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Capacity Building Seminar Package

Compiled by Chinyere Mbadiwe and Samantha Cheuk

Learning Objectives
1. To define research capacity in the context of global health research 2. To critique an example of a research capacity-building initiative in Africa based on the nine requirements for research capacity strengthening according to Whitworth et al. (2008) 3. To understand the challenges and different levels of analysis (individual, institutional, and national/societal level) that are relevant to capacity building

Nine key requirements for health-research capacity strengthening in Africa (From Panel 1 in Whitworth et al., 2008):
Improve the research environment (Societal)
By ensuring a legal framework in which research can flourish By raising the profile of science and health research with policy makers, the media, and local populations

Support Individuals
By promoting secondary-school and tertiary-school science education By creating career pathways, developing critical mass, and recruiting and retaining talented scientists By supporting senior scientists to act as research leaders and role models

Support Institutions
By developing competitive grant and fellowship schemes administered by African institutions By providing institutional support for infrastructure, management and technical services, and strategic development planning By promoting networks and partnerships, especially between African institutions By using funding mechanisms as drivers of change at African institutions

Play Title: Cappa Sid and Ti (Capacity) building for CARTA (Consortium for Advanced Research Training in Africa) Playwrights: Samantha Cheuk and Chinyere Mbadiwe

Character Role Assignment ACT I Scene 1 Jacqueline- Miss Noga Nancy- CAPPA ACT II Scene 1 Jade- TI Cynthia- CAPPA ACT II Scene 2 Kalie- University Institution Admin 1 Eniola- University Institution Admin 2 Fyfe- Funder Representative ACT III Scene 1 Ilana- Meeting Facilitator Tram- Local Population Member 1 Jas- Funder 1 Cody- Government Member Madeline- Local Population Member 2 Anne- Local Population Member 3 Erin- Media Member Leah- University Administrator Daniela- Member of the Local Population 4 Breanne- Ethicist Kaela- Member of the Local Population 5 Nancy- CAPPA

ACT I SCENE 1 Individual level In this scene, we will focus on the individual level of capacity building with CAPPA who is a young girl living in Tanzania and is talking to her secondary school teacher Miss Noga. MISS NOGA JACQUELINE Cappa, what is wrong? CAPPA NANCY (squirms in her seat and sighs) My best friend cant come to school anymore because she got a severe form of malaria. She usually bikes to school with me, but because she is so ill her parents had to sell her bike to buy her medication to get well. So now she has no way to get to school and I really miss her. MISS NOGA JACQUELINE Oh no! Im sorry to hear about your best friend, CAPPA. (MISS NOGA walks over and hugs CAPPA then sits down beside her) You know Cappa, if you become a health researcher, you can help prevent people from getting malaria in the future and then everyone can go to school. CAPPA NANCY What is a health researcher? How can a health researcher help? MISS NOGA JACQUELINE Health researchers can do work in a number of disciplines including biomedicine and social sciences. Social sciences include disciplines such as anthropology, sociology, psychology, political science, economics, and geography. People working in these disciplines are all needed to work together and improve the health outcomes of people in their communities. Some do this

by understanding the needs of their community and then they find a way to address it with interventions. CAPPA NANCY That sounds really important Miss Noga! I think I want to be able to improve the health outcomes of my community so that people like my best friend dont get sick and have to drop out of school because of illness. But Im only a secondary school student Do you really think I can become a health researcher? What can I do to get there? MISS NOGA JACQUELINE Well, Cappa, I think you can do anything you set your mind to! You already have a personally invested interest in improving the health of your community and you are also doing well in secondary school. So the next step for you to become a health researcher is for you to complete secondary school and consider doing University or tertiary school. CAPPA NANCY Thanks for the reassurance Miss Noga! Which university would you recommend that I apply for? I dont want to go too far away from home because I will miss my family and as a girl, I have chores and responsibilities to fulfill at home. MISS NOGA JACQUELINE Theres a University in Tanzania called the University of Dar es Salaam that is well respected. Although it is a while away from where you live now, you will still be relatively close to home and can go back during the breaks in school to visit your family. CAPPA NANCY I will look into the University Miss Noga. Thank you for telling me about it! I am not sure how my family will feel about it or if I can afford to go, but I really hope that I can! MISS NOGA JACQUELINE Youre very welcome Cappa. Good luck! [End Scene 1 of Act 1]

ACT II SCENE 1 Institutional level In this scene, we will focus on the institutional level of capacity building with CAPPA who is now a graduate student at the University of Dar es Salaam. CAPPA talks to her friend TI about her career prospects after graduation. CAPPA CYNTHIA I cant believe it Ti, were going to be graduating soon! We can start our work as official health researchers! TI JADE Me too, Cappa! Im both excited and nervous to graduate. Its amazing how quickly these years in University went by. Im really grateful that I can learn and be part of the inquiry process. So what are your plans after graduation? CAPPA CYNTHIA Thats probably the worst question you can ask me right now I dont know whats going to happen yet! Im considering some options but Im feeling a tug in different directions. TI JADE Yes, I know its a hard question. Trust me, I dont know what I plan to do yet either. But I am curious to know what your options are so I can start thinking about them too. CAPPA CYNTHIA Im actually having a really hard time deciding if I want to stay here in Tanzania or if I want to go abroad to do research. There are pros and cons to both options. I really want to stay in Tanzania because the people here and my community are the reason why I wanted to become a health researcher in the first place. I still want to help improve the health of members of my local community, especially given that my childhood best friend was so sick with malaria, but I dont know where I can go to find funded work! There arent enough research funds or stable positions as a health researcher here, so Im really considering going abroad because the funding base seems more secure. I hear the best places for migrating physicians are in five countries: Australia, Canada, the Federal Republic of Germany, the United Kingdom and the United States , Im guessing thats where all of the money is for health researchers too.

TI JADE I know its a tough decision. But you need to consider the consequences of where you go. If you leave and end up working abroad, will you forget about the people back home? Financially, you will be able to live a comfortable lifestyle and can even bring your family abroad. But that doesnt help building your community. I know its a tough decision, but you really need to think of the impact it will have on your community if such a bright mind like yours leaves the country. CAPPA CYNTHIA I just wish I knew what was happening a level up in research institutions. I wonder if they know that so many of their graduates are feeling stressed out about not finding funding for their research projects. They must know that this is contributing to a brain drain of researchers who emigrate from their country. TI JADE I agree. They must know that they need to set up competitive grants and establish mentorship systems and career pathways for their new graduates otherwise theyll never be able to feasibly keep people in their country. As much as people will like to stick around, theres just so much hardship that comes with staying unsupported that its forcing people to emigrate. [END SCENE 1 OF ACT 2]

ACT II SCENE 2 Institutional level In this scene, we will focus on the institutional level of capacity building by exploring the funders perspectives along with other stakeholders including researchers, University research administration and leadership, as well as other African Institutions.

UNIVERSIY INSTITUTION ADMIN 1 - KALIE

(Phone rings) Hello?

UNIVERSIY INSTITUTION ADMIN 2 - ENIOLA

Good afternoon Kalie, this is Eniola from the University administration! I just received a phone call from someone saying that they have identified an area for our research development.

UNIVERSIY INSTITUTION ADMIN 1 - KALIE

Oh hi Eniola! Its nice to hear from you again. What did they identify?

UNIVERSIY INSTITUTION ADMIN 2 - ENIOLA

(Sounding panicked) University statistics and survey evaluations have indicated that many of our graduates are not staying in country for work due to lack of institutional funding for their research projects. Most of our current graduating class is looking for work abroad as we speak!

UNIVERSIY INSTITUTION ADMIN 1 - KALIE

So effectively, youre telling me that we are undergoing a brain drain. We need to do something about this.

UNIVERSIY INSTITUTION ADMIN 2 - ENIOLA

Yes, I have a meeting with some funders in about 5 minutes here. We need to ensure they understand that their funds are incredibly important to us.

UNIVERSIY INSTITUTION ADMIN 1 - KALIE

I agree. Hopefully we can get a good mix of public and private funding to support our research work. Have a good meeting!

UNIVERSIY INSTITUTION ADMIN 2 - ENIOLA

Thanks! (Both hang up phone) (Knock on the door, funding agency representative- Fyfe enters)

UNIVERSIY INSTITUTION ADMIN 2 - ENIOLA

Welcome! Come on in and grab a seat!

FUNDER REPRESENTATIVE - FYFE

Thank you! (Shakes UNIVERSITY INSTITITUTION ADMIN 2 hand) My name is Fyfe and I am a representative from the United States National Institutes of Health who funds clinical research in Tanzania.

UNIVERSIY INSTITUTION ADMIN 2 - ENIOLA

Its a pleasure to meet you. Thank you for coming all the way to meet with me today. I am hoping to talk to you today about establishing competitive grants and fellowships for our researchers here at the University of Dar es Salaam.

FUNDER REPRESENTATIVE - FYFE

Sure. Let me just reiterate that the National Institutes of Health is dedicated to funding clinical research. So as long as the researchers that you are developing at here are interested in clinical work, wed be happy to fund you.

UNIVERSIY INSTITUTION ADMIN 2 - ENIOLA

Well we do have research programs here that go beyond clinical work here as well that we think would like to have funding support for. Im thinking particularly of some of our social science researchers.

FUNDER REPRESENTATIVE - FYFE

We have very strict guidelines here at the National Institute of Health and we have decided that we only want to fund basic science research. But Ill talk to my colleagues back in the states and will see if what we can do.

UNIVERSIY INSTITUTION ADMIN 2 - ENIOLA

Thank you for your consideration. We really appreciate it! (Both shake hands and FUNDER REPRESENTATIVE exits the scene)

(Conference call with University Administrators)

UNIVERSIY INSTITUTION ADMIN 2 - ENIOLA

Hi again Kalie. So I just got out of a meeting with Fyfe, one of our funding representatives from the United States. The funders are really looking for research that is directed in basic sciences.

UNIVERSIY INSTITUTION ADMIN 1 - KALIE

Only the basic sciences? Why is that?

UNIVERSIY INSTITUTION ADMIN 2 - ENIOLA

I didnt ask why, but Im speculating that they think this is where they might want further development.

UNIVERSIY INSTITUTION ADMIN 1 - KALIE

We need to start identifying our own agendas and finding out alternative sources of funding. As much as we benefit from external funders, we need to ensure that our funding system is sustainable so that we can retain high quality researchers at our institutions.

UNIVERSIY INSTITUTION ADMIN 2 - ENIOLA

I agree, Kalie. We need to consider other alternatives for funding. Perhaps we can see if the government is willing to allocate some more funds for diverse projects outside of the basic or clinical sciences to focus on?

UNIVERSIY INSTITUTION ADMIN 1 - KALIE

Im sure we have something in place already. But youre right, we need to try to get a diversity or projects funded. Im thinking particularly in the area of health research because we know that health and wellbeing takes more than just clinical knowledge to achieve. We need social scientists involved so we can start to build teams.

UNIVERSIY INSTITUTION ADMIN 2 - ENIOLA

I heard about this one project that is happening in Ethiopia about capacity building. Maybe we can elicit the help of members from a high income country?

UNIVERSIY INSTITUTION ADMIN 1 - KALIE

Perhaps! I think they can be helpful in providing institutional support for infrastructure management and technical services. I think of particular use, members of those institutions might be able to give us some strategic development planning help and then we can be on our way.

UNIVERSIY INSTITUTION ADMIN 2 - ENIOLA

I heard of this one project co-run by a University of Calgary professor, Dr. Guido van Marle, who supports capacity building in Ethiopia. Albeit, his work is focused on building research capacity in

10 terms of practical lab experience in molecular biology, but I think the general idea of having trainers train trainers is an effective way of building on research knowledge.

UNIVERSIY INSTITUTION ADMIN 1 - KALIE

I love the idea of researchers training researchers. We need our experts to stay here and pass on their knowledge! I think its a good idea to get support from high income country universities. I think we also might benefit from partnerships with other institutions here in the South.

UNIVERSIY INSTITUTION ADMIN 2 - ENIOLA

You mean institutions like the University of Nairobi in Kenya?

UNIVERSIY INSTITUTION ADMIN 1 - KALIE

Exactly! I think were on to something here...

[End scene 2 of act 2]

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ACT III SCENE 1 Societal level (i.e. Improve the research environment) In this scene, we will focus on the societal level of capacity building at a conference by government policy makers, university administrators, ethicists, media representatives and local populations. All are attending a stakeholder meeting to talk about next steps to improving public and population health research. MEETING FACILITATOR - ILANA
Welcome to Societys Information on Development (SID) Conference, everyone! Thank you for joining us in our meeting with some of our key stakeholders. I am pleased to see such a great turn out for our meeting today. Regrettably, we may not have all the necessary stakeholders in place, but I think this is a good start. With us today are some guests from the government, funding agency representatives, media personnel, ethicists, and members of our local population who represent the diversity of other groups and stakeholders in our country. To begin our plenary session, does anyone have anything they would like to talk about?

LOCAL POPULATION MEMBER 1 - TRAM

I think we need to address funding issues for our local students and how there are more and more well educated people doing research outside of our country. There are people in my community that are facing severe illnesses that can be prevented if we had more public and population health research policies in place.

FUNDER 1 - JAS
Well it looks like the government needs to be involved with making decisions towards improving public and population health funding research here in Tanzania. As much as we external funders can allocate resources, it may not be the most sustainable way of continuing that research tradition.

GOVERNMENT MEMBER - CODY

You bring up a key area of concern: sustainability of funding from external funders. As a member of the government, we can certainly play a role in prioritizing where funds ought to go within our own country

12 and try to redirect more of it towards building infrastructure and institutions.

FUNDER 1 - JAS
We usually have to prioritize which projects we wish to fund and quite often, we must decide to fund projects that are prioritized regionally.

LOCAL POPULATION MEMBER 2 - MADDI

These regional priorities may not necessarily match up with the priorities of local populations. As a member of the local population, I find that this prioritization of funding is greatly directed by the requirements of funders. I understand funders need to place a focus on initiatives that their money is directed towards and can have a widespread impact on. I get it, but the needs of the local populations within those regions may not be heard or addressed.

FUNDER 1 - JAS
What would you propose be a way for us to address this?

LOCAL POPULATION MEMBER 3 - ANNE

Oh I know! As another member of the local population, I have always dreamed about being able to set my own agenda priorities according to my community members and not be limited to the priorities set by someone who doesnt understand our needs.

MEETING FACILITATOR - ILANA

It sounds like we need to figure out a way to keep external funders while developing funding sources internally. From there, we need to also ensure that regional and international priorities are in alignment with local priorities. What else do we need to consider?

GOVERNMENT MEMBER - CODY

In order to convince members in our government that we need to develop and allocate funds and resources to promote competitive grant competitions. We think the local media and the way our society views and values research needs to change. We recognize that the profile for science and health research has been raised and we want to continue to emphasize its importance to our country.

MEDIA MEMBER - ERIN

Yes! As members of local media, we can definitely help with promotions of raise the profile of science and health research in the general public. We can send out newsletters or emails about local research being done to promote enthusiasm!

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MEETING FACILITATOR - ILANA

Great! Now not only will we create enthusiasm for students in school, but we can also have the wider public learning and considering ways they can be involved in health research. By generating a mass of people recognizing the importance of tertiary education and health research, Im certain that it will be easier for local funders to make investments in developing research.

UNIVERSITY ADMINISTRATOR - LEAH

And with this increase in interest of local funders, we will likely be able to attract and retain high quality students. They wont necessarily feel the need to go abroad to have a stable career in health research.

FUNDER 1 - JAS
Also, by having local funders for local projects, funds that we allocate as external funders can still be used to address additional international priorities.

MEETING FACILITATOR - ILANA

Indeed, it is our hope that we will be able to stimulate enough interest in local funders and development of researchers that we can tackle more than one issue at a time.

MEMBER OF THE LOCAL POPULATION 4 - DANIELA

Simultaneously addressing many issues at once! We need to tackle complex issues that interact with one other. By being able to work on multiple issues at once, maybe we can reduce the amplified burden it has on our community when these issues interact?

UNIVERSITY ADMINISTRATOR - LEAH

I heard that someone by the name of Merrill Singer coined a term for that in 1994 about the interacting and layering effect- if I remember correctly, this term is: syndemics! Its being applied not only as a means to understand how diseases interact, but also can be used as a framework to tackle these issues for a hopefully amplified effect as well.

MEETING FACILITATOR - ILANA

Well then, its obvious that we need to work on multiple levels and tackle a number of inter-related issues at once. What else do we need to take into consideration when developing health research?

UNIVERSITY ADMINISTRATOR - LEAH

I was just discussing with another university administrator before that we think it will be beneficial to partner with institutions outside of the continent and also partner with other institutions

14 within Africa as well. The University of Dar es Salaam agrees that this is a direction that we need to move towards.

GOVERNMENT MEMBER - CODY

Thats an excellent point. By working in these partnerships, we can gain expertise while sharing our local indigenous knowledge. How can you ensure that this is done in an ethical manner? How do we ensure that we arent being exploited by our partners?

UNIVERSITY ADMINISTRATOR - LEAH

A tool has been developed by the Canadian Coalition on Global Health Research on how to engage in research and partnerships. This toolkit is interactive and we can use it in the four phases of our partnership, from inception to implementation, to dissemination and then finally to good endings and new beginnings.

ETHICIST - BREANNE
That toolkit sounds like a great idea that can really foster strong partnering relationships. As an ethicist, I want to ensure that throughout your partnership, you are also considering reviewing models for reviewing ethics of research in your institution.

UNIVERSITY ADMINISTRATOR - LEAH

We know that there are international guidelines for ethical conduct on research, but what we are finding difficult is being able to establish our own local bioethics training models. We need something that is cost effective and sustainable.

ETHICIST - BREANNE
Thats understandable. By recognizing this, we need to coordinate with the legal framework to ensure that the research that we are funding and publishing are of high quality. We should definitely include bioethics training for students in undergraduate education, postgraduate and public health training programs.

MEDIA MEMBER - ERIN

Perhaps we can help by utilizing internet resources and E-health as a potential solution for a learning and educational opportunity surrounding ethics. Telecommunications is huge and we can certainly learn a lot from them.

UNIVERSITY ADMINISTRATOR - LEAH

That would be great! E-health has an ability to cross borders and boundaries between various jurisdictions, so we can certainly consider using the internet as a source for ethics training.

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MEETING FACILITATOR - ILANA

So as a recap, we want to encourage societal level interest in the importance of locally conducted and published research through the use of more media publicity. By retaining local talent, we can address locally identified issues and set priorities for our research. We also want to keep in contact with external funders and partner with institutions abroad for a partnership exchange, and we want to ensure we deliver basic training courses in ethics using internet training modules.

GOVERNMENT MEMBER - CODY

So what else is missing for us to be able to succeed with this discussion? What are our next steps?

MEMBER OF THE LOCAL POPULATION 4 - DANIELA

Maybe we need to start identifying other people in Africa who also want to improve research in public and population health?

UNIVERSITY ADMINISTRATOR - LEAH

Yes! We should focus on building a network of institutions to strengthen research infrastructure and also support doctoral training.

GOVERNMENT MEMBER - CODY

Have you contacted any of these potential institutions or partners yet?

UNIVERSITY ADMINISTRATOR - LEAH

Yes! We have something set up called CARTA which stands for the Consortium for Advanced Research Training in Africa (CARTA). We recently launched and have managed to get a number of institutions involved.

MEMBER OF THE LOCAL POPULATION 5 - KAELA

What is the purpose of CARTA?

UNIVERSITY ADMINISTRATOR - LEAH

The purpose of CARTA is to offer a framework for building sustainable health research capacity in Africa. We currently have 9 academic and 4 research institutions (including our own University of Dar es Salaam) that are from all around Africa (West, East, Central and Southern). We also have a select number of Northern partners and training institutes that are supporting us in this endeavor.

MEMBER OF THE LOCAL POPULATION 5 - KAELA

It sounds like members of African institutions are able to have a say in what they want.

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UNIVERSITY ADMINISTRATOR - LEAH

CARTA is African-led and it focuses on sustainable and measurable changes in research capacity.

MEMBER OF THE LOCAL POPULATION 5 - KAELA

With home grown solutions?

UNIVERSITY ADMINISTRATOR - LEAH

Precisely! Another added benefit of CARTA is the mentorship and collaborative nature of the research projects. There are Joint Advanced Seminars (JAS) that are being developed which are modules that will improve institutional capacity.

MEETING FACILITATOR - ILANA

Sounds like many disciplines can be involved in a cohort of selected candidates specifically relevant to public health.

CAPPA - NANCY
So far in the model I have noticed that fellows who are selected under the purview of CARTA are committed to ensuring gender and regional equity. Had it not been for this commitment, I am not sure whether I would have a role to play in an institution. As a woman coming from an area a smaller region in Tanzania, this commitment allowed me to become a fellow here at the University of Dar es Salaam.

MEETING FACILITATOR - ILANA

Im so pleased to hear that we have CARTA established towards promoting public and population health research. Perhaps if the CARTA model is successful for promoting public and population health in these member institutions, then its success might motivate expansion of its model to other disciplines! Now, as a wrap up of our Society for Information on Development (SID) Conference, we have gathered a lot of information on how to further develop public and population health research in Africa that we need to process. For now, great job and thanks for your contributions! Lets continue to have these conversations.

[END OF PLAY]