Evidence to guide the design and monitoring of RCS efforts in LMICs is limited and formulating a general approach is complex because each programme is unique. Capacity strengthening programmes usually start off with a ‘needs assessment’ but by doing this, two critical steps are missed out – defining the expected outcomes and identifying the capacity needed to achieve the outcomes. Both these steps are important in developing a robust and comprehensive action plan and in promoting ownership and sustaining change. Using published evidence, including literature on organisational management, we have developed a five step pathway for designing and evaluating RCS programmes and tested it in a variety of contexts in Africa[3–5].
The pathway involves:
defining the goal of the capacity strengthening effort,
describing the optimal capacity needed to achieve the goal,
determining the existing capacity gaps compared to the optimum,
devising an action plan to fill the gaps and associated indicators of change, and
adapting the plan and indicators as the programme matures.
The pathway starts with a clear goal and objectives, and it make the capacity required to achieve the goal explicit. We derive a description of the optimal capacity needed to achieve the goal from a comprehensive search of the literature and include inputs by international experts relevant to the goal of the RCS, and a ‘reality check’ by LMIC partners. The unique aspect of this 5-step approach is the production of this evidence-based ‘benchmark’ (i.e. definition of optimal capacity needed to achieve the goal) which is designed specifically for each project and against which existing capacity is compared. This approach differs from most needs assessments of research capacity which do not use a rigorous benchmark and therefore are not able to provide reassurance that significant areas have not been overlooked.
Using the optimal capacity ‘benchmark’ we identify capacity gaps and develop the action plan to fill the gaps in collaboration with LMIC partners. The plan is designed to be flexible enough to generate and utilise ongoing learning; strategies for promoting sustainability are incorporated from the outset. The plan takes into account not only technical, managerial and financial processes within an organisation, but also the individuals who work in the organisation and the wider system within which the organisation operates and is financed and managed. Interestingly we have consistently found when using this five-step approach in practice, that 60-70% of activities in the plan are ‘no cost’. For example, establishing a new committee, drafting protocols and strategies, or providing in-house training.
Five step pathway for designing health research capacity strengthening programmes
1. Define the goal of the capacity strengthening project.
This necessitates harmonising the expectations and objectives of the most critical stakeholders including developing country partners, people involved in ensuring sustainability of the activities in the long term and the funding organisation.
2. Describe the required capacity needed to achieve the goal.
This will require a search for the best evidence to describe the ‘optimal’ capacity collated from, for example, peer-reviewed published papers or expert groups, including evidence from outside the health sector.
3. Determine the existing capacity and identify any gaps compared to the required capacity.
The evidence from step two is formatted into a set of qualitative and quantitative data collection tools to identify existing capacity and capacity gaps. Data is collected from stakeholders with different perspectives; discrepancies are highlighted and resolved through further discussion.
4. Devise and implement an action plan to fill the gaps.
The prioritised list of capacity gaps is transformed into an action plan which includes objectives, activities, deliverables and monitoring indicators, and measures to facilitate sustainability
5. Learn through doing; adapt the plan and indicators regularly.
Results from experimentation and learning, and regular discussions with those responsible for monitoring progress are used to refine the plan. Progress indicators become more sophisticated as the programme matures and capacity is strengthened
10 year perspective for designing RCS programmes to enable measurements of progress and impact and allow comparisons
In order to facilitate measurements of progress and impact of individual RCS programmes, and to allow comparisons between programmes, much more effort needs to be made to develop and use common principles, and if possible, a generic approach, for designing RCS programmes.