Research and Capacity Building for the Promotion of Sexual Health and Well-Being in the West Africa Region

Copyright © Board of Regents of the University of Wisconsin System. Courtesy of Africa Focus.

Introduction
Despite three decades of capacity building, there is still little research on the health problems of the poor. This is even more acute regarding sexual health of people in West Africa. Research is essential in improving the status of sexual health in any community. Good quality research is a key tool for identifying sexual health problems and their causes and demonstrating their importance to the promotion of sexual health and well-being. It also assists in formulating solutions and evaluating progress of sexual health interventions. Sexual health research demands for interdisciplinary and integrated research. In West Africa, responding to this requirement poses great challenges to current research efforts both within and outside universities. This presentation begins with an overview of the socio-cultural aspects of sex in West Africa. It then highlights some gaps in existing sexual health research in the region and presents some capacity needs for sexual health research. The paper goes on to suggest some means of strengthening the capacity of sexual health researchers. In several respects the paper is limited to experiences in English-speaking West Africa.

Some socio-sexual cultural and research issues in West Africa
It is important to put the current paucity of research on sexuality in some perspective. Until the onset of HIV/AIDS, sexual life in Africa received little serious attention from serious researchers despite the 'great inquisitiveness in Victorian Europe about African sexual customs and the widespread belief in the sexual superiority of the African' (Bleek, 1976:25). The sexual prowess of the African was described as 'unfettered sexuality' either to be envied or feared (Schoepf, 1991). This was expected because most studies that dealt exclusively with sexuality in Africa by this time were mainly anthologies and impressionistic notes by missionaries and travelers. 

In the region, as elsewhere in Africa, the force of social change resulting from formal education, increasing urbanization, and the increasing cost of living, among others, has blended to produce changes in socio-sexual culture. In Ghana, Nigeria and several parts of West Africa, it is clear that even in some of the societies where premarital sex was not formerly permitted, it is now considered normal (Ankomah, 1998). In some societies in these countries, premarital multiple sexual partnering, serial monogamy as well as partner switching is fairly common. 

To fully understand premarital sexual relationships in the region, it is useful to view some premarital relationships as basically transactional, resulting in sexual exchange where sexual services are exchanged for material gain- a system quite different from prostitution. Similar findings have come from some Nigerian cities such as Benin City (Omorodion, 1993); in Ibadan and Zaria, (Barker and Rich, 1992); and in comparatively rural areas as for example among the Ekiti of western Nigeria (Orubuloye, Caldwell, and Caldwell, 1991). It must be pointed out however, that, there is a great diversity of sexual relationships. It is therefore misleading to generalize (which unfortunately some researchers have done) about African sexuality, or even a West African one as if the region is one homogenous entity. There is a variety of mutually contradictory sexual norms in West Africa, and even within countries. So when in West Africa Caldwell, Caldwell and Quiggin (1991) claimed uniformity of premarital sexual relationships and observed a perfect fit called the 'Ekiti model' which meant pervasive societal acceptance throughout history of premarital sexual relationships it was perhaps an overgeneralization. Mair had five decades ago observed a continuum: 

"In attitudes towards sex relations before marriage, extremes of severity and tolerance are represented by the Nupe, who prohibit them altogether, and the Korongo and Mesakin of the Nuba hills among whom premarital licence is complete, and chastity and virginity play no part" (Mair, 1953:118).

Some gaps in existing sexual health research
While the quantity and quality of sexual health research in the West African region has improved in recent years, there are still several gaps. A few are highlighted here:

• Research output on violence against women has been very general. Community- and health facility-based research as well as behavioural research on violence including longitudinal studies on the consequences of sexual violence, and the vulnerability of adolescents to sexual abuse are sorely needed. 

• The sexual rights of adolescents in West Africa is a poorly researched area. Further research is required to gather information on sexual and reproductive rights, and explore the barriers that young persons face making choices given the prevalence of transactional sex, sexual coercion and exploitation of young women.

• Detailed information on gender roles and life skills (in contrast to knowledge) to negotiate good sexual health outcomes among teenagers including married adolescents is lacking.

• STI seeking behaviour and treatment of young persons is an area with limited research evidence.

• Today there are internationally accepted definitions of some indicators in sexual health, but there is an urgent need for further research on the identification of some indicators given their importance in the sub-region. These include indicators measuring violence against women and transactional sex.

Capacity building needs for reproductive health research in West Africa
The capacity of academic and research institutions in West Africa to respond to research needs in sexual health is very limited. Developing research capacity in sexual health increases the input of local researchers into the solution of the region's problems. Research conducted locally by local people is more likely to be more timely and cost-effective in addressing local problems than is research conducted by researchers unfamiliar with the region and its context.

Lack of funds and other resources
While this may be true of other parts of Africa, the lack of funds and other resources necessary for research and research training is a most obvious constraint to building research capacity in West Africa. Resources lacking include not only the availability and conditions of equipment used in sexual health research training, but also infrastructure and services such as electricity, maintenance etc. Access to sexual health information and networks through libraries and electronic communication is very difficult. In addition there is problem of access to sexual health journals. Although a few peer-reviewed journals with African flavour and coverage has started to emerge, they appear to be based mainly in Southern Africa and access to them in West Africa is as difficult as those published in western countries. 

Weak sociopolitical status of sexual health research in West Africa
Again while this may not be limited only to the region, it is particularly pronounced. There is a particularly weak social and political status of sexual health research in the region. Local research results achieved are often not perceived as contributions to development. The general lack of political commitment may be exacerbated in Nigeria where religious and ethnic considerations may undermine local research even further.

Low recognition of researchers 
At the individual level, Nigeria and Ghana have international level sexual health researchers. The weak economic situation in the region, which expresses itself, among others, in low salary levels forces researchers to do short-term, demand driven consultancy work. It is sad but true that increasingly researchers from West Africa (and not infrequently their collaborators from the North) are motivated in sexual health research not mainly in the desire to make their knowledge useful in a development context but with expectation of personal benefit. Supplementary payments are often included in research partnership programmes, but these are uncoordinated, highly variable, and often hidden, sometimes to avoid overheads been transferred from individual researchers to general university funds. Talks and discussions with colleagues have revealed that if sexual health researchers, and indeed the whole scientific committee, is used to shape public opinion, many researchers may obtain greater satisfaction from their work and find greater acceptance in society, and hence reduce other activities that divert them.

Unreliable behaviour of donor agencies
Donor funding of sexual health research is often unreliable and adapted to the needs of recipient countries. Donors grant several fellowships in sexual and reproductive health research every year especially in Ghana and Nigeria. However, most are not linked to any research programmes, the number given ever year varies greatly and they are often given in hurry just before donors' financial year ends (often to ensure donors avoid being financially penalized by their home governments for under spending). Sometimes donors select foreign institutions for awardees and these institutions may not have strong programmes in sexual health research. Most of the emphasis on sexual health research capacity is unfortunately limited to scholarships and travel with intensive monitoring during the period, compared with lack of donor monitoring or even interest after the training. Some donors are quick to withdraw funds and terminate all existing research grants in times of political instability. The region that suffers most from this on the continent is West African region given the long history of military insurrections.

The way forward
Enhancing sexual health research capacity can be defined broadly as the process by which knowledge can be increased in order to understand the phenomena of sexual health and promotion in different situations and to reflect on problem-solving. Capacity building relies on three key areas: augmenting the number of researchers in sexual health; strongly supporting research-related institutions and organisations, and enhancing the quality of sexual health research in both its basic and applied dimensions. 

Assistance from the North can only be supplementary
Local research capacity, even within strong and credible research institutions must have national support. Without the support of local and national programmers, outside funding cannot be effective in developing sustained leadership for the solution of sexual health problems. National investments are needed, particularly in Nigeria, in research infrastructure and in systems of higher education in order to maintain a pool of incoming talents. 

In Nigeria, with over 50 universities, a principal objective of building research capacity in sexual health should be the development of research centres of excellence in the three main geographical regions and other evidence-based sexual health organisations (such as the Society for Family Health). These institutions should be identified on specific criteria that include demonstrated institutional commitment to addressing sexual health issues. Although they may be institutional, the emphasis should be on networks of these multiple sites, enabling them to communicate effectively with one another, and designing initiatives around problems, not institutions. Good research requires a critical mass of trained professionals within an institution, so that initiatives do not crumble when one or two faculty members relocate. Approaches taken should permit flexibility in responding to and working with programme focused organisations and governments departments, and should also recognize the time constraints commonly faced by full-time faculty staff. To reduce the waste on poor and patchy ill-funded research not likely to be of credible national importance, national governments with research institutions should establish a limited list of urgent research priorities most relevant to national needs. 

Sexual health research should be institutionalized 
Sexual health research has so far been restricted in the main to university based individuals. Linkage between universities, NGOs and other non-university institutions needs to be seen to be working towards a common goal. Research on sexual health promotion is not aptly institutionalized. At the moment, there are no structured courses in sexual health, although a few health-oriented graduate programmes do undertake certain aspects of sexual health in the course of their training. 

Capacity building must be sustainable
By definition, capacity building involves sustainability, not only in the individual skills and capabilities, but also in its translation into organisational capacity. In Nigeria, in particular, most of the support is bound to individual capacity building and is hence of limited sustainable character in terms of institution building. Financial support can help research institutions in West Africa to maintain their activities and formulate their own research agenda. But this is rare, as donors see little value in doing this. Usually a significant component of research cooperation is related to the funding of researchers in the North who carry out research in the south with support of local researchers. 

Furthermore, most funding schemes appear not to allow for or to foresee greater long-term support- an indispensable prerequisite for effective institutional capacity building. Long-term commitment through 'funding consortia' with varying financial contributions over time from each donor involved may be an option. This is now taking place in Nigeria where donors have agreed to fund large scale multi-round reproductive and health surveys for about eight years which is conducted mainly by indigenous researchers.

Research should be treated a key component in all development process
Research component of sexual health programmes need be pronounced and clearly budgeted. Donors are often not particularly interested in evaluating capacity building components of projects. One way of enhancing capacity is to track the success of capacity enhancing initiatives.

South-South networks or cooperation is fine but can also be donor driven
The pooling of resources through networking efforts to share and exchange ideas is an essential element of any research capacity building. Unlike East and Southern Africa, where South-South networks are in existence, (e.g. University Science, Humanities and Engineering Partnerships in Africa USHEPiA) research networks are rare indeed in West Africa. There has been a notable success in sexual health networking though in West Africa. The West African Sexual Networking Group with researchers based at University of Ado-Ekiti, Nigeria and University of Cape Coast, Ghana succeeded between 1991-1998 to undertake research and train several young researchers in sexual health research. At the moment there appears to be no viable network of sexual health researchers in English-speaking West Africa. It must be noted however that regional cooperation, which is often praised, sometimes can be donor rather than demand driven and hardly reflects the aspirations of the partner institutions. Such collaboration tends to be somewhat artificial in nature, fulfilling the requests stipulated by the funding party.

Making research findings user friendly
The cost of disseminating sexual health information is huge in West Africa, especially in Nigeria, because of its size. Sexual health researchers stand to gain more from sharing their results. Although this may be changing, health correspondents in national newspapers are often not well-trained and only a handful understand sexual health research. They often report the sensitive aspects of research making their reports seem as news and hardly educational. Nigeria is improving with the arrival of a new donor initiative InterNews which provides training and facilities for health personnel in the media. To reduce the interaction cost of sexual health research, donors and other stakeholders may need to train journalists with key national newspapers. In this case sexual health research findings get written and published in plain English in national newspapers. 

Enhancing capacity of users of research and teachers of research
Research is poor in West Africa, because there are poor users of research. Unless public officials, the media, industry, community groups, programme implementers, and others use research, the status of research and researchers will continue to be low. In a sense, therefore, these groups should also be targets for capacity building in the use of research. Politicians, editors of media houses, industry and other stakeholders could be trained in how advantageous research results can be for them. The effectiveness of capacity building depends on a step-by-step approach beginning with existing capacity building activities. Some university graduates of statistics or social sciences who have undertaken courses in Research Methods and who apply for research positions in organisations may be found not to have analysed data using computers. West African universities need to accept these grave shortcomings, develop courses that ensure that student attachments with industry are mandatory in research related courses. Teachers of research-related courses must themselves be willing to learn new ways of doing research.

Conclusion
West Africa has a pool of researchers in sexual health. Harsh economic conditions in addition to other infrastructural and institutional impediments have limited the pace of effective capacity building of other researchers in sexual health. Capacity of researchers in the field may be enhanced, among others, through the establishment of networks, presenting research findings in friendly and usable manner, and motivating governments, programmers and the business community to use research.

References
Ankomah, A. (1998). "Condom use in sexual exchange relationships among young single adults in Ghana." AIDS Education and Prevention, 10(4), 303-316.

Barker, G.N. and Rich, S. (1992) "Influences on adolescent sexuality in Nigeria and Kenya: Studies from recent focus group discussions." Studies in Family Planning, 23 (199-210).

Bleek, W (1976) Sexual Relationships and Birth Control in Ghana: A Case Study of a Rural Town. Centre for Social Anthropology, University of Amsterdam, Amsterdam.

Caldwell, J.C., and Caldwell, P. and Quiggin, P. ( 1989) "The social context of AIDS in sub-Saharan Africa." Population and Development Review 15(2) 185-233.

Mair, M.A. (1953) "African marriage and social change." In: Arthur, P. (ed). Survey of African Marriage and Family Life. Oxford University Press, London; pg 1-71.

Omorodion, F.I. (1993). "Sexual networking among market women in Benin City, Bendel State, Nigeria." Health Transition Review, 3 (Suppl.), 159-169.

Orubuloye, J.O., Caldwell, J.C., and Caldwell, P. (1991) "Sexual Networking in Ekiti District of Nigeria." Studies in Family Planning, 22 (61-73).

Schoepf, B.G. (1991) "Ethical, methodological and political issues on AIDS research in Central Africa." Social Science & Medicine 33(7): 749-763).

A paper presentation by Dr. Augustine Ankomah of the Society for Family Health, Nigeria at the panel discussion of the ARSRC during the First Congress for the Advancement of Sexual Health and Rights in Africa, February 27, 2004. Johannesburg, South Africa.