1. Strategies for capacity building for health systems research in LMIC: some lessons and ideas from ICDDRB HPF Hub Technical Review meeting Krishna Hort : Friday 7 October 2011

2. Introduction Engaged by donors of ICDDR,B in 2006 to review support, and in 2010 to follow up Article describing results published in Health Research Policy and Systems: 2011, 9: 31 as ‘Mahmood S, Hort K, Ahmed S, Salam M, Cravioto A. Strategies for capacity building for health research in Bangladesh: Role of core funding and a common M&E Framework’ Acknowledge co-authors in this presentation based on collective work

3. Literature review on research capacity building in LMIC Definition of research capacity: ‘ an ability of individuals, organisations and systems to perform and utilise health research effectively, efficiently and sustainably’ (Bates et al, 2006) Requires both institutional support and improving individual research capacity

4. Literature review on research capacity building in LMIC Some of the challenges: Adequate funds for researcher and staff salaries; Training of individual researchers; Career structure for researchers; Good research management; Access to scientific and technical information; Partnerships with international groups; Effective communication with research users; Competent and motivated research leaders

5. Role of external support Requires long term substantial financial support from development partners Technical support from international research expertise Issues of different perspectives of development partners (concern for research uptake) Different development partners may have different priorities and research interests Lack of evidence on effective development partner support for research capacity building

6. ICDDRB, Introduction ICDDR,B: international research institute located in Bangladesh Established in 1960 International board of management Broad scope: infectious diseases, nutrition, population, health systems, environment Also provides surveillance, clinical services (diarrhoea), and training 1000 + staff, budget $38 million

7. ICDDRB: situation in 2006 55 donors and research grants, separate topics and reporting Reluctant to pay 30% management levy Small group of donors contribute to infrastructure Unable to progress own strategic priorities Difficult to invest in staff development or research infrastructure

8. ICDDRB: Core funding proposal Group of donors agree to provide ‘un- earmarked’ core funds Based on implementing priorities in ICDDRB strategic plan Limited amount for ‘seed funding’ research Agreed common M&E framework to monitor progress Single financial report

9. Core funding: review after 3 years: 2010 Core funds rise from 25% to 40% total; research grants rise from $13m to $23m Savings in reporting Improved relationship with core donors Improved sense of ownership and direction Progress against strategic priorities Seed funding attracts and retains returned PhDs Supports more use of strategic direction throughout institute

10. Lessons learnt Importance of investment in ‘core’ capacity building of institutional supports Autonomy and ability of institution to determine and pursue its priorities an important aspect of capacity Use of un- earmarked core funding as potential mechanism Requires significant capacity from receiving institution + good relationships with donors

11. Strategies for hospital reform Some introductory thoughts: Why do hospitals matter ?

12. Role of hospitals in health systems Dixon J, Alakeson V. Reforming health care: why we need to learn from international experience. Nuffield Trust Briefing September 2010

13. System reform Policies that influence organisations National targets and performance management in UK NHS Institutional regulation – accreditation Financial incentives- shift from fee for service incentive to oversupply; encourage competition between providers Local accountability – UK impact unclear

14. Intra-organisational levers Most providers influenced more by organisational setting than system levers. Encourage clinical professionals to be more engaged in management and leadership of organisations: governance and patient safety initiatives, pathways of care; motivate peers Where system governance weak, organisations lead in initiatives

15. Individual motivation & behaviour Most potent force to improve care is intrinsic motivation of clinical professionals; and intrinsic motivation of patients to improve their health. Professional bodies address standards but may not address intrinsic motivation. Encourage patients to take more active role in their care; financial incentives

16. Individual motivation & behaviour Interaction between system reform levers providing external challenge to organisations, and intra-organisation levers on intrinsic motivation unexamined and unevaluated. Problems occur when dissonance / poor alignment Do we neglect intrinsic motivation and focus on economic lens ? Organisations provide excellent care by attracting staff with mission and ethos.

17. Working groups 3 groups –In country networks in Asia –Inter-country networks in Asia –Pacific networks Questions –What can networks contribute to evidence based policy making in each context ? –What management support do networks need in each context ?