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Setting up a scientific community by means of a small grants program: the Latin American experience
Acta Tropica, 57(1994)201 209
201
ACTROP 00392
Setting up a scientific community by means of a small grants program: the Latin American experience Roberto Bricefio-Le6n* Laboratorio de Ciencias Sociales, Universidad Central de Venezuela, Apartado 47795, Caracas 1041-A, Venezuela
The study of tropical diseases in Latin America has been dominated by the biomedical sciences, and whilst recently social science health research has been developed, there has been little collaboration between the two. The Latin American Small Grants Programme for Social and Economic Aspects of Tropical Diseases, launched by WHO/TDR in 1990, aimed to attract junior researchers into the area of social sciences and tropical diseases, and to create among them a scientific community. The program is unique in that it has involved the transfer of decision-making power from an international organisation (WHO/TDR) to a regional group. This article discusses the organisational structure of the program, the methods by which the program handled proposals, the evaluation process, the types of research proposals received, a profile of applicants, and the results of the applications. There was a balance of biomedical and social science applications. We conclude that the Small Grants Programme has been successful in fulfilling its objectives, due to the design of the grants scheme itself. Key words: Latin America; Leishmaniasis
Small grant;
Malaria;
Chagas disease; Schistosomiasis; Leprosy;
Introduction
Tropical diseases represent an important problem for underdeveloped countries both in terms of human suffering from mortality and morbidity and in terms of financial losses originated by them. It is estimated that half a billion people are infected with at least one of the eight major tropical diseases (Remme et al., 1993), most of them living in underdeveloped countries. From the three factors intervening in these diseases - the parasite, the vector and the individual (Gillet, 1986) - there is abundant knowledge concerning the first two but far less relating to people who suffer from these diseases, or the social conditions surrounding their transmission and possible control (Dias et al., 1993). For a long time the importance of studying social factors has been recognized; however, very little research has been undertaken of these, particularly in endemic countries. These countries have adequate human resources to enable research in biomedical or entomological areas of tropical diseases but too little to enable research in the social sciences (Singer, 1989). *Corresponding author. SSDI 0 0 0 1 - 7 0 6 X ( 9 4 ) 0 0 0 2 7 - X
202 This is very much the situation in Latin America. Important biomedical research is conducted and there have also been recent developments in the social sciences, but with little collaboration between the two. With increased interest in the social sciences by the UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases (hereafter WHO/TDR) there has been some encouragement of research on social and economic aspects of tropical diseases (Bonilla, 1991; Bricefio-Le6n, 1990, 1993), but it had been very difficult to find receptivity from among researchers in the region. This is partly due to the difficulty of initiating senior investigators into a new area alien to their training, partly to the inclination toward theoretical and macrosocial reflection which has dominated social sciences research in Latin America in the past two decades, and which privileges theory over practical and applied research.
Objectives of the program Taking this situation into account, a Small Grants Programme for Latin America was launched with the support of the THO/TDR in 1990 (Vlassoff, 1993; Vlassoff & Manderson, 1994). The goal was to attract new investigators into the area of social sciences and tropical diseases and it was addressed to junior researchers in the region and to those senior social sciences investigators who had never undertaken work in the area of health or tropical diseases. The goal was to be achieved by attracting new investigators by a small grant of up to US$5,000. This money was meant for the execution of a small research project lasting one year; only in exceptional cases would a project be financed up to two years. The program sought to create a scientific community in the area of social sciences and tropical diseases, and to contribute to the knowledge of factors which facilitated or might help prevent the transmission of diseases or, which, by addressing social and cultural factors associated with diagnosis and treatment, might allow faster diagnosis and better treatment.
Methods: An adequate strategy The program introduced and enabled the execution of an adequate strategy for the region and for the type of community which it intended to reach. Among the characteristics of the program, the following can be highlighted. (a) The program has adequate and appropriate response given the limitations, in the sense of giving consideration to small projects with a reduced financing amount. Projects longer than a year were discouraged; preference was given instead to the possibility of financing a second project after a good execution of the first one in order to stimulate the idea of conclusion and reinitiation. (b) The option of submitting projects in any of the four prevailing languages in the region (Spanish, Portuguese, English and French) was opened, which incorporated and made funding possible for both young investigators and people working in control programs without second language skills. (c) Research proposals were handled in a stimulating and comprehensible manner. It is very simple to state that a project is bad or has faults, but it is very hard to suggest mechanisms on how to improve it. Those of us involved in the administration
203 of the program endeavoured to counsel the investigator(s) and, within limits, to provide bibliographical references and reprints of articles or books which might be of help. In addition, rejections or letters of deferral were written in a delicate and encouraging way and aimed to encourage future re-applications. (d) Both formal and informal promotions of the program were made, or more accurately the program was promoted in a personalized way. The use of friendly mechanisms available to the people supporting the program (above all at the beginning of the program) were applied: people whose names had been obtained through personal networks were invited; telephone use was extensive in preference to the coldness of letters, and care was taken to ensure that all potentially interested groups were contacted and encouraged to be involved. But parallel to this informal and personal activity, formal and general promotion was undertaken to reach the unknown public, thus avoiding any bias which might result from personalized approaches. To achieve this, two posters were printed in two consecutive years and three thousand copies were distributed among universities and health ministries. The posters carried a detailed explanation of the program together with indications on how to present research proposals. (e) The program was organised in accordance with the goals and the conditions of the region. The program started from a consulting meeting which enabled wide participation of investigators and personnel from control programs. The organizational structure of the program included an executive committee which would evaluate the research proposals and be in charge of the promotion and supervision of the Small Grants Program. This committee includes seven members: three are academics and come from universities from the region and three belong to control programs; the seventh is an institutional member designated by the director of the Pan-American Health Organization (PAHO), the W H O Regional Office. Active members since the inception of the program were: Elssy Bonilla (Colombia), Joao Carlos Pinto Dias (Brazil), Alfredo M6ndez (Guatemala), Domingo Mora M~irquez (Venezuela), Alejandro Rodriguez (Colombia) and Renato Gusmao (PAHO). At the same time a secretariat which operates from the Laboratorio de Ciencias SocialesUniversidad Central (Venezuela) and undertakes executing and coordinating activities, was created. (f) The program includes an adequate evaluation process which, on one hand has followed the same norms prevailing in W H O / T D R ' s central program - those of scientific merit and relevance of the problem to be investigated - but on the other hand, has modulated these criteria to specific circumstances: age of the investigator and need of investigators in that area, institution or country. This is why a given proposal would be considered differently if the presenter were 25 or 40 years old, if it originated from an institution with research an established tradition or not, if the problem were little investigated, or if its execution required training of someone in the area.
Results
Proposals received During the three year performance of the program, 141 research proposals were reviewed. Out of the 141 proposals reviewed 33.3% were approved, 21.3% were
204 deferred, and 31.9% were rejected. An additional 13.5% were rejected because these either dealt with pure biomedical research without considering social aspects, or with social research without considering epidemiological aspects, and were therefore thought not pertinent. Interest in diseases Malaria attracted the widest attention of the proposals with 27.7% of the total, followed by Chagas disease with 22%. Between both half the research proposals are grouped. This reflects the epidemiologic situation in Latin America, where malaria and Chagas disease are the major problems. Of the remaining proposals 14.2% dealt with leishmaniasis, 12.1% with leprosy, and 7.1% with schistosomiasis. Two facts must be emphasised: first, the quasi nil presence of filariasis in the projects (only 2 project proposals in three years) and, second, the fact that there were so few projects received on schistosomiasis, even though this is a relatively important problem where social intervention is considered important and feasible. Geographic distribution The proposals received came from almost every country in Latin America. Proposals came from 16 countries: Argentina, Brazil, Bolivia, Colombia, Costa Rica, Cuba, Chile, Ecuador, Honduras, Guatemala, Nicaragua, M6xico, Peril, Dominican Republic, Uruguay and Venezuela. Among them we can classify four groups with high, medium or low levels in terms of submissions for funding. The countries with the most proposals presented were Colombia (29), Brazil (25) and Venezuela (24). Over half the proposals came from these countries. The second group consists of those with medium levels, that is Peru (14), Argentina (12) and Bolivia (8). The third group comprises Ecuador (6), Guatemala (6), M6xico (5), Dominican Republic (4), Uruguay (3) and Cuba (3). Finally, in a few countries from which only one project has been received to date: Nicaragua, Chile, Honduras and Costa Rica. It is surprising to note the absence of proposals from Paraguay and Panama where the diseases in which WHO/TDR is engaged are endemic. One must acknowledge, however, that there is very little development of social sciences in either of these two countries and accordingly, the research community which might be attracted to work in the field is limited. Professional balance." social~biomedical sciences Taken as a whole there is a balance between the proposals originating from professionals of biomedical sciences (52.5%) and of social sciences (47.5%). From a specific professional perspective, the predominance of medical doctors is very marked: they presented a third of the proposals (35.3%), followed by sociologists (16.5%), then biologists (11.5%). The remainder were drawn from a remarkable variety of professions: architects, economists, anthropologists, psychologists, administrators, engineers, historians, social workers, pharmacists, chemists, geographers, nurses, statisticians, political scientists and archaeologists.
205 Characterization of the researchers Age. The average age of those who have presented proposals is 35. However, half of those (51%) who submitted projects were aged 26 to 31. If we add to this the six percent under 26, it emerges that 57% of the proposals originate from people less than 35 years of age, suggesting that the target population is being reached. Sex. There were slightly more men than women, but in general proposals were reasonably balanced between the sexes: 52.5% were male and 47.5% female. Distribution is almost equal in all age groups, although with a majority of women among those under 25 years of age and over 40. Civil status. A little more than half of the researchers who presented proposals are married; approximately 40% are single. Some significant details In general, the distribution of the research population and projects follows the distribution mentioned above. Nevertheless, a number of features are worth mentioning. It is observed, for instance, that more women than men submit proposals from the social sciences, whereas men are drawn predominantly from biomedical sources. Also noticeable is the fact that professionals from social sciences presented more proposals on malaria and Chagas disease, in contrast to biomedical professional concentration on leishmaniasis and leprosy. There were no differences for schistosomiasis. From the point of view of gender, it can be observed that women dominate in the study of Chagas disease and men in malaria and leishmaniasis. From the geographical point of view, it was noticed that those who came from the Andean Region were predominantly men, while women came mainly from the Southern Cone.
Discussion
On the response to the call Globally it can be said that the response to the Small Grants Program has been highly positive and several factors have contributed to this success. Perhaps the fundamental reason is the design of the grant scheme itself, which is simple, formulated as a possibility for support to challenging research, demanding but not excessively difficult as to discourage young and new researchers. Apart from the attraction of the program itself, there are other important factors contributing to its success. First of all, the wide formal diffusion of information about the program (posters, letters) was complimented by a wide active personalized search of projects by Committee members. Secondly, use of local languages, particularly Spanish and Portuguese, allowed wider access to the program by young researchers whose knowledge of English or French is limited. Nevertheless, the response differs by country and this relates to two factors: first, internal conditions of the countries including the development level of the social sciences and the experience in handling projects with outside financing; second, the
206 action undertaken by members of the Committee - more proposals arrived from those countries where the Committee had members. From the researchers' perspective it is clear that the target population was reached, in terms of age as well as in professional level. The notable presence of researchers aged between 26 and 35 years, and the balance between biomedical and social sciences, proves that the message was well orientated.
On the quality of the proposals The quality of the proposals is very disparate, since it is related to the institution it comes from and the training and educational characteristics of each researcher. But, as a whole, it can be said that there has been an improvement in the quality of proposals reaching the program in terms of problem formulation, conceptualization, research methodology, and related scientific criteria. In parallel, as well, there has been an increase in the level of demands by the Committee, resulting in a decreasing number of projects submitted for consideration being approved. It so happens, however, that the publicity reaches quite isolated places, therefore encouraging proposals from applicants without familiarity with either the social or epidemiological aspects of the diseases. It does not seem possible to expect greater improvement of the proposals, since research capability is tied to the capacity of local research centers and universities; many of these are undergoing considerable problems at present. Therefore, what seems feasible is to work with researchers to offer them help and training regretfully not found at their institutions.
On the process of evaluation The evaluation process followed the patterns used by W H O / T D R , particularly the Steering Committee for Social and Economic Research (SER), and this has worked out well. Committee discussions have proven valuable and productive for they integrate several perspectives, such as those of the social and biomedical sciences, and consider the application of research to disease to control. But due to characteristics inherent to the program, risks have to be taken. This has always caused doubt and discussion on the side of the Committee, since reasonable fears arise relating to the viability of projects staffed by young people new to the area. We knew we would not find perfect proposals, because if these existed as such, a program like the Small Grants Program would be meaningless. However, there always remains a doubt as to how far the risk should be taken concerning a doubtful or innovative proposal. So far the Committee has been moderately daring. More proposals could have been approved, but a higher risk would not necessarily have guaranteed the success obtained. On the other hand, some of the proposals rejected indicate research capacity and quality, but without systematic support and training, the Committee was reluctant to run the risk of approving these proposals.
On the organization of the program The organizational structure, the Committee and the Secretariat, turned out satisfactorily. The Committee achieved good balance and integration, and through its
207 composition of three members from the academy, three from the disease control offices, and one institutional member of PAHO, it functions well. At the beginning it was difficult to establish the evaluation and performance criteria, but later a balance and equilibrium between the different interpretations of the process was achieved. The Committee managed to create in itself a skilled group capable of evaluating various social and economic aspects of tropical diseases and to maintain an overview of the status of social research. This was the continuous challenge represented in evaluating the proposals and the active involvement of Committee members in the programs activities was valuable.
On the process of research Qualitative analysis of the projects illustrate the situation of social science research in Latin America. The fact that the majority of the projects has been characteristically descriptive and exploratory reflects the status of scientific knowledge in the area: the need of greater and better information, and the limited number of hypotheses that require testing. Concerning methodology, the search for a combination of qualitative and quantitative techniques is valuable. However, a weakness in the handling of quantitative analyses is evident and, in some cases, it would appear that the decision to opt for qualitative techniques is the result of more of the lack of information and dexterity in quantitative methods than on a true decision based on the virtues of qualitative techniques to approach the problem set forth. What is really worrying is the lack of innovative force from the projects. They belong, globally, to what can be defined as 'normal science' (Kuhn, 1962); typically they refer to something, already known in another place or acquired through certain methods, to be repeated with changes in the investigation procedure or in the study area. Possible reasons for this include the fact that, in the first place, it is difficult and unfair to demand innovations from new researchers; perhaps the Small Grants Program should be understood as an introduction and familiarization process with the topic area. But, for precisely the same reason of their relative youth, one might expect more innovation. Perhaps the Committee has been too conservative in its evaluation of projects and perhaps, due to the need to guarantee results and project success, some of the innovations offered by some 'risky' proposals may have sacrificed.
On results and publications The delivery of progress and final reports has been considered satisfactory. It is normal to expect delays and failures in any program to support research. In our case we can state these have been minimal, even if some modifications to the analysis or written report, to help strengthen the conclusion of the research, there foreseen. Two measures in particular were implemented: (a) After the first meeting, it was decided to grant researchers 80°/'0 of the funds at the time of the signing of the contract and the remaining 20% when submitting in the Final Report. This step is considered useful, although it must be stated that out of the eight researchers who were granted the 100% of the funds during the first meeting, not only did no one fail to present the final report, but they even
208 re-submitted it, sometimes more than once, to address the criticisms of the Committee. (b) It was also agreed that the presentation of the progress report should be brought forward, focussing it more on methodological aspects than on the presentation of results. The reason for this decision was that at an early phase, the Committee could generate feedback for the researcher and help him or her improve what is considered to be the weakest point - methodology, whereas it was too late to give advice if no action was taken until results were available. Since it was estimated that for a one year research project, a duration of a year and a half was required (due to the delays in fund transfers and communications), the progress report had to be handed in a few months after approval and before starting data collection. This has proven to be a valuable innovation. (c) The decision to limit the maximum length of reports to 20 pages looks positive and should be kept. It is felt that this is a useful means to facilitate report evaluation and to encourage the publication of results. From the perspective of publication the situation is difficult since there is not a tradition to publish articles by social scientists in Latin America. Effort is being made to support publishing of the results, but this is an area that requires a greater training effort than is currently available, since limitations pertain not to the research per se, but to the reporting techniques and report writing skills of the scientists involved.
Conclusion
The Small Grants Program for Social and Economic Aspects of Tropical Diseases was originally a simple strategy to attract young investigators towards a new area, but has developed as an important mechanism for building a scientific community in Latin America. On the basis of submitted reports, the program has fulfilled its objectives. The target population has been reached and a satisfactory response has been obtained from the presentation of research proposals as well as from their execution. Today we can look at a group of new investigators who have been incorporated in an area in which many would never have thought of working. A training goal has been attained since this group of investigators has received training on the social investigation of tropical diseases through research action and by interaction with members of the committee. This group constitutes a scientific community because it now has similar study objectives, it begins to have a common language, and a theoretical and methodological approach which in spite of its pluriparadigrnatic nature - there being no dominant paradigm in the community - is shared in its differences, doubts and searches. The idea of working with limited financial support, of looking for people of younger ages, of working for shorter periods of time, and with a very personalized system for feedback, has turned out to be fruitful. The same applies to the desire for bigger risks. The Small Grants Program has largely been the experience of decision-making power transferred from an international organization ( W H O / T D R ) to a regional group, so that the latter could lead a process and adapt it to the conditions in which it would be developed. This program in consequence is one from and for Latin America, but the implicit philosophy and the implementing
2O9
mechanisms can be useful whenever a research area needs stimulation and in constructing a scientific community in any other place in the world.
Acknowledgements This research received financial support of the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR).
References Bonilla, E. (1991) Salud y Desarrollo. Aspectos Socioecon6micos de la Malaria en Colombia. Plaza y Yanes, Bogota. Bricefio-Le6n, R. (1990) La Casa Enferma. Sociologia de la Enfermedad de Chagas. Acta Cientifica Venezolana, Caracas. Bricefio-Le6n, R (1993) Social aspects of Chagas disease In: S. Lindenbaum & M Lock (Eds.) Knowledge, Power and Practice. The Anthropology of Medicine and Everyday Life. University of California Press, San Francisco, pp. 287-302. Dias, J.C.P., Borges Dias, R. (1993) La necesidad de investigaci6n social y econ6mica para las acciones de control de las enfermedades tropicales. In: R. Bricefio-Le6n and J.C. Pinto Dias (Eds.), Las Enfermedades Tropicales en la Sociedad Contempor~inea, Acta Cientifica Venezolana, Caracas, pp. 30-49. Gillet, J.D. (1985) The behaviour of Homo Sapiens, the forgotten factor in the transmission of tropical disease. Trans. R. Soc. Trop. Med. Hyg. 79, 12-20. Kuhn, T.S. (1962) The Structure of Scientific Revolutions, University of Chicago Press, Chicago. Remme, J.H.F., De Raadt, P., Godal, T. (1993) The Burden of Tropical Diseases. Med. J. Aust. 158, 465-469. Singer, B. (1989) Social Science and The Improvement of Tropical Disease Control. In: B. Bloom and A. Cerami (Eds.), Biomedical Science and the Third World: Under the Vulcano, Annals of the New York Academy of Sciences, New York, Vol. 569, pp. 275-287. Vlassoff, C. (1993) E1 Estado actual de la investigaci6n social y econ6mica sobre las enfermedades tropicales. In: R. Bricefio-Le6n and J.C. Pinto Dias, Las Enfermedades Tropicales en la Sociedad Contempor~inea, Acta Cientifica Venezolana, Caracas, pp. 15-28. Vlassoff, C. and Manderson, L. (1994) Evaluating agency initiatives: Building social science capability in tropical disease research. Acta Trop. 57, 103-122.
201
ACTROP 00392
Setting up a scientific community by means of a small grants program: the Latin American experience Roberto Bricefio-Le6n* Laboratorio de Ciencias Sociales, Universidad Central de Venezuela, Apartado 47795, Caracas 1041-A, Venezuela
The study of tropical diseases in Latin America has been dominated by the biomedical sciences, and whilst recently social science health research has been developed, there has been little collaboration between the two. The Latin American Small Grants Programme for Social and Economic Aspects of Tropical Diseases, launched by WHO/TDR in 1990, aimed to attract junior researchers into the area of social sciences and tropical diseases, and to create among them a scientific community. The program is unique in that it has involved the transfer of decision-making power from an international organisation (WHO/TDR) to a regional group. This article discusses the organisational structure of the program, the methods by which the program handled proposals, the evaluation process, the types of research proposals received, a profile of applicants, and the results of the applications. There was a balance of biomedical and social science applications. We conclude that the Small Grants Programme has been successful in fulfilling its objectives, due to the design of the grants scheme itself. Key words: Latin America; Leishmaniasis
Small grant;
Malaria;
Chagas disease; Schistosomiasis; Leprosy;
Introduction
Tropical diseases represent an important problem for underdeveloped countries both in terms of human suffering from mortality and morbidity and in terms of financial losses originated by them. It is estimated that half a billion people are infected with at least one of the eight major tropical diseases (Remme et al., 1993), most of them living in underdeveloped countries. From the three factors intervening in these diseases - the parasite, the vector and the individual (Gillet, 1986) - there is abundant knowledge concerning the first two but far less relating to people who suffer from these diseases, or the social conditions surrounding their transmission and possible control (Dias et al., 1993). For a long time the importance of studying social factors has been recognized; however, very little research has been undertaken of these, particularly in endemic countries. These countries have adequate human resources to enable research in biomedical or entomological areas of tropical diseases but too little to enable research in the social sciences (Singer, 1989). *Corresponding author. SSDI 0 0 0 1 - 7 0 6 X ( 9 4 ) 0 0 0 2 7 - X
202 This is very much the situation in Latin America. Important biomedical research is conducted and there have also been recent developments in the social sciences, but with little collaboration between the two. With increased interest in the social sciences by the UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases (hereafter WHO/TDR) there has been some encouragement of research on social and economic aspects of tropical diseases (Bonilla, 1991; Bricefio-Le6n, 1990, 1993), but it had been very difficult to find receptivity from among researchers in the region. This is partly due to the difficulty of initiating senior investigators into a new area alien to their training, partly to the inclination toward theoretical and macrosocial reflection which has dominated social sciences research in Latin America in the past two decades, and which privileges theory over practical and applied research.
Objectives of the program Taking this situation into account, a Small Grants Programme for Latin America was launched with the support of the THO/TDR in 1990 (Vlassoff, 1993; Vlassoff & Manderson, 1994). The goal was to attract new investigators into the area of social sciences and tropical diseases and it was addressed to junior researchers in the region and to those senior social sciences investigators who had never undertaken work in the area of health or tropical diseases. The goal was to be achieved by attracting new investigators by a small grant of up to US$5,000. This money was meant for the execution of a small research project lasting one year; only in exceptional cases would a project be financed up to two years. The program sought to create a scientific community in the area of social sciences and tropical diseases, and to contribute to the knowledge of factors which facilitated or might help prevent the transmission of diseases or, which, by addressing social and cultural factors associated with diagnosis and treatment, might allow faster diagnosis and better treatment.
Methods: An adequate strategy The program introduced and enabled the execution of an adequate strategy for the region and for the type of community which it intended to reach. Among the characteristics of the program, the following can be highlighted. (a) The program has adequate and appropriate response given the limitations, in the sense of giving consideration to small projects with a reduced financing amount. Projects longer than a year were discouraged; preference was given instead to the possibility of financing a second project after a good execution of the first one in order to stimulate the idea of conclusion and reinitiation. (b) The option of submitting projects in any of the four prevailing languages in the region (Spanish, Portuguese, English and French) was opened, which incorporated and made funding possible for both young investigators and people working in control programs without second language skills. (c) Research proposals were handled in a stimulating and comprehensible manner. It is very simple to state that a project is bad or has faults, but it is very hard to suggest mechanisms on how to improve it. Those of us involved in the administration
203 of the program endeavoured to counsel the investigator(s) and, within limits, to provide bibliographical references and reprints of articles or books which might be of help. In addition, rejections or letters of deferral were written in a delicate and encouraging way and aimed to encourage future re-applications. (d) Both formal and informal promotions of the program were made, or more accurately the program was promoted in a personalized way. The use of friendly mechanisms available to the people supporting the program (above all at the beginning of the program) were applied: people whose names had been obtained through personal networks were invited; telephone use was extensive in preference to the coldness of letters, and care was taken to ensure that all potentially interested groups were contacted and encouraged to be involved. But parallel to this informal and personal activity, formal and general promotion was undertaken to reach the unknown public, thus avoiding any bias which might result from personalized approaches. To achieve this, two posters were printed in two consecutive years and three thousand copies were distributed among universities and health ministries. The posters carried a detailed explanation of the program together with indications on how to present research proposals. (e) The program was organised in accordance with the goals and the conditions of the region. The program started from a consulting meeting which enabled wide participation of investigators and personnel from control programs. The organizational structure of the program included an executive committee which would evaluate the research proposals and be in charge of the promotion and supervision of the Small Grants Program. This committee includes seven members: three are academics and come from universities from the region and three belong to control programs; the seventh is an institutional member designated by the director of the Pan-American Health Organization (PAHO), the W H O Regional Office. Active members since the inception of the program were: Elssy Bonilla (Colombia), Joao Carlos Pinto Dias (Brazil), Alfredo M6ndez (Guatemala), Domingo Mora M~irquez (Venezuela), Alejandro Rodriguez (Colombia) and Renato Gusmao (PAHO). At the same time a secretariat which operates from the Laboratorio de Ciencias SocialesUniversidad Central (Venezuela) and undertakes executing and coordinating activities, was created. (f) The program includes an adequate evaluation process which, on one hand has followed the same norms prevailing in W H O / T D R ' s central program - those of scientific merit and relevance of the problem to be investigated - but on the other hand, has modulated these criteria to specific circumstances: age of the investigator and need of investigators in that area, institution or country. This is why a given proposal would be considered differently if the presenter were 25 or 40 years old, if it originated from an institution with research an established tradition or not, if the problem were little investigated, or if its execution required training of someone in the area.
Results
Proposals received During the three year performance of the program, 141 research proposals were reviewed. Out of the 141 proposals reviewed 33.3% were approved, 21.3% were
204 deferred, and 31.9% were rejected. An additional 13.5% were rejected because these either dealt with pure biomedical research without considering social aspects, or with social research without considering epidemiological aspects, and were therefore thought not pertinent. Interest in diseases Malaria attracted the widest attention of the proposals with 27.7% of the total, followed by Chagas disease with 22%. Between both half the research proposals are grouped. This reflects the epidemiologic situation in Latin America, where malaria and Chagas disease are the major problems. Of the remaining proposals 14.2% dealt with leishmaniasis, 12.1% with leprosy, and 7.1% with schistosomiasis. Two facts must be emphasised: first, the quasi nil presence of filariasis in the projects (only 2 project proposals in three years) and, second, the fact that there were so few projects received on schistosomiasis, even though this is a relatively important problem where social intervention is considered important and feasible. Geographic distribution The proposals received came from almost every country in Latin America. Proposals came from 16 countries: Argentina, Brazil, Bolivia, Colombia, Costa Rica, Cuba, Chile, Ecuador, Honduras, Guatemala, Nicaragua, M6xico, Peril, Dominican Republic, Uruguay and Venezuela. Among them we can classify four groups with high, medium or low levels in terms of submissions for funding. The countries with the most proposals presented were Colombia (29), Brazil (25) and Venezuela (24). Over half the proposals came from these countries. The second group consists of those with medium levels, that is Peru (14), Argentina (12) and Bolivia (8). The third group comprises Ecuador (6), Guatemala (6), M6xico (5), Dominican Republic (4), Uruguay (3) and Cuba (3). Finally, in a few countries from which only one project has been received to date: Nicaragua, Chile, Honduras and Costa Rica. It is surprising to note the absence of proposals from Paraguay and Panama where the diseases in which WHO/TDR is engaged are endemic. One must acknowledge, however, that there is very little development of social sciences in either of these two countries and accordingly, the research community which might be attracted to work in the field is limited. Professional balance." social~biomedical sciences Taken as a whole there is a balance between the proposals originating from professionals of biomedical sciences (52.5%) and of social sciences (47.5%). From a specific professional perspective, the predominance of medical doctors is very marked: they presented a third of the proposals (35.3%), followed by sociologists (16.5%), then biologists (11.5%). The remainder were drawn from a remarkable variety of professions: architects, economists, anthropologists, psychologists, administrators, engineers, historians, social workers, pharmacists, chemists, geographers, nurses, statisticians, political scientists and archaeologists.
205 Characterization of the researchers Age. The average age of those who have presented proposals is 35. However, half of those (51%) who submitted projects were aged 26 to 31. If we add to this the six percent under 26, it emerges that 57% of the proposals originate from people less than 35 years of age, suggesting that the target population is being reached. Sex. There were slightly more men than women, but in general proposals were reasonably balanced between the sexes: 52.5% were male and 47.5% female. Distribution is almost equal in all age groups, although with a majority of women among those under 25 years of age and over 40. Civil status. A little more than half of the researchers who presented proposals are married; approximately 40% are single. Some significant details In general, the distribution of the research population and projects follows the distribution mentioned above. Nevertheless, a number of features are worth mentioning. It is observed, for instance, that more women than men submit proposals from the social sciences, whereas men are drawn predominantly from biomedical sources. Also noticeable is the fact that professionals from social sciences presented more proposals on malaria and Chagas disease, in contrast to biomedical professional concentration on leishmaniasis and leprosy. There were no differences for schistosomiasis. From the point of view of gender, it can be observed that women dominate in the study of Chagas disease and men in malaria and leishmaniasis. From the geographical point of view, it was noticed that those who came from the Andean Region were predominantly men, while women came mainly from the Southern Cone.
Discussion
On the response to the call Globally it can be said that the response to the Small Grants Program has been highly positive and several factors have contributed to this success. Perhaps the fundamental reason is the design of the grant scheme itself, which is simple, formulated as a possibility for support to challenging research, demanding but not excessively difficult as to discourage young and new researchers. Apart from the attraction of the program itself, there are other important factors contributing to its success. First of all, the wide formal diffusion of information about the program (posters, letters) was complimented by a wide active personalized search of projects by Committee members. Secondly, use of local languages, particularly Spanish and Portuguese, allowed wider access to the program by young researchers whose knowledge of English or French is limited. Nevertheless, the response differs by country and this relates to two factors: first, internal conditions of the countries including the development level of the social sciences and the experience in handling projects with outside financing; second, the
206 action undertaken by members of the Committee - more proposals arrived from those countries where the Committee had members. From the researchers' perspective it is clear that the target population was reached, in terms of age as well as in professional level. The notable presence of researchers aged between 26 and 35 years, and the balance between biomedical and social sciences, proves that the message was well orientated.
On the quality of the proposals The quality of the proposals is very disparate, since it is related to the institution it comes from and the training and educational characteristics of each researcher. But, as a whole, it can be said that there has been an improvement in the quality of proposals reaching the program in terms of problem formulation, conceptualization, research methodology, and related scientific criteria. In parallel, as well, there has been an increase in the level of demands by the Committee, resulting in a decreasing number of projects submitted for consideration being approved. It so happens, however, that the publicity reaches quite isolated places, therefore encouraging proposals from applicants without familiarity with either the social or epidemiological aspects of the diseases. It does not seem possible to expect greater improvement of the proposals, since research capability is tied to the capacity of local research centers and universities; many of these are undergoing considerable problems at present. Therefore, what seems feasible is to work with researchers to offer them help and training regretfully not found at their institutions.
On the process of evaluation The evaluation process followed the patterns used by W H O / T D R , particularly the Steering Committee for Social and Economic Research (SER), and this has worked out well. Committee discussions have proven valuable and productive for they integrate several perspectives, such as those of the social and biomedical sciences, and consider the application of research to disease to control. But due to characteristics inherent to the program, risks have to be taken. This has always caused doubt and discussion on the side of the Committee, since reasonable fears arise relating to the viability of projects staffed by young people new to the area. We knew we would not find perfect proposals, because if these existed as such, a program like the Small Grants Program would be meaningless. However, there always remains a doubt as to how far the risk should be taken concerning a doubtful or innovative proposal. So far the Committee has been moderately daring. More proposals could have been approved, but a higher risk would not necessarily have guaranteed the success obtained. On the other hand, some of the proposals rejected indicate research capacity and quality, but without systematic support and training, the Committee was reluctant to run the risk of approving these proposals.
On the organization of the program The organizational structure, the Committee and the Secretariat, turned out satisfactorily. The Committee achieved good balance and integration, and through its
207 composition of three members from the academy, three from the disease control offices, and one institutional member of PAHO, it functions well. At the beginning it was difficult to establish the evaluation and performance criteria, but later a balance and equilibrium between the different interpretations of the process was achieved. The Committee managed to create in itself a skilled group capable of evaluating various social and economic aspects of tropical diseases and to maintain an overview of the status of social research. This was the continuous challenge represented in evaluating the proposals and the active involvement of Committee members in the programs activities was valuable.
On the process of research Qualitative analysis of the projects illustrate the situation of social science research in Latin America. The fact that the majority of the projects has been characteristically descriptive and exploratory reflects the status of scientific knowledge in the area: the need of greater and better information, and the limited number of hypotheses that require testing. Concerning methodology, the search for a combination of qualitative and quantitative techniques is valuable. However, a weakness in the handling of quantitative analyses is evident and, in some cases, it would appear that the decision to opt for qualitative techniques is the result of more of the lack of information and dexterity in quantitative methods than on a true decision based on the virtues of qualitative techniques to approach the problem set forth. What is really worrying is the lack of innovative force from the projects. They belong, globally, to what can be defined as 'normal science' (Kuhn, 1962); typically they refer to something, already known in another place or acquired through certain methods, to be repeated with changes in the investigation procedure or in the study area. Possible reasons for this include the fact that, in the first place, it is difficult and unfair to demand innovations from new researchers; perhaps the Small Grants Program should be understood as an introduction and familiarization process with the topic area. But, for precisely the same reason of their relative youth, one might expect more innovation. Perhaps the Committee has been too conservative in its evaluation of projects and perhaps, due to the need to guarantee results and project success, some of the innovations offered by some 'risky' proposals may have sacrificed.
On results and publications The delivery of progress and final reports has been considered satisfactory. It is normal to expect delays and failures in any program to support research. In our case we can state these have been minimal, even if some modifications to the analysis or written report, to help strengthen the conclusion of the research, there foreseen. Two measures in particular were implemented: (a) After the first meeting, it was decided to grant researchers 80°/'0 of the funds at the time of the signing of the contract and the remaining 20% when submitting in the Final Report. This step is considered useful, although it must be stated that out of the eight researchers who were granted the 100% of the funds during the first meeting, not only did no one fail to present the final report, but they even
208 re-submitted it, sometimes more than once, to address the criticisms of the Committee. (b) It was also agreed that the presentation of the progress report should be brought forward, focussing it more on methodological aspects than on the presentation of results. The reason for this decision was that at an early phase, the Committee could generate feedback for the researcher and help him or her improve what is considered to be the weakest point - methodology, whereas it was too late to give advice if no action was taken until results were available. Since it was estimated that for a one year research project, a duration of a year and a half was required (due to the delays in fund transfers and communications), the progress report had to be handed in a few months after approval and before starting data collection. This has proven to be a valuable innovation. (c) The decision to limit the maximum length of reports to 20 pages looks positive and should be kept. It is felt that this is a useful means to facilitate report evaluation and to encourage the publication of results. From the perspective of publication the situation is difficult since there is not a tradition to publish articles by social scientists in Latin America. Effort is being made to support publishing of the results, but this is an area that requires a greater training effort than is currently available, since limitations pertain not to the research per se, but to the reporting techniques and report writing skills of the scientists involved.
Conclusion
The Small Grants Program for Social and Economic Aspects of Tropical Diseases was originally a simple strategy to attract young investigators towards a new area, but has developed as an important mechanism for building a scientific community in Latin America. On the basis of submitted reports, the program has fulfilled its objectives. The target population has been reached and a satisfactory response has been obtained from the presentation of research proposals as well as from their execution. Today we can look at a group of new investigators who have been incorporated in an area in which many would never have thought of working. A training goal has been attained since this group of investigators has received training on the social investigation of tropical diseases through research action and by interaction with members of the committee. This group constitutes a scientific community because it now has similar study objectives, it begins to have a common language, and a theoretical and methodological approach which in spite of its pluriparadigrnatic nature - there being no dominant paradigm in the community - is shared in its differences, doubts and searches. The idea of working with limited financial support, of looking for people of younger ages, of working for shorter periods of time, and with a very personalized system for feedback, has turned out to be fruitful. The same applies to the desire for bigger risks. The Small Grants Program has largely been the experience of decision-making power transferred from an international organization ( W H O / T D R ) to a regional group, so that the latter could lead a process and adapt it to the conditions in which it would be developed. This program in consequence is one from and for Latin America, but the implicit philosophy and the implementing
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mechanisms can be useful whenever a research area needs stimulation and in constructing a scientific community in any other place in the world.
Acknowledgements This research received financial support of the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR).
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