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Strengthening research capability, funding and sustainability: a personal perspective
Acta Tropica, 57(1994)22%237 © 1994 Elsevier Science B.V. All rights reserved 0001-706X/94/$07.00
229
ACTROP 00394
Strengthening research capability, funding and sustainability: a personal perspective Kamolnetr Okanurak* Social and Economic Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok 10400, Thailand The need to strengthen research capability has led organizations to provide research-oriented training programs, including various short courses and protocol development workshops, at the end of which it is anticipated that the participants will be able to carry out the research work. However, to do research needs more than just training; it also requires funds, a research infrastructure, technical back-up and other support. This paper compares two of these programs from the perspective of an attendant: WHO/TDR's Fieldlincs program and the CAPS (Center for AIDS Prevention Studies) International Program. The paper also describes the experience of the approaches that have been used to get research funding. In addition, issues related to sustaining researchers in the field are discussed. Key words: Research strengthening; Funding; Sustainability; WHO; CAPS
Introduction
Academic work is characterized by two interrelated and complimentary activities, research and teaching. However, it is not easy to create a capable researcher, and formal training through master's and doctoral programs are only part of this process. A conventional approach taken by various funding agencies to develop research capability has been to encourage potential researchers to attend courses on research design and methodology, but this does not guarantee that the participant will emerge a researcher. To be a researcher involves more than participation in a research course, it needs at least a creative mind and an ability to bring things together. Good research is an art, developed on the basis of knowledge of and competence in science. The art is to capture available information, analyze it and formulate research questions, then frame these into a research proposal. With a proposal developed, one then has to look for financial and other support, often in a highly competitive environment. If the proposal gets support, then the study will be implemented; this in turn is followed by an extended period dedicated to data collection, analysis and report writing. This brief description of the research process shows that conducting research work is not simple; this is perhaps part of its attraction for academics and other research scientists as each research project generates new ideas for further research. This paper consists of three parts: it compares two research-oriented training *Corresponding author. Tel.: ( 6 6 2 ) 246-0056. Fax: (66-2) 246 3755. SSDI 0 0 0 1 - 7 0 6 X ( 9 4 ) 0 0 0 2 9 - Z
230 programs; considers issues related to seeking research funding and sustaining researchers in the field; and reflects on personal experience as a social scientist working in health-related fields within a medical institution. Some of the discussion which follows can apply to research in general, other aspects will be appropriate only to medical social scientists.
Short courses and workshops: a comparison
Recently, many organizations have arranged research-related training, including research methods and protocol development workshops, in order to strengthen research capability. This has occurred as funding institutions and multilateral organisations have identified areas where research is urgently needed in the field of health, particularly in relation to the development, acceptability and sustainability of interventions. It is expected that after attending the training program the participants will be able to carry out their own research. My own position as a social scientist within a medical research institution has meant that I have had various training opportunities and I reflect on two alternative models here: training courses held under the auspices of the W H O / T D R Fieldlincs Programme (Field Research for Intervention and Control Studies Programme of the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases) and the International Program of the Center for AIDS Prevention Studies (CAPS). In this paper, I draw on my experience of two Fieldlincs courses held in Manila in July 1989 and in Brisbane, September-October 1990, and a CAPS course held in San Francisco, 24 July-1 October 1989.
Objectives The objectives of the two programs are set out in Table 1. In broad terms the two programs share the same objectives, that is, to strengthen the research capability of the participants, and/or to help the participants to develop the proposal. The programs use similar processes to reach their objectives - a combination of didactic lectures, some practicum or workshops, and one-to-one consultation between participants and facilitators.
Participants Like other institutional strengthening programs, both the Fieldlincs courses and the CAPS program had the same target, that is, to capture the interest of researchers in the problems of a particular disease - in the case of W H O / T D R , the target tropical diseases (see Vlassoff and Manderson, 1994), in the case of CAPS, HIV/AIDS infection. When submitting an application to participate in a training course, the expected participants are usually expected to have included an outline or pre-proposal of their study, on which basis they are selected to attend the course.
231 TABLE 1 WHO/TDR Fieldlincs and CAPS International Program
Objectives
Organizer
Period Trainers
Facilities (Library, Computer etc.) Formal lecture
Research funding
Fieldincs
CAPS
To provide training in epidemiology, entomology and the social sciences for individuals conducting field research in tropical diseases To promote field research networks
To provide basic training in epidemiology, biology, research design and biostatics
To provide input into the selection and utilization of epidemiological, social science and entomological methods appropriate for the study of tropical diseases WHO/TDR
5 days Disciplines are limited to those represented among workshop facilitators No Yes (epidemiology, social science method, research design) Not assured
To assist in developing research protocol in the area of AIDS prevention
Center for AIDS Prevention Studies, University of California (San Francisco) 10 weeks Access to a wide range of skills through on-campus delivery of workshop Yes Yes (research design, biostatistics) Yes (to carry out the revised proposal and/or to attend international meeting)
Trainers
Certain differences emerge between the programs when we consider the disciplinary background of the trainers. The Fieldlincs course was organized by W H O / T D R , and therefore a number of W H O representatives acted as trainers. This has some merit in terms of developing links between the research community, W H O advisers within the region, and control program staff. However, the research experiences of such facilitators were not always made explicit, and those who had worked within the organisation for a period of time often had far less immediate knowledge or breadth of experience of research issues than those they were purportedly training. When trainers are recruited for political or institutional reasons, rather than because of the unique skills that they bring to a training program, there are inevitable compromises in the quality of training. Tuition under the CAPS program was by comparison far more rigorous, although this was assisted also by the time frame allowed for training (10 weeks rather than one). On arrival, participants were assigned one or two preceptors, and the small groups thus organised would often meet and discuss their work. The preceptors
232 would advise the trainees about the weak points of their proposal and if necessary would arrange for them meetings with other specialists who were working in the areas of the trainees' interest. Experience from the two training programs suggests the value of preceptors to coordinate the work of the participants, and if needed, to organise special tutorial sessions for particular participants. In theory this was intended also for the Fieldlincs course, but the truncated period of time and the lack of staff comfortable with various disciplines limited the value of the approach.
Formal lectures During the Fieldlincs workshops, didactic lectures on subjects such as epidemiological design, population and sample selection, and data analysis were given; these consumed about 20-25% of the time. This kind of basic knowledge may n o t be necessary for some participants who would rather spend their time in informal discussion and in working on their research proposals. It was also felt that if one really needed to know about these basic subjects, then the amount of time dedicated to formal lectures was inadequate. For those who wanted to learn about new advances in such subjects, the information given was insufficient. In general then, within a short-time frame the program attempted to meet very different needs and in consequence, fell short in a number of areas. The problem with short courses would appear to be their inability to cover a variety of topics at an appropriate level within a limited time-frame. In contrast, while participants in the CAPS course also had to attend regular lectures on research design and biostatistics, these were conducted for other graduate students in the university and on the whole they tended to offer a more coherent program.
Facilities The library is a very important and basic facility in the process of developing the research proposal. Researchers from developing countries often have insufficient library resources within their own institutions, which limits their opportunity to catch up with current knowledge and, in consequence, their chances of developing a research protocol at a level of sophistication to best ensure funding. Laboratory work is also an important tool for those who plan to use new techniques in their study where their research involves interdisciplinary collaboration, and access to a laboratory, or laboratory instruction, may be as important as the use of library facilities. Computers are another important item of equipment for a variety of purposes including the management and analysis of data. It might be quite useful for researchers to learn about software with which they are unfamiliar, and again, special purpose courses often lack the hardware and sufficient time to train researchers to use the software appropriate to their work.
Training period The duration of 5 days is a relatively short period of time for training, and it is difficult for research participants to rewrite, modify and sometimes redesign a proposal within this period. During the 5 days of Fieldlincs meetings, for example, trainees had to listen to theoretical lectures not all of which were appropriate to them; this took at least one out of five days. Then, the trainers would try to help
233 each trainee on a one-to-one basis; however not all trainers had been adequately or appropriately briefed beforehand and were unclear of what was expected of them, spending valuable time instead talking about general issues rather than focusing on the research project, providing the trainee with comments on the weak points of the particular study, and suggesting ways to improve it. Again, in contrast, the 10 weeks of the CAPS program gave the trainee a lot of time to reconsider his or her study, and after each discussion with the expert, he/she would canvas other opinions or suggestions to develop a good proposal. In addition to time spent on protocol development, during the CAPS program some of the trainees who wanted to practice or learn about a particular subject had both the time and opportunity to do so. For example, if the trainee wished to learn a particular laboratory technique which would be used in the study, she or he could work directly with those who are using that technique. When the training period of these two programs is compared, it would appear that the time allocated for the Fieldlincs meeting was too short, and that the participants had insufficient time to absorb and reflect on comments after they were received. Moreover, some of the participants did not have a chance to get specific feedback for their proposals. The CAPS program, however, would appear to use time inefficiently, and it would be possible, for example, to include formal lectures in a more intensive program by scheduling them 2 or 3 times a week instead of once a week. If everything is taken into consideration, a course of 3-4 weeks might be most appropriate. The participants would have enough time to reconsider their study, and time to work in the library or learn some new technique. In addition, within this period some specific formal lectures could be incorporated.
Research funding Attendance at the Fieldlincs meeting did not mean that the participants would get financial support for conducting their research, and very often the pre-proposals that were used in the Fieldlincs training workshop were not developed into full proposals nor submitted to WHO/TDR for funding. In contrast, those who attended the CAPS program were assured of financial support, and the program also undertook to finance the participant to attend an international meeting if a paper deriving from the study were accepted for presentation. The experience showed that CAPS fellows have enjoyed this privilege and have been motivated to conduct their research and to take steps to present their work at an international meeting. In comparing these two programs, the participants of the CAPS are more likely to conduct their own research after training, since they had both revised their proposal before leaving CAPS and had the financial support to conduct the work. In addition, the opportunity to present the study at the international meeting was very encouraging. Participants of the Fieldlincs workshops, on the other hand, had to compete with other researchers to get financial support, and participation in a course did not guarantee grant success.
Approaches to research funding Most research is dependent upon financial support; the support indicates that the particular study is worth doing and provides the basic equipment and other support
234 that are preconditions for the work to be conducted. Common approaches for research funding are:
Announcement Normally, announcements are circulated to researchers or to their institutions calling for letters of intent, expressions of interest, pre-proposals or full research proposals. These circulations are, for example, from newsletters from W H O / T D R or W H O / G P A (Global Programme on AIDS). If the scope of work in the announcement is of interest, one would prepare and submit the pre-proposal or proposal. The field is intensely competitive, however, and many developing country researchers share the experience of very little feedback, and only rarely positive responses to, for instance, pre-proposals calling for a full proposal and budget estimate. Whilst this may partly reflect the numbers who respond, the country and subject areas that are priorities, and other agency policy decisions, it also appears - from the point of view of the researcher - that there is a communication gap which exists as a result of the researcher working in a second language (usually English). However, the conceptual framework is always present in the proposal which should not be difficult to evaluate. Since the preliminary requirement is a pre-proposal, there is always room to improve the actual proposal, if the design and methodology are accepted. It was not uncommon that we are asked to comment on a pre-proposal prepared by expatriate researchers or others whose first language is English, responding to the same announcement. Very often, their conceptual framework, research questions and methodologies were not appropriate for the study area, yet their proposal was approved. This suggests that good language is more important to the donor agencies than the research design and methodology of the study. Another common problem is that some announcements are sent to the Ministry of Public Health, not to the universities or research institutions. It is very common for information to be circulated elsewhere before reaching the appropriate researchers, by which time it may be too late or the time-frame too short to allow the preparation even of a pre-proposal.
Personal communication with the international funding agencies In this approach, the researchers make direct contact with the agencies by letters or at international meetings. The communication should be both ways, so that national researchers are able to learn of areas of interest to the donor agency whilst they in turn can introduce problems to officers of the donor agency to raise their interest. Subsequently, the proposal will be submitted or considered. This approach may provide the researcher with some flexibility, and assists in the development of authorrather than agency-driven research programs, but works only for those researchers who already have established contacts and are able to maintain them.
Direct requests from the international agencies This kind of research support is based on the requirements of the donor agencies who after reviewing the situation, want someone to clarify certain points or to gather more information on a particular subject. They would make direct contact with the
235 appropriate researchers or institutions and ask them to conduct the research on that particular topic area. For example, the Social and Economic Research Unit of the Faculty of Medicine, Mahidol University, of which I am a member, was requested to make an anthropological study on treatment-seeking behaviors of malaria patients to complement the quantitative study on the utilization of antimalarial drugs in endemic areas. This kind of funding is not common, but it is available for competent researchers. Collaboration with institutions in developed countries
This approach seems more common nowadays, and of course is one way which technically enables northern researchers to pursue their own field research interests whilst they in turn contribute to staff development in developing country institutions. Several announcements from funding agencies require or support research projects developed from collaboration between institutions in developing and developed countries. This kind of funding is acceptable to institutions in non-English speaking countries. Several advantages can be seen, for example, in the preparation of the research proposal and in report writing and publishing. However, the collaboration will be more acceptable if the research input and budget are fairly shared among the collaborating institutions, and this is not necessarily or always the case (see also Lansang and Olveda, this issue).
How to sustain the researcher in the field
Most researchers, if not all, are basically interested in carrying out the research work, in discovering new information, or in finding explanations to how such things occur or why people behave as they do. There are though a few things that researchers may want to have and to do so, that they will remain active. Opportunity to conduct research that they are interested in
Most researchers after working for sometime know themselves the areas in which they want to work. Ideas usually spring from one research project to another. Some ideas may be too ambitious and may need trimming by discussing and consulting with colleagues. The opportunity to do research of their own interest is the wish of most researchers, but in some circumstances, for example, within medical institutions, it is not easy for social scientists to get support in carrying their own research as equals with medical scientists (Trostle, 1992). It needs a fairly broad-minded administrator who understands the usefulness of social science research and its applicability in helping to solve health problems. The support from the institution as such should include physical facilities and personnel. The opportunity offered to social scientists may not be only from the institution, but also from the donor agencies, particularly those that have assisted in the initiation and training of the social scientists. The re-entry grant scheme of W H O / T D R , which provides new graduates from developing countries with the possibility of funding to conduct research on their return home, is a very good program that can help newlytrained researchers remain active in their chosen field.
236
Opportunity to exhibit their talent The support for researchers to participate and present their work at the national and international meetings is an important measure to sustain the activity of researchers. The opportunity to publish their work is also a way to exhibit the talent of the researchers. Unfortunately, in Southeast Asia (and in many other regions), there is no journal dedicated to health social science research, and few medical journals accept social science papers. The problems are related to two basic things. First, most social science papers developed for publication are longer than those from the 'hard sciences' and need more space than the journals can afford. Second, most of the social science papers do not fall in line with the format of the health science and/or biomedical science papers. Several social scientists in Thailand have to publish their work in the form of research reports which are rather limited in circulation. Thus, their work has limited circulation, is seldom known of or read of the country, and is rarely quoted by others.
Working atmosphere Very often social scientists feel uneasy working in the environment of medical scientists, particularly among basic science researchers or clinicians. In the world of health and medical research, it is more or less accepted that the physician is the leader. Although some physicians, particularly those who work undertake community-based research, are able to appreciate and draw on the skills and expertise of researchers from other disciplines, other clinicians are less willing to admit this. At times such disciplinary tensions create difficulties in research, not only the social scientist, but for other researchers also. On the other hand, many of social scientists who work in medical or health institutions do not understand basic medical science. These social scientists will feel alien among their colleagues, especially when there are few social scientists in the larger health scientist community. Both health and social scientists need to a certain extent to acquire more knowledge in other areas; true collaboration across disciplines depends on their appreciation of other skills, techniques and concepts. It is also the duty of the institution to create a communal working atmosphere between the two disciplinary areas so that their work is complementary.
Financial incentive Financial incentive might be the most important component in keeping researchers in the field. In order to have continuous funding, researchers have to work very hard to keep up with current knowledge and to remain competitive as researchers. In developing countries, not many graduates are interested in becoming researchers since they know that to be a good researcher they have to devote time and effort, whilst remuneration is often very low and financial incentive rare. Without some incentive, it is difficult to sustain good researchers. The payment of a honorarium through research grants is effective, although donor agencies very seldom provide it.
237
Conclusion Several factors can encourage social scientists to be active. Some relate to their environment, including the institution and the funding agencies whose roles in supporting and encouraging social scientists in terms of financial and physical facilities are as important as moral support. Social scientists themselves have to be active in acquiring new information and updating their knowledge. Participation in scientific meetings and teaching, publication of their work and chances to test or apply their findings in disease control programs, are also a means of keeping researchers active and providing a base for their areas of research and expertise to consolidate and expand.
References Lansang, M.A. and Olveda, R.O. (1994) Institutional linkages: Strategic bridges for research capacity strengthening. Acta Trop. 57, 139-145. Trostle, J. (1992) Researchcapacitybuilding in international health: Definitions, evaluations and strategies for success. Soc. Sci. Med. 35(11), 1321-1324. Vlassoff, C. and Manderson, L. (1994) Evaluating agency initiatives: Building social science capability in tropical disease research. Acta Trop. 57, 103 122.
229
ACTROP 00394
Strengthening research capability, funding and sustainability: a personal perspective Kamolnetr Okanurak* Social and Economic Research Unit, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajvithi Road, Bangkok 10400, Thailand The need to strengthen research capability has led organizations to provide research-oriented training programs, including various short courses and protocol development workshops, at the end of which it is anticipated that the participants will be able to carry out the research work. However, to do research needs more than just training; it also requires funds, a research infrastructure, technical back-up and other support. This paper compares two of these programs from the perspective of an attendant: WHO/TDR's Fieldlincs program and the CAPS (Center for AIDS Prevention Studies) International Program. The paper also describes the experience of the approaches that have been used to get research funding. In addition, issues related to sustaining researchers in the field are discussed. Key words: Research strengthening; Funding; Sustainability; WHO; CAPS
Introduction
Academic work is characterized by two interrelated and complimentary activities, research and teaching. However, it is not easy to create a capable researcher, and formal training through master's and doctoral programs are only part of this process. A conventional approach taken by various funding agencies to develop research capability has been to encourage potential researchers to attend courses on research design and methodology, but this does not guarantee that the participant will emerge a researcher. To be a researcher involves more than participation in a research course, it needs at least a creative mind and an ability to bring things together. Good research is an art, developed on the basis of knowledge of and competence in science. The art is to capture available information, analyze it and formulate research questions, then frame these into a research proposal. With a proposal developed, one then has to look for financial and other support, often in a highly competitive environment. If the proposal gets support, then the study will be implemented; this in turn is followed by an extended period dedicated to data collection, analysis and report writing. This brief description of the research process shows that conducting research work is not simple; this is perhaps part of its attraction for academics and other research scientists as each research project generates new ideas for further research. This paper consists of three parts: it compares two research-oriented training *Corresponding author. Tel.: ( 6 6 2 ) 246-0056. Fax: (66-2) 246 3755. SSDI 0 0 0 1 - 7 0 6 X ( 9 4 ) 0 0 0 2 9 - Z
230 programs; considers issues related to seeking research funding and sustaining researchers in the field; and reflects on personal experience as a social scientist working in health-related fields within a medical institution. Some of the discussion which follows can apply to research in general, other aspects will be appropriate only to medical social scientists.
Short courses and workshops: a comparison
Recently, many organizations have arranged research-related training, including research methods and protocol development workshops, in order to strengthen research capability. This has occurred as funding institutions and multilateral organisations have identified areas where research is urgently needed in the field of health, particularly in relation to the development, acceptability and sustainability of interventions. It is expected that after attending the training program the participants will be able to carry out their own research. My own position as a social scientist within a medical research institution has meant that I have had various training opportunities and I reflect on two alternative models here: training courses held under the auspices of the W H O / T D R Fieldlincs Programme (Field Research for Intervention and Control Studies Programme of the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases) and the International Program of the Center for AIDS Prevention Studies (CAPS). In this paper, I draw on my experience of two Fieldlincs courses held in Manila in July 1989 and in Brisbane, September-October 1990, and a CAPS course held in San Francisco, 24 July-1 October 1989.
Objectives The objectives of the two programs are set out in Table 1. In broad terms the two programs share the same objectives, that is, to strengthen the research capability of the participants, and/or to help the participants to develop the proposal. The programs use similar processes to reach their objectives - a combination of didactic lectures, some practicum or workshops, and one-to-one consultation between participants and facilitators.
Participants Like other institutional strengthening programs, both the Fieldlincs courses and the CAPS program had the same target, that is, to capture the interest of researchers in the problems of a particular disease - in the case of W H O / T D R , the target tropical diseases (see Vlassoff and Manderson, 1994), in the case of CAPS, HIV/AIDS infection. When submitting an application to participate in a training course, the expected participants are usually expected to have included an outline or pre-proposal of their study, on which basis they are selected to attend the course.
231 TABLE 1 WHO/TDR Fieldlincs and CAPS International Program
Objectives
Organizer
Period Trainers
Facilities (Library, Computer etc.) Formal lecture
Research funding
Fieldincs
CAPS
To provide training in epidemiology, entomology and the social sciences for individuals conducting field research in tropical diseases To promote field research networks
To provide basic training in epidemiology, biology, research design and biostatics
To provide input into the selection and utilization of epidemiological, social science and entomological methods appropriate for the study of tropical diseases WHO/TDR
5 days Disciplines are limited to those represented among workshop facilitators No Yes (epidemiology, social science method, research design) Not assured
To assist in developing research protocol in the area of AIDS prevention
Center for AIDS Prevention Studies, University of California (San Francisco) 10 weeks Access to a wide range of skills through on-campus delivery of workshop Yes Yes (research design, biostatistics) Yes (to carry out the revised proposal and/or to attend international meeting)
Trainers
Certain differences emerge between the programs when we consider the disciplinary background of the trainers. The Fieldlincs course was organized by W H O / T D R , and therefore a number of W H O representatives acted as trainers. This has some merit in terms of developing links between the research community, W H O advisers within the region, and control program staff. However, the research experiences of such facilitators were not always made explicit, and those who had worked within the organisation for a period of time often had far less immediate knowledge or breadth of experience of research issues than those they were purportedly training. When trainers are recruited for political or institutional reasons, rather than because of the unique skills that they bring to a training program, there are inevitable compromises in the quality of training. Tuition under the CAPS program was by comparison far more rigorous, although this was assisted also by the time frame allowed for training (10 weeks rather than one). On arrival, participants were assigned one or two preceptors, and the small groups thus organised would often meet and discuss their work. The preceptors
232 would advise the trainees about the weak points of their proposal and if necessary would arrange for them meetings with other specialists who were working in the areas of the trainees' interest. Experience from the two training programs suggests the value of preceptors to coordinate the work of the participants, and if needed, to organise special tutorial sessions for particular participants. In theory this was intended also for the Fieldlincs course, but the truncated period of time and the lack of staff comfortable with various disciplines limited the value of the approach.
Formal lectures During the Fieldlincs workshops, didactic lectures on subjects such as epidemiological design, population and sample selection, and data analysis were given; these consumed about 20-25% of the time. This kind of basic knowledge may n o t be necessary for some participants who would rather spend their time in informal discussion and in working on their research proposals. It was also felt that if one really needed to know about these basic subjects, then the amount of time dedicated to formal lectures was inadequate. For those who wanted to learn about new advances in such subjects, the information given was insufficient. In general then, within a short-time frame the program attempted to meet very different needs and in consequence, fell short in a number of areas. The problem with short courses would appear to be their inability to cover a variety of topics at an appropriate level within a limited time-frame. In contrast, while participants in the CAPS course also had to attend regular lectures on research design and biostatistics, these were conducted for other graduate students in the university and on the whole they tended to offer a more coherent program.
Facilities The library is a very important and basic facility in the process of developing the research proposal. Researchers from developing countries often have insufficient library resources within their own institutions, which limits their opportunity to catch up with current knowledge and, in consequence, their chances of developing a research protocol at a level of sophistication to best ensure funding. Laboratory work is also an important tool for those who plan to use new techniques in their study where their research involves interdisciplinary collaboration, and access to a laboratory, or laboratory instruction, may be as important as the use of library facilities. Computers are another important item of equipment for a variety of purposes including the management and analysis of data. It might be quite useful for researchers to learn about software with which they are unfamiliar, and again, special purpose courses often lack the hardware and sufficient time to train researchers to use the software appropriate to their work.
Training period The duration of 5 days is a relatively short period of time for training, and it is difficult for research participants to rewrite, modify and sometimes redesign a proposal within this period. During the 5 days of Fieldlincs meetings, for example, trainees had to listen to theoretical lectures not all of which were appropriate to them; this took at least one out of five days. Then, the trainers would try to help
233 each trainee on a one-to-one basis; however not all trainers had been adequately or appropriately briefed beforehand and were unclear of what was expected of them, spending valuable time instead talking about general issues rather than focusing on the research project, providing the trainee with comments on the weak points of the particular study, and suggesting ways to improve it. Again, in contrast, the 10 weeks of the CAPS program gave the trainee a lot of time to reconsider his or her study, and after each discussion with the expert, he/she would canvas other opinions or suggestions to develop a good proposal. In addition to time spent on protocol development, during the CAPS program some of the trainees who wanted to practice or learn about a particular subject had both the time and opportunity to do so. For example, if the trainee wished to learn a particular laboratory technique which would be used in the study, she or he could work directly with those who are using that technique. When the training period of these two programs is compared, it would appear that the time allocated for the Fieldlincs meeting was too short, and that the participants had insufficient time to absorb and reflect on comments after they were received. Moreover, some of the participants did not have a chance to get specific feedback for their proposals. The CAPS program, however, would appear to use time inefficiently, and it would be possible, for example, to include formal lectures in a more intensive program by scheduling them 2 or 3 times a week instead of once a week. If everything is taken into consideration, a course of 3-4 weeks might be most appropriate. The participants would have enough time to reconsider their study, and time to work in the library or learn some new technique. In addition, within this period some specific formal lectures could be incorporated.
Research funding Attendance at the Fieldlincs meeting did not mean that the participants would get financial support for conducting their research, and very often the pre-proposals that were used in the Fieldlincs training workshop were not developed into full proposals nor submitted to WHO/TDR for funding. In contrast, those who attended the CAPS program were assured of financial support, and the program also undertook to finance the participant to attend an international meeting if a paper deriving from the study were accepted for presentation. The experience showed that CAPS fellows have enjoyed this privilege and have been motivated to conduct their research and to take steps to present their work at an international meeting. In comparing these two programs, the participants of the CAPS are more likely to conduct their own research after training, since they had both revised their proposal before leaving CAPS and had the financial support to conduct the work. In addition, the opportunity to present the study at the international meeting was very encouraging. Participants of the Fieldlincs workshops, on the other hand, had to compete with other researchers to get financial support, and participation in a course did not guarantee grant success.
Approaches to research funding Most research is dependent upon financial support; the support indicates that the particular study is worth doing and provides the basic equipment and other support
234 that are preconditions for the work to be conducted. Common approaches for research funding are:
Announcement Normally, announcements are circulated to researchers or to their institutions calling for letters of intent, expressions of interest, pre-proposals or full research proposals. These circulations are, for example, from newsletters from W H O / T D R or W H O / G P A (Global Programme on AIDS). If the scope of work in the announcement is of interest, one would prepare and submit the pre-proposal or proposal. The field is intensely competitive, however, and many developing country researchers share the experience of very little feedback, and only rarely positive responses to, for instance, pre-proposals calling for a full proposal and budget estimate. Whilst this may partly reflect the numbers who respond, the country and subject areas that are priorities, and other agency policy decisions, it also appears - from the point of view of the researcher - that there is a communication gap which exists as a result of the researcher working in a second language (usually English). However, the conceptual framework is always present in the proposal which should not be difficult to evaluate. Since the preliminary requirement is a pre-proposal, there is always room to improve the actual proposal, if the design and methodology are accepted. It was not uncommon that we are asked to comment on a pre-proposal prepared by expatriate researchers or others whose first language is English, responding to the same announcement. Very often, their conceptual framework, research questions and methodologies were not appropriate for the study area, yet their proposal was approved. This suggests that good language is more important to the donor agencies than the research design and methodology of the study. Another common problem is that some announcements are sent to the Ministry of Public Health, not to the universities or research institutions. It is very common for information to be circulated elsewhere before reaching the appropriate researchers, by which time it may be too late or the time-frame too short to allow the preparation even of a pre-proposal.
Personal communication with the international funding agencies In this approach, the researchers make direct contact with the agencies by letters or at international meetings. The communication should be both ways, so that national researchers are able to learn of areas of interest to the donor agency whilst they in turn can introduce problems to officers of the donor agency to raise their interest. Subsequently, the proposal will be submitted or considered. This approach may provide the researcher with some flexibility, and assists in the development of authorrather than agency-driven research programs, but works only for those researchers who already have established contacts and are able to maintain them.
Direct requests from the international agencies This kind of research support is based on the requirements of the donor agencies who after reviewing the situation, want someone to clarify certain points or to gather more information on a particular subject. They would make direct contact with the
235 appropriate researchers or institutions and ask them to conduct the research on that particular topic area. For example, the Social and Economic Research Unit of the Faculty of Medicine, Mahidol University, of which I am a member, was requested to make an anthropological study on treatment-seeking behaviors of malaria patients to complement the quantitative study on the utilization of antimalarial drugs in endemic areas. This kind of funding is not common, but it is available for competent researchers. Collaboration with institutions in developed countries
This approach seems more common nowadays, and of course is one way which technically enables northern researchers to pursue their own field research interests whilst they in turn contribute to staff development in developing country institutions. Several announcements from funding agencies require or support research projects developed from collaboration between institutions in developing and developed countries. This kind of funding is acceptable to institutions in non-English speaking countries. Several advantages can be seen, for example, in the preparation of the research proposal and in report writing and publishing. However, the collaboration will be more acceptable if the research input and budget are fairly shared among the collaborating institutions, and this is not necessarily or always the case (see also Lansang and Olveda, this issue).
How to sustain the researcher in the field
Most researchers, if not all, are basically interested in carrying out the research work, in discovering new information, or in finding explanations to how such things occur or why people behave as they do. There are though a few things that researchers may want to have and to do so, that they will remain active. Opportunity to conduct research that they are interested in
Most researchers after working for sometime know themselves the areas in which they want to work. Ideas usually spring from one research project to another. Some ideas may be too ambitious and may need trimming by discussing and consulting with colleagues. The opportunity to do research of their own interest is the wish of most researchers, but in some circumstances, for example, within medical institutions, it is not easy for social scientists to get support in carrying their own research as equals with medical scientists (Trostle, 1992). It needs a fairly broad-minded administrator who understands the usefulness of social science research and its applicability in helping to solve health problems. The support from the institution as such should include physical facilities and personnel. The opportunity offered to social scientists may not be only from the institution, but also from the donor agencies, particularly those that have assisted in the initiation and training of the social scientists. The re-entry grant scheme of W H O / T D R , which provides new graduates from developing countries with the possibility of funding to conduct research on their return home, is a very good program that can help newlytrained researchers remain active in their chosen field.
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Opportunity to exhibit their talent The support for researchers to participate and present their work at the national and international meetings is an important measure to sustain the activity of researchers. The opportunity to publish their work is also a way to exhibit the talent of the researchers. Unfortunately, in Southeast Asia (and in many other regions), there is no journal dedicated to health social science research, and few medical journals accept social science papers. The problems are related to two basic things. First, most social science papers developed for publication are longer than those from the 'hard sciences' and need more space than the journals can afford. Second, most of the social science papers do not fall in line with the format of the health science and/or biomedical science papers. Several social scientists in Thailand have to publish their work in the form of research reports which are rather limited in circulation. Thus, their work has limited circulation, is seldom known of or read of the country, and is rarely quoted by others.
Working atmosphere Very often social scientists feel uneasy working in the environment of medical scientists, particularly among basic science researchers or clinicians. In the world of health and medical research, it is more or less accepted that the physician is the leader. Although some physicians, particularly those who work undertake community-based research, are able to appreciate and draw on the skills and expertise of researchers from other disciplines, other clinicians are less willing to admit this. At times such disciplinary tensions create difficulties in research, not only the social scientist, but for other researchers also. On the other hand, many of social scientists who work in medical or health institutions do not understand basic medical science. These social scientists will feel alien among their colleagues, especially when there are few social scientists in the larger health scientist community. Both health and social scientists need to a certain extent to acquire more knowledge in other areas; true collaboration across disciplines depends on their appreciation of other skills, techniques and concepts. It is also the duty of the institution to create a communal working atmosphere between the two disciplinary areas so that their work is complementary.
Financial incentive Financial incentive might be the most important component in keeping researchers in the field. In order to have continuous funding, researchers have to work very hard to keep up with current knowledge and to remain competitive as researchers. In developing countries, not many graduates are interested in becoming researchers since they know that to be a good researcher they have to devote time and effort, whilst remuneration is often very low and financial incentive rare. Without some incentive, it is difficult to sustain good researchers. The payment of a honorarium through research grants is effective, although donor agencies very seldom provide it.
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Conclusion Several factors can encourage social scientists to be active. Some relate to their environment, including the institution and the funding agencies whose roles in supporting and encouraging social scientists in terms of financial and physical facilities are as important as moral support. Social scientists themselves have to be active in acquiring new information and updating their knowledge. Participation in scientific meetings and teaching, publication of their work and chances to test or apply their findings in disease control programs, are also a means of keeping researchers active and providing a base for their areas of research and expertise to consolidate and expand.
References Lansang, M.A. and Olveda, R.O. (1994) Institutional linkages: Strategic bridges for research capacity strengthening. Acta Trop. 57, 139-145. Trostle, J. (1992) Researchcapacitybuilding in international health: Definitions, evaluations and strategies for success. Soc. Sci. Med. 35(11), 1321-1324. Vlassoff, C. and Manderson, L. (1994) Evaluating agency initiatives: Building social science capability in tropical disease research. Acta Trop. 57, 103 122.