Building research capacity through “Planning for Success”

1 Centro Internacional de Entrenamiento e Investigaciones Médicas, Cali, Colombia, 2 Universidad Icesi, Cali, Colombia, 3 UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland, 4 Health Services and Access Unit, Department of Health Systems and Services of the Pan-American Health Organization/World Health Organization, Washington, DC, United States of America


Introduction
Strengthening health research capacity in low-and middle-income countries (LMICs) has been identified as a driver of development and requirement for efficient investment of limited resources. Among the unique challenges that LMICs face when undertaking research for health are a persistent shortage of experienced researchers and competent interdisciplinary research teams, limited research career opportunities [1,2,3], intense competition for scarce resources targeting LMIC priorities [3,4,5], and an urgent need for translating research results into policy and practice [3,4,5]. One common denominator of these challenges is the need for sustainable capacity in planning, monitoring, and evaluating health research projects [1,3,6,7]. How to effectively build these management skills among health researchers and their project teams is a persistent concern [8,9] because such capacities are generally not included in academic degree programs [9], and investigators already immersed in teaching, clinical, and research responsibilities have limited time to pursue further training [9].
Since 2007, TDR, the Special Program for Research and Training in Tropical Diseases cosponsored by United Nations Development Programme (UNDP), UNICEF, the World Bank, and WHO; institutions serving as Regional Training Centers (RTCs); and diverse government and regional partner entities synergized efforts towards building project management capacity for health research, especially for neglected tropical diseases (NTDs) [10]. Together, they have led the regional dissemination of the "Planning for Success" initiative based on two training courses: Skill-Building for effective planning, implementation, monitoring, and evaluation of health research projects and a Train-the-Trainer (TTT) course to ensure availability of local trainers.
Our goal in this Viewpoint is to consider unique features of the "Planning for Success" approach to project management training and its regional dissemination model and provide insight into their applicability to other needs for health-research-capacity-strengthening.

Sustainable implementation of effective project planning and evaluation in health research
The cornerstone of the "Planning for Success" initiative is the Skill-Building course on Effective Project Planning and Evaluation (EPPE) that takes participants through each of the phases  [10] in order to implement local and regional dissemination of this training. Since 2009, as an RTC for good research practices, CIDEIM-together with collaborating Latin American and Caribbean network institutionshas infused project management principles into their organizational culture. Institutional "champion" facilitators/trainers conduct regular internal courses, harmonizing project planning and evaluation tools with existing institutional and external systems of research administration and promoting the organizational value of this expertise. The uptake of this practical planning strategy is evidenced by the global and regional dissemination of the course (Fig 1) and its incorporation into diverse undergraduate, postgraduate, and continuing education programs (Table 1). In the following section, we describe key characteristics of EPPE training identified by trainers and participants as contributory to its relevance, engaging dynamic, and translation to practice (Fig 2).

Responding to a felt need and involving end-users
In 2002, TDR identified the need for ensuring efficient, timely, and cost-effective conduct of projects and management of grants funded through its Multilateral Initiative on Malaria (MIM), which aimed to "maximize the impact of scientific research against malaria in Africa, through promotion of capacity building activities and facilitating global collaboration and  coordination" [11]. The EPPE Skill-Building course was crafted specifically to address this multifaceted need. Notably, intended beneficiaries of the imparted skills contributed to the development of course content and format, thereby enhancing its relevance and applicability. Several models of project management training existed when the EPPE course was developed [12]. However, many health researchers considered project management to be outside their responsibilities or simply inaccessible [12].
The Skill-Building course developers intentionally tailored the course to the multidisciplinary backgrounds and roles of the diverse professionals involved in health research. Terms, concepts, and learning methods are conveyed through a specific case study example and immediate application to participants' own research projects. Project management concepts following a results-based management approach including alignment of objectives, definition of roles, coordination of activities and timelines, and effective mechanisms of communication are presented in practical terms, emphasizing the value of the appropriation and application of project planning and evaluation by research teams. Step-by-step learning Rooted in David Kolb's experiential learning theory [13], course content is presented in a stepby-step process, with each module building upon the previous one. This progressive and experience-based approach allows participants to consider theory, reflect through illustrative case studies, and then cement their learning by applying the new concepts to planning their own projects. Participants reach the end of the course with a realistic and achievable plan and a set of tools for monitoring the implementation of their projects. Upon completion of each course, four aspects of the training have been systematically evaluated: content, facilitators, organization, and applicability of skills introduced during the course, which have been positively rated by over 90% of participants from 2007 to 2018.

Building multidisciplinary teams
The course brings together multidisciplinary teams including investigators, data managers, project coordinators, public health practitioners, administrators, and institutional authorities from different sectors concerned with research for health ( Table 2). Participants are engaged on a level playing field of mutual interest and respect to plan their projects together. Constructive feedback is encouraged and normalized, providing opportunities for individuals approaching the research project from different perspectives to collaborate, learn from one another, and contribute to each other's success.  (Table 2). Overall participants have been affiliated with academia (47%), research institutions (29%), government (14%), healthcare delivery (8%), Pan-American Health Organization (PAHO) (2%), and undefined (1%). RTC partner institutions have increased and continue to further increase these numbers through replication of training within and beyond their institutions. This ongoing regional experience illustrates key characteristics of the dissemination strategy and the institutional appropriation that have sustained the "Planning for Success" initiative.

TTTs: Starting point for standardized, self-replicating dissemination
During piloting of the EPPE Skill-Building course (2002)(2003), MIM grantees ratified the value of the training and expressed the desire to train their team members and others. In response, TDR developed the TTT course to facilitate dissemination [10]. The TTT course provides mentored experience and practical guidance to support the presentation and uptake of the project management content. Facilitation, group management, training skills, and logistical considerations for organizing the Skill-Building course are also addressed. Additionally, a system for consistently identifying and preparing new trainers was established. Future trainers are identified during the Skill-Building course, considering innate teaching capacities and motivation to multiply project management skills. Candidates are invited to participate in a TTT course. Training materials for Skill-Building and TTT courses are available in English, Spanish, Portuguese, and French (http://www.who.int/tdr/publications/topics/project_ planning_training/en/). These standardized materials and system of replication have facilitated propagation in person and through a virtual course (http://www.cideim.org.co/moodle/) while minimizing the risk for inconsistent course quality and divergence from core messages.

Dissemination: A pay-it-forward approach
A commitment to a bottom-up leadership and distributed empowerment approach, together with the mutual leveraging of the institutional resources and capacities of CIDEIM, TDR, PAHO, and national partners, has catalyzed the dissemination of the "Planning for Success" initiative and scalable and sustainable research capacity building. CIDEIM initially built upon its established national research partnerships to develop training experience and increase its trainer pool. With the support of PAHO and TDR, CIDEIM expanded EPPE training to the Andean region, Central America, and Jamaica in the Caribbean (Fig 3). Importantly, several network institutions have also invested in the institutionalization of "Planning for Success" and participated in the dissemination of this initiative in the region. Paying it forward occurs when Skill-Building courses are conducted in regional institutions with the intent and understanding that those introduced to this training will join the regional network in building project management skills among health research teams by replicating and disseminating the training to others needing these skills. Exemplifying this "cascade" process, the Autonomous University of Honduras has become a training hub in Central America disseminating EPPE capacity to Guatemala, El Salvador, and Costa Rica. Similarly, the Caribbean Institute for Health Research (CAIHR) has served as the epicenter for conducting training in Guyana, Suriname, and Grenada. Furthermore, in addition to replicating the short training course for investigators and faculty through continuing education, several network institutions have integrated the principles and methods into their undergraduate or postgraduate programs, assuring the sustainability of the benefits among future generations (Table 1).

Beyond project management: Building upon "Planning for Success"
Beyond the Americas, CIDEIM has also introduced "Planning for Success" training capacity to RTCs in Indonesia, Kazakhstan, and Ghana and to the University of Malawi, promoting the parallel dissemination of project management skills in Central and South East Asia and Western and Eastern Africa. Through this process of inter-and intraregional dissemination, the project management course has been adapted to address a broad range of health research needs, to incorporate other project planning and monitoring challenges such as budgeting, and to allow integration into university curricula, thereby responding to participant evaluations and trainer experiences [14]. Moreover, the "Planning for Success" experience has served as a gateway to the development and dissemination of other capacity-building courses and training opportunities such as the Good Health Research Practices course sponsored by TDR, with the goal of applying good clinical practice concepts to health research involving human participation beyond clinical trials [15]. The beneficial impact and intermediate outcomes of the "Planning for Success" approach to building project management capacity among health research teams are substantiated by its sustained dissemination and appropriation and the incorporation of the methodology into institutional practices and curricula by the RTC and network institutions. The training experience and methodology described in this Viewpoint deliver a valued product to participants, namely a clear, feasible plan for their projects, thereby promoting institutional appropriation of research skill building through active learning and outcome-oriented courses that complement and are readily integrated into academic curricula. The institutional focus, regional leadership and synergistic partnerships established through the "Planning for Success" initiative have provided a foundation for strengthening regional health research. https://doi.org/10.1371/journal.pntd.0007426.g003