How To Build Trust and Engage Patients in African Clinical Trials with Dr Sam Mbunya
- David Jones
- Jun 30
- 5 min read
How To Build Trust and Engage Patients in African Clinical Trials with Dr Sam Mbunya
Africa is home to over a billion people and extraordinary genetic diversity—yet sponsors and CROs face persistent challenges in establishing clinical trial operations that are both ethical and effective on the continent. In this COG Nordics session, global patient advocate Dr. Sam Mbunya shares granular, on-the-ground insights for clinical teams planning or running studies in Africa. The discussion covers cultural context, regulatory maturity, patient engagement strategies, and what’s often missed in global clinical outsourcing strategies.
Why Local Insight Matters in African Clinical Operations
Dr. Sam Mbunya is a biomedical scientist and experienced advocate for underserved patient communities across Africa, with a focus on sickle cell disease, hemophilia, and oncology. With 15 years’ experience spanning Africa, the UK, and Sweden, Dr. Mbunya brings an essential patient-centered perspective to global study planning and clinical trial outsourcing.
Understanding Africa’s Clinical Trial Landscape: One Continent, Many Realities
Sponsors and CROs frequently overgeneralize the African landscape, assuming a “one-size-fits-all” approach will work. As Dr. Sam Mbunya emphasizes, Africa is made up of more than 50 countries, each with distinct regulatory frameworks, languages, health systems, and cultural norms. Misreading these differences can quickly undermine trust and trial performance.
Key considerations:
Cultural and religious beliefs can affect everything from informed consent to daily trial logistics.
Languages—and even reading direction—differ significantly, so patient-facing materials must be adapted accordingly.
Health literacy is often low; many patients have little understanding of their own conditions, let alone clinical research concepts.
Community trust is closely tied to family dynamics, local leaders (including religious and traditional healers), and prior experience with research—both positive and negative.
For sponsors and CROs, this means careful mapping of each country or region’s specifics before site selection, feasibility, or patient-facing engagement even begins.
Moving Beyond Recruitment: Engaging, Protecting, and Empowering Patients
Too often, recruitment is seen only as a numbers game—missing the complex motivations and vulnerabilities of African patients. According to Dr. Sam Mbunya, patients may enroll for hope or out of financial need, particularly where access to basic care is poor.
Risks and responsibilities:
Payment or reimbursement can be a primary driver, especially where alternative care is lacking. Without robust informed consent and community engagement, this can put patients at risk of exploitation.
Family decision-making dynamics sometimes override a patient’s own wishes.
Transport and distance pose real barriers to participation and follow-up (patients may travel hours for each visit).
To address these issues, early and authentic engagement with patient advocacy groups, community leaders, and family stakeholders is essential. Dr. Sam Mbunya describes the vital role of patient advisory councils both in education and in surfacing unmet needs or red flags during trial conduct.
Optimizing Clinical Trial Outsourcing and Site Selection in Africa
A key challenge in clinical trial outsourcing is that sponsors and CROs still concentrate the vast majority of global studies at the same sites, bypassing local African centers with untapped potential. As Sverre Bengtsson points out, up to 70 percent of all trials run at just 5 percent of possible sites.
Barriers to diversification include:
Longer regulatory timelines and complex local approval processes.
Limited experience with GCP and complex protocols at some centers.
Sponsorship hesitancy due to perceived risk and previous “bad stories.”
However, collaboration with well-established institutions and consortiums—often involving international partners—can bridge capability gaps, accelerate timelines, and reduce cost. Importantly, engaging authorities and demonstrating the long-term value of trials to host countries is key to political buy-in and operational continuity.
Practical Health Literacy and Technology Strategies: Meeting Patients Where They Are
Effective patient engagement in Africa depends on plain-language education and the smart use of technology. Dr. Sam Mbunya highlights the use of layperson terms, in vernacular languages, and describes initiatives such as Project Echo (University of New Mexico), which applies an “all teach, all learn” approach to patient and caregiver advocacy training.
Key elements of this patient-centered approach include:
Webinars and roundtable discussions held in accessible language.
Leveraging mobile platforms, such as WhatsApp, to circulate trial information and address misinformation.
Empowering local patient champions to act as trusted communication nodes within their communities.
Distribution of easy-to-understand informational booklets, leaflets, and digital IEC (Information, Education, and Communication) materials.
What This Means in Practice
Map local contexts thoroughly: Assess the regulatory, cultural, and health system landscape for each country or region—not just “Africa” as a whole.
Co-design engagement strategies: Involve patient advocacy groups and local leaders in protocol and material development from the outset.
Prioritize health literacy: Develop materials in local languages and culturally relevant formats; test comprehension before launch.
Plan for logistics and aftercare: Address transport barriers, reimbursement mechanisms, and define clear follow-up for adverse events and post-trial care.
Leverage technology with care: Use commonly adopted platforms like WhatsApp to spread accurate trial information and facilitate two-way communication.
Engage with governments and institutions: Secure buy-in from both health ministries and established medical centers or consortia to smooth regulatory and operational pathways.
Robust data management: Prepare for challenges in data registry and protection; clarify ownership and purpose in transparent terms.
Key Takeaways
Africa’s diversity demands tailored operational and outsourcing strategies—there is no generic solution for site or patient engagement.
Authentic, early partnership with patient groups, families, traditional leaders, and communities is fundamental to building trust and ensuring ethical enrollment.
Health literacy and plain-language materials—in local languages—are not optional but essential for ethical consent and effective retention.
An open, collaborative approach with governments and robust local institutions accelerates approvals and strengthens long-term site capacity.
Thoughtful use of digital platforms and local champions can transform study communication and patient advocacy, driving better compliance and outcomes.
Selected Quotes
“Africa has 54 to 56 countries, so it's not this one big continent of people...the practical barriers sponsors miss, from health literacy to transport to family decision dynamics, and what effective engagement looks like, including working with patient groups, community leaders and local systems before recruitment starts.” – Dr. Sam Mbunya
“It's very simple...patients in communities actually feel that they're looking for hope, they're looking for other alternatives, either because their patient care is not as great, they don't have access to medicines, they live very far in terms of transportation and so on and so forth. But when it comes to recruiting, that's very easy. But there are challenges that we don't get to see or get to hear.” – Dr. Sam Mbunya
“There's this backdrop that the global north, they put Africa as this one size fits all project in terms of clinical trials. But there's dynamics that we need to look at, including the communication.” – Dr. Sam Mbunya
“So how do we address that is basically having conversations and putting them in the beginning and not towards the end.” – Dr. Sam Mbunya
Links & References
The PBC Group and Clinical Outsourcing Group (COG) event series: https://thepbcgroup.com
Project Echo (University of New Mexico): https://hsc.unm.edu/echo/
By recognizing Africa’s diversity, investing in local partnerships, and maintaining a rigorous patient-centered approach, sponsors and CROs can improve trial performance, ethical standards, and global study optimization—unlocking the clinical and commercial potential of one of the world’s most important regions for the future of research.
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