Developing research capacity – learning from developing countries

1. Capacity Research Unit Developing research capacity – learning from developing countries

2. What does our Capacity Research Unit do? Innovative research and practice in the planning, implementation and evaluation of capacity strengthening programmes in LMICs • We have developed a 5 step process for designing and measuring sustainable capacity development that works in different contexts • Our process uses best available evidence and is tailored for each unique context • We focus on strengthening organisations’ capacity, including their staff and external linkages

3. What is capacity strengthening? On another level, it is the only thing that matters. Focusing on capacity development, complex as it may be, is really the only way to help countries continue the exit from aid dependence. On one level, capacity development is one of those issues we shouldn't beat ourselves up about too much. It is inherently difficult. It might be better just to build a road and leave the complicated stuff alone. Capacity strengthening is the process by which individuals and organisations develop the ability to set and achieve their own objectives http://www.theguardian.com/global-development/poverty-matters/2011/dec/16/capacity-building-development-aid-dependence?INTCMP=SRCH&guni=Article:in%20body%20link

4. We collated and synthesized fragmented evidence* to design a generic approach to capacity strengthening Aim of capacity strengthening To achieve autonomous, self-sustaining, problem-solving and decision-making institutions and systems Our 5 step process: • Define the goal of the CS • Use evidence to define the optimal capacity needed to achieve the goal • Determine existing capacity; identify gaps compared to optimal • Devise and implement an action plan to fill the gaps • Revisit the plan and indicators regularly *Cole, D et al (2012) Evaluations of health research capacity strengthening: a review of the evidence. American Journal of Tropical Medicine and Hygiene 87(5), 242

5. Our model for conceptualising capacity strengthening programmes

6. Our key capacity strengthening (CS) principles : • start small; gain trust • look for, and build on, what is already there • focus on individuals, institutional and network CS • planning, implementation and monitoring is participatory • evaluate using mixed methods • start with a planned exit strategy to promote autonomy and sustainability

7. How does our approach contribute to more effective CS efforts? • We have developed new methods and tools for planning, measuring and evaluating CS initiatives • We use pre-defined indicators* to provide funders with robust evidence about progress and value-for-money • Real-time monitoring means we can provide advice to continuously improve the CS programme • We actively promote lesson sharing between grantees, funders (e.g. WHO, DFID, RS), academics and decision-makers *Bates I, et al. Indicators of sustainable capacity building for health research: analysis of four African case studies. Health Research Policy and Systems 2011, 9(1), 14

8. Clinical service example: Strengthening global laboratory capacity for Neglected Tropical Diseases Background Lack of capacity in laboratory systems is a major barrier to achieving the 2020 global targets for control and elimination of NTDs • We are: • supporting systematic and measurable capacity strengthening for NTD laboratories • demonstrating laboratories are progressing towards becoming centres of excellence • strengthening a global network of NTD laboratories

9. PhD programmes: 5 African universities in the Malaria Capacity Development Consortium (Wellcome Trust)* Background Need to establish/improve PhD training in 5 African universities (Ghana, Malawi, Tanzania, Senegal, Uganda) We have: • defined ‘optimal’ capacity for PhD programmes • identified institutional gaps • recommended actions • monitored progress • shared lessons across consortia • advised other programmes/funders Bates I, et al Assessing and strengthening African universities' capacity for doctoral programmes. PLOS Medicine 2011 8(9)

10. Why is it important to strengthen capacity to do research?

11. Developing institutional research and education capacity Liverpool School of Tropical Medicine KomfoAnokye Teaching Hospital, Kumasi, Ghana

12. Diploma in Project Design and Management - 1 DPDM is part of a broader institutional research CS programme* Purpose of DPDM is to: • Generate local evidence to improve patient care • Strengthen the research activities and profile of KATH • Increase the number of appointable consultants by supporting them through the research component of professional examinations Background • Conceived in 2002 - LSTM and KATH collaboration • LSTM Diploma award/QA but run in Ghana by local team • One year, part-time, work-based programme • Expanded to Accra, Ghana in 2009 and Harare, Zimbabwe in 2011 *Bates I. Akoto AY. et al. Evaluating Health Research Capacity Building: An Evidence-Based Tool PLoS Medicine 3(8):e299, 2006 Nabwera H, Purnell S, Bates I. Development of a quality assurance handbook to improve educational courses in Africa. Human Resources for Health 2008, 6:28

13. Diploma in Project Design and Management - 2 Course participants are confident and competent to do basic research* Participants are from all hospital departments (e.g. clinical, administration, laboratory, physiotherapy etc) They research into topics of importance to their department Learning-by-doing; facilitated workshops; peer support +++ By the end of the course participants are able to: • Devise a research question to address a priority problem • Design and conduct a simple research project to answer their research question • Write a report of their research in conventional dissertation format • Describe what, and how, they learnt (reflection skills) *Bates I, Ansong D et al. Evaluation of a learner-designed course for teaching health research skills in Ghana BMC Medical Education 2007, 7:18

14. Challenges and successes of DPDM Challenges • UK inputs++ for start up • Training facilitators • UK HEI QA standards Successes • 18 DPDM faculty staff + admin • Local academic board, tutors, supervisors, markers, admin • Sustainable – finances, systems and people • ~80 graduates; successes in College exams and MSc/PhD • Increase in consultants; DPDM recognized for career progression • Extension to other sites (Accra, Harare) • Research uptake for policy and clinical care • Publications x7 Ansong, D et al (2012) Strengthening research capacity within a Ghanaian teaching hospital: ten year prospective study. American Journal of Tropical Medicine and Hygiene, 87(5), Sup1, 242.

15. LSTM and MBS collaboration Project (2010-)to explore how CS for health research has been evaluated • Funded by the Canadian Institutes of Health Research • Other collaborators: SPH@University of Toronto; ESSENCE global funders’ group • 4 papers: frameworks, indicators, challenges/tensions and policy implications New proposal: volunteering for health development - benefits for the NHS? Brings together expertise in volunteering in LMICs (LSTM) and NHS systems and networks (MBS)

16. Thank you

17. Benefits and challenges for the NHS in implementing international volunteer programmes

18. Background • Volunteer schemes contribute to demand for services, shrinking resources and boosting morale • Increase number and diversity of volunteer schemes • APPG encourages scale up of overseas volunteering • Lacking in evidence focussed on the benefits to UK institutions • Benefits match NHS and GMC professional development indicators • Need to underpin recommendations with academic evidence

19. Previous Research • Volunteering can: • Boost morale • Improve health overseas • Increased innovation (APPG) • Improve leadership/management skills • Build stronger international relationships • Lacking research in the following areas: • How to effectively implement volunteer programmes • How to recognise and disseminate good practice • How policy can support scale up

20. Aim of our Research “To produce evidence-based recommendations for the NHS regarding effective policies and their implementation for international volunteer programmes at the institutional level, to maximise benefits to the NHS”

21. Objectives of our Research • To describe the nature and form of international volunteer schemes • To describe actual and perceived barriers in international volunteer schemes • To compare institutions undertaking schemes and those that don’t. • To establish how skills and experiences have an impact within the NHS and are incorporated into policy and practice. • To derive recommendations for improving the effectiveness and impact of volunteering activities

22. Longitudinal /prospective • Feedback and action research • Key stakeholder interviews and focus groups • Literature review • Key stakeholder interviews • Phase 3: • Results and dissemination • Phase 2: • Case studies • Phase 1: • Scoping • Identify schemes • Describe format • Identify theories of change and action Increasing integration with service? Variable support Map of schemes Tested and elaborated theories Recommendations