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‘Research capacity strengthening’ (RCS) is an umbrella term that can be used to describe a wide variety of activities conducted in support of diverse objectives premised upon distinct, potentially opposing, views. Despite this, the ultimate objective of RCS activities is rarely made explicit which can be problematic when diverse objectives are possible. By ‘ultimate’ objective we are referring to the overarching (often long-term) goal an RCS initiative is intended to contribute towards (e.g. better population health) as opposed to the more immediate ‘proximate’ (often short-term) objectives of any such activity (e.g. improved capacity to undertake infectious disease research). We argue a need for those funding, designing and implementing RCS initiatives to make clear statements as to the ultimate objective that they foresee their respective initiative contributing towards as well as the proposed pathway and associated assumptions that underlie their approach. Examples of distinct ultimate objectives for RCS initiatives are presented alongside fictitious examples of how they may be transparently reported from both a funder and implementor perspective. Such transparency should be routine within the scope of funding calls for RCS activities (even when such activities are only a minor component of the call), subsequent applications to those calls and any description of an applied RCS activity/ies and/or the associated outcomes thereof. The process of determining one’s ultimate objective will further cause funders and actors to think through their respective initiatives more thoroughly and make informed choices and better designed RCS projects. Doing so would reduce any ambiguity associated with the use of the term ‘research capacity strengthening’ and would provide a stronger foundation for robust programme evaluation.

Background : Health research capacity strengthening (HRCS) has been deemed as a complex, multifaceted, and dynamic activity. Despite this, most studies that assess the effectiveness of health research capacity strengthening programmes have not employed complexity-aware approaches and therefore, evidence on how and why such programmes work across different contexts is underdeveloped. This realist study seeks to elicit the initial programme theories (IPTs) that describe how and why the ‘Developing Excellence in Leadership, Training and Science Africa’ (DELTAS Africa) programme – one of the flagship research capacity strengthening programmes in Africa – works to generate research capacity outcomes specifically in the participating African universities. Methods and Analysis : A realist review of the DELTAS Africa programme documents, and relevant published papers that report on similar research capacity interventions will be carried out. This will help to both identify the outcome pathways and underlying assumptions of the DELTAS Africa programme, as well as tacit theories as postulated by other researchers. The review evidence will inform the drafting of the initial programme theories (IPTs). Interviews with the DELTAS Africa programme designing team will be conducted using a realist interviewing technique to unearth ontologically deeper insights on context, mechanism, and outcomes. Using the realist context-mechanism-outcome configurational maps, we will identify how contexts (i.e., within the African universities) shape mechanisms (the processes, reasoning, or behaviours triggered by the HRCS activities) through which the programme brings about an outcome at institutional level. Conclusion: The initial programme theories will describe how and why health research capacity strengthening works, for whom and under what circumstances across the participating African universities. The programme theories will provide policy-relevant insights on the generative causal mechanisms of HRCS; evidence that is critically needed to inform the design, implementation, and evaluation of HRCS initiatives.

Introduction The Ugandan Tiny Target programme is an example of an international vector control partnership that held specific capacity strengthening objectives in support of a disease elimination goal. Drawing on this experience, we sought to derive transferable lessons that may inform capacity strengthening approaches within other partnership-based vector control programmes.Methods A longitudinal qualitative study encompassing semistructured interviews conducted with Ugandan partners working on the Tiny Target programme. Data analysis was informed by a general inductive approach.Results Capacity strengthening priorities evolved over time initially focusing on the immediate capacities needed to perform roles and responsibilities assigned within the partnership and then shifting towards more advanced, transferable knowledge and skills. A distinction between operational and systemic priorities was observed: the former was necessary to support successful programme implementation whereas the latter reflected fundamental limitations or complexities within the Ugandan context that were bypassed by including an international partner. Systemic priorities were fewer in number than their operational counterparts, although substantially harder to resolve. The largest apparent threat to the long-term sustainability of reported capacity gains was their concentration within a small number of individuals.Conclusion Our study highlights three key lessons that may inform the design of national capacity strengthening activities conducted within the context of international vector control partnerships, including (1) Multiple approaches to strengthen capacity are needed and that can adapt to changing capacity strengthening priorities over time; (2) Balancing operational and systemic capacity strengthening priorities, the latter becoming increasingly important within longer-term partnerships and (3) Partnership members in focal country/ies should be supported to actively facilitate the transfer of newly acquired knowledge and skills to relevant colleagues/communities outside of the partnership. The generic nature of these recommendations suggests they are likely to be of benefit to many and diverse international partnerships within the wider global health space.

Zoonotic and foodborne diseases are a major cause of morbidity and mortality, especially in low- and middle-income countries. Pork is a potential source of zoonotic and foodborne diseases, and pork consumption is rapidly increasing in Eastern and Southern Africa (ESA). Here, studies conducted in ESA describing pig- and pork-associated zoonotic and foodborne hazards were identified to clarify the distribution and prevalence of these hazards and identify research gaps in this region. A systematised literature review was conducted using MEDLINE and Web of Science to identify relevant articles according to pre-determined inclusion/exclusion criteria. In total, 140 articles from 14 countries were identified for review. A total of 42 hazards were identified, categorised as bacterial, viral, parasitic, arthropodal, or other, including drug residues. Among all identified hazards, Taenia spp. (n=40) was the most often studied, followed by Salmonella spp. (21), Escherichia coli (17), and Staphylococcus spp. (9). Further research is required to determine baseline data on the epidemiology and health and economic burden associated with pig- and pork-borne hazards and appropriate strategies are needed to mitigate the risk these hazards pose to communities.

Introduction The Partnership to Increase the Impact of Vector Control sought to develop the research and leadership capacity of 10 African postdoctoral vectorborne disease scientists via a ‘learn-by-doing’ approach. We identified factors that either supported or hindered their development and, drawing on this information, determined key lessons for future programmes with similar objectives.Methods A longitudinal qualitative study encompassing focus group discussions and semistructured interviews conducted with the cohort of African postdoctoral fellows, programme leadership, supervisory and research support staff (N=28). Data analysis was informed by a general inductive approach.Results Numerous supportive and hindering factors were identified. Supportive factors were primarily structural or attitudinal in nature, whereas hindering factors were primarily operational or contextual. None of the supporting or hindering factors were specific to vectorborne disease research. Four key lessons for future programme implementation emerged, including: the value in exposing postdoctoral fellows to a diverse work-mix and training-mix to improve understanding of the broad skillset needed for scientific career advancement; recognising and managing the potentially competing interests of different partnership members to ensure everyone benefits from participation; ensuring equity of opportunity and rewarding engagement; and ensuring flexibility in support provision.Conclusion Our study highlights numerous factors that may be readily incorporated into early career researcher capacity strengthening initiatives based on a learn-by-doing approach. Many of these factors are supported by a growing weight of evidence and would be appropriate to research capacity strengthening programmes both within and outside of a vectorborne disease context.

Background: The Strengthening Capacity in Environmental Physics, Hydrogeology and Statistics for conservation agriculture research (CEPHaS) consortium sought to to strengthen research capacity among a network of African and UK researchers, and their respective institutions, to fill knowledge gaps on the impacts of conservation agriculture practices on the water cycle in cultivated soils. We examined experiences of consortium membership and, drawing on this information, determined key recommendations for future programmes with similar objectives. Methods: A mixed methods study encompassing an online survey (N=40) and semi-structured interviews (N=19) completed between June 2021 and February 2022 with CEPHaS consortium members from Malawi, UK, Zambia and Zimbabwe. Survey and interview data were analysed separately, using univariate statistics and framework synthesis respectively Results: Survey and interview findings were generally aligned, with both revealing a wide range of reported capacity strengthening gains resulting from CEPHaS engagement at both an individual and institutional level. Participants consistently expressed their CEPHaS involvement in positive terms with praise for the applied ‘learn by doing’ approach underpinning many of the activities as well as the engaging and highly inclusive leadership. There was evidence that the various trainings and resources provided through CEPHaS were valued, frequently utilised, and often transferred beyond the immediate CEPHaS membership for wider benefit. Resource provision and staff training were seen as foundational for long-term institutional benefits. Some challenges and suggested areas for improvement were reported by participants as were potential opportunities to facilitate greater impact. Conclusion: Our findings suggest that the basic ‘template’ of the CEPHaS consortium provided a strong basis for research capacity strengthening in Conservation Agriculture, especially at the level of individual researchers, and that this template could be further enhanced in any future iteration of the same or similar programme. Recommendations for replicating and enhancing CEPHaS programme strengths are presented.

Abstract Background Papua New Guinea (PNG) has one of the highest burdens of HIV and syphilis in pregnancy in the Asia-Pacific region. Timely and effective diagnosis can alleviate the burden of HIV and syphilis and improve maternal and newborn health. Supply-side factors related to implementation and scale up remain problematic, yet few studies have considered their impact on antenatal testing and treatment for HIV and syphilis. This study explores health service availability and readiness for antenatal HIV and/or syphilis testing and treatment in PNG. Methods Using data from two sources, we demonstrate health service availability and readiness. Service availability is measured at a province level as the average of three indicators: infrastructure, workforce, and antenatal clinic utilization. The readiness score comprises 28 equally weighted indicators across four domains; and is estimated for 73 health facilities. Bivariate and multivariate robust linear regressions explore associations between health facility readiness and the proportion of antenatal clinic attendees tested and treated for HIV and/or syphilis. Results Most provinces had fewer than one health facility per 10 000 population. On average, health worker density was 11 health workers per 10 000 population per province, and approximately 22% of pregnant women attended four or more antenatal clinics. Most health facilities had a composite readiness score between 51% and 75%, with urban health facilities faring better than rural ones. The multivariate regression analysis, when controlling for managing authority, catchment population, the number of clinicians employed, health facility type and residence (urban/rural) indicated a weak positive relationship between health facility readiness and the proportion of antenatal clinic attendees tested and treated for HIV and/or syphilis. Conclusion This study adds to the limited evidence base for the Asia-Pacific region. There is a need to improve antenatal testing and treatment coverage for HIV and syphilis and reduce healthcare inequalities faced by rural and urban communities. Shortages of skilled health workers, tests, and medicines impede the provision of quality antenatal care. Improving service availability and health facility readiness are key to ensuring the effective provision of antenatal care interventions.

Gambiense Human African Trypanosomiasis (g-HAT) is a neglected tropical disease caused by trypanosomes transmitted by tsetse flies. In 2017, a pilot community-based project was launched in three villages in DRC with the overall goal of empowering community members to control tsetse using Tiny Targets which attract and kill tsetse. In this paper, we assess the community participation process in these three pilot villages over >4 years and evaluate to what extent this resulted in the empowerment of communities. We conducted a qualitative study using a participatory research approach. Together with community members of the three pilot villages from the endemic Kwilu province, we evaluated changes in project participation, community empowerment and perception of future participation at three different time points (September 2017, September 2018 and November 2021) over a 4-year period using participatory workshops and focus group discussions (FGD). We used a thematic content approach to analyse both workshop notes and FGD transcripts. The community identified five indicators to evaluate participation: (1) Leadership & Ownership, (2) Organisation & Planning, (3) Willingness, (4) Autonomy and (5) Community Involvement. The participation experience described by community members was characterised by a rapid growth of empowerment in the first year and sustained high levels thereafter. Community participants were willing to engage in potential future projects and continue to be supported by their Tiny Target project partner. However, they identified an imbalance in the power relationship within the committee and with the Tiny Target partners that limit the extent of empowerment attained. The intervention had broader benefits of community empowerment but this was limited by perceptions of being part of wider "top down" programme and by stakeholders attitude toward community participation. If empowerment is to be an important objective of projects and programmes then the needs identified by communities must be recognised and attitude of sharing power encouraged.

Abstract Background This study sought to determine how institutional environments, including values, policies, and their implementation, shape inequities in scientific career progression for women and men, and their disadvantages in relation to their multiple social identities in sub-Saharan Africa (SSA). The findings are drawn from a wider research study that was aimed at gaining an in-depth understanding of the barriers and enablers of gender-equitable scientific career progression for researchers in SSA. This was nested within the context of the Developing Excellence in Leadership, Training and Science in Africa (DELTAS Africa) programme—a health-based scientific research capacity-strengthening initiative. Methods The study adopted an exploratory qualitative cross-sectional study design. In-depth interviews (IDIs) with trainees/research fellows at various career stages supported and/or affiliated to three purposively selected DELTAS Africa Research Consortia were the main method of data collection. In addition, key informant interviews (KIIs) with consortia research leaders/directors, co-investigators, and the consortia management team were also conducted to corroborate information gathered from the IDIs, and also to provide additional insights on the drivers of intersectional gender-inequitable career progression. In total, 58 IDIs (32 female and 26 male) and 20 KIIs (4 female and 16 male) were conducted. The interviews were carried out in English between May and December 2018. The data were analysed inductively based on emergent themes. Results Three interrelated themes were identified: first, characterization of the institutional environment as highly complex and competitive with regard to advancement opportunities and funding structure; second, inequitable access to support systems within institutions; third, informal rules—everyday experiences of negative practices and culture at the workplace, characterized by negative stereotypical attitudes, gender biases, sexual harassment, and bullying and intimidation. Conclusions We contend that understanding and addressing the social power relations at the meso-institutional environment and macro-level contexts could benefit career progression of both female and male researchers by improving work culture and practices, resource allocation, and better rules and policies, thus fostering positive avenues for systemic and structural policy changes.

Abstract Background Sub-Saharan Africa (SSA) suffers from a dearth of concrete information on the causes of women’s under-representation in scientific research workforce particularly at higher levels compared with the wealth of information that exists in the global north. The goal of this study was to illuminate familial and socio-cultural drivers that contribute to intersectional gender inequities in scientific career progression in SSA to inform strategies that could promote career equity for African scientific researchers. Methods This study was nested within the context of ‘Developing Excellence in Leadership, Training and Science in Africa’ (DELTAS Africa)—a health-based scientific research capacity strengthening initiative. It adopted an exploratory qualitative cross-sectional study design. In-depth interviews were conducted among 58 (32 Female and 26 Male) trainees/research fellows at various career stages, affiliated to three purposively selected African Research Consortia. The interviews were conducted between May and December 2018 in English. The data were analysed inductively based on emergent themes. Results The study participants were nationals of thirteen SSA countries. More female than male participants had young children. Four themes were identified. They illustrate women’s and men’s characterisation of the normative career pathway and progression requirements which calls for significant ‘time’ commitments (theme 1), and how social power relations of gender within the family and wider society shapes their participation in scientific research activities (theme 2). This culminates in researchers'' differential experiences of navigating between the ‘two different lives’—family and career, and the resultant implications for their career progression and personal well-being (theme 3). Women researchers made different and conscious trade-offs for navigating the ‘two different lives’ by utilising various metaphors such as the ‘biological clock and career clock’, the ‘glass ball and rubber ball’, and the concept of ‘sacrifice’ (theme 4). Conclusions This study is the first of its kind to demonstrate how intersectional gender analysis through use of qualitative research methods may provide novel insights into the hidden familial and socio-cultural drivers of gender inequitable scientific research career progression. It offers important policy and practice measures and approaches for fostering career equity for women and men scientists within research capacity strengthening initiatives in SSA.

There has been a steady increase in health research capacity strengthening (HRCS) consortia and programmes. However, their structures and management practices and the effect on the capacity strengthening outcomes have been underexamined. We conducted a case study involving three HRCS consortia where we critically examined the consortia’s decision-making processes, strategies for resolving management tensions and the potential implications for consortia outcomes. We conducted 44 in-depth interviews with a range of consortia members and employed the framework method to analyse the data. We assessed the extent to which consortia’s management practices and strategies enabled or hindered research capacity strengthening using a capacity development lens. At the heart of consortium management is how tensions are navigated and the resolution strategies adopted. This study demonstrates that the management strategies adopted by consortia have capacity strengthening consequences. When deciding on tension management strategies, trade-offs often occur, sometimes to the detriment of capacity strengthening aims. When management strategies align with capacity development principles, consortium management processes become capacity strengthening mechanisms for participating individuals and institutions. Such alignment enhances programme effectiveness and value for money. Drawing on these findings, we propose an evidence-informed management framework that consortia leaders can use in practice to support decision-making to optimise research capacity gains. Considering the increasing investment in HRCS consortia, leveraging all consortium processes towards capacity strengthening will maximise the returns on investments made.

Abstract Background Knowledge translation (KT) is a dynamic and iterative process that includes synthesis, dissemination, exchange and ethically sound application of knowledge to yield beneficial outcomes for society. Effective KT requires researchers to play an active role in promoting evidence uptake. This paper presents a systematised review of evidence on low- and middle-income country (LMIC) researchers’ KT capacity, practice and interventions for enhancing their KT practice (support) with the aim of identifying gaps and informing future research and interventions. Methods An electronic search for peer-reviewed publications focusing on LMIC researchers’ KT capacity, practice and support across all academic fields, authored in English and from the earliest records available to February 2019, was conducted using PubMed and Scopus. Selected studies were appraised using the Mixed Methods Appraisal Tool, data pertaining to publication characteristics and study design extracted, and an a priori thematic analysis of reported research findings completed. Results The search resulted in 334 screened articles, of which 66 met the inclusion criteria. Most (n = 43) of the articles presented original research findings, 22 were commentaries and 1 was a structured review; 47 articles reported on researchers’ KT practice, 12 assessed the KT capacity of researchers or academic/research institutions and 9 reported on KT support for researchers. More than half (59%) of the articles focused on sub-Saharan Africa and the majority (91%) on health research. Most of the primary studies used the case study design (41%). The findings suggest that LMIC researchers rarely conduct KT and face a range of barriers at individual and institutional levels that limit their KT practice, including inadequate KT knowledge and skills, particularly for communicating research and interacting with research end-users, insufficient funding, and inadequate institutional guidelines, structures and incentives promoting KT practice. Furthermore, the evidence-base on effective interventions for enhancing LMIC researchers' KT practice is insufficient and largely of weak quality. Conclusions More high-quality research on researchers’ KT capacity, practice and effective KT capacity strengthening interventions is needed. Study designs that extend beyond case studies and descriptive studies are recommended, including better designed evaluation studies, e.g. use of realist approaches, pragmatic trials, impact evaluations, implementation research and participatory action research.

Background: Global efforts to strengthen health research capacity in low- and middle-income countries (LMICs) have intensified in the past few decades, and these efforts are often implemented by consortia. Our review of the literature indicated that reports on health research capacity strengthening (HRCS) consortia have primarily focused on programme outputs and outcomes while management processes and their contributions to consortia goals have received little attention. This qualitative study sought to identify the consortium management processes employed by 10 DELTAS Africa consortia, factors influencing these processes, and leaders’ consortium management experiences. Methods: We conducted 24 key informant interviews with the directors and programme managers of all the 10 DELTAS Africa consortia, and funding actors who worked closely with the consortia. The interviews were supplemented by reviews of DELTAS and consortium-specific documents. Data were analysed using the content analysis approach. Results: The consortia studied employed similar management processes but adopted different strategies in executing these processes. Study results indicate that decision-making in consortia is not always a straightforward process as leaders were often faced with dilemmas when determining management strategies to adopt, and often tried to balance multiple factors which were not always aligned. This was demonstrated as consortia selected partners, determined goals and activities, assigned roles and responsibilities, allocated resources, established governance and partner management systems, and coordinated and monitored consortia activities. Factors that influenced the choice of processes and approaches included previous experiences, funders expectations, and the pressure to deliver research outputs. Consortia’s unique approaches to management were due to varying contexts and influences and indicate that management decisions are nuanced and cannot easily be formularized. Conclusion: The study has highlighted the importance of flexibility in consortium management and the need to generate research capacity strengthening (RCS)-specific guidance that can assist consortia in resolving dilemmas and making appropriate management decisions.

Background: The ‘DELTAS Africa CPE seed fund’ was a pilot scheme designed to strengthen capacity in community and public engagement (CPE) via a ‘learn by doing’ approach. The scheme supported a total of 25 early career researchers and research support staff belonging to the DELTAS Africa network to design and implement a variety of CPE projects between August 2019 and February 2021. We examine recipient experiences of the DELTAS Africa CPE seed fund initiative, changes in their CPE attitudes, knowledge and proficiency and their CPE practice and/or practice intentions post-award. Methods: A mixed-methods process and performance evaluation drawing on three data sources: An anonymous, online knowledge, attitude and practice survey completed by CPE seed fund awardees pre- and post-project implementation (N=23); semi-structured interviews completed with a sub-sample of awardees and programme implementors (N=9); and ‘end-of-project’ reports completed by all seed fund awardees (N=25). Results: All awardees described their seed fund experience in positive terms, despite invariably finding it more challenging than originally anticipated. The combined survey, interview and end of project report data all uniformly revealed improvement in awardees’ self-reported CPE knowledge, attitudes and proficiency by completion of their respective projects. Commitment to continued CPE activity post-award was evident in the survey data and all interviewees were adamant that they would integrate CPE within their respective research work going forward. Conclusion: The DELTAS Africa CPE seed fund appeared to work successfully as a CPE capacity strengthening platform and as a vehicle for fostering longer-term interest in CPE activities.

The National Programme for the control of human African trypanosomiasis in Democratic Republic of Congo includes a large-scale vector control operation using Tiny Targets. These are small panels of insecticide-impregnated cloth that are deployed in riverine habitat where tsetse flies concentrate. The effectiveness of Tiny Targets depends partly on acceptance by local communities. In 2018, we conducted research to explore the perception and acceptability of Tiny Targets in two different village clusters where Tiny Targets had been deployed by the local community or external teams. We conducted fourteen focus group discussions and seven semistructured interviews in three villages from each cluster in the Yasa Bonga health zone. Our findings showed that acceptability was better in the cluster where communities were involved in the deployment of Tiny Targets. Also in this cluster, awareness about Tiny Targets was satisfactory and the project was implemented within local customs, which promoted a positive perception of Tiny Targets and their benefits. In the cluster where external teams deployed Tiny Targets, a lack of information and communication, stereotypes applied by communities towards the deployment teams and the impression of inadequate respect for local customs led to anxiety and a misleading interpretation of the purpose of Tiny Targets and negatively influenced acceptability. This study highlights the importance of involving communities for programme acceptance. Our research underlined how awareness campaigns and communication are essential, but also how working within the scope of community social norms and customs are equally important. Prospects for the successful use of Tiny Targets are greater when communities are involved because the use can be adapted to social norms.

Background: Information on health education institutions is required for planning, implementing and monitoring human resources for health strategies. Details on the number, type and distribution of medical and health science programs offered by African higher education institutions remains scattered. Methods: We merged and updated datasets of health professional and post-graduate programs to develop a mapping of health education institutions covering the World Health Organization African Region as of 2021. Results: Nine hundred and nine (909) institutions were identified in the 47 countries. Together they offered 1,157 health professional programs (235 medicine, 718 nursing, 77 public health and 146 pharmacy) and 1,674 post-graduate programs (42 certificates, 1,152 Master’s and 480 PhDs). Regionally, East Africa had the most countries with multiple academic health science centres - institutions offering medical degrees and at least one other health professional program. Among countries, South Africa had the most institutions and post-graduate programs with 182 and 596, respectfully. A further five countries had between 53-105 institutions, 12 countries had between 10 and 37 institutions, and 28 countries had between one and eight institutions. One country had no institution. Countries with the largest populations and gross domestic products had significantly more health education institutions and produced more scientific research (ANOVA testing). Discussion: We envision an online database being made available in a visually attractive, user-friendly, open access format that nationally, registered institutions can add to and update. This would serve the needs of trainees, administrators, planners and researchers alike and support the World Health Organization’s Global strategy on human resources for health: workforce 2030.

Introduction Disease-specific ‘vertical’ programmes and health system strengthening (HSS) ‘horizontal’ programmes are not mutually exclusive; programmes may be implemented with the dual objectives of achieving both disease-specific and broader HSS outcomes. However, there remains an ongoing need for research into how dual objective programmes are operationalised for optimum results.Methods A qualitative study encompassing four grantee programmes from two partner countries, Tanzania and Sierra Leone, in the Comic Relief and GlaxoSmithKline ‘Fighting Malaria, Improving Health’ partnership. Purposive sampling maximised variation in terms of geographical location, programme aims and activities, grantee type and operational sector. Data were collected via semi-structured interviews. Data analysis was informed by a general inductive approach.Results 51 interviews were conducted across the four grantees. Grantee organisations structured and operated their respective projects in a manner generally supportive of HSS objectives. This was revealed through commonalities identified across the four grantee organisations in terms of their respective approach to achieving their HSS objectives, and experienced tensions in pursuit of these objectives. Commonalities included: (1) using short-term funding for long-term initiatives; (2) benefits of being embedded in the local health system; (3) donor flexibility to enable grantee responsiveness; (4) the need for modest expectations; and (5) the importance of micro-innovation.Conclusion Health systems strengthening may be pursued through disease-specific programme grants; however, the respective practice of both the funder and grantee organisation appears to be a key influence on whether HSS will be realised as well as the overall extent of HSS possible.

Abstract Background Long-lasting insecticidal nets (LLIN), improved diagnosis and artemisinin-based combination therapy (ACT) have reduced malaria prevalence in Papua New Guinea since 2008. Yet, national incidence trends are inconclusive due to confounding effects of the scale-up of rapid diagnostic tests, and inconsistencies in routine reporting. Methods Malaria trends and their association with LLIN and ACT roll-out between 2010 and 2014 in seven sentinel health facilities were analysed. The analysis included 35,329 fever patients. Intervention effects were estimated using regression models. Results Malaria incidence initially ranged from 20 to 115/1000 population; subsequent trends varied by site. Overall, LLIN distributions had a cumulative effect, reducing the number of malaria cases with each round (incidence rate ratio ranging from 0.12 to 0.53 in five sites). No significant reduction was associated with ACT introduction. Plasmodium falciparum remained the dominant parasite in all sentinel health facilities. Resurgence occurred in one site in which a shift to early and outdoor biting of anophelines had previously been documented. Conclusions LLINs, but not ACT, were associated with reductions of malaria cases in a range of settings, but sustainability of the gains appear to depend on local factors. Malaria programmes covering diverse transmission settings such as Papua New Guinea must consider local heterogeneity when choosing interventions and ensure continuous monitoring of trends.

This practice note presents four conceptual tools intended to support the design, selection and evaluation of research capacity strengthening (RCS) programmes in low-income and middle-income country settings. The tools may be used by a wide range of RCS stakeholders, including funders, implementing parties and programme evaluators, to guide decision-making in lieu of largely as yet unavailable empirical evidence. The first conceptual tool guides decision-making regarding RCS intervention design, focusing specifically on the combination and integration of potential intervention activities. The second conceptual tool provides a framework for assessing the implementation challenges of potential RCS interventions in terms of: (1) the overall cost of implementing the proposed intervention in a given context; (2) the length of time required to complete full implementation of the proposed intervention in a given context and (3) the level of control the implementing partners would have over the proposed intervention in a given context. The third conceptual tool provides a means to consider the anticipated impact of potential RCS interventions in order to inform selection decisions (ie, which out of a number of potential RCS intervention options may be most impactful in a given setting given the intervention design and implementation challenges). The fourth and final tool is designed to support the evaluation of a collective RCS effort, whether that be multiple RCS interventions delivered within the context of a single or continuous programme or multiple RCS programmes delivered in a common setting.

Introduction: The mortality associated with non-communicable diseases has increased significantly in most countries in the World Health Organization Western Pacific Region over the last 20 years, as have the underlying risk factors. This study aimed to collate evidence on the prevalence of four major non-communicable diseases and their risk factors in Papua New Guinea in order to inform appropriate policy for their prevention and management. Methods: We performed a systematic review of Papua New Guinea-based population prevalence studies of cardiovascular diseases, type 2 diabetes mellitus, chronic respiratory diseases, and cancers, as well as non-communicable disease risk factors published before 2016. Five online databases were searched and screened against eligibility criteria according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results: A total of 57 articles were included in this review, most of which (n = 48) were published prior to 2000. Eleven articles reported on diabetes, six reported on chronic lung disease/asthma, two reported on cardiovascular diseases, and two reported cancer as the primary outcome, while the remaining 36 papers reported non-communicable disease risk factors. Conclusion: This review demonstrated variations in the prevalence of non-communicable diseases (0%–19%) and their risk factors (0%–80.6%) attributed to the lifestyle and genetic diversity of the Papua New Guinea population. There is a strong suggestion that the prevalence of non-communicable diseases (particularly type 2 diabetes mellitus) and key non-communicable disease risk factors (hypertension, overweight, and obesity) has increased, but there is a lack of recent data. As such, there is an urgent need for new and up-to-date data in all areas of Papua New Guinea.

Background: International development partners and research councils are increasingly funding research management and support (RMS) capacity strengthening initiatives in sub-Saharan Africa (SSA) as part of a broader investment in strengthening national and regional research systems. However, the evidence-base to inform RMS capacity strengthening initiatives is limited at present. This research note presents a synthesis of 28 RMS capacity assessments completed in 25 universities/research institutions from across 15 SSA countries between 2014 and 2018. Methods: All 28 capacity assessments were completed following a standardised methodology consisting of semi-structured interviews conducted with research and research support staff at the respective institution as well as document reviews and observation of onsite facilities. Data were extracted from the 28 reports detailing the findings of each assessment according to a framework synthesis approach. Results: In total, 13 distinct capacity gap categories emerged from across the 28 RMS capacity assessment reports. Almost all the institutions assessed faced multiple gaps in RMS capacity within and across each of these 13 categories. The 13 categories were not independent of each other and were often closely inter-connected. Commonalities were also evident across multiple categories, the two most obvious of which were severe fiscal constraints and the often-complex bureaucracy of the institutional operating environment. Conclusions: The synthesis findings reveal multiple, commonly shared RMS capacity gaps in universities and research institutions across SSA. No single intervention type, or focus, would be sufficient to strengthen capacity across all 13 areas; rather, what is needed to facilitate a significant shift in RMS capacity within such SSA universities and research institutions is a combination of interventions, consisting of differing levels of cost and complexity, variously led (or supported) by both internal and external actors.

Gambiense Human African Trypanosomiasis (g-HAT) is a neglected tropical disease caused by trypanosomes transmitted by tsetse flies. 70% of cases in 2019 (604/863) occurred in the Democratic Republic of Congo (DRC). The national programme for g-HAT elimination in DRC includes a large-scale deployment of Tiny Targets which attract and kill tsetse. This intervention is directed by vector-control specialists with small teams, moving in canoes, deploying Tiny Targets along riverbanks where tsetse concentrate. While the targets are deployed in communal areas, and the method is cheap and easy-to-use, local people have little involvement. This study aimed to evaluate if a community-led vector control programme was feasible in the context of DRC's g-HAT elimination programme. In 2017, a community-led intervention was implemented in three villages in the Kwilu province of DRC. This intervention was evaluated through an Action Research with qualitative data collected through 21 focus group discussions and 289 hours of observation. Also the geographical location and quality of each Tiny Targets were collected (total number deployed = 2429). This research revealed that community-based approach largely worked: people were motivated and proactive, showed a good application of the acquired knowledge resulting in an effective deployment of Tiny Targets. In addition, our study provided evidence that acceptability of the targets by the community can improve deployment quality by reducing target loss and damage. The approach was feasible in places where canoe-based teams could not reach. Against these advantages, a community-based approach was time-consuming and had to adapt to the seasonal and daily rhythms of the community. A community-based approach for tsetse control is technically feasible and recommended but limits to the speed and scale of the approach restraints its application as a standalone strategy in a large-scale national programme aiming to eliminate g-HAT in a short timeframe.

Background: Development partners and research councils are increasingly investing in research capacity strengthening initiatives in low- and middle-income countries to support sustainable research systems. However, there are few reported evaluations of research capacity strengthening initiatives and no agreed evaluation metrics. Methods: To advance progress towards a standardised set of outcome and impact indicators, this paper presents a structured review of research capacity strengthening indicators described in the published and grey literature. Results: We identified a total of 668 indicators of which 40% measured output, 59.5% outcome and 0.5% impact. Only 1% of outcome and impact indicators met all four quality criteria applied. A majority (63%) of reported outcome indicators clustered in four focal areas, including: research management and support (97/400), the attainment and application of new research skills and knowledge (62/400), research collaboration (53/400), and knowledge transfer (39/400). Conclusions: Whilst this review identified few examples of quality research capacity strengthening indicators, it has identified priority focal areas in which outcome and impact indicators could be developed as well as a small set of ‘candidate’ indicators that could form the basis of development efforts.

Introduction Global health research involves disciplines within and beyond the health sciences. A cross-disciplinary collaborative research approach enables an interchange of knowledge and experience and stimulates innovative responses to complex health challenges. However, there is little robust evidence to guide the design and implementation of cross-disciplinary research in global health, hampering effective collective action. This review synthesised evidence on practical actions for fostering cross-disciplinary research to provide guidance on the design and implementation of research in global health.Methods We searched five electronic databases using key words. The search included original research and research notes articles in English. We used a framework adapted from the socio-ecological model and thematic synthesis for data analysis.Results Thirty-six original research and 27 research notes articles were included in the review. These were predominantly from high-income countries and indicated that practical actions on fostering cross-disciplinary research are closely linked to leadership and teamwork which should be planned and implemented at research team and institutional levels. The publications also indicated that individual qualities such as being receptive to new ideas and funders’ power and influence have practical implications for conducting cross-disciplinary research. Practical actions that individuals, research team leaders, academic institutions and funders can undertake to foster cross-disciplinary research were identified.Conclusion Our review found evidence from high-income countries, not low-and-middle-income countries, about practices that can improve cross-disciplinary research in global health. Critical knowledge gaps exist around how leadership and teamwork processes can better integrate expertise from different disciplines to make cross-disciplinary research more effective.

Abstract Background In 2009, the Papua New Guinea (PNG) Department of Health adopted artemether–lumefantrine (AL) and dihydroartemisinin–piperaquine (DHA-PPQ) as the first- and second-line treatments for uncomplicated malaria, respectively. This study was conducted to assess the efficacy of both drugs following adoption of the new policy. Methods Between June 2012 and September 2014, a therapeutic efficacy study was conducted in East Sepik and Milne Bay Provinces of PNG in accordance with the standard World Health Organization (WHO) protocol for surveillance of anti-malarial drug efficacy. Patients ≥ 6 months of age with microscopy confirmed Plasmodium falciparum or Plasmodium vivax mono-infections were enrolled, treated with AL or DHA-PPQ, and followed up for 42 days. Study endpoints were adequate clinical and parasitological response (ACPR) on days 28 and 42. The in vitro efficacy of anti-malarials and the prevalence of selected molecular markers of resistance were also determined. Results A total of 274 P. falciparum and 70 P. vivax cases were enrolled. The day-42 PCR-corrected ACPR for P. falciparum was 98.1% (104/106) for AL and 100% (135/135) for DHA-PPQ. The day-42 PCR-corrected ACPR for P. vivax was 79.0% (15/19) for AL and 92.3% (36/39) for DHA-PPQ. Day 3 parasite clearance of P. falciparum was 99.2% with AL and 100% with DHA-PPQ. In vitro testing of 96 samples revealed low susceptibility to chloroquine (34% of samples above IC50 threshold) but not to lumefantrine (0%). Molecular markers assessed in a sub-set of the study population indicated high rates of chloroquine resistance in P. falciparum (pfcrt SVMNT: 94.2%, n = 104) and in P. vivax (pvmdr1 Y976F: 64.8%, n = 54). Conclusions AL and DHA-PPQ were efficacious as first- and second-line treatments for uncomplicated malaria in PNG. Continued in vivo efficacy monitoring is warranted considering the threat of resistance to artemisinin and partner drugs in the region and scale-up of artemisinin-based combination therapy in PNG.

Abstract Background This paper examines the impact of the scale-up of malaria rapid diagnostic tests (RDT) on routine clinical diagnosis procedures for febrile illness in primary healthcare settings in Papua New Guinea. Methods Repeat, cross-sectional surveys in randomly selected primary healthcare services were conducted. Surveys included passive observation of consecutive febrile case management cases and were completed immediately prior to RDT scale-up (2011) and at 12- (2012) and 60-months (2016) post scale-up. The frequency with which specified diagnostic questions and procedures were observed to occur, with corresponding 95% CIs, was calculated for febrile patients prescribed anti-malarials pre- and post-RDT scale-up and between febrile patients who tested either negative or positive for malaria infection by RDT (post scale-up only). Results A total of 1809 observations from 120 health facilities were completed across the three survey periods of which 915 (51%) were prescribed an anti-malarial. The mean number of diagnostic questions and procedures asked or performed, leading to anti-malarial prescription, remained consistent pre- and post-RDT scale-up (range 7.4–7.7). However, alterations in diagnostic content were evident with the RDT replacing body temperature as the primary diagnostic procedure performed (observed in 5.3 and 84.4% of cases, respectively, in 2011 vs. 77.9 and 58.2% of cases in 2016). Verbal questioning, especially experience of fever, cough and duration of symptoms, remained the most common feature of a diagnostic examination leading to anti-malarial prescription irrespective of RDT use (observed in 96.1, 86.8 and 84.8% of cases, respectively, in 2011 vs. 97.5, 76.6 and 85.7% of cases in 2016). Diagnostic content did not vary substantially by RDT result. Conclusions Rapid diagnostic tests scale-up has led to a reduction in body temperature measurement. Investigations are very limited when malaria infection is ruled out as a cause of febrile illness by RDT.

BACKGROUND:Strengthening research capacity in low-and-middle-income countries is essential to drive socioeconomic development and to achieve the Sustainable Development Goals. Understanding strengths and weaknesses in institutions' research capacity can guide effective targeting of investments and resources. This study assessed the capacity of institutions undertaking research in natural science topics in Africa to identify priority capacity gaps for future investment. METHODS:Assessments were conducted in eight African institutions that were partners in a UK-Africa programme to strengthen research capacity in renewable energy, soil-related science, and water and sanitation. Assessments involved eighty-six interviews and three focus group discussions to identify institutions' research capacity strengths and gaps against an evidence-informed benchmark. Use of the same interview guides and data collection processes across all institutions meant that findings could be compared. RESULTS:Common research capacity gaps were: lack of, or poorly maintained, equipment; unreliable, slow procurement systems; insufficient opportunities for developing the skills of research support staff such as administrators and technicians; dysfunctional institutional email communication systems; insufficient focus on the development of 'soft' researcher skills such as ethics, academic writing and, in non-Anglophone countries, English language. Programme strengths were the South-South and South-North partnerships for sharing and cascading expertise and resources, joint writing of proposals and publications, and improved individual and institutional visibility. CONCLUSION:There were many similarities in research capacity gaps irrespective of the institutions' natural sciences research focus, and these were similar to those reported in the health sector. Common capacity needs are improving the skills of technicians and administrators to support research activities, soft skills training for researchers, and more effective pan-institutional e-communication systems. These could be strategic investment targets for the joint efforts of national governments and international organisations that fund programmes for strengthening research capacity in low- and middle-income countries.

Malaria surveillance and response-systems are essential for identifying the areas most affected by malaria and for targeting interventions and optimising resources. This study aimed to assess whether the visualisation of routinely collected health facility data linked to village of residence provides evidence for targeting control interventions in four sentinel health facilities in Papua New Guinea. A video format was used to visualise the dynamics in case incidence over time and space alongside photographs illustrating the context of the data collection in the study sites. Incidence changes overtime were illustrated in animated maps. Despite limitations, this approach appeared useful in sites with very few remaining cases or with increasingly marked heterogeneity. Villages that could benefit from targeted interventions or investigations were identified.

Background Locally relevant research is considered critical for advancing health and development in low- and middle-income countries (LMICs). Accordingly, health research capacity strengthening (HRCS) efforts have intensified, increasingly through consortia. Yet, the knowledge base for managing such consortia is not well defined. This review aimed to ascertain the scope and quality of published literature on HRCS consortium management processes, management-related factors influencing consortium operations and outcomes, and the knowledge gaps.Methods Given the paucity of published HRCS literature, a ‘systematised review’ as outlined by Grant and Booth was conducted, modelling the systematic review process without restriction to research-based publications. A systematic search in PubMed and Scopus was carried out coupled with a manual search for papers using reference checking and citation searching. A quality appraisal of eligible articles using the Mixed Method Appraisal Tool was undertaken. Thematic synthesis was used to analyse the extracted data.Results The search identified 55 papers, made up of 18 empirical papers and 37 commentaries focusing on consortium-based HRCS initiatives involving LMICs and reporting management-related data. The review indicates increasing efforts being made in the HRCS field in reporting consortia outcomes. However, it highlights the dearth of high-quality empirical research on HRCS consortium management and the nascent nature of the field with most papers published after 2010. The available literature highlights the importance of relational management factors such as equity and power relations in influencing consortium success, though these factors were not explored in depth. Operational management processes and their role in the capacity strengthening pathway were rarely examined.Conclusion Findings indicate a weak evidence base for HRCS consortium management both in terms of quantity and conceptual depth, demonstrating the need for an expanded research effort to inform HRCS practice.

BackgroundRisk factors for cardiovascular disease (CVD) are negatively correlated with socio-economic status (SES) in high-income countries (HIC) but there has been little research on their distribution by household SES within low-and middle-income countries (LMICs). Considering the limited data from LMICs, this paper examines the association between behavioural and cardiovascular risk factors and household SES in Papua New Guinea (PNG).MethodsReported here are results of 671 participants from the 900 randomly selected adults aged 15-65 years. These adults were recruited from three socioeconomically and geographically diverse surveillance sites (peri-urban community, rural Highland and an Island community) in PNG in 2013-2014. We measured their CVD risk factors (behavioural and metabolic) using a modified WHO STEPS risk factor survey and analysis of blood samples. We assessed SES by education, occupation and creating a household wealth index based on household assets. We calculated risk ratios (RR) and their 95% confidence intervals (CI) using a generalized linear model to assess the associations between risks and SES.FindingsElevated CVD risk factors were common in all SES groups but the CVD metabolic risk factors were most prevalent among homemakers, peri-urban and rural highlands, and the highest (4th and 5th) wealth quintile population. Adults in the highest wealth quintile had high risks of obesity, elevated HbA1c and metabolic syndrome (MetS) that were greater than those in the lowest quintile although those in the highest wealth quintiles were less likely to smoke tobacco. Compared to people from the Island community, peri-urban residents had increased risks of increased waist circumference (WC) (RR: 1.67, 95%CI: 1.21-2.31), hypertension (RR: 2∙29, 95%CI: 1∙89-4.56), high cholesterol (RR: 2∙22, 95%CI: 1∙20-4∙10), high triglycerides (RR: 1∙49, 95%CI: 1∙17-1∙91), elevated HbA1c (RR: 5∙54, 95%CI: 1∙36-21∙56), and Metabolic syndrome (MetS) (RR: 2∙04, 95%CI: 1∙25-3∙32). Similarly, Rural Highland residents had increased risk of obesity (Waist Circumference RR: 1∙70, 95%CI: 1∙21-3∙38, Waist-Hip-Ratio RR:1∙48, 95%CI: 1∙28-1∙70), hypertension (RR: 2∙60, 95%CI: 1∙71-3∙95), high triglycerides (RR: 1∙34, 95%CI: 1∙06-1∙70) and MetS (RR: 1∙88, 95%CI: 1∙12-3∙16) compared to those in the rural Island site.InterpretationCVD risk factors are common in PNG adults but their association with SES varies markedly and by location. Our findings show that all community members are at risk of CVD weather they are part of high or low SES groups. These results support the notion that the association between CVD risk factors and SES differ greatly accordingly to the type of SES measure used, risk factors and the population studied. In addition, our findings contribute further to the limited literature in LMIC. Longitudinal studies are needed to monitor changes in rapidly changing societies such as PNG to inform public health policy for control and prevention of NCDs in the country.

[This corrects the article DOI: 10.1371/journal.pone.0211068.].

The Papua New Guinea (PNG) Department of Health introduced a 'test and treat' malaria case management protocol in 2011. This study assesses health worker compliance with the test and treat protocol on a wide range of measures, examines self-reported barriers to health worker compliance as well as health worker attitudes towards the test and treat protocol. Data were collected by cross-sectional survey conducted in randomly selected primary health care facilities in 2012 and repeated in 2014. The combined survey data included passive observation of current or recently febrile patients (N = 771) and interviewer administered questionnaires completed with health workers (N = 265). Across the two surveys, 77.6% of patients were tested for malaria infection by rapid diagnostic test (RDT) or microscopy, 65.6% of confirmed malaria cases were prescribed the correct antimalarials and 15.3% of febrile patients who tested negative for malaria infection were incorrectly prescribed an antimalarial. Overall compliance with a strictly defined test and treat protocol was 62.8%. A reluctance to test current/recently febrile patients for malaria infection by RDT or microscopy in the absence of acute malaria symptoms, reserving recommended antimalarials for confirmed malaria cases only and choosing to clinically diagnose a malaria infection, despite a negative RDT result were the most frequently reported barriers to protocol compliance. Attitudinal support for the test and treat protocol, as assessed by a nine-item measure, improved across time. In conclusion, health worker compliance with the full test and treat malaria protocol requires improvement in PNG and additional health worker support will likely be required to achieve this. The broader evidence base would suggest any such support should be delivered over a longer period of time, be multi-dimensional and multi-modal.

‘Research capacity strengthening’ (RCS) is an umbrella term that can be used to describe a wide variety of activities conducted in support of diverse objectives premised upon distinct, potentially opposing, views. Despite this, the ultimate objective of RCS activities is rarely made explicit which can be problematic when diverse objectives are possible. By ‘ultimate’ objective we are referring to the overarching (often long-term) goal an RCS initiative is intended to contribute towards (e.g. better population health) as opposed to the more immediate ‘proximate’ (often short-term) objectives of any such activity (e.g. improved capacity to undertake infectious disease research). We argue a need for those funding, designing and implementing RCS initiatives to make clear statements as to the ultimate objective that they foresee their respective initiative contributing towards as well as the proposed pathway and associated assumptions that underlie their approach. Examples of distinct ultimate objectives for RCS initiatives are presented alongside fictitious examples of how they may be transparently reported from both a funder and implementor perspective. Such transparency should be routine within the scope of funding calls for RCS activities (even when such activities are only a minor component of the call), subsequent applications to those calls and any description of an applied RCS activity/ies and/or the associated outcomes thereof. The process of determining one’s ultimate objective will further cause funders and actors to think through their respective initiatives more thoroughly and make informed choices and better designed RCS projects. Doing so would reduce any ambiguity associated with the use of the term ‘research capacity strengthening’ and would provide a stronger foundation for robust programme evaluation.

Poor-quality life-saving medicines are a major public health threat, particularly in settings with a weak regulatory environment. Insufficient amounts of active pharmaceutical ingredients (API) endanger patient safety and may contribute to the development of drug resistance. In the case of malaria, concerns relate to implications for the efficacy of artemisinin-based combination therapies (ACT). In Papua New Guinea (PNG), Plasmodium falciparum and P. vivax are both endemic and health facilities are the main source of treatment. ACT has been introduced as first-line treatment but other drugs, such as primaquine for the treatment of P. vivax hypnozoites, are widely available. This study investigated the quality of antimalarial drugs and selected antibiotics at all levels of the health facility supply chain in PNG.Medicines were obtained from randomly sampled health facilities and selected warehouses and hospitals across PNG and analysed for API content using validated high performance liquid chromatography (HPLC). Of 360 tablet/capsule samples from 60 providers, 9.7% (95% CI 6.9, 13.3) contained less, and 0.6% more, API than pharmacopoeial reference ranges, including 29/37 (78.4%) primaquine, 3/70 (4.3%) amodiaquine, and one sample each of quinine, artemether, sulphadoxine-pyrimethamine and amoxicillin. According to the package label, 86.5% of poor-quality samples originated from India. Poor-quality medicines were found in 48.3% of providers at all levels of the supply chain. Drug quality was unrelated to storage conditions.This study documents the presence of poor-quality medicines, particularly primaquine, throughout PNG. Primaquine is the only available transmission-blocking antimalarial, likely to become important to prevent the spread of artemisinin-resistant P. falciparum and eliminating P. vivax hypnozoites. The availability of poor-quality medicines reflects the lack of adequate quality control and regulatory mechanisms. Measures to stop the availability of poor-quality medicines should include limiting procurement to WHO prequalified products and implementing routine quality testing.

The aim of this study is to assess whether a text message reminder service designed to support health worker adherence to a revised malaria treatment protocol is feasible and acceptable in Papua New Guinea (PNG). The study took place in six purposively selected health facilities located in the Eastern Highlands Province (EHP) of PNG. Ten text messages designed to remind participants of key elements of the new NMTP were transmitted to 42 health workers twice over a two week period (two text messages per day, Monday to Friday) via the country's largest mobile network provider. The feasibility and acceptability of the text message reminder service was assessed by transmission reports, participant diaries and group discussions. Findings indicate that the vast majority of text messages were successfully transmitted, participants' had regular mobile phone access and that most text messages were read most of the time and were considered both acceptable and clinically useful. Nevertheless, the study found that PNG health workers may tire of the service if the same messages are repeated too many times and that health workers may be reluctant to utilize more comprehensive, yet complementary, resources. In conclusion, a text message reminder service to support health worker adherence to the new malaria treatment protocol is feasible and acceptable in PNG. A rigorous pragmatic, effectiveness trial would be justified on the basis of these findings.

Background: The Strengthening Capacity in Environmental Physics, Hydrogeology and Statistics for conservation agriculture research (CEPHaS) consortium sought to to strengthen research capacity among a network of African and UK researchers, and their respective institutions, to fill knowledge gaps on the impacts of conservation agriculture practices on the water cycle in cultivated soils. We examined experiences of consortium membership and, drawing on this information, determined key recommendations for future programmes with similar objectives. Methods: A mixed methods study encompassing an online survey (N=40) and semi-structured interviews (N=19) completed between June 2021 and February 2022 with CEPHaS consortium members from Malawi, UK, Zambia and Zimbabwe. Survey and interview data were analysed separately, using univariate statistics and framework synthesis respectively Results: Survey and interview findings were generally aligned, with both revealing a wide range of reported capacity strengthening gains resulting from CEPHaS engagement at both an individual and institutional level. Participants consistently expressed their CEPHaS involvement in positive terms with praise for the applied ‘learn by doing’ approach underpinning many of the activities as well as the engaging and highly inclusive leadership. There was evidence that the various trainings and resources provided through CEPHaS were valued, frequently utilised, and often transferred beyond the immediate CEPHaS membership for wider benefit. Resource provision and staff training were seen as foundational for long-term institutional benefits. Some challenges and suggested areas for improvement were reported by participants as were potential opportunities to facilitate greater impact. Conclusion: Our findings suggest that the basic ‘template’ of the CEPHaS consortium provided a strong basis for research capacity strengthening in Conservation Agriculture, especially at the level of individual researchers, and that this template could be further enhanced in any future iteration of the same or similar programme. Recommendations for replicating and enhancing CEPHaS programme strengths are presented.

Background: Development partners and research councils are increasingly investing in research capacity strengthening initiatives in low- and middle-income countries to support sustainable research systems. However, there are few reported evaluations of research capacity strengthening initiatives and no agreed evaluation metrics. Methods: To advance progress towards a standardised set of outcome and impact indicators, this paper presents a structured review of research capacity strengthening indicators described in the published and grey literature. Results: We identified a total of 668 indicators of which 40% measured output, 59.5% outcome and 0.5% impact. Only 1% of outcome and impact indicators met all four quality criteria applied. A majority (63%) of reported outcome indicators clustered in four focal areas, including: research management and support (97/400), the attainment and application of new research skills and knowledge (62/400), research collaboration (53/400), and knowledge transfer (39/400). Conclusions: Whilst this review identified few examples of quality research capacity strengthening indicators, it has identified priority focal areas in which outcome and impact indicators could be developed as well as a small set of ‘candidate’ indicators that could form the basis of development efforts.