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Developing research capacity – learning from developing countries

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1 Developing research capacity – learning from developing countries
Capacity Research Unit Developing research capacity – learning from developing countries Imelda Bates, Tanith Palmer, Alan Boyd

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 Multi-disciplinary team with projects in excess of £2m Use Independent academic rigour, evidence based process and methods CS of interest to funders – demonstrating effects and value for money by providing evidence about how to do and measure CS

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. Ask the audience, CS is all encompassing and is going on around us every day! Capacity strengthening is the process by which individuals and organisations develop the ability to set and achieve their own objectives

4 We collated and synthesized fragmented evidence
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
Awareness Efforts made to engage all relevant stakeholders at organisation and policy level as well as individuals involved in implementing CD cycle; emphasis on local ownership with defined role for external input Learning from doing Plans for CD, with timelines, developed in collaboration with all stakeholders with external input; local change agents identified; start small, test and intensively monitor different models; plans implemented in a continuous learning cycle Expansion Identify scalable models and easy-to-measure indicators for long-term monitoring; New capacity becomes embedded in existing structures; build on strengths and what works; efforts to influence policy and identify sustainable funds Consolidation Capacity development becomes routine, independent funds secured, minimal external input, autonomy to be flexible and solve problems. 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 Institutional: In each project we recognise CS is about the individuals but also the organisations within which they sit, and the enabling environment (political, economic). Indicators for tracking changes in technical, managerial procedures, but also changes in attitudes, collective decision making, dialogue across organisation and with policy Participatory: CNTD lab strengthening project – lab managers & staff, institutional leaders, and policy/programme stakeholders all participated in needs assessment, collecting data, developing action plans, active role in monitoring, joint advocacy to funder. Respectful partnerships, inclusive, not externally driven. Developmental design: Systematic methods, social science oriented, values the perceptions/feelings of people & institutions over experimental and controlled evaluation. Action research cycles of improvement and reflection; continuous collaboration & feedback between evaluator/ppts Sustainability: plans include short and long term goals; incorp group/programme into an organisation, integrate with another institution, or programme becomes an autonomous entity self funded. Ie CNTD work – Ghana lab – external accreditation important to become regional reference centre with a business strategy (referral and quality assurance centre, on-site and outreach training across the region) – all incorp into CS action plan

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 Novel as we begin with CS goal and make clear optimal capacity Approach and tools used mainly in health sector LMICs – applied to other sectors in current grants *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 (9)

10 Why is it important to strengthen capacity to do research?
Better decisions and policies to achieve health targets Scale up of research and innovation Need capacity to solve problems

11 Developing institutional research and education capacity
Liverpool School of Tropical Medicine Komfo Anokye 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 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 Novel as we begin with CS goal and make clear optimal capacity Approach and tools used mainly in health sector LMICs – applied to other sectors in current grants *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) Novel as we begin with CS goal and make clear optimal capacity Approach and tools used mainly in health sector LMICs – applied to other sectors in current grants *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
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 Novel as we begin with CS goal and make clear optimal capacity Approach and tools used mainly in health sector LMICs – applied to other sectors in current grants 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: 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) Novel as we begin with CS goal and make clear optimal capacity Approach and tools used mainly in health sector LMICs – applied to other sectors in current grants

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 Results and dissemination
Phase 1: Scoping Phase 2: Case studies Phase 3: Results and dissemination Identify schemes Describe format Identify theories of change and action Longitudinal /prospective Feedback and action research Key stakeholder interviews and focus groups Volunteering independently non-NHS / non- healthcare Royal Colleges NHS and private hospitals Literature review Key stakeholder interviews Increasing integration with service? Variable support Map of schemes Tested and elaborated theories Recommendations


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