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.