Research capacity strengthening

What is to be strengthened? Research capacity is multidimensional. It includes the production, dissemination and use of knowledge. It includes the ability – the existence of the necessary skills and resources –and the motivation to produce, widely disseminate and appropriately use newly acquired knowledge. It includes also systems for allocating priority, or value, to different research objectives, to ensure that research contributes to national health goals.

Dyson and Desforges have suggested strategies for strengthening research capacity. The Observatory aims to implement each of these strategies in the following ways;

Resource concentration
Available resources can be concentrated in particular institutions, teams, and networks that can focus on national health priorities in order to enable an increased volume of high-quality and well-targeted research to be undertaken.
A central element of the Observatory strategy is resource concentration through he development initially of mental health systems research groups and, where possible, centres for mental health systems research, training and development. This will bring together and support researchers with an interest and expertise in mental health systems research and will continuously build such expertise.

Improving interaction between different parts of the research system so that available resources are used effectively and efficiently, with the additional benefit that interaction may produce a ‘multiplier’ effect. The networks should be across different institutions and teams, across different parts of the research system (e.g. research producer and user groups) and across different disciplines.
A key role of the collaborating groups is to build such networks in the country in which they are located and to establish collaborations with centres in other countries  in order to facilitate knowledge exchange.

Communication infrastructure
Well-functioning communication infrastructure is essential.
The IOMHS Secretariat will develop effective means for communication within the IOMHS network, and between IOMHS and other organisations.
User-researcher interaction
When it is intended that the research should influence policies and practice, it is essential that the users of the research results are engaged as early as possible in the research process. This will improve commitment by users to the research, will ensure that the research is relevant to the goals of the users, and will make it more likely that the research results are understood and used in an appropriate manner.
IOMHS collaborating groups should have established links with key research users, particularly Ministries of Health and other relevant government agencies, as well as other research user organisations. A particularly important responsibility of the collaborating oranisations in the IOMHS network is that research outcomes are turned into tools for advocacy, for use by consumer and carer organisations and by other civil society organisations, and into policy briefs, for use by policy makers and implementers.

Strategic leadership
This involves taking a systemic view of research capacity and creating mechanisms for formulating and implementing strategies for its development.
Within countries the IOMHS collaborating groups will take primary responsibility for strategic leadership. They will particularly have responsibility for shaping the national mental health systems research agenda. They will be supported in this role by the IOMHS Steering Group, in which all IOMHS collaborating groups will be represented, the Technical Reference Group  and the IOMHS Secretariat.

Training and skills development
Those who are engaged in research must have the necessary skills if they are to carry out research confidently and well, and if they are to maintain a commitment to research. There are many forms that such training can take, such as basic skills development, research higher degrees and training in leadership for research. Often neglected but very important is training in research governance and research ethics.
Observatory partners will be explicitly linked into training opportunities, such as the professional development (International Mental Health Leadership Program) and award programs (Graduate Certificate, Graduate Diploma and Master of International Mental Health) offered by the Global and Cultural Mental Health (Figure 3). The Observatory will specifically work with IOMHS collaborating groups to support the development and delivery of priority training programs in the countries and in the languages in which the IOMHS collaborating groups work. An important focus of the training opportunities will be leadership training [11], since the strengthening of leadership for mental health system development is a fundamental objective of the Observatory. Examples of other training programs to be offered include: mental health systems research methods, writing for peer-reviewed journal publication and research ethics. Graduate Certificate, Graduate Diploma and Master of International Mental Health courses are also available for those who wish to pursue formal academic qualifications.

Research career development
Training is one component may form part of a wider attempt to open up career pathways which encourage talented individuals to become involved in research and then to develop their skills to the highest possible level.
The establishment of centres for mental health systems research in key academic departments will open up career pathways that currently do not exist for mental health systems researchers. Increased expertise and the existence of groups with the benefits of scale will improve ability to compete for scarce research funds from national and international sources, further enhancing technical capacity and career opportunities. Professional development courses and formal university qualifications in international mental health will make a substantial contribution to building careers in mental health systems development and will support career advancement.

Ensuring political independence
Establish mechanisms for the management of research that enables activity to be directed by a concern for knowledge-building rather than by short-term political expediency. Whilst research should inform policy, political micro-management of research is likely to be damaging to capacity rather than otherwise.
The expectation that most IOMHS collaborating groups will be established in influential academic institutions, which everywhere jealously guard their independence, will contribute to ensuring political independence. However, political independence does not mean political isolation. Unless such research is respected and used by those who are directly engaged in the political process it is unlikely to have any influence on, or to contribute to, mental health system development. An important element in ensuring political independence is the strengthening of a culture of research (see below).

Leadership Training
Links between the work of the Observatory, education and training and mental health system development

Cultural change
A key component of cultural change is the creation of a culture in which the production, dissemination and use of high-quality research is valued as an integral part of the health system.

National research capacity is a reflection of national culture. Culture consists of values, beliefs, practices, language and systems of power. Cultures are most clearly expressed in the patterns of relationships between individuals and in the institutions that a culture creates. Some of the beliefs concerning knowledge that are implicit in most research are that knowledge is created or discovered rather than ‘received’ or ‘revealed’. It is provisional, always open to change in the face of new evidence. The beliefs held or the knowledge promoted by authoritative individuals and institutions are not exempt from scrutiny and challenge that is made necessary by evidence. Knowledge should be publicly owned, widely disseminated and shared, and should be used for public benefit. Such beliefs may be considered dangerous, and may be suppressed, in settings where religious, social, economic, political orthodoxies prevail. Any such suppression is inimical to high quality research. Table 1 sets a possible set of research values.

Table 1: Research values

Excellence Ensure that research is of the highest quality
Curiosity Encourage curiosity and support exploration
Free inquiry Remove impediments to free inquiry
Attitudes to authority Examine and question authority
Justice and equity Ensure that research contributes to the public good
Research ethics Protect and enhance the rights and interests of research participants by establishing processes that ensure ethical research practice

Resource maximisation
Increasing the resources available within the research system (which ultimately means increasing the funding dedicated to research) is the most obvious means of strengthening capacity. However, careful attention should also be paid to the coordinated and efficient use of existing resources.
“Funding for health systems research in developing countries and by developing country researchers is meagre. Evidence suggests that such funding is at most 0.02% of health expenditure, far too low to have an impact on health system development. Funding should be mobilized from within national health systems as well as from science and technology budgets and international sources. Priority problems for research need to be identified in relation to health system and development goals and in consensus with policy makers” . The establishment of mental health systems research groups within established academic environments that are closely linked to policy development and implementation will strengthen capacity to secure research funds from national and international sources. Support from the IOMHS Technical Reference Group, which will advise on technical aspects of research design, will improve the capacity of such groups to compete for scarce research funds, as will a growing record of publications in international peer-reviewed scientific journals.