Sara Bennett, Ligia Paina, Christine Kim, Irene Agyepong, Somsak Chunharas, Di McIntyre,

Stefan Nachuk

AimsMap different facets of HSR capacity

at individual, organizational and environmental/network levels

Identify strategies to promote capacity development for HSR and those that appear effective

MethodsDefining HSR: health services, health systems

research, operational or intervention researchMapping – review of existing international

databasesSystematic review of capacity development

initiatives for HSR, including papersReported implementation of a project or initiativeHIC or LMICWhether or not evaluated

Capturing information on: nature of interventions, context, implementation issues, evaluation design, evaluation findings

Reflection on authors’ experiences

The GapThe situation in LMICs The situation in USPopulation – 5.5 billion

250-300 health systems research organizations in LMICs

6-7,500 health systems researchers

Source: Bennett et al 2010

Population – 310 million

709 research organizations that housed PIs for HSR projects

13,000 health services researchers

Source: Pittman & Holve 2009

Region # orgs offering HS or policy MScs

# orgs offering HS or policy PhDs or DrPHs

Types of course offerings

Africa 10 2 Health services planning and management, health economics, health systems and policy

Americas 20 7 Politics and planning, public policy and health, politics of health

Asia 9 5 Health economics, Health policy and systems, Health financing

Overview of review findings73 papers – 67% from HICs (especially US,

UK, Canada)Most initiatives had multiple components Initiatives targeted most at individual level,

then organizational then environmental/network

Largely targeted university based researchers (43% HICs, 54% LMICs)

But service providers, especially GPs and nurses also a key audience in HICs.

Interventions identified in systematic review

HICs

Mentoring 31%Research seminars 27%Fellowships 24%Research grants 24%Partnerships 20%Short courses 10%Networking 18%Post grad training 10%Research infrastructure 10%

LMICs

Short courses 58%Networking 38%Research grants 29%Post grad training 29%Partnerships 25%Basic training 17%Mentoring 17%Research infrastructure 8%Strategic planning 4%Research seminar 4%

Implementation factors (# studies)Facilitators Constraints

Enthusiasm and motivation of participants (5)

Institutional support from parent organization (4)

Flexibility in program design (4)

Strong leadership (3)Builds on existing

partnerships (2)Participatory approach (2)Being part of broader

program (2)

Lack of time – participants, staff and mentors (13)

Insufficient funding (sustainability) (8)

High coordination costs (7)Timelines too short (6)Lack of support from host

organization (4)Lack of confidence of

participants (4)Lack of institutional and

managerial support (3)Language barriers (3)

Key FindingsInterventions successful at the individual level

had limited overall effects due to organizational or environmental level constraints

Few interventions targeted constraints at multiple levels

Maintaining flexibility in capacity development programs is key

Mentoring is an effective strategyShort course training alone is necessary but not

sufficient for developing research capacityVery few interventions evaluated – weak

evaluation designs, most by internal evaluators, no cost data

Evaluation of interventionsHICs LMICs

Total # articles 49 24% articles with evaluation

47% 37.5%

No. articles with independent evaluation

2 2

# articles with costs

10 7

Over-arching Capacity development interventions should

be:Multi-faceted, responding to capacity needs at

different levelsTailored to the context where they are being

implemented

As we scale up investment in capacity development, we must evaluate the effects of CD initiatives

Environment/network levelExternal funders should funnel a larger

share of their funding to local stakeholders

Strengthen networks between different types of HSR actors within countries

Support capacity development among health workers and health service organizations

Organizational levelEngage with organisational leaders to

advocate for HSR

Intensify efforts to secure predictable and sustainable core funding, including endowments

Ensure better funding for research networks and cross-country partnerships

Individual LevelDevelop open access training modules in

HSR that support training needs of different types of researchers coming to the field

Provide incentives and innovative schemes for senior researchers to stay in-country