INCLEN STRATEGIC PLAN

4 June 1999

INCLEN STRATEGIC PLAN
Executive Summary

Based on extensive discussion at all levels of the organization, INCLEN is intent on transforming itself into a network of self-sustaining, autonomous regional clusters of health institutions committed to addressing major national and regional health problems. This transformation is the logical culmination of two decades of building health research capacity in 24 countries around the globe. This strategic plan covers the transition phase, during which regional capacity must be built to achieve financial sustainability and effective governance. INCLEN offers a unique resource as a network of indigenous health scientists and clinicians well trained in a range of disciplines who apply their understanding of efficacy, effectiveness and efficiency to improving health systems in their countries and building local capacity to do so even better in the future. Realizing and sustaining that resource for improving the health of peoples have been major foci of INCLEN’s strategy since 1996. Collaborative research that addresses important practices and policies has been fostered. Training and continuing education activities have been expanded. The circle of collaborators has been greatly widened, including diversification of funding. Greater visibility of the enterprise has accompanied its process of opening up to new partners. Looking forward, INCLEN sees its future as a network of regional networks, addressing health needs at the national, regional and global level. Individual Clinical Epidemiology Units (CEUs) in influential medical schools in the developing world will serve local and national needs in capacity building, policy-directed research and consultation. Regional clusters of CEUs will take a strategic approach to regional health problems and training needs, with linkages to governmental agencies and other academic institutions in the regions and beyond. The global network will facilitate communication across regions and with the wider scientific community, ensure access to state-of-the-art technology and knowledge, and promote important comparative studies infeasible for individual researchers or institutions. Through a rigorous process of regional consultation, INCLEN members sought to maximize their impact on health by focusing on matters that are important to the advancement of health, that INCLEN is capable of doing well, that can contribute to strengthening the network and that have a potential for attracting major funding for the work and for the network. INCLEN will focus efforts on four of the major health problems of the world (malaria, HIV/AIDS, tuberculosis and maternal and child health) and on five themes (drug development, rational use of drugs/technology assessment, quality of care, program planning and evaluation, and research training), as well as on other areas where funding will permit INCLEN to improve health in important ways. To maximize the likelihood that these goals will be achieved, funds remaining from the commitment of INCLEN’s founding donor -- as well as funds from other donors -- will be applied strategically over the two years beginning July 1999 to build regional strength, to invest in important research and capacity building activities that will lever INCLEN’s input, to enhance the network, to raise funds, and to revise the governance structure as necessary for best promoting its work into the future. Recommendations from a distinguished panel of external evaluators who are currently studying INCLEN’s accomplishments and prospects will be used to adjust this plan, as will success in meeting designated milestones. By 2001 INCLEN seeks to have active programs for research and capacity building at a regional level that complement its global program and to have attracted a diversified stream of resources sufficient to sustain the important work of its network of scientists.

I. INTRODUCTION

INCLEN was created in 1980 to improve the health of peoples of the developing world by bringing the science of public health -- epidemiology -- to bear on the problems of clinical medicine. Since then, nearly 500 clinicians, social scientists and biostatisticians from leading medical institutions, mostly in the developing world, have been trained at the Masters level to create Clinical Epidemiology Units (CEUs) that could serve as agents for change. Serious attention was given to continuing education and mentoring. As the CEUs matured, training that was initially done in selected medical schools in Canada, the United States and Australia was transferred to the developing world CEUs. INCLEN was spun off from the founding donor, the Rockefeller Foundation, to become a not-for-profit corporation with an independent Board of Directors and an office in Philadelphia. Regional clusters (CLENs) of CEUs were created to organize annual regional meetings and begin to address regional health issues. Efforts were begun to attract other sources of funding.

In 1996 the Rockefeller Foundation committed $14 million, the equivalent of three years’ funding, as a block grant to encourage continued development of INCLEN’s independence and sustainability. A retreat held by INCLEN’s Board of Directors in December 1996 in response to that commitment sketched out a strategy for the organization through June 1999. That strategy, as affirmed and amplified by INCLEN’s Program Committee in February 1997, included (1) enhancing INCLEN’s research program in pursuit of the founding goal of improving health of the people, with particular attention to what clinicians do with patients ("the content of the health system") and to newly recognized health problems, (2) emphasizing INCLEN’s particular strengths in working across disciplinary and geographic boundaries, (3) reaching out to new partners, including new members, collaborators and funders, and (4) increasing the participation of INCLEN faculty members in the management and decision-making of the organization. A tangible product of the last initiative was the creation of three subcommittees of the Program Committee: Research, Capacity Building and Global Meeting.

In July 1998 staff of the Rockefeller Foundation made clear that the $14 million block grant was a terminal grant. A special meeting of the Program Committee was convened in early August to address the implications of this decision and institute an intensified planning process in light of it. The Program Committee recommended to INCLEN’s Board that efforts be redoubled to advance INCLEN’s dual themes of research and capacity building, using the remaining block grant funds and roughly the current organizational structure in a concerted effort to achieve sustainability over the subsequent 2-3 years, and to draw on the ideas and leadership of INCLEN’s faculty in doing so. At a meeting in late August, INCLEN’s Board endorsed these recommendations, calling on the CLENs to use the occasion of their regional meetings that year to draft suggestions about INCLEN’s future course and creating a Strategic Planning Group -- comprising representatives of the Program Committee and the Board -- to meet in London in early December to draft a plan for INCLEN’s future.

II. THE PLANNING PROCESS

The planning process was designed to foster authorship of the resulting strategy by INCLEN faculty from the "South" and has been remarkably successful in doing so. The resulting ownership of the plan by these faculty members will be important to its success.

Representatives from the Program Committee and Board of Directors met for two days at the London School of Hygiene and Tropical Medicine to consider INCLEN’s future direction. With help from Mark Nichter as facilitator and drawing on the results of the CLEN deliberations over the previous three months, the Strategic Planning Group considered the vision for INCLEN of the future; INCLEN’s strengths, weaknesses, and comparative advantages; the need for the kind of research and capacity building that INCLEN faculty can and wish to do; themes for research or capacity building that might represent opportunities for INCLEN and its faculty both to do important work and to attract funding ("best prospects"); ways to foster leadership, both within and outside the network, for such initiatives; the importance and type of regional activities that should be pursued; the appropriate governance and management structure -- including the appropriate timing of changes -- for INCLEN’s future activities; and the allocation of funds over the next two years that would maximize the chances of achieving the goals defined.

The proceedings of the London meeting were circulated in December to all CEUs as well as to the full Program Committee and Board of Directors for consideration in advance of the global meeting 1-4 March 1999. Comments were solicited from all faculty members and shared with all members of the Program Committee and Board, prior to a joint meeting February 27-28 of those two bodies in Bangkok. At that meeting the groups reviewed the London deliberations and then focused on three areas that they felt needed particular additional attention: continuing needs and opportunities for capacity building; the advantages and challenges of regionalization, including the appropriate allocation of responsibilities between the regions and the INCLEN Executive Office (IEO); and the identification of "best prospects" for research and capacity building.

On the evening of February 28 and the day of March 1, the circle of discussion was enlarged to include all CEU Directors. After reviewing the process and tentative recommendations to date, the CEU Directors concentrated their work on additional considerations about "best prospects" and about strategies for identifying and supporting leadership for those initiatives. All agreed that the opportunity should be taken over the course of the global meeting for the CLENs to consider further how the developing plans might affect or could be advanced by the individual CLENs, as well as how effective regional functioning could be enhanced. At a breakfast meeting of the Program Committee and Board on March 4, CLEN representatives reported the results of those deliberations. The breakfast group concluded that the following additional steps were to be taken to bring the current planning process to an appropriate conclusion:

1. CLENs would complete and distribute a written summary of their planning deliberations by April 1.

2. The IEO would prepare a draft of the strategic plan, including operational steps, goals and budget, by mid-April for consideration by a Task Force consisting of a representative of each of the CLENs and the three representatives of the IEO.

3. The Task Force would meet in late April to review and revise the draft plan, which then would be circulated to all CEUs for comment.

4. The Board would consider the revised plan at a meeting in late May or early June, and approve the plan and budget for submission to the Rockefeller Foundation.

5. The IEO would prepare the submission to the Rockefeller Foundation in early June, with the hope of receiving the remainder of the block grant by July 1.

On June 1-2 INCLEN’s Board of Directors considered the revised plan. It warmly endorsed the plan as drafted, emphasized the central role of INCLEN faculty members in shaping it and made more explicit the strategic objectives at the core of the plan. In adopting the plan, the Board called for annual reviews of progress toward those strategic objectives, with adjustments as necessary in light of accomplishments and changing circumstances.

III. VISION

INCLEN offers a unique resource as a network of indigenous health scientists and clinicians well trained in a range of disciplines who apply their understanding of efficacy, effectiveness and efficiency to improving health systems in their countries and building local capacity to do so even better in the future. INCLEN sees its future as a network of regional networks, addressing health needs of clinical importance at the national, regional and global level. Its dual emphases on capacity building and research are mutually reinforcing and much needed. Its ability to work across disciplinary boundaries allows it to address important and complex health problems that may require sophisticated understanding of biomedical, cultural, behavioral and economic issues, both to design and to implement effective and efficient control measures. Its ability to work across geographic boundaries not only allows informative comparative studies to be done, but also promotes inter-regional learning. The progressive assumption of leadership of the network by developing world faculty is itself an important aspect of ongoing capacity building, as is INCLEN’s enlarging membership. INCLEN welcomes opportunities for partnership with organizations that have similar commitment to improving health but complementary skills, resources and methods of working. Such partnerships are essential for addressing many complex matters, for promoting institutional learning and for avoiding duplication of effort.

IV. STRATEGIC OBJECTIVES

Over the coming three years, INCLEN hopes to achieve its vision of becoming a network of networks, undertaking clinical epidemiologic research on health problems of national and regional priority. As essential steps in this process, INCLEN recognizes the need to strengthen its global network, enhance regionalization, achieve financial sustainability, focus on the most promising research and capacity building activities, and manage a process of change. Four strategic objectives will guide efforts over the next three years to realize the vision. These strategic objectives relate to matters of organization, management, research and capacity building:

1. Organization: To establish a structure that ensures the ongoing development and autonomy of regional clusters, while facilitating continued linkage to a global network and enhancing access to resources in the international health arena.

2. Management: To ensure that capacity exists and procedures are in place successfully to manage the devolution of responsibility to regional structures.

3. Research:    To establish a scientific platform that identifies priority research at the national and regional level that capitalizes on INCLEN’s comparative advantages and funding opportunities.

4. Capacity building: To establish a platform that identifies priority needs in research capacity building at the national and regional level that capitalizes on INCLEN’s comparative advantages and funding opportunities.



V. CURRENT ASSESSMENT

1. Internal

Having trained nearly 500 scientists at the Master’s level over the last 19 years, INCLEN has prepared the core staffing of CEUs in a selection of influential medical schools in the developing world. The coopting of additional faculty within those medical schools and the opening of institutional membership in INCLEN have enhanced the outreach and effectiveness of the individual CEUs and the network, and compensated for the expected attrition. Moving training activities to selected CEUs in the developing world has had the distinct advantage of building local and regional training capacity, although mentoring, access to scientific literature, preserving faculty time for research, and securing ongoing local funding have in some places proved challenging. Ties with the original training centers in Canada, the United States and Australia have loosened, but some threads remain strong and important, while the creation of relationships with other universities and research centers around the world has broadened opportunities for linking INCLEN faculty members with leading research and policy initiatives. As INCLEN faculty members have progressed in their careers, many have moved into positions of weighty responsibility, whether in their university, the Ministry of Health or international organizations. Within INCLEN, faculty members have taken on key roles, not just in the CEUs and training centers, but also in CLEN planning and programs, in the Program Committee and, notably, in the very active subcommittees of the Program Committee. The research activities of INCLEN faculty have expanded in both scope and importance as the organization, and the careers of individual faculty members, have matured. Increasingly, research has addressed health problems of major national, regional or global importance. The boundary between public health and clinical epidemiology has become somewhat blurred as some faculty members have concentrated, for example, on community-based prevention of clinically important health problems. Partnerships are increasingly being forged with governmental agencies, local organizations, professional societies and international groups to mount concerted efforts to define and prevent or control complex health problems. Specific efforts by INCLEN to encourage collaborative research efforts on important health problems have led to the formation of a promising number of collaborative groups intent on levering INCLEN’s investment in them. Few of these initiatives, however, are sufficiently far along to give confidence yet that they can attract definitive funding from outside sources and contribute meaningfully to the sustainability of the enterprise.

The global and regional meetings play important roles in continuing education and facilitating the continued development of the network that is judged to be so critical for INCLEN’s success. The Capacity Building Subcommittee has been attentive to ways to supplement the educational functions of those meetings by supporting requests from CEUs and CLENs for needed capacity building initiatives. The locus of initiative has shifted from the original training centers and the IEO to the CLENs and the CEUs. In part this is a constructive change, as activities now start with proposals based on local assessment of needs and opportunities. In part, however, this puts weaker CEUs at a disadvantage, as they may lack the internal resources of time and leadership to mount effective initiatives. Moreover, responsibility for control of quality (of teaching, research design, CEU management etc.) has been increasingly decentralized, so disparities between strong and weak units may be widening.

INCLEN’s regional structure has focused responsibility for the regional meetings at the appropriate level, has contributed through the Program Committee to a regional perspective in planning and has been used in some regions to advance regional capacity building and research activities. Increasingly, however, CLENs see advantage in a more active role of the regions in planning and coordinating complex initiatives.

The enhanced development effort of the last two years has yielded encouraging results in attracting funding for a variety of worthy programs, although support for core activities of the network has been harder to raise. A major grant from USAID focused on emerging infections will underwrite the major portion of INCLEN’s programs in India for at least the next three years. A series of grants from St. Luke’s Life Science Institute in Japan is allowing INCLEN to train faculty from Hanoi Medical University for a new CEU there. Grants from the Global Forum for Health Research are bringing INCLEN faculty members into major international research agenda-setting activities in regard to diseases of the brain and the cardio-vascular system. The International Center for Research on Women is supporting a project on abuse in the family environment in India. Pilot grants from Britain’s Department for International Development (DFID) and the Rockefeller Foundation are allowing the exploration of the possibility of much expanded support for INCLEN’s activities in Africa. INCLEN has collaborated with the University of North Carolina in an application to the National Institutes of Health, Fogarty International Center that resulted in a HIV/AIDS training grant of $3.2 million for work with INCLEN units in Cameroon and China.

2. External

Over the last two decades the growing worldwide appreciation of epidemiology’s importance to rational policy and practice in health has deepened understanding of the principles that underlay the creation of INCLEN and encouraged the development of a variety of other epidemiologically oriented activities, such as the Cochrane Collaboration, Essential National Health Research, and assessment of global burden of disease. Provided these newer activities are viewed as partners rather than competitors, these developments are quite positive for INCLEN. They offer new linkages and are fully consistent with INCLEN’s emphasis on multidisciplinary approaches to addressing health problems. The parallel growth of interest in financing health care, in both the North and the South, also corresponds to a strength of INCLEN, which long has emphasized the importance of cost-effectiveness in choosing health interventions.

International funding for health research and for capacity building for research has received encouraging attention in recent years, although the actual trends in funding are unclear. The creation of the Global Forum for Health Research is visible evidence of the perceived need for enhanced funding. Bilateral agencies with continued strong commitment in this area include Sida/SAREC, DFID, DANIDA, USAID, the Swiss Agency for Development and Cooperation and NORAD. Multilateral agencies include WHO, the European Community, the World Bank, and to a lesser extent UNICEF. Foundations with strong interests in international health research and capacity building include the Wellcome Trust, Rockefeller Foundation, China Medical Board, Kellogg Foundation, Thrasher Fund and the Gates Foundation, with some evidence of current or potential interest by Ford Foundation, Edna McConnell Clark Foundation, W.T. Grant Foundation, and St. Luke’s Life Science Institute (of Japan). The U.S. Agency for Health Care Policy and Research (AHCPR) and the Fogarty International Center are other important supporters of capacity building for international research. The pharmaceutical industry may also potentially yield important collaborations for INCLEN researchers. INCLEN’s efforts, enhanced over the last two years, to become better known to these institutions and to build partnership with them have led to encouraging results. Cultivation, however, must be sustained since the process of building mutual understanding and trust is of necessity slow.

The economic problems faced by many parts of the developing world, particularly Southeast Asia, have stressed the universities in which many CEUs are based and, in turn, put additional pressures on INCLEN faculty to supplement their income through private practice. This stress has slowed the process of integrating CEUs into parent universities in some places. Exceptionally, at Gadjah Mada University the country’s economic problems have increased the availability of research funds -- to study the health impact of the economic crisis.

3. Evaluation

To provide an independent assessment of what has been accomplished over INCLEN’s 19 years and to advise about promising future activities, INCLEN, with support from the Rockefeller Foundation, has engaged a team of five to do a six-month evaluation of INCLEN. The team, which is chaired by Jorge Jimenez and includes Belgin Tekce, Mushtaque Choudhury, Patrick Vaughan and Halfdan Mahler, has reviewed documents, visited CEUs in each of the regions and is speaking with a wide variety of people both inside and outside the network. Its report is expected by the end of July 1999 and will serve as an important additional resource to the Board and to the CLENs in the continued evolution of INCLEN’s strategy.

VI. THE PLAN OUTLINED

Given the vision described above and encouraging success over the last 2-1/2 years raising the visibility of the organization, increasing the involvement of INCLEN faculty in its leadership and strengthening programs of collaborative research (consistent with the December 1996 plan), INCLEN intends to mount an intensive two-year effort to move these initiatives further ahead and to achieve sustainability. This two-year timetable was first suggested by the Program Committee in August 1998, and subsequently endorsed in the London meeting in December 1998 and the Bangkok meetings of February/March 1999.

INCLEN will further emphasize its dual functions of research and capacity building and its comparative advantages of a network of indigenous scientists and the ability to work across disciplinary and geographic boundaries. It will join with partner organizations with complementary resources and skills to address important national, regional and global problems.

1. Network

The existence of a network is arguably INCLEN’s greatest strength, and one that needs to be both used and enhanced in the coming years. The network facilitates communication, provides access to the most sophisticated current thinking about health problems, and raises the quality of the work of its members. INCLEN will continue to invest in research projects and in projects for research capacity building that link up faculty members with common interests and that, because of their importance to the advancement of health, are likely to attract significant outside funding. At both the global and regional level, INCLEN will promote the network through access to up-to-date scientific information, communication among faculty members, links to technical experts outside INCLEN, and regional and global meetings that include partner organizations. In recognition of opportunities for cost-sharing and partnership, a particular attempt will be made to lower the cost of the global meeting to INCLEN.

Strength of the individual CEUs and training centers (CERTCs) will continue to be an important contributor to the strength of the network. The units provide an environment conducive to the pursuit of high quality research, thus nurturing the continued development of clinical investigators. In some cases CEUs and CERTCs are well situated to sustain their strength with local resources. In other cases continued external support is needed either to maintain capacity that has been built or to continue to build capacity. In still other cases establishment of new CEUs would add importantly to national and regional strength. In recognition of both this heterogeneity of situation and the need to move toward financial sustainability, support for the CEUs will be customized and the total amount available for CEUs and CERTCs will decrease by steps. Proposals for support will be invited from the CEUs and judged on a competitive basis, using criteria that will include the goals envisioned, the practicality of the plan and the history of prior support. In addition, efforts will be made to raise funds from outside sources for groups of CEUs with particular needs or of interest to particular donors; criteria for awards in such cases will depend on the terms of the grant and may not necessarily be competitive.

2. Best prospects

INCLEN will focus resources on a select group of high priority research and capacity building activities in order to enhance its impact in the next two years. Criteria for selection of these "best prospects" will primarily be the capacity of INCLEN to do the work well, the importance of the work to the advancement of health, the contribution that the work is expected to make to strengthening the network and, of necessity, prospects for attracting major funding for the work and the network. These four criteria can be seen as overlapping circles in a Venn diagram. Best prospects may be global, regional or national, in acknowledgment of the rich variety of situations in which INCLEN faculty members work.

Among the major health problems of the world, INCLEN will include amongst its best prospects malaria, HIV/AIDS, tuberculosis and maternal and child health. Among themes, INCLEN’s best prospects will include drug development, rational use of drugs/technology assessment, and quality of care. In addition INCLEN will promote its expertise in program planning and evaluation and in research training.

This list of best prospects, while helpful in guiding INCLEN’s investment in the coming years, is not to be interpreted as strictly exclusive. Where committed and competent partnerships can be developed to address important global or regional health problems and attract outside support, INCLEN should be prepared to provide tangible and intangible encouragement, as has been the case recently in such initiatives in child survival, obesity, depression, accidents, family violence and cardiovascular disease.

Funding for best prospect initiatives will normally come through the Research and Capacity Building Subcommittees, in recognition of their special ability to weigh the merits of various proposals across geographic and disciplinary lines. The terms of reference of those Subcommittees are to be changed so as to emphasize their critical role in directing sources to activities that advance INCLEN toward its strategic objectives.

3. Leadership

Strong leadership is required to realize even the best of prospects. Indeed, for most research activities two types of leadership are needed: technical expertise to identify the specific scientific question that needs to be answered and organizational leadership to move the project ahead. Of course, the two types of leadership may in some cases be found in the same person.

Specific efforts are planned to mobilize the technical expertise and to identify and support the "prime mover", including through grants from the Research and Capacity Building Subcommittees. The technical expertise may be found either inside or outside INCLEN, depending on the subject. The prime mover is likely to be found inside INCLEN, although certain collaborations may make it appropriate for a partner outside INCLEN to be prime mover.

For issues of regional importance, the task of identifying the research area and the prime mover is likely to fall to the CLEN. The IEO may be helpful in identifying technical experts who can supplement regional expertise.

For issues of global importance, the IEO takes the initiative in bringing together interested INCLEN faculty and outside experts. Through such meetings, a research agenda may be defined and a prime mover identified.

A successful prime mover is likely to be a person with a record of carrying projects, including research, through to a successful conclusion. The person’s commitment, organizational capacity, trustworthiness, transparency and ethics are likely to contribute greatly to that success. In order to permit such a person to be successful, attention must be paid to time protection (and related remuneration), administrative support and, in some cases, specialized training.

INCLEN will continue to foster leadership of INCLEN faculty in administrative aspects of the network, including direction of CEUs, CERTCs and CLENs and participation in the Program Committee and its subcommittees.

4. Regionalization

Regional variations in health problems, regional funding or partnership opportunities and the differential development of CEUs by region all contribute to a sense that this is an opportune time to enrich the regionalization of INCLEN’s programs and leadership. Regions vary in the set of functions that they are prepared to take on, but in all cases they want to build on what they have done in the past. At the very least, a representative decision-making body is to be established in each of the regions now represented as a CLEN. The leadership of this body would be the primary interface between the IEO and the CEUs and CERTCs. It would define regional priorities, organize regional meetings, assess regional funding and partnership possibilities, and seek to coordinate activities among the CEUs and CERTCs in the region. It would make proposals to the Capacity Building and Research Subcommittees on behalf of the regions. It would be represented on the Program Committee, which will decrease in size but increase its frequency of meeting to twice a year.

In regions where the situation seemed ripe, they would do more. They might form a legal entity, making themselves eligible to receive and manage grants. They might create an Institutional Review Board. They might create a permanent or rotating office and hire staff. They might develop regional communication networks. They might set a research or capacity building agenda and work by themselves or with the IEO in finding the resources to carry out those agendas. It is anticipated that individual regions -- presumably in rotation -- would undertake to organize and manage the global meeting.

In recognition of the heterogeneity of situations in the various regions, INCLEN would invite application from the regions for support of regionalization initiatives. Such support would be generally awarded on a competitive basis, through the Capacity Building Subcommittee, and might involve the raising of matching funds. However, the IEO and the regions could seek designated funds from a third party to support a regional initiative.

The development of regionalization is anticipated to be on-going. As regions gain experience and INCLEN as a whole matures, more functions may be moved from the IEO to the regions. Data base management, for example, might be moved to a single region or handled regionally in a distributed fashion. Responsibility for publications might become a regional function. Just which additional functions should be transferred, and when, are matters not easily defined now. The process, however, by which the strengthening of regionalization will be fostered and monitored can be outlined. The Program Committee, with its representation from each of the regions, is charged to assess progress in regionalization at each of its biannual meetings. This assessment shall include consideration of the setting of regional priorities in research and capacity building and adaptations made by individual regions to address regional health problems or funding opportunities. The Capacity Building Subcommittee will manage grants for promoting regionalization through strategic investments. Reports to the Board of Directors will highlight investment and accomplishment toward the specific strategic objectives, including regionalization, and will approve adjustments of the strategy according to changing circumstances.

5. Structure

INCLEN requires a legal and governance structure that will support the regions through the imminent transitional period and then effectively support the envisioned network of autonomous, self-sufficient regions, once the transition is complete. Over the next two years, the current structure -- a not-for-profit corporation with an independent Board of Directors and executive office in Philadelphia -- will provide the support, experience and continuity necessary to maximize chances of success in achieving the transition

Once the transition is largely complete, alternative forms might help address several concerns raised in the planning process: the importance of INCLEN faculty leading the organization; the value in being, and being seen to be, an institution of the developing world; the need to keep overhead costs to a minimum; the desire to build closer partnerships with major donors; the utility of a structure that reflects the growing regionalization of INCLEN’s activities.

In the years to come, it may be better to locate the central office outside the United States, perhaps in the developing world; to distribute more of the functions of the IEO to the CLENs; and to create legal entities in more than one country, so as to facilitate fund raising. Indeed, it may be preferable to move from a corporate structure to a trust structure, if that would permit closer collaboration between faculty and donors in the governance and "ownership" of the organization. These concerns and possible solutions need further exploration as part of the continuing evolution of INCLEN. That exploration will begin immediately with the gathering of information about alternative legal and governance structures and their likely advantages and disadvantages in supporting the envisioned network of regional networks.

6. Development

Since a critical goal of the next two transition years is to achieve financial sustainability, a major effort is needed in fund raising and related development activities. Development is viewed as one of the core functions of the IEO, although to be successful it requires close collaboration with the regions and with individual INCLEN faculty members. Development involves clear communication about the capacity and accomplishments of INCLEN, scanning of funding opportunities that match INCLEN’s strategic priorities, cultivation of relationships with current and potential donors, assembling of appropriate personnel to design proposals, writing proposals for grants, and sound management and timely reporting of grants. To accommodate this increased emphasis on development work, staffing of the IEO has been restructured; the number of people in the IEO working on development has been increased in the last year from 1 to 2-1/2, while the total staffing of the IEO has decreased from 8 to 7.

Development is an important activity of the Board of Directors, which is expected to continue to be helpful in articulating the importance of INCLEN, identifying funding prospects, and helping foster successful partnerships. Through funding of best prospects, the Research and Capacity Building Subcommittees will increasingly focus on what is, in large part, development work. The CLENs are expected to be much more involved in development activities in the coming years, as regional funding opportunities are scanned and the growing number of regional initiatives in research or capacity building involve the CLENs in donor dialogue, proposal drafting and grant management. Indeed, success of this plan relies on, among other things, success of the CLENs and CEUs in development work.

7. Time horizon

INCLEN’s goal is to make major, sustainable improvements in the health of people in the developing world. It believes that the resource that has been created over the last 20 years in the form of trained professionals and their network is one to be used and nurtured for decades to come. The horizon of this plan, therefore, is a distant one.

Still, much of the discussion in this plan relates to the next two years. That focus on the next two years reflects the consensus of the planning groups of August 1998, December 1998 and February/March 1999 that the best chance for sustainability of this important enterprise lies in an intensification, not attenuation, of the efforts of the last 2-1/2 years to broaden the financial support of INCLEN, make strategic investments likely to yield tangible returns in the near- to mid-term, build partnerships that may help in these efforts and draw increasingly on the leadership of INCLEN faculty members. INCLEN’s chances of attracting the funds necessary not only to fund new activities but also to sustain the network are judged to be greatest if the resources currently committed to INCLEN are invested over the coming two years, not rationed out over, say, 5 or 10 years. Currently, INCLEN is sufficiently strong to permit optimism that investments now will yield substantial returns. Austere rationing, however, would quickly erode the network, undercut both its functioning and credibility, and thus cause further development efforts to fail.

VII. THE PLAN TRANSLATED INTO OPERATIONAL OBJECTIVES AND BUDGET

The plan that has been outlined calls for moving toward sustainability -- both financial and in terms of impact on health -- over the course of the next few years. Emphases on progressive regionalization and building of funded research and capacity building programs are clear, although the speed and details of their development will depend on the future unfolding of events, and hence can be currently described in less and less detail as one looks further and further into the future.

It is important, however, to describe near-term activities and objectives with some precision and at least to define the target for that time in the future when financial sustainability will (it is hoped and planned) have been achieved. The translation of the plan into budgets and objectives, therefore, involves both the transition period, covering FY99-00 and FY00-01, and a projected sustainable state, represented by FY01-02 (and, by extension, beyond). The operational objectives presented are intermediate steps seen as prerequisite for the success of the organization in attaining its strategic objectives. For the most part each of the operational objectives has an impact on the six themes of the plan described above: Network, Best Prospects, Leadership, Regionalization, Structure, and Development. The matrix in Table A shows how the themes of the plan relate to the four strategic objectives. The matrix in Table B shows how the operational objectives specified below provide the links between the themes of the plan outlined in the prior section and the budget categories to be described subsequently.

The operationalization of the plan proposed by the Strategic Planning Group requires rethinking of the traditional budget categories and activities. For simplicity’s sake, we have attempted to maintain categories as much as possible in this presentation, while indicating which strategic objective or objectives are advanced by individual expenditure lines. In the future, the budget will be reorganized around the strategic objectives.
1. Capacity Building

Strategic Objectives {2,4}

Operational Objective:    By FY01-02, INCLEN CEUs and CERTCs will be self-supporting and their membership will be recognized as credible trainers and researchers in the field of clinical epidemiology and specific focal areas.

Measures:   (1) In FY01-02, 60% of the CEUs active in FY98-99 maintain current structure and members continue to work collaboratively and contribute to the global network.

(2) In FY99-00 CEUs receive 50% of operational budget from sources external to INCLEN. In FY00-01 CEUs receive 75% of operational budget from sources external to INCLEN. In FY01-02 CEUs receive 100% of operational budget from sources external to INCLEN.

(3) By FY01-02 CERTCs are recognized centers of training excellence for which all fellows will pay their own support or find fellowships. (INCLEN will continue to support the CERTCs on a decreasing scale in FY99-00 and FY00-01, by FY01-02 there will be no fellowship support available from INCLEN.

(4) By FY01-02 CEUs and CERTCs are formally integrated entities in their universities and are supported as such. (Currently, only three CERTCs have been formally recognized by their institutions.)

(5) By FY01-02 there is a 50% increase from FY98-99 in research funds awarded to INCLEN researchers.

INCLEN views capacity building as encompassing two major programmatic activities, in addition to regionalization, which is addressed below. The first is the long-term sustainability of the training centers and CEUs. The second is ongoing strengthening of investigative skills within the network. The first relates primarily to the training program and the infrastructural support previously called core support. The second relates to continuing education and development in specific areas.

The Capacity Building Subcommittee will continue to play a critical role in assessing capacity building needs and allocating support for those activities.

A. CEU Sustainability:

The CEU is seen as an essential element to the success of the INCLEN program. Investigators assert that the creation of CEUs provided a necessary environment for the development and nurturing of clinical investigators, without which they may have foundered. The CEU structure allows critical review and quality assurance of research produced by its faculty and furthers dissemination of research methodology tools to the home institution’s faculty.

The training centers and CEUs have been supported financially since their inception. In 1995 INCLEN began reducing decrementally the annual support a unit received with the intention that the units would become financially self-supporting. CEUs that had been receiving $25,000 per annum were gradually reduced to $10,000 per annum (excepting those in Africa). CEUs created through training in the regional CERTCs (R-CERTCs) were guaranteed only two years of support of $20,000 and $10,000, respectively. Support for R-CERTCs was reduced by approximately $25,000 per year. In FY98-99, the time-frame for self-support was compressed because of the changes in the INCLEN budget projections. Instead of a phase down of support for the training programs over a period of seven years, it will be accomplished in four years or, in the cases of Latin America and China, two years. Support for CEUs will no longer be guaranteed, although for FY99-00 some funds may be available upon application. In FY99-00 and FY00-01, USAID support totaling $100,000 annually is available for support of the IndiaCLEN units.

B. CERTCs:

The CERTCs have indicated that their training programs are in need of transitional funding prior to becoming self-sufficient. Many of the CERTCs have opened their training programs to non-INCLEN supported fellows with the intention of decreasing dependence on the INCLEN subsidy. Recognizing the importance of sustainable training programs to further the impact of clinical epidemiology in the regions, $305,000 has been allocated in FY99-00 and $170,000 in FY00-01 for funding of the R-CERTCs supported by INCLEN. Funding is predicated on the ongoing participation in and contribution of the R-CERTCs to the regionalization process as well as to the institutionalization of their training programs. By FY01-02 the CERTCs will no longer receive INCLEN support for training or related activities unless specific donors have been identified. The training programs will be self-supporting.

C. CEU Core Support:

Funds totaling $50,000 are being budgeted for FY99-00 for award to CEUs for activities and purchases traditionally associated with core support. There will be a maximum amount of $10,000 available per CEU. These awards will be competitive and based on a proposal submitted by the CEU which details activities at a local level and at a regional level. The proposals will be reviewed by a panel appointed by the Capacity Building Subcommittee.

All non-training centers will compete equally, including CEUs formed through training in the regions (Phase II CEUs), as well as those CEUs whose members were trained by the original CERTCs (Phase I CEUs). Units for which dedicated funding is raised may compete as well, but their proposals may be weighed against the needs of units without dedicated funds.

The USAID IIDI grant for IndiaCLEN grant distributes annually $100,000 of core support over a number of budget categories (e.g., administrative support, equipment and training), aggregated under Capacity Building Phase I/II CEUs in Table D.

D. Matching Grants:

INCLEN will continue to encourage units to raise outside support. In the event that a unit is able to raise additional funds in FY99-00, INCLEN will match those funds up to a maximum of $10,000 at a ratio of 1:2, i.e., for every $2 a unit raises, INCLEN will match $1, up to a total obligation to INCLEN of $50,000 for FY99-00. All INCLEN-supported units are eligible for matching funds, but there is a maximum of $20,000 that any CEU may receive, or $40,000 that any R-CERTC may receive, as a combination of core support and matching funds. In FY00-01, INCLEN will determine whether to continue the matching grant process based on the availability of funds and the success of the program.

E. Start-up Grants:

As part of the fellowship program, INCLEN committed to a research grant of, generally, $5000 at the completion of in-class training. A number of these grants remain outstanding and are budgeted in FY99-00. Fellows trained at the Chinese training centers in West China University of Medical Sciences and Shanghai Medical University over the last two years (1997-1999) were guaranteed start-up grants of up to $2000 per fellow, subject to a satisfactory proposal.

F. Capacity Building Subcommittee Awards:

Programs for capacity building will be funded in the context of "best prospects": capacity strengthening must be justified as part of undertaking research or programs in the identified areas, or in the other areas for which a convincing case can be made for attracting outside funding.

Innovative awards in the area of capacity building will include support for "prime movers," individuals who might take the lead in developing "best prospect" programs. The form of this support may vary and will be tailored to the individual’s needs for taking on additional responsibilities. The Capacity Building Subcommittee and the Research Subcommittee may work collaboratively in determining means of support of "prime movers."

The Capacity Building Subcommittee also will be responsible for soliciting and assessing proposals for regionalization activities, which may include: the development of a regional office and legal structure; administrative support; regional capacity building activities; regional development; data base development and other activities designed to strengthen regional identity, capacity and sustainability.

$50,000 of the funds allocated under Capacity Building Subcommittee will be used annually for administrative support of the Subcommittee.

2. Meetings: Global and Regional

Strategic Objectives {1,3,4}

Operational Objective: (1) The INCLEN global meeting is recognized as an important international health forum and will draw attendees from all over the globe.

(2) The regional meetings are recognized as important regional health fora and draw attendees from the region.

Measures: (1) The INCLEN global meeting is managed cooperatively by the IEO and regional members in FY00-01 and entirely by the regional members in FY01-02.

(2) The global meeting is an income-generating event by FY01-02 with 75% of its budget met from sources external to INCLEN.

(3) By FY01-02, 35% of attendees for both regional and global meetings are from organizations external to INCLEN.

(4) By FY01-02, the regional meeting will be supported from local and regional sources.

The global and regional meetings are viewed as important fora for meeting other scientists, sharing scientific insights and developing collaborative relationships and for underscoring the themes of efficacy, effectiveness, and equity. The meetings are unique in combining continuing education; scientific presentations in multiple disciplines; ongoing discussions of critical health topics; and mentoring of young researchers by their seniors.

A program of global meetings biennially and regional meetings annually has been proposed. The regional meetings are seen as essential to solidifying regional ties and developing regional profiles. The global meeting is essential to maintaining INCLEN’s presence on the international health scene, but alternatives may exist that are less expensive than managing the global meeting from the IEO. INCLEN proposes transferring responsibility for the global meetings to the regions beginning with the meeting in FY00-01. A transition period will be needed, not unlike the transition between the Rockefeller Foundation’s and INCLEN, Inc.’s running of the meeting, when it will be necessary for IEO staff to assist in the planning of the meeting. A total of $265,000 is available for all meetings in FY99-00. A global meeting is not planned in FY99-00, but the planning necessary for a global meeting begins a full year prior to the event. $50,000 is budgeted in FY99-00 for premeeting planning by the Global Meeting Subcommittee, aided in transition by the IEO, and $130,000 is budgeted from Rockefeller Foundation Funds for regional meetings. $45,000 has been budgeted from USAID funds for IndiaCLEN regional meetings in each of the coming two years. For AfriCLEN, $40,000 is likely to be allocated from the Africa capacity building grant for regional meetings in FY99-00 and FY00-01.

Regional meeting budgets have varied from region to region. The regional CLENs will be asked to submit proposals and justification for budget for the regional meetings, with some general budget guidance from the IEO.

3. Regionalization

Strategic Objectives {1,2,3,4}

Operational Objective: Management of critical elements of the INCLEN program, including the global and regional meetings, database management, and regional development, will be the responsibility of the regions by FY01-02.

Measures: (1) Four of the five regions have established regional offices, a legal identity and a management structure by FY00-01.

(2) Regional offices are able annually to raise $1,600,000 in regional support (primarily research and/or capacity building, but including 25% for administration, management or regionalmeetings) by FY01-02.

(3) The regions are maintaining regional data bases with a common data base structure by FY00-01 and one region assumes the responsibility of global data management by FY01-02.

(4) Global and regional meetings are managed by the regions by FY01-02

In addition to support for the regional meetings, the strategic plan calls for strengthening the regions for eventual assumption of many of the management and development responsibilities currently managed by the IEO. Regionalization will take place within the current CLEN structure, and will reinforce the identity of the CLEN while not losing the INCLEN identity. Each of the CLENs has developed a plan which best addresses its objectives in the area of regionalization. The CLENs have individually stated that there is no template for regionalization. Funds available for regionalization capacity building and activities total $200,000 annually for FY99-00 and FY00-01, excluding the regional meetings. $100,000 of the $200,000 will be in the form of matching grants available to the CLENs in a ratio of $1 in INCLEN grant for every $2 raised. Regionalization activities might include: support for a regional office, administrative support, development of regional management information systems, communications and regional development. CLENs will submit proposals to the Capacity Building Subcommittee for support in regionalization For each of the next two years the total of grants to a given region will not exceed $60,000 per year unless dedicated funds are raised for a given program. Thereafter, funds for regionalization would increase as functions are moved from the IEO to the regions.

4. Research

Strategic Objectives {1,3,4}

Operational Objective: By FY01-02 INCLEN researchers will be established as credible researchers and partners in collaborative and multi-center research activities.

Measures: (1) By end FY99-00 one and by FY00-01 three new collaborative INCLEN initiatives are funded primarily from external sources and the "prime mover" will be an INCLEN investigator (using FY99-00 as baseline year).

(2) By FY00-01 70% of CEUs (as institutions or through their individual faculty members) have formal consulting relationships with the Ministry of Health or comparable national policy-setting body

(3) By FY99-00 INCLEN members have established new formal working partnerships with 3 organizations involved in international health research and by FY00-01 10. (using FY99-00 as baseline year).

(4) By FY00-01 at least five more papers are published from INCLEN-initiated research in journals with Institute of Scientific Information impact factors greater than in FY99-00.

The support and showcasing of critical research remains a cornerstone of the INCLEN strategy. As discussed in the overview, INCLEN will focus on a number of "best prospect" research themes, chosen by assessing INCLEN’s comparative advantage, importance of issue, potential for funding and overall network capacity.

The Research Subcommittee will continue to play a pivotal role in preparing the network for the future by supporting these activities. Funds disbursed by the subcommittee will promote these "best prospects" in a number of ways. Research support will be targeted to "best prospects" with some funds reserved for extraordinary opportunities. The Research Subcommittee might also collaborate with the Capacity Building Subcommittee to support the development of leadership in the network and to heighten the presence of INCLEN investigators on the international health scene.

$50,000 of the funds allocated under Research Subcommittee will be used annually for administrative support of the Subcommittee.

5. Network Coordination Across Regions

Strategic Objectives {1,2,3}

Operational Objective: (1) In FY 01-02 the Global Network is maintained as a vibrant entity that continues to contribute to the discussion and development of international health agendas in the future.

(2) The Network members are vested in its management and sustainability and in maintaining the INCLEN identity.

Measures: (1) By end FY99-00, INCLEN is a recognized participant in global health fora.

(2) INCLEN has completed restructuring by the end of FY00-01 to facilitate participatory governance and greater ownership by network members.

(3) By FY00-01 regional structures have taken over the planning for the Global Meeting and have begun the process of managing network information regionally. By beginning FY01-02, the regions share responsibility for global network coordination with whatever central coordination entity exists by taking active responsibility for many of the previously centralized functions, including global meeting, data management, and development.

The strategic planning for the organization stressed the importance of preserving a global network in addition to fostering greater regional presence. The Global Meeting is a key element of the global network, but is dealt with in a separate section related to meetings. Other key network functions include: data base and web page management, grant making, grant management, financial monitoring and reporting, strategic planning, publication of monographs, annual reports, descriptive brochures, participation in international health fora and communications within network. Currently and for FY99-00, these activities are being managed by the IEO. During this period the regions will assess the activities that they will assume in FY00-01 and onward. It is possible that some of these activities may be shifted to the regions within the upcoming fiscal year. In that event, there will be a transition from the IEO to the region(s) providing the coordinating functions.

The Program Committee will be reorganized so as to reinforce the regionalization initiative. Each of the existing CLENs will have one representative member, as will Universit� Claude Bernard, in anticipation of the creation of a CLEN for Europe or the Mediterranean. The chairs of the Capacity Building, Research and Global Meeting Subcommittees will be members. The remaining INCLEN members will be three representative of the IEO. One or two non-INCLEN members would bring additional perspectives. The Program Committee will meet twice a year, instead of the current arrangement of annual meetings of the full committee.

During FY99-00 the appropriateness of a change in the governance structure will be explored. If such a change is indicated, it will be implemented in FY00-01. The Board of Directors and Program Committee currently are coordinated by the IEO. Changes in structure may alter this situation, but for the upcoming fiscal year they remain part of IEO activities.

6. Development

Strategic Objectives {1,2,3,4}

Operational Objective: By FY01-02, INCLEN will have a diversified funding base locally, regionally and globally that generates sufficient funds for regional support and administrative support necessary to maintain the global network.

Measures: (1) By FY99-00, INCLEN, Inc. has submitted 15 new funding proposals and established funding agreements with four new major donors; by FY00-01, an additional five donors.

(2) By FY99-00 CEUs and regional CLENs are raising 35% of their needed support; by FY00-01, 65% and by FY01-02, 100%.

(3) By FY00-01, INCLEN, Inc. is able to raise $450,000 in administrative and management support funds and by FY01-02, $600,000.

Developing new partnerships and raising additional resources to support the Network are essential elements in the strategic plan. There are a number of development strategies that INCLEN proposes to implement. The IEO will continue to seek new resources, identify opportunities, and facilitate partnerships. Specifically, the IEO will concentrate on bilateral and multi-lateral organizations, foundations in the United States and U.S. government agencies. In addition the IEO will produce and distribute publications that showcase the work of INCLEN investigators. However, the regions and the individual CEUs will also undertake development activities targeted at identifying and soliciting donors with specific regional and/or national focus. Budgeted funds allocated to promote regionalization may reasonably be used toward this end. Where appropriate the IEO may identify donors in a region for follow-up by the regional offices. In FY99-00 funds for development will be managed primarily by the IEO, but some may be added to regionalization capacity building funds directed toward development activities in a region. In FY00-01, the situation may merit budgeting additional development support for regional activities.

7. Annual assessment of progress in meeting objectives

The Program Committee will lead an annual assessment of progress in meeting the objectives of the plan. No budget has been allocated for this activity in the belief that it will not entail additional spending. CEUs, CERTCs, CLENs and the IEO will be asked to undertake a self-evaluation of progress against the plan. Their input will allow INCLEN to make mid-course corrections where needed and to fine tune the plan and budget as required.

8. Revenue and expenditure budgets for FY99-00 through FY01-02

The following four tables summarize revenues and expenditures anticipated for FY99-00 through FY01-02 and compare them to the projected figures for FY98-99.

A. Projected statement of revenue and balances, FY98-99 through FY01-02 (see Table C)

Revenues are projected to increase from $3.0 million in FY99-00 to $5.6 million in FY01-02, assuming that the third tranche of the Rockefeller Foundation block grant is received in FY98-99. These figures relate to "above the line" revenue, which generally passes through INCLEN, Inc. and which is in contradistinction to "below the line"revenue, which flows directly to CEUs, CLENs or collaborators. Of the latter, only administrative and management support that funds INCLEN, Inc.’s overhead expenses or which directly provides for administrative and management activities that INCLEN, Inc. would otherwise seek to underwrite (e.g., support for a regional office or for grant management) is counted above the line. It is assumed that CEUs will continue to be at least as successful in future years in raising local support as they were in 1998, when in an annual survey ("Questionnaire A") they reported receiving $6.4 million in below-the-line local support. That base is not "taxed" to provide support for projected programs, management or administration, although new grants received by CEUs, CLENs and collaborators are assumed to provide varying degrees of support in those areas.

Current grantors are specified in Table C. Anticipated grants are indicated either as New Grants or as future-year projections of funds from current grantors. New Grants that are projected to be made to INCLEN, Inc. are categorized as Global. Revenue that has not yet been committed is shown in italics.

Balances at the beginning of each year are increased by revenues received and decreased by expenditures made, thus determining the balance at the end of the year. The balance at the end of FY01-02 is projected to be $64,778.

B. Statement of projected expenditures, FY98-99 through FY01-02 (Table D)

Expenditures are expected to increase on average about 10% per year from FY98-99 to FY01-02 as INCLEN builds its portfolio of externally funded research and capacity building programs. The link between expenditure lines and each of the four strategic objectives is noted in Table D. It is envisioned that in FY01-02 (and beyond), rough equity will be reached between the funding of research and capacity building, although the particular grants that will support those activities cannot be specified at this time. Increasing investments are anticipated in development and regionalization, while cuts are projected in the global meeting costs to INCLEN and in IEO management -- in addition to the discontinuation of a variety of activities (which cost $48,550 in FY98-99) judged lower priority in the current planning process. In recognition of the unresolved question about the appropriate governance structure for the future, funds are reserved in FY99-00 to study the question and in FY00-01 to implement changes, if needed. For FY99-00 and FY00-01 expenditure categories Regionalization, Capacity Building and Research include some items for which funds are dedicated by the donor for specific regions and others for which application can be made by any region. In general, the resources already available to an applicant may be taken into account in making competitive awards.

C. Proposed operating budget by funding source, FY99-00 (Table E)

A crosswalk between funding sources and the expenditures that they are expected to support in FY99-00 shows the increasing linkage of INCLEN’s activities to support from a variety of donors, some already identified and some not. Revenue sources that are basically unrestricted as to use are distinguished from those that are restricted. In this transition period funds from the Rockefeller Foundation block grant continue to support key activities that help to maintain the network, including the expanded development initiative. The line Grants to be Allocated shows the critical role to be played by new grants in funding not only an as-yet-unspecified variety of programs (likely to be largely research and capacity building) but also administrative and management costs at the local, regional and global level. The Grants to be Allocated line includes administrative and management support from grants shown below the line, as well as from New Grants shown above the line.

D. Indicative operating budget by funding source, FY00-01 (Table F)

As the transition proceeds, more and more of the support for programs as well as administration and management will come from newly identified grant sources.

E. Commentary

Assuming that the diversification of funding proceeds as planned, the shortfall of INCLEN’s revenues relative to its expenses will drop progressively from 45% ($2.5 million/$5.5 million) in FY99-00 to 7% ($0.4 million/$6.1 million) in FY01-02 (Table C), leading it toward a financially sustainable position in subsequent years. Critical to that sustainability, however, is success in attracting grants and other funds to maintain the network and support regionalization. By FY01-02, $1,400,000 must be raised from those sources to support Network Coordination Across Regions, Development, Regionalization and the Global Meeting (Table D). Unless major sources can be identified that support these functions explicitly, this support will need to be found largely as direct or indirect costs provided by grants aimed primarily at other program activities. It will be a great challenge to attract such funds at this scale, which represents 23% of the indicative FY01-02 budget. Since it is unlikely that many grantors will provide "overhead" at such a rate, careful attention will be needed to specifying these expenses as direct costs and to attracting support from grants below the line as well as those above the line. Another challenge will be to manage cash flow so as to ensure continuity.

As INCLEN makes the transition to a "soft money" organization, it will need to take care to undertake only those activities for which it has attracted grants, either directly or indirectly. A corollary of that general rule is that a shortfall in funds raised or in the fungibility of those funds, should it occur, would require nimble action in cutting back the scale of anticipated programs and network activities. Below a certain level, the type of network envisioned could not be sustained, which reinforces one key theme of this plan: that an intense investment be made over the next two years to maximize the chances of long-term sustainability.

1.	CLENs would complete and distribute a written summary of their planning deliberations by April 1.
2.	The IEO would prepare a draft of the strategic plan, including operational steps, goals and budget, by mid-April for consideration by a Task Force consisting of a representative of each of the CLENs and the three representatives of the IEO.
3.	The Task Force would meet in late April to review and revise the draft plan, which then would be circulated to all CEUs for comment.
4.	The Board would consider the revised plan at a meeting in late May or early June, and approve the plan and budget for submission to the Rockefeller Foundation.
5.	The IEO would prepare the submission to the Rockefeller Foundation in early June, with the hope of receiving the remainder of the block grant by July 1.

1.	Organization:	To establish a structure that ensures the ongoing development and autonomy of regional clusters, while facilitating continued linkage to a global network and enhancing access to resources in the international health arena.
2.	Management:	To ensure that capacity exists and procedures are in place successfully to manage the devolution of responsibility to regional structures.
3.	Research:	To establish a scientific platform that identifies priority research at the national and regional level that capitalizes on INCLEN’s comparative advantages and funding opportunities.
4.	Capacity building:	To establish a platform that identifies priority needs in research capacity building at the national and regional level that capitalizes on INCLEN’s comparative advantages and funding opportunities.

Measures:	(1)	In FY01-02, 60% of the CEUs active in FY98-99 maintain current structure and members continue to work collaboratively and contribute to the global network.
	(2)	In FY99-00 CEUs receive 50% of operational budget from sources external to INCLEN. In FY00-01 CEUs receive 75% of operational budget from sources external to INCLEN. In FY01-02 CEUs receive 100% of operational budget from sources external to INCLEN.
	(3)	By FY01-02 CERTCs are recognized centers of training excellence for which all fellows will pay their own support or find fellowships. (INCLEN will continue to support the CERTCs on a decreasing scale in FY99-00 and FY00-01, by FY01-02 there will be no fellowship support available from INCLEN.
	(4)	By FY01-02 CEUs and CERTCs are formally integrated entities in their universities and are supported as such. (Currently, only three CERTCs have been formally recognized by their institutions.)
	(5)	By FY01-02 there is a 50% increase from FY98-99 in research funds awarded to INCLEN researchers.

Operational Objective:	(1)	The INCLEN global meeting is recognized as an important international health forum and will draw attendees from all over the globe.
	(2)	The regional meetings are recognized as important regional health fora and draw attendees from the region.
Measures:	(1)	The INCLEN global meeting is managed cooperatively by the IEO and regional members in FY00-01 and entirely by the regional members in FY01-02.
	(2)	The global meeting is an income-generating event by FY01-02 with 75% of its budget met from sources external to INCLEN.
	(3)	By FY01-02, 35% of attendees for both regional and global meetings are from organizations external to INCLEN.
	(4)	By FY01-02, the regional meeting will be supported from local and regional sources.

Operational Objective:		Management of critical elements of the INCLEN program, including the global and regional meetings, database management, and regional development, will be the responsibility of the regions by FY01-02.
Measures:	(1)	Four of the five regions have established regional offices, a legal identity and a management structure by FY00-01.
	(2)	Regional offices are able annually to raise $1,600,000 in regional support (primarily research and/or capacity building, but including 25% for administration, management or regionalmeetings) by FY01-02.
	(3)	The regions are maintaining regional data bases with a common data base structure by FY00-01 and one region assumes the responsibility of global data management by FY01-02.
	(4)	Global and regional meetings are managed by the regions by FY01-02

Operational Objective:		By FY01-02 INCLEN researchers will be established as credible researchers and partners in collaborative and multi-center research activities.
Measures:	(1)	By end FY99-00 one and by FY00-01 three new collaborative INCLEN initiatives are funded primarily from external sources and the "prime mover" will be an INCLEN investigator (using FY99-00 as baseline year).
	(2)	By FY00-01 70% of CEUs (as institutions or through their individual faculty members) have formal consulting relationships with the Ministry of Health or comparable national policy-setting body
	(3)	By FY99-00 INCLEN members have established new formal working partnerships with 3 organizations involved in international health research and by FY00-01 10. (using FY99-00 as baseline year).
	(4)	By FY00-01 at least five more papers are published from INCLEN-initiated research in journals with Institute of Scientific Information impact factors greater than in FY99-00.

Operational Objective:	(1)	In FY 01-02 the Global Network is maintained as a vibrant entity that continues to contribute to the discussion and development of international health agendas in the future.
	(2)	The Network members are vested in its management and sustainability and in maintaining the INCLEN identity.
Measures:	(1)	By end FY99-00, INCLEN is a recognized participant in global health fora.
	(2)	INCLEN has completed restructuring by the end of FY00-01 to facilitate participatory governance and greater ownership by network members.
	(3)	By FY00-01 regional structures have taken over the planning for the Global Meeting and have begun the process of managing network information regionally. By beginning FY01-02, the regions share responsibility for global network coordination with whatever central coordination entity exists by taking active responsibility for many of the previously centralized functions, including global meeting, data management, and development.

Operational Objective:		By FY01-02, INCLEN will have a diversified funding base locally, regionally and globally that generates sufficient funds for regional support and administrative support necessary to maintain the global network.
Measures:	(1)	By FY99-00, INCLEN, Inc. has submitted 15 new funding proposals and established funding agreements with four new major donors; by FY00-01, an additional five donors.
	(2)	By FY99-00 CEUs and regional CLENs are raising 35% of their needed support; by FY00-01, 65% and by FY01-02, 100%.
	(3)	By FY00-01, INCLEN, Inc. is able to raise $450,000 in administrative and management support funds and by FY01-02, $600,000.