South African Medical Research Council 2009/10 Annual Report

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Health

26 October 2010
Chairperson: Dr M Goqwana (ANC)
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Meeting Summary

The South African Medical Research Council (MRC) presented its 2009/10 Annual Report, and highlighted some key issues and the strategies that it would adopt in addressing some challenges. Historically, MRC had relied on government to fund its activities and this had been linked to its growth and international reputation. Its budget grew from R53 million in 1994 to R535 million in 2009. Government had doubled its grant between 1998 and 2002. The majority of the differential funding came from external sources. However, it still noted that there were some funding concerns that hindered its work in some areas. Although an unqualified audit report was given, the Auditor-General had raised concerns about wasteful expenditure, problems with supply chain management and the preferential procurement policy framework, as well as the fact that the Key Performance indicators had been too numerous, too vague and did not allow for proper measurement of performance. These problems were in the process of being addressed and the following business plan should be more accurate. National Treasury had been approached to discuss the requirements around finance leases, which were inappropriate, given the nature of the MRC’s business.

The MRC set out some achievements, including the part played by the researchers, although there were some concerns about the gap between the generation and presentation of data, although the situation had slightly improved. The Health Systems Research Unit now interacted actively with the Department of Health (DOH). Input was given by MRC into the World Health Organisation Anti Retroviral (ARV) therapy guidelines and effective implementation. There was high prevalence of HIV amongst women in communities.  The South African Aids Vaccine Initiative (SAAVI) gave an update on its activities and highlighted its funding and human resources challenges, asking the Portfolio Committee to discuss its future with government, since no response was given to requests for 2010/11 funding by the Department of Health, although it had secured some Italian government funding. A detailed account was also given of the MRC’s efforts to put in place a proper data management system for the Cancer Registry, and to have the provision of data on cancer made compulsory, within a legal framework, and name cancer as a registrable disease. In Eastern Cape, there were efforts to decrease sources of fungal toxins through proper sorting of maize. Further vaccines were introduced for children in 2009. MRC had collaborated with neighbouring countries on malaria control. It was looking into gender research and women’s health. Policies were also in place in regard to nutrition. The importance of African traditional medicines was underscored. Challenges included the appointment of the new MRC President, the drafting the 2010-2015 Strategic Plan, the appointment of the new MRC Board, and the need to attracting continued funding for research, and to translate research findings into practice.

Members stressed the importance of research to policy-making. They asked how many PhD graduates had been produced. They noted that need to bridge inequalities, particularly in rural areas, asked how much funding SAAVI had requested, and agreed to assist in this regard. Members would be given a report on ARV treatment failure and its research indications. Members discussed the implications of obesity and the figures for burden of disease research, asked what could be done to reduce the child and maternal mortality rates, and discussed the sources of information, and whether erratic or interrupted treatment led to resistance to antiretroviral drugs. Members questioned the audit findings, and what remedial actions were instituted, and asked about the gender composition at executive management level, as well as the criteria for the bursaries. They asked for further clarification on poor data management, and whether MRC checked whether its research results had been used, whether there was interaction with the Forensic Chemistry Laboratories, asked where MRC was working to promote sexual reproductive health among adolescents, whether there was a possibility of a cancer vaccine, and noted that training of medical personnel on post-rape care was not uniform or consistent. They were also interested in hearing more about the work on traditional medicines and interaction with traditional leaders, commenting that often there was too much secrecy attached to using traditional medicines, with the result that people may be taking conflicting treatment. They noted MRC’s concerns that the draft policy on African traditional medicines should be resuscitated.

Meeting report

South African Medical Research Council (MRC) 2009/10 Annual Report
Dr Muhammad Dhansay, Acting Chief Executive Officer and Vice- President, Medical Research Council, highlighted key issues from the 2009/10 Annual Report of the Medical Research Council (MRC or the Council). Dr Dhansay indicated that Prof Anthony Mbewu and Prof Terreblanche had left the MRC in 2010, creating two executive positions.

He explained that the MRC’s strategic objectives were to promote and conduct research, professional support for research and research translation. The MRC was divided into the following units: South African Aids Vaccine Initiative (SAAVI) and HIV/AIDS prevention research, Tuberculosis (TB), Infectious Disease, Cardiovascular Disease and Diabetes, Crime, Violence and Injury, Cancer and Health Promotion, Public Health, Genomic and Proteomics, Women, Maternal and Child Health, Nutrition, Environment and Health, Brain and Behaviour and African Traditional Medicines.

MRC’s income grew from R53 million in 1994 to R535 million in 2009. Government had doubled the grant between 1998 and 2002. The majority of the differential funding came from external sources.
The MRC’s role as both conductor and funder of research was discussed, together with its relationship with various local academic institutions. He tabled information on capacity development and the demographic profile of intramural scientists. There were 203 scientists. 81% were female junior scientists, and 66% were female senior scientists. Overall, females constituted 70% of scientists in all categories, reflecting an improved gender ratio. Transformation had progressed steadily. There were currently 817 personnel, of whom 66% of the managers were black; 28% of the managers and researchers were black African and 66% of managers and researchers were female. MRC had produced 50 PhD graduates.

Mr Bulelani Mahlangu, Chief Financial Officer, MRC, outlined the financial status of the organisation and highlighted that the Auditor-General (AG) had given an unqualified audit report, although some concerns had been raised. MRC had more than 200 projects, and the funders required audits to be performed. The challenge with both government and external funding related to allegiance and agenda-pushing, as it was always tricky to strike a balance between the two. MRC remained exposed on pension funds as some were linked to the performance of the economy, forcing it to carry the liability. Last year it had a deficit of R10 million in the pension fund, although this seemed to have levelled out because of the improvement in the world economy.

Wasteful expenditure had been noted on two occurrences. Firstly, interest of R77 000 had to be paid on the senior managers’ delayed bonuses. This was because the Board had wanted to familiarise itself with the process and methodology. A further R14 000 interest was due to suppliers who had been paid late. The second instance of wasteful expenditure was for contingent liability. MRC’s salaries had been 2% to 3% below public service rates. The Executive took the decision to add that 2% to the 8% that had already been awarded. The Board had issues about payment for senior people, but the matter had been resolved.

The audit found that the Key Performance Indicators (KPIs) had been badly structured and some of them were not measurable and needed to be revised. However, MRC had submitted its business plan to the Department of Health before the AG’s comment on the viability of the KPIs. Next year the AG would express an opinion on the KPIs, so it was necessary urgently to modify them so that they could be audited.

The AG pointed out areas of weakness in the supply chain management. Although MRC’s preferential procurement policy framework (PPPF) was another area of concern to the AG, a service provider had been appointed to put together a supplier database and software that would calculate the PPPF.

National Treasury approval was required before finance leases could be entered because it wanted to have a mechanism to control borrowings. This meant that calculations had to be made every time to determine whether it was better to buy or lease, given the nature of scientific research that was carried out by the MRC. A motivation had been written to National Treasury on this and its response was pending.

Dr Dhansay noted that research could only make a difference to the nation’s health if it translated into actions in response to that research. He noted the active participation of MRC staff members in various publications, and said that the papers they contributed had helped to give direction on what should be done in the health sector. He added that accurate information of high quality was an important asset to government. This would always remain a challenge that had to be addressed.

Dr Dhansay set out the research highlights (see attached presentation). He noted that Statistics SA was the source of the 2007 mortality data. Dr Dhansay expressed concern about the gap between the generation and presentation of data, although the situation had slightly improved.

He reported that a new director had been appointed for the Health Systems Research Unit (HSR Unit), which interacted actively with the Department of Health (DOH). He added that the HSR Unit was assisting DOH with credible health economics and health systems inputs for the National Health Insurance Policy. Again, one challenge was the translation of knowledge into policy and practice. The HSR Unit secured a project in the Eastern Cape on the promotion of sexual and reproductive health among adolescents, and had regional and international collaborators.

MRC had inputted into the World Health Organisation Anti Retroviral (ARV) therapy guidelines and effective implementation. Increased government funding would empower the MRC to set the research agenda.
Epidemiological data had shown the high prevalence of HIV among women in communities (ranging from 38% to 47%), with HIV incidence ranging from 5% to 9%. The HIV Prevention Unit was an important collaborator in a clinical trial of vaginal microbicide (PRO2000) that reduced HIV by 30%, compared to the placebo. A follow up study released in December 2009 showed that the gel was safe but did not prevent HIV infection in women.

Ms Elise Levendal, Project Manager, South African Aids Vaccine Initiative updated the Committee on SAAVI’s activities and emphasised the importance of looking at this unit in the context of HIV / AIDS prevention methodologies and research. Ms Levendal highlighted the funding and human resources issues as well as the standing of SAAVI locally and internationally.

She discussed the pitfalls of relying on government support, citing the drops in funding that had so badly affected Eskom and the Department of Science and Technology. The Department of Health had given SAAVI R10 million in 2009/10 yet it had not responded to the business plan that had been submitted in May 2010 for the 2010/11 funding. However, through the South African / Italian government collaboration, SAAVI would receive €38 million. The funding would not only cover vaccine research and development but would cover the health service, production and clinical trials components. Ms Levendal added that South African trials started through SAAVI had gained world recognition because of the expertise and clinical trials run according to national and international clinical and ethical guidelines.

Prof Vikash Sewram, Director, Oncology Research Unit, MRC, gave background information which reflected the vitality and the input into the creation of the national cancer registry. He discussed extensively the queries around the late reporting of cancer data, and indicated that since the resignation of the director of the National Cancer Registry (NCR) ten years ago, there had not been a cancer epidemiologist to oversee the Registry, and this had resulted in challenges in data collection and reporting. The National Cancer Registry obtained its data from the National Health Laboratory Services (NHLS) database but this was problematic because there was no legal framework around cancer reporting and it therefore was not compulsory for private laboratories to provide data. Currently the reporting system was purely done on a voluntary basis, pending legislation that would make cancer a registrable disease. The MRC had been approached to assist the Cancer Registry to put in place a data management system that would make data collection, reporting and dissemination process easily available to the public, and make the systems user friendly.

Prof Sewram had formed a Technical Task Committee of the NCR, to establish a national cancer registry data management system. The registry had experienced human resources issues and relied on paper copies of reports submitted. Data had to be manually entered into the database, which was untenable for large data sets. The Technical Task Committee set up the database and met the 15 October 2010 timeline. The database was currently being tested for acceptability and refinement. The next phase was the auto coding system, which would make it easier for data to be populated into the national data registry database. This project was due for completion in February 2011. Prof. Sewram indicated that the goal was for the 2009/10 cancer data to be reported by the end of 2011, and the parallel process would be to fill in the gap from 2002 to 2008. The data would be reported in rolling five-year averages, to follow time trends, and by 2012 the NCR would report on 2008 to 2012, with the 2009 to 2013 data being made available in 2013.

Dr Dhansay reflected that in the Eastern Cape’s Centane district, a system had been put in place to decrease the sources of fungal toxins, by assisting the community to implement practical measures of sorting maize that had been contaminated. In the area of child health, the DOH had introduced the pneumo-coccal conjugate and rotavirus vaccines into the Expanded Programme on Immunisation for children, in 2009. These vaccines resulted from collaboration by MRC’s two researchers.

MRC had collaborated with neighbouring countries on malaria control, and this had resulted in the decline of malaria incidence in KwaZulu Natal and Mpumalanga by 99%, compared to the baseline of 2000.

Women’s Health was being looked at through gender research, especially in regard to sexual violence towards women and the socio economic factors behind such behaviour. The imbalance in gender relationships impacted negatively on women and children.

Dr Dhansay discussed nutrition issues and noted that policies were in place. He highlighted a study from the Northern Cape which showed that, despite the community’s low socio-economic status and high prevalence of stunting, there was no Vitamin A deficiency. He added that currently the Vitamin A supplementation programme was questioned, and MRC was checking its relevancy in South Africa, because its coverage was low. MRC’s specific interest was to be involved in monitoring and evaluating guidelines and programmes in support of the DOH.

Dr Dhansay underscored the importance of African traditional medicines. The spectrum of research was based on ground-level interaction, training and learning from traditional healers up to high tech laboratory based researchers.

MRC was also involved with the Department of Health in trying to rise to the challenge of Telemedicine, especially in rural areas.

Dr Dhansay reiterated that MRC continued to grow in terms of its research portfolio through increased research publication outputs over the twelve month-period. It had shown growth in external income. There were increasing numbers of black and female scientists at doctoral and postdoctoral level. It was succeeding in translation of research into policy, practice, products and health promotion, and had increased confidence in its research mandate of using research, development and technology transfer in the provision of quality health for all South Africans. However, he outlined that the challenges that faced MRC related to the appointment of the new MRC President, the drafting the 2010-2015 Strategic Plan, the appointment of the new MRC Board, and the need to attracting continued funding for research, and to translate research findings into practice. MRC would continue to support DOH in reaching its goals.

Discussion
The Chairperson commended the MRC for its good work, despite the challenges it faced, and underscored the importance of research in policy making. He asked whose interests would be served if MRC got more external funding, and whether this argument could be used to persuade the DOH to increase its funding of MRC.

The Chairperson asked how many PhDs had been produced by MRC in the year under review, and how many of these were historically disadvantaged students.

Dr Dhansay responded that 50 PhDs had graduated.

The Chairperson further asked about the causes of deaths, especially of people in rural areas, and those who worked in the mines. He asked about bridging inequalities, pointing out that these seemed mostly to exist in the rural, rather than urban areas, and whether MRC’s research reflected these inequalities. He added that the increased baby deaths could be related to poor sanitation, especially in rural areas. He also asked for more details on microbicides.

There was no direct response to this question.

The Chairperson briefed Members about the Nestle-sponsored workshop that he attended in America, and mentioned that his interest was aroused by discussions on the growth hormone and its effect on individuals’ life expectancy. He noted that MRC had not been represented at the conference.

He asked Prof Sewram to comment on the Ihasa fungus, which was prevalent in the Eastern Cape where people were storing mealies in holes that they had dug, and asked if it was a cause of cancer.

Mr M Waters (DA) commended MRC for updating cancer registry. He asked about SAAVI’s business plan that had been submitted to the DOH in May 2010, and asked how much had been requested, its plans for the future, and who was responsible for its funding.

Ms Levendal replied that the business plan had been submitted in May but SAAVI had not received any response from the Department of Health. SAAVI’s funding was dedicated, was awarded through National Treasury, and was not part of MRC’s funding. MRC had a legal agreement with the DOH for R10 million per year until 2012. She said SAAVI’s way forward was dependent on government plans, because SAVVI was established as a lead programme of the Medical Research Council and was part of a Cabinet initiative. Funding was a major cause for concern, and lack of funding was the reason why so much capacity had been lost. She urged the Portfolio Committee to discuss SAAVI’s future with government.

Mr Waters asked what percentage represented the ARV treatment failure, and what had been the research indications for it.

Dr Dhansay responded that an appropriate response would be given by the relevant experts. He added that the public service and health services strikes probably contributed to possible ARV resistance. Although the MRC was a research organisation, its TB support and its unit in Pretoria had assisted the DOH wherever possible during the strike, in giving treatment.

Mr Waters queried the figures given in the current and previous financial years, for the comparative assessment study on the burden of disease research. He also asked about the problem of obesity in South Africa and the huge implications of this for the burden of disease.

Dr Dhansay replied that obesity was an international and local issue and the DOH had recognised that the impact on lifestyles of obesity was an important area. On the research front, there were differences between men and women and different population groups, but the basic principles of exercise, moderation and balanced diet remained important.

He noted that the 3% figure should be seen in the context of a comparative risk assessment study, as there was a specific methodology used by the MRC’s Burden of Disease Research Unit that looked at existing prevalence of violence and the risk patterns associated with it. This did not necessarily mean that the actual risk pertained in reality, but highlighted the top ten areas where it was possible to make a difference by targeting the risk factors. Obesity in children was also an issue involving both under and over nutrition.

Mr Waters asked about research on women and maternal health, and asked what could be done urgently to reduce the child and maternal mortality rates.

Ms Levendal replied that two trials had been held. The microbicides Caprisa and the Thai trial showed, for the first time, that HIV could be prevented, and that Aids could be stopped. The use of condoms, male circumcision and other methods should continue, but vaccines were hoped to be the eventual answer to the research.

Dr Dhansay agreed with Ms Levendal that SAAVI’s future was in the hands of government. He added that MRC had been engaging with the DOH and the Department of Science and Technology and expressed optimism that the new DG may be instrumental in promoting more action.

Dr Dhansay noted that child and maternal mortality rates depended on the sources of information, adding that MRC had held a meeting with Human Sciences Research Council (HSRC) and Statistics SA to look at the baseline issues for reporting for the Millennium Development Goals (MDGs). He said HIV/AIDS played a major role during pregnancy and had an effect on the new born child, and in child and maternal mortality. Improved access to ARVs for both the mother and child should have an impact. Sanitation also played a major role in mortality rates. A multi-sectoral approach was needed to tackle this problem. MRC worked with roleplayers in sectors such as Health, Agriculture, Social Development, and Education.

The Chairperson asked what resistance was likely to develop from irregular ARV treatment, making specific reference to the erratic supply in the Eastern Cape. He asked whether any research had been done to find out if resistance that developed after breaks in the treatment regime.

The Chairperson commented on the importance of evidence in policy making, and noted that MRC was an important organisation whose input helped politicians make important decisions. He added that the information given had huge implications for the health sector and the country as a whole. He acknowledged the request to the Committee to assist SAAVI to secure additional funding from government and said the Committee would do its best.

Mr E Sulliman (ANC) congratulated MRC on its unqualified audit report. He asked whether the MRC had rectified the issues raised in the AG’s report, in relation to the lack of quarterly reports on performance, and requested an explanation on how the irregular expenditure occurred.

Dr Dhansay responded that there had been challenges in getting information but MRC had instituted responses. Remedial action had been implemented, and a dedicated team had been put in place to source information from various units and consolidate it for quarterly reporting. MRC had not been involved in setting up KPIs at the beginning of last year. These had now been trimmed to make them more objective, so that they could be defined and quantifiable, which would aid in holding people accountable.

Mr Mahlangu responded on the irregular expenditure. In respect of the two finance leases, MRC had indicated to National Treasury that, because of the long-term nature of its research work, the lease period of three years was too short. MRC calculated that if it had bought the machines outright, this would have been more expensive than leasing. MRC had also indicated to National Treasury that it had grappled with supply chain issues, but had identified a supplier of the database and the new software would be able to do the calculations. He further explained that in one instance, MRC had not gone to tender. However, he outlined the circumstances under which that had happened, which were related to the complexity of the work that involved partnerships with organisations outside South Africa.

Dr Dhansay added that although the MRC was a parastatal, it did health research and interacted both locally and internationally, and this had implications for the accounting system. This was the reason why it was important for MRC to meet with National Treasury to get direction from it. Measures had been put in place to respond to the requirements of National Treasury.

Ms M Segale-Diswai (ANC) commended MRC on its presentation as well as the fact that the delegation showed good gender balance, which reflected the 66% of women managers and researchers. She asked whether there were any women at the executive management level.

Mr Zukile Vokwana, Executive Director: Operations, MRC, replied that there were two prominent positions available at the top level. At the moment there were three men. Women were free to apply for the Chief Executive Officer post and the other top vacant position.

Ms Segale-Diswai requested clarification on the AG’s comment on badly structured KPIs, and asked what actions had been taken to correct the anomaly, and how the KPIs were measured if they had been badly structured.

Dr Dhansay replied that a full explanation was set out in the Annual report, and that it was not possible to give responses in certain areas, such as women’s violence, and sexual abuse. He noted that these were multi-faceted issues and MRC could not respond to all, but this was poorly reflected in the KPIs. In the next business plan, the number of KPIs had been trimmed down from the 72 given earlier, to ensure that they were more defined, accountable and measurable.

Dr Dhansay also mentioned that although MRC had graduated 50 PhDs, when the AG requested the certificates they could not be provided, and the figure for performance had been recorded as three.

Ms Segale-Diswai said that the AG made a critical observation that the DOH had poor data management, and asked how MRC dealt with that data for its research purposes.

Dr Dhansay responded that Prof Sewram had outlined the interventions that MRC had made with the National Cancer Registry, by assisting the NHLS and the DOH in setting up a system that would ensure that the data was correct. The Director General of the Department of Health had convened a meeting between Statistics SA, HSRC and MRC, to advise her which of the many sources of information should be used when measuring the Department’s performance on the national service delivery agreement. The Health Systems Research Unit and the Burden of Disease Research Unit were also involved.

Ms Segale-Diswai asked whether MRC checked whether its research results, such as the HIV/AIDS survey, were fully utilised.

Dr Dhansay expressed optimism that the relationship with DOH would be strengthened, as it had been an area of concern. He reiterated that the previous person on the Board had left some time ago and the interaction had been intermittent.

Ms Segale-Diswai noted that TB management was not doing well and asked whether MRC had ever researched the usefulness of the TB electronic register, since its inception.

No direct response was given to this question.

Ms E More (DA) asked whether the MRC’s Nutrition Intervention Unit had a working relationship with the Forensic Chemistry Laboratories. If so, she queried the impact of that relationship, especially with regard to food labelling that reflected incorrect information as to the food content or composition.

Dr Dhansay responded that there was no interaction with the Forensic Laboratory. However, the Nutrition Intervention Research Unit interacted with the DOH in connection with the new Regulatory and Foodstuffs Act, which called for food labelling and that required manufactures like Nestle to show the correct nutrient composition of food. He added that an electronic and hard copy composition of South African foods had been developed. The challenge was to move from holding information from overseas to South Africa having its own information. Traditional foods were also being looked into, as they were different to the rest of the world. MRC was involved in legislation, policy making and interaction with industry. There was interaction with industry in relation to food safety on the scientific front, and the MRC was part of the national committee of the International Union of Nutritional Scientists, and also was involved in food safety and technology.

Ms More asked whether people were aware of educational MRC bursaries and the criteria used to award them.

Dr Dhansay reiterated that there were in fact 50 PhDs who graduated. Information on the awards was sent to the research administrations of higher education institutions. The awarding was competitive but preference was given to women and black applicants.

Ms More commented on the PRO2000 gel as an achievement and asked when it would be available on the market.

Dr Dhansay commented that the information on the gel had not been included in the Annual Report, and the interesting results. He noted that during the budget presentation with the Department of Science and Technology, the Deputy Minister had presented the results of the microbicide trial with an ARV. This showed for the first time that there could be a preventive effect in using microbicide gel.

Ms T Kenye (ANC) sought clarification on the conflicting maternal and neo-natal deaths, which the DOH had indicated would increase, and MRC’s 2.2% cited, and on the low death rate in HIV/AIDS.

Dr Dhansay responded that MRC was not directly involved in generating data, as this was done by Statistics SA. This was the most current data. He noted that HIV was embedded in TB and other diseases as well, and that the completion of death certificates was often not done properly, because the underlying causes were often not mentioned. The MRC’s Burden of Disease Research Unit was interacting with Statistics SA and Department of Home Affairs, to improve the quality of the data. Pilot projects were in place to train doctors and students on how to complete the forms accurately.

Ms Kenye asked in which area the project on promotion of sexual reproductive health among adolescents was carried out.

Dr Dhansay responded that information would be given by the relevant director.

Ms Kenye noted the progress achieved by SAAVI on the HIV/AIDS vaccine, and asked whether there was a possibility of a cancer vaccine initiative, given that the data collection and registry was being regularised.

Prof Sewram responded that a lot of work was being done with regards to cancer research in the Eastern Cape. He added, in answer to the question asked earlier by the Chairperson, that a link had been shown between the toxins in the maize fungus and cancer, and some interventions were under way in the Eastern Cape. Prof Sewram also explained that there were some vaccines against viruses that caused cancer, like the human papiloma virus that caused cervical cancer, and that a vaccine was currently available in South Africa. There were also vaccines for Hepatitis B, which caused liver cancer. He added that young girls should be vaccinated before the onset of puberty. Currently MRC, in partnership with the Cancer Association of South Africa, funded a project by the Cancer Research Initiative of South Africa, costing R2 million, to vaccinate 2 000 girls in three provinces as a trial of whether vaccination would work in the South African setting.

Prof Sewram noted that cancer, on a large scale, was linked to risk factors, and that these could be amended through behavioural and lifestyle changes.

Dr Dhansay added that there were ethical issues involved and that there was a constant need to monitor and evaluate.

Ms Kenye commented about the training of doctors and nurses on post rape care and noted that there was no uniformity or clear protocol for post-rape treatment, especially in situations where an individual had been gang raped. She urged that this training be speeded up.

Dr Dhansay noted that MRC was not primarily focused on training, but could assist and advise the relevant sectors. Although there were protocols in clinics, these tended not to be followed and these issues, which also involved human resources, were issues for health systems research. He agreed that it was an area of concern.

The Chairperson expressed concern that most cancers occurred at an advanced age and asked whether there was anything that could be done to help old people boost their immune systems to increase their chances of dealing with the cancer.

Mr D Kganare (COPE) asked about the nature of MRC’s collaboration with Southern African Development Community (SADC), other than in the area of malaria.

Dr Dhansay responded that there were other areas of collaboration besides malaria. MRC had collaborated with Mozambique on crime, violence and injury; sexual violence and women’s health. There was also collaboration on HIV/AIDS, and nutrition. There was interaction with Zambia, not only in training, but in analysis of blood samples for Vitamin A, iron and zinc levels.

Mr Kganare asked about the objective of the Memorandum of Understanding (MOU) signed with traditional leaders.

Dr Dhansay said the MOU with traditional leaders in the Eastern Cape was done for the Health Promotion Research and Development Unit, which was looking at the role of men in the initiation practices, and circumcision related to HIV/AIDS prevention. Millions of South Africans recognised the important role played by traditional leaders. Three months ago, MRC signed an MOU with the National House of Traditional Leaders. Besides the Health Promotion Unit, there was also an Indigenous Knowledge Research Unit in health which looked at traditional practices and medicines.
 
Mr Kganare asked whether MRC had checked with other research institutions about the preferential procurement framework, to solve the challenges it experienced.

Mr Mahlangu responded that MRC had contacted the HSRC’s auditors to find out which system worked for that Council, and see how MRC could integrate that input.

Mr Kganare sought clarification on PRO2000 gel and its impact on HIV/AIDS.

Dr Dhansay responded that MRC had recognised the ethical issues, and the protocols submitted had undergone rigorous scientific and ethical approvals. MRC research protocols went through the MRC Research Ethics Committee. The Chairperson of that Committee also chaired the National Health Research Ethics Committee of the Department of Health. Women were informed, and understood that their consent was required before they took part in the trials. They were also informed, trained, and supported in using other preventive measures such as female or male condoms, before the start of the programme.

Mr Kganare asked whether MRC had district and provincial breakdowns of the causes of death, to enable it to formulate policies.
 
Dr Dhansay confirmed that these breakdowns were available and had been reflected in the report. Statistics SA was responsible for the breakdown to the specific areas.

The Chairperson commented on the serious ethical question on microbicide use by HIV-negative women, and asked what would happen to them if they became HIV positive.

The Chairperson commented on indigenous knowledge and said there was an observation that some indigenous plants had been deemed less important, for economic reasons, and the promotion of certain other nutrition, to the detriment of overall knowledge.

Dr Dhansay said MRC valued indigenous knowledge and had a dedicated research unit that looked into traditional medicines and knowledge. Traditional healers sometimes formed part of the research team. He made reference to the Pharmacology and Toxicology Conference held in Cape Town, and said that one of the presentations looked at the interaction of traditional medicines with ARVs. It was revealed that often patients would not tell nurses if they took traditional medicines together with ARVs. He noted that 80% of population had had contact with or had used traditional medicines. MRC needed to know this information and conduct scientific tests.

The Chairperson commended the MRC’s attitude towards traditional medicines. He noted that the practice of traditional medicine practitioners was often shrouded in secrecy. This even cascaded to users of Western medicines, who shied away from admitting to the use of these medicines, and often visited traditional doctors on the quiet. This resulted in ineffective treatment, because of the interaction of different types of medicines. He acknowledged the efficacy of traditional medicines but deplored the secrecy around their use.

Dr Dhansay commented that health, or the absence of disease, was not clear cut. It crossed all racial divides, and even went beyond lifestyle and exercise, and involved the psychological and social well being of an individual. The biggest challenge was awareness. MRC interacted with India and China. The Chinese recognised both the western and traditional Chinese medicines. South Africa’s challenge was the interaction with traditional healers, and documentation of the uses. The question of intellectual property was important and the MRC had an Innovation Centre that looked at these proposals.

The Chairperson said the Committee would try and ensure that SAAVI and other programmes got more money. He urged MRC to produce more PhDs who understood the South African terrain to enable the drawing of appropriate policies that fitted the South African situation.

Prof Sewram added that MRC had contributed to the draft policy on African traditional medicines. It had been involved in the research and development and in formalising the legal framework within which traditional medicines could be tested, where there would be a hospital for traditional healers and clinical trials. This policy had since been shelved somewhere in the Department of Health. He called for the resuscitation of the policy, and emphasised that this had to be done in partnership with the healers and not just by the scientists alone.

The Chairperson agreed with Prof Sewram but expressed concern that unscrupulous people took advantage of the confusion about traditional medicines and made quick money, and they were not likely to respond to the calls for discussion. The Committee would work towards the resuscitation of the policy.

The meeting was adjourned.




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