Research Capacity Building through: Opportunities and challenges in low income settings

1. Research Capacity Building through: Opportunities and challenges in low income settings Charles Michelo MBChB, MPH, MBA, PhD Chair, Dept of Public Health, University of Zambia, SoM SACORE: Professional Development Unit

2. A noble Call No 1! prevention • Tertiary education is a critical pillar of human development, providing high-level skills necessary for every labor market ……..for myriad personnel. • These trained individuals develop the capacity and analytical skills that drive local economies, and help governments, make important decisions which affect entire societies and lives.

3. Clearly, universities are a key part of such systems but there is growing need for research schools, research laboratories, centers of excellence, professional development units, etc—if key and critical competences are to be developed. • In CONSTRUCTING KNOWLEDGE SOCIETIES there is need to know that the appropriate investments and functional structures and systems is critical. • (Mamphela Ramphele, MD Human Development, The World Bank), modified

4. A noble Call No 2! prevention • ….but Science is not a competition between scientists; it is a contest of ideas- namely, explanations of what is out there in reality, how it behaves, and why!!! (Albert Einstein, 1915) • Managing and sieving through such idea contests requires • Appropriate scientific orientation • Through appropriate and traceable structures & systems-Capacities

5. Generating evidence for new preventive interventions with the intention of scaling up Scaling up & MES Cost-effectiveness RCTs Evidence of candidates for new interventions Comprehensive Baseline Information (e.g. HIV Survey Systems) RCTs: Randomised Community Trials; MES: Monitoring & Evaluation system

6. THE NEED & ACTION • Need: • Understanding the above illustrated scientific basis needs a new set of skills • Setting up implementation to build such skills-A strategic response • But what works and in what context, must be examined • Hence this discussion on RCB

7. Research Capacity • Building research capacity in health services • Is important for evidence based decision-making policy and practice. • Critical Activities include initiatives to support individuals and teams, organisations and networks. • Debate on how to measure this (effectiveness of research capacity building-RCB) has continued. • Goal for RCB: To improve the ability to conduct research, to use results effectively, and to promote demand for research (Bates et al, PLOS, 2006).

8. Definition • Ability to define problems, set objectives and priorities, build sustainable institutions and organisations, and identify solutions to key national health problems. • Research capacity levels: Individuals; Research groups; Institutions, and Nations. • Research capacity domains: 1. skills and competencies; 2. Scientific activities; 3.Outcomes; and 4. Impacts on policies and programmes which are necessary to capture a comprehensive picture

9. Lost opportunities 1: Long-term investment perspectives lost • No investment in academia/research seeking to understand complex medical strategies that saves lives e.g. In HIV prevention, NTDs, Vaccines, Diseases of lifestyles, etc • Urgently needed now: major investment in capacity building (national and sub-national levels) • to build academic (public & private health) centres for research, effective assessment & programme management • An attitude transformation- to accommodate teams

10. Lost opportunities II: Evidence based structural approaches missed out • Possible reason: Strong methodologically based research understanding is poor among faculty & students • More so and worse still is the poor record of implementing results generated from obvious evidence e.g. Trials (Pitfalls of implementation policies).

11. Approaches to capacity building (The CRISP model) • Top-down organisational approach • Bottom-up organisational approach • Partnerships • Community organising approach (Adaptedfrom B. R. Crisp et al., Health Promotion International, 2006 15:2)

12. Top-down organisational approach • Policy development • Resource allocation (leverage) • Organizational implementation • Sanctions/incentives for compliance

13. Example- 1: The NUFU Approach Norwegian Programme for Development, Research & Education Realising universities as development hubs Leads to putting High priority on investment in research & higher education in the South throughacademic partnership (South-North/South-South) forinstitutional capacity building formore relevant research with high quality based on principles of equality in partnerships and institutional commitment

14. Others Wellcome Trust NIH ECDP The Regional HIV group (sSA) RSA through MRC?? And many others

15. Bottom-up organisational approach • Workforce/professional development program • Staff skills, understanding, participation and commitment • Ideas generated and implemented

16. Example 2-A WT response: SACORE Aim: To build a competence-based scientific & academic career (scientific upbringing) responding national needs & medical evidence gaps, strong enough for Research, Teaching & Service. Focus Doctoral training Post-doctoral training Skill development enhancing professional pillars (Scientific & Academic-Pedagogical ) for all faculty and skilled manpower

17. Partnerships • Community activation • Collaborations & information sharing between organizations • Network density • Reorienting of services and programs provided by individual organizations

18. Example-3: The NOMA Approach Focus: Master level training Building life long skills for professional development Interdisciplinary nature Relevance driven Aim: investment in research & higher education in the South Strategy- Academic partnership South-North/South-South institutional capacity building 4. Values: Relevant research and based on principles of equality in partnerships and institutional commitment

19. Community organizing • Involvement of key community leaders • Involvement of persons from disadvantaged groups • Community ownership

20. Example-4: The Global Fund initiatives Civil societies (Need and Relevance driven actions ) Management processes (Logistics) Infrastructural, The Malawi example Vs Uganda Values: Relevant activities and based on principles of equality in partnerships and institutional commitment

21. Table 1: Capacity building approaches and measurement areas

22. Opportunities (external scanning) • Supportive Politics & political will • Economics-booming economies support R&Ds • Social factors • Existing Networks, • Social programs running without evidence calls on researchers; • Burden of disease dynamics calls for new set of academic prowess; • Reforms in educational sector calls for science of evidence early in school & reformed medical graduate education

23. Opportunities (external scanning) • Technology linked opportunities • increases production frontiers in general, more so in research-software industry; bench skills enhances • Differential Environments • Developing countries (gapping needs-more evidence in say preventive medicine and vaccinology, emerging challenges-NTDs, Lifestyle disorders, combinational tools like GIS and correlations, etc); • Developed world- aging and the aged; opportunities for basic and applied science • Legal frameworks-National, regional & International

24. Challenges –Sector Lag • Poor Resource base • Infrastructural support –huge threat • Supportfor research POOR, dwindling or stopped; Even fellowships for analysis of existing databases • Basic science support a challenge • Backbone for strong graduate programs • Internet access • Cost of publication

25. Challenges –Sector Lag • Competence challenges-many basic skills • Where are the advanced and specialised? • Where are strategic thinkers and drivers; so programs seems to be externally driven in non-priority areas. We need board room to be filled with owners of destiny!! • Poor understanding of ethics and ethics of research • Writings skills remain a challenge • System challenges • IRBs, Mentorship pool

26. r WHAT THEN WHAT THEN RESPONSE?

27. A model of the elements of strategic response Source: Textbook Exploring Corporate Strategy, 7th Ed; Pearson

28. Some Responses-suggestion • Training in critical areas; Reform med. edu. • Make use of available resources and networks-what is that in your hands; PS for resource allocation • Advocacy and lobbying for appropriate infrastructure, cite Makerere College of HS • Leadership response-We need scientific leaders who will drive social strategies & social capital • Borderless realisation-globalisation has made travel, communication, networking and operations hugely efficient. Utilise the borderless environmental for networks, consultation, training, etc

29. Some Principles for Responses to RCB • Research capacity is built by developing appropriate skills, and confidence, through training and creating opportunities to apply skills in critical areas. • Research capacity building (RCB) should support research 'close to practice' in order for it to be useful. • Remember that: Linkages, partnerships and collaborations enhance research capacity building • RCB should ensure appropriate dissemination to maximize impact • RCB should include elements of continuity and sustainability • Appropriate infrastructures enhance RCB

30. SUMMARY • Health problems continue to rise (unequalled RCB response) • Major Criticism (Problem analysis) • Limited understanding of the research and other evidence generation tools • Extremes: Emergency approach or fire fighting • No investment in the “local” academia: higher education and research • We argue: Of several and unique possible responses, the CRISP partnership approach (The power of academic partnerships) might be a priority approach • Why? It is a local/regional response for local challenges and self driven by locally present networks • Summary: A version of the “the education vaccine”

31. References Cooke Jo (2005) A framework to evaluate research capacity building in health care; BMC Family Practice, 6:44 Crisp B R et al (2000), Four approaches to capacity building in health: consequences for measurement and accountability; Health Promotion International 15:2 Imelda Bates Imelda, et al (2006) Evaluating Health Research Capacity Building: An Evidence-Based Tool PLoS; 3:8 Kotter John (1995) Leading change: Why transformational efforts fail, HBR, March-April Johnson, G., Scholes, K., & Whittington, R. (2008). Exploring Corporate Strategy: Text & Cases. Sydney: Prentice Hall International (UK), 8th edition.

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