DELTAS Africa II Guidance to Applicants

Developing Excellence in Leadership, Training and Science in Africa

December 2019

2 | DELTAS Africa

Table of Contents

Background ...................................................................................................... 3

Call for aplication ............................................................................................... 5

DELTAS Africa strategic areas and key outcomes ............................................. 7

Additional information & guidance ..................................................................... 15

DELTAS Africa II thematic research areas ........................................................... 17

Key principles to note ......................................................................................... 33

3 | DELTAS Africa

BackgroundThe African Academy of Sciences (AAS) and partners have launched Phase II of the DELTAS Africa initiative (DELTAS Africa II). The long-term vision is to support the development of the next generation of scientists and research leaders in Africa who will play a major part in advancing research for health and wellbeing, and the social-economic and sustainable development of the continent. This is an open call and equal opportunity to both existing and new DELTAS Africa networks and extends the breadth and diversity of subject areas to reflect the current health and social issues in Africa, for example non-communicable diseases, trauma/injuries and disability, climate change, ‘one health’, as well as social sciences, humanities and cross-disciplinary priorities.

Vision

The vision of DELTAS Africa is to support the African-led development of world-class research and research leaders in Africa. This new generation of scientists will play a major part in shaping and driving a locally relevant health and social sciences research agenda for Africa, contributing to improved health and well-being and sustainable socio-economic development in the continent.

Overview of the initiativeDELTAS Africa aims to produce world-class scientific research in health, social sciences and priorities that can be addressed through a multi-disciplinary approach including climate and environmental aspects. It supports the development of the next generation of African researchers and research leaders. The initiative funds training programmes that focus on producing researchers with the capacity to conduct, publish and lead locally relevant and high-quality research that will have societal impact and contribute to improved health, wellbeing and sustainable development in Africa.

Initiated in 2015 by Wellcome and partners, the transition of the management and funding of DELTAS Africa to AAS has been a transformative model for shifting the center of gravity for funding science and research in Africa. This shift is a new and crucial element in the long-term strategy of the initiative, which also aims to enhance collaboration

with other funders and African governments to co-ordinate activities and support for African research.The ‘health gap’, the ‘health research gap’, ‘social science gap’, ’environment and climate change gap’ and the ‘sustainable development gap’ in Africa provide an overwhelming rationale for investments to accelerate the development of research excellence in Africa. In addition, national policy makers are increasingly recognising the importance of locally relevant research, and national governments acknowledge the broader social and economic impacts of investments in science and technology.

Since 2015, AAS through its Alliance for Accelerating Excellence in Science in Africa (AESA) platform has supported the development of research leadership and high-quality scientific environments in sub-Saharan Africa through several different programmatic models. These have focused on the agenda setting and prioritization of research focus areas, development of talented individual researchers, as well as strengthening institutional and national environments for research. Other interventions have included identifying and filling critical gaps in Africa’s research ecosystems including training early career researchers, providing pathways for translating research into innovative products and services, community and public engagement in research, strengthening governance and research management through creation of standards, and building a pan-African platform for mobilising resources for funding research on the continent; and launching

© A

MS

, 201

9

4 | DELTAS Africa

an Open Research publication platform to promote access to research findings. Building on this, and in recognition of the long-term commitment needed to strengthen and sustain capacity development on the continent, DELTAS Africa was designed with a long-term vision and recognition that attaining excellence and critical mass is an inherently long-term horizon. This announcement of DELTAS Africa II takes the commitment of the AAS, Wellcome and other partners to a 10-year commitment from 2015-2025.

DELTAS Africa II

The DELTAS Africa II call will be an open call to all regions of Africa, not only sub-Saharan Africa as was the case in DELTAS Africa I. Additionally, in DELTAS Africa II, the AAS and partners are setting strong expectations of co-funding and stronger commitments from institutions hosting DELTAS Africa II networks, and the engagement of other relevant stakeholders such as community groups, policy makers and think tanks/NGOs that have advisory roles to governments and/or involved in national/regional scientific priority setting, translation and implementation. This guidance document sets out the eligibility and requirements for potenial applicants and provide links where neccessary to additional reference documents.

To achieve its vision, DELTAS Africa will fund programmes that address all four strategic areas of the Theory of Change (ToC Fig 1) i.e. • Scientiic Quality• Research Leadership• Research Management, Culture and

Infrastructure• Scientific Citizenship

These strategic areas have been recognised as necessary for strengthening, sustaining, attracting and retaining excellence in research. Within each strategic area, the initiative identifies several key outcomes; these key outcomes can be considered as descriptions of capacities required for that strategic area to function well.

The initiative’s strategic areas and key outcomes have been identified using stakeholder consultation and through The AAS’s and funding partners’ experience in funding excellent research and strengthening research capacity in Africa and in other low- and middle-income countries. A map of the strategic areas and the key outcomes is presented in Figure 1(i.e. The DELTAS Africa Theory of Change)

Objectives

The objectives of DELTAS Africa are aligned to the strategic areas. They are:

• To produce world class Africa and globally relevant research for health, social and economic advancement in Africa,

• To strengthen research leadership training and mentorship to build a critical mass of high calibre scientists in Africa

• To cultivate professional environments to manage and support research and build positive research cultures on the continent

• To foster equitable collaboration in research and enhanced engagement with community, public and policy stakeholders in Africa

Aims of DELTAS Africa II: The underpinning aim of DELTAS Africa II is strong research outputs that address local challenges and contexts, and of global relevance, strengtheining research capacity and translating research outputs to impacts over the medium to long-term, as espoused in the DELTAS Africa Theory of Change. Research studies supported by DELTAS Africa II are expected to lead to the following outcomes and outputs:

• DELTAS Africa programmes produce high quality scientific output measured by diverse outputs including publishing, the winning of competitive grants, citations and translations of research through policy, public and community engagement.

• Every DELTAS Africa programme will have a specific influence on health or social policy or practice at national/regional level; or has an output directly translated into a tangible health or social influence, wellbeing and sustainable development.

• A cumulative total of at least 1,500 African researchers will have been trained by 2025 (this includes DELTAS Africa I) with about 50% of DELTAS Africa trainees being female.

• Institutions hosting a DELTAS Africa initiatives commit to greater support, with options including complimentary and co-funding support; creation of new posts for researchers and career pathways; infrastructure; and research culture initiatives.

5 | DELTAS Africa

DELTAS Africa invites applications for health-, social-, and sustainable development-focused, interdisciplinary and multidisciplinary scientific programmes aligned to the initiative’s strategic areas and key outcomes – taking into consideration pressing local, national and regional research needs, resources, priorities and existing capacity. This flexible approach is intended to encourage innovation by supporting alternative activities and processes, within the remit of the initiative.

The primary location of proposed programmes must be in Africa, and preliminary applications are invited from universities and research institutions based in Africa; institutions outside Africa are invited to collaborate on applications led by an African institution. Applications that strongly support and commit to safeguarding and diverse workplaces, balance excellence with equity in selection of partner and collaborating institutions and recruitment of trainees, and which can demonstrate value for money, risk management and ability to build strong research cultures and environments are strongly encouraged to apply. Awards will be made for up to five years, with opportunities for competitive renewal anticipated after this period subject to continued funding of the programme.

Applications must be submitted on the AAS Grants Management system (Ishango).

Application forms and guidance notes and links to other relevant documents are available online at http://www.aasciences.africa/deltasafrica.

Preliminary applications open at 20:00 EAT on 18 December 2019 and close at 17.00 EAT on 28 February 2020.

Call for Applications

Successful preliminary applicants will be invited to submit full applications by 08.00 EAT, 28 April 2020, and funding decisions will be made before December 2020.

Letters of Support

Applications must be supported by letters of support from senior institutional leadership (VC, DVC, Directors of research) in all lead and partner institutions. However, for the preliminary application only the letter of institutional support from lead institution will be required.

Compliance with DELTAS Theory of Change

Applicants are required to comply with the DELTAS Africa theory of change and M&E framework i.e. preliminary application should indicate how their consortia will address all four areas of programme governance, research quality/productivity, scientific citizenship, Training/mentorship, and strengthened research environments and research culture.

Compliance with the AAS Good Financial Grant Practice

Because the lead institution will be responsible for overall funds management, accountability and reporting on behalf of the entire consortium they will be required to be compliant at the GFGP Gold Level Standard or higher which is platinum (or provide timelines to achieve the gold level by Q4 of 2020); Partner Institutions are defined as those responsible for delivery of a significant programmatic work package on behalf of the consortium, they will receive significant funds from the lead institution and will be required to be compliant at the GFGP Silver Level

©S

hutt

erst

oc, 2

019

6 | DELTAS Africa

Standard, at the start of the grant, and to commit to work towards achieving the gold status or higher in due course; Collaborating institutions may be in Africa or non-African, and although they may be responsible for delivering a significant work package, they will not be required to be GFGP compliant since they will not be receiving regular budgets from DELTAS lead institutions.

Programme strategy and management

In addition to the strategic areas of the initiative, successful programmes will have a defined scientific research strategy that is relevant to national, regional health and/or non- health research, socio-economic, environmental and sustainable development priorities. Programmes should capitalise on the existing strengths of institutional partners, which should be selected based on their ability to contribute to this research strategy and to the overall programmatic goals. In selecting partners, programme should also consider how issues around balancing excellence with equity, co-funding from host governments, gender, equality, diversity and inclusion, and a thriving research culture are enhanced and achieved to collectively and synergistically strengthen Africa’s research ecosystems.

Programmes must also demonstrate the ability to implement robust internal programme governance and management and should consider issues of long-term sustainability. Specifically, programme and partner risk assessments, management processes and systems, strong financial governance and controls, documented standard operating protocols, programme monitoring, evaluation and learning frameworks must be clearly articulated. Equally important are strategies for monitoring, documenting and reporting short- term, medium-term and long-term impact stories arising from the priority research being undertaken by the consortium and the ability to use these for advocacy and policy change objectives.

Monitoring, evaluation and learning (M&E)

Monitoring, Evaluation and Learning (M&E) processes support learning and development, provide accountability to stakeholders, and grants assurance to funders. Dedicated staff should be assigned to monitoring and evaluation, and appropriate activities and resources should be included in all programmes.

Individual programmes will be required to develop M&E plans and to integrate their findings into improved practice. Programmes will also be required to participate

in a DELTAS Africa-wide M&E plan that will evaluate the performance and impact of the initiative and the research it generates. Strategies to accurately identify and measure the long-term impact of DELTAS Africa funding are important interventions of the DELTAS Africa programme.

DELTAS Africa strategic areas and key outcomes

Fig 1. DELTAS Africa strategic areas and key outcomes

Link to Theory of Change document: https://www.lucidchart.com/documents/view/1ac12fc3-09f3-4451-8f8d-a910a928dd71/0_0

7 | DELTAS Africa

The following sections describe the strategic areas and some associated key outcomes of the initiative, together with examples of activities that applicants might wish to consider in their proposals.

8 | DELTAS Africa

Scientific quality

Objective 1: To produce world class Africa and globally relevant research for health, social and economic advancement in Africa

Ensuring that training and research is of high quality is a priority of the initiative. DELTAS Africa aims to produce world-class research that addresses research priorities in health, social, environmental, economic, and sustainable development; of high quality and relevance as assessed at every level.

Assessing and ensuring high scientific quality are recognised challenges in resource-limited environments. This is an area where collaborations with well-resourced universities, research institutions and think-tanks can help to strengthen capacity.

Figure 2. Scientific quality outcomes

Scientific oversight is available

Access to processes and resources for scientific review and independent scientific advice will allow students and researchers to receive the guidance they need to produce high-quality and locally relevant research. Care should be given to having appropriately matched expertise to research areas.

Activities might include:

• establishing and using a scientific advisory board

• establishing a review process for research projects.

Research data

The quality of research data, its reproducibility, protection, management and sharing are important aspects of research quality. Networks are required to put in place measures to ensure that research data is produced and handled using the highest standards of peer review and reproducibility, and to have plans for ensuring research integrity and to guard against research misconduct and misuse.

Activities might include:

• Formation and adoption of analytical frameworks to validate research data

• Development and implementation of SOPs for data capture and verification

• Developing policies for ensuring research integrity and ethical use of research, and to check on plagiarism, misconduct and misuse of research.

Research questions and research plansWell-thought out and well-articulated research questions and research plans are some of the foundational elements for ensuring research quality. These must be grounded on issues of specific relevance to national, regional and global priorities

Activities might include:

• Development and adoption of research frameworks that are aligned to local contexts and local priorities

• Development of realistic research work plans • Development of programme risk management

plans and mitigation measures

9 | DELTAS Africa

Research leadership

Objective 2: To strengthen research leadership training and mentorship to build a critical mass of high calibre scientists in Africa.

Training – specifically, training for research – is a fundamental element of research capacity strengthening. Research leadership training is equally essential. DELTAS Africa focuses on the tertiary and postgraduate training in sciences (including the social sciences) and professionals along a defined career pathway.

Figure 3. Research training career pathway

The initiative identifies three key research leadership training outcomes:

Figure 4. Research and Research leadership training outcomes

Enhanced Knowledge

Having a pool of appropriately skilled candidates who are interested in a career in scientific research is a prerequisite for selecting trainees. Programmes should carefully consider existing levels of local scientific research capacity when determining the training stages that are appropriate to include – from graduate interns to senior researchers.

A research career pathway is also crucial. In many contexts, research might not be a favourable career choice by potential candidates. In this case, it is particularly important to develop and promote scientific career pathways that are attractive and viable.

Researchers receive appropriate supervision and mentorship

Supervision is a key element of training programmes. Appropriate supervision and mentorship involve the right expertise and adequate time and safeguarding measures. Students and their research projects should be matched to supervisors and mentors who have a strong track record in their field and sufficient expertise to direct the student’s research; for complex or multidisciplinary research, a student may require more than one supervisor. At senior levels (PhD and above) researchers should be supervised by a minimum of two supervisors, who can be from different institutions.

Activities might include:

• assessing the local capacity for health and social sciences research

• student outreach programmes.• Pre-training and orientation

Students and supervisors and mentors should both commit to an agreed schedule. Supervisors and mentors must ensure that they have enough time and appropriate expertise to properly supervise and mentor their students and should meet with each student

Activities might include:

• assessing the local capacity for scientific and social science research

• student outreach programmes• Pre-training and orientation

10 | DELTAS Africa

Other Possible Outcome and activities:

High-quality candidates are selected Selecting appropriately qualified and motivated candidates for training programmes requires robust processes. Selection decisions should include academic merit, among other clear and agreed criteria. When applying at PhD level and above, candidates might also be asked to demonstrate an interest in pursuing a scientific research career. Programmes should also strive to balance excellence with equity in the selection of candidates as a means of leveling the playing field between strong and weak countries and regions.

Activities might include:

• identifying supervisors and mentors to match programme research themes

• supervisor and mentor orientation and/or training

• keeping supervision logbooks• Independent and fair mechanisms for

dispute resolutions

A high-quality training programme is in place

Training programmes should provide individuals at all career stages with the academic support and research facilities they need to develop into world-class researchers, and programmes should clearly define research themes or areas in which they can offer appropriate training support and facilities. This includes supporting trainees to publish their research findings in high-quality and relevant peer-reviewed publications.

Ensuring that the right expertise is available can be particularly important when developing multidisciplinary training programmes

Activities might include:

• running study programmes and specialized short courses

• securing teaching commitments from expert faculty members

• supporting students seeking to be published in academic journals

• Facilitating access to other well- resourced and advanced research environments and new tools and technologies through exchange visits to other labs within Africa and in partner/collaborating institutions

11 | DELTAS Africa

Research management, culture and infrastructureObjective 3: To cultivate professional environments to manage and support research and build positive research cultures on the continent

Developing and supporting research requires specific expertise in the area of research management. Researchers need access to skilled administrative support and adequate resources to compete at a global level, and creating supportive, sustainable environments is crucial to developing research capacity. Equally important is the requirement for catalyzing the right research cultures including safeguarding to provide a safe environment for research to thrive without any form of harassment, intimidation or bullying of those involved in research; and with mechanisms for aggrieved persons to safely report abuses and access fair hearings and justice.

Figure 5. Research management and environment outcomes

Functional research management, and governance structures are in place

Successful research programmes are backed up by functions such as finance, grants management, administration and ethical review. These activities require specialised support services, delivered by dedicated and professional staff, to bridge the gap between academic research and business management.

Activities might include:

• strengthening financial accounting systems• providing training in grants management• ensuring quality ethical review processes• GFGP assessments and certifications• Achieving research management standards

certification

Appropriate, functional physical infrastructure is available

Appropriate infrastructure should be available to support a vibrant environment for both research training and research management.

Research training infrastructure refers to the basic physical facilities needed to conduct scientific training, such as laboratories, field equipment, IT equipment, internet, lecture theatres and classrooms.

Research management infrastructure includes the facilities needed for the management of a research programme, such as a research support office, finance and accounting system, and grants management software.

Applicants will be asked to describe how any requested resources will complement existing resources. Requests will only be supported if they demonstrably meet an unmet need.

Activities might include:

• furnishing a research management centre• paying for access to scientific journals• upgrading bio-safety equipment• Procurement of anti-plagiarism tools

12 | DELTAS Africa

Building a strong research culture

Deliberate actions to instill a strong research culture, including safeguards against any form of research misconduct. Deliberate actions towards safeguarding to prevent any form of intimidation, harassment, bullying and negative and abusive power relationships between trainees and their supervisors or other research participants.

Activities might include:

• Developing and implementing policies on research misconduct and safeguarding

• Training on research misconduct and safeguarding

• Developing and implementing SOPs and fair processes for reporting and addressing cases of research misconduct and safeguarding

Other possible outcomes and activities:

Sustainable funding is securedSecuring independent and sustainable financial resources will enable programmes to adapt and flourish. Programmes should include plans to seek funding from other parties, including governments, local and external agencies. Evidence of government co-funding for programmes will be highly rated in the review of DELTAS Africa II applications.

Activities might include:

• running study programmes and specialised short courses

• securing teaching commitments from expert faculty members

• supporting students seeking to be published in academic journals

• Facilitating access to other well- resourced and advanced research environments and new tools and technologies through exchange visits to other labs within Africa and in Europe and Africa

13 | DELTAS Africa

Figure 6. Scientific citizenship and CPE outcomes

Scientific citizenship

Objective 4: To foster equitable collaboration in research and enhanced engagement with community, public and policy stakeholders in Africa

As researchers develop, they should be supported when taking on more responsibility in their research programmes and demonstrating greater independence in their research careers. Scientific excellence is often the product of good leadership and scientific collaborations, so researchers should be encouraged to develop their leadership and networking skills.

For research to achieve real impact, it needs to leave the desk, the laboratory and the field.Communication with policy makers will help research findings inform health, social, economic, environmental and science policy. Engaging with the public can raise public awareness and interest in scientific research, and increase the uptake of new products, policies and practices by governments and the local communities.

Researchers take on increasing leadership roles in scientific programmes

As researchers mature, they should be encouraged to take on increasingly responsible positions in their research programmes and laboratories. Support from mentors, as well as formal development programmes, will help researchers acquire the professional skills they will need to take on these roles.

Activities might include:

• leadership development courses• mentorship programmes.

Activities might include:

• scientific open days• community meetings or workshops• publishing opinion pieces• Training in CPE for fellows and staff

Researchers join regional and international networks and collaborations

Regional and international collaborations encourage the exchange of ideas and provide opportunities to expand networks, allowing reciprocal benefits. Researchers should be encouraged to participate and contribute where possible.

Activities might include:

• participating in international scientific meetings

• participating in peer review committee for journals

• sharing data.

Researchers and programmes engage with the media, community and public to raise awareness and interest

An engaged community and public is better positioned to be involved in conversations about scientific and social science research and science-driven health policy. Public engagement also supports collaborations between researchers and local communities, public organisations and cultural partners, and it can help attract the next generation of researchers by getting school children interested in science at an early age.

14 | DELTAS Africa

Researchers and programmes engage with and influence policy makers

Translating research into evidence-based policies and practices is instrumental in achieving real health, social-economic and sustainable development impacts. Researchers can inform science policy by engaging with policy makers and communicating their research at policy forums. They can also contribute through local advocacy or by working with national and regional policy groups and think tanks that have advisory roles to governments.

Activities might include:

• contributing to health, social science, economic, political, environmental and science policy forums

• developing government submissions on these and other development issues

• contributing to national and/or regional technical guidance.

15 | DELTAS Africa

1. Research alignment to country and regional needs Applicants will have to demonstrate that their research is aligned to country or regional needs. This is particularly important as DELTAS Africa II plans to fund a mix of discovery, translational and applied sciences, so the applicants need to demonstrate that they are meeting a need identified through wide stakeholder and community engagement, and that there is strategic level endorsement of the application. Therefore, at the full application stage strong letters of support beyond the institutions will be required e.g. from Ministries of Health or from policy think tanks, scientific, economic and social commissions with advisory role to governments, confirming strategic level alignment of proposed studies with national and regional priorities.

2. Diversity and inclusion in consortia leadership and recruitment of trainees

Leadership by women will be particularly encouraged both as lead and/or co-applicants. Merit will remain the key criterion, however gender diversity with regard to consortia leadership is encouraged i.e. networks will be strongly encouraged to consider gender of PIs/Co-PIs when considering partners and as for DELTAS Africa I recruitment of staff and students upon award will be tracked to seek gender parity and equity.

Additional information and guidance

3. Balancing excellence with equity in consortia formation and recruitment of trainees

Single institution applications will NOT be accepted. To achieve a measure of equity, and without compromising on excellence, institutions that are generally recognised as strong or high performing research institutions will be required to pair with institutions across countries and regions that are generally perceived as not being strong in research. AAS intends to use the consortia approach to achieve this goal. All consortia must be no less than 3 African institutions with other partners from within Africa and international institutions, normally up to a maximum number of 8 institutions. Applicants are advised to carefully consider the number of partner institutions.

A partner is an institution that will carry out a well-defined work package and will receive a significant budget and be GFGP compliant. A collaborator can be other institutions that support delivery of the research objectives but are not receiving budgets and do not need to be GFGP compliant. There will be no limits on number of collaborators, but the numbers should be indicated in their applications and where they are based i.e. African, Northern or South-South collaborations. Applicants are advised to carefully consider the number of collaborators, so consortia are manageable and realistic, and in proportion to the work plan and budget. Applicants can include a maximum of three Northern partners (Europe, USA, Japan or other high-income countries) who can

© A

MS

, 201

9

16 | DELTAS Africa

receive budgets, but total budget allocated to Northern partners cannot exceed 10% of entire DELTAS Africa budget.

Selecting partners: Applicants MUST select partners and recruit students/post-docs/researchers from diverse cultural/geographies across the African continent as explained below. While merit remains the overriding criteria, lead applicants are strongly encouraged to consider geography, regional spread and economic status when selecting their partner institutions. For example, consider World Bank classifications based on country GDP (Link) i.e. Africa can be divided into three categories: Upper middle income, ii) Middle income and iii) Low income countries. AAS strongly encourages group selections that represent different regions and include ‘less advantaged’ institutions.

Knowledge partners: Given the momentum created by DELTAS Africa I and the need to strengthen pathways to, and evaluation of impacts, it is strongly recommended that applicants identify at least one knowledge broker/partner, Think Tank, or a consortium advisory board of the right mix of membership including policy people, community stakeholders etc. The goal is to have a good mix of academic, think tank and policy thought leaders to steer and advise the Consortium on knowledge translation, linkages with governments and communities and to bridge the gap between research, policy and practice.

17 | DELTAS Africa

These outlines are only aimed as guidance or background, for information only rather than a menu for applications. As much as possible we have included references as sources of the materials and as pointers to applicants for in-depth reviews; however, we emphasize that we are looking for visionary consortia who will develop their own programmes of relevant research work appropriate to their context. Applicants are also free to propose other topics not outlined here if they meet the broad criteria of health, social sciences, and cross-disciplinary research. The proposed work can be along the continuum of basic-translational-clinical-applied- implementation-operational research.

Research PrioritiesThe African continent has a triple burden of infectious diseases, NCDs, epidemics, and must also contend with priorities for food and nutrition, climate change and other socio-economic challenges. The DELTAS Africa call shall receive applications for research in all priority areas but also including the broad underpinnings of social sciences and inter/cross/transdisciplinary research particularly the nexus of health, food/nutrition, energy, and climate change/environment, politico-economy, public policy etc. Applicants can propose DELTAS Africa networks in any of the research priority areas listed in these guidelines (and others not on this list if they are in the broad areas mentioned above). Key focus areas could include but not limited to:

DELTAS Africa II thematic research areas

Malaria

According to the World Health Organization (WHO) Malaria Report 2019, the number of malaria infections recorded globally has fallen for the first time in several years. WHO estimates that there were 228 million reported cases in 2018, a decrease of around 3 million from the previous year. This drop can be attributed mostly to fewer cases in southeast Asia, where funding increased to fight the disease. But in other parts of the world, malaria is on the rise: there were one million more cases in Africa, home to 94% of the people who died from the disease.

Fragile health-care systems and a lack of funding and infrastructure threaten to undermine the fight against malaria in Africa. Malaria robs the African continent of US$12 billion per year in lost productivity, investment and associated health care costs, and 1.3% of lost annual GDP growth. As malaria is both a major cause and consequence of poverty and inequality, the Sustainable Development Agenda is critically linked to a malaria-free world. Even in Africa, the burden of malaria is highest in the least developed areas and among the poorest members of society – particularly children, pregnant women and other vulnerable populations such as migrants, refugees and the displaced. Malaria is also a frequent cause of catastrophic household health expenditure. In endemic countries, scaling up malaria interventions contributes strongly to reducing child mortality and improving maternal health.

Optimizing the access of malaria interventions is essential for achieving universal health coverage, ensuring healthy lives and promoting well-being of all ages, particularly for vulnerable and marginalized

© A

MS

, 201

9

18 | DELTAS Africa

populations.

African nations have renewed their commitment to strengthen instruments to attain a malaria-free Africa by 2030, by sustaining the political commitment as articulated in the continental Agenda 2063, increased domestic financing, increased access to life-saving malaria interventions, as well as more robust health systems. However, the goal of malaria elimination is an ambitious one that may not be met unless new and existing R&D tools are quickly identified, developed and deployed. According to WHO, for the first time in more than a decade, progress against malaria on the African continent, which accounts for >90% of the global malaria burden, has stalled. Progress across Africa has been uneven, putting at risk the tremendous progress to-date and the collective ambition to end the disease. While some African countries have seen a greater than 20% increase in malaria cases and deaths since 2016, others are showing that beating malaria is possible. In 2016, just 15 countries carried most of the global malaria burden, together accounting for 80% of all malaria cases and deaths. All but one of these countries are in Africa. The World Malaria Report sends a clear warning that we have stopped making progress and that, without urgent action, we risk going backwards. Domestic funding needs to be urgently stepped up. These investments — only a fraction of what African nations will save if we succeed in eliminating malaria — will pay off, in millions more lives saved, health systems strengthened, economies grown and the world back on track to end this disease.

Research needs: The DELTAS Africa call will support malaria networks that focus on priority R&D gaps including those outlined below (list is not exhaustive). Five key challenges that represent threats or barriers to achieving the global technical strategy for malaria that can be alleviated with new health products have been identified and are; Biological adaptation leading to resistance; Addressing transmission; Transforming surveillance; Achieving universal access to treatments; and focus on P. vivax and non-falciparum species. The DELTAS Africa call is an opportunity to propose solutions to improve interventions i.e. tools which are improved versions of the existing core interventions e.g. new partner drugs in ACTs; or to propose to innovate novel tools and technologies, e.g. a new active ingredient with insecticidal properties; or to investigate novel concepts and technologies at discovery stage e.g. gene drives to prevent mosquitoes carrying malaria parasites. For many of these approaches, basic science is needed to advance product development. For health products to have an impact in malaria, implementation science is needed to operationalize new tools in combination with the existing core interventions for malaria, including surveillance.

Some priority R&D areas are outlined below.

Vector control: New insecticide classes used in combination in LLINs and IRS; Extended duration combination LLINs and IRS; novel vector control tools including endectocides and genetic approaches;

Diagnostics: High-throughput mosquito assays; Validated POC diagnostics for identifying low density infection; RDTs that detect and differentiate all Plasmodium species; Multiplexed POC tests of acute febrile illness; Non-invasive/ self-administered diagnostic tests; Non-invasive Self-administered Sensitive and specific POC diagnostics for P. Vivax; Diagnostics to identify hypnozoites; Affordable, simple and accurate POC tests for G6PD deficiency; POC diagnostics to identify drug-resistant parasites; POC/health system falsified drug screening; Infectivity/gametocyte diagnostics; Gametocyte Infectivity; Stable, valid, specific and sensitive RDTs that do not depend on Pfhrp2/3. Drugs: Simplified therapy and prophylaxis; Transmission-blocking drugs; Novel drugs for chemoprevention; New drug combinations suitable for use in MDA, etc; Simplified therapy for P. vivax radical cure; Drugs for P. vivax radical cure without G6PD liability; New drug classes used in combination therapies for malaria treatment; Novel drugs for severe malaria

Vaccines: Preventive and transmission-blocking vaccines for P. Falciparum; Preventive and transmission-blocking vaccines for P. Vivax.

Implementation Research: Research should not stop after providing the proof of principle for a product, or after demonstrating its effectiveness in selected situations, it has an additional critical role to play in helping solve major implementation challenges. Experience has shown that implementation research can make a major difference and help ensure that proven control products have the maximal possible impact on improving health. Implementation research strengthens the evidence base for the access and delivery of new and improved tools, strategies and interventions; can be used to strengthen health systems, improve patient safety, expand community-based interventions and local implementation capacity, and improve the outcomes of public-private partnerships and global health initiatives. Applications focusing on malaria operational and implementation research are encouraged.

Ref: https://www.who.int/researchobservatory/analyses/malaria_rd_priorities_working_paper.pdf?ua=1

19 | DELTAS Africa

HIV/AIDS

HIV/AIDS continues to be a major global public health issue, having claimed more than 32 million lives so far. However, with increasing access to effective HIV prevention, diagnosis, treatment and care, including for opportunistic infections, HIV infection has become a manageable chronic health condition, enabling people living with HIV to lead long and healthy lives. However, not everyone is able to access HIV testing, treatment and care. Notably, the 2018 Super-Fast-Track targets for reducing new paediatric HIV infections to 40 000 was not achieved. Global targets for 2020 are at risk of being missed unless rapid action is taken. Over two thirds of all people living with HIV live in the WHO African Region (25.7 million). While HIV is prevalent among the general population in this region, an increasing number of new infections occur among key population groups.

DELTAS Africa II will consider quality applications from African research leaders and their consortium working on HIV/AIDS based on priorities defined by local/national/regional strategies and international partners who are leaders in HIV research priority setting (WHO, NIH, Wellcome, UNAIDS etc.). Some general research focus areas are presented below (note that this list is not exhaustive).

Reduce the incidence of HIV, including supporting the development of safe and effective vaccines, microbicides and pre-exposure prophylaxis. Preventing new infections will be critical to achieving an end to the HIV pandemic. Additional biomedical research, development of new tools, and addressing behavioral and social factors all will be needed to reduce the incidence of new cases of HIV. Historically, vaccines have been integral to preventing the spread of many infectious diseases. The development of a safe and effective HIV vaccine remains a key strategy for ending the pandemic.

Develop next-generation treatments/therapies for HIV with improved safety and ease of use. Combination antiretroviral therapy (ART) has prevented many HIV-related deaths but despite its benefits, only about half of the 37 million people with HIV worldwide receive treatment. Several factors prevent people from beginning and continuing treatment including the high cost of treatment, the need for daily dosage, the possibility of (adverse) interactions with other drugs, and the potential for drug resistance and/or adverse events. Unequal access to treatment also reduces health outcomes across race, ethnicity, sex and gender, age, and socioeconomic status. People living with HIV/AIDS need treatments that are longer acting, less toxic, and have fewer side effects and complications. Research could also include basic and clinical research to quickly identify infection, measure

treatment success, determine drug resistance and epidemiological research to inform treatment strategies and improve health outcomes.

Conduct research toward an HIV cure. Although combination antiretroviral therapy (combination ART) allows people living with HIV to live longer and in better health, it does not cure HIV. Investing in research to find a cure for HIV is focused on two broad aims: sustained viral remission and, in the longer term, viral eradication. Latent HIV reservoirs—small amounts of HIV that persist in people taking cART—present a significant challenge to finding a cure for HIV, and latent reservoirs remain in infected people when HIV becomes part of the body’s DNA in infected cells. Additionally, reservoirs of HIV can be found in certain “sanctuary” sites in the body that allow the virus to hide and be protected from both the immune system and cART. To cure HIV, researchers need to propose novel approaches and treatments that target these HIV reservoirs, but which are as safe, effective, and available for widespread use as are current cART regimens.

Address HIV-associated comorbidities, coinfections, and complications through research designed to decrease and/or manage these conditions. HIV causes many health issues that are not improved by combination antiretroviral therapy. Treatment may also lead to harmful side effects, adverse interactions with other medications, HIV drug resistance, and other complications. A major overarching research priority is to improve the health outcomes of people with HIV by addressing these co-occurring conditions—or comorbidities—along with the other infections and complications faced by infected persons across the lifespan. Research is needed to better understand the relationships of aging, HIV infection, treatment, and related comorbidities.

Advance cross-cutting areas of research in the basic sciences, behavioral and social sciences, epidemiology, implementation science, information dissemination, and research training.

Basic research provides the underpinning for HIV science in all priority areas. It also may identify gaps and emerging areas where additional work can improve our understanding of how HIV develops and is transmitted. Specific areas of basic research study include: how HIV affects the immune system and causes chronic inflammation; the influence that an individual’s microbiota has on HIV treatments; the role of genetics in whether a person is likely to become infected with HIV and how the disease progresses in an infected individual; immune system responses that may prevent HIV disease or make it progress more quickly; prevention and disease

20 | DELTAS Africa

outcomes.

More research is required in behavioral and social sciences. Although effective HIV prevention options currently exist, significant disparities or inequalities in access to care, treatment adherence, and health outcomes limit their use. Disparities persist by race, ethnicity, sex and gender, age, and socioeconomic status, among others. Social determinants of health, such as poverty, unequal access to health care, stigma, racism, and lack of education contribute to health disparities. This calls for studies of individual, interpersonal, social, and systemic factors related to the transmission, prevention, treatment, and cure of HIV/AIDS. Consortia can propose behavioral and social sciences research that addresses the behavioral and social factors that are barriers to HIV prevention and also helps identify factors that can facilitate HIV prevention, influence HIV transmission and prevention e.g. mental health status or substance use, may influence the adoption of prevention strategies.

Applicants can propose epidemiological research to understand the HIV epidemic at the population level and develop strategies to prevent, identify, treat, and cure HIV. This should include research aimed at reducing health disparities, for example, we need a better understanding of why young women aged 15-24 years are the greatest risk group for HIV in Africa. This group often do not know their HIV status and are less likely to receive HIV care and treatment. Research can define and address the biologic, genetic, epidemiologic, behavioral, and systemic factors that contribute to these differing health outcomes. There is also a need to address the barriers to information dissemination e.g. to enable wide dissemination HIV research findings and to recruit hard-to-reach populations and individuals to participate in clinical studies. Proposed approaches can include research to improve the delivery of HIV-related services i.e. implementation science, which helps identify factors which are barriers to or can help facilitate effective health care programming and policy development. This knowledge helps to create and implement new evidence-based practices and strategies that improve public health.

The goal for a successful DELTAS Africa HIV network and for HIV/AIDS R&D in general should be to prevent new cases of HIV, reduce HIV transmission, advance treatment adherence, and improve the health outcomes of people with HIV. To ensure sustainability and to raise the level of HIV/AIDS research in Africa, proposals for DELTAS Africa support should be underpinned by strong programmes in research training and mentorship, infrastructure, and capacity strengthening across the various consortium partners.

Mycobacteria Tuberculosis

Mycobacterium TB is an ancient disease and over the course of history the disease has killed more people than any other infectious disease. Over the past 200 years, it is estimated that at least 1 billion people have died from TB—more than the number of deaths resulting from malaria, smallpox, HIV/AIDS, cholera, plague, and influenza combined. TB remains the deadliest infectious disease in the world. In 2017, the WHO estimates 10 million people, including 1 million children, became ill with TB, and 1.6 million people with TB died, including 230,000 children, making it the leading infectious cause of death in the world. Globally, approximately 1.7 billion people are living with asymptomatic Mtb infection, known as latent TB; they have a lifetime 5 to 10 percent chance of developing active disease. An estimated 417,000 people died from the disease in the African region in 2016. Over 25% of TB deaths occur in the African Region with Nigeria and South Africa the most affected. TB is a leading killer of HIV-positive people: in 2016, 40% of HIV deaths were due to TB. About 82% of TB deaths among HIV-negative people occurred in the WHO African Region and the WHO South-East Asia Region in 2016. WHO estimates that there were 451,551 new cases with resistance to rifampicin in the African region – the most effective first-line drug.

Efforts to halt the spread of TB in Africa and globally are critical to reducing TB-related morbidity and mortality. The total global economic burden associated with TB from 2000 to 2015 was an estimated $617 billion. To address the global health emergency that TB represents, the World Health Organization (WHO) End TB Strategy sets ambitious goals for 2035 to reduce TB deaths by 95 percent and to reduce TB disease incidence by 90 percent (relative to 2015 levels). Global objectives are also focussed on strengthening patient care and improve policies and support systems to immediately benefit patients. The United Nations General Assembly held its first ever high-level meeting on TB in September 2018 to discuss a unified approach to address the TB pandemic.

Research acceleration is required to prevent, diagnose, and treat tuberculosis (TB). We need a better understanding of the immunology and pathogenesis of TB to enable quicker development of new tools to more effectively combat this disease. These tools include preventive vaccines and therapies, less-toxic treatment regimens of shorter duration, and rapid, accurate, easily implementable, point-of-care diagnostics to detect all forms of TB, including latent, disseminated, and drug-resistant (DR) TB, in the diverse populations and age groups affected.

Proposals for DELTAS Africa funding can focus on

21 | DELTAS Africa

priorities that capitalize on recent advances in the field and are critical to the development and evaluation of the knowledge and tools needed to end TB globally. The overall aim is to accelerate basic, translational, and clinical research to improve understanding of TB and expedite the development of innovative new tools and strategies to improve diagnosis, prevention, and treatment to end the TB pandemic. Specific research areas could include (but are not limited to):

• Improve fundamental knowledge of TB to understand host and bacterial factors (and their interplay) that drive Mtb pathogenesis, transmission, and epidemiology, and including the elucidation of the immune mechanisms responsible for limiting or failing to limit Mtb infection and disease.

• Advance research to improve the diagnosis of TB, including research to identify biomarkers and biosignatures for different forms of TB that can facilitate the development of accurate, rapid, and easily implementable diagnostic and prognostic tests for use in all populations.

• Accelerate research to improve TB prevention by supporting science to design, develop, and evaluate preventive vaccines and chemoprevention, and to identify markers of protective immunity that can predict vaccine efficacy.

• Support research to improve treatment for all forms of TB in all populations and age groups, including research to develop less toxic regimens of shorter duration for safe and effective treatment, host-directed therapies (HDTs), and therapeutic vaccines.

• Develop tools and resources to advance research in understanding, preventing, diagnosing, and treating TB, including human cohorts and clinical capacity; animal models representative of human disease; and assays, reagents, and tools to assess vaccine, therapeutic, and diagnostic candidates.

To achieve these goals a successful DELTAS Africa network will need to leverage their current resources, local/African and global collaborations. They would be expected to promote a multidisciplinary approach to TB research, drawing on expertise from fields within and outside of TB research to facilitate studies of complex biological questions and encourage the application of state-of-the-art technologies used successfully in other fields. DELTAS Africa will provide critical support for training and mentorship of the next cadre of TB researchers in Africa to accelerate an impactful research agenda. With these research efforts and an emphasis on rapid translation of results to patients—facilitated through collaborations with country level Government departments, policy think tanks and with other key partners—new TB prevention and control strategies can be developed and implemented in Africa to move the

world closer to end TB, which is among the health targets of the UN Sustainable Development Goals.

For more information, applicants should consult various priority setting documents including those developed at country, regional, continental levels and by leading international agencies that support global TB research such as WHO, NIH, Gates foundation etc.

Anti-Microbial Resistance

Anti-Microbial Resistance (AMR) is now recognised as one of the most serious global threats to human health in the 21st century, with the resistance of bacteria to antibiotics increasingly spreading from one country to the next. AMR essentially renders some drugs ineffective and has contributed to 700,000 deaths globally each year. Although resistance to commonly prescribed antibiotics has been witnessed in Africa, the full scope of the burden is not yet understood as 40% of African countries do not have enough data on AMR. It is a complex threat to global health that is likely to compound the high disease burden in Africa and therefore requires us to increase our understanding to be adaptive and responsive.

DELTAS Africa II will consider support for an AMR network that would help to deepen our understanding of the scale of antimicrobial resistance in Africa and help to inform our strategic response to counter the impact of AMR in the provision of present and future healthcare on the continent. The network would embark on research to understand the extent of the AMR burden in Africa while also focusing attention on the development of new drugs and interventions.

The network research focus could be directed to identify new sources of data, particularly those that would bring together different research communities in Africa and globally for new perspectives on the problem. The use of analytical methods and bioinformatics approaches, including those that combine or connect existing databases in novel ways; identification of new biomarkers or combinations of biomarkers that could lead to new understanding of the actionable implications of antimicrobial resistance surveillance data; development of low-cost technologies and products including those that specifically target improved infection prevention and control in healthcare settings to reduce reliance on healthcare provider behaviour change, and technologies to remove antibiotics from effluents.

Applicants can propose a ‘One Health’ approach to tackling AMR which would span humans, animals,

22 | DELTAS Africa

food and the environment, working at a local, regional, national and international level in a collaborative and transdisciplinary manner to build AMR research capacity, foster interdisciplinarity and to achieve optimal health outcomes. Preventing and containing AMR requires increased and sustained investment and a cross-disciplinary approach, and successful consortia would also be expected to work hand in hand with industry and global partners.

Different work packages of the successful AMR network could focus on some or all of the following: Therapeutics: Discovery of new antibiotics and therapeutic alternatives, and the improvement of current antibiotics and treatment regimens; Diagnostics: Development and improvement of diagnostics to improve use of antibiotics and alternatives to antibiotics; Surveillance: Optimisation of surveillance systems to understand the drivers and burden of antimicrobial resistance in a One Health perspective; Transmission: Understanding and preventing the transmission of antimicrobial resistance; Environment: The role of the environment in the selection and spread of antimicrobial resistance; Interventions: Investigation and improvement of infection prevention and control measures in One Health settings.

Since 2018 the AAS has funded about 18 small/medium sized grants on AMR projects through the Grand Challenges Africa programme and in partnership with the Bill & Melinda Gates Foundation, Swedish International Development Agency (SIDA) – Joint Initiative on AMR, and Grand Challenges South Africa/SAMRC. A successful DELTAS Africa AMR network would be required to provide leadership and stewardship for the existing AAS-funded researchers while proposing new directions for AMR research in Africa.

Neglected Tropical Diseases and ONE Health

Neglected tropical diseases (NTDs) are a diverse group of 20 communicable diseases that prevail in tropical and subtropical conditions in 149 countries. They affect more than one billion people and cost developing economies billions of dollars every year. Populations living in poverty, without adequate sanitation and in close contact with infectious vectors and domestic animals and livestock are those worst affected. While NTDs rarely lead to death, they can cause significant disability that persists for a lifetime, including fatigue, blindness, and disfigurement. Sufferers miss school, are unable to work, or are too embarrassed to seek medical care. By diminishing quality of life and opportunities to succeed, NTDs can reinforce the cycle of poverty among the world’s disadvantaged populations.

As outlined in the WHO NTD Roadmap, effective control can be achieved when selected public health approaches are combined and delivered locally. Interventions are guided by the local epidemiology and the availability of appropriate measures to detect, prevent and control diseases. Implementation of appropriate measures with high coverage will contribute to achieving the targets of the neglected tropical diseases, resulting in the elimination of many and the eradication of at least two by 2020.

NTDs are “neglected” because they generally afflict the world’s poor and historically have not received as much attention as other diseases. To address this neglect and to provide opportunities for research, training and capacity building for NTDs in Africa, DELTAS Africa applications are invited from consortia of NTD researchers in Africa. Applications can focus on research devoted to better understanding, prevention, and treatment of NTDs. Studies could be focused on important new discoveries about the pathogens that cause NTDs, the identification of targets for potential new drugs, vaccines and diagnostics, and the development of strategies for controlling the organisms that transmit NTD-causing agents to humans.

Areas of focus for the consortia could include those identified by WHO and other NTD priority setting strategies (list is not exhaustive):

• Preventive chemotherapy and transmission (PCT) control. PCT focuses on diseases for which a strategy exists as well as on tools and the availability of safe and effective drugs that make it feasible to implement large-scale preventive chemotherapy.

• Innovative and intensified disease management (IDM): IDM focuses on diseases for which cost-effective control tools do not exist and where large-scale use of existing tools is limited.

• Vector ecology and management (VEM); Vector control is an important component in the prevention and control of vector-borne diseases, specifically for transmission control. VEM develops and promotes strategies and guidelines based on the principles and approaches of integrated vector management, including sound management of pesticides.

• Neglected zoonotic diseases; Zoonoses are diseases naturally transmitted from vertebrate animals to humans and vice-versa and are a subset of the NTDs. Their management needs integrated approaches and application of veterinary science, a multidisciplinary approach that considers the complexities of the ecosystems where humans and animals coexist to make them part of the NTD strategic approach to transmission control.

23 | DELTAS Africa

• Water, sanitation and hygiene: provision of safe water, sanitation and hygiene (WASH) is a key intervention within the global NTD roadmap, as it is critical in the prevention and the provision of care for all neglected tropical diseases. There is a need for research and data that helps to design and deliver programmes that maximise the effectiveness of WASH interventions for NTD control and elimination

Many of the R&D strategies for tackling NTDs render themselves to the One Health approach which can be defined as the integrative effort of multiple disciplines working locally, nationally, and globally to attain optimal health for people, animals, and the environment.

Given the extensive breadth and remit of NTDS and One Health (>20 diseases), applicants would be required to indicate how they will achieve research prioritization for the specific projects that will be implemented by their proposed consortia. For example the consortia could adopt a “sandpit” approach i.e. the consortium leaders, advisors and fellows would meet with the goal of establishing priority research questions for the fellows projects; they start on a blank slate with only the broad disease areas defined; then progressively they would draw out the fine details to end up with a set of priority research questions which the fellows would develop as their Msc, PhD, or post-doc projects.

Epidemic Pathogens

Africa continues to experience major outbreaks of epidemic pathogens including Ebola, Marburg, Lassa virus and vector borne arboviral diseases such as Rift Valley Fever, Yellow Fever and Chikungunya. The threat of these diseases spreading across borders is real and recognized by the African leadership and global public health community as priority for R&D and interventions. Viruses causing these diseases are transmitted through various means and can quickly spread across borders.

The emergence and re-emergence of these infections has been enabled by our existing gaps in knowledge viz. our understanding of the natural history of the pathogens and the lack of or little capacity to diagnose, monitor or respond to hemorrhagic, arboviral and related infections in Africa. To improve our understanding of these diseases, especially viral hemorrhagic fevers (VHFs), proposals are invited from DELTAS Africa partnerships that brings together consortium of African and other researchers who envision setting up a strong foundation for a One Health surveillance-research-training-response package to enable the prediction of transmission risk, proactively prepare the network of trained response units and effectively augment disease control operations across the widest breadth of the African continent, including through strong

collaborations with Africa Centers for Disease Control (Africa CDC) and national CDCs.

Therefore, the overarching aims of the the network could be inter alia: to gain insights into pathogen distribution at key foci and within border/migration routes; elucidate inter-epidemic maintenance of these pathogens in vectors and reservoirs; refine existing climatic models for predicting disease transmission; develop novel diagnostics for detecting asymptomatic pathogen carriers in humans and animals; strengthen local research and health sector capacity to establish an Early Warning System (EWS) to support the response to outbreaks through digital platforms/mobile telephony, establishment of small tactical research and response units; and to leverage a strong interdisciplinary, international team of African and global researchers to focus on a range of threats such as Ebola virus disease, Rift Valley Fever Virus (RVFV), Yellow Fever virus (YFV) and Crimean-Congo Haemorrhagic Fever Virus (CCHFV) etc

Applicants could focus on surveillance and discovery; Biology, pathogenesis, immunity; product development and pilot product manufacturing; mechanisms to deploy interventions. Approaches could include utilization of synthetic vaccinology, starting with surveillance and discovery, followed by design and synthesis, focusing on pathogen-infected persons from new outbreak areas; including isolation of pathogens and extraction and sequencing of genome; digital transfer of information/bioinfromatics; using historical knowledge about pathogen biology and structure to understand antigenic targets and basis for immunity and leading to synthesis of key genes encoding vaccine antigens and other reagents (See ref Graham & Sullivan. Nature Immunology 2018).

Reviewers would be looking for comprehensive information on: basic data and knowledge about target pathogens: qualitative analysis of data: status of vaccines/therapeutics for target pathogens: relevant information across or within target pathogen families (e.g. known info about a pathogen that can aid investigation into related pathogen).

A successful DELTAS Africa network could be required to collaborate, (and will be assisted to establish), specific collaborations with AAS partners such as CEPI, Africa CDC, University of Florida and others working in this priority area.

Maternal & Child Health

With only just over a decade to meet the SDGs, there is an ongoing burden of 5.4 million deaths globally,

24 | DELTAS Africa

including newborns (2.5 million), stillbirths (2.6 million), and maternal (0.3 million). Africa, with only 13% of the world’s population, carries more than half of this burden with 2.3 million deaths per year. Based on current trends, most sub-Saharan African countries won’t meet the SDG target of 12 or fewer newborn deaths per 1,000 births and are also at risk of missing targets for maternal mortality reduction.

In 2018, the African Academy of Sciences and UK’s Academy of Medical Sciences organised a workshop to discuss the improved implementation of proven interventions, brainstorm novel solutions, and strategise on methods for supporting investment in maternal and newborn health (MNH) science and research leadership in Africa. MNH researchers and other stakeholders from 15 African countries and other countries around the world attended the meeting. Their recommendations were that to close these gaps, there are four Grand Challenges to address, and science and research is crucial in accelerating implementation and developing innovations. The four Grand Challenges which are central to achieving the SDGs by 2030 are:

• Better care during pregnancy• Better care at birth• Better postnatal care for women and their newborns• Better hospital care for sick newborns

The expert convening further identified the prioritisation of MNH research questions as a critical contribution towards the SDGs and corresponding targets among other issues in areas like research leadership in MNH, gaps between scientists and policymakers, gender disparities in MNH research, MNH multisectoral collaborations, and MNH research umbrella networks. A report summarising this meeting and providing additional details on proposed implementation and discovery science solutions, “From minding the gap to closing the gap: science to transform maternal and newborn survival and stillbirths in sub-Saharan Africa in the Sustainable Development Goals era,” is available through the AAS (online at https://www.aasciences.africa/sites/default/files/Publications/

A follow-on meeting was hosted in 2019 which resolved to identify research priorities in maternal and neonatal healthcare in Africa through a research prioritisation exercise using the Child Health and Nutrition Initiative (CHNRI) tool. This tool was first used in 2008 to set global, national, and regional research priorities in areas ranging from maternal, newborn, child health and nutrition, sexual health, disability, and dementia. CHNRI uses the principles of the wisdom of the crowds to systematically collect and transparently score research options against pre-set criteria. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5481891/

This exercise involved more than 9000 researchers and 699 individual research questions were proposed. The top 46 questions were put out for scoring to address the four challenges above, and they cover all types of science including discovery, development, and delivery research questions. Some examples are: diagnostics for maternal bacterial infections, or for neonatal sepsis, context-specific packages for MNH, maternal and neonatal nutrition, upskilling health personnel and task shifting, identification of high-risk pregnancies, monitoring of labour and its complications, care for preterms including management of respiratory distress, adherence to policy recommendations, uptake of known beneficial MNH behaviors by communities, breastfeeding, HMIS and data improvement.

Applicants to the DELTAS Africa programme can propose to work in these MNH research priorities or others that are relevant, comprehensive and linked to root causes of MNH morbidity and mortality in Africa. Since 2016 the AAS has funded more than 20 individual MNCH innovation and data sciences projects through its Grand Challenges Africa programme.

A successful DELTAS Africa Network will be required to demonstrate how they would link with the existing MNH researchers and their projects to create a productive, consolidated network approach that addresses research priorities, leadership development, careers and collaborations.

Climate Change & Planetary Health

(This section has been shaped by presentations and discussions between the AAS climate sciences team and the One Planet, One Health team at Wellcome).

Africa emits less than 10% of carbon dioxide and other greenhouse gases responsible for global warming, but seven of ten countries that will suffer the worst devastations due to the climate crises are in Africa. The African Union (AU) recognises that addressing climate change and its impacts such as droughts and extreme weather patterns is now an emergency and fundamental to achieving the continent’s over-arching strategic framework Agenda 2063. Protecting Africa from climate change impacts and ensuring a resilient future are key issues for the continent’s development agenda. Agenda 2063 identifies the identification and establishment of regional technology centres, support to programmes on climate change and establishing climate resilient development programmes as key actions.

Across the African continent, the 21st century has

25 | DELTAS Africa

ushered in rising expectations for improved health and wellbeing and economic success. Yet the imperative for growth that meets the needs of African people is challenged by the critical intersecting trends of growing populations (particularly in cities and slums), and accelerating social, economic, and health impacts from global and regional environmental change. While this confluence poses significant challenges, it also offers the tantalizing possibility that African nations can bypass development mistakes of the past to achieve societies in which health and sustainability are mutually supporting.

The emerging field of planetary health seeks to understand how human impacts on the environment in turn affect human health and well-being and to develop effective solutions through integrated, systems approaches. By applying a systemic lens to these issues, it can offer integrated solutions that harness the capabilities and knowledge of diverse stakeholders, leverage synergies and manage trade-offs along potential action pathways, and facilitate decision-making under uncertainty. As such, planetary health can support Africa in realizing its enormous potential and protect the African development agenda from the growing risks of global environmental change. At a recent session at the annual Grand Challenges Annual meeting in Addis Ababa that was co-hosted by the Wellcome Trust’s Our Planet Our Health Programme and the African Academy of Sciences, various discussions explored how planetary health can support Africa in realizing its enormous potential, protect the African development agenda from the growing risks of environmental change, provide immediate relief for challenges confronting African nations—such as air pollution, changing infectious disease profiles, and growing population exposure to extreme weather events and drought—and improve public health. Applications to DELTAS Africa II can be centered on these topics and those related to cities, food systems, climate change, and the nexus/interactions among them, and on institutional and capacity development to promote African planetary health sciences.

A successful DELTAS Africa climate network could have research work packages including: how to prioritise best practices for developing capacity for climate change in Africa, focusing on excellence in science, early career researchers, institutional strengthening and translational work; promote a nexus, transdisciplinary approach to climate research and enable inclusion of diverse actors; facilitate local and global collaborations in the delivery of climate change priority activities; mobilise African climate expertise to support African governments in co-producing climate policies relevant to national development plans; facilitate and increase representation and participation of African climate change scientists and ensuring their contribution to international climate processes such as the

IPCC, UNFCCC, UNGA, AU high- level meetings, and other related platforms.

The network can focus on opportunities and major research needs for the development of applied climate services supporting cross-sectoral innovative approaches for e.g. sustainable agriculture, renewable energy, water management, nature conservation, as well as for anticipating the risks associated with climate change in this region. A key gap in climate governance in Africa is the weak linkage between science and policy and building an interface between them is crucial to ensure that national, regional and continental development strategies, policies and programmes are climate informed.

The AAS and partners have funded more than 120 climate scientists in Africa over the past few years through initiatives such as CIRCLE and CR4D. The successful network would be required to establish a mechanism for aggregating this cohort and to establish structures for consultations, co-creation and delivery of activities using the network approach.

Mental Health and Neurosciences

About 14% of the global burden of disease is attributable to mental disorders. Even in sub-Saharan Africa, where communicable diseases are common, mental disorders account for nearly 10% of the total burden of disease. Mental disorders are linked to many other health conditions and are among the costliest medical disorders to treat. The magnitude of mental health problems in Africa and other LIMCs typically exhibit the so-called “10/90 gap”; that is, only 10% of global spending on health research is directed towards the problems that primarily affect the poorest 90% of the world’s population

What is needed is a network that is deeply committed to closing the R&D gap between what is needed and what is currently available to reduce the burden of mental disorders in Africa and to promote mental health. Priorities include health policy and systems research; where and how to deliver existing cost-effective interventions in a low-resource context; and epidemiological research on the broad categories of child and adolescent mental disorders or those pertaining to alcohol and drug abuse. Epidemiological research is important because of the lack of policy-relevant information in Africa. There should also be a focus on the generation of new technologies, knowledge and processes, and on the implementation of already proven interventions. A primary objective could be to increase the information and evidence base on mental health. In turn, this information can be used to strengthen mental health care systems which will result in better

26 | DELTAS Africa

care and services to individuals and communities. This could include the collection and dissemination of data on mental health resources such as policies, plans, financing, care delivery, human resources, medicines, and information systems in Africa, and which could feed into the WHO mental health atlas.

The network could also focus on deep research on Neuroscience (or neurobiology), which is the scientific study of the nervous system. Applicants could propose a multidisciplinary approach that combines physiology, anatomy, molecular biology, developmental biology, cytology, mathematical modelling and psychology to understand the fundamental and emergent properties of neurons and neural circuits. The understanding of the biological basis of learning, memory, behaviour, perception and consciousness has been described by Eric Kandel as the “ultimate challenge” of the biological sciences.

The applications should reflect the fact that the scope of neuroscience has broadened over time to include different approaches used to study the nervous system at different scales and the techniques used by neuroscientists have expanded enormously, from molecular and cellular studies of individual neurons to imaging of sensory, motor and cognitive tasks in the brain.

Proposal can address all or a combination of the following and networks that clearly articulate work packages in those key areas with each work package led by a Co-PI are particularly encouraged: Molecular & cellular neuroscience; Neural circuits and systems; cognitive & behavioral sciences; computational neuroscience; translational neuroscience research and medicine etc. These could also be linked to specific diseases: stroke, epilepsy, dementia, Parkinsons etc. Networks can propose the use of humans as subjects or animal models (use of humans and animal models will be subject to rigorous pre-award ethical reviews based on AAS policies on human subjects and use of animals in research).

Given the low state of development of neurosciences in Africa, applications proposing to work in this area should consider the following questions (list is not exhaustive). What are key neuroscience research strengths that the network will focus on? What are the key universities/institutes/partners that can support this work and who will be Co-PIs? Are there sufficient numbers of researchers in each proposed work package that can be invited as partners in the network? Are there significant collaborations between neuroscience researchers in the proposed network and other colleagues in Africa and globally? If so, in what areas of neuroscience are these

collaborations? what are the key opportunities for African neuroscience that the network will bring on board? what are the key challenges for African neuroscience, including capacity building and strengthening, that this network will address?

Reference: Setting priorities for global mental health research; https://www.who.int/bulletin/volumes/87/6/08-054353/en/

Clinical & Applied Research

The DELTAS Africa II call will support competitive applications focused on supporting high quality applied and translational health research that is focused on improving the health, wellbeing and productivity of the continent through clinical research and public health. This includes patient-oriented research i.e. leading-edge research with the needs and involvement of patients and the public at its heart, and which delivers high quality high impact research into clinical practice, policies and products. It should be research that focuses on patients/public and their needs, produces the best evidence to inform health decisions, is a catalyst for growth and provision of improved social care, and contributes to development of future research leaders in Africa.

The proposed programmes can address global threats to public health, such as infectious diseases and drug resistant infections, disciplinary and interdisciplinary research and innovation partnerships and strengthening capacity in clinical & applied research. Thematic focus can include a wide array of discovery, translational and applied priority subjects including non-communicable diseases (Cancer, Diabetes, Cardiovascular, Stroke, Mental Health, Neurological,,Respiratory, Blood, Musculoskeletal); Infections (Major infections such as Malaria, TB, HIV, neglected tropical diseases, epidemics pathogens, AMR); injuries, accidents and trauma; reproductive health and complications of childbirth such as still births, pre-term babies, snakebite research; health systems strengthening; health in fragile environments and during conflict, migration, urban slums; health economics & inequalities; broad public health impact (tobacco, clean air, immunisation, multimorbidity); Nutrition and exercise; Global and context specific surgery in Africa etc

By clinical research we refer to all research carried out on humans (healthy or sick people) that focuses on improving knowledge of diseases, developing diagnostic methods and new treatments or medical devices to ensure better patient care. It is very framed and respects a precise study protocol and is only realized under certain conditions. It must have the goal of increasing medical knowledge, be carried out by competent persons, take all necessary measures to protect those who lend

27 | DELTAS Africa

themselves to research, obtain regulatory approvals and take all the necessary legal and ethical steps, and collect the consent of those involved in research. Clinical research can either be observational studies (cohort studies, epidemiology) or interventional studies or clinical trials.

A clinical trial is a type of clinical research study, but a clinical trial is an experiment designed to answer specific questions about possible new treatments or new ways of using existing (known) treatments. For the purposes of registration, a clinical trial is any research study that prospectively assigns human participants or groups of humans to one or more health-related interventions to evaluate the effects on health outcomes. Interventions include but are not restricted to drugs, vaccines, cells and other biological products, surgical procedures, radiological procedures, devices, behavioural treatments, process-of-care changes, preventive care, etc. DELTAS Africa will support clinical research but will not support late phase clinical trials i.e. DELTAS Africa can provide support only up to pre-clinical and clinical phase 1 studies.

Cancer This summary was developed as a product of an emerging AAS-Halle University partnership. There is a lack of well-established cancer research groups in Africa, so partnerships with established global leaders in cancer research such as Halle, IARC etc. are strongly encouraged.

Cancer is increasingly becoming a problem in low- and middle-income countries (LMICs) due to ageing of the population as well as increasing prevalence of risk factors associated with changes of lifestyle (modernization of societies, urbanization, smoking, alcohol, obesity, physical inactivity and reproductive factors). The existing health systems are widely unaware of such threats and mostly still focus on acute diseases within their health strategies. Between 2012 and 2030, the number of new cancer cases in Africa is expected to increase by 70% - faster than any other region of the world [Bray 2019]. In figure 1, the frequency of the most common cancers in females and males are summarized. In sub-Saharan Africa overall, 811,200 new cancer cases (4.5% of the world total) and 534,000 cancer deaths (7.3% of the world total) were estimated for 2018.

There are some unique features of cancer in Africa: Contrary to cancer profiles in other parts of the world, 80% of all deaths due to cancer occur in the population younger than 60 years. Also, the prevalence of paediatric cancers is 6% in African

countries and higher than in other parts of the world. This is because of the high proportion of a young population in Africa. With rising life-expectancies, older patients will also present to the health system but there is a lack of geriatric specialists.

In terms of cumulative risk to acquire cancer within a lifetime, the situation is similar to other world regions, in some cases even worse: cumulative cancer mortality e.g. in African women, is greater than the global average. In addition, one third of all cancers in SSA are clearly caused by or associated with infectious diseases such as Hepatitis virus B/C and liver cancer, Epstein Barr virus and Burkitt lymphoma, human papilloma virus and cervical cancer, helicobacter pylori and gastric cancer, HIV and Kaposi sarcoma (Figure 7).

Promotion and prevention measures may therefore be specifically effective to decrease the future burden of cancer in the general population and specific risk groups like girls and young women, and sexually active women and men. The very broad genetic diversity of the African population is different compared to other ethnic groups and yet tumour biology has not been studied in depth.

Additionally, patients in Africa are in a unique environmental, cultural and social setting (e.g. distance to

Figure 7. Most common cancers WHO/AFRO region (cases, deaths: thousands)

28 | DELTAS Africa

Promotion and prevention is highly important as well as improving and expanding the treatment options. There are still only few radiotherapy facilities and the number of specialised health workers is low. In addition, anti-smoking and anti-alcohol campaigns addressing general lifestyle patterns and the related health risks can further decrease potential developments of related cancers in the populations.

International organizations have increasingly become aware of the existing and future burden of NCDs in LMICs. The UN’s Sustainable Development Goals (SDGs) for 2030 call for reducing premature mortality from non-communicable disease [Target 3a]. In May 2017 the World Health Assembly released the resolution “Cancer prevention and control in the context of an integrated approach” (WHA70.12). A recent initiative by WHO “Global strategy towards the elimination of cervical cancer as a public health problem” has a strong focus on low-income countries. Since 2002 the WHO has promoted for all countries the development of National Cancer Control programs to reduce incidence, mortality and improve quality of life of affected people. Also, governments in SSA show growing awareness: a WHO survey from 2015 revealed that above 80% of countries in the AFRO region have a Cancer Control plan and around 65% have an operational plan in place.

Figure 8. Infection-related cancers in Africa Taken from “The Cancer Atlas” by American Cancer Society

To date, only few institutions on the African continent address cancer as an imminent threat and promote and conduct related research. Applicants responding to this DELTAS Africa II call are required to address cancer as a growing, but still underestimated public health burden on the African continent.

This will require building a network of excellence for oncology research in Africa aims to link various African and northern partners (such as Halle university). This should bring together a series of African universities, research institutes and countries in accelerating efforts to improve oncology prevention, treatment and long-term care.

A DELTAS Africa Cancer consortium could have three key project pillars: (i) research, (ii) knowledge sharing/networking, and (iii) capacity development. The network will develop strong regional and global networks, increase the number of well-trained oncology experts, better understand the nature of cancer in the African setting, and generate evidence for better cancer health services. The capacity building approach should be centered on the development and evaluation of innovative and integrated essential interventions to tackle risk factors, enhance early detection, provide access to diagnostics and treatment, and assure long-term care. As overarching activity, the project could improve existing population-based cancer registries and eventually promote the establishment of new ones to monitor the magnitude of different forms of cancer in men and women and their impact on morbidity and mortality over time. The concept could also aim to promote bio-banking in pilot sites to improve this essential part of up-to-date molecular oncology research to eventually allow individual tailored targeted therapy concepts (and could collaborate with established biobanking partners such as IARC, H3Africa, BVGH).

To avoid duplication and achieve value for DELTAS Africa funds, the expectation is that existing networks who are developing/generating regional resources that can support research will be invited as partners and collaborators in the new DELTAS Africa network. The African Cancer Registry Network, which includes registries in 31 countries could be specifically targeted for strengthening and researchers from the consortium can be provided access to analyze the data generated since 2012. Currently, there are pathology institutions that archive formalin-fixed tissues and some research is performed. Within this project a number of suitable sites could be selected to build capacity for high-quality bio-banking to include frozen tissue, blood and other material. The expectation is that this would be an ambitious undertaking, but with key steps and milestones outlined in the direction of African bio-banking and to start a learning and research laboratories to benefit the whole network. Identified partner institutions will contribute to identify relevant research topics in oncology which may also involve e.g. hospital surveys, field studies, population studies, genomics etc.

29 | DELTAS Africa

The network could also propose how they will disseminate best practice of oncology research, implementation and evaluation, and the development of curricular teaching modules and tracks or degree courses in the area of oncology including modules on chronic disease epidemiology implemented e.g. in Masters or PhDs programmes on cancer epidemiology, immunology, pathology and other selected topics. As with all DELTAS Africa programmes, the expectation is that PhD students will be mentored and coached by African and partners senior scientists to develop research questions and apply related appropriate research methods. Post docs can also be recruited into the network who can support the supervision of PhD students while also being mentored by senior researchers to improve supervision skills and to build their own research groups. The researchers should also benefit from a wide range of soft-skills and practical courses e.g. scientific writing, grant applications, management, didactics, problem-oriented learning, and specific laboratory skills for scholars, and including strengthening the interdisciplinary capacities for cancer research and health services. Selected topics could include improved cancer registration, cancer biology, screening & early detection, compliance in using clinical guidelines and palliative care. The winning network should demonstrate strong links with organizations such as the African Organization for Research and training in Cancer (AORTIC), International Union for Cancer Control (UICC) World Cancer Congress, the American Society of Clinical Oncology (ASCO) in Africa, the International Agency for Research on Cancer (IARC) and others, with the ultimate goal of positioning the new DELTAS Africa Cancer network as an internationally recognized network of sentinel partner sites of excellence in oncology throughout Africa.

Diabetes

Researchers have estimated that diabetes cost Africa more than US$20 billion in 2015, with an even gloomier prognosis for the future. Of the total costs, US$12bn were incurred in Southern Africa. Previous research has identified South Africa and Egypt as the prime drivers of Africa’s diabetes epidemic. The report judged that 70 per cent of South African women are overweight or obese. East Africa incurred diabetes-related costs of almost US$4bn, while West and Central Africa’s burdens were estimated at US$1.7bn and US$1.8bn respectively. Of Africa’s total diabetes bill, just over 40 per cent came from indirect costs such as productivity losses and premature death. The researchers say things might get even worse. A best case scenario puts costs at US$35.3bn by 2030, while the gloomiest forecast is almost US$60bn.Research needs: The availability of heat-stable insulin,

for use in developing countries with limited access to refrigeration, and for use by travellers, would be a major public health advance. Another major advance would be the development of glucose-responsive insulin. At present, all insulin treatments for people with diabetes release an amount of insulin at fixed times that is not in proportion to local blood glucose levels, in contrast to people without diabetes, in which the body secretes insulin in proportion to local blood glucose levels. A glucose-responsive insulin for people with diabetes could therefore be a transformative solution, vastly improving the quality of life of people with insulin-dependent diabetes. In addition, there is a need for therapies directed at multiple risk factors for type 2 diabetes, such as dyslipidemia, hypertension and obesity. These have been a major focus of research and therapy. One possible future strategy is the fixed-dose combination ‘polypill’, whereby several risk factors are treated with a single capsule containing a combination of pharmaceuticals, which can be assembled in various ways. A second pharmacological strategy to reduce the problems associated with polypharmacy for patients with several risk factors is to develop single drugs that have multiple targets or modulate targets that affect several risk factors.

Research is also needed into effective delivery of preventive strategies to delay progression of the disease and its complications. This should integrate individual, clinical, system, and society-level approaches that span the full course of life. The evidence base for clinical and public health interventions needs to be expanded to include a much broader spectrum of disciplines including, for instance, experts in behavioural economics, systems dynamics, political science, and urban planning. Integration of surveillance, clinical and population-based epidemiology, health services research and economics is sorely needed.

Large, long-term intervention studies are needed to identify effective strategies for reducing barriers to diabetes care and improving adherence to treatment and management regimens. The gap is large between scientific and technological progress and its implementation. Efforts are needed to assure that children and adolescents in Africa do not suffer premature death and disability because their diabetes is mismanaged. Although effective preventive strategies exist for type 2 diabetes, the susceptibility genes identified so far do not provide predictive abilities strong enough to warrant genetic screening.

Therefore, continued research into genetic screening is needed particularly for African people and people of African descent. The safety, efficacy, and economic impact of self-adjusting closed-loop control systems

30 | DELTAS Africa

are currently unknown and deserve further investigation. Translational research, which seeks to understand how advances can be adopted in community-based and often uncontrolled conditions (particularly resource-poor African environments) has received little attention in the diabetes field. Some of the important questions in translational research cannot be addressed in randomized trials. Community-based participatory research, issues related to lifestyle, diet, physical activity and cultural preferences should be explored.

A diabetes registry that keeps track of glycosylated haemoglobin (A1C) values is one example of linking diabetes with key policy decisions. Substantial resources continue to be allocated to diabetes research by public and private funders but little of this research is being carried out in Africa. By 2019, the global market for diabetes is expected to be worth US$ 35 billion and the private sector is investing heavily. The pharmaceutical industry considers development of effective diabetes medications to be a major goal and approaches that link industry and academia in Africa should be explored. The African diabetes researchers together with support from international networks and organizations, has the opportunity to launch research on genetic and environmental factors in different African population groups.

Ref: World Health Organization, Global Burden of Disease Database 2008. Available at http://www.who.int/healthinfo/global_burden_disease/projections/en/index.html

Cardiovascular Disease (CVD) According to the World Health Organization, the burden of cardiovascular disease is increasing rapidly in Africa, and it is now a public health problem throughout the African Region. Most important are hypertension, stroke, cardiomyopathies and coronary heart disease. Rheumatic heart disease is still a major concern. One of the reasons for increased cardiovascular diseases (CVDs) worldwide is the increase in aged populations. Another reason is exposure to various modifiable risk factors that are responsible for at least 75% of all the CVDs. As with other noncommunicable diseases, CVDs are not often given the attention they deserve, and this is particularly true for Africa. As a result, most countries do not have national programmes or strategies to address CVDs. Likewise, surveillance systems for risk factors are almost non-existent in the African region.

Priority interventions aimed at reducing the burden of CVDs in the African region include setting up national noncommunicable diseases programmes which include

CVD; setting up surveillance systems based on risk factors; capacity building of health personnel; ensuring availability of cost-effective medications; implementing the Framework Convention for Tobacco Control and the Global Strategy on Diet, Physical Activity and Health; and incorporating both primary and secondary prevention of rheumatic heart disease.

Research needs for CVD: From a global perspective, the large and diverse African population is disproportionately affected by cardiovascular disease (CVD) (Refer to article by Keates et al 2017, see full citation below). The historical balance between communicable and noncommunicable pathways to CVD in different African regions is dependent on external factors over the life course and at a societal level. The future risk of noncommunicable forms of CVD (predominantly driven by increased rates of hypertension, smoking, and obesity) is a growing public health concern. The incidence of previously rare forms of CVD such as coronary artery disease will increase, in concert with historically prevalent forms of disease, such as rheumatic heart disease, that are yet to be optimally prevented or treated. The success of any strategies designed to reduce the evolving and increasing burden of CVD across the heterogeneous communities living on the African continent will be dependent upon accurate and up-to-date epidemiological data on the cardiovascular profile of every major populace and region. Keates et al 2017 highlight some key challenges that require more research in the context of CVD in Africa.

Socioeconomic forces beyond the individual’s control influence the life-course of CVD, and consistent with the phenomenon of epidemiological transition, risk factors for CVD are high in many parts of Africa. Historically, the number of epidemiological reports from Africa has been low, with a predominance of projected estimates used to characterize the pattern of cardiovascular risk and disease. Major knowledge gaps include patterns of maternal cardiovascular health, the prevalence and balance between congenital and acquired CVD in children, and the spectrum of CVD in adulthood. In many regions of Africa, the burden of cerebrovascular disease, cardiomyopathies, and rheumatic heart disease still predominate, with HIV-related CVD presenting a new communicable threat. In more affluent regions of the continent, hypertensive heart disease and related heart failure predominates, with emerging reports of previously scarce conditions such as coronary artery disease, peripheral artery disease, and atrial fibrillation. Compared with the global burden of CVD, affected Africans are typically younger, predominantly female, and mostly from disadvantaged communities.

31 | DELTAS Africa

Research should also be conducted to evaluate the socioeconomic impact of cardiovascular diseases in the African region to make them relevant beyond the health sector. Operational research in the health sector is necessary to adapt, implement and evaluate cost-effective and affordable approaches for CVD prevention and control.

Reference: Keates, A., Mocumbi, A., Ntsekhe, M. et al. Cardiovascular disease in Africa: epidemiological profile and challenges. Nat Rev Cardiol 14, 273–293 (2017) doi:10.1038/nrcardio.2017.19

Social Sciences and HumanitiesThe R&D approach can be applied to either a social or a technology problem and DELTAS Africa II will therefore support proposals in social sciences and humanities. Social problems are issues where the barrier to improved outcomes rests mainly in the human response to an existing situation. The approach to solve these problems typically requires investigation of a social science nature, for example, research exploring the political-economy, the causes of the issues and the efficacy of potential solutions. Therefore applications that propose pathways for greater use of evidence in guiding policy decisions are encouraged. This would be a response for greater calls in Africa that evidence-based policy derived from high quality scientific evidence should guide policy decisions, rather than tradition, intuition, or political ideology.

Social science research can be quite complex, and some social problems have been shown to be just as intractable as technology problems, for example reducing corruption. For a given level of problem heterogeneity, we assume that R&D addressing social problems can pay very important dividends. As with all fields of scientific investigation, applications in the social sciences and humanities are required to demonstrate how they will gather the evidence which could consist of observations, experimental results and/or randomized trials to test development-related theories that serve to support, refute, or modify a scientific hypothesis or theory, when collected and interpreted in accordance with the right scientific methods.

The research can be focused on testing and investigating new ideas; exploring and describing useful scalable experiences; or analysing and questioning social and cultural phenomena in the context of key developmental challenges in Africa. Assuming the research passes the necessary ethical clearances, there is a reasonable ‘line of sight’ between applying the research and finding a partial solution.

Successful applications for DELTAS Africa social sciences support could help Africa solve challenges that hinder delivery in key areas including those articulated by leading African institutions, think tanks and international development agencies. For example, given the rising economies in Africa (and disparities in wealth distribution), proposals can focus on how to achieve sustainable economies and equitable societies so that in the longer-term Africa builds sustainable livelihoods supported by strong foundations for inclusive economic growth and innovation; how to build sustainable cities and communities; and how to sustainably produce and consume materials and other resources.

Applications should identify challenges that the humanities and social sciences are uniquely placed to meet, such as those that require ethical, social or legal analysis, or need social or cultural insights for progress to be made. The specific work packages can propose research and scholarship that improves understanding of the political economy and public policy, research that is grounded in the needs, values and priorities of the people and communities affected by various developmental challenges.

Given the status of young democracies in Africa, social sciences applications that address human rights, good governance and social justice are invited and these can address research and innovation that enables Africa to address the challenges of forced internal and cross-boundary displacements and multiple refugee crises; reduce conflict and promote peace, justice and humanitarian action; reduce poverty and inequality, including gender inequalities to lift the most vulnerable groups particularly women and children out of poverty. The role of innovation and entrepreneurship as a potential substitute for good governance deserves more attention on how it can help solve challenges of weak governance and deliver societal transformation in Africa.

The successful network will be required to support researchers at key points in their careers, helping them to fulfil their potential to become leaders and team players in a diverse and inclusive research community. The proposal should outline how the consortia will invest in facilities and resources necessary for world-class social sciences and humanities research, including platforms and databases to provide networking opportunities to trainees, advisors and collaborators. It should encourage cooperation across the research community, adopting multidisciplinary approaches and collaborations between African and international partners to maximize the impact of their work.

32 | DELTAS Africa

Reviewers and decision panels for the proposed DELTAS Africa social sciences and humanities networks will consider these or related arguments and other areas of research that are relevant and render themselves to social sciences R&D approaches.

33 | DELTAS Africa

DELTAS Africa is aligned to international principles for strengthening research capacity in low- and middle-income countries, as identified by ESSENCE on Health Research – an initiative to improve the coordination of research capacity investments by international funders. The principles are listed below, together with a description of how they will be applied in this scheme.

Network, collaborate, communicate and share experiences

Efforts to strengthen and develop research capacity are part of wider networks of activity. Programmes should make efforts to link with scientific collaborations and communicate effectively with a range of relevant stakeholders.

Understand the local context and evaluate existing research capacity

Research priorities should be informed by local needs, which can be determined in consultation with researchers, communities and policy makers. Decisions on research investments should be informed by assessments of existing and planned resource capacity.

Ensure local ownership and active support

Programmes should be owned and led by African institutions with full institutional commitment, and government support as demonstrated by high-level support and active participation, management and leadership.

Key principles to note

Build in monitoring, evaluation and learning from the start

Programmes will be asked to develop and implement a monitoring, evaluation and learning plan, based on the initiative’s monitoring, evaluation and learning framework, to capture individual programme learnings and strategy-wide metrics.

Establish robust research governance and support structures and promote effective leadership

Programmes should ensure that appropriate mechanisms are used to support staff and researchers and to give programme management the mandate to lead and make decisions.

Embed strong support, supervision and mentorship structures

Programmes will be asked to include strong supervisory and mentorship structures, which are crucial to ensure the success of individual students and contribute to a strong research culture.

Think long-term, be flexible and plan for continuity

DELTAS Africa is an initiative with a long-term vision. Initially, awards will be made for up to five years, and funded programmes will be encouraged to actively seek long-term sustainability through support from national governments and other funders.

© A

MS

, 201

9

34 | DELTAS Africa

ESSENCE on Health Research, ‘Seven Principles for Strengthening Research Capacity in Low- and Middle- income Countries: Simple ideas in a complex world’, ESSENCE Good practice document series. Available online at www.who.int/tdr/publications/seven- principles/en/

The African Academy of SciencesNo. 8 Miotoni Lane, Karen | P.O. Box 24916 – 00502 Nairobi, Kenya | Tel: +254 20 896 0674/5

africaaasciences