Health policy analysis institutes: landscaping and learning from experience, South Africa
The case of the Health Economics Unit in South Africa
The multi-national landscaping study of Health Policy Analysis Institutes supported by the Alliance HPSR and funded by the Rockefeller Foundation aims to achieve three goals: (i) mapping existing national and regional health policy analysis institutes and initiatives; (ii) deriving lessons about the different organizational models and factors that contribute to the effectiveness and sustainability of such institutes and (iii) making recommendations to the Rockefeller Foundation and other stakeholders about how best to support the development of health policy analysis institutes in low- and middle-income countries (LMICs).
For South Africa, the Health Economics Unit - based at the University of Cape Town - was selected to derive lessons about the organizational features and other factors that contribute to the effectiveness and sustainability of a policy institute. A range of key informants were interviewed, along with an analysis of publications and reports to assess the effectiveness and sustainability of the Health Economics Unit and to devise recommendations on how to improve the effectiveness and sustainability of the Unit.
Lessons for establishing policy units, especially in the area of health economics: Some lessons from the Unit’s experience relevant to members of the international community (specifically universities, governments and donors) interested in initiating or strengthening similar units in low- and middle-income countries include:
- Sustained leadership, in the form of a committed, long-term leader, has been critical to the development and success of the Unit.
- This leader has been supported by a core of hard-working, like-minded researchers, providing continuity for the Unit, even in the face of turnover of other staff members.
- The Unit’s location has been fortuitous, being within a supportive institution possessing relatively efficient managerial and administrative processes. Recently, formal recognition of ‘social responsiveness’ (including the provision of policy advice) has helped promote staff whose contributions in this area had previously been over-looked. The university base also preserved a certain quality and objectivity of its research, especially when the government environment is not enabling.
- The Unit built its credibility on the back of objective, high-quality, policy-relevant research and training. It demonstrated foresight in undertaking forward-thinking research that government had not always identified as a priority, and sourcing funding from donors for self-initiated projects. This enabled the Unit to engage in innovative, long-term research and to present timely data to government.
- Participating in a variety of research, teaching and networking spheres, and creating partnerships with a range of different players, including research collaborators, has been important for the Unit’s sustainability.
- The Unit invests heavily in developing the skills of its staff members. This includes paying course fees for postgraduate study, allocating time for staff to engage in study, allocating time for staff to write journal articles, providing supervision and granting sabbaticals. This level of commitment to capacity-building is unusual for a “soft-funded” unit.
- The vulnerability of the Unit lies in the fact that it finds it very difficult to attract senior staff - principally because the university structure dictates low salaries, and because it does not have core funding to offer secure contracts. This means that existing senior staff are over-burdened and are not able to respond to all of government’s needs. A major challenge for the Unit is to improve salaries for senior staff. In the meantime, the Unit’s supportive, stimulating and collegial environment is a major factor in the retention of existing staff.
Project description
Programme: Health policy analysis institutes: landscaping and learning from experience
Research title: The case of the Health Economics Unit in South Africa
Thematic Research Area: Evidence to Policy
Grantee Country: South Africa
Grantee Institution: School of Public Health, University of the Witwatersrand
Program Coordinator/Principle Investigator:Jane Doherty
Start date: July 2009
Status of grant: Completed (September 2010)