The last twenty years have seen an increased focus on research capacity building and capacity strengthening efforts in development interventions, by a variety of organisations such as donor governments, multilateral agencies, science funders and product development partnerships (PDPs). These interventions aim to help build new or develop existing research capacities in low- and middle-income countries (LMICs) in order to reduce dependency on research conducted in high income countries and to address local needs (Jones et al. 2007). The International AIDS Vaccine Initiative (IAVI) is one of a number of PDPs created to address the risk of vaccine development for scientifically challenging pathogens. IAVI is committed to bridging the gap between scientific and technological potential and the health needs of populations in LMICs by demonstrating the feasibility of an HIV vaccine to ensure industry resources for advanced development and licensing. The remit of IAVI is to ensure the development of a safe, effective, accessible, preventive AIDS vaccine for use throughout the world. To achieve this mission, IAVI's work involves a wide range of stakeholders in industrially developing and developed countries. IAVI's capacity building activities aim to strengthen the ability of its partners to conduct clinical research and vaccine trials and also to enhance a variety of other areas ranging from scientific and technological capacity through to organisational, advocacy and broader development capabilities. In essence, IAVI's capacity building activities aim to build and strengthen health research systems that are conducive to vaccine discovery and to increase preparedness for a vaccine's eventual licensure.
However, empirical evidence about the impact of IAVI's capacity building in developing countries is fragmented and far from comprehensive (Chataway & Hanlin 2008; Hanlin et al. 2007; Vian et al. 2013). This is perhaps surprising given the recognised importance of different forms of capacity building and the need to strengthen health research systems. Efforts by IAVI and its partners to continually build capacity make the need for this evaluation even more relevant, as increasingly competitive funding environments mean that demonstrating strong rationales and evidence of success, is increasingly important.
This evaluation therefore seeks to address the following research questions:
- How has IAVI conceptualised capacity building? How has this changed over time? How does practice match up with this theory of change?
- What examples stand out with regards to IAVI's capacity building in East Africa, specifically in the areas of: a) Human resource development (to conduct research and to support research), b) Research capacity: technology transfer and infrastructure development, c) Community and policy level activities
- Are there specific communities and segments of society where IAVI's work has led to significant improvements in policy and health service delivery?
- Have IAVI's capacity building activities fed into attempts to strengthen capacity in the healthcare and health research systems in the countries in which they have worked?
- Is IAVI making particularly notable and important contributions to health innovation and research capacity compared to other organisations in this field?
We identified four key categories into which IAVI's capacity building activities can be placed and which will be used as the units of analysis for this evaluation. These are highlighted in Figure 1 below. Note, while observations in this study are limited to IAVI's work in East Africa, the below framework may be relevant for future evaluation of IAVI's capacity building programs in Southern Africa and India. We define “capacity building” as including “any efforts to increase the ability of individuals and institutions to undertake high quality research and to engage with the wider community of stakeholders” (ESSENCE 2014:7). Unlike previous studies, it therefore seemed appropriate to include advocacy and community engagement activities within our assessment of capacity building.
Figure 1. Conceptual Framework for IAVI's Capacity Building Activities
Box 1 below highlights how IAVI's conceptualisation has evolved over time as well as the findings across each of the four key categories outlined in Figure 1 above and how these activities have had an impact on key population groups in each of the three countries.
As a result of its clinical research activities in East Africa, IAVI's mission to develop an HIV vaccine has become increasingly connected to wider health research systems strengthening. Since it began operations in the region, IAVI has made a significant contribution to training interventions aimed at supporting scientific excellence and Good Practices (Clinical, Clinical Laboratory and Participatory) as well as investing in infrastructure and laboratories at clinical research centre (CRC) partners. In addition, IAVI has created platforms for engaging with local communities and policymakers on issues related to HIV and vaccines. IAVI's advocacy and communications strategies are based on an underlying belief that the very significant investment needed in HIV/AIDS research was contingent on demand from those who most needed new research in the area—i.e. by populations and their political representatives in developing countries worst affected by the disease. This demand, in turn, would depend in part on greater awareness of and involvement in HIV vaccine research. A key factor in the success of IAVI's scientific capacity building in the region is its ability to act as a broker between researchers, policymakers and local communities. Strong leadership and a commitment to facilitating South-South collaborations between CRCs have also been important in enabling IAVI to both build capacity and make progress towards their larger mission. Increased research capacity across the CRCs has also meant that East African researchers have made a significant contribution to some of the key scientific achievements by IAVI-sponsored research to date, highlighted in Box 2.
The findings from our interviews with key stakeholders at IAVI highlight the diversity of factors which have influenced the evolution of their capacity building activities in East Africa. Box 3 presents some of the key overarching themes emerging from IAVI's activities, as well as some considerations for IAVI's future capacity building, based on our findings and observations.
While IAVI's progress in building scientific capacity in Africa appears to have been widely acknowledged in previous evaluations, we have observed an increased emphasis on capacity building as a core component of their strategy in East Africa. This shift may be due, in part, to a proactive effort to more closely align IAVI's work with donor priorities. IAVI's challenge for future capacity building activities will depend on how it balances a broader focus whilst maintaining its core mission of developing an HIV vaccine. These two aims are of course not mutually exclusive. However, as IAVI diversifies its portfolio of activities, demonstrating the impact of its work and securing further funding will be helped by a better understanding and articulation of: (i) what IAVI considers to be its core capacity building activities, which require monitoring and strategic objectives; (ii) where its activities have a spillover effect in further strengthening capacity; and (iii) which activities are outside its remit.
Although clear challenges still exist in ensuring sustained investment, accessing marginalized populations and demonstrating progress in capacity building, the experiences of IAVI to date suggest that substantial progress is being made towards wider health research systems strengthening in the region. The efforts to discover an HIV vaccine have been, and will continue to be, a global endeavour, relying on strong international research collaborations and increasingly African scientific leaders. As we move into a post-2015 agenda and begin to focus on improving the sustainability of health research systems in sub-Saharan Africa, organisations such as IAVI can play an important role in developing and advocating improvements in the African research landscape.
References
Chataway, J., & R. Hanlin. 2008. “Sustainable (Vaccine) Development: The International AIDS Vaccine Initiative (IAVI) and Capacity Building.” In Matlin, S., A. de Francisco, L. Sundaram, H.S. Faich, M. Gehner (eds.) Health Partnerships Review. Geneva: Global Forum for Health Research. 43–46.
ESSENCE (Enhancing Support for Strengthening the Effectiveness of National Capacity Efforts). 2014. Seven Principles for Strengthening Research Capacity in Low- and Middle Income Countries: Simple Ideas in a Complex World. Geneva: ESSENCE. As of 27 May 2015:
http://www.who.int/tdr/publications/Essence_report2014_OK.pdf
Hanlin, R., J. Chataway, & J. Smith. 2007. “Global Health Public—Private Partnerships: IAVI, Partnerships and Capacity Building.” African Journal of Medicine and Medical Science 36: 69–75.
Jones, N., M. Bailey, & M. Lyytikainen. 2007. Research Capacity Strengthening in Africa: Trends, Gaps and Opportunities. London: ODI (Overseas Development Institute).
Vian, T., S. Koseki, F.G. Feeley, & J. Beard. 2013. “Strengthening Capacity for AIDS Vaccine Research: Analysis of the Pfizer Global Health Fellows Program and the International AIDS Vaccine Initiative.” BMC Health Services Research 13 (378): 1–12.
The research described in this article was prepared for the International AIDS Vaccine Initiative and conducted by RAND Europe.
