CODESRIA INSTITUTE ON HEALTH, POLITICS AND SOCIETY INAFRICA

Theme: Africa and the Global Pharmaceutical Industry
Date: 06 – 31 October, 2008
Venue: Dakar, Senegal

Call for Applications for the 2008 Session

The Council for the Development of Social Science Research in Africa (CODESRIA) was established in 1973 as an initiative of African scholars for the promotion of multidisciplinary research that extends the frontiers of knowledge production in and about Africa, and also responds to the challenges of African development. Within the broad framework of the mandate defined for the Council in its Charter, various research and training programmes have been developed over the years for the purpose both of mobilising the African scholarly community and responding to its needs. The Council also has a robust publications programme which has earned it a reputation as one of the leading academic publishers in Africa. Its training programmes are particularly targeted at younger, mid-career scholars whose need for support in advancing their reflections on conceptual and methodological questions was at the origin of the initiation by the Council of a number of annual thematic institutes. At present, CODESRIA runs annual Governance, Gender, Humanities, and Child and Youth Studies institutes; similar programmatic initiatives are under consideration for other fields of research in which the Council is engaged.

As part of on-going programme innovation and expansion, the Council in 2004 launched an institute on Health, Politics and Society in Africa in a bid to promote an enhanced interest in multidisciplinary health research among African scholars. The initiative flowed from the CODESRIA Strategic Plan 2002 - 2006 which has placed a considerable emphasis on the promotion of social science approaches to health studies in Africa and a structured dialogue between the Social Sciences and the Health/Biomedical Sciences. The initiative has also become imperative at a time when the African continent is faced with one of the most severe health crises in its history. Most symbolic of this crisis is the HIV/AIDS pandemic which has been ravaging the continent for sometime now even as such diseases as malaria continue to take a heavy toll while tuberculosis and polio, once under control, are enjoying a resurgence. The HIV/AIDS pandemic itself came to the fore in the context of a generalised weakening of the health structures and processes of African countries, as well as the decline in the average health and nutritional status of Africans, the latter speaking directly to the increased levels of personal and household impoverishment on the continent. At the root of the decline in the health status of Africans are such factors as the prolonged economic crises which African countries have faced in the period since the early 1980s, the inappropriate adjustment measures prescribed by the International Financial Institutions (IFIs) for containing the crises but which exacerbated the problems that were already being experienced in the health sector, and the massive brain drain from the sector.

Objectives:
The main objectives of the Institute on Health, Politics and Society are to:
1. Encourage the emergence and sustenance of a networked community of younger African scholars in the field of health research;
2. Promote methodological and conceptual innovations in research on African health questions through the application of enhanced social science and humanistic approaches;
3. Encourage a structured dialogue between the Social Sciences/Humanities and the Health/Biomedical Sciences as part of the quest for a holistic approach to understanding health, politics and society in Africa; and
4. Promote the sharing of experiences among researchers, activists and policy makers drawn from different disciplines, methodological/conceptual orientations, and geographical experiences on a common theme over an extended period of time.

Organisation:
The activities of all CODESRIA institutes centre on presentations made by resident researchers, visiting resource persons, and the participants whose applications for admission as laureates are successful. The sessions are led by a scientific director who, with the help of invited resource persons, ensures that the laureates are exposed to the range of research and policy issues generated by or arising from the theme of the Institute for which they are responsible. Open discussions drawing on books and articles relevant to the theme of a particular institute or a specific topic within the theme are also encouraged. Each of the participants selected to participate in any of the Council’s institutes as a laureate is required to prepare a research paper to be presented during the course of the particular institute they attend. Laureates are expected to draw on the insights which they gain from the Institute in which they participate to produce a revised version of their research papers for consideration for publication by CODESRIA. For each institute, the CODESRIA Documentation and Information Centre (CODICE) prepares a comprehensive bibliography on the theme of the year. Access is also facilitated to a number of documentation centres in and aroundDakar.

The 2008 Session:
Africa and the Global Pharmaceutical Industry African countries attained independence in the 1960s on the basis of a broad social contract between the nationalists who inherited state power from the colonial authorities and the general populace whose support was instrumental to the success of the independence struggle. At the centre of the contract was a commitment by the nationalists to an across-the-board improvement in the lives and well-being of the populace in ways which also overcame the discriminatory restrictions that underpinned colonial social policy and opened new opportunities for social advancement. The health and educational sectors occupied a pride of place in the early investments which post-colonial governments made in the social sectors; overall, those sectors witnessed an all-round expansion in the period up to the end of the 1970s. As it pertains specifically to the health sector, the primary accent was placed on developing the infrastructure for the provision of “modern” medicine to the bulk of the populace. From the primary health centres that were created to the bigger, mostly urban-based general hospitals and specialist medical centres, the expansion of the “modern” health sector was treated as a tangible goal of independence to which public investments were poured. At the same time, attention was given to the training of health personnel – nurses, midwives and doctors – both locally and abroad to staff the medical establishments which governments set up. Efforts were also made to promote local medical research – mainly through university-based medical schools – and support the development of a domestic industry – initially of an import-substituting nature - in the medical sector.

For the period up to the middle of the 1980s, most of the public medical centres that were established functioned relatively well: They were well-provisioned in most senses, including the drugs and personnel they needed to render services to the citizenry. Governmental financial subventions to meet their operational expenses were also regular even if not always sufficient. In turn, public medical establishments generally enjoyed the confidence of the public and were often the first choice of most patients on account of the quality of their services and the equipment at the disposal of their staff members. In several countries, investments were also made in the local production of basic provisions and equipment. This picture was, however, to begin to change rapidly from the mid-1980s onwards when, in the wake of the economic crises which African countries one after the other began to undergo, the health sector suffered severe setbacks from which it still has not fully recovered. Apart from the severe cut-backs in the budgetary allocations by governments under severe pressure to balance their budget, the sector was to witness a mass exodus of qualified personnel on account of a variety of factors. The brain drain from the public health sector was fuelled by the sharp deterioration of the physical infrastructure and equipment base of most health institutions; the severe shortages of drugs and other supplies that became a way of life; the deterioration in the remuneration of public heath staff; and overall environment of work that discouraged professional excellence. As if the exodus of staff was not enough, governments were also to carry out retrenchment exercises as part of their public sector reform programmes crafted within the framework of IMF/World Bank structural adjustment. The adjustment framework also became the platform through which so-called cost-sharing/cost recovery policies were introduced from the 1980s onwards, policies which, taken with the deterioration in the public health system, acted as a disincentive for continued popular access to and use of the services of the public health institutions. Furthermore, the adjustment context contributed to the demise of local medical laboratories and factories as part of a generalised experience of de-industrialisation witnessed on the continent. The full depth of the crises of public health provisioning experienced in Africa has been brought out in sharp relief by the activities and interventions of the global pharmaceutical companies that seat atop the international production and supply chain for medicines and related health services. Indeed, through the global and local strategies of the companies, it is possible to develop a political economy of the crises of the African health system in all its dimensions and inter-connectedness. During the course of the last two and half decades, both as a result of new possibilities opened by contemporary processes of globalisation and as a defensive mechanism that has, itself, become part and parcel of the globalisation of corporate activities, the international industry in the production, distribution and consumption of medicines underwent a structural recomposition that is evidenced, in part, by major acquisitions and mergers. This process of recomposition has resulted in the emergence of a group of major international pharmaceutical companies such as GlaxoSmithKline, Bristol-Meyers-Squib, Pfizer, Hoffmann-LaRoche, Johnson & Johnson, Merck & Co., AstraZaneca, Abbott Laboratory, Novartis, and Sanofi-Aventis, among others, exercising an undisputed global dominance. Their dominance spans the area of pharmaceutical research and experimentation, product development and innovation, production systems, product packaging, distribution and marketing, and the shaping of patterns of consumption. They mobilise local and external support to protect their advantages through the intellectual property rights and patents that they obtain and guard jealously. Their enhanced global and sectoral reach is reckoned to be as significant as their connections to local and international policy and political institutions, including inter-governmental agencies and organisations like the World Health Organisation, the World Bank and the World Trade Organisation. Indeed, radical critics suggest that the firms collectively constitute a cartel that drives global and local health policies. In the face of the power projected by the pharmaceutical majors and the influence which they are able to mobilise, most African health systems are, perhaps unsurprisingly given their crises, easily vulnerable to the pressures which they exert in order to secure their interests. Participants in the 2008 session of the CODESRIA Institute on Health, Politics and Society will be encouraged to explore the various dimensions of contemporary global pharmaceutical industry and the way in which it impacts on the African health system in general and its capacity to respond to the health needs of the peoples of the continent in particular. Experience registered in different African countries and anecdotal evidence available points to various dimensions of the impact of the activities and practices of the pharmaceutical majors on African health systems. At one level, there are legitimate questions which have arisen about the making of public health policy in contemporary Africa and the power/influence exerted over the relevant policy processes and structures by the global pharmaceutical industry. At issue is the question of who the dominant forces are behind the public health policy choices made in Africa and what the interests they represent are. At another level, the dumping of pharmaceutical products on African markets, sometimes packaged as aid or humanitarian assistance, has had detrimental effects on the local pharmaceutical industry in some countries. Furthermore, the major pharmaceutical players have engaged in pricing policies which have contributed in no small measure to straining the health budgets of African countries and diminished the affordability of drugs by patients and other consumers of medical products. This has, in turn, pushed many African’s into a search for alternative methods for meeting their health needs, including faith healing and the revival of indigenous medicine. It has also opened a window for a flourishing market in fake medical products that take a daily toll in lives lost.

The strain placed on the health budgets of African countries by the pricing policies of the leading pharmaceutical conglomerates has not been mitigated by the transfer-pricing techniques employed by the companies through the intra-firm trade that goes on between them and their subsidiaries established in key African countries. Additionally, various ethical questions have emerged from the pilot experiments undertaken by some of the firms, with the basic approaches which they employ when they try out drugs for the treatment of diseases such as tuberculosis, HIV/AIDS, and malaria being questionable. Also, under the guise of the huge outlays they make on research and the protections that are offered to them by internationally-agreed rules on intellectual property rights and patents, they spare no effort to discourage the production of local generic drugs. The experience of South Africa in its quest to procure generic drugs for treating HIV/AIDS is salutary in this regard. As part of the effort they have deployed to discourage generics in Africa, the pharmaceutical majors have supported campaigns aimed as discrediting the drugs – which are much cheaper in price terms – as fakes that are both ineffective and damaging. Amidst orchestrated publicity and fanfare, the big firms have also occasionally offered price reductions on essential drugs in order to reduce the pressure mounted on them over the huge costs involved in procuring their products. South Africa has also been a leading example of African countries where the global pharmaceutical majors have attempted to build and project corporate social responsibility and participants in the Institute will be encouraged to weigh the significance of the corporate responsibility measures they have pursued on the continent.

The drug regulatory agencies in many African countries are largely under-staffed, inadequately financed and poorly equipped. In consequence, they are mostly not very well-placed to perform their duties of establishing and enforcing standards of behaviour among the firms operating in their jurisdiction. Indeed, in some cases, the pharmaceutical majors offer them equipment, funding and other forms of support to carry out their statutory functions, calling their independence into question. Links are also forged by the pharmaceutical majors with African health professionals as much for the purpose of securing a competitive edge over their rivals as for anything else. Such is the power of the firms and the extent of their reach that they have also joined not only in the pillage of Africa’s indigenous medicines but also taken out patents on local herbal remedies used in the treatment of common diseases. Furthermore, they have established a strong foothold in the growing global industry in wellness and well-being. Indeed, it has been suggested that the big pharmaceutical firms have taken a frontline role in the “invention” of diseases and of treatments for them, doing so by feeding into a momentum that characterises as illness, conditions which may not in fact require elaborate medical diagnosis and treatment. The range and variety of research and policy issues associated with the role of the global pharmaceutical industry in the functioning – and dysfunctionalities – of African health systems, and the consequences of their activities for the health and well-being of the peoples of the continent are numerous, and various multidisciplinary entry points are required for the achievement of a holistic understanding. Prospective participants in the Institute are invited to address themselves to these different entry points and other related aspects of research on health system governance in Africa. The Director For every session of its various institutes, CODESRIA appoints an external scholar with a proven track-record of quality work to provide intellectual leadership. Directors are senior scholars known for their expertise on the topic of the year and for the originality of their thinking on it. They are recruited on the basis of a proposal which they submit and which contains a detailed course outline covering methodological issues and approaches; the key concepts integral to an understanding of the object of a particular Institute and the specific theme that will be focused upon; a thorough review of the state of the literature designed to expose laureates to different theoretical and empirical currents; a presentation on various sub-themes, case-studies and comparative examples relevant to the theme of the particular Institute they are applying to lead; and possible policy questions that are worth keeping in mind during the entire research process.

Candidates for the position of Director should also note that if their application is successful, they will be asked to:
- participate in the selection of laureates;
- identify resource-persons to help lead discussions and debates;
- design the course for the session, including the specification of sub-themes;
- deliver a set of lectures and provide a critique of the papers presented by the resource persons and the laureates;
- submit a written scientific report on the session.
In addition, the Director is expected to (co-)edit the revised versions of the papers presented by the resource persons with a view to submitting them for publication in one of CODESRIA’s collections. The Director also assists CODESRIA in assessing the papers presented by laureates for publication as a special issue of Africa Development or as monographs.

Resource Persons
Lectures to be delivered at the Institute are intended to offer laureates an opportunity to advance their reflections on the theme of the programme and on their own research topics. Resource Persons are, therefore, senior scholars or scholars in their mid-career who have published extensively on the topic, and who have a significant contribution to make to the debates on it. They will be expected to produce lecture materials which serve as think pieces that stimulate laureates to engage in discussion and debate around the lectures and the general body of literature available on the theme.

One selected, resource persons must:
- submit a copy of their lectures for reproduction and distribution to participants not later than one week before the lecture begins;
- deliver their lectures, participate in debates and comment on the research proposals of the laureates;
- review and submit the revised version of their research papers for consideration for publication by CODESRIA not later than two months following their presentation.

Laureates
Applicants should be African researchers who have completed their university and /or professional training, with a proven capacity to carry out research on the theme of the Institute. Intellectuals active in the policy process and/or in social movements/civic organisations are also encouraged to apply. The number of places offered by CODESRIA at each session of its institutes is limited to fifteen (15) fellowships. Non-African scholars who are able to raise funds for their participation may also apply for a limited number of places.

Applications Applicants for the position of Director should submit:
1. an application letter;
2. a proposal, not more than 15 pages in length, indicating the course outline and showing in what ways the course would be original and responsive to the needs of prospective laureates, specifically focussing on the issues to be covered from the point of view of concepts and methodology, a critical review of the literature, and the range of issues arising from the theme of the Institute;
3. a detailed and up-to-date curriculum vitae; and
4. three writing samples.

Applications for the position of resource persons should include:
1. an application letter ;
2. two writing samples ;
3. a curriculum vitae ; and
4. a proposal, not more than five (5) pages in length, outlining the issues to be covered in their proposed lecture.

Applications for Laureates should include:
1. an application letter;
2. a letter indicating institutional or organisational affiliation;
3. a curriculum vitae ;
4. a research proposal (two copies and not more than 10 pages), including a descriptive analysis of the work the applicant intends to undertake, an outline of the theoretical interest of the topic chosen by the applicant, and the relationship of the topic to the problematic and concerns of the theme of the 2008 Institute; and
5. two reference letters from scholars and/or researchers known for their competence and expertise in the candidate's research area (geographic and disciplinary), including their names, addresses and telephone, e-mail, fax numbers.

An independent committee composed of outstanding African social scientists will select the candidates to be admitted to the institute.

The deadline for the submission of applications is set for 14 July, 2008. The Institute will be held in Dakar, Senegal in October 2008. All applications or requests for further information should be addressed to:

CODESRIA Institute on Health, Politics and Society in Africa Avenue Cheikh Anta Diop x Canal IV BP 3304, CP 18524, Dakar, Senegal Tel.: (221) 33 825 98 21/22/23 Fax: (221) 33 824 12 89 E-Mail: [email][email protected] Website: http://www.codesria.org