Global mapping of capacity strengthening strategies for Health Policy and Systems Research (HPSR) in low and middle income countries (LMICs) focusing on institutions that support them and networks that are engaged in them Draft Report Michelle Jimenez, MSc 30th October 2014
CONTENTS Acronyms ...................................................................................................................................................................3 Executive Summary ...................................................................................................................................................4 1.
Introduction ......................................................................................................................................................7 1.1.
2.
3.
Framework ...............................................................................................................................................8
Methodology ....................................................................................................................................................9 2.1.
Definition of mapped strategies ..............................................................................................................9
2.2.
Web-based data collection ....................................................................................................................10
2.3.
Complementary qualitative data collection ..........................................................................................11
Results ............................................................................................................................................................11 3.1.
Institutions .............................................................................................................................................11
3.2.
Networks ................................................................................................................................................17
3.3.
Institutions and Networks: Map ............................................................................................................22
4.
Discussion .......................................................................................................................................................24
5.
Conclusions .....................................................................................................................................................27
List of Annexes .........................................................................................................................................................29 References ...............................................................................................................................................................29
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ACRONYMS AFRIQUEONE AHPSR APARET ANHSS BMBF BMGF CARTA CHESAI CNHR CUGH DFID ESSENCE EU FHS GHPHSR GHR-CAPS GIZ HPSR IDRC IIDP LMICs MRC NORAD NORHED NWO PEER PEPFAR RESYST SACIDS SACORE Sida SNOWS SURE TDR THRIVE WHO WHO – EVIPNet WHO – HRP WOTRO
One Health Initiative, African Research Consortium for Ecosystem and Population Health Alliance for Health Policy and Systems Research African Programme for Advanced Research Epidemiology Training Asia Network for Capacity Building in Health Systems Strengthening Federal Ministry of Education and Research (Germany) Bill and Melinda Gates Foundation Consortium for Advanced Research Training in Africa Collaboration for Health Systems Analysis and Innovation Consortium for National Health Research Consortium of Universities for Global Health UK Department for International Development Enhancing Support for Strengthening the Effectiveness of National Capacity Efforts European Union Future Health Systems Global Health Policy and Health Systems Research programme/platform Global Health Research Capacity Strengthening Program Deutsche Gesellschaft für Internationale Zusammenarbeit Health policy and systems research International Development Research Centre Institute of Infectious Diseases of Poverty Low and middle income countries Medical Research Council (UK) Norwegian Agency for Development Cooperation Norwegian Programme for Capacity Development in Higher Education and Research for Development Netherlands Organisation for Scientific Research Partnerships for Enhanced Engagement in Research U.S. President's Emergency Plan for AIDS Relief Resilient and Responsive Health Systems One Medicine Africa-UK Research Capacity Development Partnership Programme for Infectious Diseases in Southern Africa Southern Africa Consortium for Research Excellence Swedish International Development Cooperation Strengthening Research Capacity in Environmental Health Supporting the Use of Research within African Health Systems Special Programme for Research and Training in Tropical Diseases Training Health Researchers into Vocational Excellence in East Africa World Health Organization Evidence Informed Policy Network Special Programme for Research, Development and Research Training in Human Reproduction NWO’s Science for Global Development Division
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EXECUTIVE SUMMARY Capacity strengthening for research can be defined as the process of building the abilities of individuals, organizations, and systems to perform rigorous research, sustainably, and to continue to improve and develop over time. Ideally, the process should be evidence-based, have a long term view and include mixed strategies and approaches. Health policy and systems research (HPSR) is the production of new knowledge to improve how societies organize themselves in achieving collective health goals, and how different actors interact in the policy and implementation processes to contribute to policy outcomes. The purpose of this mapping exercise was to identify current strategies and potential gaps in capacity strengthening for HPSR in low- and middle-income countries (LMICs). This will contribute to determining the role or niche for the Alliance for Health Policy and Systems Research (AHPSR) in this field in the short to medium term. Institutions (entities that provide support to other institutions, networks or academic groups to carry out capacity strengthening activities) and networks (entities that receive support to carry out capacity strengthening activities for HPSR) were included in the exercise. Data was collected on: a) overall objectives of institutions and networks to confirm that capacity strengthening for HPSR was part of their remit, b) activities and approaches used they used at different levels: individual, organizational and system-level, c) lessons learned from implementing these activities, and d) approaches and strategies to measure impact and carry out monitoring and evaluation. The strategies to be mapped were defined using existing literature and refined as data collection progressed. Most data-collection was web-based and was complemented with a small number of semi-structured interviews. A data abstraction spreadsheet was developed to facilitate data collection and tabulation of results. A total of 14 institutions and 33 networks were included in the final sample. Only one institution, the Alliance for Health Policy and Systems Research has a specific focus on HPSR. Most of the others (8) have a focus on health research and the remaining 5 have a broader focus on development research. Seven institutions have government funding and 6 others have a combination of funding from various international funders and 1 was a charitable foundation. The geographical focus of institutions varied, with three having a country specific focus: India, Kenya and Philippines/Indonesia, two with a regional focus on Africa, and nine with a global (LMIC) focus. Six of the institutions highlighted the importance of engaging policy-makers in research and capacity strengthening activities but only two, IDRC and CNHR (Kenya) described specific activities to engage and build their capacity. The two main expected outcomes from capacity building activities included: improved capacity to carry out highquality, multi- and trans-disciplinary research and the development of career structures that allowed progression for researchers. Only four institutions outlined indicators used for monitoring and evaluating capacity strengthening activities, including number of peer-reviewed publications, level of financial sustainability, and evidence of career progression/development. During the interviews, all the institutions described a process by which they realized that providing support to individuals was not enough to build significant, long-lasting capacity, and how this led to an evolution in their thinking around capacity strengthening, moving towards institutional capacity building. As part of the evolution in their thinking, these institutions highlighted the importance of taking a long-term view (10, 15 and even 20 years). The lessons learned of these institutions, included lessons on the difficulties of implementing appropriate supervision and mentorship as capacity strengthening activities, lessons on management such as balancing strict vs. open criteria to receive applications, and adding small amounts of research funds to get individuals started on research projects, as well as some examples of how partnerships work and where more effort is needed to make 4
them work. This mixture shows not only the importance of considering and using varied capacity strengthening strategies but also the need to find efficient ways manage the process and make their use more efficient or useful. Of the 33 networks mapped, 11 had a geographical focus on Africa, 2 on Asia, 2 had a national focus (India and Thailand), 6 had a mixture of Africa and Asia (i.e. specific countries in both continents), 1 had a Africa and Latin th America focus, and 8 a global (LMIC) focus. The main funders included the EU’s 7 Framework Programme, DFID, the Wellcome Trust and IDRC. When networks are time-limited, most had multi-million funding for a period of 4 – 6 years. In terms of activities to engage and build the capacity of policy-makers, 12 out of the 33 networks had specific examples of the activities they carry out, including: a) preparing accessible, relevant and timely messages in a variety of dissemination products, b) organizing forums, meetings and briefings with key stakeholders, c) participating in international conferences and agenda-setting meetings, d) building on policy networks to increase, understand and stimulate demand for evidence, and e) developing short courses or other training forums. The remit of institutions and networks that were mapped covers not only HPSR but also health and development research. Although, the main interest of the mapping exercise was strategies used to strengthen capacities for HPSR, the limited number of institutions and networks that have a sole focus on this field made it necessary to expand the inclusion criteria and include institutions and networks with broader remits. Furthermore, it was considered that the strategies as defined for this mapping exercise would not differ significantly between institutions and networks that focused on HPSR and other with a broader remit. It was important to understand whether there were some strategies used more frequently by institutions or networks that focus on HPSR, but the results showed that there was not a noteworthy difference, expect for the curriculum development and infrastructure development/equipment updating strategy. This lack of difference between the strategies used can be considered an advantage as it provides a broader menu of capacity strengthening strategies to consider in the future. The role of institutions vs. networks was considered to differ. Institutions usually have broader remits and may choose to focus or highlight HPSR as a particular field they would like to develop or include it along with a number of other themes, while networks on the other hand, tend to have more specific remits. In terms of the differences between the strategies used by institutions and networks, on an individual level, individual support, delivering training courses and mentorship were common to both, but networks did significantly more ‘learning by doing’ and curriculum development. These differences make sense as it may not be practical for institutions to run ‘learning by doing’ programmes or develop curriculums themselves as these can be quite labour intensive and require specific skills. Although many institutions recognised the limitations of individual strategies in building sustainable capacity for research, they still include a significant number of these strategies within their activities. For organizational strategies, the most common strategies coincided for both institutions and networks and were ‘group support’, networks, partnerships and institutional development. A number of institutions and networks either provided or received funds to run grant schemes, carrying out the selection process themselves. This was considered a gauge of institutional development as it would require the establishment of credible and transparent processes to award and manage funds. Systems development strategies were limited to some institutions and only two networks, with a low level of specificity in what these strategies actually involved. Sustainability was not considered to be a significant problem for institutions; many of them are government funded and/or have a long history of running their capacity strengthening strategies. However, 15 networks are coming to an end in 2014 or 2015, including 5 focused on HPSR: Africa Hub, African Doctoral Dissertation Research Fellowships Program - Phase III, ARCADE, CHEPSAA and SURE. The first two are already in their second and third 5
th
phase and are funded by DFID and IDRC respectively, the latter three are supported by the EU’s 7 Framework programme. It is unclear whether there are mechanisms in place to renew support for any of these networks. Results showed the spread (or lack thereof) in the geographical focus of networks. The majority have an African focus, with some that include specific countries in Asia and Africa, 3 with an Asian focus and only one (SDH-Net) that covers Africa and Latin America, along with some with a global focus. The increasing research governance/management responsibilities that are now being transferred to African/LMIC institutions show a significant shift in how partnerships are viewed, with increased emphasis on equality and commitment to institutional development. This move was highlighted as particularly challenging, not the least in the management of governance and accountability mechanisms within the institutions implementing these shifts. Although activities to monitor, evaluate and measure impact of capacity strengthening activities are carried out by most institutions, this was more difficult to pinpoint for networks. When these activities are carried out by institutions, they are mainly done for internal purposes and are not used to develop the collective knowledge in the area or develop capacity in other groups (local ones especially) to carry out these evaluations. There is a role in gathering some of this existing knowledge, systematising it and publishing it to disseminate it more widely and inform the field in general. Having been through the mapping exercise and evaluated the results, there is a certain degree of confidence in the ability to describe in detail the activities and approaches used to build capacity for HPSR at different levels (individual, organization and system) and by different actors (institutions and networks). Some lessons learned were gathered from institutions and provide a starting point and useful insights but cannot be considered exhaustive. The fact that most institutions have recognised the need to go beyond individual capacity strengthening (and have done so) is a reflection of what has been happening in the field of capacity strengthening in the last 5 – 7 years, and although reassuring is not necessarily innovative. For the outcomes and their measurement, the information gathered was even more limited, principally because this information is mainly used for internal purposes. Overall, results showed a spread of capacity strengthening activities and a variety of institutions and networks involved. The sustainability of some key networks is a concern. Potential gaps remain in regions outside of Africa, in building up more institutions/partners in LMICs (as well as in Africa) – to spread opportunities beyond the usual players, and developing more system-level approaches, involving more institutions and networks. Significant opportunities exist to play an advocacy role to develop and maintain the importance of capacity strengthening for HPSR at an institutional level, and to systematically gather existing knowledge on impact measurement and monitoring and evaluation – mainly kept for internal purposes – to disseminate knowledge and build local/regional capacity to carry out these evaluations.
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1. INTRODUCTION Capacity strengthening for research can be defined as the process of building the abilities of individuals, organizations, and systems to perform rigorous research, sustainably, and to continue to improve and develop over time. Ideally, the process should be evidence-based, have a long term view and include mixed strategies and approaches. Health policy and systems research (HPSR) is the production of new knowledge to improve how societies organize themselves in achieving collective health goals, how different actors interact in the policy and implementation processes to contribute to policy outcomes, and is characterized by the types of questions it addresses focusing primarily on policies, organizations and programmes, and not clinical management of patients or basic biomedical 1 research . The field of HPSR has received a high level of attention in recent years, highlighting the need to strengthen capacities to carry it out at country level, within strong networks, at robust institutions and with 2 rigorous content (e.g. postgraduate courses) . In order to build capacity for HPSR, institutional capacities that lead to the development of locally trained highly3 skilled researchers with a strong and functioning regional network to rely on are needed . Specifically, the institutional capacities required include strengthening of human resources to improve teaching, research and administrative systems, as well as skills in graduate-level teaching and higher degree supervision (e.g. mentoring, writing grant application skills, research management, and technology-based knowledge management, dissemination, and information retrieval). The implementation of transparent and efficient processes to select 4 grantees and award funds is an important part of institutional development . This includes the establishment of a system to facilitate review processes (e.g. application and reviewer templates), mechanisms to ensure that regional or gender balance is attained without compromising quality, ways to measure availability and quality of supervision, etc. Furthermore, the importance of having access to core or unrestricted funds to allocate towards building research capacity and supporting infrastructure, as well as strategic research priorities has been highlighted as key to an 5 institution’s ability develop sustainable research capacity , as well as the development of country-specific 6 programmes in collaboration with national authorities to address the specific needs of a country . 7
Although long-lasting partnerships have been shown to be successful at strengthening capacity for HPSR , the challenges of maintaining them and/or developing new ones with an equity focus requires not only the transfer of research skills so that research agendas can be defined and coordinated locally, but the actual ownership of these 8 research agendas and the coordination of these partnerships needs to shift to local/national level . Measuring impact and evaluating health research capacity strengthening strategies or approaches can be 9 10 challenging, and although some work has been done on identifying indicators , frameworks and the tensions 11 involved these are not necessarily applied in any consistent manner. The purpose of this mapping exercise was to identify current strategies and potential gaps in capacity strengthening for health policy and systems research (HPSR) in low- and middle-income countries (LMICs). This will contribute to determining the role or niche for the Alliance for Health Policy and Systems Research (AHPSR) in this field in the short to medium term. In this mapping exercise, institutions were defined as entities that provide support to other institutions, networks or academic groups to carry out capacity strengthening activities. Providing this support in the form of funding may be an institution’s main role or may be one of various other roles. These institutions develop calls for proposals, 7
receive feedback from their community of grantees, inform, influence and are influenced by their decision-making bodies, and thus have a role to play in developing the field of capacity strengthening for research in HPSR and beyond. For some of the institutions mapped (e.g. NORAD, GIZ, etc.), specific programmes that included capacity strengthening for HPSR were mapped to facilitate data collection. These specific programmes in most cases are implemented collaboratively between government departments responsible for international cooperation and research. Networks were defined as groups of organizations that receive support to carry out capacity strengthening activities for HPSR. Importantly, these capacity strengthening activities are developed and/or delivered through the links created between these organisations. Their remits tend to be more specific and because their roles is more of an implementer one, they gather lessons learned and try-out new capacity strengthening activities in realtime. The networks mapped in this study, include long-standing ones with multiple funders (e.g. INDEPTH, INCLEN) as well as those that are time-specific, with one main funder (e.g. CHEPSAA, ARCADE). They also include partnerships composed of institutions that have come together to deliver a particular research programme (e.g. ReBuild Consortium and RESYST) that include capacity strengthening within their strategic objective.
1.1. FRAMEWORK 12
The framework outlined in Figure 1 (adapted from PEPFAR ) was used as a basis to carry out the global mapping exercise. It was selected because it was considered to cover the scope, objectives and strategies used by institutions and networks to strengthen capacity for HPSR (including implementation research and operations research), and would provide a guide for the different types and levels of information that were collected. The list of attributes collected on each institution and network (see Annex 1) was been developed with this framework in mind. Figure 1: Proposed Capacity Strengthening Framework for Mapping
Source: Adapted from PEPFAR.
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2. METHODOLOGY The list of attributes was developed by considering all the information that would be useful and potentially interesting to collect on the institutions and networks that implement capacity strengthening strategies for HPSR. Certain groups of variables were selected to provide information on different parts of the framework (Figure 1) as follows: Overall objectives of institutions and networks to confirm that capacity strengthening for HPSR was part of their remit. Activities and approaches used at different levels: individual, organizational and system-level. Lessons learned by collecting information on the principles and philosophy that guide and institutions’/network’s capacity strengthening activities. Monitoring and evaluation strategies and outcomes/impact that these activities/approaches have achieved, including indicators. These were based on a matrix of key indicators for individual, organizational and systems 13 capacity components developed by ESSENCE , ranging from number of peer-reviewed publications (individual), to levels of financial sustainability (organizational), through to number of evidence-based policies and interventions (systemic). However, if other indicators were used, this information was also collected.
2.1. DEFINITION OF MAPPED STRATEGIES The identification of the capacity strengthening strategies to be mapped was based initially on those outlined in 14 the Sound Choices (Table 3.1, p. 55) book, with the addition of specific strategies used in the Wellcome Trust’s i African Institutions Initiative of which the consultant had previous knowledge. Table 1 provides a definition of each of the strategies that were mapped in this report; they have been divided by individual, organizational and systems-level. Table 1: Definition of mapped strategies Strategy/Activity Definition INDIVIDUAL STRATEGIES: Develop knowledge and skills in people. Individual support (e.g. Develop an individuals’ research capacity (and possibly that of their immediate team). fellowships for graduate They are usually provided to get research careers started and established, but are and post-graduate also used at more senior levels by some institutions. studies) Learning by doing Build the capacity of individuals within their current jobs, i.e. the training does not take them out of their regular environment for extended periods of time; they maintain their jobs and can apply their learning on a real-time basis. Curriculum development Creation of planned curriculums, covering content, pedagogy, instruction and delivery methods. Delivering training courses Delivery of educational material through a variety of media e.g. classroom, seminars, workshops, online, digital, etc. It focuses on the provision only. Mentorship Independent support and advice usually from one individual to another, to enable a less experienced colleague to realise their full potential and help establish their career. Leadership training Skills and abilities that go beyond research capacities. They are meant to facilitate i
http://www.wellcome.ac.uk/Funding/International/African-Institutions-Initiative/
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and/or professional career development and produce well-rounded professionals. development ORGANIZATIONAL STRATEGIES: Provide a framework for individual capacities to connect and achieve collective goals. Group support Support for a group of researchers to carry out a defined research programme/project, which includes capacity strengthening activities either embedded or with ear-marked funds. Institutional development Develop the ability of an institution to support and conduct research, may include support for a grants management office, financial reporting, library improvement, access to journals, etc. Project management Support for the development of dedicated and professional staff to deliver the training specialized support services required by research programmes (e.g. finance, grants management, administration and ethical review). Networking/ Networks Support for the association of institutions with a common interest to provide mutual assistance, helpful information, etc. Partnerships Agreements between two or more institutions, in which they pool skills or other resources and agree to share the associated risks and rewards; usually it is based on a formal contract or agreement. Infrastructure Covers basic physical facilities needed to conduct training (e.g. field equipment, IT development/ Equipment equipment, internet, lecture theatres and classrooms) and for the management of a updating research programme (e.g. research support office, finance and accounting system, grants management software). Run grant schemes For the purposes of this mapping exercise, support provided to other institutions so that they can run their own competitive grant schemes, or in the case of some institutions and networks, support received to run them. SYSTEMS DEVELOPMENT STRATEGIES: Provide an enabling environment to conduct research including policies, rules, norms and values governing the mandates, priorities and modes of operation.
2.2. WEB-BASED DATA COLLECTION The list of attributes was transformed into a data abstraction spreadsheet to facilitate data collection. The variables included in this spreadsheet are presented in Annex 1. Each variable represents a column in the spreadsheet, with categories or binary variables as relevant. The spreadsheet included one sheet to collect data on institutions and one to collect data on networks. It also included a sheet with the institutions and networks that were considered and eventually excluded from the mapping exercise as they did not meet the inclusion criteria. The following inclusion criteria for institutions and networks were used: Institutions or networks should have a focus on developing capacity for RESEARCH, not to deliver health services or other related activities Capacity strengthening activities target researchers and/or policymakers Institutions or networks that focus specifically on health systems and policy research and those that include it within a broader remit (e.g. health research or even health and other themes – e.g. IDRC), but all must include capacity strengthening for HPSR within their activities Capacity strengthening activities focus (at least in part) on low- and middle-income countries
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The institutions and networks that were mapped were based initially on the list compiled by in Sound Choices ii (Table 3.1, p. 55) book, which was complemented with the list of ESSENCE members , and updated and expanded with the consultant’s existing knowledge. This was then complemented with a Google search, starting with the identification of links or partnerships from the webpages of the institutions and networks on the initial list (i.e. using principles of snowball sampling), and then using search terms to ensure comprehensiveness. The search terms used are outlined in Table 2. The aim was to achieve maximum variation with respect to the locations, organizational characteristics, and country focus of the organizations identified. Based on the consultant’s existing knowledge of the area, it was estimated that the mapping exercise would identify approximately 10 -15 institutions and 20-25 networks. Table 2: Specific search terms and combinations entered into Google AND AND Health research capacity building programme/program Health systems research capacity strengthening project Health policy research capacity development strategy
OR Network Partnership Consortium Hub Alliance
These search terms were also entered into Google Scholar to identify peer-reviewed publications, reports and other documents to inform the mapping exercise, not only in terms of potential institutions and/or networks, but to understand the main themes and discussions currently taking place in the field.
2.3. COMPLEMENTARY QUALITATIVE DATA COLLECTION The web-based data collection was completed with a short semi-structured interview with representatives from institutions and networks. The objective of these interviews was to ensure accuracy of the data collected for that institution or network, and to collect qualitative information not available or obvious from the webpage and other documents. A set of questions was drafted for the interviews (Annex 2). The questions were tailored for each interview and sent in advance, to provide the representative with the opportunity to consider the type of information sought and discuss with colleagues if necessary. Given the number of institutions and networks mapped, it was considered that interviewing them all would not be feasible. The aim therefore was to interview the institutions with the largest capacity strengthening programmes and the networks that had a focus on HPSR.
3. RESULTS The results are presented separately for institutions and networks with a map at the end that shows the links between them.
3.1. INSTITUTIONS The final list of institutions mapped was 14 (see Annex 3). All have current capacity strengthening initiatives. The capacity strengthening activities of two IDRC programmes: Global Health Research Initiative and Governance for Equity in Health Systems were mapped separately to maintain some granularity on how they have different focus areas and use different strategies. The Wellcome Trust’s African Institution Initiative has not been mapped as a ii
http://www.who.int/tdr/partnerships/initiatives/essence/en/
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separate institution; rather 5 of its 7 consortia have been mapped as part of the networks. The two consortia (Strengthening research capacity in environmental health – SNOWS and One Medicine Africa-UK Research Capacity Development Partnership Programme for Infectious Diseases in Southern Africa – SACIDS) that were not mapped were not considered not include HPSR within their remits and thus were excluded. Table 3 presents characteristics of the institutions, including their funding source (multiple international funders, government or charitable foundation), overall remit, geographic focus and whether they include activities for researchers based in high-income countries too. Only one institution, the Alliance for Health Policy and Systems Research has HPSR as a specific remit. Most of the others (8) have remits that are focused on health research and the remaining 5 have a broader focus on development research, including health but also other areas such as agriculture, climate change, education, etc. Seven institutions have government funding and 6 others have a combination of funding from various international funders. Only one (Wellcome Trust) is a charitable foundation. The geographical focus of institutions varied, with three having a country specific focus: India, Kenya and Philippines/Indonesia, two with a regional focus on Africa, and nine with a global (LMIC) focus. Nine out of 14 institutions also supported activities in one or more highincome countries. Data quality on the level of funding provided by each institution towards capacity strengthening activities in HPSR or otherwise, was extremely variable and thus was not included as it did not allow for useful comparisons. Not all institutions highlighted specific areas or topics they would be interested in supporting but of the ones that did, most highlighted health systems generally, while the specific topics that were repeated more than once included: a) maternal and child health, b) neglected diseases, c) malaria, HIV and TB, d) eHealth, and e) health financing. Table 3: Characteristics of mapped institutions: source of funding, remit, geographic focus and activities in high income countries Institution
Alliance for Health Policy and Systems Research (AHPSR)* BMBF/GIZ - Research Networks for Health Innovation in Sub-Saharan Africa. Consortium for National Health Research Fogarty International Center International Development Research Centre (IDRC) MRC/DFID African Leader Scheme NOHRED - The Norwegian Programme for Capacity Development in Higher Education and Research for Development NWO & WOTRO (Science for Global Development) Partnerships for Enhanced Engagement in Research (PEER) HEALTH (USAID + NIH) SIDA – Research Cooperation TDR (Special Programme for Research and Training in Tropical Diseases) Wellcome Trust
Source of funding
Remit (HSPR, Health or Development) HPSR
Global
Includes activities in high-income countries too No
Development
Africa
Yes (Germany)
Multiple international funders Government Multiple international funders Government Government
Health
Kenya
No
Health Development
Global Global
Yes (USA) Yes (Canada)
Health Development
Africa Global
Yes (UK) Yes (Norway)
Government
Development
Global
Yes (Netherlands)
Government
Health
Yes (USA)
Government Multiple international funders Charitable foundation
Development Health
Philippines, Indonesia Global Global
Health
Global
Yes (UK)
Multiple international funders Government
Geographic focus
Yes (Sweden) No
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Wellcome Trust/DBT India Alliance
Multiple international funders Multiple international funders
WHO - HRP (Special Programme for Research, Development and Research Training in Human Reproduction *Focus on HPSR.
Health
India
No
Health
Global
No
The capacity strengthening strategies that are used by the mapped institutions have been divided into individual, organizational and systems-level, as defined in Table 1. The strategies that have been associated with each institution are presented in Tables 4 and 5. Most of these data were collected during the web-based data collection. One of the limitations of this data collection is that it is based on information published by institutions on their websites or otherwise publicly available, and this may not be provide a complete picture of all activities, but rather highlight those that might be considered a priority at a given point in time. An effort was made to review strategic documents and annual reports, when these were available as they were found to be much more comprehensive and provide more detailed descriptions of activities. Where interviews took place, the strategies identified were confirmed with the interviewee to ensure accuracy. Table 4: Individual strategies used by mapped institutions Institution
Alliance for Health Policy and Systems Research (AHPSR)* BMBF/GIZ - Research Networks for Health Innovation in Sub-Saharan Africa Consortium for National Health Research Fogarty International Center Governance for Equity in Health Systems (IDRC) Global Health Research Initiative (IDRC) MRC/DFID African Leader Scheme NORAD/NOHRED - Norwegian Programme for Capacity Development in Higher Education and Research for Development NWO & WOTRO Partnerships for Enhanced Engagement in Research (PEER) HEALTH (USAID + NIH) Sida – Research Cooperation TDR Wellcome Trust Wellcome Trust/DBT India Alliance WHO - HRP (Special Programme for Research, Development and Research
Individual support (e.g. fellowships)
Learning by doing
Curriculum development
Delivering training courses
Mentorship
■ ■
■
■
■
■ ■
■
■
■
■ ■
■
■
■ ■
■
■
■ ■ ■ ■
■ ■ ■
■
■
Leadership training and professional development ■
■
■
■
■
■ ■
■
■ ■ ■
■
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Training in Human Reproduction) *Focus on HPSR.
Table 5: Organizational strategies and system development used by mapped institutions Institution
AHPSR* BMBF/GIZ initiative Consortium for National Health Research Fogarty International Center GEHS (IDRC) GHRI (IDRC) MRC/DFID African Leader Scheme NORAD/NOHRED NWO & WOTRO PEER HEALTH SIDA – Research Cooperation TDR Wellcome Trust Wellcome Trust/DBT India Alliance WHO - HRP *Focus on HPSR.
Group support
Institutional development
■
■ ■
■
Project management training
Networking/ Networks
Partnerships
Infrastructure development/ Equipment updating
■ ■
■
■
■
■
■
■
■
■
■
■
■ ■ ■
■
■
■
■
■
■
■
■
■
■
■
■
■
■
■
■
■
■ ■
■ ■
■ ■
■
■ ■ ■
■ ■ ■
■ ■
■
■
■
Run grants schemes
Systems development
■
■
■
■
■
■
■
■ ■
■
■
■
■
In terms of links to policy and policy-makers, 8 do not mention this in their objectives or strategic documents. Of the ones that do, two (NWO/WOTRO and BMBF/GIZ) mainly highlight the importance of engaging policy-makers at the outset of research activities but do not specify any strategies to ensure this happens. Another institution (TDR) highlights this engagement not as part of their capacity strengthening activities, but as part of their knowledge management and convening activities. The best examples are IDRC and CNHR (Kenya), with specific activities to engage and work with policy-makers, and build their capacity to use research. IDRC’s Global Health Research Initiative even expects a policy-maker to be co-principal investigator on all the grant applications they receive. The measurement of the impact of capacity strengthening activities and the approaches used to do so, including use of indicators, was one of the areas where less information was available. The study collected data on stated outcomes expected or achieved, related to capacity strengthening and only half of the institutions mapped had these (7/14). Among the stated outcomes, the two main ones included: improved capacity to carry out highquality, multi- and trans-disciplinary research, and the development of career structures that allowed progression for researchers. Other outcomes highlighted were the importance of developing sustainable south-south 14
collaborations among researchers, the development of an information system to carry out monitoring and evaluation activities, and the strengthening of institutions, particularly improving libraries and access to international journals. Two institutions highlighted the importance of developing the monitoring and evaluation strategies in collaboration with partners to ensure feasibility and sustainability. Only four institutions outlined indicators used for monitoring and evaluating capacity strengthening activities, the common ones included number of peer-reviewed publications (in some cases specifying that the first author should be from a LMIC), level of financial sustainability (i.e. further on funding), and evidence of career progression/development. Semi-structured interviews were used to confirm the strategies identified, gain understanding of the strategies that were found to be more or less useful, as well as get a better overview of how impact was measured. See Annex 4 for a list of interviewees. All the representatives of institutions that were interviewed described a process by which institutionally they had realized that providing support to individuals was not enough to build significant, long-lasting capacity, and how this led to an evolution in their thinking around capacity strengthening, moving towards institutional capacity building and developing a ‘critical mass’ of research capacity that could act as peer support and also attract other researchers. Not all the institutions had moved into systems development strategies (e.g. thinking of the research environment at a national level) but the ones that did, described the importance of strengthening government entities to provide this support. As part of their evolution in thinking, these institutions highlighted the importance of taking a long-term view (10, 15 and even 20 years) and the challenges that this sometimes represented within their accountability mechanisms. Table 6 presents some specific strategies mentioned by the institutions that are either not covered in the strategies mapped or provide more specific detail that could be useful for discussion. Table 6: Additional capacity strengthening strategies mentioned by institutions during interviews Strategy Description ‘Sandwich’ training Training programme during which individual fellows share their training time between their local institution and an institution in a high-income country. This was seen as a good way for the individual to maintain links to their local institutions and have a place to implement their skills. ‘Rising star’ model Provides seed grants ($200 – 300k) to junior researchers identified as prospective leaders, to set-off their careers. It was highlighted as a strategy with good value for money as long as the selection of the grantees was rigorous. Training researchers on Institutions have received good feedback from researchers that this type of training engaging with policyis extremely useful for them and not easy to get in other contexts. It can include makers knowledge translation strategies, writing policy briefs, etc. Other training Other training that researchers and policy-makers have found particularly useful included: monitoring and evaluation, research methodology (mixed and qualitative methods) and gender mainstreaming in research. Alumni database Used to track the career progress of the researchers they have supported and contribute to measuring impact. The challenges include maintaining good quality, timely data. Two institutions have tried to implement this with different levels of success but both still think it is a useful tool and want to develop it more. Strengthening National A specific example of systems development that was mentioned as being used by at Research Councils least two institutions. Programme-officers in Placement of programme-officers representing the institution in countries with high 15
country Including policy-makers in decision-making Committees on funding Regional policy brokers to provide support to research teams
levels of activity/investment. This has been found to contribute to understanding the context and develop key relationships. A challenging strategy to implement as points of view on applications differed significantly between policy-makers and academics but made final decisions on funding much more policy-relevant. Identify and support regional organizations to act as policy brokers for a specific research programme. The activities of these brokers include for example: developing workshops and training courses, engaging with policy-makers, and looking for opportunities for the research teams to participate in high-level meetings.
Most institutions confirmed that the main strategy they use for evaluating their activities and measuring impact is based on external evaluations. These are tailored to the particular programme and institution commissioning the evaluation, and thus are mainly used internally and not widely shared. They are used to inform the development of new initiatives or the subsequent phases of existing ones. Some institutions commented on the limited capacity at regional or local levels to carry out these evaluations and also mentioned that not all are particularly useful. The decision of some institutions to increase the research governance and management responsibilities (e.g. managing funds, selection of individuals for training, development and delivery of training, etc.) of institutions in low and middle-income countries (with Africa representing the most common experience for the institutions that were interviewed) has presented some challenges. The challenges included the level of effort and resources required to provide support to these institutions to take over these responsibilities, providing reassurance to their own governance mechanisms that the institutions can manage these responsibilities, and managing relationships with partners in high-income countries with different expectations and modus operandi. Lessons learned that were mentioned included: Ensuring the capacity strengthening grants include some research funds to provide small seed-funding (e.g. $50,000) to individual fellows to develop and launch a research project. This helps attract high-calibre trainees and adds more practical learning to the training. For supervision and mentoring it was important but also very challenging to ensure quality. It was difficult to find the right people to do it as not many current leaders have been through this process. Balance between issuing calls for proposal with very strict criteria vs. leaving them broader and open to give people a chance to propose. The first can limit the number of high-quality applications received and the latter can lead to a high number of mixed applications, making decision-making and subsequent evaluation of impact difficult. It was easy to overestimate the level of institutional development at [African] research institutions. It was necessary to develop it from the most basic level and required more time, resources and effort than originally intended. Partnerships between funders are most effective when the parties involved have a shared goal, complementary strengths, and roughly equal size/contributions. Partnerships between institutions in high-income countries and LMICs, have tended to be unequal and are now concentrated in a few institutions (e.g. Makarere University, University of the Witwatersrand, University of Cape Town, etc.). More effort is required to ensure a higher level of equity in partnerships, as well as develop other institutions, spreading opportunities more widely.
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There is such a thing as a partnership with too many partners, money gets spread too thinly and communication is difficult. Furthermore, the composition of partnerships is difficult to change along the way so careful consideration needs to be put into its composition at the outset.
3.2. NETWORKS The final list of networks mapped was 33 (see Annex 3). Two of the networks – REACHOUT and Effective Health Care Consortium state clearly that capacity building for health research, including HPSR is one of their main objectives but the information available on the strategies and activities they use to achieve this objective was limited. Ten of the networks mapped had a focus on HPSR, while the rest had a health research focus. None of the networks included were broad enough to focus on development more generally and also include HPSR. Table 7 outlines the characteristics of the networks, including their geographic focus, main funder, budget (if available), and period of activity (if relevant). Eleven networks have a geographical focus on Africa, 2 on Asia, 2 have a national focus (India and Thailand), 6 have a mixture of Africa and Asia (i.e. specific countries in both continents), one has an Africa and Latin America focus, and 8 have a global (LMIC) focus. The main funders include th the EU’s 7 Framework Programme, DFID, the Wellcome Trust and IDRC. When networks are time-limited, most have multi-million level funding for a period of 4 – 6 years. Not all networks institutions highlighted specific areas or topics but of the ones that did (22/33), the topics that repeated themselves more than once were human resources for health, health financing, social determinants of health, mental health and infectious diseases. Table 7: Characteristics of mapped networks: geographic focus, main funder, budget (where available) and period of activity (where relevant)
Network
Geographic focus
Main funder
Period of activity, if applicable
DFID
Budget (where published by main funder) DFID: GBP £7.5 M
Africa Hub - Future Health Systems*
Africa
African Doctoral Dissertation Research Fellowships Program - Phase III* AFRIQUEONE – One Health Initiative, African Research Consortium for Ecosystem and Population Health APARET - African Programme for Advanced Research Epidemiology Training ARCADE - HSSR in Africa and RSDH in Asia*
Africa
IDRC
CAD $1.9 M
2010 – 2014¥
Africa
Wellcome Trust
GBP £4.9 M
2009 – 2014
Africa
EU’s 7th Framework EU’s 7th Framework NWO/WOTRO Fogarty and others World Bank Institute Canadian Government Departments Wellcome Trust
EUR €2.2 M total, EUR €2.0 M EU contribution EUR €4.4 M total, EUR €4.0 M EU contribution
2011 – 2014
ARISE - Amsterdam Institute for Global Health ASCEND Research Network Asia Network for Capacity Building in Health Systems Strengthening* Canadian Coalition for Global Health Research
Africa Asia Asia
CARTA – Consortium for Advanced Research Training in Africa CHEPSAA*
Africa
GBP £3.4 M
2009 – 2014
EU’s 7th Framework IDRC
EUR €2.2 M total, EUR €1.9 M EU contribution CAD $1.6 M
2011 - 2015
Collaboration for Health Systems Analysis
Africa
Africa and Asia
Global
Global
2010 – 2015¥
2011 – 2015 2012 – 2014 2010 – 2014
2012 – 2016
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and Innovation (CHESAI)* Consortium of Universities for Global Health – CUGH
Global
Effective Health Care Research Consortium EMERALD GROUP
Global Africa and Asia
Global Health Policy and Health Systems Research programme/platform (GHPHSR)* Global Health Research Capacity Strengthening Program (GHR-CAPS)
Global
Institute of Infectious Diseases of Poverty – IIDP INCLEN
Africa
INDEPTH
Global
International Health Policy Programme INTREC
Thailand Africa and Asia
NIMH Collaborative Hubs for International Research on Mental Health PHFI-UK Consortium REACHOUT
Global
ReBuild Consortium* RESYST - Resilient and Responsive Health Systems* Southern Africa Consortium for Research Excellence – SACORE SDH-Net SORT IT
Global
SURE - Supporting the Use of Research within African Health Systems* Training Health Researchers into Vocational Excellence in East Africa – THRIVE WHO – EVIPNet (Evidence Informed Policy Network)
Africa
Bill & Melinda Gates Foundation, Rockefeller Foundation DFID EU’s 7th Framework NWO/WOTRO
GBP £6.0 M EUR €7.2 M total, EUR €5.8 M EU contribution Three calls, budget for last call was EUR €1.0 M
2010 – 2016¥ 2012 – 2017
GBP £1.4 M
2009 – 2014
EUR €2.2 M total, EUR €2.0 M EU contribution
2012 – 2015
GBP £5.0 M EUR €7.3 M total, EUR €5.8 M EU contribution GBP £6.0 M GBP £6.0 M
2009 – 2014 2013 – 2018
Africa and Asia Africa and Asia
Wellcome Trust EU’s 7th Framework DFID DFID
Africa
Wellcome Trust
GBP £5.3 M
2009 – 2014
Africa and Latin America
EU’s 7th Framework Multiple international funders EU’s 7th Framework Wellcome Trust
EUR €2.4 M total, EUR €2.0 M EU contribution
2011 – 2015
EUR €3.8 M total, EUR €3.0 M EU contribution GBP £5.5 M
2009 – 2014
Global
Global
India Africa and Asia
Africa Global
CIHR, Réseau de recherche en santé des populations du Québec Wellcome Trust Multiple international funders Multiple international funders Thai Government EU’s 7th Framework NIMH
2009 – 2017¥
2011 – 2017 2011 – 2016
2009 – 2014
Multiple international funders
*Focus on HPSR. ¥ Currently in second or third phase.
The capacity strengthening strategies that are used by the mapped networks have been divided into individual, organizational and systems-level, as defined in Table 1. The strategies that have been associated with each network are presented in Tables 8 and 9. Most of these data were collected during the web-based data collection.
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One of the limitations of this data collection is that it is based on information published by networks on their websites and this may not be provide a complete picture of all activities, but rather highlight those that might be considered a priority at a given point in time. An effort was made to review strategic documents, annual reports, and reports to funders where available, as these were found to be much more comprehensive and provide more detailed descriptions of activities. Where interviews took place, the strategies identified were confirmed with the interviewee to ensure accuracy. Table 8: Individual strategies used by mapped networks Network
Africa Hub - Future Health Systems African Doctoral Dissertation Research Fellowships Program - Phase III AFRIQUEONE APARET - African Programme for Advanced Research Epidemiology Training ARCADE ARISE - Amsterdam Institute for Global Health ASCEND Research Network Asia Network for Capacity Building in Health Systems Strengthening Canadian Coalition for Global Health Research CARTA CHEPSAA CHESAI Consortium of Universities for Global Health Effective Health Care Research Consortium EMERALD GROUP Global Health Policy and Health Systems Research programme/platform (GHPHSR) Global Health Research Capacity Strengthening Program (GHR-CAPS) IIDP - Institute of Infectious Diseases of Poverty INDEPTH INCLEN International Health Policy Programme INTREC NIMH Collaborative Hubs for International Research on Mental Health PHFI-UK Consortium REACHOUT ReBuild Consortium RESYST - Resilient and Responsive Health Systems
Individual support (e.g. fellowships)
Learning by doing
Curriculum development
■ ■ ■
Delivering training courses
Mentorship
■ ■
■ ■
Leadership training and professional development
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■
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■
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■
■
19
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SACORE SDH-Net SORT IT SURE THRIVE WHO – EVIPNet
■ ■ ■ ■ ■ ■
■ ■ ■
■
■
■ ■
■
Table 9: Organizational and system-level strategies used by mapped networks Network
Africa Hub - Future Health Systems African Doctoral Dissertation Research Fellowships Program AFRIQUEONE APARET ARCADE ARISE ASCEND Research Network Asia Network for Capacity Building in Health Systems Strengthening Canadian Coalition for Global Health Research CARTA CHEPSAA CHESAI Consortium of Universities for Global Health Effective Health Care Research Consortium EMERALD GROUP Global Health Policy and Health Systems Research programme/platform (GHPHSR) Global Health Research Capacity Strengthening Program (GHR-CAPS) IIDP INDEPTH INCLEN International Health Policy Programme
Group support
Institutional development
Project management training
■
■
■ ■
■ ■
Networking/ Networks
Partnerships
Run grant schemes
Systems development
■
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■
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■
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■
■
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■
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■
■
Infrastructure development/ Equipment updating
■
■
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■
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■
■
■
■
■ ■ ■
■ ■
■
20
INTREC NIMH Collaborative Hubs for International Research on Mental Health PHFI-UK Consortium REACHOUT ReBuild Consortium RESYST - Resilient and Responsive Health Systems SACORE SDH-Net SORT IT SURE THRIVE WHO – EVIPNet
■
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In terms of activities to engage and build the capacity of policy-makers, 12 out of the 33 networks have specific examples of the activities they carry out. The ones that were mentioned by more than one network include: Prepare accessible, relevant and timely messages in a variety of dissemination products Organize forums, meetings and briefings with key stakeholders Participating in international conferences and agenda-setting meetings Build on policy networks to increase, understand and stimulate demand for evidence Develop short courses or other training forums In addition, 2 other networks include engaging policy-makers as part of their overall objectives but do not provide details on the type of activities they carry out: CHEPSAA and ReBuild Consortium. The data available on the measurement of impact and the strategies used to measure it for the mapped networks was limited. In terms of stated outcomes expected or achieved specifically related to capacity strengthening; only 11 out 33 networks stated them. Among those stated, the most common ones were: Researchers equipped with greater skills to carry out research and train others Strengthened curriculums/courses Improved networking capacity and stronger links between researchers, educators and policy makers Increased number of post-graduates (MSc and PhD) The most common indicators proposed to monitor and evaluate capacity strengthening activities, by the mapped networks included: Number of peer-reviewed publications Number of graduate students (MSc and PhD) Number of policy briefs developed Level (number of grants or value) of additional grant funding obtained Development and review of communication strategies for networks and their partners Given the number of networks mapped, it was considered that interviewing them all would not be feasible. The aim therefore was to interview those that had a focus on HPSR. However, the responses to requests for interviews were significantly less enthusiastic than expected and only three interviews were carried out.
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The interviews highlighted some common activities, achievements and challenges as follows: Networks highlighted their roles as catalysts i.e. facilitating activities for member partners, rather than actually doing most of the work themselves. All three networks considered the curriculums and training materials they have developed to be one of their greatest achievements and also expect them to be their main legacy, once their current funding cycles end. The ways of delivering these materials and curriculums, as well as engaging with students varied across the networks. One network faced particular technological challenges as it provides online blended learning courses on HPSR for teachers and students. Identifying the right technology to deliver the courses was important but also ensuring that there was institutional ownership (e.g. using national case-studies). Furthermore, combining the online course with some face-to-face seminars/group work was found to reduce drop-out rates. In terms of challenges, the coordinating role of the network and the fact that it needs to be wellresourced was highlighted. Maintaining a balance between making sure that the partners in the network deliver on their activities on one hand and giving them some flexibility to develop their niches was considered a particular difficulty. Another challenge was ensuring that materials and resources shared via online repositories, websites and libraries were maximised and used to their full potential. Interestingly, two of the networks started their activities with an assessment of needs carried out by each of their partners. These assessments laid out the baseline for each partner and informed the activities each proposed, as well as the overall cross-cutting issues covered by the network. The outcomes of these 16 17 18 19 20 assessments have been published . The networks all highlighted the importance of their annual face-to-face meetings to discuss, agree and modify the strategies they use for capacity strengthening. All networks highlighted the difficulties of measuring the impact of their activities but provided common patterns of how they consider and document it. For example, by documenting the career advancements and achievements of the students or fellows they have supported, as well as the uptake and dissemination of the materials and curriculums they have developed. All networks highlighted sustainability as a particular challenge, as they currently explore opportunities to access additional funding to continue activities and build upon them. One network highlighted two strategies that had complemented their activities significantly: a) engaging policy-makers and the media through stakeholder meetings had enriched their experience as researchers making them rethink what they do and how, as well as developing their relationships with the Ministry of Health and the media; and b) providing support to researchers to return to the communities where they carried out their field work and report back on their findings, which has even achieved policy influence at the local level. Another challenge mentioned by one network was the ongoing need to raise awareness and develop the understanding of what HPSR is, how it works and encourage more people to become involved. Their experience had shown that they needed to be quite pro-active in this area.
3.3. INSTITUTIONS AND NETWORKS: MAP Figure 2 presents an overview of the links and connections between the institutions and networks included in this mapping exercise. The institutions have been colour coded according to the funding source, networks according to 22
their geographical focus, and the links between them as funding relationships or partnerships. Two institutions in the map below: Rockefeller Foundation and Bill and Melinda Gates Foundation have not been included in the mapping exercise as they do not currently support specific capacity strengthening initiatives for health research that could include HPSR, although they do support some of the networks. Figure 2: Links between mapped institutions and networks
Institutions: funding source ■ Multiple international funders ■ Government funding ■ Charitable foundations
Geographical focus of networks Global Africa Asia Africa & Asia Africa & Latin America
Connections between institutions/networks Funding relationship --> Partnership/Other
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4. DISCUSSION The results are discussed following the themes outlined below.
C ATEGORISATION CHALLENGES The majority of the results presented above are based on web-based data collection, with the limitations this represents in terms of completeness and accuracy. The most useful sources of information were institutions’ and networks’ strategic plans, annual reports and evaluation reports (where these were available). Categorising capacity strengthening strategies was not always straightforward, particularly for those that may cover a large number of activities, or might mean slightly different things for different institutions or networks (e.g. institutional development, systems development and networks vs. partnerships). Although the definitions were relatively clear, the details of the strategies were not always as readily available. Identifying the individual strategies was more straightforward, most likely because these have been ongoing for longer and they tend to be more clearly described.
C APACITY STRENGTHENING STRATEGIES FOR HPSR VS . HEALTH / DEVELOPMENT RESEARCH The remit of institutions and networks that were mapped covers not only HPSR but also health and development research. [NB: This latter one, only for institutions.] Although, the main interest of the mapping exercise was strategies used to strengthen capacities for HPSR, the limited number of institutions and networks that have a sole focus on this field made it necessary to expand the inclusion criteria and include institutions and networks with broader remits. Furthermore, it was hypothesised that the strategies as defined for this mapping exercise would not differ significantly between institutions and networks that focused on HPSR and others with a broader remit. It was important to understand whether there were some strategies that were used more frequently by institutions or networks that focus on HPSR but the results above show that there are not many differences. It is worth noting though that the Curriculum Development strategy is one used mainly by networks focused on HPSR, and that Running Grants Schemes and providing Leadership Training seems to be concentrated in the health focused institutions and networks rather than the broader development ones. The focus of HPSR networks on Curriculum Development could show the need to still develop a broader and more common understanding of the field. The difference in the latter two strategies might mean that these are more commonly used in health research as opposed to development research but the sample is too small to draw any conclusions. A noteworthy difference is the Infrastructure development/ Equipment updating strategy which is not used very much in HPSR. This is to be expected as the needs in this category for HPSR are limited, compared to broader health research, which can include laboratories, field work, etc. This lack of difference between the strategies used can be considered an advantage as it provides a broader menu of capacity strengthening strategies for HPSR to consider in the future.
I NSTITUTIONS VS . NETWORKS : DIFFERENT ROLES = DIFFERENT STRATEGIES ? The role of institutions vs. networks was considered to differ in terms of their remits. Institutions tend to have broader remits and may choose to focus or highlight HPSR as a particular field they would like to develop or include it along with a number of other themes. For the purposes of mapping institutions, specific platforms/programmes were selected, where HPSR was clearly included, for example the German’s Governments BMBF initiative and the Norwegian Governments’ NORHED partnership. This also made the mapping of the strategies more feasible as it focused the search. Networks on the other hand, tend to have more specific remits
24
but in some cases had limited information on their activities – the amount and quality of information available varied significantly. In terms of the differences between the strategies used by institutions and networks, on an individual level, individual support, delivering training courses and mentorship were common to both, but networks did significantly more ‘learning by doing’ and curriculum development. These differences make sense as it may not be practical for institutions to run ‘learning by doing’ programmes or develop curriculums themselves as these can be quite labour intensive and require specific skills. Although many institutions recognised the limitations of individual strategies in building sustainable capacity for research, they still include a significant number of these strategies within their activities. For organizational strategies, the most common strategies coincided for both institutions and networks and were ‘group support’, networks, partnerships and institutional development. A number of institutions and networks either provided or received funds to run grant schemes, carrying out the selection process themselves. This was considered a gauge of institutional development as it would require the establishment of credible and transparent processes to award and manage funds. Systems development strategies were limited to some institutions and only two networks. As mentioned above, it was difficult to identify specific strategies within systems development, but during the interviews it became clear that some institutions were providing support to national Research Councils and considered this to be a good example of systems development. Although it is possible that these types of activities are not covered well in the information that institutions and networks publish on their websites, annual reports and strategic documents, the 13 growing understanding of what these strategies involve was clear from recent publications and the interviews carried out, thus providing some confirmation of the observation that the use of these strategies is overall limited.
S USTAINABILITY Sustainability was not considered to be a significant problem for institutions; many of them are government funded and/or have a long history of running their capacity strengthening strategies. Table 7 includes the period of activity of some of the networks, where this is relevant. It is important to note that 15 are coming to an end in 2014 or 2015. The Wellcome Trust has launched a renewal of their African Institutions iii Initiative, now called DELTAS which aims to support African-led development of internationally competitive researchers working across sub-Saharan Africa. However, this is an open competition so does not guarantee further support for the existing networks. A number of the networks focused on HPSR are due to end in this period: Africa Hub, African Doctoral Dissertation Research Fellowships Program - Phase III, ARCADE, CHEPSAA and SURE. The first two are already in their second and third phase and are funded by DFID and IDRC respectively, the th latter three are all supported by the EU’s 7 Framework programme. It is unclear whether there are mechanisms in place to renew support for any of these networks.
B IG PLAYERS IN CAPACITY STRENGTHENING : EU, W ELLCOME T RUST , DFID, IDRC The map in section 3.3 shows that many of the networks and institutions themselves are funded by four main th players: EU’s 7 Framework programme, Wellcome Trust, DFID and IDRC. All of them have slightly different approaches, for example DFID funds mainly other institutions (e.g. AHPSR, TDR, CNHR) and research programmes th with embedded capacity strengthening activities, such as Africa Hub, RESYST and ReBuild Consortium. The EU’s 7 Framework has a focus on networks, and the Wellcome Trust and IDRC have a mixture of stand-alone capacity
iii
http://www.wellcome.ac.uk/Funding/Biomedical-science/Funding-schemes/Strategic-awards-and-initiatives/WTP057105.htm
25
strengthening programmes, embedding activities within research programmes, and in the case of the Wellcome Trust also funding institutions (e.g. CNHR and WT/DBT India Alliance). It is unclear in all cases whether these different approaches are associated with a specific overall strategy or are mainly a reflection of historical reasons and/or feasibility of implementation given governance mechanisms. The fact that all of these institutions have broad remits means that HPSR does require some support to maintain its visibility. The AHPSR has a role in this area, given that it is the only institution with a focused remit on HPSR. Some of the networks could also have an important role to play in maintain this visibility – CHEPSAA, ARCADE, Africa Hub, etc.
G EOGRAPHICAL FOCUS Figure 2 shows clearly the spread (or lack thereof) in the geographical focus of networks. The majority have an African focus, with then some that include specific countries in Asia and Africa, 3 with an Asian focus and only one (SDH-Net) that covers Africa and Latin America, along with some with a global focus. Although there is no doubt that increased capacity is required in Africa, there does appear to be a large concentration of activities in this 21 region. A recent assessment of health systems research and training activities in Latin America showed that capacity for HPSR is still limited in the region as most of the training available is focused on training health service managers. Although an increased demand for research results and evidence by Ministries of Health and other institutions has been observed, the use of evidence in decision-making processes still needs to be strengthened and the limited number of researchers available struggle to approach policy-makers effectively and meet these demands. This shows that capacity strengthening in HPSR is still needed across LMIC and that efforts should be made to ensure greater geographical balance. The increasing research governance/management responsibilities that are now being transferred to LMIC institutions (usually in Africa) show a significant shift in how partnerships are viewed, with increased emphasis on equality and commitment to institutional development. This move was highlighted as particularly challenging, not the least in the management of governance and accountability mechanisms within the institutions implementing these shifts.
E MERGING TRENDS IN HOW CAPACITY STRENGTHENING IS DONE Some of the emerging trends in capacity strengthening that have been highlighted by this mapping exercise include the awareness that individual strategies do not build lasting and sustainable capacity, which has led to a growing awareness of the limitations and constraints caused by weak institutions. Although there are more activities in this area, there is still significant work to be done with some of the interviewees highlighting the limited number of ‘good’ partners in LMICs and how these are overwhelmed by opportunities. In addition, the long-term commitment required to build this type of capacity in a sustainable manner and the challenges associated with this long-term commitment were also highlighted. Nevertheless, within the individual strategies there is recognition of the need to develop skills that go beyond research capacities such as grant writing, writing for peer-reviewed journals, to more broader professional skills such as leadership training, coaching and management, to develop well-rounded research leaders. The proposed strategies highlighted in the interviews present a mixture of capacity strengthening activities (e.g. ‘sandwich’ training, ‘rising star’ model), specific themes that have contributed to capacity strengthening (training to engage policy-makers), and options to improve management and decision-making (mixed academic and policymaker funding Committee, in-country programme officers), and some systems-level examples such as supporting national Research Councils and regional policy brokers. The lessons learned also included lessons on the difficulties 26
of implementing appropriate supervision and mentorship as capacity strengthening activities, lessons on management such as balancing strict vs. open criteria to receive applications, and adding small amounts of research funds to get individuals started on research projects, as well as some examples of how partnerships work and where more effort is needed to make them work. This mixture shows not only the importance of considering and using varied capacity strengthening strategies but also the need to find efficient ways manage the process and make their use more efficient or useful.
I MPACT , M ONITORING AND E VALUATION Although activities to monitor, evaluate and measure impact of capacity strengthening activities are carried out by most institutions, this was more difficult to pinpoint for networks. When these activities are carried out by institutions, they are mainly done for internal purposes and are not used to develop the collective knowledge in the area or develop capacity in other groups (local ones especially) to carry out these evaluations. There is a potential role in gathering some of this existing knowledge, systematising it and publishing it to disseminate it more widely and inform the field in general.
HPSR CAPACITY STRENGTHENING FRAMEWORK A framework of how to consider capacity strengthening for HPSR was proposed in Figure 1. Having been through the mapping exercise and evaluated the results, there is a certain degree of confidence in the ability to describe in detail the activities and approaches used to build capacity for HPSR at different levels (individual, organization and system) and by different actors (institutions and networks). Some lessons learned were gathered from institutions and provide a starting point and useful insights but cannot be considered exhaustive or complete. The fact that most institutions have recognised the need to go beyond individual capacity strengthening (and have done so) is a reflection of what has been happening in the field of capacity strengthening in the last 5 – 7 years, and thus is not necessarily innovative although it is reassuring. For the outcomes and their measurement, the information gathered was even more limited, principally because this information is mainly used for internal purposes (see section above). Overall, the framework was useful to provide parameters for the type of information to be collected but given the information available, it is not complete.
5. CONCLUSIONS This mapping exercise has provided a good overview of the capacity strengthening strategies used for HPSR and health research more generally. It has highlighted that within these strategies, there no specific ones that are used more or less for HPSR, except for curriculum development which seemed to be a particular focus on HPSR networks. Furthermore, although institutions and networks have different roles, there are not significant differences between the strategies used by both, with the exception of infrastructure development and updating equipment, and possibly systems development. There is a large concentration of work by both institutions and networks in Africa, highlighting potential gaps. Although strengthening research capacity in Africa is still very much required, the fact that it many cases it is the same partners that keep being involved in partnerships and consortia does require some consideration, particularly as the period of activity of some networks comes to an end in the near future. The sustainability of some of the activities currently being carried out by networks focused on capacity strengthening for HPSR is a concern and points to a probable decrease in activities if at least some of these networks do not receive further funding. There is a role in maintaining the visibility of HPSR and keeping capacity strengthening for research in the area a priority. It currently has a high profile but this is unlikely to last in the medium to long-term. A systematic gathering of existing knowledge and experience in measuring the impact and evaluating capacity strengthening activities would contribute to this visibility. 27
Overall, results showed a spread of capacity strengthening activities and a variety of institutions and networks involved. The sustainability of some key networks is a concern. Potential gaps remain in regions outside of Africa, in building up more institutions/partners in LMICs and Africa in particular – to spread opportunities beyond the usual players, and in developing more system-level approaches that involve more institutions and networks. Significant opportunities exist to play an advocacy role to develop and maintain the importance of capacity strengthening for HPSR at an institutional level, and to gather existing knowledge on impact measurement and monitoring and evaluation – mainly kept for internal purposes to disseminate knowledge and build local/regional capacity to carry out these evaluations.
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LIST OF ANNEXES 1. 2. 3. 4.
Data abstraction list List of questions for interviews Mapped institutions and networks: Brief description List of interviewees
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