Brian Greenwood, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. Tel.: +44 20 7299 4707; Fax: +44 20 729 4720; E-mail: email@example.com
Recently, there has been a major increase in financial support for malaria control. Most of these funds have, appropriately, been spent on the tools needed for effective prevention and treatment of malaria such as insecticide-treated bed nets, indoor residual spraying and artemisinin combination therapy. There has been less investment in the training of the scientists from malaria-endemic countries needed to support these large and increasingly complex malaria control programmes, especially in Africa. In 2000, with support from the Bill & Melinda Gates Foundation, the Gates Malaria Partnership was established to support postgraduate training of African scientists wishing to pursue a career in malaria research. The programme had three research capacity development components: a PhD fellowship programme, a postdoctoral fellowship programme and a laboratory infrastructure programme. During an 8-year period, 36 African PhD students and six postdoctoral fellows were supported, and two research laboratories were built in Tanzania. Some of the lessons learnt during this project – such as the need to improve PhD supervision in African universities and to provide better support for postdoctoral fellows – are now being applied to a successor malaria research capacity development programme, the Malaria Capacity Development Consortium, and may be of interest to other groups involved in improving postgraduate training in health sciences in African universities.
Récemment, il y a eu une augmentation importante du soutien financier pour la lutte antipaludique. La plupart de ces fonds ont, à juste titre, été dépensés sur les outils nécessaires pour une prévention efficace et pour le traitement du paludisme tels que les moustiquaires imprégnées d’insecticide, la pulvérisation de résidus d’intérieur et la thérapie de combinaison à l’’artémisinine. Il y a eu moins d’investissement dans la formation des scientifiques en provenance des pays endémiques pour le paludisme, nécessaires pour appuyer ces programmes de grande envergure et de plus en plus complexes du contrôle du paludisme, en particulier en Afrique. En 2000, avec le soutien de la Fondation Bill & Melinda Gates, le Partenariat Gates Malaria, a été créé pour soutenir la formation postuniversitaire des scientifiques africains désireux de poursuivre une carrière dans la recherche sur le paludisme. Le programme comportait trois volets de développement des capacités de recherche: un programme de bourse de doctorat, un programme de bourses postdoctorales et un programme d’infrastructures de laboratoire. Au cours d’une période de huit ans, 36 étudiants africains en doctorat et 6 post-doctorants ont été pris en charge, deux laboratoires de recherche ont été construits en Tanzanie. Certaines des leçons apprises au cours de ce projet - telles que la nécessité d’améliorer la supervision des doctorants dans les universités africaines et de fournir un meilleur soutien aux post-doctorants - sont maintenant appliquées dans un programme successeur de développement des capacités dans la recherche sur le paludisme: le Consortium de Développement des Capacités dans le Paludisme, et peuvent être intéressantes pour d’autres groupes impliqués dans l’amélioration de la formation postuniversitaire en sciences de la santé dans les universités africaines.
Recientemente ha habido un aumento importante del apoyo financiero para el control de la malaria. La mayoría de estos fondos se han invertido en herramientas necesarias para la prevención y el tratamiento efectivo de la malaria, tales como mosquiteras impregnadas de insecticida, el rociado residual intradomiciliario y la terapia de combinación con artemisinina. Ha habido una menor inversión en el entrenamiento de científicos de países endémicos para malaria, necesarios para apoyar los programas de control de la malaria - grandes y cada vez más complejos - especialmente en África. En el 2000, con el apoyo de la Fundación Bill & Melinda Gates, se estableció la Gates Malaria Partnership para apoyar el entrenamiento a nivel de postgrado de científicos Africanos que deseasen seguir una carrera en la investigación de la malaria. El programa tenía tres componentes de desarrollo de capacidades en la investigación: un programa de becas de doctorado, un programa de becas para entrenamiento postdoctoral y un programa de infraestructura para laboratorios. Durante un periodo de 8 años, 36 estudiantes de PhD africanos y 6 post-doctorandos recibieron becas, y se construyeron dos laboratorios de investigación en Tanzania. Algunas de las lecciones aprendidas durante este proyecto – tales como la necesidad de mejorar la supervisión en las universidades Africanas durante el doctorado y ofrecer un mayor apoyo a los post-doctorandos – ya están siendo aplicadas en el programa sucesor de desarrollo de capacidades en investigación de malaria – el Malaria Capacity Development Consortium (Consorcio para el Desarrollo de Capacidades en Malaria), y podría ser de interés a otros grupos involucrados en la mejora del entrenamiento de postgrado en ciencias de la salud en universidades Africanas.
During the past decade, malaria has attracted the world’s attention once again, and malaria control now receives about ten times more funding from organisations such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, the World Bank, the President’s Malaria Initiative and other bilateral donors, than was the case a decade ago. A large part of these funds have been spent appropriately on provision of the tools needed for effective malaria control such as artemisinin combination therapy, insecticide-treated bed nets and indoor residual spraying. Support for the training of staff with the requisite skills needed to run these large and complex control programmes and to monitor their impact (Malaria Consortium 2011) was relatively neglected until recently. It is recognised increasingly that effective public health programmes need to be underpinned by sound research (Zicker 2001; Whitworth et al. 2008; Mgone et al. 2010; Nuyens 2011). Despite the efforts of organisations such as the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (Special Programme Per Research and Training in Tropical Diseases 2011) and the Multilateral Initiative on Malaria (MIM/TDR 2011), the European Union’s Framework and European and Developing Countries Clinical Trials Partnership (EDCTP) programmes (Mgone & Salami 2009; Holtel et al. 2011) and the National Institutes for Health’s Fogarty International Center (2011) over several decades, there are still too few African scientists to support these expanding malaria control programmes, which will become technically more demanding as their focus moves from national control programmes towards more targeted regional control programmes and eventually to elimination.
When the London School of Hygiene & Tropical Medicine (LSHTM) received a generous grant from the Bill & Melinda Gates Foundation in July 2000 to support its work on malaria, the lack of African scientists trained in many of the disciplines needed to support malaria control was even worse than it is today. Therefore, it was decided that a substantial proportion of this award would be used to strengthen malaria research capacity in Africa through a programme that became known as the Gates Malaria Partnership (GMP). The need to provide more support for postgraduate training in health sciences in African universities is now recognised more widely, and a number of new initiatives have been launched, such as the Initiative to Strengthen Health Research Capacity in Africa (ISHReCA 2011) and the Wellcome Trust’s (2009) African Universities programme. For this reason, we considered that it would be helpful to summarise some of the key lessons learnt during the course of GMP.
Creation of the Gates Malaria Partnership
Gates Malaria Partnership had both a broad-based research agenda and a focus on capacity development. The research activities of GMP have been summarised previously (Greenwood et al. 2006). These resulted in over 400 publications in peer-reviewed journals (Gates Malaria Partnership 2011). Once a decision had been made to devote a substantial component of the Gates Foundation grant to malaria research capacity development, it was quickly appreciated that LSHTM did not have sufficient staff to provide the support that the African partners in the programme would need. Links were therefore established with three other northern institutions known to have a strong commitment to malaria research capacity development in Africa and with four African institutions and one long-established Africa-based centre with whom these northern partners had worked previously (Box 1).
Table Box 1 . Partners in the Gates Malaria Partnership (GMP)
• Danish Bilharziasis Laboratory (DBL) (now the DBL Institute for Health Research and Development), Copenhagen, Denmark
• Department of Parasitology, the University of Copenhagen (CMP), Denmark
• Liverpool School of Tropical Medicine (LSTM), UK
• London School of Hygiene & Tropical Medicine (LSHTM), UK
• College of Medicine (COM), Blantyre, Malawi
• Kilimanjaro Christian Medical College (KCMC), Moshi, Tanzania
• Medical Research Council Laboratories (MRC), Banjul, The Gambia
• National Institute of Medical Research, Amani, Tanzania
• School of Public Health (SPH), University of Ghana, Accra, Ghana
The GMP had a small secretariat based in London supported by scientific review and external advisory committees. The annual budget of the partnership, half of which was devoted to research capacity strengthening activities, was about $8 million per year. The GMP programme commenced in 2001 and concluded in 2009, when many of its training activities were taken over by a new consortium, the Malaria Capacity Development Consortium (MCDC 2011), which includes new partners as well as many of the partners in GMP and which is supported by both the Wellcome Trust and the Gates Foundation.
Research capacity development activities of GMP
Gates Malaria Partnership’s research capacity development programme had three main components: (i) a PhD programme, (ii) support for postdoctoral scientists, and (iii) provision of research infrastructure. For 5 years, GMP also built and provided support for four malaria centres whose brief was to act as a link between the malaria research and malaria control communities in their respective countries (Greenwood et al. 2006). Two of these centres [the Centre for Innovation Against Malaria (CIAM) in The Gambia and the Malaria Alert Centre (MAC) in Malawi] have become independent centres successfully fulfilling the role for which they were established and they are generating their own income from a variety of sources. The centre in Tanzania, which provided improved facilities for the National Malaria Control Programme, has been incorporated into the Tanzanian National Institute of Medical Research (NIMR). The centre in Ghana is now part of the School of Public Health, University of Ghana.
The GMP PhD programme
A key component of GMP was its PhD programme for African scientists. Three annual calls for PhD fellowships were made, and more than 300 applications were received, about a half from scientists who were well qualified to undertake a PhD degree. After initial screening, a short list was prepared by each northern partner from among candidates seeking to register at that university, and these lists were reviewed by an independent, external scientific committee that made the final selection. Thirty-five fellowships were awarded; 33 to scientists from Africa, and 30% of the selected students were women. The majority of applications came from Anglophone countries.
Selection during the initial round of awards was made only on the basis of a candidate’s past academic record, previous research experience and proposed project. This created difficulties when applications were received from very able candidates based in an institution with no research track record and no previous links with a GMP northern partner. Thus, during the second and third rounds of awards, preference was given to candidates from established research centres with which GMP already had links. Balancing individual merit and the support likely to be provided by the host institution is a challenge to any open PhD scholarship programme. One potential solution is to appoint the best students but ask them to move to a more established centre in Africa for the period of their PhD training, a course followed for three students by MCDC.
Gates Malaria Partnership PhD students were provided with a generous stipend, comparable to that of a UK PhD student and a grant of up to $50k to cover the cost of their research project. The latter allowed students to undertake a worthwhile research project, in contrast to the situation faced by many African PhD students who are severely constrained in the choice of their PhD topic because of lack of financial support and, consequently, end up with a weak project. In some cases, GMP students were able to link their PhD project to a larger study, such as a clinical trial, that was funded in other ways.
Gates Malaria Partnership PhD students were registered at one of the northern partner universities, although they were expected to spend most of their fellowship in Africa. On average, students spent about one-third of the time of their fellowship in the north to ensure that they met the residential qualifications of their host university for overseas PhD students and to make the most of the support offered by the northern partner in developing their proposal, learning new techniques and writing up their project. Students were able to attend selected modules of courses designed for resident PhD students during their time in Europe, such as a short course on statistics, and they were provided with data management support throughout the course of their project. Each student had a supervisor from the northern partner institution and had to fulfil all the regulations for PhD students at the northern university including formal review of their progress. In some cases, an additional supervisor from the African centre where the student was based was identified but this approach was not pursued systematically. Towards the end of the programme, each student was enrolled in a Personal Development Planning (PDP) programme, initially proposed by Professor Imelda Bates, LSTM, which encouraged them to identify areas outside their specific research field in which they needed support to further their career, and GMP provided them with an award of $5000 to support their choices. Students were guided and supported with their PDP programme, and provided with help in choosing an appropriate course or collaborative group, by an educational adviser supported by GMP, who formally evaluated the programme. Most students found this a valuable exercise. An expanded PDP programme has been provided for all PhD students enrolled in the new MCDC project, and they have been encouraged to engage in a PDP at the start of their PhD fellowship. GMP funded a PhD project designed to undertake an evaluation of the use of PDP for career development of African research scientists.
Towards the end of their fellowships, GMP students were encouraged to present their research findings at high profile international meetings, such as the American Society for Tropical Medicine and Hygiene’s annual meeting. GMP was able to finance their attendance as well as to provide training on the development of high-quality oral presentations or posters.
All 33 African students enrolled in the GMP PhD fellowship programme obtained their degree, and another three African scientists obtained a PhD as a result of their participation in a research project supported by GMP outside the fellowship programme. The PhD students produced approximately 140 publications in peer-reviewed journals based on the research undertaken during their fellowship, including about 20 first-authored papers in high-impact journals. After completion of their PhD, 31 of the 33 African PhD students who obtained a competitive fellowship returned to work in Africa, whilst two took up postdoctoral training positions in the USA. At the last count, 27 of the 33 African PhD students trained by GMP are still involved in research, 24 of them based in Africa. Three of the six students not directly involved in research are involved in research-related activities such as laboratory management and trial co-ordination, whilst the remaining three are involved in other health-related activities such as working for, or consulting for, health-related NGOs. All six are based in Africa. Factors that contributed to the success of the GMP PhD programme, identified through feedback from the students, research staff, the partners, an Expert Oversight Committee and an external evaluation of the programme, are summarised in Box 2.
Table Box 2 . Factors contributing to the success of the GMP PhD programme
• Entry into the scheme was highly competitive and only very able students were recruited
• Students received a generous research grant that allowed them to take on a significant, locally relevant research project as the topic for their thesis
• Students received a high level of supervision from their northern supervisors
• Students had to meet the stringent assessment and monitoring criteria imposed by the university where they had registered
• Students received strong logistical and moral support, and financial guidance from the GMP secretariat
• The overall career development of the students was supported by a PDP programme
• Provision of re-entry grants for many students encouraged their return to an effective institution in Africa
Successful GMP PhD students were eligible for a re-entry grant of up to $150 000. These awards were competitive and peer-reviewed by external referees and the scientific committee. Eleven students obtained such an award. Re-entry grants were made to an African institution and not to the student themselves, ensuring that the research fellows had a credible institution to support them during their crucial first postdoctoral period. Re-entry grants provided a powerful incentive for recently graduated students to return to work in Africa.
Although the GMP PhD programme provided strong support for individual African scientists, it did not contribute directly to strengthening the ability of African universities to support effective PhD programmes, and many of the students did their fieldwork under the auspices of a research institution rather than an African university. This issue has been addressed in the successor MCDC programme in which African PhD students are registered with one of five African universities and have a primary supervisor from that university. MCDC is also supporting its partner African universities in improving their overall facilities for PhD students and is providing training and continuing support for PhD supervisors.
Support for postdoctoral graduates
At the time that GMP was established, many able African scientists who had recently obtained their PhD, usually in Europe or the USA, were being lost to Africa because they could not find positions in Africa where they would receive a salary commensurate with their new expectations and/or be able to practice the skills that they had acquired during their training. Therefore, GMP established a 3-year, postdoctoral fellowship programme to support African scientists who had recently obtained their PhD or an equivalent higher degree who wished to continue to work on a malaria-related subject in Africa. Sixty applications for these fellowships were received, nine applicants were short-listed and interviewed by an independent panel, and six awards were made. Successful applicants received a salary comparable to that of a scientist with equivalent qualifications based in the UK, although they were required to be based in a research institution in Africa. They were eligible for research awards of up to $300 000. These awards were made only after submission of a detailed proposal that underwent extensive peer review by both external referees and a scientific review panel to ensure the scientific validity of the proposed study. All six postdoctoral fellows obtained an award but, in several cases, only after extensive revision of their project. This initial rigorous review process contributed to their eventual scientific value. The size of these research grants allowed postdoctoral fellows to take on a significant, locally relevant research project. No formal mentoring programme was established but each of the fellows already had an established link to a scientist based in one of the northern partner institutions or developed one during the course of their fellowship.
Each of the GMP postdoctoral fellows has continued a highly productive research career in Africa; two direct research centres, one heads the Multilateral Initiative on Malaria (MIM) secretariat and a multi-country consortium for biomedical training of young scientists in poverty-related diseases, and the others lead active and productive research groups. The fellowships provided a link to a supportive research group in a northern institution, a link that has continued on completion of their fellowship.
This programme was expensive, each postdoctoral fellowship costing around $400 000. However, by providing support for potential leaders of African health research that allowed them to undertake high-impact research projects at a critical stage of their career, this programme may be considered as good value for money. Nevertheless, less expensive ways of helping African scientists to make the transition from PhD student to independent scientist able to generate their own research funds need to be explored and this is being done by the MCDC that provides smaller grants but a more formal mentorship programme than the one employed by GMP.
Provision of infrastructure
Gates Malaria Partnership provided funds for the construction and equipping of two research laboratories in Tanzania, one at Kilimanjaro Christian Medical College (KCMC), Moshi, and the other on the coast at Tanga. These sites were chosen as three of the northern partners in the consortium already had strong research links with KCMC and with NIMR Amani. Co-ordination of the construction of these two buildings from London placed heavy demands on the GMP secretariat but a high standard of construction was achieved.
It was envisaged that with core support from GMP and from a linked UK Medical Research Council (MRC) grant over a period of several years, the new laboratories would become self-sufficient, attracting outside research groups to their high-quality facilities and utilising this approach to support their running costs. With strong and sustained support from Tumaini University, the biotechnology laboratory at KCMC has continued to thrive and to become a core component of the recently established Kilimanjaro Clinical Research Institute (2011) (Figure 1). Its facilities have been extended by a liquid nitrogen plant, insectaries and experimental huts for studies on malaria transmission. Its remit has extended beyond malaria to include HIV and trachoma, and it has attracted research groups from the University of Nijmegen, Netherlands, Duke University, USA, and the University of Virginia, USA. Grants obtained from NIH, PEPFAR and the EU have helped to sustain its running and maintenance costs. The laboratories at Tanga, situated in a less developed area of Tanzania and outside a university institution, have been less successful in attracting external research partners.
Whether to invest predominantly in infrastructure or in people is a challenge faced by many funding agencies involved in research capacity development. Accumulating experience, supported by that of GMP, is that it is probably best to invest in people first and then provide them with the facilities that they need once they have established their worth, rather than the other way round, but ultimately both infrastructure and able, well-trained and committed scientists are needed.
Gates Malaria Partnership was an experiment in research capacity development that evolved as the project progressed. A number of important lessons were learnt during the course of the project. Because of the nature of the initial award, the programme had to be developed rapidly and it would have benefited from an initial ‘start-up’ grant during which partnerships and plans could have been developed in a more measured way than was possible. A ‘start-up’ period would also have allowed more careful planning of how the new laboratories to be built in Tanzania would be able to sustain their running costs.
The subsequent academic success of the GMP postdoctoral and PhD fellows has validated the substantial efforts invested in selecting the most able applicants and providing them with sufficient financial resources to undertake a useful research project. By focussing on one research area, malaria, GMP has helped to create a community of 40+ able African scientists working on one disease who maintain a network of productive communications with each other, interactions encouraged through annual meetings, and who are collectively making a major contribution to the control of malaria in Africa. This has been one of the major strengths of GMP, which might not have occurred with a less focussed programme.
Registering GMP PhD students with a northern partner university ensured that they received high-level supervision and monitoring but this did not help support postgraduate training in African universities. This has been corrected in the successor MCDC programme in which PhD students are registered at an African university. MCDC has also endeavoured to recruit more francophone students by incorporating a francophone university into the partnership. Learning from the experience of GMP, MCDC PhD students are enrolled in a PDP programme at the beginning their course.
A need to strengthen postgraduate training in health sciences in African universities is gaining increasing attention with new programmes such as the Wellcome Trust’s African Universities programme (Wellcome Trust 2009). We hope that some of the lessons learnt by GMP (Box 3) will help others entering this crucial but relatively neglected area.
Table Box 3 . Key messages learnt from the Gates Malaria Partnership
• A planning period is desirable before embarking on a large capacity development programme
• Focusing on a single major topic, such as malaria, allows fertilisation across scientific disciplines and helps to create an interactive group of scientists
• Fellowship programmes must be well funded if they are to attract the best candidates and to enable them to undertake a useful project as the topic of their PhD or postdoctoral fellowship
• PhD students need support for their career development outside their specific area of research; a PDP programme offers one way of providing this
• Registering African PhD students at a northern partner institution ensures good supervision and monitoring for an individual student but does not help the development of effective postgraduate training programmes at African universities, an area that needs strengthening in many African universities
• Postdoctoral fellows need support in developing their independent research careers
We thank the many individuals in the GMP partner institutions whose contributions helped to make this programme a success and on whose behalf this paper is written. We also thank the Bill & Melinda Gates Foundation, which not only provided financial support for the project but also provided advice and support in many other ways throughout the course of the project. We thank also Imelda Bates, Kalifa Bojang, David Brandling-Bennett, Diadier Diallo, Wilfred Mbacham, Hazel McCullough, Seth Owusu-Agyei and Erin Shutes for their helpful comments on this paper.