Page 88 - A Widening Idea of Health and Health Research - The South African Medical Research Council from Creation to COVID
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Positively into the New South Africa: The MRC, 1995–2012


                  into their own malaria control programmes.
                     In contrast to the unified nature of malaria research, in the case of TB a research
                  unit, a research group, a centre and a programme coexisted, unwilling to combine
                  their particular foci as they were rooted in different disciplines like microbiology,
                  molecular genetics, immunology and therapeutics and were, in addition, located at
                  different universities. Thus, even as the HIV/AIDS epidemic and the emergence of
                  drug-resistant TB were driving TB’s incidence higher and higher in the last years of
                  the 20th century, research on TB by MRC-backed units was chequered. It ranged
                  from devising ways to implement the new Directly Observed Treatment Short Course
                  Strategy (DOTS) more effectively to developing techniques for shortening the time
                  needed  to  diagnose TB,  from  setting  up  a  reference  centre  for  anti-TB  drugs  to
                  helping to sequence the fourth TB genome. Warning against such over-ubiquity in TB
                  research without a commensurate publication output, an MRC committee noted that,
                  although ‘there is a lot of money available for TB research from overseas … the MRC
                  needs to take action or it may end up embarrassing itself’. 127
                     Two other pre-1995 research units continued to put their specialist skills in the
                  field of health statistics to significant effect in the new century too. The Biostatistics
                  Unit’s statistical evaluation of the efficacy of upskilling public health nurses to be
                  able to administer antiretroviral therapy was accepted nationwide with important
                  consequences for the practical rollout of this therapy in the country, while the unit’s
                  detailed  geographical  analysis  of  the  prevalence  of  HIV  enabled  provincial  health
                  authorities to target high-risk areas for HIV prevention and treatment programmes.
                     More tightly targeted were the efforts of the Burden of Disease Research Unit
                  (BODRU) after 1994 to capture a demographic picture of the newly democratic
                  South Africa. From early on BODRU therefore sought to identify the large lacunae
                  (or ‘black holes’ as they dubbed them ) in South Africa’s vital statistics through
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                  demographic surveys, mortality surveillance and burden of disease studies which drew
                  methodologically on its pioneering investigation of vital registration and statistics in
                  Cape Town. Most glaringly revealed was the gross inadequacy of the country’s official
                  mortality statistics – it was estimated that they captured only 56 per cent of all deaths
                  in 1994 – even though these statistics were central to any demographic portrait, for
                  they were what an expert report to the Department of Arts, Culture, Science and
                  Technology called ‘the cornerstone of health status data’.  With this in mind, not
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                  only did BODRU press the state to improve its registration procedures and facilities
                  appreciably, but it also sought to have the questions on death certificates augmented
                  and clarified, and even how to fill in the certificate added to medical curricula so as
                  to secure more informative and comprehensive outcomes. The upshot of the former

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