Science and international development

Written evidence submitted by the
London School of Hygiene &Tropical Medicine (Int Dev 08)

Many thanks for the opportunity to submit evidence to the Science and Technology Committee. Our comments below focus on health.

How does the UK Government support scientific capacity building in developing countries and how should it improve?

1. In the health field, UK Government support for scientific capacity building through research is delivered mainly through MRC and DFID, with DFID providing much of the funds for MRC's developing country activities, as well as through smaller funding arrangements with other research councils. MRC supports two large and active research centres in Africa and research in other geographical areas through programme and project grants. The provision of core support to its overseas units is a major boon to these centres, and one which is much envied by other developing country research centres which have to struggle to cover their core costs through grant overheads. Core support provides a measure of scientific independence and means that a coherent research programme can be developed which is not always dependent on achieving the next grant, however uninteresting this is, to keep the centre afloat. This support needs to be sustained but the new model that increases the pressure on MRC centres to achieve additional support for specific research activities is a good one.

2. On the whole, MRC manages its developing country research portfolio reasonably well. MRC awards are generally made fairly using peer review and units and grants are monitored. MRC also has a good record in training. Training for many categories of staff is provided at the MRC's overseas units. This includes local training courses for more junior members of staff, including support staff, and also support for scientific staff to take higher degrees. The UK government also provides funds for support of excellent researchers and research leaders in East Africa. A good example of this is the MRC-DFID and EDCTP African research leadership schemes.

3. Some research is funded directly by DFID and it is less apparent that this is always done effectively. DFID has decreased capacity in technically qualified manpower in the health sciences and thus would now have difficulty in operating an open, peer-reviewed system with effective project monitoring as it did in the past. As a consequence it is likely that some projects of doubtful utility are being supported and that others are allowed to continue after the period when they should have stopped for lack of effective monitoring. However, DFID does bring a very important policy angle to the research table, which is different from the interests represented by the research councils, so it is critical that DFID’s funding is maintained for research and related capacity strengthening. Increasing DFID’s staffing in order to manage a research programme more directly and effectively would not be a popular idea at the present juncture but some of this work could effectively be outsourced to other agencies which have these skills such as MRC and the Royal Society among others, as long as the arrangements ensure that the policy-related aims of DFID research funding are maintained and safeguarded.

4. Apart from the critical support for capacity building via research, the UK government provides valuable scholarships to students via funding to the Commonwealth Scholarships Commission. These are mainly used for study in the UK, and to pursue distance learning Masters degrees, and are important as many of the degrees that the students take are either not available in their own country, or are not of sufficient quality. To improve this, the UK government could sponsor students to take in-country courses, and to support the provision of external quality assurance for those courses. The best way to do this would be to link Universities in developing countries with Institutions in the UK and provide funds for some transfer of skills, technology, and support, to enable such universities to broaden their range of courses (see also under next section). This could include support for both students, and for lecturers/tutors within those institutions. Another way it could help would be to support student loan schemes for students to study in their own, or other countries. Many more people would be able to develop their scientific skills if the money was available (as loans) for them to access.

5. Strengthening capacity in scientific research should go along with building national decision-making capacity around the introduction of innovations such as new vaccines.  This means support for countries in developing national capacity in gathering/assembling and evaluating data, as well as in using data in appropriate ways for decision-making.  Ministry involvement and ownership is crucial for capacity building and ensuring that the evidence feeds into national policy deliberations.  As an example of what can be done, a PAHO initiative is supporting universities (Centres of Excellence) in the PAHO region to do the gathering/assembling of evidence and evaluation of new vaccines, and has provided policy makers in the region with tools and workshops to do the analysis and decision-making. 

What are the most effective models and mechanisms for supporting research capacity in developing countries?

6. There is no single model for supporting research capacity development in developing countries that can be guaranteed to work. Successes and failures have been achieved with many different models including institution to institution partnerships, large consortia, small collaborative research groups and links between individual scientists in the north and the south. Some of the advantages and disadvantages of different models of north/south and south/south partnerships were discussed at a recent meeting co-hosted by the RCP and Academy of Medical Sciences. The report of this meeting, which is reaching the final stages of preparation, would be a helpful contribution to this debate. Some common features of successful partnerships were identified as -

· the need to clearly identify the purpose of the collaboration at its outset,

· a need to ensure that all partners had something to gain from the collaboration,

· avoiding dominance by one partner, especially the northern one,

· identifying in advance mechanism for the exit of one or more partners if things are not working out.

7. Schemes which support long-term interaction and exchange between developing country and UK universities and research institutes are critical. Including South South as well as North South interactions within such schemes is often valuable. Developing research capacity takes time - e.g. at least 10 years to educate a scientist to a level where they may competently manage, innovate and begin to lead their field locally. Thus there is a need for long-term programmes that are dedicated to both investing in individuals and strengthening the organisations they work within, including their administration, governance, and support systems including IT. Some of the key needs are:

· ensuring training in research methods, proposal development, research project management and paper writing

· access to excellent training in the UK for high flyers (with competitive entry)

· free online teaching materials and interactive documents to facilitate learning of key analytical methods

· sponsoring research internships/degrees at institutions within the region of appropriate standing

· access to reading materials (text books) and up to date research; free online journal access (eg extending HINARI to broaden the number of journals covered)

· support for software license fees for key analytical software and manuals

· support for scientific exchange

· support for equipment maintenance

· for translational science/medicine: encouragement of interaction with the private sector

· support for building clinical capacity / platforms (GCP and quality training, local sustainability and leadership, use of sites once training in place) as exemplified by trial capacity for leishmaniasis and trypanosomiasis built in East Africa and Central Africa, and now being locally driven.

8. Some long term programmes have successfully used a model of simultaneously bolstering teaching capacity by situating experienced researchers in the target country for the medium to long term while at the same time sending students overseas to undertake their doctoral training - post graduate study in a world class environment can be truly empowering and help to create internationally competitive research leaders. It is vital that both these activities are undertaken simultaneously because it establishes a "research culture" in the target country while also turning out fully trained scientists. Retention of graduates in the target country has been achieved by ensuring that large components of their thesis work (if not all) are undertaken in the home country and by providing add-on postdoctoral components to the programme. Both of these initiatives foster the idea (for the student) that there is a future in research in their home country. The existence of a stimulating research institute in which to carry out doctoral and postdoctoral studies is also vital to the encouragement and retention of programme participants and graduates.

9. Good examples of long term partnership programmes include:

· the development of the Kintampo Health Research Centre in Ghana. This was enabled by a long-term large scale collaborative research programme funded by DFID that was sufficiently long to enable the establishment of a credible infrastructure that then attracted more funding. DFID allowed training costs (PhDs, MScs etc) to be included which were used not just for research staff but to build research capacity more generally - thus it enabled 2 of the computer centre staff to come to the UK for computer science masters. In recent years 2 staff also received Commonwealth PhD scholarships with the Centre being allowed to apply for these as part of a DFID consortium.

· a large EDCTP trials network focussed on malaria combination therapy in West Africa. The funding model has generated an excellent project, and the capacity development aspects are very promising - the European partners (3 plus Medicines for Malaria Venture) mainly provide technical assistance with laboratory investigations and training of PhD and Masters students from the African sites; the more advanced African partners (3) are directly providing capacity development activity in Guinea-Conakry, which has a very poor infrastructure in terms of clinical trials capacity. The focus of all decision-making and protocol development has been the lead African partner (University of Bamako, Mali).

10. As indicated above, a key part of strengthening research capacity is post-graduate training of developing country scientists. Provision of residential and distance learning (DL) high quality post graduate training for scientists from developing countries is still of major value and likely to continue to be so for a long time to come. Distance learning has especial value as a means of extending access to education – e.g. LSHTM has around 5 times as many students enrolled on DL than London-based courses, and it has proven enormously attractive to students who otherwise cannot or do not want to come to London to study. The cost for a DL Masters is approx one third that of a London-based MSc and students can study whilst working and apply learning immediately in their professional context. Mixed mode study - doing some study in London and some by DL - is also of interest although not feasible for all.

11. There has been effort devoted to evaluation of training – eg evaluation of the impact of scholarships (e.g. Commonwealth Scholarships Commission -, and evaluation of postgraduate education involving tracing and career mapping of alumni (eg ). Such evaluations generally identify the critical value of support to post graduate education in furthering scientific careers.

12. Experience is increasing of supporting post-graduate training in institutions in developing countries through programmes such as the Malaria Capacity Development Consortium which has built on the successful Gates Malaria Partnership which trained many PhD students from Africa, and the Wellcome Trust’s African Institutions Initiative and the PHFI-UK consortium This type of support is likely to become an increasingly important component of the UK government's support for research capacity development in developing countries in the future. Careful evaluation of how effective is this kind of capacity development will be needed.

How does the Government monitor and evaluate the effectiveness of the scientific capacity building activities it supports? Is further assessment or oversight required?

13. Monitoring of the effectiveness of scientific capacity building programmes is a weakness, as the time scale for impact is much longer than the implementation. For example building a new course, or School of Public Health can take at least 3-5 years. But the results of that course will take many years, or decades, to bear fruit as the students enter research and make their name by doing good science, and excellent research. The quality of the ground work will only be apparent when the graduates become research leaders in their own right.

14. However the UK Government could play a role in developing interim process benchmarks of excellence. This could include markers of sound implementation, realistic and important milestones of success, and measures of sustainability of the programmes. An important aspect is to ensure that barriers of discrimination within the country are broken down, and that access to higher education and professional development is based on merit and not on patronage.

What role does DfID's Chief Scientific Adviser play in determining priorities and in the development and assessment of capacity building policies?

15. The CSA clearly has an important role, but care should be taken not to over-generalise policy. Different solutions will be required for different countries / regions, and an awareness of what strategies would best suit the locale should be demonstrated in any project proposals. The multiplicity of funding streams for any given country can greatly hamper capacity strengthening – it can be capacity destroying, so local leadership (and supporting the creation of such leadership) to set priorities is critical.

16. That said, a "best practice" model could be synthesised via a "lessons learnt" evaluation of the capacity building policies to date, and should inform policy (i.e. policy should be evidence based).

How are government activities co-ordinated with the private and voluntary sectors?

17. DFID works reasonably well and effectively with the voluntary sector. MRC is more successful with collaboration with the private sector, for example by supporting trials in developing countries of tools developed by pharma. An area that seems to have been little explored is collaboration with the private sector in developing countries and this should be possible in a number of countries such as India and China which have thriving private companies in the health sector. A recent example of a successful project of this kind has been the development of a new meningitis vaccine for Africa through a collaboration between PATH and the Serum Institute of India, a private company. DFID appears now to be providing some support to the Serum Institute to develop a further meningitis vaccine and this kind of collaboration should be encouraged and may be possible in other areas.

18. Agencies such as VSO can play a valuable role in local capacity development. Relevant skills go beyond those of doctors and nurses; for example biomedical scientists are critical for helping develop high quality laboratory services.

London School of Hygiene and Tropical Medicine

15 December 2011

Prepared 22nd December 2011