1. Research Capacity Building Susan Bradley, Centre for Global Health, TCD & HSSE team Supported by: Irish Aid & Ministry of Foreign Affairs, Denmark UNIVERSITY EDUARDO MONDLANE Faculty of Medicine

2. Partners to the Project Centre for Global Health, University of Dublin, Trinity College, Dublin (Eilish McAuliffe, Susan Bradley) Averting Maternal Death and Disability Program (AMDD), Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, USA (Lynn Freedman (Helen de Pinho, Samantha Lobis, Rachel Waxman and Sang Hee Won) Realizing Rights: the Ethical Globalization Initiative, USA ( Mary Robinson, Peggy Clark, Ibadat Dhillon, Naoko Otani) Regional Prevention of Maternal Mortality network, Accra, Ghana (Angela Sawyer, Dora Shehu) Ifakara Health Institute, Mikocheni, Dar Es Salaam, Tanzania (Godfrey Mbaruku, Honorati Masanja, Tumaini Mikindo, Neema Wilson, Debby Wason, Abdallah Mkopi, Aloisia Shemdoe) University of Malawi, College of Medicine, Centre for Reproductive Health, Malawi (Francis Kamwendo, Mwizapanyuma Simkonda, Wanangwa Chimwaza, Andrew Ngwira, Effie Chipeta, Linda Kalilani) Department of Community Health, Faculty of Medicine, Eduardo Mondlane University, Mozambique (Mohsin Sidat, Maria de Fatima Cuembelo, Sozinho Daniel Ndima)

3. Project objectives Expand the evidence base in support of effective use of mid-level health workers within an enabling environment through the generation of new evidence and a critical analysis of existing evidence; Increase recognition and effective use of mid-level health workers among national, regional, and global policymakers to address the human resources crisis in district health systems based on project evidence; Advocate for an enabling environment that optimises performance of mid- level providers in order to strengthen health systems; and In partnership with African institutions, deepen local capacity to research and analyse human resource and health systems problems, develop innovative solutions, influence policymakers at local and global levels, and sustainably implement new strategies; and build the capacity of northern institutions to successfully engage in and support partnerships of this kind. Research Advocacy

4. Research capacity building activities Training for in-country teams in qualitative and quantitative techniques (broader than project requirements) Installation of analysis software (NVivo & SPSS) and training in its use Training in costing study techniques Joint data analysis Collaborative writing and publishing

5. Reported benefits Researchers felt part of a process where they gained skills and confidence Sharing of expertise and learning from each other S  S, S  N, N  S New skills are transferrable to other projects

6. Reported Challenges Capacity building is not just about skills, it is also about time Unreliable ICT Local expertise/context needs more prominence, particularly at the design stage Focus on data collection, insufficient emphasis on analysis skills or publication Shortage/capacity of senior research scientists in country; lack of ‘mid level’ researchers Mentorship for publications is needed - time and funding

7. Lessons for future projects Undertake a full skills assessment of the existing platform of each partner’s research resources and gaps prior to study commencement Use facilitated sessions with all partners at the beginning of a project where partners can openly explore their strengths/weaknesses, contributions, and expectations of personal and institutional gain.

8. Lessons for future projects Improve data management processes – Commitment to in-country data analysis and data management needs a dedicated data manager – More streamlined process from data collection to analysis to write-up – Adopt a phased approach, with responsibility assigned to each partner – Integrate advocacy into phases for better alignment

9. Lessons for future projects Creative mechanisms, sufficient time and adequate resources are needed to build and maintain a respectful, equitable and mutually beneficial collaboration Communication is key, but is a complex area that requires explicit attention to ensure optimum engagement Engage in capacity building to enhance accountability and responsibility of in-country partners thus contributing to in-country partners’ ability to lead research teams

10. Conclusion The project demonstrated the need to engage in capacity building that is a lasting and sustainable investment in the work of all partners. The commitment to research capacity building exposed a number of issues that could be considered for future work, both at institutional level and more broadly within health systems research.

11. With Thanks HSSE Team: AMDD, Mailman School of Public Health, Columbia University, USA Centre for Global Health, Trinity College, University of Dublin Centre for Reproductive Health, College of Medicine, Malawi Dept. of Community Health, Eduardo Mondlane University, Mozambique Ifakara Health Institute, Tanzania Realizing Rights: Ethical Globalization Initiative, USA Regional Prevention of Maternal Mortality Network, Ghana Funders: IrishAid & Ministry of Foreign Affairs, Denmark