Research capacity in lower-income countries: assessing the status quo

June 11, 2018
Global
The need to develop and expand research capacity in low- and middle-income countries (LMICs) has been recognised for more than 25 years. In 2013 the World Health Organisation stated that it was vital in order to achieve health goals. Yet, despite some progress, there are still strides to take to ensure that research capacity isn’t merely an afterthought or a side effect of other interventions—and many of these strides are attitudinal.

Having conducted and analysed a  of literature around research capacity development (specifically in health, but with application in other fields), I believe that it is clear that the methods of pursuing capacity development in LMICs are insufficient and often fragmented. While it must be acknowledged that there are many factors at play, it is worth giving focused consideration to two prominent barriers to the strengthening of capacity development, both of which relate to the design and intentions of research programmes and development models: dependence on high-income countries (HICs), and the setting of narrow research goals at the expense of sustainable impact.

Dependence on HICs

The effect of power relations came up as the most common narrative in the papers analysed during the review. There has been a positive increase in involving LMICs in projects, and recognition of the importance of North-South collaboration, but goals are still set by HICs, and the research aims and structure are frequently expatriate-driven.

The example of clinical trials shows that local staff are often given only supporting roles, rather than being involved in the planning, analysis or write-up stages. This leaves them without the skills and experience needed to replicate the processes autonomously. Indeed, sample analysis is often undertaken outside of the host LMIC, meaning that laboratories are not always sufficiently developed; we must consider material capacity as a vital component of developing research capacity. Equally damaging has been the practice for HICs to focus on high-performing individuals in an LMIC, rather than strengthening local institutions to develop greater numbers of researchers.

More broadly, a partnership between an HIC and an LMIC is only worth the name if it is seen as a relationship between equals—and enshrining capacity development as a locally-owned endeavour is one way to make that more likely. Indeed, the terms describing capacity development have evolved to represent this more equitable partnership, eschewing building and strengthening, for words like utilisation and unleashing, to recognise that latent capacity exists but requires harnessing or unlocking. 

Scaling up capacity development

Even when local staff are given more significant roles in a research project, it’s important that capacities don’t remain project-specific. The example of clinical trials shows that capacity development (if done) is often seen in relation to narrow short-term goals: those required to complete the specific remit of the trial in question. While these skills could be transferable, more holistic capacity development is required to enable individuals to independently address a broader research agenda, and systemic deficiencies will need tackling.

While new approaches to the "big three" diseases (HIV/AIDS, malaria and tuberculosis) continue to attract funding and research projects, the capacities developed through these parallel programmes are unlikely to improve broader health research systems in an LMIC. The equivalent is true for comparable high-profile projects outside of health.

If capacity-related goals continue to be set chiefly by the research community, with the immediacy of research-led priorities, then capacity development runs the risk of only ever being considered an optional extra or an adjunct.

Capacity development has to be separated from the context of a dedicated research model as an independently worthwhile (and occasionally diverging) objective with its own dedicated strategy. This is much more likely to ensure avoiding a trade-off or inadequate compromise—that is, choosing good research at the expense of good capacity development, or vice versa.

The way forward

Any call for a change in attitude isn’t solely directed at HICs, though; as well as a need for these stakeholders to recognise the importance of capacity development and the longer-term potential of LMIC institutions and systems, LMIC governments themselves must take on the responsibility of setting their own research agendas and be willing to invest in them. Stewardship and funding for domestic research is frequently weak and, unless national governments begin valuing locally generated evidence and their research systems, HIC dominance will be inevitable.

We mustn’t oversimplify. Making this choice won’t lead to an overnight transformation in the way capacity is developed, of course; willingness from HICs and LMICs alone is not enough. More empirical evidence on how to build capacity is needed, with operational and implementation research and quality evaluation data. Education may be needed to encourage policymakers to respect the results of locally-run research. But this meta-analysis demonstrates that a change in attitude and in expectations—about how research capacity development is designed, what it achieves and why it should be performed—is essential if it is to be sustainable, equitable and effective.

Sam Franzen
Contributor

Sam Franzen is a senior consultant in the health team at Oxford Policy Management. Sam has broad social policy experience with a background in HIV research. Over a very international career, he has worked with the Rwandan government to scale-up an innovative national HIV intervention and lived in India working with a non-governmental organisation to evaluate their provision of services for very poor people living with HIV in slums. He recently led an international collaboration to develop a framework for strengthening health research system capacity in universities, healthcare institutions and government departments in low- and middle-income countries.

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