Challenges
Often originating from former national public health laboratories, national health institutes (NHIs) are entities that focus on research, training, monitoring, evaluation and the generation of evidence to improve public health policies (these policies are generally more permanent in nature than health authorities). Thus, the creation and/or consolidation of NHIs in African countries is essential for the strengthening of their national health systems, especially considering that their roles include managing resources destined for public health and supporting the formulation of policies in this sector. NHIs are in fact technical-scientific bodies of strategic scope that are considered the main means to overcome public health problems in a structural manner in the long term. The challenge is therefore the solid training of NHIs in African countries, particularly regarding their scope of action and the development of human competencies.
Toward a Solution
Following an integrated approach to public health issues, the Network of National Public Health Institutes of the Community of Portuguese Speaking Countries (RINSP-CPLP) is one of the networks of strategic institutions defined in the Health Cooperation Strategic Plan of the Community of Portuguese Speaking Countries (CPLP). The network’s executive secretariat is under the responsibility of the Oswaldo Cruz Foundation (Fiocruz, Brazil) and follows a cooperation approach between developing countries that prioritizes the use of each country’s endogenous capacities and resources (as opposed to a unidirectional transfer of knowledge and technology). Thus, concrete interventions for knowledge generation are promoted in parallel to dialogue between partners to enable local agents to assume leadership of the processes in the health sector of each country and autonomously formulate their own development agendas.
The initiative is implemented by Fiocruz and Brazil’s Ministry of Health, with support from the CPLP, the Brazilian Cooperation Agency (ABC), the World Bank, the International Association of National Public Health Institutes (IANPHI) and the ministries of health of RINSP-CPLP participating countries. Formally established in 2011, the RINSP-CPLP aims to promote technical-scientific cooperation among its members to: (1) improve the quality of scientific knowledge about the social determinants of health; (2) technically support concerned ministries for epidemiological, sanitary and environmental surveillance; and (3) improve health public policies based on scientific knowledge.
To this end, cooperation within the network has focused on the training of human resources in the biomedical and public health domains, as well as on organizational strengthening and institutional development. Activities carried out in these areas include strategic planning workshops, consultations and benchmarking visits, postgraduate courses, in-service training and polytechnic health training. Implementation of NHIs in CPLP Member States in which they do not yet exist is one of the network’s priorities.
Thus, within the scope of its initiatives, the RINSP-CPLP supported Mozambique to revise its NHI strategic plan, construct a new institutional building, implement master courses in health sciences and in health systems (in partnership with the International Development Research Centre – IDRC), reformulate the NHI’s scientific journal and establish a National Health Observatory, among others. In Angola, it set up a master’s course in public health for the training of professionals at the School of Public Health and contributed to the reorganization of the country’s technical health schools. The RINSP-CPLP supported the creation of the national health institutes of Guinea-Bissau (INASA) in 2010 and Cabo Verde (INSP) in 2014 following technical cooperation exchanges involving Fiocruz, Portugal’s Institute of Hygiene and Tropical Medicine and Peru’s NHI. In turn, Cabo Verde’s recently created INSP took part in a Fiocruz mission to São Tomé and Príncipe to support the creation of the country’s national health institute.
The RINSP-CPLP conducts international fundraising activities to leverage the development of its member NHIs. Because of its clear impact on African NHIs, the network mobilizes funding sources outside of the CPLP, such as IANPHI and IDRC. The network promotes the articulation of African NHIs with congenerous entities to carry out joint research and capacity-building initiatives, ensuring the sustainability of the programmes developed under the network.
Overall, the NHIs of the network’s African countries have gained greater strategic and scientific importance with their respective ministries of health, paving the way for further replication opportunities through South-South cooperation. For instance, in recognition of its development, Mozambique’s NHI hosted, in 2016, delegations from Malawi and Sierra Leone interested in learning from its organization.