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Research Capacity Building: Nurturing and Strengthening Emerging Scientists


>> WEBINAR OPERATOR: Good day, everyone. Welcome to today's Research Capacity Building: Nurturing and Strengthening Emerging Scientists webinar. At this time, all participants are in a listen-only mode. If you'd like to submit a topic or a technical-related question, you may do so at any time via the Q&A pod located at the bottom of your screen. Please note, this webinar is being recorded, and I'll be standing by if you need any assistance. It is now my pleasure to turn the call over to Miss Makeda Williams. Please go ahead, ma'am.

>> MAKEDA WILLIAMS: Thank you, Roxanna. Hello. My name is Dr. Makeda Williams. I'm from the National Institute of Mental Health, and I'm pleased to welcome you to today's webinar, titled "Research Capacity Building: Nurturing and Strengthening Emerging Scientists." This is the third in a series of four webinars in the 2017 webinar series on global mental health issues sponsored by NIMH's Office for Research on Disparities and Global Mental Health. Please note that this webinar is being recorded and will be posted on our website.

It now gives me great pleasure to introduce you to our speakers today. Our first speaker is Professor Soraya Seedat. She is a Distinguished Professor of Psychiatry and the Executive Head of the Department of Psychiatry at Stellenbosch University in South Africa. She holds the South Africa Research Chair in Post-Traumatic Stress Disorders funded by the Department of Science and Technology and the National Research Foundation. She has 19 years of clinical, genetic, epidemiological, and basic neuroscience experience as a psychiatrist and researcher in the field of trauma, anxiety, and neuroAIDS, and has existing collaborative research projects with colleagues in Europe, the United States, and Africa. She is extensively involved in research, training, and mentoring activities and serves as a research capacity-building project lead on an NIMH-funded collaborative hub called Partnerships for Mental Health Development in sub-Saharan Africa. She is currently a member of Stellenbosch University's Senate Research Ethics Committee, and she was recently appointed as board member of the International Society of Traumatic Stress Studies.

I'd now like to introduce Professor Oye Gureje. He is a Professor of Psychiatry at the University of Ibadan and Director of the World Health Organization's Collaborating Centre for Research in Mental Health, Neurosciences, and Substance Abuse, and he's also in the Department of Psychiatry at the University of Ibadan. His current research interests include global mental health, epidemiology, aging, intervention for mental disorders, and mental health systems strengthening. He has received grants from many organizations such as the Wellcome Trust, the MRC in the UK, the government of Australia, and Grand Challenges Canada. He is on the editorial board of several journals, including Drug and Alcohol Dependence, International Review of Psychiatry, and Current Psychiatry Reports. He is a member of the WHO International Advisory Committee for the Revision of ICD[-10] Chapter on Mental and Behavioural Disorders, and shares workgroups on somatic and dissociative disorders, and is Vice Chair of the field studies coordinating group.

I am delighted to welcome our speakers today for their talk on research capacity building, and I will now turn it over to Professor Gureje.

>> OYE GUREJE: Thank you very much, Makeda. This is the first part of this webinar. My talk today will focus on these learning objectives. So I will be trying to present the context in which capacity building is taking place in low- and middle-income countries, to understand the capacity needs of those countries, highlight the factors that contribute to sustainable research capacities in these countries in those settings, and also to review the challenges to building research capacity in low- and middle-income countries. I will be focusing on those activities aimed at strengthening individuals to become independent [inaudible 00:04:21] individuals, but also strengthening institutions to be able to create] evidence to meet health challenges people have made in the country.

Now, as many people know, these capacity efforts will be occurring in the context of the burden of disease in those countries, which according to the [inaudible 00:04:52] the global burden of mental, neurological, and substance use disorders globally. As we know also, the great majority of suicide occurs in those countries. Within this burden and the context of this burden, there's also the consideration of the large unmet need that exists in those countries. More than 80% of patients with serious conditions, or mental health conditions, do not often get the treatment that they require. When treatments or facilities or services are available, they're often used inefficiently in those countries, so that there is sort of a gross misuse of the [inaudible 00:05:44] available resources that exist in those countries.

In that context, it is subsequently the case that the only way in which service can be brought to the majority of people who need them, would be to scale these up and [inaudible 00:06:04] primary care service. We know that primary care providers are often poorly trained to be able to recognize and treat common mental, neurological, and substance use disorders in those countries. So, the picture is one of inefficient use of services, big burden of … large burden of disease, and a lack of routinely available sources. That calls for a need to respond [inaudible 00:06:38] in those countries.

In order to do this in a way that will provide the best outcome, this reform has to be influenced, or in fact has to be based on research evidence. So, it is in that context that capacity building is effective [inaudible 00:07:04] of particular necessity. Ideally, as we know, those challenges should call for a greater focus on research. In fact, you would imagine that the greater the need, the greater should be the efforts to generate evidence to meet this need. But paradoxically, less than 6% of the global production of [inaudible 00:07:33] research articles in mental health has come from low- and middle-income countries in the years between 1998 and 2011. I don't think that there's much difference now.

Also, we do know that this really large need for research in mental health and substance abuse is within the larger context of research inequity in the world. We say that only about 5–10% of the world research budget is actually spent on the burden [inaudible 00:08:08] that is located in low- and middle-income countries. So we have a situation in which health research is very low generally, and mental health research is particularly abysmally poor and inefficiently directed in those countries. Because of a capacity [inaudible 00:08:38] and so neurological and substance use in those low- and middle-income countries is fairly clear. It has to be one in which we embrace the larger picture on problems of development, poverty alleviation, and social and economic inequity. In the context of these particular disorders, research has to have a particular focus on reducing the treatment gap for these disorders, reducing inequity in access to care, strengthening the mental health system in order to be able to have sustained growth and sustained efforts to address those needs. And of course, reducing the level of stigma, which is often very high and [inaudible 00:09:29] in many of these countries.

The capacity building efforts in these countries therefore need to emphasize a multidisciplinary translation approach, including efforts to build capacity for researchers to be able to engage in sustained policy dialogue with policymakers, so that young researchers are able to understand how to translate research into practice and into policy. We also need to be mindful of the need to create a critical mass of researchers in those countries for more sustainable [inaudible 00:10:14], and I'm going to talk a little bit more about that later on. Especially engage the need for [inaudible 00:10:20] to have a good [inaudible 00:10:28] career advancement, to have opportunities for [inaudible 00:10:33] research productivity, and of course, to be able to secure grants [inaudible 00:10:37]. As I've mentioned also in other [inaudible 00:10:44] to communicate their research findings both to the academic and scholarly community, but also to policymakers and to service users.

So what kind of research is needed in that case? In fact, it needs to [inaudible 00:11:05] meet particular efforts in the area of generating epidemiological evidence confirming on geographical and temporal trends in [inaudible 00:11:16]. Also, to be able to generate evidence on how best to respond to the [inaudible 00:11:24]. So clinical epidemiological studies are also required in order for us to understand access to care; analytic studies that explore risk and protective factors; and of course, skill in the conduct of efficacy and effectiveness studies, including cost-effectiveness, of course, which will be very important in order to communicate the need and how we can meet those needs to policymakers. So, translational studies in general, and how to bring effective interventions to scale is a particular necessity in this country. And the skills required to do this include skills in biostatistics, in psychometrics, especially in the ability to use instruments to validate the [inaudible 00:12:19] needs, and [inaudible 00:12:20] use. Research ethics are very important, and I also should mention [inaudible 00:12:30] implementation research.

Of course, systematic reviews of particularly needed in order for us to be able to generate, to pull together the information that is available in order for this to be translated, with the goal of improving policy development [inaudible 00:13:00] use requiring specific skills for them to be conducted appropriately, and be conducted appropriately, and be conducted in [inaudible 00:13:11] from evidence. Of course, grant writing and scientific writing for journals and policy briefs and such like expertise needs to be provided in capacity-building metrics.

So the aim of all of this, of course, would be to develop researchers with adequate knowledge of the public health importance of mental, neurological, and substance use disorders who are able to plan their research and to target their research at improving the health of the communities where they live, within the constraints of resources that exists in these countries. So people need to be mindful of what are the available resources and be able to target and plan their research and do whatever can be done with the best available resources.

It is in that regard that I think it's particularly important … that mentoring skills I think will be very important in building a sustainable effort at capacity building. Good research capacity building is not an event, but a sustained process, an apprenticeship. It may involve the acquisition of degrees, such as Ph.D.s and such like, but certainly it has to have the opportunity for [inaudible 00:14:50] and [inaudible 00:14:53] relationship in the work environment between a senior career incumbent, who is the mentor, and a beginner, and which means sustained effort [inaudible 00:15:08] promoting the development of both of them, because this is a reciprocal relationship.

For mentoring we focus on building critical mass of researchers. Brain drain is a major problem in many low- and middle-income countries, especially those in sub-Saharan Africa and some parts of Asia. Of course, when we have inter-generational research interest and activity, so that when one generation leaves, another one is there to take over from there, to continue the work. So training and mentorship is particularly important in order for the critical mass to be built, and in order for sustained productivity to be generated. The importance of getting a mentor needs to be emphasized in the capacity-building efforts, ideally early in one's career, but getting the right person is important, more than how soon that person is actually found.

The nature of the reciprocal relationship between the mentee and the mentor requires time commitment both on the part of the [inaudible 00:16:33] agreement about apportioning credits for joint work. We know that [inaudible 00:16:39] mentor or mentee is part of an important invitation to [inaudible 00:16:49] of the world, and this is something that needs to be emphasized in all capacity-building efforts that are aimed at generating the critical mass of our nation, and also building sustained research productivity. So we need to be able to emphasize the qualities of a good mentor -- the personal attributes, the relational attributes, and the professional attributes. Of course, the person for this needs to be a senior person who's experienced in the area of interest of the mentee. [inaudible 00:17:26] that he needs to have ability to take criticism, to be considerate of the mentor's position and time and their own particular work demands.

This relationship needs to be one that is built on trust, and one that is built on [inaudible 00:17:59]. The mentoring is a relationship which is focused on the developmental needs of the mentee, and it will include good educational and personal and professional aspects. It has to take place over an extended period of time. We need to emphasize what mentoring is not. It's not just the peer support or tutoring advising or counseling. It is all of this put together that constitutes mentoring.

In all of this, of course, the challenge is in thinking about the potential effect of properly [inaudible 00:18:44] capacity-building activity in low- and middle-income countries. Those challenges go from the individual level where poor knowledge of the public health aspect of mental and neurological disorders might be a hindrance. Many of the aspiring researchers often have very limited knowledge of what is the overall burden of mental health conditions in their community. They're often concerned with only the patients that come through the door in their hospitals or in their clinics. Having that poor knowledge of the public health aspect is a big limitation to [inaudible 00:19:26] research efforts. Of course, poor awareness about the rudiments of research may mean that aspiring researchers feel very much terrified about this research, thinking it's some kind of esoteric activity. And that needs to be identified early in capacity building, that research doesn't necessarily have to be a highfalutin exercise, and anyone can do research in the sector in which they find themselves.

Clinical and administrative roles are often more fulfilling, so that mainly younger career clinicians are often taken up by early administrative roles. They then sort of lose interest in conducting research. And of course, when people have a sense of isolation, and there's no supporting envelopment, so I'm not sure how to motivate them -- that may also be a hindrance or challenge for capacity-building activities.

At the institutional level, inadequate incentive and reward systems, lack of enabling work environment -- protected research time is something that is alien to many of the work environments in which [inaudible 00:20:55] career researchers might find themselves, so that no time is [inaudible 00:21:00] for them to actually engage in research activities. Of course, lack of teachers and mentors. Often there's a big problem where there are no teachers, no experienced ones to provide mentorship. Intellectual stimulation, as I've mentioned before, a sense of isolation -- no one else is around doing the same thing, or in the same field. That's not going to change the issue; that creates a fairly arid environment for research. Infrastructural limitations may also be impediments to capacity-building efforts in low- and middle-income countries.

At the societal level, there are also challenges. Limited appreciation of the value of research is a particularly handicapping one, in which there's very little uptake, or little demand for research. And when people feel there is very little need for the exercise they are engaged in, the incentive to engage in that activity will be very low. So limited appreciation or value of research is an important challenging situation in many of these countries. Of course, lack of funding: Few countries in sub-Saharan Africa, for example, have dedicated research funding mechanisms and institutions, so that young researchers will have to look outside of their immediate country or immediate environment for funding. So that creates really difficult situations for them to be able to engage in competent research or grant applications, and to be able to get funding for research activities.

Cultural barriers: Hierarchy is a major problem. The hierarchies that exist in many cultural ... in many traditional societies [inaudible 00:23:20] problem, it could be difficult to [inaudible 00:23:25] research is [inaudible 00:23:31] generally. [inaudible 00:23:45] where there is discussion, where there are opportunities to challenge and ask questions, and to generate controversies. But in traditional societies where hierarchy might make it difficult for the young ones to actually engage with the seniors, then it's a little difficult for people to engage in research. And then of course, stigma: Stigma is a major problem in all of these contexts of which we are talking. Stigma often limits the number of people who are interested in mental health research. In fact, in mental health field generally, so that deprives the field of teachers and also deprives the environment of other colleagues who might be interested in conducting research.
So these are the challenges that are faced in this setting. But in spite of those challenges, there are opportunities for progress and for getting things done. That is what we will be discussing in the second part of this [inaudible 00:25:18]. Thank you very much.

>> SORAYA SEEDAT: In considering the needs, goals, and contextual challenges associated with implementing capacity building, it's important to consider some of the principles that underpin this practice, and this is what I will address in my talk, and we'll use an illustrative case study of capacity building and how it can be immersed or embedded in research activities that are being undertaken. I will supply some pointers on how capacity building, and particularly strengthening research capacity, can be developed and delivered for impact, then end off with highlighting some of the factors that contribute to building sustainable capacity.

So research capacity development is a rapidly growing field, both in terms of the number of initiatives that have emerged, as well as the consensus regarding best practice. The World Health Organization as well as the United Nations and other agencies have come up with a number of publications, as highlighted here, around strengthening health research capacity, particularly in low- and middle-income countries. I'd like to highlight the complexity of research capacity strengthening as a concept. It has been defined by the United Nations' leading research program for research on diseases and poverty as an effort that increases the ability of individuals and institutions to undertake high-quality research and to engage with a wider community of stakeholders.

Capacity building, therefore, is a long-term process, and has to be considered as such. I want to highlight a publication by Essence, which is a collective initiative by Fogarty, the Wellcome Trust, and a number of other agencies, which provides some principles of good practice in research capacity strengthening. The first principle relates to the issue of communication, that capacity strengthening is part of a wider network of activity, and it's important to understand the local context and to factor in both the opportunity, as well as the financial costs that come with networking and collaboration. Then secondly, in order to set the research agenda, it is really important to have an understanding of the political context, the political economy, what existing infrastructure there is, who the key stakeholders are, what the administrative and governance structures are, how they function, what is the skills mix, the staff. It's important to build on and work in synergy with what is already in existence, and particularly in low- and middle-income countries.

Thirdly, I think that capacity building requires both a top-down, as well as a bottom-up approach. So it's important to engage local stakeholders, because one needs their buy-in, as well as to engage high educational and other organizational and governmental structures. Fourthly, evaluating the effectiveness of capacity-building initiatives is really crucial for understanding the impact and also for justifying continued investment. And I'll speak more to this in a while.

It's important to think about indicators that will be most useful for measuring the success of any capacity-building effort, and this will depend on the type of intervention or interventions being employed. It's also important to think about how long you want to evaluate for, when you're going to commence the evaluation, and what metrics you're going to be using, and important to do this from the start, and to incorporate the monitoring and evaluation into the design of capacity-building activities.

Then fifthly, research governance and support as well as administrative and financial accountability are key. For capacity building to succeed, it requires skilled, passionate, and committed supervisors and mentors. In low- and middle-income countries, as the previous speaker has alluded to, there are challenges with providing supervision and mentorship. Supervision really is there to support the researchers' work, while the mentor is there to support the researchers' personal and career development. Securing funding for face-to-face contact with supervisors and mentors is also an important aspect of capacity building to consider.

Then finally, I think that for capacity building to have long-lasting benefits it's important to think long term, to be flexible as you implement activities, and to think about funding, which is usually a major hurdle to sustainability. So a strong emphasis has to be placed on developing fundraising, and to engage policymakers to encourage long-term sustainable support for high-quality research.

I want to use the example of the Collaborative Hubs for International Mental Health Research, which is a network that the previous speaker and I are members of. So, the NIMH launched an initiative known as the Collaborative Hubs for International Mental Health Research in 2011. The primary objective of this initiative was to address the treatment gap that exists in low- and middle-income countries, and to accelerate investigator-initiated research on mental health interventions, specifically in low- and middle- income countries, to the integration of epidemiological, clinical, translational, and policy-relevant knowledge. At the time, five hubs were established through five R01 research grants, and these five hubs straddle three geographic regions -- Latin America, South Asia, and Africa -- with two hubs based in Latin America and two on the African continent. And all hubs have a major focus on capacity building, and capacity-building activities have taken place within the hub, as well as across hubs. So a much larger network has been established as a result.

Each hub, as I indicated, has a capacity-building core, and the hubs have a mandate to provide opportunities for research training, career development, as well as mentoring of early-career and mid- researchers, in particular, in the countries in which they are based. The hubs have, in addition, invested much time, effort, and financial resources in selecting extremely promising early-career researchers who have significant potential for mental health leadership in these regions. The capacity-building activities have focused primarily on the development of research skills in the domain of public mental health. The overarching goal is to capacitate researchers who can then be change agents, and who can conduct high-quality research in their own settings.

So, if we think about some of the good practices centering on capacity building, I think that it is crucial that capacity strengthening be closely linked to the greatest mental health research priorities in the geographical region in which that research is being conducted. Secondly, I think it is important to anchor capacity-building activities to our current and ongoing research, because that is both pragmatic and time-efficient. An example of that would be in the Partnerships for Mental Health Development in sub-Saharan Africa hub there is a strong focus on qualitative research, and as such, capacity-building activities have to some extent focused on up-skilling young researchers in qualitative research methodology.

Then it is also I think really important to identify champions who are committed individuals who have a long-term vision of capacity building. These are lead individuals at the research sites who would be responsible for building capacity locally, as well as for liaising with other researchers who may be based in geographically distant locations, but who form part and parcel of this collaborative network. Then together with local as well as international collaborators, to undertake brainstorming, because I think that it is really important to build a network that can grow over time, and a network that comprises both like-minded trainees as well as trainers.

Then research skills that need to be transferred to be prioritized: The previous speaker as alluded to some of the deficiencies that exist among researchers, particularly early-career researchers in low- and middle-income countries. So, a strong emphasis on research methodologies, both quantitative and qualitative, biostatistical skills, skills in undertaking systematic reviews and meta-analyses, skills in evaluating the implementation of interventions. Then very important to leadership and organizational skills.

As it happened with the collaborative hubs, there has been a strong emphasis on the exchange of training to the provision of short-term fellowships and courses across country sites and even inter-regionally.
Then capacity building needs to, I think, provide as many opportunities as possible for early-career researchers to practice the core skills that have been introduced to them. I will allude to some of the capacity-building activities that have taken place within the Partnerships for Mental Health Development, where this has indeed happened.

So the Partnerships for Mental Health Development in sub-Saharan Africa is, as I mentioned, one of the five hubs. It brings together researchers, service providers, policymakers, who have expertise in global mental health, and this was the way in which the hub was established. It provides a center that allows for innovative research that informs service development in the region as well as strengthens capacity. The Partnerships for Mental Health Development in sub-Saharan Africa has primarily focused on an implementation trial that is aimed at examining the effectiveness of providing collaborative care between conventional medical practitioners and traditional healers in addressing psychosis in Nigeria and Ghana. Capacity-building efforts have taken place across all of the five countries that constitute that hub -- so, in Nigeria, South Africa, Ghana, Liberia, and Kenya. From the outset, a number of capacity-building activities were delineated over the 5-year period of the grant, and I will take you through some of these activities.

The first activity that was introduced in the first year of the hub was a mental health leadership and advocacy workshop. This built on an existing program that provided an opportunity to strengthen capacity in mental health professionals, in a diverse group of mental health professionals, including clinicians, researchers, policymakers, managers of NGOs. The workshop was primarily targeted at strengthening mental health leadership skills, and skills and policy formulation, evaluating mental health services, and strengthening communication advocacy skills among this group. The delivery format was in lectures and practical training, including individual and group work.

In addition, in year 2 a number of workshops were introduced, including biostatistics short courses, both introductory and intermediate short courses, because this was identified as a deficit and as a need. In addition, seed grants were also provided to early-career researchers, and also provided the opportunity for research supervisors and for mentors to be actively involved in a research study that was led by an early-career researcher.

In addition, I've mentioned, because this hub has been using mixed methods research to gather data for the randomized controlled trial, a qualitative research methods workshop was also hosted. This provided an opportunity for attendees to learn how to write qualitative research protocols, to gain hands-on experience in conducting qualitative research interviews and focus groups, to learn how to critique a qualitative research study, and also to learn the principles of thematic analysis. It was a workshop that was very well received by the attendees, and indicated that attendees had a very steep learning curve in terms of qualitative research methods, particularly in terms of their ability to select the appropriate strategy for their study.

So, in addition to each hub having a capacity-building core, there's also a need to establish an inter-hub capacity-building workgroup to allow for a wider network or researchers to share their experiences and to strengthen the network in terms of researchers' skills. We, at the point of setting up this inter-hub group, considered a number of questions. We looked at the opportunities for building additional research capacity-building synergies. We considered some of the challenges to achieving this. We thought about how best to monitor and evaluate our efforts, not only within our own hubs, but also across the five hubs.

As a workgroup, which met largely through teleconferences and then at our annual face-to-face meeting, we developed a common platform for all hubs to share information and data. In that way, we were able to identify some of the cost-cutting challenges and opportunities for implementing capacity-building efforts in our low- and middle-income country settings. We were also able to disseminate our collective experience, and we did this through several cross-hub publication outputs. We're currently in a process of putting together other publications based on the experiences, particularly of early-career researchers, emerging researchers, in our hub. We have also spent time thinking about how best we can optimize funding and funding to sustain the existing training programs, as well as develop common programs that will leave a legacy and can be used by the hubs and in the regional networks for years to come.

And then a very important component of the inter-hub capacity-building work, in fact one in which much time and energy was invested, was in developing a common monitoring and evaluation framework for all capacity-building hub activities. We then considered how our capacity-building efforts had a common goal, as well as whether those common goals in fact had some impact in expanding the network of trainees, in being able to provide mentorship, not only at a local level, but also in partnership with international mentors. And whether this indeed translated to high-quality mental health research, through monitoring the outputs of early-career researchers, both their publication, conference outputs, as well as success in securing grant funding.

So these were some of the publications that emanated from the inter-hub capacity-building workgroup, but also from the intra-hub capacity-building workgroups, where each hub considered its unique capacity-building portfolio of activities, and had shared this through some of these publications.

I think that in the last part of the talk it would be prudent to think about impact, and what is needed for impact in capacity building. I think we can consider impact on various levels:
At an individual level, for the individual researcher, or the individual research team At an organizational or institutional level, where the intention of capacity building would be to strengthen the scientific or academic institution through building on existing infrastructure, or creating new infrastructure through improving staffing levels; improving the curricula offerings of those institutions; increasing the funding, third-stream income of educational institutions; and also through the number of external contracts that institutions are able to secure.

Then at a national, regional, and international level, it's important to then think about commitment to financing and whether capacity building will have buy-in at a policy level, in order to promote sustainability.

When we think about impact, we can think of impact as both the outcome as well as the outputs that result. So outcomes and outputs should both be specific, they should be measurable, they should be achievable, they should be relevant, and then they should also be time-bound. Indicators can then be applied to evaluate outcome and output, and indicators are the variables for measuring the change that has happened. A mixture of both quantitative and qualitative indicators are highly recommended. Indicators should be informed by theory of change, which really refers to a series of events that would be expected to lead to a desired outcome. Indicators should also be iterative, because they may need to be adapted and refined as research capacity changes, or as research capacity is strengthened.

So, this is really just some examples from the Essence planning, monitoring, and evaluating framework of how individual indicators can be assessed in terms of outcome, output, and through the activities that are implemented. Similarly, at an organizational level, the outcome, output, and activities may be quite different. And then at national and regional levels.

This would all be informing the development of a research network, which refers to a much larger network, or much larger sort of initiative of capacity building. This may be at a continental level, at an international level.

Through our inter-hub workgroup, we developed a number of monitoring indicators. These were primarily quantitative indicators, although through engagement with our early-career and mid-career researchers we have also been able to collect some qualitative data. So we considered both intra-hub activities as well as inter-hub activities in our monitoring framework.

So what have been some of the successes? Well, we've seen that there has been a fair amount of growth of researchers in our hubs through mentoring efforts; that there has been an increased interest and awareness of mental health research in low- and middle-income countries, so a multiplier effect. We've also seen that capacity building seems to have impacted quite positively on trainees and their career trajectories.

Some of the challenges that we've experienced have been in identifying capacity-building activities that have the most impact -- so, trying to differentiate those activities that have the most impact in the bouquet or suite of activities that we've offered. Sustainability is a concern, particularly in terms of strengthening our inter-regional networks, given the constraints on funding. The continuation of monitoring and also developing perhaps a more robust set of metrics that has a stronger emphasis on qualitative metrics is important. The high cost of implementing many of these activities, particularly face-to-face activities through courses and workshops, is a hurdle. The geographical distances, as many of the countries that constitute a hub are geographically very distant. Then also the repeatability of many of these activities because of time constraints, cost being a huge factor, and the availability of trainers and mentors.

So, in sum, when researchers in low- and middle-income countries are able to drive, manage, and innovate their own capacity-building programs, I think that that is a strong indicator that efforts can be sustainable. As I've previously alluded to, identifying sources of sustainable funding early on, and making concerted efforts to secure that funding, is important. Establishing partnerships with decision-makers early on, and strengthening those partnerships over time is also key.

Then ensuring that the new research skills that are transferred through capacity-building efforts are put to good use. So, they need to be utilized effectively, and early-career researchers need to then be agents of change. And then finally, important that evidence from research projects, that evidence is used optimally to influence policy. Building research capacity in a wide range of settings to our experience has been feasible, and has been facilitated, I think for the most part, by fairly equitable research collaborations between partners in low- and middle-income countries and high-income countries. A mix of implementation approaches using both traditional as well as Web-based approaches has been shown to work in some of the hubs. We have, I think, learnt through experience that barriers should, as far as possible, be addressed early on.

Many of our challenges relate to limitations on infrastructure, on access to statistical software and programs, language and cultural constraints, particularly in the context of scientific manuscript writing as well as procurement of grants.

Thank you very much for your attention.

>> MAKEDA WILLIAMS: Thank you so much–

>> SORAYA SEEDAT: I would be happy to take–

>> MAKEDA WILLIAMS: Sure, I was just going to say thank you to both of you, to Professors Gureje and Seedat, for your presentations. If anyone who's on the webinar now has a question, please feel free to type that question in, and they will be able to answer your question. I leave it up to both of you, Professors Seedat and Gureje, to field the questions, and it looks like you have one question at the top of the queue.

>> SORAYA SEEDAT: This is a question that is specific to Nigerian undergraduates and recent graduates. I think that Prof. Gureje is better placed to address this question.

>> OYE GUREJE: Okay, I hope that I can be heard, because I understand that when I was making my presentation the audio was very low. Well, yes, Daniel, any efforts to identify, nurture, and encourage [inaudible 00:55:31] and commitment to mental health services research among Nigerian undergraduates and recent graduates ... In terms of Nigerian undergraduates, that's a little difficult to answer, because as you know, there are more than 120 universities in Nigeria. So they have different approaches to the way they build the skills of their students. Where I work, in the University of Ibadan [inaudible 00:56:07] opportunities for undergraduates to get exposed to research through institutional process of mentoring, which we have put in place now for quite a few years. But beyond that, there are also courses that, for example, medical students will have to undertake, especially in public health, when they are rotating through public health, that will expose them to some of the rudiments of research. So that's in terms of Nigerian undergraduates, and I think the situation will be different from one university to another.

In terms of graduates, again it depends on what area we're talking about, and what skills we're talking about, and in what setting we're talking about. You probably will know that several universities in fact have programs on epidemiology and biostatistics -- not just degree programs, but also short-term workshops where people can have their skills in some of these areas built and developed.

So there are certainly opportunities for people to develop their research skills. Those opportunities exist in the country now. Whether there are also opportunities for sustained mentoring is another situation entirely. As I mentioned before, that will certainly depend on several of the factors that I mentioned in my presentation, including where they work, whether they have a conducive environment there, whether they have enough teachers or mentors or potential mentors. [inaudible 00:58:02] or interest in that. So I think when you speak for Nigeria as a whole, I would say is maybe there are some [inaudible 00:58:19] institutions [inaudible 00:58:20] in the way that these opportunities are provided for both undergraduates and graduates. But certainly in Ibadan the environment is much more nurturing. In fact, that's perhaps part of the reason why people choose to go to one place or the other in terms of whether they think they are going to have the opportunity for sustained mentoring and growth under the guidance of a much more senior person.

I can take a crack at question two, "Are there any new hubs opening up?" Well, after the five hubs that Professor Seedat described, a new set of hubs are also ... I've [inaudible 00:59:10] to about 18 months ago now, I think there's a second year. I think they have probably a little different focus in terms of their research capacity-building activities, but certainly there are new hubs that are operational [inaudible 00:59:38] Professor Seedat described. I think in fact there may be new ones coming up next year from the last call by the NIMH for some other research proposals.

>> MAKEDA WILLIAMS: Sorry to interrupt. This is Makeda, I can actually answer that question as well. We have scale-up hubs which are focusing on research partnerships for scaling up mental health interventions in low- and middle-income countries. The collaborative hubs that Professors Seedat and Gureje were a part of have really set the tone and the template for now creating hubs that are focusing on how mental health interventions are being scaled up. We currently have five hubs that are in their year 2, and we are now bringing on another cohort, which we will be announcing very, very soon on our website. But if you'd like to learn more about the hub that was presented today, and their cohort in the collaborative hubs, as well as the current scale-up hubs, that information is located on our ORDGMH website.

>> OYE GUREJE: All right. Okay [inaudible 01:00:55] next question by Daniel is, "What are the steps one needs to take to be [inaudible 01:01:03] in one of the sub-Saharan African hubs?" Well, the first five hubs that Professor Seedat described, they have actually come to, they're coming to the end of their sponsored or funded time now. So maybe the new ones might be the ones that you might want to indicate your interest in. But I don't know about the question of becoming a mentor, because usually mentors are sought out by their mentees or maybe a program that is there to attach mentors to mentees, or mentees to mentors. I don't think it's something that you can apply to say I want to be a mentor. I think if you are working within the hub, and your expertise is noted, then you might be given a chance to provide mentoring for younger aspiring researchers.

So, I don't know if in fact there are steps to take [inaudible 01:02:22]. There certainly might be steps to take for you to become involved, or participate in some of the activities of these new hubs that have just been mentioned to you. If you do go on the NIMH website, you might see some of the scale-up hubs and you might want to contact their principal investigators, or investigators, and express your interest in the areas of their work, and in that way you might be then identified as a potential mentor for any of the mentees that they may have in the region where they work.

>> MAKEDA WILLIAMS: Any of the other participants have questions? If so, please feel free to go ahead and enter that into the question-and-answer box. Okay, well, seeing as though there aren't any other questions, I would like to say now thank you so much to Professors Seedat and Gureje for presenting the great work that you all have been doing around research capacity building, and especially highlighting the collaborative hub that NIMH has been supporting. We really appreciate all the hard work that you all have been doing. It was great to hear about the research capacity-building activities and also the activities of the other hubs that were in your cohort.

As I mentioned earlier, this webinar and our previous webinars will be posted on the NIMH Office for Research on Disparities in Global Mental Health website. I would like to thank NIH, The Bizzell Group, and OneSource for their support of our webinar series and logistics. Our final Global Mental Health Webinar will be tomorrow, Wednesday, September 13th, 2017, from 9:00 a.m. to 10:30 a.m. U.S. Eastern time, and its title is "NIMH Research Domain Criteria Initiative." Please visit the Global Mental Health Webinar website for more information. Now I would like to turn it back over the webinar operator, Roxanna, to close out today's webinar.

>> WEBINAR OPERATOR: This does conclude today's webinar. We do appreciate your participation. You may disconnect at any time, and have a wonderful day.