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
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
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
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
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
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
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
ICDDRB: Core funding proposal
• Group of donors agree to provide ‘unearmarked’ 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
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
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
Strategies for hospital reform
• Some introductory thoughts:
• Why do hospitals matter ?
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
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
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
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
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.
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 ?