INCLEN STRATEGIC PLAN

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.