SA Medical Research Council (MRC) on its 2011 Strategic Plan and Budget

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Health

22 March 2011
Chairperson: Mr B Goqwana (ANC)
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Meeting Summary

The Medical Research Council (MRC) presented its three-year strategic plan and current year annual performance plan. The strategic plan was very thorough in outlining the sources of information and reasoning behind its strategic goals. The Medical Research Council had aligned its plans with the higher level goals of the Department of Health. Given its advisory role to other areas of government, the MRC had ensured that its plan was aligned with government targets in other areas such as the Millennium Development Goals. The MRC provided a series of statistics on health, disease, and reasons for mortality. It also described the various research units within the MRC and provided examples of projects within each unit. It provided links to demonstrate how each research unit contributed to the vision and mission of the MRC. The MRC presentation then focused on the fiscal aspects of its strategic plan. It noted that its total budget was R579 million, with R279 coming from government grants. The remainder came from external project funding. The presentation concluded with some of the challenges facing the MRC and some of the risks it faced and proposed some solutions to address these challenges.

The members of the Committee questioned some of the new technologies and medications that were presented, including the costs of such items. They questioned the advancements in the indigenous medicine unit and how much funding was being provided to this research unit. Member's questions turned to the area of mother and child mortality. They asked why there were so many inconsistencies in data collection figures and why there was little progress in improving child and maternal health. Questions were then asked on whether it was realistic to reach the targets set for the Millennium Development Goals in this area. Other questions pursued the lack of standardised reporting of statistics, including the causes of death written on hospital forms.

Members then questioned the financial aspects of the strategic plan. They asked what biases were present when conducting research that was funded externally, including issues of intellectual property rights. They asked why only ten external funders were listed in the presentation, and if there were more and why they were not reported. Lastly, members questioned the deficit that was forecast in the plan.

Meeting report

Presentation by the Medical Research Council
Dr Muhammad Ali Dhansay, Acting President, Medical Research Council (MRC), stated that the organisation had a new Strategic Plan, given that the previous one lapsed in 2010. He reiterated the MRC's alignment as a public entity under the National Department of Health. Given the recent election of the new Board, he explained that the MRC did not yet have a five-year plan, but the consultation process would begin in May/June 2011.

Dr Ali Dhansay reviewed the vision, mission and values of the MRC. He presented a slide that outlined the key documents that guided the operations of the MRC. He noted that the mandate of the MRC was legislated in the South African Medical Research Council Act, 1991. The Medium Term Strategic Framework (MTSF) was a key guiding document and it positioned the MRC within the high level development objective to "Improve the nation's health profile and skills base and ensure universal access to basic services". The key outcome of this development objective that applied to the MRC was Outcome number 2: A long and healthy life for all South Africans. The MRC would also support the National Department of Health (NDOH) in achieving its 10 Point Plan. Dr Ali Dhansay presented a slide that aligned the NDOH outcomes with the Millennium Development Goals. These slides demonstrated the linkages between the MRC's strategic goals to both national objectives and international initiatives.

Dr Dhansay presented a slide that outlined medical journals that would be used to inform the MRC as they move forward. He explained that South Africa had a quadruple burden of disease profile. Namely, there were poverty-related conditions, emerging chronic diseases, violence and injury, and HIV / AIDS. These presented a difficult problem of competing priorities. Dr Dhansay presented a series of slides comparing statistics from 1997 to 2008. Of particular note, the number of natural deaths, predominantly due to HIV and Tuberculosis (TB) had more than doubled from 263,040 in 1997 to 539,123 in 2008. He noted the ranking by cause of death for 2007 and 2008, which demonstrated that TB remained as the primary cause of death. He did qualify that these statistics relied on the quality of data supplied by the health care practitioners, which was not always accurate or complete. The following slide presented the top-ten risk factors for disease.

Dr Dhansay noted that the MRC also had a linkage to the Department of Science and Technology. He presented the high-level organogram of the MRC that showed which vacancies currently existed within the organisation. He noted that challenges for the organisation get increasingly more complicated once the organisation moved from controlled internal activities to attempting to measure the MRC outputs and the impact of those outputs on health outcomes.

Turning to the research structures of the MRC, Dr Dhansay noted that the MRC operated through a variety of research structures that made up its intramural and extra-mural activities. He stated that this flexibility enabled the MRC to harness and support expertise in academic institutions across the country as well as having capacity for national priority areas. Dr Dhansay reviewed each of the MRC Research Units, listed as:
- HIV and AIDS
- Tuberculosis
- Infectious Disease
- Cardiovascular Disease and Diabetes
- Crime, Violence and Injury (name changed to Safety and Peace Promotion Unit)
- Cancer
- Health Promotion
- Public Health
- Genomics and Proteomics
- Women, Maternal and Child Health
- Brain and Behaviour
- African Traditional Medicine

The MRC had also set up National Collaborative Research Programmes (NCRP), which address priorities in South Africa in a multidisciplinary and multi-institutional fashion. NCRPs include cardiovascular and metabolic disease, and CARISA (Cancer Research in South Africa). The MRC also had Collaborative Research Groups in Brain and Behaviours, and Environmental and Health Research.

Dr Dhansay noted some of the barriers that made it difficult to move from research to practical applications. These included such blocks as a lack of qualified investigators, incompatible databases, and high research costs to name a few. The MRC hoped to attract and retain top scientists to improve productivity.

Addressing the specifics of the Strategic Plan, Dr Dhansay noted the MRC's two strategic outcome oriented goals. These goals were: Improve Health through Research, Development and Innovation by generating new knowledge through high quality, relevant and ethical health research and Establish Effective and Efficient Research Support by ensuring an efficient, effective and compliant public entity and health research organisation. The MRC provided five strategic objectives within these two strategic goals. The strategic objectives informed the research agenda and action plans of the organisation for the next three years. Implementation was through the relevant research projects conducted by both intra- and extramural research entities of the MRC, as well through its funding of self-initiated projects and capacity development initiatives.

The strategic objectives were:
Strategic Objective 1: Prioritise & conduct research to support four outputs of the Health Negotiated Service Delivery Agreement for 2010-2014;
- NSDA Output 1: Increasing life expectancy; - Cancer Risk Reduction - Malaria - Alcohol and Drug Abuse - Nutrition - African Traditional Medicines
- NSDA Output 2: Decreasing maternal and child mortality - Influenza and Pneumonia
- NSDA Output 3: Combating HIV/AIDS and reducing the burden of TB - New technologies to control TB, including TMC207, a new drug that works against all drug resistant strains of TB that was currently undergoing clinical trials. - HIV and AIDS South African AIDS Vaccine Initiative (SAAVI) Clinical Trials at various stages.
- NSDA Output 4: Strengthening health system effectiveness - Telemedicine

Strategic Objective 2: Contribute to National System of Innovation by conducting & promoting Research for Health

Strategic Objective 3: Translate health research; strengthen capacity to synthesize and disseminate evidence to be used for policy making and health care

Strategic Objective 4: Health Research Capacity Development; and develop research capacity in individuals, institutions, MRC research units and within the MRC itself

Strategic Objective 5: Effective, Efficient and Compliant Research Support. The details of each strategic objective could be found in the attached presentation.

Dr Dhansay presented slides that reflected the amount of money that the MRC paid out in grants in 2010. He also presented the demographic profile of intramural scientists at the MRC as of March 2011. He noted the changes in both the Black and Female population in the organisation between 1997 and 2010. He noted that the MRC received approximately 50 percent of its funding from the NDOH and 50 percent from external funding. He presented the top 10 external funding sources to the MRC and the growth in MRC baseline grant from 2006/07 to the present. He noted that although the MRC experienced growth for the past 5 years, the budget for this year was cut by R10 million. He compared the working budget figures for the current fiscal year against the five key strategic objectives. He noted, for each key strategic objective, the breakdown of funding that came from the baseline grant and the contribution of external contracts. He noted that key issues affecting the budget for this year could be a proposed salary increase of 7 percent.

Dr Dhansay noted other challenges facing the MRC included:
human capacity – ageing of productive scientists, poor school education and the high demand for skilled individuals; research infrastructure – equipment for research could be costly to keep up to date and to maintain; financial sustainability – the flat-lining of the baseline grant and international funding sources.

Dr Dhansay addressed the key priorities for the immediate term. He noted the problem of interim leadership at the CEO and Executive Management levels. The MRC would also be addressing the strategic planning process for finalising the 5-year Strategic plan, while maintaining on-going productivity of the MRC during this transitional period.

Dr Dhansay presented the key risks facing the MRC. He stated that making the Research Integrity Office operational would address any potential lack of integrity in research. He also noted that the MRC was heavily involved in clinical trials. There was always a risk to the reputation of the MRC should trials work out negatively. He explained that the MRC's media strategy combined with adherence to codes of ethics would address this risk. There was always a challenge with external funding. The MRC often pursued research that met the needs of donors rather than necessarily addressing the main disease areas of South Africa. He also stated that there was high demand for scientific skills, and the MRC was reviewing its reward and recognition strategy to counter this problem.
 
Discussion
The Chairperson asked the members to engage MRC.

Ms B Ngcobo (ANC) asked what funding was directed towards the indigenous medicine unit. She asked if there was literature available on the quick diagnostic tool for TB. She asked what the cost of development was for the new drug to combat extreme drug resistant TB, and the cost of implementing and using the drug. Lastly, she asked if there were other countries on the continent that were participating in telemedicine, or if South Africa was sharing any information, and how was telemedicine benefiting rural communities.

Mr M Waters (DA) asked when the MRC thought there would be a standardised tool for measuring maternal and child mortality, and why there was no standard tool yet, given that we were 11 years in to the project. He asked what other barriers were there to successfully preventing mother-to-child transmission of HIV/AIDS and what other barriers were there to achieving Millennium Development Goal targets. He noted that the cancer registry was not updated; in fact, it was over ten years old. Did this not mean that we were potentially allocating money against outdated information. For example, there was an increase in cervical and breast cancer incidents; however, we may be allocating more money to other types of cancer. He asked if he could be informed of when this registry might be completed and what the role of the MRC would be in ensuring that the registry was completed and updated. In regards to AIDS/HIV, he asked, since AIDS was a non-notefiable disease, how did the MRC obtain statistics on the number of AIDS deaths.

Mr G Lekgetho (ANC) asked the MRC to verify their current vacancy rate and when they planned to fill their vacant posts. He asked if the MRC could provide any information on a recent discovery in diabetes medicine from KZN University.

Ms E More (DA) asked where the lack of willing participants as noted by the MRC was occurring. Was this a lack of participants for research studies, and was this occurring at the community level, or at what level. She asked if the MRC could further elaborate on both the career disincentives and the incompatible databases that they spoke about. In regards nutrition, she asked if the MRC verifies the nutritional information that goes onto food labelling. She asked who would procure and pay for the telemedicine workstations and who would maintain them.  She noted that the Department of Health had reported an increase in administrative staff and a decrease in clinical staff and she asked if the MRC was moving in this direction. She also asked how the MRC was going to meet its Employment Equity targets. Ms More noted that the last time that the MRC presented to the Portfolio Committee, they had spoken about an innovated communications strategy to the general public. She asked how far along the MRC was in implementing this communications strategy, and if it was yielding results.

Mr D Kganare (COPE) asked who the MRC regarded as their key stakeholders in their strategic plan. He asked the MRC that if they felt that they were not going to reach the targets for the Millennium Development Goals, were there ways in which they could intervene to assist. He also asked how they interacted with other departments to share research. He asked if the MRC could further define the phrase ' other diseases of the immune system' presented in their statistics. When funding was provided by an organisation outside of the government, who owned the resulting intellectual property from their research. He also asked what role external funding organisations play in directing research. In regards to the health research capacities of universities, he asked if universities apply, or did the MRC seek engagement and how the
MRC avoided duplication of research between universities. Mr Kganare noted that the budget showed a plan for a deficit in the 2011/12 fiscal year. He asked how the income from external funding was represented in the budget and how it was accounted for in the strategic plan. He asked the MRC to explain what the rental expenditures noted in the budget was for. Lastly, he noted that the presentation listed the top 10 external sources of funding. He queried the MRC if there were other external sources of funding and why they were not listed in the presentation. 

Ms C Dudley (ACDP) referred to the challenges that the MRC noted in the presentation. She asked what specific measures the MRC would use to counter these challenges. Was the problem largely financial, if not, what would the MRC need to attract the necessary skills. Did the MRC see the situation changing during the year or had the council resigned themselves to the situation as it existed. She asked if Employment Equity was actually stopping the MRC from filling posts.

Ms M Dube (ANC) asked the MRC to clarify the point in their presentation regarding halving poverty and unemployment by 2014, and did the MRC have the capacity to achieve this. She noted that much of the MRCs data was collected in 2007/08. She asked how often data was collected and did the 2011/12 budget rely on the figures from 2007/08. How was the data collected. She asked if the MRC collected data on the types and quantities of illegal drugs circulating in the country. Ms Dube asked if the MRC had research on, or could advise on health issues of processed food. Lastly, she asked if the MRC would be filling vacant posts or creating extra posts to assist with the government's job creation strategy.

Ms Kenye (ANC) asked how much longer it would take to implement the clinical trials under the SAAVI program.

Ms M Segale-Diswai (ANC) noted that it would have been beneficial to have had a performance review of the previous fiscal year to review the impacts of their efforts. She asked how the MRC worked around the issues with data quality problems to produce accurate research. She wanted to know how well the MRC worked with provinces other than the Western Cape. She asked what the Western Cape had that other provinces did not.

The Chairperson asked if the government had been using the MRC to make policy based on their research and if so, what was the impact.

Dr Dhansay noted that the slide showing self-initiated research represented a reflection of the numbers of research grant applications that were submitted and the numbers that were successful.

The Chairperson noted that grants could not be given to universities that did not have the capacity to do research. He stated that the MRC should identify the areas where capacity did not exist at universities so that the Committee could look for solutions.

Dr Dhansay noted that the MRC sent teams to universities to assist with grant writing.

A member from the MRC stated that communities were involved in the process of commercialisation of research. Although in the past two years, there were no companies registered for commercialisation. However, he stated that commercialisation could happen in many forms. It was understood that when communities were involved in research, there had to be an environment created were the communities could benefit. In regards to international funding, most funders did not want to see any money going directly into the fiscus. Therefore projects had to be structured so that they did not trigger a portion of the funding going towards VAT requirements. Governmental policy stated that where the government was spending money on research, the intellectual property must stay within the country.
Dr Dhansay noted that the NRF and Department of Science and Technology were proving substantial funding to the Indigenous Knowledge Unit. He stated that he would supply the Committee with the costing and literature on the latest TB diagnostic tool.

Dr Dhansay recognised the problem with developing a standardised tool for measuring child and maternal health. There was a data coordinating committee that was established by the Director General of Health to determine a set of baseline data. The MRC was involved in this committee. In addressing other questions of data quality, he stated that evidence was relevant for the time it was collected. The challenges of national data collections stem from the variety of tools that could be used and the accuracy of each tool. He noted that South Africa was well ahead of their African neighbours in data collection and quality. He noted that all data could be used, as long as the context was provided.

In regards to the Cancer registry, Dr Dhansay noted that it had been flagged as a concern. There was a partnership with the NHLS where the repository of information would be made available. He would supply more detailed information to the Committee.

Dr Dhansay noted that the source of information for the statistics on natural causes of death was the death certificate filled in by the medical practitioner. Although HIV / AIDS was not notefiable like pneumonia but it was the responsibility of the attending physician to fill in the form according to his or her discretion. The MRC was working with undergraduate medical students at the universities to teach them to fill it in accurately.

Turning back to the barriers to achieving child and maternal health targets, Dr Dhansay noted there was a wide range of difficulties such as rural locations, the nature of the clinics, the nature and capacity of the staff, and access to medications to name a few. Beyond the clinic there were also social contexts to consider such as community stigmas. In some cases there were other Departments that were involved that required coordination. He explained that this was a broad answer, but the reality was that there were many reasons why the mortality could be so high.

A member from the MRC responded that the vacancy rate at the MRC was below 3 percent. The current board was considering the matter of the President's position that had been vacant for just over 1 year. He noted that the emphasis for hiring was for scientists. When administrative positions became vacant, the MRC conducted a thorough review of the position requirements to ensure that the duties could not be filled by someone else.

Dr Dhansay stated that he was not aware of any traditional medicines that had been introduced recently in the treatment of diabetes. However, another member from the MRC noted that there had been the recent release of a new insulin delivery system through a skin patch.

Dr Dhansay noted that there were areas with problems and that the MRC was conducting projects in those areas such as in the Easter Cape and Limpopo.

He stated that career disincentives was a problem because the entire chain for developing researchers from school to undergraduate onwards did not just affect the MRC. He noted that the MRC did not have enough baseline posts to offer a suitable tenure to scientists.
Dr Dhansay remarked that incompatible databases were a reflection of different sources of information and a lack of standardisation between projects. In regards to food labelling, he noted that the MRC had not conducted any specific research; however, they were involved with the food safety and control divisions of the government. Besides formal research projects, the MRC was also involved in an advisory capacity with various sectors of government. The MRC was involved in conducting research into food compositions, but not specifically for labelling purposes.

Dr Dhansay qualified the term manager from the strategic plan. He noted that the MRC was a research organisation so the operational people were researchers whether scientists or not. The unskilled people in the organisation represented occupations such as gardeners. Thus the term manager was not a manager in the business sense of the work, but it was the researchers who were actually conducting the work of the MRC.

Ms Jill Fortuin, Manager: Telemedicine, MRC, responded that telemedicine was being used in other low income countries such as Brazil and China. Although it could not replace a doctor, it was demonstrated in these countries as cost effective. She noted that the MRC still had to prove to the Minister of Health that tele-radiology was also cost effective. She stated that the MRC developed the original telemedicine workstation and the latest version would be procured by the MRC and deployed by a sub-contractor. The funder, MTN SA Foundation, had paid for one year of maintenance and support for the systems. The MTN SA Foundation requested that the MRC have an MOU with the provinces to ensure that the provincial departments of health made the ongoing payments for the next 10 to 15 years.  She noted that South Africa was the leader in Africa for telemedicine. Nigeria was the only other country that had telemedicine, but everyone was looking to South Africa for guidance on this issue.

Dr Dhansay noted that in order to ensure that research reaches the communities, directors and project managers of MRC units were expected to not only initially engage with communities but also to provide feedback with them. He noted that he needed to get more feedback from the units, but the MRC engaged the community, they did not use the community.

Dr Dhansay stated that this strategic plan considered only internal stakeholders such as MRC senior researchers, managers, and the current board. The engagement of external stakeholders would occur in May and June 2011 when the MRC considers the five-year strategic plan.

In order to reach the MDG's, Dr Dhansay noted that the MRC was not a service provider. The MRC intervened through providing research, advice and support to the Department of Health. Achieving the MDGs was a huge task, and he stated frankly that there would be areas where it would be very difficult to affect change.

Dr Dhansay stated that projects were done in partnership from the beginning. It was not a case of completing a project and handing it over. Progress and feedback reports were provided throughout the life of a project. However, monitoring and maintenance for something that the MRC researched would be the responsibility of that sectoral department.

Dr Dhansay noted that the codes provided in the presentation for immune mechanism disease statistics were classified in accordance with the International Classification of Diseases version 10 (ICD 10) codes. The most common disorder used for classification of immune diseases was "other", which did make analysis challenging.

Dr Dhansay noted that the duplication of research was very important. It was essential that the MRC have a data bank or inventory to ensure that research was not duplicated.

A member of the MRC noted that the strategic plan was based on the overall budget of R579 million. The presentation isolated the R279 million that was provided by the Department of Health. The remaining R300 million was made up of more than 200 external contracts. For each study, there was a budget that was approved by the funder. He noted that there was a deficit planned into the budget. This was due to the government reduction in funding by R10 million to the MRC. The MRC factored in a 7 percent salary rise for the year which produced this deficit. However, noting that the MRC could not plan for a deficit, the strategic plan was provisional. The Board would be meeting shortly to determine if the deficit was justifiable or not.

He noted that the other funders were small but numerous. The top ten funders that were provided in the presentation made up over 90 percent of the external funding that the MRC provided. Lastly, he noted that the clinical trial sites that the MRC was using were rented, hence the rental charges provided in the budget plan. The MRC was not in a position to acquire infrastructure.

The Chairperson asked that any unanswered questions be provided to the Committee in writing. He asked the Chairperson of the Board address the Committee.

Mr Lizo Mazwai, Chairperson of the Board, MRC, spoke to some of the new Board's activities following the handover period. He noted that the MRC had aligned itself to what the Department of Health required. He noted the MRC's requirement to show accountability with funding and relationships. There would be a push to further cooperation with departments and not just alignment with priorities. They would be addressing transformation of governance in the MRC's units and improving upward mobility within the organisation.

The Chairperson thanked the MRC for their presentation and he stated that the Committee would be monitoring their progress.

Adoption of Minutes
The Committee reviewed and adopted the latest minutes of the Committee with minor amendments.

The Chairperson adjourned the meeting.

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