Sonja Marjanovic

Evaluating a complex research capacity-buildingintervention: reflections on an evaluation of the AfricanInstitutions Initiative

There is increasing policy demand for real-time evaluations of research and capacity-building programmes reflecting a recognition of the management, governance and impact gains that can result. However, the evidence base on how to successfully implement real-time evaluations of complex interventions in international development efforts is scarce. There is therefore a need for reflective work that considers methodologies in context. This article shares learning from the experience of conducting a participatory, real-time, ‘theory driven’ evaluation of the African Institutions Initiative, a Wellcome Trust-funded programme that aimed to build sustainable health research capacity in Africa at institutional and network levels, across seven research consortia. We reflect on the key challenges experienced and ways of managing them, highlight opportunities and critical success factors associated with this evaluation approach, compared with alternative evaluation approaches.

Hepatitis C: Understanding factors that influence the physicians' treatment decisions

This study aimed to inform Hepatitis C (HCV) treatment by (1) better understanding the nexus of factors physicians consider when making HCV treatment decisions; (2) investigating the comparative influence and importance of specific factors and the trade-offs implicated in the decisionmaking process; and (3) examining how much thrombocytopenia impacts treatment decisions and how it impacts treatment. To meet this goal, we conducted five analyses, focusing on four European countries characterised by different approaches to healthcare organisation and financing, which alongside cultural differences may have potential implications for treatment pathways for patients with HCV infection. These were: France, Italy, Spain, and the United Kingdom. These analysis included: Review the academic literature and of relevant national and European guidelines;Conduct key informant interviews (KIIs) with national experts to contextualise the data from the literature review and further explore some emerging themes;Map the patient journey in the four countries to identify stages HCV patients pass through once they have entered the healthcare system and map, for each stage, potential points of departure from the typical journey;Design and conduct of Discrete Choice Experiments (DCEs) to quantitatively assess the importance of factors that influence treatment decisions;Conduct expert workshop to help build scenarios identifying challenges to HCV treatment.The five analyses build on one another, with the first three providing evidence that fed into the design of the DCEs and with the DCE results in turn serving as the key inputs into building the scenarios for the expert workshop.

How policy can help develop and sustain workforce capacity in UK dementia research: insights from a career tracking analysis and stakeholder interviews

Objectives To identify research support strategies likely to be effective for strengthening the UKs dementia research landscape and ensuring a sustainable and competitive workforce. Design Interviews and qualitative analysis; systematic internet search to track the careers of 1500 holders of UK doctoral degrees in dementia, awarded during 1970–2013, to examine retention in this research field and provide a proxy profile of the research workforce. Setting and participants 40 interviewees based in the UK, whose primary role is or has been in dementia research (34 individuals), health or social care (3) or research funding (3). Interviewees represented diverse fields, career stages and sectors. Results While the UK has diverse strengths in dementia research, needs persist for multidisciplinary collaboration, investment in care-related research, supporting research-active clinicians and translation of research findings. There is also a need to better support junior and midlevel career opportunities to ensure a sustainable research pipeline and future leadership. From a sample of 1500 UK doctorate holders who completed a dementia-related thesis in 1970–2013, we identified current positions for 829 (55%). 651 (43% of 1500) could be traced and identified as still active in research (any field) and 315 (21%) as active in dementia research. Among recent doctoral graduates, nearly 70% left dementia research within 4–6 years of graduation. Conclusions A dementia research workforce blueprint should consider support for individuals, institutions and networks. A mix of policy interventions are needed, aiming to attract and retain researchers; tackle bottlenecks in career pathways, particularly at early and midcareer stages (eg, scaling-up fellowship opportunities, rising star programmes, bridge-funding, flexible clinical fellowships, leadership training); and encourage research networks (eg, doctoral training centres, succession and sustainability planning). Interventions should also address the need for coordinated investment to improve multidisciplinary collaboration; balanced research portfolios across prevention, treatment and care; and learning from evaluation.

ADDRESSING THE CHALLENGE OF WORKFORCE CAPACITY IN DEMENTIA RESEARCH

were institutionalized (21.4 vs 8.8, p<0.001). Conclusions: Later stage CI patients incur more HCRU than prodromal/mild patients, consequently imposing a heavier burden on healthcare system. Therefore, therapies that could delay cognitive decline can have the potential for important clinical benefits and substantial cost savings for healthcare systems in countries with rapidly aging populations.

058: EVALUATING A COMPLEX CAPACITY-BUILDING INTERVENTION IN AN INTERNATIONAL DEVELOPMENT CONTEXT: REFLECTING ON THE AFRICAN INSTITUTIONS INITIATIVE EVALUATION

Background In the past decade, global health funders, non-government organisations and policymakers have increased their efforts to support health research capacity in developing low and middle income countries (LMICs). These efforts are aimed at securing the provision of—and eventually access to—high-quality health services. The Wellcome Trusts African Institutions Initiative (AII), launched in 2009 aimed to broaden the research base for scientific endeavour in under-resourced environments; to support areas of science with the potential to contribute to health benefits for people and livestock; and to support international networks and partnerships focused on health problems of resource-poor countries. Objectives We present findings from an independent real-time evaluation of the first four years of the Initiative, from 2009–2013. The evaluation project aims to address the gaps in our understanding of effective capacity building initiatives and to help inform the next phase of the Initiative. Methods Evaluation in real time – during a programmes life as opposed to at the end of it – is particularly suitable for the kinds of complex interventions and uncertain contexts reflected in this Initiative. With real-time evaluation, on-going learning can be optimised to inform programme implementation. This evaluation adopted an approach which mirrored the participatory, African-led ethos of the overall Initiative. It worked with the funding recipients to evaluate them against their own articulated and documented aims and objectives. Result The AII was not designed to deliver “quick wins”. Rather it plans to lay the foundations for increased research capacity and the emergence of locally relevant health research agendas over time, which is reflected in its direct engagement with African universities and research institutes to develop Africa-led research programmes. This being said, programme-wide achievements during the first phase of funding are evident.The AII has successfully supported active networks amongst African institutions and between African and Northern partners. Networks present a cost-effective approach to supporting many institutions with limited resources. A fundamental component of the Initiatives intervention logic is the notion that collaborative networks, through a consortium-based model, can maximise potential impacts of investments in capacity-building activities. Conclusion Overall, the objectives of the AII represent an ambitious departure from traditional modes of strengthening research capacity in LMICs. While the Initiative is still at an early phase, evidence gathered in this evaluation show that consortia are contributing in multiple ways to developing sustainable research capacity. The unique features of the Initiative—an African-led, networked approach—have facilitated many of these achievements. The diversity of networking models for capacity building developed by consortia present a range of models with different strengths and weaknesses, enabling funders to reflect on future models.