Research policy in Mozambique: the impact of health research

By Paul Chinnock

Mozambique, the host nation for the Tenth EDCTP Forum, was itself the focus of the first session on Monday morning: “Research Policy in Mozambique: the impact of health research”. The meeting was honoured that the former president of Mozambique, Joaquim Chissano, was present in the audience.

The Master of Ceremony, Albertina Palalane, introduced the five speakers of this session. The first speaker was Mozambique’s Minister for Science, Technology and Higher Education, David Nivagara. He thanked EDCTP for choosing his country for the Tenth EDCTP Forum; his ministry is very pleased to be part of it. The government of Mozambique has recently approved a new science and technology policy which will take effect from next July. It is important that a country should define the principles it will adhere to in using science to help build the nation. EDCTP has contributed towards the development of the new policy. Priority and cross-cutting areas have been defined and health is one of those areas. The plan also includes the development of capacity, especially human resources, in health research. This will be achieved in collaboration with the World Bank, EDCTP and other partners. There has already been a growth in the numbers of qualified researchers, so Mozambique is moving in the right direction. A mapping of innovations in scientific research has also been conducted supported by UNICEF and the Islamic Bank. This has included recommendations for further action. This session of the Forum is an opportunity to gather further inputs that will also assist in developing science research and policy in Mozambique.

Ilesh Jani, Director of the National of Institute Health of Mozambique (INS) spoke of the role of the Institute. He gave three examples of health research in Mozambique which have had a significant impact: studies with Haemophilus influenzae vaccine have guided the launch of a vaccination programme that has reduced disease incidence; the introduction of diagnostic technology for HIV in children has made it possible to expand treatment with antiretroviral drugs; and epidemiological studies of the SARS-CoV-2 vaccine have helped develop policy and practice in the control of COVID-19. Dr Jani went on to describe how five institutions involved with health research in Mozambique have been strengthened thanks to support from partners. He then spoke of the challenges that still face health research in Mozambique, focusing largely on training. Seventy staff have received training for masters degrees and 22 for PhDs but some training areas have not been adequately addressed. Bioethics is another area requiring more attention. He noted that Mozambique has to compete for support with other nations and concluded that more needed to be done in partnership. Scientific research has definitely contributed to the wellbeing and health of Mozambicans and, institutions have been strengthened but there are still gaps and much more needs to be done.

The next speaker was Alfredo Vegara, Country Director of the US Centers for Disease Control (CDC). While CDC is based in the USA, it has a substantial global presence, with 1700 staff in over 60 countries. In particular it has supported, both technically and financially, HIV/AIDS programmes, with much of that support going to southern Africa. In Mozambique, CDC has sought to close gaps in prevention and response to disease outbreaks. Since 2014 it has supported the work of INS and other activities in the country. The US President’s Emergency Plan for AIDS Relief (PEPFAR) has been the source of most of the funding made available by CDC to Mozambique. This has been given to a variety of areas including: health information systems, human resources, supply chain, laboratory systems and civil society engagement. It has been done through Cooperative agreements (CoAgs) which have been set up with several government departments. He gave examples of recently supported projects including HIV surveillance and the Jornadas Nacionais de Saude conference, which is held every three years. Lessons learned and challenges remaining included: the importance of human resource investment (especially the retention of staff), the need for long-term vision in capacity building, putting key data to use, and the need for flexible funding to address changing needs. There are many organisations supporting health research; he called for ‘convergence of mission’ to achieve effective collaboration.

Francisco Saúte, Director of the Manhiça Health Research Centre (CISM) then addressed the meeting. The objective of CISM, which marks its 25th Anniversary this year, is to focus on Mozambique’s main priority public health concerns. A graph of the number of scientific publications from the centre shows that it is on the right path for growth. There were 200 staff at CISM in 2014; now there are over 700, of whom 42% are women. Training is a pillar of CISM activities. Many of the researchers working there are still, however, from overseas. CISM activities include support for Manhiça Hospital and epidemiological and surveillance. CISM is also a WHO regional reference laboratory for rotavirus and for malaria. Among the contributions made to health policy was informing the decision to change first-line malaria treatment from chloroquine to Artemisinin-based combination therapy (ACT). The trials of the Haemophilis influenza B vaccine have been of great importance. It has also evaluated new treatments for children under two years and a new strategy will be piloted. RTS,S4 malaria vaccine phase II and III trials have taken place. The use of malaria vaccines and treatment in pregnant women has also been investigated. Dr Saúte went on to describe CISM’s financial model and acknowledge the support from Spain and others. Challenges that remain include: human resources, funding issues, infrastructure and management structure.

Pilar Montero Gullon of the Agencia Española De Cooperación Internacional was the final speaker of this session. Last week an agreement was signed between Mozambique and Spain. Health is a priority in this agreement (together with education and other areas). Under the agreement, Spain will support primary health care, training and research in health. An accord was signed between the two countries back in 1981 for collaboration on scientific and technical projects. Since then, there have been improvements in infrastructure, and the number of researchers and their number of publications. Support from the Agency has also helped CISM gain international recognition. Dr Gullon listed a number of areas where CISM has done important work, including on malaria in children. The sustainability of CISM is a challenge. It is growing but it needs a sound structure to assure its future. It needs more national researchers and more specialised doctors. The Agency hopes extend its cooperation with CISM.

Close of this session. Following session: Celebration of the 25th anniversary of the Manhiça Health Research Centre