About that funding…

I have been thinking a lot about funding for the next year of my PhD. It will be Year Four. Almost universally, it seems that PhD programs only fund you for about ¾ of the time you actually need to complete your studies.  Is the idea that you get a job towards the end? Or that you hurry up and finish?  If you go online my story is not unique; this is a common experience for many PhD students. This happens in South Africa, the rest of the continent, and even abroad. Discussion forums abound with PhD students offering each other encouragement and tips on how to survive/ where to get funding. It would almost be charming if it wasn’t so serious.

My lack of future funding feels like an individual failure – but it really is part of a larger societal problem. Postgraduate funding in South Africa is quite inadequate for a country that wants to pull up its socks. Not enough people are funded, and the lucky ones are not funded sufficiently. The issue of funding is not just about making life easy for a PhD student, as important as that peace of mind is. For South Africa in particular, there is a “need to bring a fresh outlook to the country’s development hurdles by training up postgraduate students who have been raised in disadvantaged communities and deeply understand the kinds of problems we need to overcome as a nation”. These are some of the thoughts of UCT vice chancellor Professor Mamokgethi Phakeng on the issue of postgraduate funding in the country.

To widen our lens a bit, we live on a continent that is 16% of the world population but only produces 1% of its research output. Wait, that’s less than 1%.  Lack of political will to invest in research and development (R&D) on the continent is one of the main factors leading to these dire statistics. South Africa is cited as only one of a few countries who have fulfilled the African Union pledge to spend 1% of their budget on R&D.

Where does this leave us? International funding and collaboration. There is nothing wrong with international partnerships. But as Dr Alan Christoffels of the University of the Western Cape writes, “the dependence on international collaboration and investment without any pan-African framework for increasing and sustaining local funding, limits Africa’s ability to drive a scientific agenda that is aligned to its specific needs”.

Long story short is that my problems with funding are the problems of every PhD student in South Africa and on the continent. The option is to accept it as the nature of the beast. Or we can look beyond the surface and examine the root causes, and advocate for better performance by our governments and even the private sector. As a society we need to care about our knowledge economy and home-grown solutions.  While we wait, and as we toil through fieldwork and data analysis (on our way to an even more uncertain researcher career),  we will nurse in our minds the nagging question whether it was/is all really worth it.

Ideal research in un-ideal environments

I’ve been following the tragedy happening in the North West province, regarding the collapse of the health services due to the community and trade union protests. Health systems are the stage where the impact of corruption and bad leadership plays out very dramatically, because they cost people’s lives. What was a trade union-led slow-down of health services in the province has escalated to full-on community strikes that shut down roads and health facilities.

Mahikeng service delivery protest
Welcome to the hospital. Source Bhekisisa.org (Photo by Oupa Nkosi).

 

North West hits close to home because it is the focus of my research. I am investigating how we can measure all the elements that come together to improve maternal health outcomes, including community factors. Although I love evidence and metrics, they always show you the picture in retrospect. They show you something that has already happened. They can help model future trajectories for sure, but those depend on certain conditions that in turn depend on the whims of individuals in positions of power. And they can tell you what needs to be done but can’t make people do it. And they are not empowering to the person they are supposed to benefit, the patient. Because measurements don’t equip a patient for dealing with the unexpected challenges that spring up in the public health system.

Mahikeng protest
The worst affected are those who need health services the most. Source Bhekisisa.org (Photo by Oupa Nkosi)

In this case I use the word “unexpected” very generously. As the reports state, the trouble in the North West has been brewing for years.  And it now manifests in a health system where the budget was overspent but few of its targets met. Where prices of medicines are inflated. Where money is divested from hiring more nurses and doctors to fraudulent projects. Where the frustrated reaction of health workers that feel powerless leaves patients without medicines and being discharged prematurely from hospital. Clinics closed. Patients stranded. So I may research the effect of lack of services on health trajectories all I want, and sure enough contribute to the “evidence vault”. But I can’t make people not award contracts to their friends, and that makes me angry.

I became a public health researcher to make a difference, but instances like these make you think hard about how to do that. We are all pieces of a puzzle, I understand. But nothing makes you feel more powerless than the self-interested actions of powerful individuals who can adopt or not adopt whatever guideline you come up with. It’s a reminder of just how embedded health systems are in society – and how a researcher therefore has to be embedded in society-wide action in order to make a difference.

So I’ve been looking for the links between my academic research and those people and organisations that play a more active role. I’ve learned about organizations that track stock-outs, that advocate for rural health, that are on the ground now as we speak, monitoring the situation. They are active behind the scenes, working to entrench real change in the health system. Maybe in the next few weeks I will figure out how to align myself with these actors, beyond just a Twitter follow. Maybe the hopelessness will subside.