Sot.Sci.Med. Vol. 35,No. II,pp.1379-1387, 1992

0277-9536/92 $5.00+0.00

Printed in Great Britain. All rights reserved

Copyright 0 1992Pergamon Press Ltd

BUILDING APPLIED HEALTH RESEARCH CAPACITY LESS-DEVELOPED COUNTRIES: PROBLEMS ENCOUNTERED BY THE ADDR PROJECT JAMES TROSTLE

Applied

Diarrhea1

and

IN

JONATHON SIMON

Disease Research Project, Harvard Institute for International One Eliot Street, Cambridge, MA 02138, U.S.A.

Development,

Abstract-As governments and other donors renew their support for research scientists in less developed countries, it becomes important to consider new questions about the process of funding scientific research and scientific researchers. This paper argues that research capacity building is a development goal subject to structural constraints and cultural impediments among both donors and recipients. Using data from one specific research capacity building program, the Applied Diarrhea1 Disease Research Project (ADDR), we describe a set of constraints among donors, recipient institutions, and individual recipients of research grants. We then describe how ADDR supports its investigators, how it has responded to the identified constraints, and what obstacles it still faces. Research capacity building programs in health would be well-served application

by focusing more attention of research findings.

Key words-research

capacity

building,

on research

diarrhea1

problem

diseases,

INTRODUCTION

Governments and other donors are renewing their interest in supporting the growth of local scientific communities in less-developed countries (LDCs) [l]. For over three decades they have invested in sending LDC students for graduate training overseas, and in establishing institutes of tropical medicine, often led in their early years by European or American expatriates. They can now complement such efforts with investments in scientific research projects led by trained nationals. But these investments in scientific researchers and research institutions (called ‘research capacity building’) are creating new understandings and raising new questions about the process of funding science. This paper argues that research capacity building is a development goal subject to some of the same constraints that have hindered more conventional development efforts, for example, those intended to increase agricultural production, provide better primary health care, increase literacy, and improve institutions of higher education. Examining research capacity building as a development goal shows that there are structural constraints and cultural impediments that affect both recipients and donors of funds. We define ‘structural constraints’ as economic and organizational factors that limit the intended range of function or adaptation of social programs, or the behavior of individuals. By adding knowledge of structural constraints to knowledge of the cultures of development agencies and recipients of funding, we can construct a more accurate and complete description of the various factors that inhibit the success of development efforts in health research.

identification,

applied

research,

and

dissemination

international

and

health

This paper provides, in essence, a donor’s perspective on the research funding process. Our data is drawn primarily from our combined eight years of experience as managerial and technical staff in the Applied Diarrhea1 Disease Research Project (ADDR). ADDR provides technical and financial support to researchers in developing countries who are studying the causes, prevention, and treatment of diarrhea1 diseases, which kill more than 4 million infants and children each year. The Project funds grant proposals-about 120 in 14 countries since 1985-and sends consultants to groups of social and medical scientists from LDCs. It is administered by a consortium of U.S. universities, including the Harvard Institute for International Development, the Johns Hopkins University School of Hygiene and Public Health, and the New England Medical Center associated with Tufts University. Approximately $11 million in funding has been provided to ADDR since 1985 by USAID through the Bureau of Science and Technology, Office of Health, and through specific allocations (‘buy-ins’) from AID Missions in developing countries. BACKGROUND

Over the last three decades anthropologists looking at development projects have produced what is by now a conventional wisdom: agriculture and health development projects often fail partly because they have not accommodated local cultural beliefs and practices [2-1]. Some more recent social science scholarship about the development process [5-91 has reinterpreted the failures of development to ask why international agencies have been unable to make

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and

good use of available knowledge about local culture and decision-making. These more recent studies have concluded that, among other reasons, the culture and environment of the international bureaucrat, consultant, and donor agency must also be taken into account in explaining the successes and failures of development projects. These scholars have identified a range of problems in implementing successful development projects, including communication gaps between international planners and policy implementers; lack of local knowledge and long-term rural experience on the part of the indigenous planning elite; local officials’ concern for job security rather than innovation; rapid changes in program priorities on the part of funding agencies; and agencies’ pressing need to distribute funds. We need to combine knowledge of development agency culture with a more critical understanding of the motivations, incentives, and constraints upon collaborating LDC scientists who participate in externally funded development activities. To evaluate the quality and potential influence of international health development programs, we need more detailed knowledge about the organization and incentive structures within local institutions, and broader understanding of the activities of external funders. It is important for international funders of LDC scientific research to be self-critical, for efforts to build or sustain research capacity abroad reflect both the strengths and weaknesses of research production at home. Despite the enormous productivity of North American scientists, there are a number of important weaknesses in the organization and production of research in the United States, including that: (1) new proposals must constantly be written and funded to support present ongoing research; (2) institutions create incentive structures which value the pursuit of new projects more highly than the careful and thorough analysis of present work; and (3) the attractiveness of scientific research projects is evaluated partly by their ability to generate overhead funds for the institution. Academic institutions give increasing emphasis to quantity of papers produced, and researchers have begun to divide their results into ‘smallest publishable units.’ Medical schools and other departments reliant on external research funds evaluate their personnel partly on their ability to generate such funds, and investigators have begun to list the number and dollar value of their prior grants on their CVs. Donors from developed countries, especially the United States, must be aware of their system’s limitations to avoid reproducing them in LDC research institutions. This paper first describes a set of problems encountered in ADDR’s research funding process, then describes ADDR’s research support and how it has responded to concerns about structural constraints and the impediments created by donor culture. We focus on funding by external donors, not indigenous national agencies, though many of the difficulties may

JONATHON SIMON

be parallel. Structural constraints, we argue, can cause projects to fail, and these constraints may be as important to the results of development efforts as are the culture, skill, or goals of particular individuals involved. CONSTRAINTS ENCOUNTERED BY ADDR IN BUILDING RESEARCH CAPACITY

This section presents a few illustrative examples of three levels of constraints encountered during the ADDR Project: those of donors, recipient institutions, and recipient professionals. Understanding these constraints is important because it allows us to focus attention on the causes of recurrent problems; recognize the limits to individual initiatives; and learn which problems are inherent in the present structure of international development assistance and which are specific to particular goals, projects, or actors. This understanding is crucial to developing a realistic longer-term perspective on what individual projects can produce. A. Donor-based

constraints

The list of donor-based constraints to funding health research is long and daunting. It includes the need to spend large amounts of funds quickly; the splitting of primary health care funding into separate disease-specific vertical programs; the obligation of government donors to satisfy a changing domestic political agenda; and the competition among donors for fundable issues, diseases, research institutions, and researchers. Constraints among U.S. government donors include the need to justify disbursements to Congress and the public; the conflict between political, humanitarian, and scientific objectives and evaluation criteria; pressure to distribute funding widely both internationally and nationally; and the frequent reliance on quantitative measures of success, and the concomitant neglect of qualitative measures. 1. The financial needs of donors. Donors’ need to move money is an important structural constraint which often causes programs to be larger and more complex than necessary. As those who have studied development funding have pointed out [l&13] most foundation program officers or development program managers-not to mention the programs themselves-are evaluated partly on how rapidly and efficiently they can allocate funds. This administrative constraint applies to donors, contractors, local embassy officials, and recipient institutions. Mandates to spend money can be conveyed with harsh candor: a federal official once asked about the ADDR Project’s ‘burn rate,’ as if the Project needed to attain a certain velocity of disbursements or would come crashing like a rocket back to earth. Project officers’ future ability to secure operating funds for projects can be constrained by below-budget expenditures. It was in the Project’s and the official’s best interest to keep expenditures large and up to budget.

Problems building research capacity

The ‘seasonality of disbursement’ can also cause distortions as program managers seek to disburse as much money as possible before meeting to set budgets for the following period. This ‘flooding the pipeline’ can cause absorption problems for recipient institutions and can cause events (conferences, workshops, technical consultancies) to be conducted at non-optimal times for the host country nationals. Although capital-intensive projects are obviously an important part of development activities, the pressure to move large amounts of funds can result in poor decision-making and a neglect of small and/or creative initiatives. In its first 2 years ADDR had a relatively high ratio of large (greater than $50,000) to small (less than $25,000) grants, but it subsequently urged investigators to keep requests below $25,000 whenever possible. The Project had found that groups could learn just as much about the process of conducting research by doing a small study as a large one, and that the smaller, more efficient studies were easier for investigators to complete successfully. We found that, with some exceptions, most of the applied research questions of importance for the national program efforts could be addressed by smaller, more highly focused research efforts. Although the administrative work load of one $250,000 grant is far lighter than that of ten $25,000 allocations, the Project nonetheless chose to encourage proposals with narrower scientific scope and more limited budgets. Magnifying the problems inherent in spending large sums of money is the imperative to do so quickly. The rapid introduction of foreign currency can reduce the quality of financial supervision and accountability within the recipient institutions’ system. Funds can be poorly used or even misappropriated. Cynical program personnel will say that it is ‘a cost of doing business’ if a percentage of expenditures are unaccounted for. Though not completely avoidable, this ‘leakage’ in the funding process can be minimized by thoughtful disbursement policies. In sum, then, funding priorities and decisions are often more influenced by donor financial expediency than by local research priorities. This tendency runs counter to the goal of sustaining development efforts, but is an important outcome of the present organization of these efforts. 2. Sustaining donor interest. Much emphasis has recently been placed on analyzing factors which lead to the ‘sustainability’ of health development efforts by host governments [ 141.Sustaining donor interest in development goals is equally important, given that such goals usually cannot be attained quickly. (The existence of the phrase ‘donor fatigue’ is one manifestation of this problem.) In order to satisfy domestic political agendas, bilateral donors need to be able to show results within politically meaningful time periods, commonly those between the elections of national leaders. But real changes in infant mortality

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or rates of disease transmission bear no necessary relationship to presidential or parliamentary election schedules. It is always tempting for governments and for donors to claim success, declare the struggle over and retire from the field. Given the political pressures, donors keep funding cycles short to allow for rapid response to changing political needs. The length of the funding cycle also influences the development of priorities and programs as each new group of policymakers sets out to put it’s mark on the agenda. Given the cyclical nature of funding themes, short project funding cycles often mean program priorities also change frequently. Until recently most large USAID projects were implemented and evaluated in 2-3 year cycles, though project extensions and renewals were possible. Encouragingly, now many large USAID projects are on 5 year cycles, and discussions have begun about 10 year cycles issued in renewable 5 year terms. As project cycles lengthen, so do hopes increase that sustained interest and experience will lead to more significant and enduring results. This is especially important in research capacity building, where the aim is not just to produce particular research findings but also to stimulate, support and maintain scientific careers and institutions. 3. Competition among donors and among contractors. Another structural constraint for donors is that they compete for programs and results for which they can claim unique credit. This can lead to increased creativity among program officers, but can also lead to uncoordinated funding agendas. Often the size and source of funds of a donor agency helps determine the level of competition it faces. Donors whose funds come from private endowments and from governmental budgetary allocations (for example, the Rockefeller and Ford Foundations, the Carnegie Corporation, the British Overseas Development Authority, the Canadian International Development Research Centre, the United States Agency for International Development) have had decades to develop specific geographic and topical areas of specialization, and thus to reduce, though not eliminate, competition. Large entities like the disease-specific divisions of the World Health Organization depend on multiple donors for support, and hold periodic donor meetings to help in the division of thematic and geographic territory. On the other hand, contractors (universities and profit or nonprofit consulting groups) often compete with each other for new contracts. Capacity building programs implemented by university contractors (for example, the ADDR Project, the Rockefellersponsored International Clinical Epidemiology Network [INCLEN], the International Health Policy Program [IHPP], and programs implemented by private development contractors (the International Network for Rational Use of Drugs [INRUD], Water and Sanitation for Health [WASH], and Primary Care Technologies for Health [PRITECH]) may have

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difficulties in cooperating because they are begun by institutions with histories of competition. Competition over access to and commitments from host country national scientists may be just as important. Many of these scientific communities are small in size and the requirements from multiple donors may quickly overwhelm the limited number of scientists trained to undertake the desired work. The individual donors rarely forego an opportunity to fund a talented scientist even when they know other donors have already committed funds. ADDR found that the best of the national scientific communities were often involved simultaneously with multiple donors. In several cases, ADDR learned through its proposal review process that a proposed study had already been submitted to, or in one case, funded by, other donor agencies. Multiple relationships with donors can be an important part of building financial security and sustainability but their success depends on the ability of the scientists to complete the funded activities. Developing country scientists and institutions facing multiple financial constraints are reluctant to turn down offers of external funds even when they do not have the personnel available to conduct the required exercise. Shortages of research support staff (research nurses, trained fieldworkers and/or statisticians) constrain the most well intentioned scientist’s ability to conduct high quality research. An inflationary cycle of too many donors trying to fund too few researchers can create problems of unmet promises, over-budgeted costs and eventually damaged scientific reputations within the recipient countries. B. Constraints of recipient institutions 1. Weakness of financial management systems. In part because of donor-driven pressures to disburse funds, the absorptive capacity of the host country institutions is often overlooked. The level and quality of research management systems vary broadly among countries and institutions; the level of reporting and financial accountability required by donors varies as well. Many LDC institutions have limited personnel and systems to manage and account for external grant funds. These institutions are frequently unable to spend grant funds effectively, because the administrative mechanisms within the institutions become overburdened leading to administrative delays for research projects. For example, conversion of foreign currency often can be time-consuming and difficult for a university in countries with banking laws that preclude foreign currency accounts. These and other administrative difficulties have sometimes prompted ADDR to require that checks be co-signed both by the grantee and by an institutional finance officer in order to facilitate the researchers’ rapid access to the funds. 2. Pressures of foreign currency budgets. The fact that budgets and disbursements are done in U.S. dollars or other foreign currencies adds other problems. Investigators’ reliance on foreign currency bud-

gets allows them to undertake activities beyond the constraints imposed by the local economy. But national scientific institutions are then less able to sustain the research funding process because they are unable to generate sufficient internal funds to support followon research. This increases their dependence on external funds. Foreign currency funding may provide some protection to investigators from local currency devaluations, but can also contribute to inflation and drive up local salary scales. 3. Infrequent availability of overhead. Some donor regulations create problems for the institutions where recipients work. Overhead funds are additional monies paid by donors to support an institution’s administrative and other indirect expenses (e.g. rent, electricity, equipment depreciation). Overhead is commonly based on a fixed proportion of project costs. Some donor agencies offer overhead to local institutions, but others do not. Even if they do receive overhead, few foreign universities have been able to command overhead rates like those customarily granted to North American institutions. Some institutions in LDCs have had external financial audits done to establish legitimate overhead rates, and then been told that their needs exceed donors’ willingness to pay. This is especially important because payments for overhead expenses are an important potential source of institutional sustainability. If incoming funds are always project-specific, an institution cannot easily establish autonomy and local control. 4. Poor communication among researchers, policymakers, and program planners. As health research in LDCs becomes more applied, both granting agency and grant recipient face the often challenging problems of sharing research information with Ministries of Health and other implementing agencies. Subject to many of the same rivalries and communication problems of their Western counterparts, LDC research institutions and government ministries often have different visions of the breadth and potential solutions to health problems. For example, one research center which ADDR has supported has published hundreds of articles in English, but far fewer in the local language. Realizing the importance of having a strong local constituency, the center has more recently attempted to increase its involvement in applied research and its scientific contributions to the local community. Much greater emphasis needs to go into identifying methods to communicate research results to program planners and implementors in a succinct, easily interpretable manner. Scientific journals may not always be the most appropriate vehicle. Even where Ministries’ visions of important research match those of research institutions, few Ministries have sufficient highly trained staff available to commission, interpret or evaluate research. Countries like Thailand and Mexico have assembled a critical mass of qualified personnel in their Ministries of Health, but this training has itself required decades,

Problems building research capacity and may be beyond the reach of financially distressed countries. Health research capacity building efforts thus cannot always be expected to improve government programs. In some countries only the private sector or NGOs have the ability to transform research results into changes in health programs or behaviors. C. Individual recipient constraints Structural and cultural constraints at the donor, national, and institutional levels create multiple pressures for individual recipients of research funds in LDCs. Scientists who embark upon research projects funded by external donors receive major benefits but also encounter multiple risks. Some of their constraints include: I. Low salaries andfew localfinancial resources for research. Health research scientists in most LDCs supplement their research salaries with income from private practice (for clinicians) or additional outside consulting (for social scientists). If they are employed in academic rather than government institutions they face onerous teaching demands which compete with their research time. Research is something which must be done in individuals’ spare time, of which there is often little. In many LDCs research funds for clinicians are most likely to be available from commercial firms, which are more interested in testing new products than supporting applied research. These types of constraints are relatively well known [I] and have prompted the founding of many existing capacity building programs. Other less well-known constraints are described below: 2. Little local technical support following specialized training. Scientists who have been funded to undertake advanced training outside their country often return home to find that their specialized training is not sustainable within their home country. They may require technology and skills that their compatriots do not have or understand, and their institutions cannot afford to purchase or maintain. For example, one African ADDR researcher had received doctoral level training in epidemiology, but returned home to find that his analyses were limited to what could be performed with the hand-held calculator he purchased as an undergraduate. 3. Distinct career paths. The rewards and career pathways for researchers vary internationally: in the United States a high priority is placed on publishing in prestigious journals. In some countries, however, original articles in peer-reviewed journals are less important to promotion and salary increases than compendious research reports. These reports are published internally by research institutions, and are distributed to other organizations within the country. Their prominence is based on a complex and wellcodified system than ties promotion and salary increases to the number of credits researchers accumulate for producing various types of research products, teaching various types of classes, and

1383

providing other services to the institution. In some countries promotion of researchers has nothing to do with their productivity, but rather with their length of service, political connections, or patronage. 4. Few resources for publishing. The career incentives mentioned above may limit the perceived importance of publishing for LDC research scientists. If research reports are valued more highly than books or articles, there is no local incentive to produce such products. In fact in some countries translations of foreign-language publications also receive credit. Although scientific articles may be shorter and appear easier to write than reports, many developing country scientists do not have access to well-equipped libraries, do not write English well, and are not familiar with scientific conventions such as placing information in a ‘Results’ vs a ‘Discussion’ section. In addition, many researchers may not be familiar with, or culturally attuned to, a system of peer review of manuscripts that prides itself in speaking ‘plain facts’ and giving ‘frank opinions’. Some researchers are not at all eager to read the criticisms of a group of anonymous reviewers. Despite donor inducements to publish, these researchers are likely to conform to their local system of reward allocation. 5. Promotion to non-research positions. The creation, expansion, or mobilization of a research community can increase accessibility to foreign postings or to positions in one’s own country with international organizations or non-governmental organizations. In many cases, the most talented researchers are drawn away from research to become departmental chairpersons or fill other administrative roles in the hierarchy of the university or the Ministry. This ‘internal brain drain’ [15, 161 is devastating to the local scientific community. For example, ADDR funded four investigators in one African university. Within 18 months, one left to become a UNICEF country representative in a different part of Africa; one is receiving additional training in epidemiology in the United States; and a third is acquiring additional training in pediatric oncology and epidemiology in Canada. Only the fourth is still teaching at the university. This may not be a loss to science overall, but the loss of the highly trained scientist to the national research community is significant. This loss is particularly acute if the scientists choose to remain in the country of training rather than returning home. Not only is there a limited return on the major investment in training, but the scientist is no longer in a position to train the next generation of researchers. The academic salary scales in the countries surrounding the Persian Gulf (prior to the war) drew many scientists away from Nigerian universities. This has a negative impact on the sustainability of the national research community. 6. Znfation of research scope. Researchers in developed countries and in LDCs all know to request the maximum level of funding they can obtain: this gives them more status with their colleagues, more leeway

JAMESTROSTLE and JONATHON SIMON

1384 for

contingencies,

and

in limited

head for their sponsoring means

that

inflated-more

salaries often

cases,

institutions. and

equipment

it means

that

more

Sometimes the

costs scope

research

overthis are of

a

particular research project gets expanded to fit just barely within the funding ceiling. This inflation of research sometimes means that investigators are engaged in studies more scientifically and logistically complex than they need to be. Such studies are difficult to manage and hard to complete; they also provide an unsustainable model for project design. In addition to the financial incentive for complex research designs, LDC researchers also face uncertainties over future funding. They are therefore tempted to put multiple objectives together in one proposal rather than plan a coherent sequence of research projects. Pre-proposals sent to ADDR by LDC researchers often describe excessively complex projects, as though the researchers thought this was their only research opportunity. If researchers are to be sustained over time, resources must be invested in training and in opportunities to practice their craft. Continuing education programs are perfectly understood in hospitals and academic institutions throughout most developed countries, but have not been considered seriously for LDC research scientists. Travel to meetings to interact with colleagues is a crucial part of creating and maintaining a collegial network. Additional shortterm training opportunities may be necessary to develop new skills, or to refine old ones. An indigenous training infrastructure needs to be created so that those who receive training have the opportunity to pass it on to others. Investments in analytic tools such as computers or laboratory equipment may also be necessary. These essential components of research capacity are often overlooked or viewed as superfluous. The following sections of this paper describe how the ADDR Project supports investigators, how it has responded to the types of constraints identified earher, and what obstacles it still faces.

THE ADDR PROJECT AS AN EXPERIMENT IN BUILDING APPLIED RESEARCH CAPACITY

The ADDR Project is responding to changes in international scientific collaboration by experimenting with alternative models of researcher development. ADDR is guided by two main principles. First, the research supported by ADDR is ‘owned’ by the host country nationals, and as such, all principal investigators supported by the Project are nationals or permanent residents of the host country. ADDR has rarely provided opportunities for U.S. scientists to conduct original field studies. Second, ADDR has attempted to support applied research with the potential to contribute to local, national, or international disease control policies and programs. The Project has encouraged the development of country-specific

agendas

the international The

Project’s

themes,

including

which

may

overlap

research

agenda.

research

portfolio

home

or differ

from

comprises

four

use of

foods and fluids in the management of diarrhea; behaviors of mothers/ caregivers or of health care providers; diarrheas with specific epidemiological characteristics, including invasive, persistent, and cholera-like diarrheas; and prevention and intervention studies in these areas. Although originally authorized only to support studies on diarrhea, the Project has widened its scope to include other infectious diseases as comparison groups. The ADDR Project has funded studies in Nigeria, Kenya, Senegal, Cameroon and Zaire; Guatemala, Peru, Costa Rica, Mexico, and Ecuador; and Pakistan, Bangladesh, Thailand and Indonesia. Approximately 120 grants for research projects, and thirty grants for equipment, conferences, and workshops have been made between the Project’s inception in 1985 and early 1992. The research projects have supported approximately 245 LDC scientists. A. ADDR’s

process

steps before project

of developing

research

studies:

implementation

Technical assistance is provided at numerous stages in the research process. Sometimes Project staff or consultants are involved in preliminary steps of problem identification, refining research questions, or reviewing first drafts of proposals. In its initial stage the Project relied upon investigator interest to prompt proposal submissions. ADDR sometimes sent technical consultants out to work with research teams to refine these initial submissions. Later the Project came to rely upon proposal development workshops as a more effective and efficient way to generate fundable proposals. ADDR has developed stiff admission criteria for participation in these proposal development workshops. No scientist comes alone: at least one other member of the research team participates. We have strongly encouraged senior researchers to identify a younger colleague to accompany them if they plan to participate. Where appropriate, we ask that an interdisciplinary both

research

the biomedical

team and

be

social

formed sciences.

representing The

teams

have to submit a first draft protocol prior to the workshop. This protocol is reviewed and comments are returned to the teams. Admission to the workshop is based on the quality of the revised second draft of the proposal. The proposal workshop lasts 8-10 days and involves a rewrite of the protocol with the support and guidance of technical advisors (both local and expatriate) selected by ADDR. Teams are provided access to personal computers with word processing software to help overcome any hesitance to make substantive or editorial changes. Many of the scientists were used to writing one or at most two drafts of documents. The burden of completely retyping the document if a change is made created a strong

Problems

building

incentive against modifications. At the ADDR workshops, it is not uncommon for groups to produce 4 or 5 versions of each section of the research proposal modifying it in the work sessions each evening after dinner. Groups generally work about 1612 hr per day, with 2-3 hr per day spent attending short (30-60 min) didactic lectures. Background scientific literature is sent to researchers in advance or brought to the workshop and distributed as necessary. At the completion of the workshop, the research protocol is presented orally to the whole group, commented upon, and then sent off for another round of external review. The ADDR Project has developed a system of scientific review and technical assistance aimed at improving the quality of the research undertaken. The review process has two goals. It helps the technical staff to determine whether a study should be funded, and also provides constructive criticism of the proposal to the research team. Every final proposal is reviewed both internally (by ADDR staff) as well as by 2 or 3 reviewers usually from outside the originating country. Review comments are synthesized and sent back to the research team regardless of the funding decision. Additional key literature on the proposed topic is often attached. In most cases the research team is asked to resubmit a revised protocol based on the reviews and accompanying literature. The review process is seen as a crucial part of the development process. In countries where national diarrhea1 disease control programs exist, or where formal proposal review panels have been established, these in-country review procedures are also used to acquire additional criticism for proposal authors. A funding decision commonly is made after a revised proposal has been submitted. The reviewers sometimes recommend additional modifications, and these are often incorporated into project designs before they are implemented. The review process is intentionally long and requires active engagement by the researchers. The requests for multiple iterations can come as a shock to investigators who have not worked with ADDR before. Some investigators choose not to resubmit; others have gone through as many as five drafts before receiving funding. Almost all funded proposals have been revised at least once or twice. Scientists lacking commitment to undertake research usually self select out of the review process before it is completed. B. Research support after project approval Each research team, upon advice of ADDR Project staff, selects a mutually acceptable consultant for the course of the study. Consultants come predominantly from U.S. academic institutions, but the Project also employs consultants from other developed and developing countries. We have occasionally employed our own grantees as consultants to other projects. The consultant scientist is responsible for helping the

research

capacity

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research team to conduct the study at the highest possible level of quality. The consultant makes at least one, and preferably two, field visits during the study to provide the research team with an opportunity to interact with the consultant on site, and offer suggestions for improvements in the study implementation. The Project has also sponsored short data management workshops to help familiarize investigators with computerized data entry, verification, and cleaning techniques. After groups complete their data collection, ADDR has been bringing the same teams together again for a workshop on data analysis and writing of research results. Entry requirements for this workshop are also kept high. Groups must have cleaned their datasets, produced data codebooks, and done preliminary analyses of frequencies before they are invited to attend. The Project encourages researchers to do some additional analysis before the workshop to facilitate report writing and scientific paper preparation. The data analysis workshop has three goals: to stimulate the best possible data analysis; to assist researchers to select which of their major research questions they wish to present in which publications; and to help them identify the programmatic significance of their conclusions. The teams prepare a number of ‘products’ during the workshop, including an abstract of the research paper; a draft of the paper itself; a poster for a scientific conference; an executive summary for policymakers; and most importantly, a ten minute talk which is given at the conclusion of the workshop before colleagues and invited guests. The data analysis workshops have been successful in helping scientists to overcome the problem of collecting data without analyzing it or writing it up for publication. Many have submitted their first papers to international or national journals following these workshops. To improve the process of communicating research results, ADDR continues to experiment with training researchers in presenting papers and writing of executive summaries for submission to Ministry or other program personnel. The Project is also undertaking selected case studies of how its investigators have used scientific information to develop health policies and programs. The conclusions from these studies will be used to modify the Project’s efforts to train researchers to disseminate and apply their results. C. ADDR’s support for research careers ADDR has been subject to the structural constraints mentioned above, but has experimented with a number of methods to counter or minimize these constraints. The Project has recognized the importance of focusing on institutions rather than individuals, and has invested financial and technical resources in a limited number of key institutions in each country. For example, in Mexico most grants have gone to researchers within the Institute Mexicane del Seguro Social (IMSS), the Social Security

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Institute, and in Peru most grants have gone to the Instituto de Investigaciones Nutricionales (IIN), the Nutrition Research Institute. This gives multiple investigators the opportunity to participate in research, and provides relatively long-term funding to a department or institution. It helps build or sustain a critical mass of investigators in one institution. Where interdisciplinary teams are assembled, sustained funding gives the team more time to explore new research areas, get to know the strengths and weaknesses of different disciplines and individuals, and discover new ways to organize research and analysis. ADDR has also tried to build on existing networks of researchers, stepping in to continue funding for projects or teams which have been supported or initiated by other funding agencies such as the Rockefeller-supported International Clinical Epidemiology Network (INCLEN), the World Health Organization, the Ford Foundation, or private companies. This gives researchers the opportunity to analyze data that might otherwise remain unanalyzed, practice their research skills in new areas, or continue to do research. The Project has given second grants to some researchers who have successfully completed a first research project with ADDR funding. This allows scientists to work over time with a familiar agency. The continuity of funding encourages deeper exploration, and keeps scientists from loading all their research goals into one complex project. Research teams can collaborate for longer periods of time, and practice their new found skills. Continuity of research funds can provide junior scientists with an opportunity to establish a track record in research. The Project recommends and sends technical literature to its investigators and offers them both technical editing and copy-editing services. These last services have been most welcomed by those researchers who are unaccustomed to the format of biomedical science writing, or who have difficulty writing in English. This effort is meant to supplement, not replace, the writing of papers for national journals. The goal of this effort is to maximize the likelihood that international scientific journals will review these manuscripts. Finally, ADDR has used a number of other activities to assist investigators in developing their careers. The proposal development and data analysis workshops have involved the same set of researchers, so that national and regional networks of ADDR scientists have been formed. The Project has also made funds available for researchers to attend national or international scientific meetings, present results, and meet with colleagues. These meetings have ranged from Asian and African Conferences on Diarrhea1 Disease to the Society of Pediatric Research or the International Congress of Nutrition. This helps scientists to build their own independent research networks, ones which will ideally last longer than financial support for any particular project. In those

cases where the Project has employed its investigators as consultants to other projects, it has done so partly to build national or international networks and to legitimize the expertise of its researchers. The Project has tried to address some of the financial management issues by assisting in the development of research management and financial accountability systems. In addition, the Project purchases foreign currency checks in the U.S. and disburses the grant funds in the local currency equivalent to the dollar amount whenever possible. This has improved the availability and timeliness of funds for the research teams. ADDR has developed a model of research support that extends from problem identification through proposal design, data collection, and analysis, to dissemination of results. While this comprehensive scope is not required of every donor, this range of resources must continue to be developed and made available from within the community of funding agencies. CONCLUSION

Research capacity as a development goal can and should be subjected to some of the same critiques that are leveled at the technologies and products of rural development. Foremost among these is the warning that new technologies and production methods have unintended social impacts. Scientists receiving additional advanced training can become oriented toward an international research agenda only loosely connected, if at all, to specific local problems. Better communication with scientific colleagues can reduce pressure and interest in presenting results understandable and relevant to local officials and policymakers. Foreign support for local research, and the consequent expansion of that research, can reduce local institutions’ ability to fund follow-up activities. These are some of the potential negative aspects of research capacity building. Although ADDR has experimented with supporting researchers, our experiments are not immune from the constraints we have mentioned. Our activities still take place within a narrow arena: we are funded as a vertical (disease-specific) program, subject to U.S. government policies. Our emphases on proposal writing and publishing, if pushed to extremes, can lead to the weaker aspects of science as practiced in the United States and many other industrialized countries. These include valuing publication over research application; valuing quantity of publications over quality; and creating incentive systems that value investigators according to the amount of research money they can attract. Within these constraints, however, our efforts to build research capacity are directed toward increasing the ability of local researchers to monitor and identify salient problems in their regions, create their own research priorities, conceptualize and carry out

Problems

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research projects that will help to solve these problems, form local or regional collegial networks, and communicate their results to policymakers, scientific colleagues, and their public. These are newer and more challenging aspects, emphasizing science as a communication and application process more than a production process [ 171. This paper has emphasized the existence of structural constraints to help make research capacity building a more realistic goal: while bilateral donor agencies cannot remove the political element from development programming, they can be bureaucratically structured to minimize the impact of short-term foreign policy considerations, and they can argue for longer funding cycles and more stable funding themes to reduce the disruptions in development efforts. Donors should help local investigators to pursue research topics of international interest, but they should also encourage and support more sophisticated research on local problems. They can better encourage researchers to publish (or otherwise disseminate) research findings by understanding and working within local systems of academic rewards, and by emphasizing communication skills. These are incremental changes, but their cumulative effects will lead toward stronger independent scientific communities in LDCs. Acknowledgements-This paper was supported by the Applied Diarrhea1 Disease Research Project (ADDR) of the Harvard Institute of International development (HIID), with funding from the United States Agency for International Development, Cooperative Agreement No. DPE5952-A-00-5073-00. James Trestle is Senior Social Scientist and Jonathon Simon is former Project Manager of the ADDR Project. Both are Research Associates at HIID. Prior comments by Lynn Morgan, Anne Marie Foltz, Richard Cash, Fitzroy Henry, and anonymous reviewers are gratefully acknowledged. Based on a presentation at the American Anthropological Association Annual Meeting, Washington DC, 15 November 1989, at an Invited Session entitled “Fostering Research Capacity in the Developing World: Problems and Prospects in Medical Anthropology.”

REFERENCES 1.

Commission on Health Research for Development. Health Research: Essential Link to Equify in Development. Oxford University Press, New York, 1990.

research

capacity

I387

2. Paul B. Health, Culture and Community. Russell Sage, New York, 1955. and development. Ann. Rev. 3. Hoben A. Anthropologists Anthropol. 11, 349-375, 1982. 4. Kottak C. When people don’t come first: Some sociological lessons frbm- completed projects. In Putting People First: Sociological Variables in Rural Deoelovmeit (Edited by Ceriea M. M.). pp. 323-358. Woild Bank/Oxford University Press, New York, 1985. of a new 5. Colson E. Planned change: The creation community. The Moses Lecture of the University of California, Berkeley. 20 October 198 1. Manuscript. Anthropology Department, University of Californ’ia. November, 198 1. aspects of international health 6. Foster G. Bureaucratic agencies. Sot. Sci. Med. 25, 1039-1048, 1987. of 7. Justice J. Policies, Plans and People. University California Press, Berkeley, CA, 1986. context of international 8. Justice J. The bureaucratic health: a social scientist’s view. Sot. Sci. Med. 25, 1301-1306, 1987. R. Shortcut methods for gathering social 9. Chambers information for rural development proiects. In Purting People First: Sociological Variables ii R;ral development (Edited bv Cernea M. M.), PP. 399415. World Bank/Oxfdrd University Press, 6;~ York, 1985. policy. Center 10. Demeny P. Social science and population for Policy Studies Working Paper Series No. 138, pp. 15-16, The Population Council, New York, 1988. L., Anderson J. and Colson E. Volunfar) 11. Ralston Efforts in Decentralized Management, Research series, %. 53, pp. 69. Institute of International Studies, Universitv of California, Berkeley, 1983. Hellinger D. and O’Regan F. M. Aid for 12. Hellinger-S., Just Development: Report on the Future of Foreign Assistance, pp. 5-6, 65, 165. Lynne Rienner. Boulder, CO, 1988. 13. Hancock G. Lords of Poverty: The Power, Prestige, and Corruption of the International Aid Business. The Atla&Monthly Press, New York, 1989. get alone without us? Sustainabilitv 14. Bossert T. Can thev__ of donor-supported health projects in Central America and Africa. Sot. Sci. Med. 30, 1015~1023. 1990. 15. Frenk J. Los mkdicos y la politica: fuga de cerebros. Mundo MPd. (Mex.) 3, 7, 1976. 16. Frenk J. Balancing relevance and excellence: Organizational responses to link research with decision making. Sot. Sci. Med. 35, 1397-1404. 1992. 17. For recent examples of this emphasis on research application, see van Willigen J., Rylko-Bauer B. and McEIroy A. Making Our Research 7Jsqfid: Case Studies in the Utilization of’ Anthropological Knowledge. Westvicw Press, Boulder, CO, 1989; Chen L., Kleinman A.. Potter J. and Ware N. Advancing Health in Dewloping Countries: The Contributions qf‘Social Scienw Researc~h. Auburn House, Dover, MA. 1991.