Partners’ HPSR report – 2021
South Africa
Overview
South Africa has a well-established group of 12 institutions that conduct a wide range of HPSR, including looking beyond the South African context to contribute to global knowledge processes on health systems strengthening. Seven of these institutions are university-based. Two are located within science councils and there is also one large NGO of relevance.
Information in this country profile is based on the data submitted from nine of the twelve total institutions.
While meetings with policy-makers were curtailed by the COVID-19 restrictions in 2020, the HPSR community remained productive, producing almost 650 reports between 2018 and 2020.
Institutions by type
List of HPSR institutions
Knowledge generation
South Africa’s institutions conduct a diverse range of research, ranging from research focused on governance, leadership, health economics, human resources, community health systems, and broader issues of health systems development, as well as some research on health programmes and services (notably, HIV/AIDS, and tuberculosis).
The South African HPSR community remained productive over 2018-2020, producing 646 reports over the three years – with 262 of them produced by the South African Medical Research Council (though it is probable that not all of these reports were on HPSR specifically). Not all of the work reported addressed issues that were exclusively South African: HPSR also fed into cross-country research, supported global processes and contributed to globally-innovative HPSR work.
Average number of reports produced per institution each year in South Africa and overall
Engaging policy-makers and the public
A series of national processes took place in 2018-19 in the context of the health system reform process, which generated the National Health Insurance Bill of 2019. These were opportunities for engagement between health system policy-makers, managers and researchers. While not linked to specific research projects, they were opportunities for researchers to share their knowledge with policy-makers on long-standing concerns within South Africa’s HPSR.
These processes included: the South African National Commission on High Quality Health Systems (2017-8); the National Health Summit, organized by national government (2018) and the Ministerial Task Team on Human Resources (2019). In addition, the 2019 UHC national dialogue was organized specifically by researchers from the HPSR community, enabling them to dialogue with each other and with policy-makers.
The number of meetings with policy-makers rose from 35 in 2018 to 48 in 2019 before falling to just 17 in 2020 when such engagement was, inevitably, impacted by COVID-19. There may, however, have been opportunities for policy engagement at provincial level: researchers in at least one province, for example, have supported senior health-system managers in reflecting on and learning from COVID-19 responses to strengthen those responses over time.
While it is difficult to provide definitive examples of HPSR influence in South Africa over a particular timeframe, examination of the work of the Western Cape HPSR Journal Club Team demonstrates provincial-level policy influence (in this case around health system development) beyond a specific piece of research and specific policy focus. This experience reveals the potential for influence at a provincial level, where more regular engagement between researchers and policy-makers may be possible.
Average number of meetings held with policy-makers per institution each year in South Africa and overall
Average number of media articles published per institution each year in South Africa and overall
Academic and institutional capacity
Institutions in South Africa reported around 70 staff or faculty members working on HPSR issues. All of the university-based HPSR groups submitting information for this country profile support MPH programmes that include at least some HPSR-related training. Some offer specific HPSR-linked ‘tracks’ within the broader MPH programme, for which HPSR courses are compulsory. The universities also support PhD-level training with a HPSR focus. In addition, some universities offer specialist postgraduate Diploma training in HPSR-related topics, such as postgraduate Health Management/Leadership Diplomas, which are targeted at health system managers and include a focus on critical research skills. Post-graduate diplomas and Master’s in public health training targets primarily those who intend to work within the health system, rather than those who intend to become full time researchers.
The University of the Western Cape is noteworthy for its more than 20-year history of support for continuing professional development through an annual winter school of short courses. Five of its courses address HPSR issues explicitly, and a total of 196 students attended these courses across 2018-19 (the courses did not run in 2020 as a result of COVID-19). With this exception, few stand-alone short courses were offered by the submitting institutions.
The research also found that a wide range of short course training is also provided to health managers by institutions other than the nine that submitted data for this report. Some of this training could be considered HPSR-related, even though it may not address research skills specifically. Given that formal postgraduate training programmes are the main vehicle for HPSR training within South Africa, the focus on short courses in this report under-estimates the extent of HPSR training activities in-country. Data reflecting students participating in HPSR short courses drop off notably in 2020 because of the COVID-19 pandemic.
Total number of HPSR faculty and staff
Total number of participants in HPSR-related short courses
HPSR financing
South Africa’s annual national health research budget was estimated to be around US$ 45 million between 2018 and 2020. This figure draws from the budget line for the South African Medical Research Council (SAMRC), based on the Medium-Term Expenditure Framework. However, as we have indicated elsewhere, this figure is likely to underestimate government funding for health research. Factors that contributed to the challenges of acquiring comprehensive data from the institutions surveyed included the following: staff serving multiple functions (and, therefore, not paid exclusively for HPSR); research expenditures that are not evenly spread per year across multi-year grants; and different fiscal years for institutions, funders, and even this report.
HPSR funding is estimated to be around US$ 26 million across 2018 to 2020; an average of over US$ 8.6 million per year. This represents a fall over time from around US$ 12 million in 2018 to around US$ 5.8 million in 2020. HPSR funding also represents a declining proportion of government funding to the SAMRC – falling from 26% in 2018 to 13% in 2020. Given an analysis undertaken in 2016/17, HPSR spending might very approximately be estimated at less than 4% of total health research spending. The division of international vs domestic sources of funding for HPSR varied from 69% / 31% in 2018, to 45% / 55% in 2020.
The Government provides direct grants to two HPSR groups: the Health Systems Trust and the Health Systems Research Unit of the Medical Research Council. Through the National Research Foundation, the Government of South Africa has funded four HPSR-focused Research Chairs (two each in the Universities of Witwatersrand and the Western Cape) at around US$ 120 000 to US$ 180 000 per year per chair. International funding supports research-related salaries and fieldwork costs across all groups and is sourced via competitive research funding processes, consultancy-related work and HPSR capacity strengthening activities.
Total institutional expenditure
Credits and disclaimers
Partners’ health policy and systems research report, 2021
WHO/SCI/HSR/21.1
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