INCLEN STRATEGIC PLAN

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.