The Medical Research Council (MRC) presented its Annual Report for the 2010/11 financial year. In this year, the MRC had received an unqualified report with matters of emphasis relating to wasteful expenditure, irregular expenditure of R38.3 million, mainly as a result of non-compliance with the Preferential Procurement and Supply Chain Management requirements, and one instance of theft of funds handled by MRC, although no MRC staff were involved. The various detailed comments from the Auditor-General were set out and the MRC reported that it had interventions to address those, and was in contact with the Auditor-General to confirm the steps taken. The MRC reported to the Minister of Health. It had experienced some difficulties in the last financial year because the Department of Health had dissolved its Board, and a new Board was appointed with effect from November 2010, yet it still had no President, and some of the staff appointments were standing over until the appointment of an Interim President. Some key positions were vacant but the Board had also experienced difficulty in attracting the right applicants, and had finally made recommendations to the Minister around the seven short-listed candidates, although this appointment too would stand over until the Board’s position was regularised.
The MRC said that South Africa faced a quadruple burden of disease profile, made up of poverty related conditions, emerging chronic diseases, violence and injuries, and HIV and AIDS. The environment in which it operated included not only complying with its own legislation and the Department of Health (DOH) initiatives and ten point plan, of which research was a key component, but also responding to science and technology developments. Some of the major research innovations were fully set out and described, including the work into vaccines, particularly through the South African AIDS Vaccine Initiative (SAAVI), work into TB and the co-infection between TB and Aids, the multiple interventions that were being piloted for TB, studies by the Alcohol and Drug Abuse Research Unit, including whether there was routine testing of clients here for other illnesses, and various HIV prevention projects. There were also studies into drug abuse amongst school-going youth. There had been studies into initiation and circumcision practises, and Memoranda of Understanding were signed with the Eastern Cape House of Traditional Leaders. The MRC was pleased to announce increased numbers of black and female scientists, and an improvement in employment equity, although it noted that there were still challenges. Its physical premises did not presently allow it to employ any physically-disabled people. The filling of senior management positions remained a challenge.
The issues raised by the Auditor-General were fully discussed, including the challenges around the verification of performance management information, and internal control processes. MRC had managed to retain its external income sources, which accounted for about 50% of its total income, despite the economic downturn. There were challenges around how to translate research results into policy, practice, products and health promotion. It was also necessary to ensure alignment and integration of MRC research with the strategy of the DOH, and to respond to the SETI Review Report. MRC was currently working on its new strategic plan, in which a number of the former issues would be addressed.
Members were generally quite appreciative of the work being done by the MRC. However, there were concerns expressed, and a number of questions asked, about the Auditor-General’s report and how MRC intended to address the issues, as well as concerns about the human resources component and the need to achieve stability, and detailed responses were given. Members also queried why the strategic plans were submitted late, why they were not approved and how this would be addressed in future. They enquired about traditional medicines and what input MRC had into the collaborations for the Traditional Medicines Research Programme. They asked about development of the HIV and possible cancer vaccines and how long it was likely to take from testing to final implementation. Members asked when a National Cancer Register would be available and noted that the MRC was spearheading work on this, but that the Register itself did not fall under its control. Members noted various studies being done and enquired if there had been any links established between increased brain tumour incidences, and use of cellphones, the reason for pica being prevalent in Johannesburg, the reasons why children in the Northern Cape tested for high levels of Vitamin A, the baselines used for under-five mortality and maternal mortality studies and the lack of good data and monitoring. They also asked about the work of the MRC on the National Health Insurance, what had prompted certain research, particularly that on male homicides, whether the Cancer Research Units considered data from all provinces, and why more offices had not been established in each province, why the Wellness Programme was not yet implemented and what was being done about chronic disease, and lifestyle diseases. They noted that prevention was infinitely more effective than reactive steps. They questioned the links between mental health, and use of drugs and alcohol, asked for report-backs on some programmes and noted that other questions could be submitted in writing.
Medical Research Council 2010/11 Annual Report
The Chairperson welcomed Professor Lizo Mazwai, Chairperson of the Board, Medical Research Council, and his delegation.
Prof Muhammad Dhansay, Vice President: Research, and Acting President, Medical Research Council, also introduced Prof Mazwai and Prof Zodwa Dlamini, Deputy Chairperson of the Board, and Deputy Executive Dean, UNISA. He noted that there were also various other members of the Medical Research Council (MRC) without whose contribution MRC would not have achieved its outcomes.
Prof Dhansay noted that he had brought written responses to the questions that Members had asked during the strategic planning session earlier in the year, when there had not been sufficient time to respond to those.
Prof Dhansay then briefed the Committee on the Annual Report of the MRC for 2010/11, setting out that the South African Medical Research Council Act and various policies (outlined in the presentation) governed its activities. He noted that the MRC was currently busy with the 2011 to 2016 strategic plan. Besides its own legislation, it was also important for MRC to examine the science and technology environment, which also gave guidance on scientific and clinical research in South Africa. A Review of the MRC had taken place in May and June 2010.
The Medium Term Strategic Framework (MTSF) of the MRC identified five development objectives, of which the most important were probably to improve the nation’s health profile and skills base, and to ensure universal access to basic services. MRC’s research contributed most directly to ensuring a long and healthy life for all South Africans, but also contributed to other government outcomes. It also spoke to achievement of Millennium Development Goals (MDGs) 4, 5 and 6, which related to reducing child mortality, improving maternal health, and combating HIV/AIDS, malaria and other diseases.
Prof Dhansay turned to the National Department of Health (DOH) Ten-Point Plan for 2009-2014. The MRC’s Research portfolio applied to all ten points, but he highlighted that the revitalisation of physical infrastructure was particularly important, as well as the strengthening of research and development.
He noted that in the 2010/11 year, Negotiated Service Delivery Agreements (NSDA) were entered into between the different ministries and the President. The outputs were similar to the strategic objectives, except for a specific highlight on decreasing maternal and child mortality rates.
Prof Dhansay noted that in the health environment, South Africa faced a quadruple burden of disease profile, which he said was made up of poverty related conditions, emerging chronic diseases, violence and injuries, and HIV and AIDS. Although the Comparative Risk Assessment Study of 2007/09, which estimated the burdens attributable to selected risk factors, appeared outdated, the analysis had taken a long time to do and much work had gone into it that remained relevant. Major risks were sexually transmitted disease, violence and alcohol.
Prof Dhansay noted that the MRC reported to the Minister of Health. The current Board had taken office in November 2010. The position of President of the MRC was currently vacant, as well as posts of Executive Director: Innovations and Technology, and Executive Director: Finance (who had been poached by another academic institution three weeks earlier). He noted that staff tended to move between research organisations, and possibly MRC’s good training and the experienced people it produced placed it more at risk of losing staff. Its work was centred around research that would achieve increased health, quality of life, and efficient and optimal health services that would impact on the lives of South Africans through social upliftment and economic development. Training and capacity building were amongst the core mandates.
The research highlights were set out, although Prof Dhansay said that he could not do justice, in this presentation, to the intensity of work and interaction of the MRC Research Unit.
As part of its work in HIV and AIDS, the MRC’s HIV Prevention Research Unit of the MRC was involved in the VOICE (Vaginal and Oral Interventions to Control the Epidemic) Trial. He noted that because HIV and Aids were complex, multiple strategies were needed, and this trial was looking specifically at oral anti-retroviral (ARV) therapy and use of the microbicide gel. The trial had commenced in 2010/11, but was later abandoned for lack of effectiveness. Integrated prevention and treatment studies were also tackling the complex problems of the CD4 count enumerator, with patients, at point of care at clinics. Additionally, the MRC’s Biostatistics Unit was involved in a series of trials conducted in the primary health care clinics of the Free State. The aim was to train nurses at primary health care (PHC) level in integrated care of lung health diseases, sexually transmitted infections and HIV, including the initiation and prescription of ARVs. These pragmatic trials evaluated the interventions in daily setting of the PHC clinics.
The Health Systems Research Unit, under directorship of Prof Charles Hongoro, carried out an important study on the South African prevention of mother-to-child transmission. (PMTCT). The results were presented by the Minister. Another study was done on the impact of provider-initiated HIV testing and counselling (PITC) intervention for patients with sexually transmitted infections in Cape Town.
The South African AIDS Vaccine Initiative (SAAVI) during the reporting period conducted Phase 1 trials, on the SAAVI 103 vaccine, developed in South Africa but first tested in America. Results showed the vaccine to be safe and well tolerated. The Medical Control Council (MCC) approved the second trial in January 2011.
A full protocol amendment to that trial, to evaluate the safety and immunogenicity of the South African vaccine, also incorporating input from the private industry player Novartis, was submitted to the Food and Drug Administration (FDA) for approval. Furthermore, there was international cooperation between South Africa and the government of Italy where a therapeutic vaccine was being tested at sites within South Africa. Approval for SAAVI 103 was granted in January 2011, and since then, another amendment had been submitted and approved, in October 2011. SAAVI 102 was enrolled in the United States in October 2011, and a Biosafety Committee approval letter was awaited.
The DOH had requested that SAAVI be incorporated into the MRC budget for the future.
SAAVI was leading the development of a National HIV Vaccine Plan, which was an important initiative that would be incorporated in the HIV/AIDS strategic plan for the current year.
Prof Dhansay turned to Tuberculosis (TB) inputs, noting the presence of Dr Martie van der Walt, Director: TB Epidemiology, MRC. He noted that South Africa had a facility at the Mpumalanga Provincial MDR-TB Referral Hospital that was quite unique in the world. Not only were patients treated there, but there was also a facility to test the effects of treatment and interventions in an animal model in the same building. Because of the co-infection risks of TB and HIV/AIDS, a treatment, support, and integrated therapy programme was designed to ensure that patients suffering from TB and HIV received a comprehensive range of services. This was rolled out to 183 clinics, mostly in rural settings, in five provinces. An important aspect of new TB drug development was that multiple interventions, and not drug therapy alone, were used. MRC was involved in ongoing clinical trials, and diagnostic tests that were reasonably cheap and applicable in the clinic setting, with the Cepheid Xpert® MTB/RIF Assay, in conjunction with the Foundation for Innovative New Diagnostics (FIND). Countries included in the evaluation were Peru, Azerbaijan, India and South Africa.
Prof Dhansay said one of the questions asked, but not responded to during the strategic planning meeting, was the cost of the latest TB diagnostic tool. The TB Clinical Research Unit in Durban were co-collaborators in the project, and in publication of evaluation of this instrument. Subsequent to that, the World Health Organisation (WHO) had adapted its policy of diagnosis of TB, using the new South African instrument in rural clinic settings. Bio Science and MRC had partnered in the venture. Special funding and cost arrangements were made. The National Health Laboratory Services (NHLS) bought twenty of the machines at a cost of US$75 000 and the cost of the test, per sputum sample, was US$17. That was around 75% of the cost to the rest of the developed world. It was still expensive, but the price would reduce as the usage increased. The pricing may be restrictive, but it was important to note that relatively untrained staff could apply the test. Dr Dhansay cautioned that it did not pick up all cases of TB, but only those where the sputum was positive on microscopy, with about a 60% detection rate where there was co-infection of both HIV and TB.
The Centre for Molecular and Cellular Biology was one of the leading TB Research Units at Stellenbosch University. It looked at the diverse aspects of drug resistance diagnostics, and the genetics, and co-infection and health amongst school children. Many children were infected by soil-transmitted health risks, and there appeared to be some link between the immunology of the two infections.
The Chronic Diseases of Lifestyle Research Unit of MRC had developed and evaluated a smoking cessation intervention for pregnant women attending public-sector antenatal clinics in Cape Town. This was an important intervention, but the prevalence of pregnant women smoking was extremely high. A Cardiovascular Risk on Black South Africans (CRIBSA) study was done, involving 1000 participants, which the intervention looked at improving awareness and intervention, and managing chronic diseases. The area of non-communicable and chronic diseases was high on the agenda, both nationally and globally.
In the area of rotavirus infections and diarrhoea, the MRC’s Research Units were at the forefront of encouraging vaccination, and the first trial of trivalent influenza vaccine (TIV) HIV infected adults showed a 75% reduction in confirmed influenza.
Prof Dhansay noted that it was essential for South Africa to work with neighbouring countries on malaria. Although prevalence of malaria had decreased, it must be remembered that it crossed geographical boundaries, and pockets of malaria cases were identified in areas of Gauteng. The Auditor-General (AG) had isolated some instances of fraudulent activity into a joint project with the Department of Health in Mozambique, it was found that no MRC employees were involved in fraudulent activities.
The Safety and Peace Promotion Unit looked at prevention of violence and injury. MRC was active in the DoH Strategic Framework for the Prevention of Intentional and Unintentional Injury, which also involved eight other ministries. The automated National Injury Mortality Surveillance System (NIMSS) sought to improve data turnaround time.
In respect of cancer interventions, Prof Dhansay noted that the Cancer Epidemiology Research Unit had analysed twelve years of data on hormonal contraceptive use, and cancers of the breast, cervix, ovary and endometrium, diagnosed at tertiary hospitals in Johannesburg. The results showed that use of contraceptives carried a transient increased risk for breast and cervical cancers but, with longer duration of use, a reduced risk of ovarian and endometrial cancers.
The Oesophageal Cancer Research Unit established a hospital-based oesophageal cancer registry at Groote Schuur Hospital and also started one at Tygerberg Hospital.
The Oncology Research Unit showed that tobacco smoking and alcohol consumption were strongly associated with oesophageal cancer in the Eastern Cape. In the area of Centane, Eastern Cape, practical interventions were implemented. Community members learnt how to separate potentially harmful maize. Research was also done on inhibitory effects of certain herbal teas on papilloma growth, indicating possible reduced tumour growth applications in oesophageal cancer.
In the public health arena, the Burden of Disease Unit was involved in several studies, including measuring maternal mortality, child mortality, a national burden of disease study, a local level mortality surveillance; and the Cochrane Centre-based cancer study in the former Transkei. The Cochrane Centre was invited to provide the evidence base for the WHO guideline ‘Recommendations for a public health approach’ and existing Reviews had been updated.
The Pan African Clinical Trials Registry (PACTR)was a prospective registry of clinical trials conducted in Africa and was the only WHO-endorsed Primary Registry on the continent. The DOH had approached the MRC to host its SA National Clinical Trials Registry.
Senior members of the Health Systems Research Unit were actively involved in assisting the DOH with credible health economics and health systems inputs for the National Health Insurance Policy. The Unit had a significant impact in translating management of health systems from local down to district level, and contributed to knowledge being translated into policy. This Unit had secured a European Commission project on the promotion of sexual and reproductive health among adolescents, with collaborators worldwide.
The Alcohol and Drug Abuse Research Unit conducted several studies. An audit of substance treatment centres in seven provinces found that less than half of these 72 facilities routinely tested clients for infectious diseases that co-occurred alongside HIV. An HIV prevention project was initiated in Tshwane, where on-site trained bar servers would encourage responsible drinking and sexual risk reduction among bar patrons, some bar patrons were also trained as peer educators or leaders, and on-site professional counsellors would provide education, counselling, and referrals to outside counselling and treatment services.
A Cape Town school survey found that lifetime methamphetamine use, in addition to other substances, was significantly associated with non-attendance at schools later on, so early identification of students with substance use problems may improve high school completion and student retention rates.
The Health Promotion Research and Development Research Unit released results of the second South African Youth Risk Behaviour Survey, which was conducted on 10 000 Grade 8 to11 learners. Recommendations were made for tailoring of sexual education, promotion of sport and recreation programmes, and implementation of comprehensive prevention programmes for tobacco, alcohol and drug use. This Unit had also looked at initiation and circumcision, and a Memorandum of Understanding was signed with the Eastern Cape House of Traditional Leaders, after a workshop to gain an understanding of determinants of men’s health and behaviours was held. Research was conducted in male initiation, including circumcision and the cultural norms and behaviours associated with this practice.
The Gender and Health Research Unit conducted studies on rape penetration, partner violence and links to HIV, and worked on strengthening responses to sexual assault in the African region. The Unit developed and evaluated the national curriculum for training health professionals (doctors and nurses) in post-rape care.
The Maternal and Infant Health Care Strategies Research Unit was involved in an international collaboration on preventing stillbirths. The Unit developed the background to implementing changes and defined the seven key interfaces that were involved in implementing new programmes or improving the quality of those already in place. The Unit identified the key programmes that were shown to reduce mortality and described strategies on how they could be implemented.
In the area of nutrition, a baseline assessment for the Sustainable Food Production and Nutrition Education in Schools programme, implemented by the Department of Education, in collaboration with the Agricultural Research Council and international agencies, put an agricultural organisation within a schools context. High to adequate vitamin A status was found among pre-school children in the Northern Cape Province, which had implications for the current national policy of blanket high doses of vitamin A supplementation.
Prof Dhansay said Prof Dan Stein, Director of the Unit on Anxiety/Stress, MRC, could answer any questions on the brain and human behaviour. The treatment of anxiety and stress disorders influenced national policy and treatment guidelines. The area of mental health was important both in South Africa and globally, and important interventions were needed.
He noted that Genomics and Proteomics was a broad area. The Bioinformatics Capacity Development Research Unit at the University of the Western Cape had conducted and published on studies. In the Bioinformatics area, high-tech technologies were used to handle huge sample-size databases, and to interrogate the information.
Within the area of community engagement and work within the communities, MRC’s Human Genomic Diversity Research Unit was invited by the San and Khoe community from Uitenhage to assist them in understanding their history.
The Gauteng Research Unit conducted a study in a Johannesburg hospital and looked at the habit of pica (eating non-food items) during pregnancy, which was a common phenomenon in that area, and which raised concerns about health risks, and this practice required further investigation and education for affected communities.
A Health, Environment and Development (HEAD) study was also conducted in Johannesburg, and provided a rich database of trends and conditions among urban poor in Johannesburg. Findings included the fact that these households experienced more violence than unintentional injuries, and this should be a major priority. Common mental disorders were widespread in impoverished communities, although mental health services were poor or absent altogether. There had been major improvements in the provision of basic services such as water, sanitation and waste services, but in some areas low numbers of households had access to hot water, which was a major injury risk and burden, especially for women.
The Indigenous Knowledge Systems (IKS) Lead Programme developed preclinical toxicological platforms, using an animal model, to test the toxicology of traditional medicines. It also had a special project for manufacturing traditional medicines and the effects of the traditional medicines.
Telemedicine was an important area, and the MRC was pursuing the best way to supplement the existing services of health provisions, such as collaborations with industry for deployment of telemedicine workstations at public health clinics.
Prof Dhansay then tabled the review of the Key Performance Indicators (KPIs) He noted that the MRC had had nine strategic objectives. In the research strategy and business plan, it had achieved 798 new knowledge activities, as against the target of 800, and achieved 95% on peer review publications, above target.
In the area of finance, it had aimed to increase its income, and had increased the baseline by 7% but external income had grown by only 0.1%. In respect of capacity development, MRC had 33 graduates in the year, as against a target of 50, but had exceeded its target of registering PhD students, and African PhD students, with 302 registered and 117 African PhDs. Ten of the most prestigious Career Awards were given to senior researchers.
The MRC had aimed to make all employees aware of research integrity, ethics and good business conduct. It had launched an Employee Wellness Programme was launched. It had transformed, with 50% of its staff complement now being African, coloured was 18%, Indian was 17%, and white was 15%. The male to female ratio was 31% male to 69% female. There were 65% black scientists in the internal research units, of whom 35% were African scientists, whilst senior black scientists occupied 55% of senior posts. The MRC wanted to increase its numbers of black, and specifically African, scientists. 14% of scientists had an MBChB degree. About half the posts were contract-funded, and he pointed out that the availability of posts was important for attracting those with scientific and clinical degrees.
MRC had produced 50 technical reports and 4 policy briefs.
Prof Dhansay turned to the financial statements. The total budgeted income was R208.9 million, and there had been a 8% salary increase. He set out the top ten funders (see attached presentation). There had been an increase in the research budget, from R259.9 million in 2009, to R280.9 million in 2010. He noted that the self-initiated grant system was one way to develop research capacity. This reflected both the numbers and qualities of applications. Established universities had, in the past, received the bulk of funding, but the MRC was trying to target historically and currently disadvantaged universities, not only in giving funding, but also in improving skills and grant writing abilities. The MRC remained exposed to risk in respect of the pension fund, and some of its members were on the defined benefit plan.
In respect of the audit report, Prof Dhansay noted that the MRC had received an unqualified audit report for 2010/2011, but there were matters of emphasis. An amount of R20 906 was wasteful expenditure, which was related to interest on late payments. Irregular expenditure of R38 273 291 was noted, mainly as a result of non-compliance with the Preferential Policy Procurement and Supply Chain Management principles. The MRC had implemented interventions. The Auditor-General (AG) had also raised comment on the usefulness of some information. There had been late submission and non-approval of strategic plan and quarterly reports, lack of supporting information and procedures for collecting data, and no regular reviews of monthly and quarterly reports. The AG had also highlighted a lack of responsibility regarding compliance with relevant laws and regulations, overall internal control deficiencies, and non-compliance with procurement and contract management. Steps were not taken to prevent irregular expenditure. There was one instance of
misappropriation of funds by a foreign national in a neighbouring country, who was not in the employ of the MRC.
Prof Dhansay outlined the response of the MRC to the audit findings. A five year strategic planning process was on track to meet submission deadlines. A dedicated Supply Chain Management (SCM) team was appointed. The supplier database would be managed by an outside company, who had been awarded a tender, and this database would accommodate the necessary legislative requirements. Any deviations from competitive bidding processes must be approved. Compliance policies were in the process of being approved by the Board. A dedicated ‘KPI Team’ was established who must coordinate the information for the quarterly report submissions. Finally, an internal audit was being done on the control processes governing the gathering, capturing and reporting on targets.
Prof Dhansay summarised that MRC had faced challenges of prolonged interim leadership in several positions over the reporting period. Nonetheless, it managed to maintain research productivity and output, as well as fulfilling its capacity building mandated. It had increased the number of black and female scientists at doctoral and postdoctoral level. There were issues around performance management information and internal control processes, but these were being addressed. On the positive side, it had maintained its external income sources, despite of the global economic downturn. The challenge was ‘flatline’ funding from MRC’s line department.
He summarised further challenges around translation of research results into policy, practice, products and health promotion. The MRC research had to be aligned and integrated with NSDAs of the Department of Health and the Review Report, but the current strategic planning would address these and human and infrastructural issues. In future, a new President must be appointed. The organisational structure would be revisited, when the 2012-16 strategic plan was finalised. It would support the DOH in reaching its goals and would continue to seek funding for research.
Prof Mazwai added that there were four Board Committees, the Audit and Risk, Human Resource and Remuneration, Finance and Planning, and Research and Development committees. The Board met four times a year, in between committee meetings, and some issues raised in this presentation would only be presented at the next meeting in ten days’ time. He noted that whilst the core function lay in research, MRC would like to do more interventions and therapy, to address the burden of disease. The DOH’s National Health Research Committee advised on research priorities, and a White Paper was expected to be issued in December. Publications and training were other important focal areas, as the MRC could not retain its national and international status without having scientists, particularly young scientists.
The Chairperson asked what part of a virus would be used to create antibodies. He wondered if the MRC believed that a vaccine could be produced for cancer. He also noted that he was interested in the studies into Vitamin A.
Ms M Segale-Diswai (ANC) asked for how long Prof Dhansay had been Acting President, and how long the positions had been vacant.
Prof Dhansay responded that he had been acting, following a resignation, from 1 January 2010, but was also the Vice President for Research. Because of the change-over from the old to new board, the SETI Review and the strategic planning sessions, there was no resolution to fill the posts. He noted that some other vacancies had occurred in the last year, and three weeks ago.
Prof Mazwai added that after Prof Dhansay assumed the Acting position, advertisements were published and a number of people were short-listed by June, but the board was not entirely happy, looked again at the candidates and had produced a list of three names in August. However, by that stage the Minister asked that the appointments be held over until the new Board took over. Some time was taken simply to find and nominate a company to do the head-hunt and advertising. The new Board had not been happy with those shortlisted, and the post was readvertised in February 2011. Another four names were added to the original three. Between March and May the Board held interviews and made recommendations to the Minister at the end of June. However, because the President of the Board had left, the Board first had to apply for an interim President, and then had head-hunted. An Interim President was likely to be appointed in January. There had been about 23 applications made over the two years.
Ms Segale-Diswai asked how the MRC followed up its findings to see that the results of the research were implemented. She also asked how the Auditor General’s findings were implemented.
Prof Dhansay responded that he hoped everything would be properly implemented with the implementation of the new strategic plan. There was also a period of transition in the Department and Ministry of Health. There were report-backs currently on individual research and research studies, especially those funded by the Department of Health, on a one to one basis. However, from the side of senior management and executive directorate, forums for direct reporting and feedback had to be set up, and in future it was hoped to implement bi-monthly or quarterly meetings on specific projects that impacted on the Department and South Africa.
Ms Segale-Diswai asked for clarity on the wasteful, and also on the irregular expenditure. She asked what had been done about the people who were responsible for fruitless expenditure.
Prof Dhansay explained that the wasteful expenditure related to late payments attracting interest.
Mr Zukile Vokwane, Executive Director: Operations, MRC, noted that MRC had used the Diners’ Club facility, but the need to clarify some matters led to payments being made late, and interest being charged. Mr Vokwane had discussed this with Diners Club and this would not recur in future.
He added that the MRC’s procurement system was decentralised, with all the units procuring. Certain procedures around Black Economic Empowerment (BEE) procurement were not followed, and although no fraud had occurred, there was non-compliance with the BEE systems. That had been corrected. From the beginning of this financial year, MRC made use of a database where all suppliers, including current ones, had to apply again for registration and had to comply with the processes. Random selections would be made. The MRC was experiencing huge challenges in the move from a decentralised system to a centralised system, but although there were still problems, the problems and the irregular expenditure were being monitored.
Ms E More (DA) questioned why eighteen, instead of the targeted four Stakeholder Management meetings were held.
Prof Dhansay responded that in the variance column, background information was given, and he added also that in this financial year the calculations had changed, so that the baseline was taken from the previous Annual Report. It may have been that the baseline target in that year was not accurate.
Ms More asked why strategic plans had been submitted six months late, and she questioned how complex MRC could be if it could not submit strategic plans on time. She further noted that those plans had not been approved.
Prof Dhansay explained that, as with the appointment of the President of MRC, the previous cycle for the strategic plan ended in 2010. The MRC had presented the business plans, but the Committee had demanded strategic plans. It was decided that these should be linked to the process of the SETI Review, and they were treated as a combined issue. Delays occurred, with the result that the AG could not compare an approved strategic plan to the performance. That was the reason for the comment that the indicators or measurement of targets did not link exactly to the strategic plan targets. The current strategic plan was presented to the Committee on 23 March 2011, within the time frames. He noted that the previous three-year strategic plan was not approved by the Executive Authority, although the Minister had approved the Annual Performance Plan. The MRC was on track to submit the second draft of the five-year strategic plan to the Committee by end of November.
Ms More asked why the supply chain management process was not followed.
Mr Vokwane noted that he had responded to this question earlier.
Ms T Kenye (ANC) asked what structures were in place to attract people with disabilities.
Mr Vokwane responded that that was a difficult issue, and currently the MRC did not have any disabled people, despite the fact that it would like to, because its facilities could not accommodate them. Currently, a .lift was being installed, and further ideas would be most welcome.
Ms Kenye wished to know the current status on traditional medicines.
Prof Dhansay responded that the idea behind having a national collaborative South African Traditional Medicines Research Programme was to extend research beyond one research unit in isolation, to a collaborative approach. The core of research was very small. The MRC did have a plan and strategy but some of the initiatives to formalise a national research programme, although the research activities themselves were continuing.
Ms Kenye asked when the MRC intended to implement the development of the HIV vaccine, and how long this would take.
An MRC representative answered that SAAVI had been asked by the DOH to lead the coordination and development of this plan. An initial meeting of stakeholders was held late in July and another would be held in December, when draft proposals would be discussed. It was too early to say when implementation would take place. The overall South African HIV/AIDS SPI study or strategic plan must take cognisance of the initiative, and formulate an HIV vaccine plan for South Africa.
Mr M Waters (DA) noted that in respect of the SAAVI 102 clinical trial (Phase II), MRC was awaiting an approval letter from the Biosafety Committee, and asked for how long that was awaited, suggesting that perhaps the Committee could assist.
Prof Dhansay said the MRC would respond to that in writing.
Mr Waters asked when an updated National Cancer Register would be available.
Prof Vikash Sewram, Director: Oncology and Cancer Research, MRC, responded that last year the MRC had been asked to provide leadership on the reporting of cancer, and to develop the capacity of the National Cancer Registry, which had broken down over the last decade. There were virtually non-existent systems to report cancer in an efficient way. Over the last year the MRC had provided assistance in revamping the computer systems, to automatically retrieve information from the National Health Laboratory Services (NHLS) data warehouse into the Cancer Registry. The data analysis systems were also revamped. The MRC was currently validating the automatic process, to reduce the downtimes of manually entering data, which would facilitate faster reporting. However, the MRC noted that cancer regulations were also being implemented, to make cancer a notifiable disease. This meant that although, formerly, the National Cancer Registry only dealt with cancers reported in the public health setting, information was now coming also from the private sector and this would require more capacity. It was an ongoing process to tackle the ten-year backlog, as well as the increase in information. MRC was trying to improve HR and infrastructure capacity. It was striving to be able to produce annual reports.
Prof Sewram, who chaired the Committee, expressed the opinion that although MRC was providing information and leadership, there were implementation difficulties because the National Cancer Registry was based in another organisation, because another level of structures had to be taken into account. If the MRC was to take leadership in a truly responsive manner then perhaps the National Cancer Registry needed to be placed within the ambit of the MRC.
Mr Waters asked if the results of the studies at Johannesburg Hospital had found any evidence of increases in brain tumours since the introduction of cell phones.
Prof Sewram responded that the MRC had not seen any increase in brain tumours, and there was no evidence, either locally or internationally, to suggest that the use of cell phones increased the development of brain tumours.
Mr Waters noted that the MRC was battling to find a baseline for the under-five year old mortality data. There were clear MDG targets in respect of under-five and material mortality. He asked why an amended baseline was not drawn in 2000.
The Chairperson remarked that the Committee had that report from the Human Rights Commission, but he agreed with Mr Waters.
Prof Dhansay said there would be an announcement soon on a meeting being held in Cape Town, and agreed that this information was vital.
Prof Debbie Bradshaw, Director: Burden of Disease Unit, MRC, said that the work done in the last year had highlighted the sad reality that MRC did not have good data to monitor the MDGs. In October last year, the Director General of the Department of Health had appointed a Health Baseline Coordination Committee, which was an advisory committee comprising representative experts from the MRC, the Presidency, the DOH, private sector and Human Sciences Research Council. They would discuss and advise the DOH how to make use of the available data to monitor outputs. A report had been drawn and provided to the DOH, and it was expected to be released soon. Concrete suggestions had been made on how to track current developments. Some further research was being done on clarifying trends between 1990 and now.
Mr D Kganare (COPE) stressed that steps must be taken to ensure that there was not further non-compliance. He was concerned about the suggestion that a change in Board impacted on the financial or other systems, stressing that correct systems should be implemented, no matter who headed the Board.
Dr Mongezi Mdhuli, National Manager, MRC, responded that the JB Edwards project involved upgrading of financial systems and involved an amount above the regulatory framework of the MRC. The DOH had been approached to approve the amount involved, in line with the Public Finance Management Act, but the DOH had not approved it, because of the change in the Board. DOH had felt that the new Board should ratify the deal.
Mr Kganare referred to the report of the Auditor General, which stated that there was non-compliance with the law, and that the MRC did not exercise oversight with regard to compliance and supply chain management.
Mr Vokwane responded that the leadership had spoken with the Auditor General about the Tshwane Executive Management, and the comments on the BEE procurement processes, and all that had been dealt with. The Audit Committee of the Board had contacted the Office of the Auditor-General and had indicated that the problems were being attended to. There was already increased compliance.
Ms C Dudley (ACDP) asked for more information on the issue of interim posts, and how these impacted on the budget.
Prof Dhansay responded that it was not just a question of finance. Prof Mazwai had already responded on the senior positions. In other areas within the MRC, especially the Intramural Research Unit, there were permanent posts and contract posts, but the permanent appointments were linked to finances. Once the strategic plans were set, and the structures linked to those were finalised, then the question of human resources and the filling of posts would be addressed.
Ms Dudley referred to the Health Systems Research Unit, saying that its work on National Health Insurance was critically important. She asked if the MRC had maximum access, whether it was limited by funding, or what more might be needed. The National Health Insurance (NHI) issues needed to be prioritised and everything possible should be put into that.
Prof Hongoro responded that the MRC was actively involved and one of its members was on the Steering Committee on NHI, which had designed the initial draft of NHI. The MRC was also involved in a number of technical processes to support policies around the initial costing of the NHI. The MRC was looked at revenue models that could be used to fund the transformative policy. It was also involved in developing the HR strategy that had to support that financing, and was concentrating on the initial modelling and production of human resources across professional categories. The MRC was also involved in other aspects. The MRC was likely to contribute to the design of the pilot studies.
Ms Dudley referred to Risk Factors in Male Homicides as one of the lead projects, and asked what prompted that research, where it was relevant, and how the research would impact more meaningfully in terms of policy.
Prof Dhansay said that although no member from that Unit was present, homicides were a major problem, especially in the deprived areas. Males were seven times more involved in homicides than females.
Ms H Msweli (IFP) understood that Cancer Research Units were established in certain places such as Cape Town and the Eastern Cape, but asked if they also existed elsewhere.
Prof Sewram responded that currently the Cancer Epidemiology Research Unit was based in the Gauteng area, but it did not have a unit director, and the Cancer Epidemiology Research Group was established at the University of Cape Town. Subsequently, the Oncology Research Unit was established, to focus on a broader sector of recent activity relating to cancer, including treatment outcomes, risk factors, and to enlighten and help with policy formulation and guidelines. The Cancer Research Initiative looked at ways of streamlining cancer research, so that there was no duplication, or wasteful expenditure of research resources. There could not be research units in all areas, but the national research programme would encompass the whole country.
Prof Mazwai added that the former Transkei was a high-risk area for cancer. The MRC and UCT established a research unit at the University of Transkei, because of capacity issues, and that unit ran for about five years. Unfortunately, the person who headed it moved to Stellenbosch to finish a PhD, and the unit was left with only one person, who had passed away, resulting in closure of that unit. MRC was now looking at reviving that unit, with capacity building earmarked from other institutions, but he noted that collaborative efforts were needed, as well as financial resources.
Ms Msweli questioned why only five provinces received a comprehensive range of services.
Ms Msweli asked why the wellness programmes were not being implemented, and what the MRC was doing.
Mr Vokwane responded that the issues of compliance with procurement had become quite serious at that stage and MRC wanted to deal with it thoroughly. The MRC only had the opportunity to tender in this financial year.
Ms M Dube (ANC) asked what the MRC was doing about chronic diseases such as diabetes, cancer and heart disease, which were becoming increasingly prevalent. She asked if the causes had been isolated.
Prof Dhansay said formerly, chronic diseases were considered to be diseases of affluence, but this had now been shown not to be true. No population groupings were spared from the “quadruple burden” of disease highlighted earlier. Climate change did not assist. From the point of view of ante-natal and paediatric care, it was very important to have preventive measures. These diseases were not merely genetic, but complex and multi-factoral issues were involved.
Prof Bradshaw added that the DOH had organised a summit in September, on non-communicable diseases. The MRC had highlighted the worrying trends and the risk factors for a number of chronic diseases, including the increased intake of dietary fat, harmful alcohol use and overweight and obesity trends. Only smoking showed a slight decline. In addition, levels of physical activity had dropped, with not enough people undertaking regular exercise. Unless something urgent was done, soon, South Africa would face an enormous burden. The DOH was leading the development of a non-communicable disease strategy to try to reverse the trends.
Prof Charles Parry, Director: Alcohol and Drug Abuse Unit, MRC, said that his unit was involved in a review of risk factors for chronic diseases for the summit in September, and agreed with Prof Bradshaw that high-risk contributors were alcohol, tobacco, lack of physical activity and poor eating habits. There was a lot that could be done to prevent those areas, rather than trying to take remedial action after the event. A two-day summit was to take place in Johannesburg, run by Soul City and the National Council Against Smoking, with representation also from MRC, the DOH and the HSRC. A Health Promotion Foundation was to be discussed, which would address the four issues simultaneously and look at new approaches. Two experts from the Thai Health Foundation and from the Victoria Health Foundation in Australia would share their experiences in setting up health promotion foundations, of which there were already fourteen across the globe, as well as an international network linked with the WHO.
Prof Dan Stein, Director: Unit on Anxiety /Stress, MRC, added that mental health was also considered an important factor that contributed to chronic disease, and data suggested that there was an increase in depression in younger South Africans. The Minister would be calling a summit early next year to map a plan for mental health, and a number of MRC members would contribute
Ms Dube asked how long it was likely to take between research and implementation.
Ms Dube was concerned that the MRC was heavily dependent on donations and asked what the donors expected in return, and how that funding was accounted for to the Auditor General?
Mr Philip du Plessis, Divisional Manager, HRC, responded that the donor funding was about 50% of the MRC baseline. Almost all funding was based on a Research Plan drawn by the donor. If MRC was successful with the proposal, there would be an agreement and funding would come to the MRC. The funding was based on the terms and conditions of the agreement, but in most cases there would be a technical report based on the research conducted in that specific area.
Ms B Ngcobo (ANC) referred to vaccines and asked if the MRC worked with Caprisa, who was a world-leader in vaccines.
Prof Dhansay responded that it did, but in a limited number of projects. The MRC was involved in the Biometric Co-Involvement Prevention Programme, which was an innovation established by the MRC to prevent people enrolling in several clinical trials, in order to get participant fees. It was a digital system, checking fingerprints, and immediately the network would be able to ascertain whether that person took part in multiple projects.
Ms Ngcobo asked what was the cause of the high volumes of Vitamin A in the pre school children of the Northern Cape.
Prof Dhansay responded that in the Karoo and the Northern Cape the high levels of Vitamin A were attributed to high intake of organ meat in the form of liver, lungs and kidneys. The Northern Cape area had a prevalence of very low birth weight and a high prevalence of stunting and underweight. This would assume malnutrition but it was necessary not to generalise, but to find out the real cause.
Ms Ngcobo asked how the misappropriation of funds by a foreign national came about.
Mr du Plessis responded that that related to the Lebombo Spatial Development Initiative project between South Africa and Mozambique, who were implementing a malaria control programme funded by global funding. MRC had a sub-agreement between the DOH and MRC in Mozambique, where MRC transferred some global fund money to Mozambique to implement the programme. The mismanagement took place in one of the provinces, and was picked up during the annual audit. Subsequent to that, a forensic audit was also conducted to ascertain the exact value of the mismanagement.
The Chairperson asked for more information on chronic diseases, and also called for more information on genetically modified organisms.
A Member asked if there was a link between illegal drugs and mental health.
Prof Parry responded that there was some evidence between use of cannabis and the triggering of a predisposition for mental health and schizophrenia attacks. This, however, would generally only be a trigger to a pre-existing condition. Substances such as alcohol, which was a depressant, could have a mood altering effect. There was a psychosis link with methamphetamine use, because it altered brain chemistry.
Prof Stein added that over the last period there had been an increase of admissions to hospitals in South Africa as a result of methamphetamine psychosis. Many beds that used to be taken up by people with schizophrenia and maniac depression, were now taken up by tik or methamphetamine abusers, and this posed a real problem in terms of resourcing. No dedicated addiction psychiatrists or dedicated addiction psychologists were available to deal with the critical aspects. The Western Cape Province, which experienced the worst problems in this regard, had put a number of initiatives in place to improve the clinical care of those patients. However, Prof Stein noted that alcohol abuse caused the worst medical problems. This reflected in a very prevalent condition, of foetal alcohol syndrome, which was highest worldwide in South Africa, because many women abused alcohol during pregnancy. This condition was preventable. Some initiatives had been taken by the alcohol industry, but much more could be done to promote the prevention of alcohol intake during pregnancy, with the help of the role players. Interventions could be very cost-effective. The increase of tax on cigarettes had a global effect on smoking. One of the interventions now being considered was how to reduce salt intake in the diet. The MRC was holding discussions with industry on how to bring down the salt level in bread, a key source of hidden salt intake, and he pointed out that high salt intake was one of the contributors to high blood pressure that caused strokes and heart problems.
Prof Dhansay agreed that it was very important to have interventions. He also noted, especially in terms of Vitamin A, that it was important to have monitoring. The amount of salt in bread depended on the quality of the wheat, for if the quality was not good then the industry needed to add more salt.
Prof Mazwai expressed his gratitude to the Committee for the opportunity to make a presentation, and said that the MRC always strove to be honest in its reporting and to answer questions to the best of its knowledge and understanding.
He noted that when the MRC was established 40 years ago, it was in an academic environment. It was now of course governed by legislation, and it was now a public entity subject to corporate governance. The first action when the new Board took over was a thorough study of the King III Report on Corporate Governance. It was found that many of the practices of the MRC, although they were working quite well, were not actually compliant, and in the last year the Board had tried to address the non-compliance, such as centralising the supply chain. Because the DOH had decided that a new Board was needed, the new Board entered a difficult pitch, from scratch, with little institutional memory available to it, and it had tried to pick up pieces, which was why there had been problems with the strategic plan ran into such problems. However, the Board was now finishing its first year, and was beginning to stabilise, so hopefully things would only get better. The lack of a President had been a setback, particularly since staff appointments had been held back pending that new appointment. However, the Board was not being forced into making appointments, and would ensure, when appointing, that it met targets.
Ms Segale-Diswai suggested that any further questions could be sent to the MRC in writing. She noted that she was still concerned about non-implementation of programmes, or non-reporting on them. She wanted, for instance, to hear about the improvement of the HIV and TB initiatives, support and integration, as mentioned in the Annual Report.
Dr Martie van der Walt responded that that was an integrated TB/HIV treatment platform, whose intellectual property was jointly owned by the MRC and the Foundation for Professional Development. It was established in 2005, at a stage when the idea of Integrated TB and HIV care was non-existent. However, it was to provide for TB patients and HIV care, using either entry point. This programme was hugely successful. The success was measured in how many TB patients were counselled and tested for HIV, and the follow up HIV care, but in fact it also contributed directly to much improved outcomes in the TB programmes themselves, in the clinics at the districts where it was based. She offered to provide more details in writing.
A Member asked about the study at the Johannesburg Hospital, and asked if it was only in Gauteng that women were eating soil and drinking herbs.
The Chairperson said Gauteng had been isolated for study as the economic hub of South Africa, to which people migrated from all over the country.
Prof Dhansay responded that the reality was that the MRC had 42 research units with programmes that covered a wide variety of disciplines and areas of research. This specific programme was a programme based in Johannesburg, in an urban setting, and an impoverished area, and the studies into pica formed only one area of a multiple research project.
Ms Kenye asked an inaudible question about whether there was a link between female hormones and HIV vulnerability.
Prof Dhansay said that there had been some suggestion of that, but he did not think that MRC was doing any research on that, although it was conducting research into the risks of transmission from a negative to a positive-HIV partner, when one person was ARV treatment. Many women in South Africa were on ARV medication.
The Chairperson thanked the MRC, and hoped a new President would be appointed soon to the MRC.
The meeting was adjourned.
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