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Tankwanchi AS, Asabor EN, Vermund SH. Global Health Perspectives on Race in Research: Neocolonial Extraction and Local Marginalization. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6210. [PMID: 37444057 PMCID: PMC10341112 DOI: 10.3390/ijerph20136210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/17/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023]
Abstract
Best practices in global health training prioritize leadership and engagement from investigators from low- and middle-income countries (LMICs), along with conscientious community consultation and research that benefits local participants and autochthonous communities. However, well into the 20th century, international research and clinical care remain rife with paternalism, extractive practices, and racist ideation, with race presumed to explain vulnerability or protection from various diseases, despite scientific evidence for far more precise mechanisms for infectious disease. We highlight experiences in global research on health and illness among indigenous populations in LMICs, seeking to clarify what is both scientifically essential and ethically desirable in research with human subjects; we apply a critical view towards race and racism as historically distorting elements that must be acknowledged and overcome.
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Affiliation(s)
- Akhenaten Siankam Tankwanchi
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA
| | - Emmanuella N. Asabor
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA; (E.N.A.); (S.H.V.)
| | - Sten H. Vermund
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA; (E.N.A.); (S.H.V.)
- Department of Pediatrics, Yale School of Medicine, New Haven, CT 06510, USA
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Balandya E, Sunguya B, Kidenya B, Nyamhanga T, Minja IK, Mahande M, Mmbaga BT, Mshana SE, Mteta K, Bartlett J, Lyamuya E. Joint Research Mentoring Through the Community of Young Research Peers: A Case for a Unifying Model for Research Mentorship at Higher Learning Institutions. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:355-367. [PMID: 35478975 PMCID: PMC9038151 DOI: 10.2147/amep.s356678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/15/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND Mentorship is pivotal for sustainability of a successful research culture at higher learning institutions. Various models have been proposed for provision of research mentorship in health sciences but are challenged by utilizing predominantly hierarchical mentoring, as well as being centred on one discipline or one institution. This paper describes the approach and successes of an inclusive mentorship model employed in a resource-limited setting in sub-Saharan Africa. METHODS Through the NIH-funded Transforming Health Professions Education in Tanzania (THET) project, a consortium of three prominent health sciences higher learning institutions in Tanzania (MUHAS, CUHAS and KCMUCo) and two collaborating US institutions (UCSF and Duke University) was formed. Within THET, the Community of Young Research Peers (CYRP) was constituted, comprised two cohorts of undergraduate students and young faculty (fellows), and senior scientists. Besides mentorship and research training, fellows received funded research awards and in turn mentored undergraduate students. RESULTS By the first quarter of project year four, the number of fellows and mentored undergraduate students had increased from 12 to 24 and from 41 to 67, respectively. Fellows in the second cohort (junior fellows) included medical doctors, nurses, dentist, biomedical scientist, sociologist and education psychologist. In fostering peer-to-peer mentoring, the cross-institutional pairs of fellows from the first cohort (senior fellows) were assigned to reciprocal pairs of junior fellow mentees and took a leading role in research training. Furthermore, the senior fellows had made significant strides, including eight enrolled in PhD programmes, eight publications from mentored research projects, and six small to medium-size research grants won. CONCLUSION The unifying model of research mentorship employed by the CYRP has been demonstrated as an effective model for joint research mentorship of the diverse group of young investigators from collaborating higher learning institutions in Tanzania. This model is recommended for scale-up, particularly in sub-Saharan Africa.
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Affiliation(s)
- Emmanuel Balandya
- Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania
| | - Bruno Sunguya
- Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania
| | - Benson Kidenya
- Department of Biochemistry and Molecular Biology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Tumaini Nyamhanga
- Department of Development Studies, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania
| | - Irene K Minja
- Department of Restorative Dentistry, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania
| | - Michael Mahande
- Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Blandina T Mmbaga
- Department of Pediatrics and Child Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Stephen E Mshana
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Kien Mteta
- Department of Urology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - John Bartlett
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Eligius Lyamuya
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar-es-salaam, Tanzania
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Nembaware V, Glasser S, Priest A, Davies A, Skelton M, Bodzo P, Lelong O, Naidu A, Masimirembwa C, Mutambiranwa A, Hay A, Wonkam A, Dandara C. Competency-based Training Needs Assessment for Research Managers and Administrators in Africa and the United Kingdom to Strengthen Equitable Partnerships. AAS Open Res 2022; 5:11. [PMID: 36420448 PMCID: PMC9648359 DOI: 10.12688/aasopenres.13272.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 11/20/2022] Open
Abstract
Background: The need for competent research managers and administrators (RMAs) has increased due to the complexity in managing research projects between disparate and international partners. To facilitate the creation of robust training and professional development programmes it is essential to first understand the status quo. A collaborative project, Sustainable Management and Administration for Research: Training across the project Lifecycle (SMARTLife), made up of RMAs from South Africa, Zimbabwe and the United Kingdom (UK) developed a set of competencies to conduct an RMA competency-based training needs assessment scoping tool. Method: Nine areas were identified: Equitable partnership; Finance Management; Project Management; Monitoring and Evaluation; Reporting and Communications; Equity, Diversity & Inclusion; Training and Capacity Development; Impact a& Sustainability; and Ethical, Social, Legal a& Social Implications. Tasks for each competency area were identified to develop an scoping tool that had 168 data collection points. The tool was advertised through press releases, mailing lists and social media. Results: 108 responses were obtained: with 49% from 15 Africa countries/the remainder from the UK. The UK (71%) had more permanent RMA staff members compared to Africa (39%). There were more respondents in Africa with the title of Research Manager/Coordinator(p=0.0132) compared to the UK where most of the RMAs were employed as Finance/Contract officers. 60% of respondents from the UK had more than three years experience while only 35% from Africa had experience. While most RMAs had formal higher education qualifications, their training was not in research management and administration, which requires a diverse range of skills. Confidence in specific tasks varied between the UK and Africa whereas collaborative partnerships challenges and enablers were similar. Conclusion This work highlights differences in RMA training and experience RMA between Africa and UK, this work could inform much needed competency-based training for RMAs and partnership strategies that aid mutual-learning.
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Affiliation(s)
- Victoria Nembaware
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town,, 7925, South Africa
| | - Simon Glasser
- Research and Enterprise Development, University of Bristol, Bristol, BS8 1QU, UK
| | - Anne Priest
- Research and Innovation Services, University of Bath, Bath, BA2 7AY, UK
| | - Ailsa Davies
- Research and Innovation Services,, Cardiff University, Cardiff, CF10 3AT, UK
| | - Michelle Skelton
- H3Africa Administrative Coordinating Centre, Integrative Biomedical Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, 7925, South Africa
| | - Paidamoyo Bodzo
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town,, 7925, South Africa
| | - Olivia Lelong
- Research, Business & Innovation Service, University of the West of England, Bristol, BS16 1GY, UK
| | - Alecia Naidu
- South African National Bioinformatics Institute, University of the Western Cape, Cape Town, 7535, South Africa
| | - Colleen Masimirembwa
- African Institute of Biomedical Science and Technology (AiBST), Harare, Zimbabwe
| | - Alice Mutambiranwa
- African Institute of Biomedical Science and Technology (AiBST), Harare, Zimbabwe
| | - Annette Hay
- Research Services Office, Coventry University, Coventry, CV1 5FB, UK
| | - Ambroise Wonkam
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town,, 7925, South Africa
| | - Collet Dandara
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town,, 7925, South Africa
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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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Koon AD, Windmeyer L, Bigdeli M, Charles J, El Jardali F, Uneke J, Bennett S. A scoping review of the uses and institutionalisation of knowledge for health policy in low- and middle-income countries. Health Res Policy Syst 2020; 18:7. [PMID: 31959208 PMCID: PMC6971874 DOI: 10.1186/s12961-019-0522-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 12/20/2019] [Indexed: 12/21/2022] Open
Abstract
There is growing interest in how different forms of knowledge can strengthen policy-making in low- and middle-income country (LMIC) health systems. Additionally, health policy and systems researchers are increasingly aware of the need to design effective institutions for supporting knowledge utilisation in LMICs. To address these interwoven agendas, this scoping review uses the Arskey and O’Malley framework to review the literature on knowledge utilisation in LMIC health systems, using eight public health and social science databases. Articles that described the process for how knowledge was used in policy-making, specified the type of knowledge used, identified actors involved (individual, organisation or professional), and were set in specific LMICs were included. A total of 53 articles, from 1999 to 2016 and representing 56 countries, were identified. The majority of articles in this review presented knowledge utilisation as utilisation of research findings, and to a lesser extent routine health system data, survey data and technical advice. Most of the articles centered on domestic public sector employees and their interactions with civil society representatives, international stakeholders or academics in utilising epistemic knowledge for policy-making in LMICs. Furthermore, nearly all of the articles identified normative dimensions of institutionalisation. While there is some evidence of how different uses and institutionalisation of knowledge can strengthen health systems, the evidence on how these processes can ultimately improve health outcomes remains unclear. Further research on the ways in which knowledge can be effectively utilised and institutionalised is needed to advance the collective understanding of health systems strengthening and enhance evidence-informed policy formulation.
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Affiliation(s)
- Adam D Koon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD, 21205, United States of America. .,International Development Division, Abt Associates Inc, Rockville, MD, United States of America.
| | - Lauren Windmeyer
- Upstream USA, Oakland, CA, United States of America.,John F Kennedy School of Government, Harvard University, Cambridge, MA, United States of America
| | | | - Jodi Charles
- Office of Health Systems, United States Agency for International Development, Washington, D.C, United States of America
| | | | | | - Sara Bennett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD, 21205, United States of America
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Rees CA, Keating EM, Dearden KA, Haq H, Robison JA, Kazembe PN, Bourgeois FT, Niescierenko M. Improving Pediatric Academic Global Health Collaborative Research and Agenda Setting: A Mixed-Methods Study. Am J Trop Med Hyg 2020; 102:649-657. [PMID: 31933470 PMCID: PMC7056414 DOI: 10.4269/ajtmh.19-0555] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Academic global health collaborations have the potential to improve joint understanding of health issues in low- and middle-income countries (LMICs). Our objective was to elucidate perceptions of benefits and challenges of academic global health collaborations as well as areas for improving collaborative research conducted in LMICs. This cross-sectional, mixed-methods study surveyed investigators' perceptions of benefits and challenges of pediatric academic global health collaborations. Authors of articles from four pediatric journals reporting pediatric research conducted in LMICs published between 2006 and 2015 were surveyed. Responses of LMIC investigators were compared with those of investigators in high-income countries (HICs). Responses to open-ended questions were analyzed using a combined thematic and content analysis approach. Of 1,420 potential respondents, 252 (17.7%) responded to the survey. Collaborative research with investigators from other countries was perceived as beneficial by 88.5% of respondents (n = 223), although this perception was more common among HIC respondents (n = 110, 94.0%) than LMIC respondents (n = 113, 83.7%) (p = 0.014). Sixty-seven percent (n = 170) of respondents perceived that HIC investigators had set the research agenda in work conducted in a LMIC. Respondents identified several critical factors to improve academic global health collaborations, including research capacity building, communication, and early involvement of LMIC investigators with shared decision-making during study conception and grant writing. Pediatric academic global health collaboration was widely perceived as positive. However, despite calls for capacity building and locally generated research ideas, many respondents felt that HIC investigators set the research agenda for work conducted in LMICs. This study provides suggestions for improving collaboration among pediatric academicians globally.
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Affiliation(s)
- Chris A Rees
- Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Elizabeth M Keating
- Division of Pediatric Emergency Medicine, University of Utah, Salt Lake City, Utah
| | | | - Heather Haq
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Jeff A Robison
- Division of Pediatric Emergency Medicine, University of Utah, Salt Lake City, Utah
| | - Peter N Kazembe
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Florence T Bourgeois
- Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michelle Niescierenko
- Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Research Capacity Strengthening in Sub-Saharan Africa: Recognizing the Importance of Local Partnerships in Designing and Disseminating HIV Implementation Science to Reach the 90-90-90 Goals. AIDS Behav 2019; 23:206-213. [PMID: 31098746 PMCID: PMC6773819 DOI: 10.1007/s10461-019-02538-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Capacity building in implementation science is integral to PEPFAR’s mission and to meeting the 90–90–90 goals. The USAID funded Project SOAR sponsored a 4 day workshop for investigators and governmental and non-governmental partners from 12 African countries. The workshop was designed to address both findings from a pre-workshop online needs assessment as well as capacity challenges across the capacity building pyramid, from individual skills to institutional systems and resources. Activities were output-oriented and skill based. An online survey evaluated sessions and changes in perceptions of needs; a majority of respondents strongly agreed that after the workshop, they better understood their personal and institutional capacity strengthening needs. Participants ‘strongly agreed’ that workshop content was relevant to their jobs (90%) and that they left the workshop with a specific plan for conducting future research (65%). Workshop results suggest that skill-building should be done in conjunction with systems capacity building within the cultural context.
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Mayor A, Martínez-Pérez G, Tarr-Attia CK, Breeze-Barry B, Sarukhan A, García-Sípido AM, Hurtado JC, Lansana DP, Casamitjana N. Training through malaria research: building capacity in good clinical and laboratory practice in Liberia. Malar J 2019; 18:136. [PMID: 30999908 PMCID: PMC6471755 DOI: 10.1186/s12936-019-2767-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/04/2019] [Indexed: 11/20/2022] Open
Abstract
Background Limited health research capacities (HRC) undermine a country’s ability to identify and adequately respond to local health needs. Although numerous interventions to strengthen HRC have been conducted in Africa, there is a need to share the lessons learnt by funding organizations, institutes and researchers. The aim of this report is to identify best practices in HRC strengthening by describing a training programme conducted between 2016 and 2017 at the Saint Joseph’s Catholic Hospital (SJCH) in Monrovia (Liberia). Methods A call for trainees was launched at the SJCH, the Liberia Medicines and Health Products Regulatory Authority (LMHRA), the Ministry of Health and Social Welfare, the Mother Pattern College of Health Sciences (MPCHS) and community members. Selected trainees participated in four workshops on Good Clinical Laboratory Practice (GCLP), standard operating procedures (SOP) and scientific communication, as well as in a 5-months eLearning mentoring programme. After the training, a collectively-designed research project on malaria was conducted. Results Twenty-one of the 28 trainees (14 from the SJCH, 3 from LMHRA, one from MPCHS, and 10 community representatives) completed the programme satisfactorily. Pre- and post-training questionnaires completed by 9 of the trainees showed a 14% increase in the percentage of correct answers. Trainees participated in a mixed-methods cross-sectional study of Plasmodium falciparum infection among pregnant women at the SJCH. Selected trainees disseminated activities and research outcomes in three international meetings and three scientific publications. Conclusion This training-through-research programme successfully involved SJCH staff and community members in a practical research exercise on malaria during pregnancy. The challenge is to ensure that the SJCH remains active in research. Harmonization of effectiveness indicators for HRC initiatives would strengthen the case for investing in such efforts. Electronic supplementary material The online version of this article (10.1186/s12936-019-2767-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alfredo Mayor
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
| | | | | | | | - Adelaida Sarukhan
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | | | | | | | - Núria Casamitjana
- ISGlobal, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
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Raftery J, Hanney S, Greenhalgh T, Glover M, Blatch-Jones A. Models and applications for measuring the impact of health research: update of a systematic review for the Health Technology Assessment programme. Health Technol Assess 2018; 20:1-254. [PMID: 27767013 DOI: 10.3310/hta20760] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND This report reviews approaches and tools for measuring the impact of research programmes, building on, and extending, a 2007 review. OBJECTIVES (1) To identify the range of theoretical models and empirical approaches for measuring the impact of health research programmes; (2) to develop a taxonomy of models and approaches; (3) to summarise the evidence on the application and use of these models; and (4) to evaluate the different options for the Health Technology Assessment (HTA) programme. DATA SOURCES We searched databases including Ovid MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature and The Cochrane Library from January 2005 to August 2014. REVIEW METHODS This narrative systematic literature review comprised an update, extension and analysis/discussion. We systematically searched eight databases, supplemented by personal knowledge, in August 2014 through to March 2015. RESULTS The literature on impact assessment has much expanded. The Payback Framework, with adaptations, remains the most widely used approach. It draws on different philosophical traditions, enhancing an underlying logic model with an interpretative case study element and attention to context. Besides the logic model, other ideal type approaches included constructionist, realist, critical and performative. Most models in practice drew pragmatically on elements of several ideal types. Monetisation of impact, an increasingly popular approach, shows a high return from research but relies heavily on assumptions about the extent to which health gains depend on research. Despite usually requiring systematic reviews before funding trials, the HTA programme does not routinely examine the impact of those trials on subsequent systematic reviews. The York/Patient-Centered Outcomes Research Institute and the Grading of Recommendations Assessment, Development and Evaluation toolkits provide ways of assessing such impact, but need to be evaluated. The literature, as reviewed here, provides very few instances of a randomised trial playing a major role in stopping the use of a new technology. The few trials funded by the HTA programme that may have played such a role were outliers. DISCUSSION The findings of this review support the continued use of the Payback Framework by the HTA programme. Changes in the structure of the NHS, the development of NHS England and changes in the National Institute for Health and Care Excellence's remit pose new challenges for identifying and meeting current and future research needs. Future assessments of the impact of the HTA programme will have to take account of wider changes, especially as the Research Excellence Framework (REF), which assesses the quality of universities' research, seems likely to continue to rely on case studies to measure impact. The HTA programme should consider how the format and selection of case studies might be improved to aid more systematic assessment. The selection of case studies, such as in the REF, but also more generally, tends to be biased towards high-impact rather than low-impact stories. Experience for other industries indicate that much can be learnt from the latter. The adoption of researchfish® (researchfish Ltd, Cambridge, UK) by most major UK research funders has implications for future assessments of impact. Although the routine capture of indexed research publications has merit, the degree to which researchfish will succeed in collecting other, non-indexed outputs and activities remains to be established. LIMITATIONS There were limitations in how far we could address challenges that faced us as we extended the focus beyond that of the 2007 review, and well beyond a narrow focus just on the HTA programme. CONCLUSIONS Research funders can benefit from continuing to monitor and evaluate the impacts of the studies they fund. They should also review the contribution of case studies and expand work on linking trials to meta-analyses and to guidelines. FUNDING The National Institute for Health Research HTA programme.
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Affiliation(s)
- James Raftery
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Steve Hanney
- Health Economics Research Group (HERG), Institute of Environment, Health and Societies, Brunel University London, London, UK
| | - Trish Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Matthew Glover
- Health Economics Research Group (HERG), Institute of Environment, Health and Societies, Brunel University London, London, UK
| | - Amanda Blatch-Jones
- Wessex Institute, Faculty of Medicine, University of Southampton, Southampton, UK
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Dean L, Gregorius S, Bates I, Pulford J. Advancing the science of health research capacity strengthening in low-income and middle-income countries: a scoping review of the published literature, 2000-2016. BMJ Open 2017; 7:e018718. [PMID: 29217727 PMCID: PMC5728300 DOI: 10.1136/bmjopen-2017-018718] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Substantial development assistance and research funding are invested in health research capacity strengthening (HRCS) interventions in low-income and middle-income countries, yet the effectiveness, impact and value for money of these investments are not well understood. A major constraint to evidence-informed HRCS intervention has been the disparate nature of the research effort to date. This review aims to map and critically analyse the existing HRCS effort to better understand the level, type, cohesion and conceptual sophistication of the current evidence base. The overall goal of this article is to advance the development of a unified, implementation-focused HRCS science. METHODS We used a scoping review methodology to identify peer-reviewed HRCS literature within the following databases: PubMed, Global Health and Scopus. HRCS publications available in English between the period 2000 and 2016 were included. 1195 articles were retrieved of which 172 met the final inclusion criteria. A priori thematic analysis of all included articles was completed. Content analysis of identified HRCS definitions was conducted. RESULTS The number of HRCS publications increased exponentially between 2000 and 2016. Most publications during this period were perspective, opinion or commentary pieces; however, original research publications were the primary publication type since 2013. Twenty-five different definitions of research capacity strengthening were identified, of which three aligned with current HRCS guidelines. CONCLUSIONS The review findings indicate that an HRCS research field with a focus on implementation science is emerging, although the conceptual and empirical bases are not yet sufficiently advanced to effectively inform HRCS programme planning. Consolidating an HRCS implementation science therefore presents as a viable option that may accelerate the development of a useful evidence base to inform HRCS programme planning. Identifying an agreed operational definition of HRCS, standardising HRCS-related terminology, developing a needs-based HRCS-specific research agenda and synthesising currently available evidence may be useful first steps.
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Affiliation(s)
- Laura Dean
- Department of International Public Health, Capacity Research Unit, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Stefanie Gregorius
- Department of International Public Health, Capacity Research Unit, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Imelda Bates
- Department of International Public Health, Capacity Research Unit, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Justin Pulford
- Department of International Public Health, Capacity Research Unit, Liverpool School of Tropical Medicine, Liverpool, UK
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Kass NE, Ali J, Hallez K, Hyder AA. Bioethics training programmes for Africa: evaluating professional and bioethics-related achievements of African trainees after a decade of Fogarty NIH investment. BMJ Open 2016; 6:e012758. [PMID: 27633644 PMCID: PMC5030587 DOI: 10.1136/bmjopen-2016-012758] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Our primary aim was to evaluate the impact of US National Institutes of Health (NIH)-funded bioethics training programmes (Fogarty bioethics training programmes, FBTPs) that trained individuals from Africa over the programme's first 10 years to examine changes between pretraining and post-training in individual achievement and to document any associations between individual, training programme and post-training accomplishments. DESIGN We surveyed trainees from the 10 bioethics programmes funded by NIH Fogarty International Center from 2000 to 2011 that included African trainees. McNemar's and Wilcoxon signed rank-sum tests were used to analyse pre-post levels of general and bioethics-related professional achievement. Likelihood of specific post-training achievement outcomes was measured using logistic regression including demographic, pretraining and intratraining variables. SETTING 10 different FBTPs that trained individuals from Africa from 2000 to 2011. PARTICIPANTS Of 253 eligible respondents, 171 completed the survey (response rate 67.6%). PRIMARY OUTCOME MEASURES Pre-post comparisons of professional achievement indicators (eg, serving in leadership roles, teaching, publishing manuscripts); likelihood of specific post-training achievement outcomes. RESULTS Post-training, respondents were significantly more likely to report serving in a leadership role, being an investigator on a research grant, serving on international committees, serving as a mentor, and publishing manuscripts than at pretraining. Post-training, significantly greater numbers of respondents reported bioethics-related achievements including being a bioethics instructor, serving on an Institutional Review Board (IRB), being an investigator on a bioethics grant and publishing bioethics-related manuscripts than pretraining. Controlling for other factors, there were no significant differences by gender in the post-training success of these participants in terms of leadership roles, being instructors, investigators on grants and holding IRB roles. CONCLUSIONS African trainees who participated in FBTPs reported significantly higher levels of professional achievement after training. There was no single factor-either demographic, related to a trainee's professional background, or in programme design-that consistently predicted greater levels of post-training achievement.
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Affiliation(s)
- Nancy E Kass
- Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joseph Ali
- Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA
| | - Kristina Hallez
- Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA
| | - Adnan A Hyder
- Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Rabbani F, Shipton L, White F, Nuwayhid I, London L, Ghaffar A, Ha BTT, Tomson G, Rimal R, Islam A, Takian A, Wong S, Zaidi S, Khan K, Karmaliani R, Abbasi IN, Abbas F. Schools of public health in low and middle-income countries: an imperative investment for improving the health of populations? BMC Public Health 2016; 16:941. [PMID: 27604901 PMCID: PMC5015344 DOI: 10.1186/s12889-016-3616-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 08/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Public health has multicultural origins. By the close of the nineteenth century, Schools of Public Health (SPHs) began to emerge in western countries in response to major contemporary public health challenges. The Flexner Report (1910) emphasized the centrality of preventive medicine, sanitation, and public health measures in health professional education. The Alma Ata Declaration on Primary Health Care (PHC) in 1978 was a critical milestone, especially for low and middle-income countries (LMICs), conceptualizing a close working relationship between PHC and public health measures. The Commission on Social Determinants of Health (2005-2008) strengthened the case for SPHs in LMICs as key stakeholders in efforts to reduce global health inequities. This scoping review groups text into public health challenges faced by LMICs and the role of SPHs in addressing these challenges. MAIN TEXT The challenges faced by LMICs include rapid urbanization, environmental degradation, unfair terms of global trade, limited capacity for equitable growth, mass displacements associated with conflicts and natural disasters, and universal health coverage. Poor governance and externally imposed donor policies and agendas, further strain the fragile health systems of LMICs faced with epidemiological transition. Moreover barriers to education and research imposed by limited resources, political and economic instability, and unbalanced partnerships additionally aggravate the crisis. To address these contextual challenges effectively, SPHs are offering broad based health professional education, conducting multidisciplinary population based research and fostering collaborative partnerships. SPHs are also looked upon as the key drivers to achieve sustainable development goals (SDGs). CONCLUSION SPHs in LMICs can contribute to overcoming several public health challenges being faced by LMICs, including achieving SDGs. Most importantly they can develop cadres of competent and well-motivated public health professionals: educators, practitioners and researchers who ask questions that address fundamental health determinants, seek solutions as agents of change within their mandates, provide specific services and serve as advocates for multilevel partnerships. Funding support, human resources, and agency are unfortunately often limited or curtailed in LMICs, and this requires constructive collaboration between LMICs and counterpart institutions from high income countries.
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Affiliation(s)
- Fauziah Rabbani
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Leah Shipton
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Franklin White
- Pacific Health & Development Sciences Inc., Victoria, Canada
| | - Iman Nuwayhid
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Leslie London
- Division Public Health Medicine, School of Public Health and Family Medicine University of Cape Town, Cape Town, South Africa
| | - Abdul Ghaffar
- Alliance for Health Policy and Systems Research, WHO, Geneva, Switzerland
| | - Bui Thi Thu Ha
- Hanoi School of Public Health, Giang Vo, Ba Dinh, Hanoi, Vietnam
| | - Göran Tomson
- Depts LIME & PHS, Karolinska Institutet Stockholm, Stockholm, Sweden
| | - Rajiv Rimal
- Department of Prevention and Community Health, George Washington University School of Public Health and Health Services, Washington, USA
| | - Anwar Islam
- School of Health Policy and Management, York University, Toronto, Ontario Canada
| | - Amirhossein Takian
- Department of Global Health & Sustainable Development, School of Public Health-Tehran University of Medical Sciences, Tehran, Iran
| | - Samuel Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Shehla Zaidi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Kausar Khan
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Rozina Karmaliani
- School of Nursing & Midwifery and Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Imran Naeem Abbasi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Farhat Abbas
- Medical College, Aga Khan University, Karachi, Pakistan
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13
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Yarber L, Brownson CA, Jacob RR, Baker EA, Jones E, Baumann C, Deshpande AD, Gillespie KN, Scharff DP, Brownson RC. Evaluating a train-the-trainer approach for improving capacity for evidence-based decision making in public health. BMC Health Serv Res 2015; 15:547. [PMID: 26652172 PMCID: PMC4676893 DOI: 10.1186/s12913-015-1224-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 12/08/2015] [Indexed: 11/25/2022] Open
Abstract
Background Evidence-based public health gives public health practitioners the tools they need to make choices based on the best and most current evidence. An evidence-based public health training course developed in 1997 by the Prevention Research Center in St. Louis has been taught by a transdisciplinary team multiple times with positive results. In order to scale up evidence-based practices, a train-the-trainer initiative was launched in 2010. Methods This study examines the outcomes achieved among participants of courses led by trained state-level faculty. Participants from trainee-led courses in four states (Indiana, Colorado, Nebraska, and Kansas) over three years were asked to complete an online survey. Attempts were made to contact 317 past participants. One-hundred forty-four (50.9 %) reachable participants were included in analysis. Outcomes measured include frequency of use of materials, resources, and other skills or tools from the course; reasons for not using the materials and resources; and benefits from attending the course. Survey responses were tabulated and compared using Chi-square tests. Results Among the most commonly reported benefits, 88 % of respondents agreed that they acquired knowledge about a new subject, 85 % saw applications for the knowledge to their work, and 78 % agreed the course also improved abilities to make scientifically informed decisions at work. The most commonly reported reasons for not using course content as much as intended included not having enough time to implement evidence-based approaches (42 %); other staff/peers lack training (34 %); and not enough funding for continued training (34 %). The study findings suggest that utilization of course materials and teachings remains relatively high across practitioner groups, whether they were taught by the original trainers or by state-based trainers. Conclusions The findings of this study suggest that train-the-trainer is an effective method for broadly disseminating evidence-based public health principles. Train-the-trainer is less costly than the traditional method and allows for courses to be tailored to local issues, thus making it a viable approach to dissemination and scale up of new public health practices. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-1224-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Laura Yarber
- College for Public Health & Social Justice, Saint Louis University, St. Louis, MO, USA.
| | - Carol A Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA.
| | - Rebekah R Jacob
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA.
| | - Elizabeth A Baker
- College for Public Health & Social Justice, Saint Louis University, St. Louis, MO, USA.
| | - Ellen Jones
- School of Health Related Professions, University of Mississippi Medical Center, Jackson, MS, USA. .,National Association of Chronic Disease Directors, Atlanta, GA, USA.
| | - Carsten Baumann
- Department of Public Health and Environment, Health Statistics and Evaluation Branch, Denver, CO, USA.
| | - Anjali D Deshpande
- Division of General Medical Sciences, Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.
| | - Kathleen N Gillespie
- College for Public Health & Social Justice, Saint Louis University, St. Louis, MO, USA.
| | - Darcell P Scharff
- College for Public Health & Social Justice, Saint Louis University, St. Louis, MO, USA.
| | - Ross C Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO, USA. .,Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.
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14
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Heimburger DC, Carothers CL, Blevins M, Warner TL, Vermund SH. Impact of Global Health Research Training on Career Trajectories: The Fogarty International Clinical Research Scholars and Fellows Program. Am J Trop Med Hyg 2015. [PMID: 26195466 DOI: 10.4269/ajtmh.14-0705(july] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
From 2004 to 2012, the Fogarty International Clinical Research Scholars/Fellows Program (FICRS-F) provided 1-year research training opportunities for U.S. and international doctoral "Scholars" and postdoctoral "Fellows" at low- and middle-income country (LMIC) centers. We collected data prospectively and then surveyed a representative sample of 100 alumni (94% response), assessing Program impacts on their careers and collaborations. Frequently, collaborations continued beyond the formal training period with U.S.- (63%) and site-based mentors (66%). U.S. Fellows reported the highest post-training focus on research (88 on a 100-point scale), and the highest Program impact on competitiveness for career or training positions and choices of post-training topics and institutions (95 points). Interest in global health research increased markedly during the training period, especially for LMIC trainees, and was sustained post-training. LMIC alumni reported a significantly higher focus on global health and research than did U.S. alumni. Alumni reported that their mentored research training had a substantial impact on their career trajectories.
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Affiliation(s)
- Douglas C Heimburger
- Departments of Medicine, Biostatistics, and Pediatrics, Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee; Fogarty International Clinical Research Scholars and Fellows Support Center at Vanderbilt, Vanderbilt University, Nashville, Tennessee
| | - Catherine Lem Carothers
- Departments of Medicine, Biostatistics, and Pediatrics, Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee; Fogarty International Clinical Research Scholars and Fellows Support Center at Vanderbilt, Vanderbilt University, Nashville, Tennessee
| | - Meridith Blevins
- Departments of Medicine, Biostatistics, and Pediatrics, Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee; Fogarty International Clinical Research Scholars and Fellows Support Center at Vanderbilt, Vanderbilt University, Nashville, Tennessee
| | - Tokesha L Warner
- Departments of Medicine, Biostatistics, and Pediatrics, Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee; Fogarty International Clinical Research Scholars and Fellows Support Center at Vanderbilt, Vanderbilt University, Nashville, Tennessee
| | - Sten H Vermund
- Departments of Medicine, Biostatistics, and Pediatrics, Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee; Fogarty International Clinical Research Scholars and Fellows Support Center at Vanderbilt, Vanderbilt University, Nashville, Tennessee
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15
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Heimburger DC, Carothers CL, Blevins M, Warner TL, Vermund SH. Impact of Global Health Research Training on Career Trajectories: The Fogarty International Clinical Research Scholars and Fellows Program. Am J Trop Med Hyg 2015. [PMID: 26195466 DOI: 10.4269/ajtmh.14-0705] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
From 2004 to 2012, the Fogarty International Clinical Research Scholars/Fellows Program (FICRS-F) provided 1-year research training opportunities for U.S. and international doctoral "Scholars" and postdoctoral "Fellows" at low- and middle-income country (LMIC) centers. We collected data prospectively and then surveyed a representative sample of 100 alumni (94% response), assessing Program impacts on their careers and collaborations. Frequently, collaborations continued beyond the formal training period with U.S.- (63%) and site-based mentors (66%). U.S. Fellows reported the highest post-training focus on research (88 on a 100-point scale), and the highest Program impact on competitiveness for career or training positions and choices of post-training topics and institutions (95 points). Interest in global health research increased markedly during the training period, especially for LMIC trainees, and was sustained post-training. LMIC alumni reported a significantly higher focus on global health and research than did U.S. alumni. Alumni reported that their mentored research training had a substantial impact on their career trajectories.
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Affiliation(s)
- Douglas C Heimburger
- Departments of Medicine, Biostatistics, and Pediatrics, Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee; Fogarty International Clinical Research Scholars and Fellows Support Center at Vanderbilt, Vanderbilt University, Nashville, Tennessee
| | - Catherine Lem Carothers
- Departments of Medicine, Biostatistics, and Pediatrics, Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee; Fogarty International Clinical Research Scholars and Fellows Support Center at Vanderbilt, Vanderbilt University, Nashville, Tennessee
| | - Meridith Blevins
- Departments of Medicine, Biostatistics, and Pediatrics, Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee; Fogarty International Clinical Research Scholars and Fellows Support Center at Vanderbilt, Vanderbilt University, Nashville, Tennessee
| | - Tokesha L Warner
- Departments of Medicine, Biostatistics, and Pediatrics, Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee; Fogarty International Clinical Research Scholars and Fellows Support Center at Vanderbilt, Vanderbilt University, Nashville, Tennessee
| | - Sten H Vermund
- Departments of Medicine, Biostatistics, and Pediatrics, Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, Tennessee; Fogarty International Clinical Research Scholars and Fellows Support Center at Vanderbilt, Vanderbilt University, Nashville, Tennessee
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Paina L, Ssengooba F, Waswa D, M’Imunya JM, Bennett S. How does investment in research training affect the development of research networks and collaborations? Health Res Policy Syst 2013; 11:18. [PMID: 23688105 PMCID: PMC3671195 DOI: 10.1186/1478-4505-11-18] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 04/30/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Whether and how research training programs contribute to research network development is underexplored. The Fogarty International Center (FIC) has supported overseas research training programs for over two decades. FIC programs could provide an entry point in the development of research networks and collaborations. We examine whether FIC's investment in research training contributed to the development of networks and collaborations in two countries with longstanding FIC investments - Uganda and Kenya - and the factors which facilitated this process. METHODS As part of two case studies at Uganda's Makerere University and Kenya's University of Nairobi, we conducted 53 semi-structured in-depth interviews and nine focus group discussions. To expand on our case study findings, we conducted a focused bibliometric analysis on two purposively selected topic areas to examine scientific productivity and used online network illustration tools to examine the resulting network structures. RESULTS FIC support made important contributions to network development. Respondents from both Uganda and Kenya confirmed that FIC programs consistently provided trainees with networking skills and exposure to research collaborations, primarily within the institutions implementing FIC programs. In both countries, networks struggled with inclusiveness, particularly in HIV/AIDS research. Ugandan respondents perceived their networks to be more cohesive than Kenyan respondents did. Network cohesiveness was positively correlated with the magnitude and longevity of FIC's programs. Support from FIC grants to local and regional research network development and networking opportunities, such as conferences, was rare. Synergies between FIC programs and research grants helped to solidify and maintain research collaborations. CONCLUSIONS Networks developed where FIC's programs focused on a particular institution, there was a critical mass of trainees with similar interests, and investments for network development were available from early implementation. Networks were less likely to emerge where FIC efforts were thinly scattered across multiple institutions. The availability of complementary research grants created opportunities for researchers to collaborate in grant writing, research implementation, and publications. FIC experiences in Uganda and Kenya showcase the important role of research training programs in creating and sustaining research networks. FIC programs should consider including support to research networks more systematically in their capacity development agenda.
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Affiliation(s)
- Ligia Paina
- Department of International Health, Johns Hopkins School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205, USA
| | - Freddie Ssengooba
- Health Policy, Planning and Management Department, Makerere University School of Public Health, Mulago Hill Rd, Kampala, Uganda
| | - Douglas Waswa
- Independent consultant, P.O. Box 43994–00100, Nairobi, Kenya
| | - James M M’Imunya
- Institute of Tropical and Infectious Diseases, University of Nairobi, College of Health Sciences (KNH Campus), P.O. Box 19676–00202, Nairobi, Kenya
| | - Sara Bennett
- Department of International Health, Johns Hopkins School of Public Health, 615 N. Wolfe St, Baltimore, MD 21205, USA
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