“This type of funding has also contributed a model of implementation that puts the delivery of several health interventions directly in the hands of Western non-governmental organisations, which further diminishes the capacities and ownership of national programs to deliver to their populations and ultimately leads to weak health systems and a lack of sufficient local capacity.”

For the authors, these funding practices “impede progress toward justice and equality for populations that they intend to help”.

The letter argues that the PMI’s decision to grant US$31 million to PATH cannot be defended on the grounds that African research institutions lack the appropriate expertise as “there are strong African institutions with excellent capabilities in this area, including some already actively engaged on the ground, such as the KEMRI Wellcome Trust Information for Malaria”.

Ultimately, INFORM will have a direct impact on the roll-out of anti-malaria programmes across Africa, and this will be done without a substantive contribution from African institutions.

The letter argues that instead of concentrating these decisions in a Western clique, they should be “made in consultation with in-country scientists and researchers involved in this work alongside ministries of health and national malaria-control programs, to augment national priority research efforts”.

This wouldn’t only be just, but good science: “Such efforts have the best chance of success if they are run by local research agencies and institutions that can work closely with governments and are well positioned to support decision-makers in integrating data into local policies and strategies.”

There are some funders that are committed to funding African institutions, including The New Partnerships Initiative from the US Agency for International Development and the Alliance for Accelerating Excellence in Science in Africa. According to the authors, AESA in particular is “ensuring its funding is provided directly to African scientists and institutions, which in turn empowers and enables them to shape their research agenda and to conduct research relevant to the continent”.

The authors want funders to reform their funding models and create “sustainable funding models with local researchers and organizations at their center.”

Asked for comment, PATH sent us a statement that acknowledged the criticism. It states that INFORM aims for “clear alignment with local stakeholders on research priorities”. Yet, “despite this intentional approach to collaborate, the criticism about power and decision-making is fair”.

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