B Hlongwa: Wits Annual Research Day

10 May 2007

Honourable Vice Chancellor,
Distinguished guests,

It is an honour for me to be part of this very important event. While we as
government have clustered Health and Education as part of the social cluster,
the two differ fundamentally. For example, complicated cases of ignorance at
primary school level are not rushed to secondary level of education, nor do we
live in a society where extreme cases of ignorance are rushed to
university.

If these disciplines were similar we would refer a person to a higher level
of learning if it has been evidently proven that he or she can not be helped at
the elementary level of learning. In health we find ourselves referring a sick
person to a higher level of care when there is clear evidence that he or she
can no longer be helped at the primary level.

Programme Director,

We all know that if it is difficult to obtain good results at the lower
level of education, it is extremely difficult for that student to proceed to
the next level of education. This influenced the approach of government when it
sought to re-organise the health system. The Reconstruction and Development
Programme proposed a health system that is based on:
* the Primary Healthcare approach
* a unified health system that integrates public and private health
sectors
* the reduction of inequities and expansion of access to essential
healthcare

The above approach was also informed by a realisation that health is not
just a by-product of social and economic policies. Government considers health
to be an influential co-determinant of social transformation and economic
development. We believe that health and healthcare play a key role in
generating social cohesion, a productive workforce and ultimately economic
growth.

Programme Director,

I am aware that we still have to convince some economists that investment in
better health outcomes has significant economic benefits. In other words funds
that are appropriated through budget votes are not just for the purposes of
expenditure but should be viewed in the context of both social and economic
investments. Better health outcomes are not only an indicator for economic
development and reduced poverty. Better health outcomes are actually
co-determinants of economic development.

This approach influenced the Gauteng Development Strategy (GDS) which
acknowledges that the marginalisation of health in terms of investment will
have disastrous consequences for a developing society such as ours. This is
also equally true for developed societies. The Gauteng government therefore
believes in investing in better health outcomes as a contributory factor
towards economic growth.

Programme Director,

I know we still have a mammoth task in convincing some government economists
of the above, but those of us who are in the health sector, especially those
who shape policy, have to make conscious policy choices that make sense to
those economists who have yet to be convinced that a healthier nation is
beneficial to economic growth.

It is therefore desirable that investment in health research should have a
medium and long-term vision of harvesting benefits that are associated with
better health outcomes. The investment that is made on healthcare and research
should therefore be accompanied by corresponding outcomes.

It is a worrying factor that Gauteng's economy is the second biggest in
Africa with a health budget of more than 12,5 billion rand, but has to deal
with worse health outcomes when compared to those countries with less health
budgets. In the Gauteng health department we are very conscious of the need to
encourage and support research programmes and to instil a culture of life-long
learning among our staff members. However, we equally believe that there is a
need to de-mystify healthcare. Health is not only about complicated findings
and sophisticated machinery, but it is also about improving the health status
of the population in order to ensure that the disease burden is reduced.

In other words, any research that excludes improvement of the health status
of the population, but exclusively focuses on intervention as the sole option
for addressing health problems is self-serving.

Programme Director,

I state the above being informed by the conditions I have witnessed at our
hospitals and clinics. The burden of illness that is prevalent in Gauteng is
mainly due to communicable diseases, many of which are driven by lifestyle
related factors. It follows therefore that research in health; if we are to
make any difference on the disease burden, must be driven by factors such as
education, with a view to improve the health status of our people.

Delivery of quality healthcare at our facilities should also become our
focus. However the primary focus should be ensuring that we keep our people
healthy thus prevent them from seeking help from our facilities. An improved
health status provides a sound basis for labour productivity and for the
capacity to learn and grow intellectually, physically and emotionally.

The net benefit for individuals and the family unit is the capacity for
personal development and economic security. It is therefore beyond debate that
human capital is a contributor to social stability, and economic development.
As the province of Gauteng we recognise this when we state our objective to
create a society that is both healthy and productive.

Programme Director,

I do not want to be misunderstood to suggest that research should shift its
focus to improvement of human capital at the expense of other interventions.
History is abound with examples where neglect of health as a co-determinant of
economic development, resulted a roll back of the gains of other indicators of
economic development.

This requires investment in research that enhances an understanding of the
effectiveness of and return on investments in human capital with a strong
emphasis on improving the health status of people. The research I am referring
to must support us as policy makers in opting for those policies that
consciously strike a balance between health as consumption good and health as a
capital good.

Individuals who understand that health is a good that depreciates with time
will find it easier and willing to partner with government in investing and
maintaining it as a stock. The focus of research would therefore become patient
centric. The research work that you are doing would then help us to improve the
quality of care that we provide and to find better and more productive ways of
service delivery. Through our work we will be able to direct the limited
resources at our disposal to areas where they can have the maximum impact on
quality healthcare.

Programme Director,

Research co-ordination with the Gauteng Department of Health is done in
accordance with chapter nine of the national Health Act. This Act determines
that every institution, at which health research is conducted, must establish
or have access to a health research ethics committee, which is registered with
the national Health Research Ethics Council. In Gauteng all our academic
institutions conform to this regulation and we are proud of the way these
ethics committees are functioning. But there is another ethical aspect which
needs to be addressed:

When academic institutions conduct research in our institutions and are
being funded by us, they have an obligation to report their findings to us
prior to publishing. There have been a number of unfortunate cases where
findings of research funded by the department were released into the public
domain without us being aware and without us being provided the opportunity to
make inputs. This is not meant to undermine academic independence, but it is
rather a question of professional courtesy more so when we are both the fonder
and a subject of such enquiries.

Following the guidelines of the national Department of Health, we have
established a Provincial Research Co-ordination Committee to ensure proper
management, co-ordination, and funding of research in the province. As
healthcare professionals and scientists you are aware of the fact that your
research cannot be done in a vacuum.

The challenges in the delivery of quality healthcare in our province, in our
country and, indeed on the continent of Africa, are such that we need the best
minds and the best skills to provide us with practical solutions. While we
encourage research and the expansion of the scientific knowledge base we also
want to challenge you to direct your efforts to find practical solutions to the
issues that dominate our provincial health agenda.

In this way you can make a valuable contribution to improving the quality of
healthcare that we provide in Gauteng and, by extension, also the quality of
life of the people of our province. To encourage research that will advance the
objectives of our provincial health system, applications for research projects
are carefully screened.

I am pleased to note that the Provincial Research Co-ordination Procedure
has been finalised and that 100 members of our staff have been trained in
research methods. In the coming year the objective is to train staff at second
level hospitals in good clinical practice. I also believe that one of our
objectives coming out of this conference should be to encourage research
projects throughout all the districts in our province to ensure an equitable
spread of activities.

I wish you well in your deliberations.

I thank you.

Issued by: Department of Health, Gauteng Provincial Government
10 May 2007