Council of Scientific and Industrial Research (CSIR) contribution to the country's health research

Meeting report

The Chairperson in welcoming the CSIR delegation, said no country could be transformed without research work and the CSIR was a very important commodity to South Africa, because of its potential to assist leadership to plan effectively for the future of the country.

Dr Rachel Chikwamba, CSIR Group Executive: Strategic Alliances and Communications, said there was a need for the organisation to be visible to stakeholders, particularly Parliament. She hoped to effectively introduce the organisation to Members as an asset of state, paid for by the public. The focus of their endeavours was to ensure that their work improved the quality of life of South Africans. Ordinarily, CSIR would come to Parliament to present to the Portfolio Committee on Science and Technology, but today, their focus was on presenting information that affected health. CSIR had been around since 1945, and was constituted by an Act of Parliament in order to do multi-disciplinary research, especially in the fields of science and technology. The main objective of CSIR was improving the quality of life of South Africans.

The CSIR reported to the Minister of Science and Technology. It was affiliated with selected funding agencies and public research institutions, including the Medical Research Council (MRC). CSIR was the only research council that was multi-sectoral. It was tasked with developing technology and innovation in sectors that were identified as important for the purposes of improving South Africans’ quality of life. The interface with the MRC came in when CSIR considered technology with a view to seeing if it could be harnessed to assist the MRC. There was no competition between the bodies, since the work of CSIR was complementary to that of the MRC. CSIR was looking at ways to devise technologies and infrastructure to make the health sector more efficient. It was a large organisation with 2 400 staff, including 1 500 specialising in science, engineering and technology. Most staff members had engineering degrees, and about 700 had post-graduate degrees in the sciences. Their headquarters were based in Pretoria, and they had offices across the country. CSIR received R0.5 billion from Parliament and R1.2 billion from industry in the form of contract work. Some top scientists worked for CSIR, and the organisation was perceived internationally as a “power-house”. That should happen in South Africa too.

The main objective of CSIR was to practically direct technology into solutions for the improvement of the lives of South Africans. They were responding to the Millennium Development Goals. Further, the National Development Plan was currently in their hands for them to critique and add value to. They had listened to the recent State of the Nation Address, and understood the inherent value in the President’s vision of a national infrastructure drive. CSIR had decided to focus its work and capacity on six areas: natural environment; built environment; health; energy; industry; and defence and security. Defence technologies were not just for times of war, but were also used for peaceful purposes. Their enabling technologies included smart materials, additive manufacturing, sensors, robotics, ICT for society, environmental monitoring, built environment, and research infrastructure and facilities, amongst others.

CSIR’s focus on health was informed by challenges presented in the field of health in a global perspective. A diagram showing life expectancy in relation to the Gross Domestic Product (GDP) of a country revealed that South Africa was doing well in terms of its GDP, but that when life expectancy was considered, South Africans could not expect to live longer than much poorer populations in Ethiopia, Uganda and Malawi. This spoke to a serious problem. The MRC had published the Burden of Disease Report, which showed that South Africa was hit hard by HIV and AIDS, crime, respiratory infections, and increasingly, chronic diseases. When looking at investment in health, South Africa’s investment was comparable to that of developed countries, but it still ranked low in terms of life expectancy, which showed that it was not just about money, but that something was “broken” in the health system. From a technology perspective, CSIR was seeking to determine what they could do to help. To this end, their two main areas of focus were health care systems and reducing the impact of the burden of disease. The Minister of Health and the nation were currently working hard at putting the National Health Insurance (NHI) system into place, and CSIR was able to support this important initiative. In the field of healthcare delivery, CSIR provided Information and Communication Technology (ICT) support to health care facilities, and assisted the National Health Laboratory Service (NHLS). Their burden of disease interventions included a focus on diagnosis, eHealth, affordable cures, and nutrition. The problems in health were huge, and CSIR did not claim that they could fix them. They could, however, contribute to solutions, by working with and providing support to many stakeholders, including producers, purchasers, and providers.

Some recent CSIR highlights in the field of health included infrastructure that addressed tuberculosis (TB) infection control. CSIR had designed hospital infrastructure to control the flow of air in healthcare facilities so that cross-contamination was minimised as between TB and drug-resistant TB patients, as well as to health care providers. CSIR’s job was not to implement technology widely, but rather, to demonstrate its efficiency so that government could choose whether to use it, and how. Another recent advance was the work CSIR had done on technology along with the MRC, including the Umbiflow Foetal Assessment System for clinics. They were also developing point of care diagnostics using emerging health technologies such as small computer tablet equipment. Some less sophisticated technologies included using drums to transport clean water to areas where it was not accessible.

Discussion
The Chairperson remarked that CSIR innovations were addressing the inequalities and asymmetries that existed in South Africa, and opened the floor to questions by members.

Ms D Robinson (DA) was excited about the work the CSIR was doing. She asked how soon the Department of Health would be able to implement some of the innovations described in the presentation. She was especially interested in the idea of implementing remote surgery technology in rural areas. If patient records could all be kept in an electronic register, it would ease a lot of problems. She asked how soon that could happen.

Ms M Segele-Diswai (ANC) said that although the presentation had some exciting elements, she was “anxious” because of the challenges raised by implementation, which was another matter altogether. She wanted to understand the exact nature of CSIR’s relationship with the Department of Health, and whether it was fruitful. She asked how the Department could ensure that CSIR’s research was being implemented, and how the technology would reach the rural areas that needed it the most. She asked how CSIR worked with training institutions within the healthcare arena, and how CSIR ensured that their work connected with people at the “lower level”. The Chairperson chimed in that with all the discourse around the concept of “rural accessibility”, there was a tendency for people to forget that there were actually two groups of rural areas. The rural parts of South Africa were divided into organised rural areas (commercial farms) and villages. It was the latter group that needed the most assistance, in response to the problem of people moving from rural to urban areas in search of access to services.

One member said that she was originally from the Eastern Cape. She wanted more information on CSIR’s strategy to service rural areas. Both the reduction of the burden of disease and hospital design issues raised particular concerns pertaining to rural areas. She asked whether there were any pilot projects in place for the UmbiFlow project, and if so, where they were. She raised the matter of “window periods” in the detection of diseases, and asked whether there were any methods for early detection of diseases that had been uncovered by CSIR. She asked what the relationship between CSIR and MRC was like currently.

Ms L Makhubele-Mashele (ANC) said that the presentation pointed to “an ideal healthcare system”. South Africa had the skills and the resources, and therefore, the power to successfully change the healthcare environment. She asked how CSIR would help to bring about necessary changes, and whether they had adequate capacity. She also wanted to know what role CSIR could play to address the issues raised by skills-shortages.

The Chairperson wanted to know what happened in the case of new inventions, and whether people would be able to approach CSIR with their inventions in confidence that their intellectual property rights would be protected.

Mr G Legetho (ANC) was excited about the UmbiFlow technology, and asked whether it had reached all the clinics. He asked when the Committee could expect CSIR to do diagnostic work among rural communities.

Mr D Kganare (COPE) asked whether CSIR was working on any projects in partnership with the Human Sciences Research Council (HSRC). He enquired whether, once innovations and technological equipment were put into place, CSIR played a role in ensuring that medical practitioners and trainees were able to use them. He wanted to know whether potential users were informed about the costs and savings involved in rolling out those new technologies described in the CSIR presentation.

Ms Robinson acknowledged her fellow members’ concerns about reaching remote areas, and said that was precisely what technology had the capability to do. As politicians, the members of the Committee could speak to the National Treasury to secure funds for CSIR. She was interested to discover whether the capacity and funding existed to harness nanotechnology so that smaller and fewer doses of medicine could be supplied in contrast to intensive drug regimens with enormous pills. One potential benefit of telemedicine was that it could help new medical practitioners who felt insecure without much support, by putting them in touch with more experienced practitioners. She asked whether something like the television show “Hello Doctor” could be used to reach people in rural areas and teach them about health issues.

Ms B Ngcobo (ANC) remarked that the awards received by CSIR were “impressive”, but that they were from limited sources. She found it impressive that drug-resistant TB was being treated better, and asked whether more could be done in that area. She asked if the Department of Science and Technology (DST) took CSIR with it when it went on roadshows. There were increasing problems with genetic diseases these days, and she wondered whether CSIR had done research into genetics and the link to diseases. She knew that the DST had been working on a nano-drug for TB, and asked how far they had progressed in that respect. She also wanted more detail about the progress of the artificial liver programme.

The Chairperson asked whether there was currently enough legislative protection for the patent rights of innovators, since innovations generally ended up being a business venture for someone. He wanted to know to whom CSIR reported primarily, and whether it was mainly government or business.

Dr Chikwamba called on CSIR’s Head of Department, Dr Makobetsa Khati, to articulate more about the core work of CSIR and the limits of their mandate. Dr Khati said that CSIR selected their battles, and that they did a lot of feasibility studies and capability studies. Their focus was more on HIV and AIDS and TB, as those were common diseases in South Africa, and less on genetic diseases. In addressing the “window period” question, he said that it involved a combination of variables, including costs. More expensive technologies yielded answers more rapidly. Currently, HIV diagnostics were very good, but CSIR was still looking at ways of narrowing the window for TB detection. Dr Chikwamba added that rural penetration and access were areas of broad concern for CSIR.

Mr Matthew Chetty, the area manager for CSIR’s Meraka mobile platform, stated that technology should be seen as an opportunity to address challenges confronted by rural areas. Rural penetration was one of CSIR’s main priorities. The advantages of ICT made distance less of an issue. CSIR had established over 200 Digital Doorway installations, of which over 80% were in deep rural areas. There were currently 20 additional Digital Doorways being established in containers, due to funding by the Department of Rural Development and Land Reform. In rural areas, these Digital Doorways were solar-powered, and did not require electricity. Because broadband connectivity was limited in rural areas, CSIR was working on portable wireless technology. This technology was being used to provide wireless connectivity to 200 schools in Mpumalanga, most of which were in rural areas. CSIR believed that there was a major role for ICT to play in serving rural areas. On the question of how soon projects could be implemented, he said that from the ICT perspective, CTIS had several mature technologies that were already up-and-running. In terms of preventative care, CTIS had developed different technologies that could be used to communicate with people on a mass scale. One of these had the capacity to translate text-to-speech and speech-to-text in any one of South Africa’s 11 official languages. Social media platforms were being developed rapidly, and CSIR had the technology to send mass text messages to large groups of people. The “Dr Maths” programme gave high school students access to maths tutors via Mixit and text messaging. Approximately 100 000 students had made use of that technology over the course of the previous three years. Similar technology could be used in the health environment. Telemedicine was currently being advanced by video technology that transferred video over cell phones without any need for buffering. That technology would be an excellent tool to empower doctors and community healthcare workers. Although CSIR did not currently have the data that would need to be sent over that platform, they had the technology available and MRC was working on providing the necessary data.

The Chairperson remarked that government needed to be dynamic, and that it was important to use the powers of social media to achieve its objectives.

Dr Dusty Gardiner, Competency Area Manager for CSIR, said that in relation to intellectual property rights, CSIR had very well-developed systems in place. If an innovator approached CSIR with an innovation, the first step would be to sign a confidentiality agreement, in order to protect that innovator. Thereafter, the parties would enter into a benefit sharing agreement so that more than one party could benefit from the innovation. As a result of this system, more people were approaching CSIR with innovative ideas, including an increasing number of traditional healers. Some of the innovations were licensed to private enterprise, which would in turn pay royalties to the innovator. Part of CSIR’s strategy included the development of new start-up companies. Many technologies were developed specifically for implementation by the public sector, but it was important to note that roll out and implementation fell outside of the mandate of CSIR. There was a concern that the public sector did not have the capacity to fully roll out and implement new technologies, and that as a result, some of those technologies were failing to meet their full potential. There was a need to find solutions by working with both government and the private sector, and this was perhaps an area in which the Portfolio Committee could provide assistance. Implementation on a mass scale was very expensive. International donors had provided funding for CSIR’s initial eight TB facilities, and the Western Cape provincial government had provided funding for one in that province. Many more were needed, and there was a major funding gap. In the health space, CSIR had been looking at using technologies that had been developed in other fields. Many of those existing technologies were mature. The platforms existed, and the MRC was in a position to provide much of the content that was needed to harness those platforms for use in the healthcare sector. Many were ready to go that very day.

The Chairperson said that Dr Gardiner had addressed the core of the matter. He wondered whether relevant government departments were using some of the innovations developed by CSIR. He suspected they were not. Sadly, one of the reasons that vital technologies were not moving forward was because some people in government did not see how they stood to gain personally from rolling them out. He suggested that maybe a state-owned enterprise should be established to work together with CSIR, on the basis that it would pay royalties back to CSIR.

Dr Chikwamba said that most of CSIR’s funding was provided by the Department of Science and Technology, but that it also received funding from other government departments, including the Department of Health. Training stakeholders in the use of new technologies fell outside of the mandate of the CSIR. There had been a great deal of collaboration with the MRC, especially relating to traditional medicine and the transportation of water in drums, but they should still find ways to interact more with MRC and other partners. To this end, CSIR had established an Office for Strategic Alliances, in order to ensure increased collaboration with interested stakeholders. Overall, CSIR needed to improve its communication capabilities.

Ms Claudina Loots, Director: Health Innovation, Department of Science and Technology, spoke on the issue of integration between stakeholders. In the past, there had been problems with service delivery by both the Department of Science and Technology and the Department of Health. Now, a Public Health Integration Forum had been established in order to allow scientists to communicate with government about ways to adapt and roll out existing technology. Telemedicine and eHealth could be dramatically improved by an innovation that used computer tablet technology to allow nurses to communicate with off-site doctors. There was, however, a need to examine the legal implications of that device before it could be rolled out. The technology and databases were already in existence. Wireless mesh technology was currently being used to convey health information and increase healthcare in rural areas. There was a focus on technology that could be taken to the “lowest common denominator”, even in places where there was no water or electricity. In terms of integration, the Department of Science and Technology was making a priority of linking researchers from different sources in order to get quicker results. Collaboration was encouraged as far as was possible, and the Consortium on Rooibos Tea Research was an example of this. It was crucial to remember that benefits should be for the people of South Africa. Large pharmaceutical companies were still ruling the domain of TB drugs. The Department was building links with the global organisation, the TB Alliance, but more funding was still needed.

Dr Gardiner said that CSIR had embarked on spatial planning in order to monitor and predict patterns of migration. CSIR had compiled databases of population distribution and the location of geographical features. This was crucial for the purposes of the Department of Health, as it needed to know where people were located currently, where they were moving to, and what geographical obstacles might exist to hinder service delivery. On a national basis, these databases could assist the Department of Health to determine where exactly they should be investing in resources and infrastructure. That could start as soon as tomorrow.

Ms Robinson asked whether CSIR had approached National Treasury, the South African Revenue Service (SARS) and the Southern African Development Bank for assistance with its funding gap. The Chairperson commented that the Portfolio Committee could also step in to assist communication with those potential funders. Funding would depend on whether those parties saw the importance of the work of the CSIR.

Dr Chikwamba said that CSIR had reached the point where they wanted to do more, and that meant that increased funding was needed. CSIR was currently trying to craft a flagship programme to make an impact on primary healthcare. In terms of stakeholder engagement, specific research focus areas had been identified in consultation with stakeholders. CSIR consulted with other research councils about working in a complementary capacity, as well as with universities and industry. A very important stakeholder was the public, as represented by the Portfolio Committee. CSIR hoped this was not the last time that they consulted with the Committee, and that the next time, they would be able to show more results. CSIR was actively working to get it right and to forge lasting relationships with government.

The Chairperson said that the Committee was impressed by the presentation, and could see the potential presented by the various dynamic technologies. As parliamentarians, they wanted to be engaged and advised about new technological innovations, so that they could take active steps to take those projects further. On the matter of finances, the members of the Committee would speak to the relevant departments about setting aside specific budgets for the CSIR.

Meeting adjourned.