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Abstract
Background Training and mentorship in research skills are essential to developing a critical mass of researchers in low- and middle-income countries (LMICs). However, reporting on the details of such training programs, especially regarding the cost of the training, is limited. Objectives This paper describes a year-long operational research training and mentorship course in Rwanda, implemented between 2013 and 2017. Approach We describe motivations for the design of the Intermediate Operational Research Training Course (IORT) across four iterations. We also report outputs, evaluate trainee experiences, and estimate training and mentorship costs. Findings Of the 132 applicants to the course, 55 (41.7%) were selected, and 53 (96.4%) completed the training. The ratio of female-to-male trainees in the course increased from 1:8 in 2013 to 1:3 in 2017. Trainees developed and co-first-authored 28 research manuscripts, 96.4% (n = 27) of which are published in peer-reviewed journals. For the 15 trainees who completed the post-course evaluation, 93.3% and 86.7% reported improvement in their research and analytical skills, respectively. The median cost per trainee to complete the course was US$908 (Range: US$739-US$1,253) and per research project was US$2,708 (US$1,748-US$6,741). The median annual training delivery and mentorship cost was US$47,170 (US$30,563-US$63,849) for a course with a Rwanda-based senior mentor, junior mentor, and training coordinator. The total essential cost for a year-long IORT course with 16 trainees co-leading eight research projects and mentored by two senior and four junior mentors was US$101,254 (US$73,486-US$157,569). Conclusion We attribute the high course completion rates, publication rates, and skills acquisition to the learning-by-doing approach and intensive hands-on mentorship provided in the course. IORT was costly and funded through institutional resources and international partnerships. We encourage funders to prioritize comprehensive research capacity-building initiatives that provide intensive mentorship as these are likely to improve the pool of skilled researchers in LMICs.
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Odhiambo J, Amoroso CL, Barebwanuwe P, Warugaba C, Hedt-Gauthier BL. Adapting operational research training to the Rwandan context: the Intermediate Operational Research Training programme. Glob Health Action 2018; 10:1386930. [PMID: 29119872 PMCID: PMC5700541 DOI: 10.1080/16549716.2017.1386930] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Promoting national health research agendas in low- and middle-income countries (LMICs) requires adequate numbers of individuals with skills to initiate and conduct research. Recently, non-governmental organizations (NGOs) have joined research capacity building efforts to increase research leadership by LMIC nationals. Partners In Health, an international NGO operating in Rwanda, implemented its first Intermediate Operational Research Training (IORT) course to cultivate Rwandan research talent and generate evidence to improve health care delivery. Objective: This paper describes the implementation of IORT to share experiences with other organizations interested in developing similar training programmes. Methods: The Intermediate Operational Research Training utilized a deliverable-driven training model, using learning-by-doing pedagogy with intensive hands-on mentorship to build research skills from protocol development to scientific publication. The course had short (two-day) but frequent training sessions (seven sessions over eight months). Trainees were clinical and programme staff working at the district level who were paired to jointly lead a research project. Results: Of 10 trainees admitted to the course from a pool of 24 applicants, nine trainees completed the course with five research projects published in peer-reviewed journals. Strengths of the course included supportive national and institutional research capacity guidelines, building from a successful training model, and trainee commitment. Challenges included delays in ethical review, high mentorship workload of up to 250 hours of practicum mentorship, lack of access to literature in subscription journals and high costs of open access publication. Conclusions: The IORT course was an effective way to support the district-based government and NGO staff in gaining research skills, as well as answering research questions relevant to health service delivery at district hospitals. Other NGOs should build on successful programmes while adapting course elements to address context-specific challenges. Mentorship for LMIC trainees is critical for effectiveness of research capacity building initiatives.
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Affiliation(s)
- Jackline Odhiambo
- a Research Department , Partners In Health/Inshuti Mu Buzima , Kigali , Rwanda
| | - Cheryl L Amoroso
- a Research Department , Partners In Health/Inshuti Mu Buzima , Kigali , Rwanda
| | - Peter Barebwanuwe
- a Research Department , Partners In Health/Inshuti Mu Buzima , Kigali , Rwanda
| | - Christine Warugaba
- a Research Department , Partners In Health/Inshuti Mu Buzima , Kigali , Rwanda
| | - Bethany L Hedt-Gauthier
- a Research Department , Partners In Health/Inshuti Mu Buzima , Kigali , Rwanda.,b Department of Global Health and Social Medicine , Harvard Medical School , Boston , MA , USA
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Thomson DR, Semakula M, Hirschhorn LR, Murray M, Ndahindwa V, Manzi A, Mukabutera A, Karema C, Condo J, Hedt-Gauthier B. Applied statistical training to strengthen analysis and health research capacity in Rwanda. Health Res Policy Syst 2016; 14:73. [PMID: 27681517 PMCID: PMC5041513 DOI: 10.1186/s12961-016-0144-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 09/07/2016] [Indexed: 11/22/2022] Open
Abstract
Background To guide efficient investment of limited health resources in sub-Saharan Africa, local researchers need to be involved in, and guide, health system and policy research. While extensive survey and census data are available to health researchers and program officers in resource-limited countries, local involvement and leadership in research is limited due to inadequate experience, lack of dedicated research time and weak interagency connections, among other challenges. Many research-strengthening initiatives host prolonged fellowships out-of-country, yet their approaches have not been evaluated for effectiveness in involvement and development of local leadership in research. Methods We developed, implemented and evaluated a multi-month, deliverable-driven, survey analysis training based in Rwanda to strengthen skills of five local research leaders, 15 statisticians, and a PhD candidate. Research leaders applied with a specific research question relevant to country challenges and committed to leading an analysis to publication. Statisticians with prerequisite statistical training and experience with a statistical software applied to participate in class-based trainings and complete an assigned analysis. Both statisticians and research leaders were provided ongoing in-country mentoring for analysis and manuscript writing. Results Participants reported a high level of skill, knowledge and collaborator development from class-based trainings and out-of-class mentorship that were sustained 1 year later. Five of six manuscripts were authored by multi-institution teams and submitted to international peer-reviewed scientific journals, and three-quarters of the participants mentored others in survey data analysis or conducted an additional survey analysis in the year following the training. Conclusions Our model was effective in utilizing existing survey data and strengthening skills among full-time working professionals without disrupting ongoing work commitments and using few resources. Critical to our success were a transparent, robust application process and time limited training supplemented by ongoing, in-country mentoring toward manuscript deliverables that were led by Rwanda’s health research leaders.
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Affiliation(s)
- Dana R Thomson
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda. .,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America.
| | | | - Lisa R Hirschhorn
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America.,Ariadne Labs, Boston, MA, United States of America
| | - Megan Murray
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America
| | - Vedaste Ndahindwa
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Anatole Manzi
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.,Partners in Health-Rwanda, Rwinkwavu, Rwanda
| | - Assumpta Mukabutera
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Corine Karema
- Ministry of Health, Rwanda Biomedical Center, Kigali, Rwanda.,Quality and Equity Healthcare, Kigali, Rwanda.,Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Jeanine Condo
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Bethany Hedt-Gauthier
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.,Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States of America.,Partners in Health-Rwanda, Rwinkwavu, Rwanda
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Binagwaho A, Farmer PE, Nsanzimana S, Karema C, Gasana M, de Dieu Ngirabega J, Ngabo F, Wagner CM, Nutt CT, Nyatanyi T, Gatera M, Kayiteshonga Y, Mugeni C, Mugwaneza P, Shema J, Uwaliraye P, Gaju E, Muhimpundu MA, Dushime T, Senyana F, Mazarati JB, Gaju CM, Tuyisenge L, Mutabazi V, Kyamanywa P, Rusanganwa V, Nyemazi JP, Umutoni A, Kankindi I, Ntizimira C, Ruton H, Mugume N, Nkunda D, Ndenga E, Mubiligi JM, Kakoma JB, Karita E, Sekabaraga C, Rusingiza E, Rich ML, Mukherjee JS, Rhatigan J, Cancedda C, Bertrand-Farmer D, Bukhman G, Stulac SN, Tapela NM, van der Hoof Holstein C, Shulman LN, Habinshuti A, Bonds MH, Wilkes MS, Lu C, Smith-Fawzi MC, Swain JD, Murphy MP, Ricks A, Kerry VB, Bush BP, Siegler RW, Stern CS, Sliney A, Nuthulaganti T, Karangwa I, Pegurri E, Dahl O, Drobac PC. Rwanda 20 years on: investing in life. Lancet 2014; 384:371-5. [PMID: 24703831 PMCID: PMC4151975 DOI: 10.1016/s0140-6736(14)60574-2] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Two decades ago, the genocide against the Tutsis in Rwanda led to the deaths of 1 million people, and the displacement of millions more. Injury and trauma were followed by the effects of a devastated health system and economy. In the years that followed, a new course set by a new government set into motion equity-oriented national policies focusing on social cohesion and people-centred development. Premature mortality rates have fallen precipitously in recent years, and life expectancy has doubled since the mid-1990s. Here we reflect on the lessons learned in rebuilding Rwanda's health sector during the past two decades, as the country now prepares itself to take on new challenges in health-care delivery.
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Affiliation(s)
| | | | | | | | | | | | - Fidele Ngabo
- Ministry of Health, Government of Rwanda, Kigali, Rwanda
| | | | - Cameron T Nutt
- Dartmouth Center for Health Care Delivery Science, Hanover, NH, USA
| | | | | | | | - Cathy Mugeni
- Ministry of Health, Government of Rwanda, Kigali, Rwanda
| | | | - Joseph Shema
- Ministry of Health, Government of Rwanda, Kigali, Rwanda
| | | | - Erick Gaju
- Ministry of Health, Government of Rwanda, Kigali, Rwanda
| | | | | | | | | | | | | | | | | | | | | | - Agathe Umutoni
- Ministry of Health, Government of Rwanda, Kigali, Rwanda
| | - Ida Kankindi
- Ministry of Health, Government of Rwanda, Kigali, Rwanda
| | | | - Hinda Ruton
- Ministry of Health, Government of Rwanda, Kigali, Rwanda
| | - Nathan Mugume
- Ministry of Health, Government of Rwanda, Kigali, Rwanda
| | - Denis Nkunda
- Ministry of Health, Government of Rwanda, Kigali, Rwanda
| | | | | | | | | | - Claude Sekabaraga
- Quality and Equity HealthCare-Social Health Enterprise, Kigali, Rwanda
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Anne Sliney
- Clinton Health Access Initiative, Boston, MA, USA
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