6.6 Concluding Thoughts
7.1.4 Political transition
T
he political transition in South Africa, heralded by talks between the South African government and liberation movements in the early nineties, reflected itself in the health and medical science en- vironment. Inevitably, the national research agenda was influenced, shaped and dis- torted by the minority government’s policy of apartheid, which served to legislate the existing racial inequalities in South African society. The anti-apartheid academic boy- cott adversely affected all South African science activity. The political turbulence of the 1980s, which presaged the failure of apartheid, reflected itself in the changing nature and emphases in health and medi- cal research in South Africa.Notwithstanding the fact that most health and medical research is conducted at higher education institutions, the MRC, South Africa’s premier health and medical research organisation, which collaborates with virtually all the major health scientists and institutions in South Africa, serves as a useful prism for viewing the change in the nature of South African health and medical sciences. The MRC’s annual report for 1989 raised the question ‘whether the manner in which research is practised, supported and
managed is still suitable in a rapidly chang- ing South Africa’. The futile efforts at estab- lishing international links (colloquia were held with Taiwanese and Israeli scientists), and a recognition that the government’s policies, including its influx control policy, were failing, saw the creation of the Centre for Epidemiological Research in Southern Africa (CERSA), the main aim of which was to study the interaction between urbanisa- tion and health. (The prime purpose of the decades-old influx control policy had been to restrict the movement of black people from rural areas to the cities; decades of forced removals from urban to impover- ished rural labour reserves and the crimi- nalisation of the process of rural-to-urban migration had led to untenable population pressure in the Bantustans, which were cre- ated as quasi-independent mini-states for black South Africans). The MRC also refor- mulated its mission statement to reflect its role as providing the research base for the improvement of the health of all South Afri- cans. Research highlights in that year were work on air and water pollution, parasitic diseases in communities, infectious diseas- es in developing communities, urbanisa- tion and health, the importance of exercise, heart attacks and heart disease, diet and cardiovascular disease, organ transplants, nutrition in developing communities, and trauma, a far cry from the disease- and labo- ratory-oriented rubrics cited earlier.
The impact of political change was further highlighted in the MRC President’s report the following year (1990), thus: “……….
fast changes in political, economic and social spheres of South African life caused major demands on research practice and
management”. The MRC responded to this change in the research environment by making major changes to its research pro- grammes with “greater stress on communi- ty health research in an attempt to improve the quality of life of all population groups in South Africa”. For the first time, the MRC annual report mentions the evaluation of health care as a research highlight, reflect- ing a new emphasis on the relevance of re- search to the provision of health services, in a changing discourse in health and medical sciences.
Significantly, the MRC experienced an up- surge in international contacts following the unbanning of liberation organisations in 1990. The academic boycott was relaxed, and opportunities for communication and scientific exchange mushroomed. South Af- rican scientific collaboration was no longer limited to Taiwan and Israel, and visiting scientists to the country increased dra- matically. This was accompanied partly by the formation of bilateral links with some African countries. In the words of the MRC President in the 1992 annual report: “It now only needs a political settlement here to enable us to fully develop and implement our research development programmes with our neighbouring countries as our full partners for the benefit of all the people of Africa.” This was a dramatic shift indeed!
By 1991, the Fogarty International Centre of the National Institutes of Health in the United States provided six postdoctoral bursaries to South Africans, premised on a selection process that was openly affirma- tive in character.
The early nineties also saw the establish-
ment of a National AIDS Research Pro- gramme, almost a decade after the first patients were reported in the country. In- terestingly, it was AIDS research that estab- lished a ‘breakthrough in international rela- tions’ through a visit of a delegation from the US Centres for Disease Control in 1991.
The largest longitudinal study in Africa, the Birth-to-Ten study, launched in 1990, exam- ined the relationship between social, eco- nomic and environmental factors and child health over a decade. Studies on causes of infant death, adolescent death and risk-tak- ing behaviour in teenagers, diabetes preva- lence in urban populations and trauma in urban areas were conducted from 1991 on- wards. Environmental research focused on air pollution in the Vaal Triangle1, respira- tory tract illnesses in smoking households, indoor air pollution, childhood lead expo- sure and the use of environmental health services by urban populations.
The new legislation, the South African Med- ical Research Council Act, Act 58 of 1991, changed the way in which the MRC was governed. For the first time the board was chaired by an independent chairperson, and it immediately identified tuberculo- sis, malaria, nutrition intervention, trauma, AIDS and urbanisation as research priorities.
The MRC introduced a system of national programmes in these priority areas in or- der to facilitate the networking of research and researchers across science councils (Human Sciences Research Council (HSRC),
CSIR, Foundation for Research Develop- ment (FRD)), higher education institutions (universities and technikons2) and non-gov- ernment organisations, and to ensure that the whole spectrum of research would be carried out. The new system envisaged that
‘basic’ research would be conducted mainly in the higher education sector, while epi- demiological and community-oriented re- search would be conducted by the MRC and its associates. The MRC, consonant with the activities of the South African govern- ment, established contact with the African National Congress3 and hosted its Secre- tary for Health, amongst other internal or- ganisations - thus marking a dramatic shift in policy.
In the same year the MRC’s National AIDS Research Programme mounted a series of studies which ranged from improving di- agnostic methods to developing strategies to encourage reductions in risk behaviour.
(The dire predictions made by scientists in 1991 would come to pass some years later).
The year 1991 was also the year in which a major initiative in malaria research, in- volving a number of countries in southern Africa (Mozambique, Zambia, Zimbabwe, Swaziland, Namibia and South Africa), was planned. It was to become one of the most significant international contributions made by South African scientists. Research into rapid methods of tuberculosis diagno- sis led to the MRC’s Centre for Molecular and Cellular Biology at Stellenbosch Univer-
1 A heavily industrialised and urban area situated to the south of Johannesburg.
2 Technikons are tertiary education institutions which focus on technical instruction. They are now referred to as universities of technology.
3 The African National Congress (ANC), South Africa’s present-day ruling political party, was for decades declared an illegal organisation by the apartheid government.
sity developing a technique for Polymerase Chain Reaction testing of sputum samples which could be performed in mass screen- ing for the disease. Significant community- based studies on coronary risk factors were conducted in this year which provided an opportunity to re-assess interventions in the Coronary Risk Factor Intervention Study (CORIS) in three towns in the Western Cape, and to determine the nature of coronary risk factors in urban Africans in the Cape Town metropole. Other major events in- cluded the discovery of the chromosome on which the gene for albinism was located, and the launch of a national collaborative programme to advance the development of technology for health care.
The year saw studies into the provision of health services in Port Elizabeth, the evaluation of health services in two Cape Town teaching hospitals, an investigation of the attitudes of private practitioners to health care provision, and a consultative ap- proach to establishing the priorities for a post-apartheid health system. All of these marked a radical departure from the tradi- tional research agenda of the MRC up to that time, and heralded the beginning of a different emphasis on the role of research in the health of populations. Concurrent with this were efforts at defining newer sampling techniques in peri-urban areas, and the creative use of routinely collected data in these atypical environments.
7.1.5 Changes in research gov-