Analysis of pan-African Centres of excellence in health innovation highlights opportunities and challenges for local innovation and financing in the continent

The identification of potential centers of excellence was implemented through an open call for applications [25]. Considering the different languages in Africa, the call was prepared in both English and French, and broadly publicized at relevant meetings in Africa and overseas, various websites as well as through mailing lists, e-mails and advertisement in a major scientific journal. At the deadline of the call, 117 applications from institutions across Africa were received (Figure 1).

Some of the 117 applications requested to be considered as centers of excellence in multiple competency areas, thereby making the number of applications based on competencies to be 132. The country distribution, regional spread and the various competencies across the product R&D value chain for the applications received are shown on Table 1 and Figure 1. The geographic spread of CoE applications across the different African countries and regions, demonstrates the pan African significance of this process. Applications were received from 26 countries covering the five regions of Africa. Similar numbers of applications were received from Southern, Eastern and Western Africa as follows, 25.6%, 25.6% and 24.0% respectively; while Northern and Central Africa had lesser numbers with 15.4% and 9.4% of the applications respectively (Figure 1). The fact that about 50% of African countries were represented in this first call for CoE is indicative of the level of interest in the process within the continent. We believe that with broader advertisement of future calls for application, many more countries will be covered.

The 117 applications were evaluated using a 4-step review process based on defined qualitative and quantitative criteria [25]. These criteria include: availability of infrastructure and equipment for the specific research area; number of staff working in the area; track record of the technical staff; productivity of the institution over a period of time as measured by publications in peer reviewed journals or patents or products discovered or developed; availability and access to good communication tools including internet, website, telephone etc., as well as financial sustainability of the institution as evidenced by budget allocation over a 3-year period (2008–2010).

The review of the applications for CoEs was implemented in different phases as follows:

The applying institutions were requested to provide information on funding for their research and sources of the funding for the period 2008–2010, detailing local or external sources of funds. Local sources refer to all funds coming from within the institution or the country where the institution is located, while external funding refers to funds from outside the country or the continent, both from public and private sources.

From the 117 applications received, 93 applications (including those from the manufacturing sector) had financial data for the three-year period while data was available for either one or two years for the rest of the applications. Following the removal of duplicate funding information from institutions applying for more than one centre of excellence, a total of 88 applications were analysed. All the applications provided specific names of funding agencies on an annual basis, however, the exact amount provided by each funder or donor were not included. Therefore it is important to stress that the ranking of funding agencies or donors presented here does not represent the amount provided by each funder, but rather the frequency of appearance within all the applications received by ANDI.

All financing information were collated and analysed as follows:

The review process resulted in the identification of 32 institutions (Figure 2) plus 6 manufacturers, spread across the five African regions, that met the ANDI criteria for CoE. It should be mentioned that recognizing the manufacturers should in no way be seen as an ANDI endorsement of these manufacturers‘ capacity to produce under GMP or relevant national and international standards. Rather, the goal is to identify manufacturers that have met criteria established by ANDI, to enable them to participate in relevant ANDI network activities, including product development projects, public-private partnerships, training, etc.

The list of all the CoEs with their areas of competency and contact information are presented in Table 2. CoEs were announced during the 4^th ANDI stakeholders meeting in Addis Ababa, Ethiopia from 24^th to 27^th October, 2011 [26], while the finalisation of the evaluation of the manufacturing CoEs followed the meeting. A significant number of the successful CoEs are located in Southern Africa (16 in number), particularly in Republic of South Africa with a total of 12 centers, which is the highest number seen per country. The Eastern and Western African regions followed Southern Africa with 8 and 7 centers respectively, predominantly located in Kenya, Uganda, Nigeria and Ghana. Northern Africa recorded 5 CoEs of which 4 came from Egypt and one from Tunisian. It is not clear why more applications were not received from Northern Africa especially with the increasing role of Northern African region in R&D exemplified by a recent announcement from Algerian government for increased funding for research [27]. This will probably improve with better communication of future calls for applications in the Northern African region. The Central African region had the lowest number of accredited CoEs with only 2 centers located in Cameroon. The result also highlights the need for more investment and capacity building in the Central African region, particularly the Francophone countries [3, 20].

It is important to mention that no one African country has the full capacity for all the components of the products value chain (Table 1), reinforcing the value of continental network with the critical mass of institutions with capacity spread across the innovation value chain [3, 20, 28]. With regards to academic-industry or public-private partnerships, about 38% of the CoEs claim to having active partnerships with industry. These types of public - private partnerships will further be strengthened through an integrated CoE framework programme that supports capacity building and project implementation, as further elaborated below.

The total annual research funds from all applications excluding and including manufacturers are shown in Figure 3, bar diagrams A and B respectively. The data show a steady and modest increase in annual funding over the three year period largely due to increased funding from external sources, while funding from within Africa decreased from 39% to 32% (Figure 3A). This suggests that most African countries and governments were unable to sustain investment in health R&D in the period and the hope is that this trend will now change. However, when the budget for the manufacturers are included in the analysis, the internal/external ratio was reversed with more funding coming from internal sources up to an average of 57% over the three year period (Figure 3B). This suggests that funding from both private and public sectors in Africa, largely targets manufacturing activities. Although a steady increase in funding for health innovation was observed over a three year period (Figure 3), our data highlights a number of challenges as well as opportunities for African health innovation financing. The annual budget of departments or units, within African institutions range from five hundred US Dollars ($500) to thirty five million US Dollars ($35 million) with a mean value of $1.49 million. The relatively low budget of most African institutions compared to other parts of world, could explain some of the challenges faced by African institutions in translating their research findings into usable health products. It also underlines the need for a better coordination of funding and access to grants in Africa.

A listing of all the funders/donor agencies named in each of the applications is presented in Additional file 1: Table S1. The data shows that a total of 266 different donor agencies supported research of the applying African institutions over the three year period. Out of these 266 agencies, only 27 donors were identified as African based. This financing information made it possible to further determine the 21 most frequently mentioned funding agencies in all the applications (Figure 4). The National Research Foundations (NRF) of South Africa was identified as the only African institution that made the list of 21 most frequent health research funders in Africa [29]. The fact that NRF has also been highlighted as the biggest research funding agency in Africa in the area of natural and physical sciences corroborates our data [11]. Accordingly, the Republic of South Africa also featured as one of the top 10 funders of research in Africa by country when all sources of funding are considered (Table 3). It is therefore not surprising to have identified the highest number of successful Centers of Excellence as coming from South Africa. Our data is in agreement with a trend in R&D across Africa in which institutions from countries and regions that invest more resources, as measured by the percentage of GDP invested in research and development, have a higher chance of qualifying as CoE. Countries such as Kenya, Uganda and South Africa have averaged about 1% of GDP investment in R&D [6, 30]. These numbers substantiate previous publications and collaboration patterns in Africa [20].

In the context of external donors, European and North American countries and agencies (including public, private and philanthropic sectors) have a strong presence in health research in Africa (Table 3). Finally, it is important to highlight the absence of emerging economies, namely China, India, South Korea and Brazil, from the list of donor countries, suggesting the need to engage these countries and to reinforce south-south partnerships with Africa.

As expressed above, the key measure of investment in R&D is the percentage of a country or region’s GDP devoted to such activities. This is often termed gross expenditure on research and development - GERD [11, 13]. Available data show that Africa as a whole accounted for only 0.9% share of world GERD in 2007 while Asia had 32.2%, Oceania 1.6%, Latin America and the Caribbean 3%, Europe 27.4% and North America 38% [31]. On the other hand, some recent economic analyses have highlighted the economic growth potential of Africa - the continent's GDP rose by an average of 4.9% annually from 2000 to 2008, making it the world's third-fastest growing region [32].For this growth to be sustained, significant resources and efforts has to be invested in R&D and innovation, including through support for strong intra-African exchange and collaboration. Medical research now dominate African research, having overtaken agricultural research, which was the leading field in the 1990s [13, 24]. It is important therefore to intensify and leverage this existing health R&D momentum to support collaboration among African R&D institutions to develop the most needed health products to address the continent's health needs. This will also bring economic benefits including human capital development, retention of health researchers and experts and African integration. We believe that a critical mass of CoEs in health innovation in Africa, working collaboratively and sharing information and know-how, would contribute to achieving this goal through joint projects, networking, capacity building and training as well as technology transfer and diffusion across the continent. Indeed, lessons learned from a number of international initiatives further illustrate the power of organized centers of excellence [23, 33‐36]. For example, Canada Network for Centres of Excellence, has helped to turn Canadian research and entrepreneurial talent into economic and social benefits for all Canadians by funding research partnerships between academia, industry, government, and not-for-profit organizations [33].

The ANDI CoEs are envisioned as a network that will bring African scientific and technical resources together to build capacity, develop and diffuse technology to address African's health challenges in a significant way [3, 25, 37]. A detailed project framework that defines how the ANDI COEs network will achieve the desired objectives is being finalised. For example, a structured pool of fellowships and training across the continents can be implemented through the CoE network, including MSC, PhD, postdoctoral, vocational or technical training as well as sabbatical for scientists from other African institutions, who wish to spend time at an ANDI CoE for specific training purpose. A central capacity building fund can be established to support qualifying candidates and African institutions that aspire to become a CoE in a specific field. Through this same mechanism, North–South and South-South collaboration and exchange can be enhanced. The CoE network can also support the placement of external experts who wish to spend time in an African CoE to support capacity building of Africans and gain more experience in Africa. This will include placement of experts from industry and leading academic institutions and laboratories abroad, who wish to support specific R&D, management, regulatory training and other needs of the network. Having said these, there are arguments for and against, for example the concentration of research funding in few institutions versus the distribution of academic talent and research funding among universities [38]. Indeed, the goal of ANDI is not to focus research funding on the CoEs but rather to use them to support capacity building and create partnerships to implement projects that come from a variety of African institutions.