Dr. Kim Ozano: Hello listeners and welcome to Connecting Citizens to Science,

a podcast where we discuss current research and debates in global health.

I'm your host, Dr. Kim Ozano, and today we're launching a brand-new miniseries

produced in partnership with the Centre for Capacity Research at the

Liverpool School of Tropical Medicine.

Across three episodes, we'll be exploring the what, why, and how

of research capacity strengthening.

In this first episode, we'll hear from colleagues who've embedded capacity

strengthening into a real-world

implementation research project called PACTS.

PACTS is an NIHR Global Health Research Group on patient-centred sickle cell

disease management in Sub-Saharan Africa.

Prof. Obiageli Nondu: Capacity strengthening research is

important because it brings along all the stakeholders who

can make an impact or not in

whether that research is implemented or not for sustainability.

Dr. Kim Ozano: Our guest today will share how strengthening research skills

and systems can improve patient care and truly foster sustainable change.

We're recording on location at the PACTS year three Partners Meeting

and are joined by four guests.

We'll start by hearing from Dr. Justin Pulford from the Center for

Capacity Research at the Liverpool School of Tropical Medicine, who sets

the stage on why research capacity strengthening is so essential.

We'll then have a conversation with three guests, including Professor

Obi Nnodu from the University of Abuja, who is the co-lead for PACTS.

Dr. Alex Osei-Akoto from Kwame Nkrumah University of Science and Technology in

Ghana, and Dr. Catherine Chunda-Liyoka from the University of Zambia.

So, let's hear from Justin first.

Justin, welcome to the podcast.

It's great to have you with us today.

So research capacity strengthening.

Tell us a bit about what it is, why we need it, and its impact on global equity.

Dr. Justin Pulford: Okay.

So yes, I'm Dr. Justin Pulford, reader at the Centre for Capacity Research,

Liverpool School of Tropical Medicine.

And our centre, as the name implies, focuses on producing research to support

good capacity strengthening practice.

Research capacity strengthening refers to the entire research process

from firstly recognising a research question or a problem that could be

addressed through research, right through to carrying out the research

and then, applying the research results and practice for some benefit.

In global health, we talk about research for development.

So, a lot of research that takes place in the global health space is

to support development objectives.

So, research capacity strengthening, in that sense, is supporting

research for development goals.

Taking that very broad understanding, what that then means is we are

not just focused on researchers.

Often, when we talk about research capacity strengthening, you think about

the individual researcher who might have a PhD or a higher degree and perhaps they've

got their lab coat and things like this.

Our understanding is much broader than that because research requires

more than just the researchers.

Uh, it requires research support teams.

So, all, all those project administrators, project managers,

lab techs, research assistants who support the research process.

It involves the communities and settings in which research takes place.

And importantly, it involves the end users of research.

So, we produce research for a purpose, and we need to ensure that, that the

audiences that we want to use and benefit from our research understand

why it's important, how to access it, how to use it for, for good.

Dr. Kim Ozano: Excellent.

And when we think about research capacity strengthening, you mentioned some of

the people that are part of that process.

Is it beyond the individual level?

Is it with the institution and the system as a whole?

Dr. Justin Pulford: Absolutely.

We talk about research capacity strengthening in a systems context.

You have the individual researchers and research team members, you have

the institutions in which they work.

And then you have the broader system, uh, needed to apply that research, we need

to support capacity strengthening at all three levels if we want to have impact.

Dr. Kim Ozano: And when we see publications and outputs, we don't always

see that capacity strengthening element.

Is it about culture in global health that we don't see that so much?

Dr. Justin Pulford: Absolutely.

So, a, a lot of research that takes place within global health

takes place in partnership.

So, for example, UK researchers and research teams working with their

colleagues from the Global South or whatever term we might use, and the

focus is often, particularly in the publications, just on the research output.

So re research takes place for a reason.

Maybe there's a, a, a research question around, uh, malaria or

malaria control, or sexual health, or maternal mortality or some such thing.

So, the partnership can have an objective around producing research

to support development in those areas.

However, the research partnerships can also be used for capacity

-strengthening purposes.

They can have a dual objective if you like, but they need to be designed that

way in order for that to work well.

If the focus is only on the research, then often the capacity

strengthening opportunities are missed.

It can also be the case that these partnerships can support a lot of

really good capacity strengthening activity, but it's not necessarily

as well advertised or promoted as the research outputs that they produce.

Dr. Kim Ozano: Okay.

So sometimes it's there, even if we may not have heard about it and in other

places, perhaps there needs to be more of a focus to ensure that capacity

strengthening is multi-directional?

Dr. Justin Pulford: I think fundamentally, again, particularly in the global

health space, we need to think about why there are international research

partnerships in the first place.

Often the reason we have such partnerships is because the needed

capacities locally are not available.

So in order to carry out research of national importance, these international

partnerships need to be formed.

However, if those partnerships only ever focus on the research and not

strengthening the system in our partner countries, then that reliance on your

international partner will continue.

And the potential for inequity will remain in place.

However, if such partnerships have these capacity strengthening objectives,

if they're designed in a way that can support system strengthening, then not

only are we producing good research, we are reducing the reliance on such

partnerships in the first place...

... Dr. Kim Ozano: Affecting that power dynamic that we're seeing a lot

played out in global health and addressing some of that equity.

One more question, you mentioned a lot of the actors involved

in capacity strengthening.

Can you talk to me a bit more about capacity strengthening for research

in the field of being a clinician

? Dr. Justin Pulford: When supporting research strengthening with clinicians,

we, we have to be mindful of two things.

One, one, they're not research specialists.

Two, they don't necessarily have as much time or resource as a research specialist.

And so, we are looking for research approaches that fit

well in that context and can be readily employed for good effect.

Dr. Kim Ozano: So, thank you to Justin for that overview of

research capacity strengthening.

Now let's turn to those who are putting these principles into practice.

I'm delighted to welcome Professor Obi Nnodu,Dr.

Alex Osei-Akoto and

and Catherine Chunda-Liyoka to share their experiences of embedding capacity

strengthening on the ground and how it's transforming patient-centred

care for sickle cell disease.

Obi, welcome to the podcast.

It's great to have you with us today.

You're very passionate about research capacity strengthening in

the work you do, but in terms of thinking about global equity, the

importance of research capacity strengthening is also quite critical.

So, please set us up by talking about how you became aware of

research capacity strengthening and what it has meant to you.

Prof. Obiageli Nondu: Oh, thank you very much.

I'm a consultant haematologist and I'm also a professor of haematology.

The first 15 years of my career was in a purely clinical setting where I

acquired trainings that were supposed to help me to provide services and

improve my care of the patients.

Then when I made a career transition to a teaching position in the university, I

really felt that I needed to strengthen my ability to conduct research.

And that sets me on a pathway to where I am today.

So, I would say that by training you are getting clinical skills, but that research

aspect is not so well demonstrated and not so well embedded in what we're doing.

And um, if you're not careful, when you do collaborate with people from

research-intensive universities, you may just end up being like

a specimen collector, and so you have to go after that skill.

You have to develop that skill to be able to think, to be able to do

proposals, to be able to generate ideas and to be, you know, a core

contributor in that process instead of just being at the receiving end of it.

So that equity is very important, and it can only be done intentionally

for you to build that capacity.

So, that's what I've always wanted to do, not only for myself, but to

make sure that the people I'm working with in my institution and other

institutions, also have that capacity, strength and I think the very first

instance was when I had a DFID project, so I came to the Liverpool School of

Tropical Medicine and I did a course in international health consultancy.

And this aspect of strengthening the capacity of LMIC investigators or

clinicians or, when you have a project, DFID wants to see capacity of those

institutions built as a part of it.

So that also opened my eyes to desire and to ask and to embed it

in collaborations going forward.

Dr. Kim Ozano: Alex and Catherine, welcome to the podcast.

Does this resonate with your experience as well?

Prof. Alex Osei-Akoto: Thank you.

Yes.

It's very important for those of us in the LMIC that we're able to

stand on our own and also collaborate effectively with collaborators

from the high-income countries.

So that there are no gaps in there, so that if we are doing the work

for funders, we'll do it on the same scale to bring up needed outputs.

Dr. Kim Ozano: And what has been some of the surprising moments for you as

you've learned more about research?

Prof. Alex Osei-Akoto: I started also as a clinician with no research agendas,

because in school we are not trained very much on research until after school.

So, when I joined a research group, I had to learn the basics from the start.

And this is what we want to change so that as soon as people enter

school, we start strengthening them with knowledge and skills of research.

Dr. Catherine Chunda-Liyoka: I had slightly a bit of a difference in

experience in that I was probably coming in a generation where Dr.

Catherine Chunda-Liyoka who took me on as soon as I finished my undergraduate

training and was even fortunate enough whilst I was doing my undergraduate

training, I managed to get a grant.

And that's where the interest came and as soon as I completed,

I was doing my clinical work, but I already had this mentor who was

heavily embedded in research and I was already doing research with her.

And that's where my interest really grew to the point where I am right

now doing my own independent research.

We do have a situation in my country right now where young doctors graduating

are not getting employed immediately.

So, it gives me an opportunity to actually take them in and begin doing research.

And I must say also I have seen as well that research field has really grown.

There was so much of doing quantitative sort of research, but now even as we

move on to where we are, where the three countries are collaborating,

we are now trying to do what we are calling implementation research.

It's something that is new, but something that we are learning and

also hoping we can pass on to the younger generations that are coming.

Dr. Kim Ozano: It is good to get a feel for that change over time as well.

And it sounds like generations as they go on are understanding

the importance of research and strengthening that capacity earlier on.

Obi, tell us about PACTS what it's about and how you embedded research capacity

strengthening within the programme.

Prof. Obiageli Nondu: So, PACTS is a Patient-centred Management of Sickle

Cell Disease in Sub-Saharan Africa.

It's a project that is actually embedded on two other projects, which

are common to all three countries.

The first is a Sickle Pan African research consortium project, where

three countries, Tanzania, Ghana, and Nigeria, were involved in

developing a registry of sickle cell patients in the three countries.

We aimed to have that registry of 13,000 patients who were coming to our clinics.

We recruited them into the registry.

Then we also developed uniform standard of care guidelines,

multi-level- primary, secondary, tertiary level, and also home care.

And then we wanted to develop capacity for database management

research as well as multidisciplinary management of sickle cell disease.

Alex and I chaired the skills working group, but we realised that within

that project we did not have as much skills in research as we wanted.

So that still left a gap.

The other project is the Consortium for Newborn Screening for

sickle cell disease in Africa.

In that consortium we wanted to demonstrate the feasibility of newborn

screening to African government so that they'll be able to take it up.

So, this is the foundation of patient centred management.

So, we have these patients in the registry in the countries, but we felt that

we were not doing much for them apart from enrolling them in the registry.

So we still felt that we needed to do a little bit more to centre the

care on the patient, especially when we see the rate of loss to follow up.

So that was why we felt evidence-based interventions were not being implemented

and we sought to do another project where we'll focus on the patients and where

we'll focus on bringing evidence-based interventions to the patient.

So that is what PACTS is about, of course, within that, we also wanted to embed

skills for research inside of it, both at institutional and at personal level.

Dr. Kim Ozano: I think at the individual level we'll be hearing

more in the following episodes.

But Catherine, you mentioned how strengthening research capacity

can improve care for patients, can help inform policy makers and

also connect with communities.

Can you tell us more that link?

Dr. Catherine Chunda-Liyoka: Yes, you can have these different consortium

of research groups doing different things and yet all those activities

coalesce to actually ultimately improve the care of the patients.

Maybe to highlight some of the things that we have discovered; caregivers

find it difficult to accept a diagnosis for a child who looks well, okay, we

inform them the child has got this disease, and yet the child looks well

to them so they're not coming back.

Quite a number of our patients live very far from where they seek healthcare,

that in itself is a barrier that is preventing them from, even when they

want to come to the health facility to seek help, they're actually not.

Within the work that we have been doing, we are discovering that actually

a particular area has got a lot of people that have got this disease

and yet there's no health facility that is close, or the health facility

itself does not provide the kind of care that they need, the patients

themselves are actually getting involved.

We have one particular health facility in my country, Zambia, where the patients

themselves, the community themselves, they actually speaking to the policy makers

or the leaders within their community to see if they can introduce care.

If they can begin to put within the health facility, things that would help

them provide care for the patients and not have to walk long distances to seek

help as they've been doing in the past.

That is just how you know, research and the information that you unearth from

research can actually change how you care for the patients, change how the policy

makers think about the disease and how they can provide better care to patients.

Dr. Kim Ozano: Thank you.

It's that know-do gap.

It's creating evidence and then making sure it's heard by

the right people and taken up.

And Alex, at the national level and through policy makers, do

you have any comments on how they respond to evidence and whether

there has to be research capacity strengthening for that level as well?

Prof. Alex Osei-Akoto: Capacity strengthening for policy makers is also

important because they would have to take the research findings and put it

in policy, and so they must understand what the capacity they need and also

from the researchers' point to be able to have an interaction with them.

Currently in Ghana we have formed between the researchers, journalists,

and also policy makers, a forum such that if research findings come out, it'll

be easy to be able to be captured by journalists and giving out to the public

as well as the policy makers also using that for policy change and all that.

And these are all in the end going to help patients.

When Catherine was speaking about communities, it's important that now

even with PACTS, we are going into the communities trying to educate

them and the community members themselves; also carrying information

back to others who haven't had that.

That is also a way of empowering the community members and at the

same time also trying to demystify sickle cell disease stigma.

There's a lot of stigma about the disease, and we know that if many people

get the information, the knowledge, they will be able to pass it on

Yeah.

to others who don't have the chance to go to clinics or other areas of for help.

Dr. Kim Ozano: We have a lot of evidence here of how research capacity

strengthening helps to improve patient care, and connect with policy makers.

How has that affected strengthening capacity for research?

Have you had to do it quickly because, it's quite a quick turnaround

in terms collecting evidence and embedding it within programmes.

Dr. Catherine Chunda-Liyoka: Particularly within the participatory action cycles,

we have come to a point where we are interacting more with the community as

compared to the way we interacting before.

Being clinicians, we sit at healthcare facilities and, wait for patients to come.

But now we've actually begun to realise we need to do something to

be able to draw the patients to us.

And I believe on the community side, it has helped them demystify us.

Okay.

Because I think a lot of things have come out.

The patients have actually mentioned them thinking we're very unfriendly

as one of the reasons why they won't to come to the hospital.

Okay.

It is very interesting also to see that we seem to have very similar, problems,

whether it's in the health facilities themselves or the community; the very

things that are coming out from Nigeria are coming out from Ghana from, from

Zambia as well, but also it has enabled us from these groups where those kind

of conversations can go on, helping us understand each other, helping us see

how we can better provide a service and also bring the patients to us.

Dr. Kim Ozano: So, looking towards the next generation, 'cause we've talked

about the different generations already.

What advice would you give to others who are at that beginning of not

really understanding research capacity strengthening, but knowing it's important?

What advice would you give to them?

Prof. Obiageli Nondu: Interestingly two of my former students, I involved them

in the research I was doing right from when they were undergraduate students.

So, they're learning by just watching and being a part of what I'm doing.

And they've grown.

They are, they're doing well.

They're publishing and they're excited to have the opportunity to work with us.

Dr. Kim Ozano: So, creating that motivation and getting in there early

on in, in training to really talk about research much more in evidence.

That's great.

Alex?

Bit of advice.

Prof. Alex Osei-Akoto: Clinicians should not look at patients just

by the little time of interaction with them in the consulting rooms.

Rather, they should think beyond the consulting room.

How did this patient even come to the consulting room?

Some of them come from very far off and they spend money, transport and all that.

Sometimes it's a, it is a barrier for them, and so when as a clinician you

are seeing such patients, you should just think beyond that little time, 10

minute, 15 minute interaction, so that you are able to give advice, you are able

to, show them what it is that they have to do to have a good quality of life.

If you're able to explain things to them very well and then they can take care of

themselves when they have problems, and so they get the trust to be able to, as

it were, come nearer you, because if the patient don't come, they will suffer.

We don't want that to happen.

Dr. Kim Ozano: Thank you very much.

It's, it sounds like it's about identifying mutual benefit for them as

well, so that motivation comes through, but also, I love hearing from you don't

just think about the person as a treatment in a one-off, but think about their

whole lives and how they're impacted.

Take us home.

One final piece of advice for future clinicians around research.

Dr. Catherine Chunda-Liyoka: I think I would just like to begin with indicating

that the picture may look a bit gloomy for young people that are coming on

to research, but drawing from my own experience, I would like to say to the

young people that the mentors are there.

I found them myself even as I joined PACTS, I know Alex

and and uh, Obi actually been working together for some time.

They're quite seasoned researchers.

So, I was being taken on as somebody who had very little knowledge

about implementation research.

And all I went in with was I had some little experience and I was ready to

learn this other form of doing research.

So, my first advice is that the mentors are there.

Okay.

And then also just to appreciate really the landscape of research.

Most of research done in the past has been to go in, find out

numbers or this is the problem.

That is a problem.

That is a problem, okay.

So this other arm of research that has come is actually now to

trying to find out why is there that high number of this problem?

Why is there this long number of this problem?

And that is, I think, how the concept that Alex mentioned comes in.

These are people.

They have these problems.

They're not able to come to the health facility.

They don't have money.

The old research that we used to do, really just used to bring out those

numbers, not really telling us why our patients are having those problems.

Implementation research with the standard based audits and the participatory action

cycles does not just unearth reasons why things are this bad, things are that good,

but actually begins to find solutions with all the people that are involved.

Whether it's the clinicians, it's the patients, it's the communities they

live in, it's the families they live in.

It actually begins to formulate solution that are tailored to the communities

that those patients actually live in.

So, for me, that is something I find really interesting.

It almost like answers all the questions.

It's a roundabout way of answering all the potential problems that patients may have.

In implementation research or in the cycles that we're following,

we are actually trying different ways of solving a problem so that

if this doesn't work, you can abandon it and start something else.

And you are actually doing that not just as clinicians, sitting up high

there and we have the solutions now, but actually involving the very people

that you've identified the problem in getting them on board to actually find

out what could be done different so that things are different for them.

Dr. Kim Ozano: Thank you so much for joining us today.

What a, a great way to end and a great summary of the conversation

we've had today as well.

So, thank you for joining our podcast and we will be learning more

moving on to the next episode about how that's been done in practice.

So, thank you.

Prof. Obiageli Nondu: Thank you very much.

Dr. Catherine Chunda-Liyoka: Thank you very much.

Dr. Kim Ozano: That brings us to the end of this first episode in our miniseries

on research capacity strengthening.

We've heard how a structured collaborative approach can bring vital benefits,

not just for researchers, but also for the communities they serve.

In our next episode, we'll explore in more depth how learning by doing helps

bridge the know-do gap with a focus on bridging diverse stakeholders from

national project managers to the media.

So, if you found this episode valuable, please take a moment

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Until next time, stay curious, stay engaged, and let's continue challenging

the systems that shape global health.