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Innovators, policymakers, and investors gathered in Johannesburg last month for the South Africa Innovation Summit and after this, it is worth asking, are we as a nation doing enough to finance health innovation and technology? South Africa faces many challenges when it comes to the health of our people. As South African Minster of Health Dr. Aaron Motsoaledi said, “We must markedly reduce this burden of disease because it is too high a burden for the nation to carry.” It is encouraging to see South Africa raising its game to advance home-grown solutions for the challenges we face.

Investments in science, technology, and innovation for health by governments around the world will be critical to meeting the ambitious targets of the Sustainable Development Goals (SDGs). However, when investment is not significant enough, or a supportive policy environment does not exist, many promising products and innovations will not be taken to market and reach the people who need them the most to avoid preventable deaths. I have seen this happen far too often in my four decades in health research and development (R&D) and innovation.

How does South Africa measure up?

PATH, an international NGO dedicated to saving lives through global health innovation, partnered with the Centre for Economic Governance and AIDS (CEGAA) to produce an analysis titled Health Research and Development Budget Allocations and Expenditures in South Africa: A baseline report. This report tracks investments by the South African government in health R&D and highlights gaps. It provides important evidence for civil society to inform advocacy for investments in health R&D.

So, what is the gist of the report and what interesting data is in it? Below are some of the topline findings.

The South African government is committed to health R&D. South Africa has undoubtedly made commitments over the past decade toward ensuring that R&D is prioritized and funded to bolster the economy and create jobs. Positive developments include the fact that the South African government has established various research institutes in the country and has committed to ensuring that research funding is prioritized.

An example of government commitment towards health R&D, mainly through support from the Department of Science and Technology, has been the establishment of the Medical Research Council’s Strategic Health Innovation Partnerships (SHIP) which acts as an upstream R&D catalyst for the development of transformative health technologies. SHIP has now partnered with PATH to create the Global Health Innovation Accelerator (GHIA) in South Africa, for downstream commercialization and introduction of technologies together with industry. The government has also set a target in the 2014–2019 Medium Term Strategic Framework (MTSF) that investment in R&D should increase to 1.5 percent of GDP by 2019.

However, funding for health R&D has yet to reach its full potential. Currently, health R&D only accounts for 0.1 percent of total government spending and is not increasing at a rate that keeps up with inflation. Moreover, investment in health R&D is decreasing as a share of total government spending. As the financial climate in South Africa is becoming increasingly burdened with other issues such as food and nutrition security, energy security, climate concerns, and financial instabilities, those commitments remain in doubt.

Health R&D funding is inconsistent across government. The report also shows that health R&D is inconsistent across government with the Department of Science and Technology (DST) currently funding the most in health R&D while the Department of Trade and Industry and the Department of Health spend less. It is important that government departments all contribute a significant portion of their budgets towards health R&D to ensure that health innovations are adequately financed. This should ensure that local health technology manufacturers are able to grow their sector leading to job creation and lifesaving technologies for those in need.

A funding gap remains. The South African government has set a target that investment in R&D should increase to 1.5 percent of GDP by 2019. However, in 2013 investment dropped to 0.76 percent of the GDP, declining from 0.92 percent cited by the National Development Plan in 2007. Clearly more funding is needed to ensure that health technologies are developed to reach the people in need with the added benefit of local manufacture and job creation.

Recommendations

Based on the analysis, PATH and CEGAA have several recommendations. First, government spending on health R&D should align with the National Research Strategic Plan in order to reach set gross expenditure targets for R&D, and additional resources should be made available to enhance evidence generation and innovation.

Additionally, the government should measure contributions of other sectors, such as donors and the private sector, in R&D to ensure that those investments cover high-priority health needs. The private sector needs to invest more in health R&D in order to reach targets of the South African National Development Plan. One way to increase private sector participation is for the government to implement strategies for incentivizing private-sector investment. The government has, for example, introduced tax incentives for R&D with the aim of encouraging South African companies to invest in scientific or technological R&D.

Lastly, more in-depth assessments are needed to get a deeper understanding of where R&D funding is spent in the South African public sector, what drives the spending, and what are the results. Much of the R&D spend has been wasted on poorly selected opportunities and lack of expert scientific scrutiny. Expenditure should be driven primarily by in-depth needs assessments, followed by rigorous scientific and technological due diligence. With such limited resources, R&D funding needs to be spent with every chance of a successful outcome. Entities such as SHIP and GHIA have been established toward this end.
 
Monitoring accountability

Armed with such evidence, civil society has a critical role to play in monitoring government accountability to ensure funding commitments are fulfilled and activities are aligned with national plans.

For this reason I recently joined a group of nongovernmental organizations to launch the South Africa Health Technologies Advocacy Coalition (SAHTAC). SAHTAC represents organizations with interests in healthcare and advocacy who work together for an enabling environment for R&D and access to lifesaving health technologies and innovations. The organizations within SAHTAC work in partnership to strengthen the voice of civil society in advocating for health R&D.

We have many pressing financial priorities in South Africa, but investing in the future is a tangible way to attack the vicious cycle of poverty and underdevelopment. A healthy nation is a wealthy nation, and the efforts being made in health R&D today will positively impact the economic status of South Africa tomorrow. It is key that we invest in long-term, sustainable health technologies for local manufacture that can potentially save millions of lives.

  • Dr. Tony Bunn is a Senior Advisor/Consultant with the MRC-PATH Global Health Innovation Accelerator

Minister of Higher Education and Training, Dr. BE Nzimande's statement on Government's 2017 fee support to students from poor, working and middle class families Good morning ladies and gentlemen of the media, and thank you very much for making time to be here for this important announcement.

Our public universities are a significant national asset. They empower the next generation with skills and knowledge, and contribute significantly to the ability of our economy to compete globally through innovative and appropriate research.

Our universities currently face serious challenges in terms of funding. At the same time, large numbers of South Africans are currently finding it difficult to access post-school education because of the financial challenges they as individuals or as families face.

Government is aware of these challenges and takes them very seriously. Indeed, government remains firmly committed to progressively realise free post-school education for the poor and working class, as called for by our Constitution, and to assist middle class families who are unable to pay.

This is demonstrated by the creation of the Presidential Commission of inquiry into higher education and training funding, which includes universities, and Technical and Vocational Education and Training (TVET) colleges, as well as the substantial increases in funding to the National Student Financial Aid Scheme since 2010.

The task of the Presidential Commission is to advise on systemic and long-term measures to achieve a far-reaching reconstitution of the entire post-school education and training funding system, thereby enabling South Africans to access higher education even if they come from poor and working class families.

The Higher Commission recommendations will hopefully also contribute significantly to building and strengthening our universities and TVET colleges – and the Commission should be allowed to complete its vitally important task.

In the interim, while we all wait for the recommendations of this Commission, our university system has to continue functioning, producing skills for the economy, and empowering young South Africans and students from countries around the world, in particular the South African Development Community (SADC).

Currently, our universities face an extremely difficult financial situation. The effects of last year’s moratorium on fee adjustments and the extra costs associated with insourcing have both added to these challenges.

Our immediate and pressing task is to ensure that as we continue to improve access to post-school education and strengthen the quality of learning and teaching, we do not erode the financial sustainability of the sector. 

Our economy is currently weak and our fiscal position parlous. The tax burden has been rising in recent years, and we must preserve the fiscal space to fund government’s policy agenda in future years. This means that any funding government mobilises to support the pressing challenges in higher education, it would need to reprioritize from other government programmes.

We understand the legitimate student concerns about the affordability of university education. At the same time, we need to ensure that those who can afford to pay must pay.

Equally importantly, the post-school budget has to cover students in technical and vocational education and training, while we also face the challenge of building a community college sector to provide educational alternatives for 18 million South Africans who are unable to study at university.

In other words, our job as government requires a number of very delicate balancing acts.

To achieve our objectives, we must continue arguing for as significant a budget allocation as possible for post-school education. Indeed, a look at this year’s budget shows that this sector received the largest increase in funding of any government department.

Higher Education and Training this year received an additional 18 percent for 2016/17, with an average annual increase of 9.8 perent across the Medium Term Expenditure Framework period up until 2018/19.

From R42 billion in the 2015/16 financial year, the department’s budget is set to rise to R55.3 billion in 2018/19.

Government has this year provided R1.9 billion of the R2.3 billion shortfall resulting from the subsidisation of the 2016 university fee increase. More than R4.5 billion in the 2016/17 financial year has been reprioritised to the National Student Financial Aid Scheme (NSFAS).

Expanded funding is targeted to support 205 000 students entering universities for the first time or continuing this year, and a further 200 000 students at TVET colleges. This means that a total of 405 000 students would receive government support to access universities and colleges in 2016.

The National Skills Fund (NSF) has allocated R1.393 billion in 2016 towards funding undergraduate and postgraduate bursaries in scarce and critical skills. This funding is directed at meeting the full cost of study for over 13 500 undergraduate and 1 200 postgraduate students enrolled in programmes at our 26 public universities.

In addition, and perhaps most importantly, we must also ensure that we strengthen and empower those sectors, which are charged with training, and skilling people either who choose not to go to university or who do not have the opportunity, but nevertheless must be assisted to become useful contributors to the economy.

To support this aim, the NSF has allocated R626.795 million in 2016 towards supporting TVET college students in occupational programmes with a specific emphasis on occupations in high demand and R1.237 billion towards funding students in workplace-based learning.

Artisan development is also key on our agenda to address the National Development Plan target of 30 000 artisans per annum by 2030. Dependent on the artisan trade, it costs between R350 000 – R400 000 over a period of three years to train an artisan. This year the target is to register 30 750 new artisan learners, which will amount to approximately R4.6 billion in artisan learner grant funding through the Sector Education and Training Authorities (SETAs).

It is indeed a fine balancing act and we must all participate, whether at the national level, in university administrations, or as student leaders – because it is the nature of balancing acts that if one falls, all fall.

Last month I received recommendations from the Council on Higher Education (CHE) on university fees for 2017. I have studied these recommendations, consulted with university vice-chancellors and council chairs, various student organisations, organised labour, faith communities, political organisations and government.

Ladies and gentleman, the issues at stake are complex, and there are differing opinions and arguments across the system.

The CHE argued for a consumer price index (CPI) based fee adjustment for 2017, while many university leaders have made a strong case that an eight percent agreement (CPI+2 percent) is essential.

On the other hand, some students have called for a moratorium on all fee adjustments until the outcome of the Presidential Commission is announced, while others are supporting government’s measures to assist students from poor, working and middle class families, which includes the 'missing middle'.

Currently, the authority for determining fee adjustments resides with University Councils. The CHE has suggested to their leadership that the system will be best served by a national approach. However, at the same time we do recognise the differentiated nature of the system and that a one-size fits all approach may not lead to sustainability in the system over the long run.

Government is alive to the legitimate cries of students regarding fees and to those of the universities who must continue to pay for specialist books and equipment in foreign currency and ensure that academic, support and service staff are adequately paid for their work.

As we wrestle with how to respond comprehensively, the equally critical building and transforming of our post-apartheid universities has to be supported. Starving our universities of funding is not the way to go, which is effectively what another across-the-board fee rise moratorium against the current fiscal backdrop would mean at this point.

While the Presidential Commission does its important work in developing proposals for a long-term funding model, universities will not be able to operate with less funds than what they already have. Everything is more expensive today than it was this time last year.

That is the reality of inflation.

We have looked at the challenges at hand from all sides and have concluded that the best approach would be to allow universities individually to determine the level of increase that their institutions will require to ensure that they continue to operate effectively and at least maintain existing quality – with the caution that this has to also take into account affordability to students, and therefore has to be transparent, reasonable and related to inflation-linked adjustments. Our recommendation is that fee adjustments should not go above eight percent.

To ensure that such inflation-linked fee adjustments on the 2015 fee baseline are affordable to financially needy students, government is committed to finding the resources to support children of all poor, working and middle class families – those with a household income of up to R600 000 per annum – with subsidy funding to cover the gap between the 2015 fee and the adjusted 2017 fee at their institution. This will be done for fee increments up to eight percent.

This will in effect mean that all NSFAS qualifying students, as well as the so-called ‘missing middle’ – that is, students whose families earn above the NSFAS threshold but who are unable to support their children to access higher education, will experience no fee increase in 2017. Government will pay for the fee adjustment. This will bring huge relief to nurses, teachers, police, social workers, and other parents who work in occupations that do not earn huge salaries, and who have children at university. This will apply to students at universities and TVET colleges.

Administrative mechanisms will be developed and students informed on how to apply for the gap-funding grant before the end of this academic year.

There are many students from upper middle class and well-off families, as well as students on full company bursaries in our institutions who can afford to pay the adjusted 2017 fees, and we expect them to do so.

It is very unclear to government why families who can afford private schools should, under the current circumstances, be receiving further state subsidies for their children at universities.

To subsidise these students would require taking funding from the poor to support cheaper higher education for the wealthy, which is not justifiable in a context of inequality in our country. We cannot subsidise the child of a cleaner or unemployed person in the same way as we subsidise the child of an advocate, doctor or investment banker.

While NSFAS will continue to provide loans and bursaries to poor students, the Department of Higher Education and Training and universities will continue to mobilise institutional and private sector financial support to enable affordable financial aid options for the “missing middle” students.

I have constituted the Ministerial Task Team on funding support for the poor and “missing middle” students, which is developing a model that will be tested in 2017 to provide affordable support to these students. We will continue to look for other ways of supporting financially needy students not covered by NSFAS, whilst a long-term solution is being developed to raise sufficient funding from the public sector, private sector and other sources to fund “missing middle” students at universities and TVET colleges.

Universities must urgently, effectively and comprehensively advance our shared transformation as articulated in the 2015 Durban Statement on Transformation, and provide annual reports on their progress. Moreover, universities are expected to pay all of their staff, both permanent and contracted, a fair living wage.

I thank you.

Enquiries:

Busiswa Gqangeni
Mobile: 061 351 2695
Email: Gqangeni.B@dhet.gov.za

For more about the Department of Higher Education and Training, refer to www.dhet.gov.za.

The Right2Know Campaign (R2K) launched in August 2010 and is growing into South Africa’s first post-Apartheid movement centred on freedom of expression and access to information. The R2K is a democratic, activist-driven campaign that strengthens and unites citizens to raise public awareness, mobilise communities and undertake research and targeted advocacy that aims to ensure the free flow of information necessary to meet people’s social, economic, political and ecological needs and live free from want, in equality and in dignity.
 
The R2K family is grieving for the loss of Godfrey Maximillian Phiri (18 July 1962 – 29 August 2016), who passed away suddenly on Monday, 29 August 2016. Phiri was an elected leader of Right2Know, and a lifelong human rights activist of fierce principles and a gentle heart.
 
The R2K also appeals to friends to assist the Phiri family with repatriating him to his home soil in Zimbabwe.

Donations can be made to:

Account holder: The Right 2 Know
Bank: Standard Bank
Account Number: 07 022 865 5
Branch Code: 020909
Reference: Phiri

The memorial service will be held this afternoon at the Holy Trinity Catholic Church, 16 Stiemens Street, Braamfontein at 16h00.
 
Venue: Holy Trinity Catholic Church, 16 Stiemens Street, Braamfontein (Entrance on Jan Smuts Avenue)

For more about the Right2Know Campaign, refer to www.r2k.org.za.

This was a heated topic on our WhatsApp group earlier this month and funny enough, Stian sent a chat that a woman sitting next to him on the plane was breastfeeding…Quite funny since we have been discussing about it and even though the discussion had died down it suddenly erupted again. Well, my personal take on it at first was that women can feed anywhere, it doesn’t matter as long as they cover up and some of my mates where just not for that compromise, especially the females in the group. Well I can say the end of it all - let me leave the dashes for now and share some of the interesting views shared.

Ruth shared that women in rural communities in Africa breastfeed in public as a sign of pride. This is quite true especially when the women are in a polygamous marriage. I’m quite the imaginator when such things are said and as it might not seem funny to others, I could just imagine the first wife who was not able to bear a child for the union or one that only gave birth to baby girls looking at this wife number two or three breastfeeding her son with so much envy. As terrible as it might sound, especially with the term, ‘son’. We will leave that for another day’s topic. The point I’m driving at is the reality in most patriarchal led traditional communities. This moved the topic to becoming a discussion about patriarchy oppression of the women.

There was an argument from one men when I heard the discussion on radio who complained that breasts are seen as a sexual object and that was his argument to why women should never be allowed to breastfeed in public as it invokes wild thoughts in the men’s mind. Munya then added an interesting comment that, patriarchy plays a part in that men are the beneficiaries always, they are ‘protected’ from wild thoughts of being bombarded with ‘breasts’ in public. So go the ‘safety’ of men, breast feeding in public has to be banned. It is never in the interest of women and hungry babies, but men and their egos. A show of control…That just summed it all for me and left me feeling bad and agreeing that breastfeeding wherever as being a civil right that should be respected and not frowned upon.

A few interesting quotes shared which I think we should all ponder upon…

Breasts are viewed as sexual objects…how about men who urinate in public alleys everyday, what is it they will be holding while urinating and why ain’t it frowned upon in the same way too
 
Why should breasts be covered when breastfeeding, who covers their plate when eating?
 
Feeding should not be confined to secret rooms, toilet cubicles and dark alleys. If a grown man can have food in a fast food outlet, what’s to stop that child from being breastfed in the same place…breast feed in open spaces without suffocating the hungry baby.

This one is for board members. It is easy to say “Yes, thanks, I accept nomination to your Board”, but board positions come with a lot of responsibility that many of us may not know about. Here is a quick quiz for you and your fellow board members - you should at least know the answers to these questions below. In fact, all organisational staff and board members should know the answers - and there are many more that could be added.

Use these questions to hold a quick quiz with your board and with the organisational staff team:

  1. What type of entity is your organisation?
  2. What type of document of formation/ founding document does the organisation have? (what is it called)
  3. What is the legal governing authority or registration body for your organisation?
  4. What other state institutions/ government departments is your organisation accountable to?
  5. What other registration documents does your organisation have or need to get?
  6. When was the organisation founded?
  7. Who is the Chair of your board?
  8. How many board directors/ members/ trustees do you have?
  9. Who are they, and what particular skills do they bring to the board?
  10. What official registration of directors/ trustees is required, if any?
  11. How long is a board member’s term of office in your organisation?  What are the rules on this in terms of the kind of entity?
  12. Who was your most recent funder?
  13. Who are your organisational accountants/ auditors?
  14. What is your key responsibility as board member?
  15.  When last did the board sign off on a set of audited annual financials?
  16. How many paid employees does your organisation have?
  17. What is the name of your organisation’s flagship project or core programme?

For information on core governance practice, values and ethics go to www.governance.org.za for South Africa’s Independent Code of Governance for Nonprofit organisations.

For additional tips and information on governance more generally, refer to www.nonprofitlawyer.co.za for great resources.

  • Gabrielle Ritchie is a director at The Change Room.

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