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 ‘un-earmarked’ 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 ?