Investigation and development of strategies to strengthen the implementation and governance of Health Research Systems (HRS) in Namibia
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Date
2017
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Publisher
University of Namibia
Abstract
The overall aim of the study was to investigate the status of HRS in Namibia and to develop strategies that will contribute to strengthening its implementation and governance. This study was conducted within a positivist paradigm which employs quantitative research approach, exploratory, descriptive and non- experimental designs were employed. The study was conducted in 3 phases namely: Phase 1: situational analysis comprised of document review using an adopted WHO checklist in phase 1 A and a survey in phase 1 B. The situation analysis was conducted to explore and describe the current approaches as well as the viewpoints of stakeholders with regard to HRS implementation and governance in Namibia. In addition, it was conducted to identify and describe factors that influence the implementation and governance of HRS in Namibia. The population for phase 1A comprised documents that guide the implementation and management of HRS in Namibia that is, the Research Management Policy which is the official policy document of the Ministry of Health and Social Services. In phase 1A, a checklist was developed based on the attributes set out in the WHO Health Research Systems Analysis Initiative (2010), checklist which is specifically developed to indicate which attributes should be in place per HRS functions which are: stewardship function and ensuring good governance, financing, capacity development, creating and sustaining resources as well as producing and using research findings functions.
In phase 1 B, respondents were persons responsible for the coordination of health research in Namibia, or institutions involved in health research (n=67). The population was divided into two sub-populations. The first sub-population included persons from different departments/sectors within the Ministry of Health and Social Services. They are referred to as the ministerial respondents (n=52). The exo- ministerial sub-group comprises respondents/participants from institutions other than the Ministry of Health and Social Services, such as relevant government ministries, offices and agencies (O/M/As), state-owned enterprises, international organisations, tertiary education institutions and agencies of other governments. The constituents of the second subgroup are referred to as exo-ministerial respondents (n=15). The main challenges that were identified from phases 1A and B include: gaps in legislative frameworks including the outdated Research Management Policy (RMP), lack of coordination of health research in the country. Challenges related to the ethic review committees in MoHSS, and the institutional review boards (composition and structure), lack of support and motivation; resources are donor-driven; and absence of an articulated research agenda, no health research vision, priorities. Furthermore, the findings indicated that only a few officials have received training in health research the Namibian government (GRN) is not doing enough to contribute towards the creation and sustaining of resources and human resources capacity development for health research, GRN is not providing incentives to researchers, funding from GRN is not provided in a way that is most appropriate for the country’s research needs. In addition, the findings pointed out that there is a need for promotion and advocacy for HRS, to strengthen different cadre of professionals with the capacity to conceptualise, conduct, analyse, disseminate and translate the findings of various forms of health research, to secure international linkages and technical cooperation in health research. These findings fashioned the basis for conceptualisation in phase 2 and development and verification of strategies in phase 3. Phase 2: In this phase conceptualisation of the key findings on HRS from the study linking them to the Practice Theory of Dickoff, James and Wiedenbach (1968) was done. This practice-oriented theory, essentially, consists of concepts such agent, (the researcher) recipient, (all individuals and groups involved in health research in Namibia), context (the Ministry of Health and Social Services’ internal and external environments), dynamics (challenges that emanated from the study findings), procedures (process followed by the agent in the development of strategies for effective implementation and governance of HRS), and terminus ( implementation and governance of effective and efficient HRS in Namibia through the developed strategies). The conceptualised findings indicate that the issues of concern are mostly related to the context’s internal environment therefore there is a need to create a conducive environment for HRS in the areas of policies and guidelines for HRS; human and financial capacity. The challenges that emanated from the study are summarised under the dynamics as follows and include lack of: legal basis and regulatory mechanisms, coordination mechanisms for health research in the country, research capacity, human capacity development for health research, adequate financial support for the country’s research needs, data dissemination to enhance a data sharing culture, and research ethics committees’ coordination and inability to attract and retain researchers in the public health sector. Phase 3: This phase outlines the procedures followed in developing the strategies after conceptualisation of findings from phases 1 & 2. In addition, the strategies in this study were developed using Howe’s (c@ps), which was developed in 2011. According to the Compass Aligned Performance System each strategy comprises of the following components: key performance indicators strategic objective/s, used to monitor implementation and measure achievement of each strategic objective, strategic objective that are providing directions towards realisation of the proposed strategies, and the proposed actions/critical success factors which are actions to be undertaken in order to achieve the strategic objectives, the compass also allows the developed strategies to be aligned to the values and the vision of the Ministry of Health and Social Services. A one-day meeting was organised with the team of experts where a power point presentation of the proposed strategies was made by the researcher for inputs and finalization of the proposed strategies. The study recommends that MoHSS provide a conducive environment for effective implementation and governance of HRS through effective leadership that guarantees fortification of: policies and guidelines for HRS; human and financial capacity. The research further recommends that MoHSS implement the following: establish a career advancement programme for researchers; provide a market related remuneration package and benefits for researchers; and offer attraction and retention strategies for health research human resources such as introducing incentives for researchers. It is further recommended that a training needs assessment be carried out by MoHSS to identify the training needs on HR at individual, institutional and national levels. Lastly, it is recommended that the developed HRS strategies should be integrated into the overall MoHSS strategic plan.
Description
A dissertation submitted in fulfilment of the requirements for the Degree of Doctor of Philosophy in Public Health
Keywords
Health research systems