Date: 26/03/2008
Source: Department of Social Development
Title: SA: Skweyiya: HIV and AIDS in Africa Colloquium

Opening address by, Dr Zola Skweyiya, Minister for Social Development, Republic of South Africa at the HIV and AIDS in Africa: Getting Research into Policy and Practice Colloquium

Chairperson;
Mr Pierre Sane, Assistant Director-General in the United Nations Educational, Scientific and Cultural Organisation (Unesco);
Dr Olive Shisana, CEO of the Human Sciences Research Council;
Dr Philip Davies, Deputy Director, United Kingdom Government Social Research unit;
Representatives from civil society and academia;
Government officials;
Esteemed guests;
Ladies and Gentlemen;

We gather here at an opportune time, having yesterday marked World TB Day. The human immunodeficiency virus (HIV) epidemic has fuelled the worst tuberculosis (TB) epidemic in Africa since the advent of antibiotics. Although 11 percent of the world's population lives in Africa, the continent carries 29 percent of the global TB burden. TB is the most common co-existing condition in people who die from AIDS-related causes. Research has shown that TB and HIV compound the acquired immune deficiency syndrome (AIDS) epidemic in two ways: those with latent TB contract HIV which leads to the reactivation of TB, while HIV-positive people with weakened immune systems acquire new TB infections.

The special summit of the African Union on HIV and AIDS, tuberculosis and malaria, held in Abuja, Nigeria in May 2006 acknowledged some of the key dimensions of this context. These included the importance of leadership in mobilising society as a whole, the importance of regional level action and cooperation, and the importance of advocacy activities and campaigns. There was an acknowledgement that, partly because of a lack of institutional and human resource capacity at the national level, inadequate planning continues to be a major challenge. Inadequate monitoring systems and insufficient evaluation were also identified as major obstacles.

The Abuja Summit call for accelerated action towards universal access to HIV and AIDS services in Africa includes a rededication to:

* The mobilisation of local resources for sustainable and predicable financing
* The enhancement of an enabling policy, legal and social environments that promote human rights
* The integration of HIV and AIDS programmes into poverty reduction strategies
* The strengthening of health systems and data management
* Evidence-based prevention as the most cost effective intervention
* Support for research and development and
* Well-coordinated partnerships.

The Special Summit of the African Union on HIV and AIDS, Tuberculosis and Malaria concludes with a call for intensified efforts by civil society and the private sector in support of the operationalisation of these commitments. This colloquium is taking place against the backdrop provided by this context.

The outcomes of the summit also informed the implementation of the new TB Strategic Plan in government's Programme of Action. I'm sure you'll agree that this is a very clear example of evidence-based policy making in action. Despite this, evidence-based policy making remains somewhat of an enigma, especially in the developing world. A mystery we are slowly seeking to unravel in policy formulation in South Africa.

The National Strategic Plan for HIV and AIDS and Sexually Transmitted Infections (STI) 2007-2011 serve as South Africa's primary HIV and AIDS policy document. Recognising the growing local and international interest on the relationship between research and policy especially in the area of HIV and AIDS, the National Strategic Plan for HIV and AIDS and STI 2007 - 2011 includes research, monitoring and surveillance as key priority areas. The plan prioritises operational policy and regular surveillance research.

This recognition is premised on the belief that research-informed policies can make a significant contribution to making policies and programmes more effective and relevant. This contribution is relevant at three important stages of the policy-making process:

* agenda setting
* policy formulation and
* implementation.

The basic assumption of knowledge utilisation related to policy-making is that policies which are research informed are far better.

Chairperson, allow me a moment to reflect on the relationship between research and policy making process. It is assumed that research exposes policy-making to a wider range of validated concepts and experiences than those that can be drawn from the normal time limited and politically constrained processes of policy deliberation. It thus allows a broader choice of policy options to emerge. Research often enables policies to be generated upon technically well informed basis and it gives warnings of reasons why some policies succeed and others fail. Promoting good practice in policy making is fundamental to effective of governments and the delivery of quality outcomes for their citizens.

Policy making, implementation and delivery, inevitably involves decisions about the use and allocation of scarce resources. Consequently, evidence is required about the most cost-effective way of achieving a given objective, and about the greatest benefit and utility that can be achieved from the available resources. To ensure this, policy makers should have available to them the widest and latest information on research and best practice and all decisions should be demonstrably rooted in this knowledge. The involvement of potential users of research such as policy makers will increase the likelihood that research result will be utilised.

As indicated earlier, the research-policy relationship is a function of the interaction between context, evidence, and linkages. Very few institutions of global governance have managed to internalise this linkage. United Nations Educational, Scientific and Cultural Organisation (Unesco) sits in pole position in fostering linkages between policy makers and researchers. As a contribution to strengthen the link between social science research and policy-making, Unesco through its Management of Social Transformations programme serves a facilitator of regular meetings of ministers of social development on this issue. The Forum of Ministers of Social Development for Latin America was launched in 2001 and similar networks have been established for the SADC; for the Economic Community of West African States (ECOWAS) countries; for South Asian countries; and for the Maghreb region and Egypt, Lebanon and Jordan.

With due respect for the autonomy of social science research, these forum support the strengthening of networks that bring together social scientists, policy-makers, and non-governmental and grassroots organisations around their shared concern for the urgent demands of social and economic development.

This colloquium is another example of our commitment to this principle. It is an opportunity to restate our conviction that better use of research in the social sciences and humanities can lead to more effective policies and outcomes. The world needs more innovative spaces and mechanisms that foster the interaction between research and policy.

While it is widely accepted that it is crucial to enhance the interface between research and policy, applying research findings to policy decisions and practice is not a simple process. Unfortunately policies are often developed without taking into account social science research findings and recommendations, despite the plethora of such research studies. The fundamental reason is that often it is impossible to ascertain if primary research asks questions that are relevant to policy making and policy makers.

Research is not an end in itself; rather it is intended to generate knowledge that can be used to improve service delivery, policies, and practices. Many research findings are available to inform interventions and practice, yet a gap exists between research results and the desired outcome of putting them into practice. This is of particular concern in our continent and most of the developing countries, where the challenges of providing quality services to a growing population are enormous.

The other reason for poor utilisation of research into policy is largely due to the fact that researchers and policy makers often work in isolation. Policy is effective if it aids the nation to attain its long-term goals of national development. Policy formulation and the implementation thereof depend on the political context and the specific needs at hand. The information required to understand the specific context and needs must be based on rigorous research to ensure accuracy and relevance.

The implementation of evidence-based decision-making has been shown to be successful, especially in the area of health care in the 1990s. However, research findings are not always a gateway to successful policy adoption and or implementation. Lack of consultation and communication between policy makers and researchers can render potentially valuable information useless in the policy making process.

To illustrate that a working linkage between research and policy is not only possible but invaluable, reference is made to the case study of orphans and vulnerable children in Southern Africa.

In 2002 the WK Kellogg Foundation commissioned the Human Science Research Council (HSRC) to establish a project to develop interventions to:

* improve the social conditions, health, development and quality of life of orphans and vulnerable children
* support families and households coping with an increased burden of care for affected and vulnerable children
* strengthen community-based support systems as an indirect means of assisting vulnerable children
* strengthen HIV and AIDS awareness as well as advocacy and policy to benefit orphans and vulnerable children.

The Department of Social Development and its counterpart ministries in the SADC region used evidence generated from the research project to inform programme development and interventions on orphans and vulnerable children. Recommendations from the project are currently being implemented by what is referred to as the implementation network comprising a team of researchers, policy makers, non-governmental organisations (NGOs), community based organisations (CBOs) and donors. This network is active in several districts in Botswana, South Africa and Zimbabwe.

In South Africa, the orphans and vulnerable children (OVC) research project informed the country programme and policy development in two ways through literature reviews identifying relevant interventions and the establishment of coordinating structure - the National Action Committee for Children Affected by HIV and AIDS (NACCA) and the establishment of Research Reference Team on HIV and AIDS and OVC.

The Department of Social Development has commissioned a number of research projects to inform our strategic interventions on HIV and AIDS and to mention just a few:

* evaluation of costs and process indicators for home-community based care and support programmes
* an analysis on the lessons learnt in addressing the OVC situation in Southern Africa
* situation analysis of child-headed households in south africa
* audit of child care forums
* estimation of orphans using vital registration data.

The key questions relating to success of the policy-research nexus process are:

*How can policy-makers best use research, and move towards evidence-based policy-making?

As one might expect, it is essential that researchers are seen as independent, and that they have academic credibility.

An understanding of the political environment - knowing what topics are of concern to policy makers, and who influences the policy-making process can be crucial. Discussions with policy makers and key users, ideally when the research is being planned can help researchers to ensure that their work is targeted to policy needs. In addition, research ethics require that study participants and their communities benefit from research more directly as opposed to viewing communities as passive participants in research projects.

Some of the suggestions on improving research-policy nexus include the following:

* More financial investment in HIV and AIDS research.
* Increase research-related discourse on HIV and AIDS related policy documents.
* Donors should be urged to fund policy relevant research as opposed to research for the sake of research.
* Healthy dialogue between researchers, policy makers and stakeholders for effective interaction between research producers and users.
* Openness to findings from research - policy makers' openness to new ideas influences the extent to which they would consider research findings on particular topics.
* The need for capacity development for initiation, facilitation and interpretation of research for evidence based policy formulation.

In his novel "Three-Letter Plague" author Jonny Steinberg confronts the fact that HIV is as much a social disease as it is a health concern. Despite the massive antiretroviral (ARV) programme that government has implemented and widespread awareness of AIDS it continues to spread at an alarming rate. Steinberg states that one of the reasons for the failure of HIV-prevention programmes has been the failure of social movements to speak meaningfully to heterosexual black men. Lack of discussion about male sexuality is seen as a fundamental problem in prevention and treatment campaigns. Besides the shame and stigma associated with contracting the virus, HIV strikes at the heart of masculinity and is one of the reasons why men would rather not be tested.

This is borne out by a recent Amnesty International report that indicates that South African women younger than 25 are up to four times more likely to be infected with HIV than men of the same age and a culture of violence and stigma is exacerbating the problem. The report found that rural women were disproportionately affected by poverty and unemployment and continued to suffer subjugation at the hands of men, facing the threat of sexual and other gender-based violence and increasing their risk of contracting AIDS. The majority of rural women interviewed by Amnesty International said that their male partners were reluctant to test for HIV or refused to be tested even when there were strong indications they might be HIV infected. Many of the women faced abuse from their partners when they tried to access health services for HIV-related treatment and care.

Steinberg says one of the benefits of treatment in Lusikisiki is that it brought the epidemic into the open. He states, "You are defining what the epidemic is, you are getting people to talk about it, you are making sick people visible and I think that's a route into prevention and, where everything else is failing, that's a very powerful route into prevention." As much as a cure for AIDS is vital to overcoming the epidemic in the future, research into the social aspects of AIDS prevention is vital to confronting and combating the disease today. I urge you to approach the treatment and prevention of AIDS from this perspective so that as government we continue to formulate policy that is both effective and relevant.

I am looking forward to your deliberations and am delighted to declare this colloquium on "getting Research into Policy and Practice" officially open.

Thank you

Issued by: Department of Social Development
26 March 2008