Strengthening Research Ethics Capacity in West Africa, 2015–2024

Abstract

This article reviews the development and evolution of Fogarty International Center–funded research ethics training programs in West Africa over the past decade. In response to local and global challenges in bioethics and biomedical research, these programs are fostering ethical awareness, shaping local and national ethics review systems, and enhancing bioethics capacity in the region. These efforts have expanded alongside increased democratic governance, technological advances, and significant increases in global research funding and international research collaborations, particularly related to HIV/AIDS and malaria. We believe that the West Africa Bioethics (WAB) Training Program in Nigeria played a central role in this growth, serving as a model for subsequent programs in Ghana, Mali, and The Gambia. This paper describes the nature, successes, and challenges of these programs. It also outlines an agenda and strategies for future work to enhance research ethics and bioethics capacities in the region, both in terms of education and governance.

1. Introduction

The current research ethics training climate in the region of West Africa is vibrant, animated by several training programs developed in response to various local and international events in bioethics and health research. These events made manifest the need to create platforms for rapid and sustained upscaling of research ethics expertise and to entrench research ethics infrastructure in the different regions of the world but most especially in those regions where research ethics and bioethics awareness in the conduct of research are low (Adebamowo 2007; Glass 2013; Singh & Mills 2005; De Lange 2005; Loff et al. 2005). These global responses, particularly those championed by the Fogarty International Center (FIC) of the National Institutes of Health (NIH), developed and supported platforms to create bioethics awareness, establish research ethics systems, and develop a critical mass of research ethics professionals who would stimulate discussions and engage in latent and emerging ethical issues in the conduct of research.

The West Africa subregion towards the end of the last millennium witnessed increased democratic governance and a stable polity in many of the countries of the region (Karatnycky 2000; Boafo-Arthur 2008). Together with the internet revolution, mobile telecommunication, coupled with easier and faster travel across the globe, these enabled increased access to global knowledge and increased international research activities.

Following these developments and the growing awareness of research ethics and bioethics, there was a greater appreciation within the region of the central place of ethics in biomedical research, clinical practice, and training of clinicians and researchers. Moreover, with increasing funding by governments and donor agencies, there was a significant growth in the number and types of research activities in the region. Typical examples are the HIV/AIDS epidemic and genetics epidemiology research in Africa, the Roll Back Malaria Project and the President’s Emergency Plan for AIDS Relief (Roll Back Malaria Partnership 2022; PEPFAR 2023). Most of these interventions were multi-institutional, collaborative, and externally funded programs by such bodies as the NIH, Wellcome Trust, the Bill and Melinda Gates Foundation, the European and Developing Country Clinical Trials Program (EDCTP), among others (NIH 2023; Wellcome Trust 2021; Gates 2020). Furthermore, an increasing number of Africans who had either received training or were enrolled in US government–funded research ethics training programs in the US, Canada, and South Africa were eager to engage in exploration of ethical issues developing in health-related research in Africa. Others who received local training through ethics programs linked to funded research grants played a pioneering role in bioethics education within the region by organizing research ethics training sessions and awareness workshops (Ajuwon 2015). These groups of trained experts, the majority of whom were based in Ibadan, Nigeria, formed the core faculty of the first research ethics training program in the region, the West African Bioethics Training Program (WAB) (Ndebele et al. 2014). WAB quickly became the fulcrum for bioethics graduates from different foreign programs to deploy their bioethics and research ethics expertise locally (Ajuwon 2015; Ewuoso 2016).

Following the pioneering activities of FIC-funded programs in sub-Saharan Africa (Ndebele et al. 2014), and with increasing academic and research partnerships with institutions across the globe, other funded research ethics training programs sprang up in Ghana, the Gambia, Mali, and other parts of West Africa. These programs, most of which were set up as joint projects with multiple principal investigators, and their collaborators in US institutions further expanded the reach and capacity for research ethics training and expertise in the subregion. In an earlier communication initiated by FIC in 2014, a collective description of the programs, their challenges, successes, and failures in the first decades of their existence was published (Adebamowo 2007; Ndebele et al. 2014). While the experiences gained from the earlier years provided the impetus for establishing and building research ethics infrastructure and human capacity in the West African subregion, the last ten years have witnessed the expansion of the older programs and the emergence of new ones.

In this paper, we provide a comprehensive review of the activities of these programs, document how research ethics capacity has been strengthened, identify common challenges and innovations made in the West African subregion over the past decade, and identify novel approaches for future advancements.

2. Regional Profile: Health, Health Research, and Research Ethics System, Capacity, and Needs

2.0. Regional Overview

The West African subregion is characterized by diverse cultures, languages, and histories, creating a complex health landscape. The region faces a dual burden of endemic communicable diseases, such as malaria, typhoid, yellow fever, Lassa fever, and noncommunicable diseases (NCDs), including obesity, hypertension, diabetes, and cancers (Agyepong et al. 2017). Rapid urbanization, dietary shifts, and decreased physical activity contribute to rising NCD rates, compounding challenges in a region still grappling with infectious diseases.

Historically, West Africa has experienced repeated outbreaks of epidemic diseases, including seasonal meningitis, cholera, Lassa fever, and more recently, the Ebola epidemic (2014–2016) and the COVID-19 pandemic (Wang et al. 2023; Ngom et al. 2023). These recurring health crises expose systemic deficiencies in health systems while highlighting their resilience.

Efforts to integrate health policies across West Africa face significant hurdles due to governance, infrastructure, and economic disparities among the 15 ECOWAS member states. The West African Health Organization (WAHO), established under ECOWAS, coordinates public health responses and works to improve policy coherence (WAHO 2021). Empirical evidence underscores WAHO’s critical role in shaping health systems and responses to regional challenges (Hedquist et al. 2022).

The World Health Organization (WHO) emphasizes the importance of National Health Research Systems (NHRS) in generating evidence to guide health system improvements (Kirigia et al. 2015). However, West African NHRSs remain weak, with limited research output and capacity (Sombié et al. 2013). Compared to other African regions, West Africa has fewer scientific publications per population (Irikefe et al. 2011; Sam-Agundu et al. 2016). Barriers include inadequate research funding, insufficient training, and limited cross-border collaboration, particularly between Anglophone and Francophone countries (Aidam & Sombié 2016; Sawyerr et al. 2004).

Despite disparities, the region has seen significant growth in research infrastructure. From 2000 to 2014, African health research publications increased by 10.3% annually, driven largely by international funding (Uthman et al. 2015). However, research productivity often correlates with national GDPs, with wealthier countries like Nigeria and Ghana contributing more (Agyepong et al. 2018). International collaborations, including those with WHO, CDC, NIH, Wellcome Trust, and the European and Developing Countries Clinical Trials Partnership (EDCTP), have been vital in advancing health research capacity (Kozma et al. 2018).

The regiońs health research ethics system is in transition, its capacity is improving, with multiple needs. Health research ethics systems in West Africa play a critical role in safeguarding participants and ensuring research integrity. While many countries have established research ethics committees (RECs)¹, the capacity, functionality, and efficiency of these systems vary widely. Challenges include limited financial and human resources, gaps in research ethics training, and the need for culturally relevant ethical guidelines (Hyder et al. 2004; Tindana et al. 2007; Silaigwana & Wassenaar 2015).

2.1. Nigeria

Nigeria, the most populous African country, has over 223 million people and a median life expectancy of 63.4 years (Abubakar et al. 2022). Despite its large economy, Nigeria experiences stark health disparities, with significant differences in health outcomes between urban and rural populations and between socioeconomic groups. While Nigeria has made progress in reducing mortality from communicable diseases, the burden of NCDs is rising. NCDs now account for over 50% of life years lost from the leading causes of death (Angell et al. 2022). Economic challenges have exacerbated health inequalities, with Nigeria housing a large proportion of the world’s poor (Galal 2025).

Nigeria’s health research landscape is evolving rapidly, with increasing numbers of clinical trials and genomic studies. The country’s large population and its relatively less stringent ethics review systems attract global research projects (Abubakar et al. 2022). However, cases of research misconduct, such as the Pfizer Trovan trial, underscore the importance of robust ethical oversight (Etkin 2008; Ezeome & Simon 2010). Future developments in data science, artificial intelligence, and wearable technologies highlight the need for enhanced research ethics frameworks (H3Africa Consortium et al. 2014; Adebamowo et al. 2023).

Nigeria has made notable strides in research ethics, with the National Health Research Ethics Committee (NHREC) overseeing the National Code of Health Research Ethics (NCHRE) (Adebamowo 2007). However, gaps in training and infrastructure persist. Institutional Health Research Ethics Committees (HRECs) often struggle with compliance, and many lack adequately trained personnel (Yakubu et al. 2017). The Center for Bioethics and Research (CBR) has trained numerous bioethicists, but the rapid growth of research in Nigeria requires further capacity building. Challenges in investigator conduct and oversight underscore the need for enhanced ethical governance (Adeleye & Adebamowo 2012; Brownstone et al. 2020).

2.2. Ghana

Ghana, with a population of 34 million, has made considerable strides in health outcomes, achieving the Millennium Development Goal on hunger reduction and progressing toward the Sustainable Development Goal on stunting (Agyemang et al. 2016). However, NCDs such as hypertension, diabetes, and cardiovascular diseases are emerging as major public health concerns (WHO 2018).

Ghana’s health research infrastructure includes key institutions like the Ghana Health Service (GHS) and its three health research centers (HRCs) in Navrongo, Kintampo, and Dodowa. These centers focus on policy-relevant research and inform national health priorities (Adjei et al. 2019). Universities and academic institutions also play critical roles in capacity building, training, and policy influence, partnering with both state and nonstate actors to address health challenges (Laar et al. 2020). Despite progress, disparities in healthcare access persist, especially in rural areas.

Like Nigeria, Ghana’s health research ethics infrastructure includes multiple ethics committees, with the GHS ERC playing a central role. However, the absence of a national coordinating body creates gaps in oversight, particularly for non-clinical research (Seddoh et al. 2015; Laar et al. 2020). Establishing a National Research Ethics Council such as established in Nigeria and South Africa could improve standardization and compliance across institutions.

2.3. The Gambia

The Gambia, with a population of 2.4 million, faces significant health challenges, including high poverty rates and a heavy disease burden. Infectious diseases such as malaria and respiratory illnesses, alongside rising NCDs, strain the healthcare system (Ceesay et al. 2008; Jobe et al. 2024a; Jobe et al. 2024b). Healthcare access is hampered by inadequate infrastructure and a limited workforce, with only 1.33 health workers per 1,000 people (WHO 2022).

Efforts to improve health outcomes include initiatives to strengthen healthcare systems and research capacity. The Medical Research Council Unit at the London School of Hygiene and Tropical Medicine (MRCG) plays a pivotal role in health research, and the government’s National Research Policy emphasizes ethical governance and capacity building (Jallow 2024).

The Gambia is developing its research ethics framework through initiatives like the National Research Policy. Collaborations with organizations like WHO support these efforts, but significant capacity building is required to meet and implement ethical standards and support the growing research landscape (WHO 2023a).

2.4. Mali

Mali faces high burdens of communicable diseases, including malaria and tuberculosis, and rising NCDs like hypertension and diabetes (WHO 2023b). Despite low healthcare expenditure, the country has made progress in health research, particularly through collaborations like the NIH International Centers of Excellence (Doumbia et al. 2022). Several research programs have been developed in the past two decades at University of Bamako-USTTB that raise ethical and governance challenges, including clinical trials (PREVAC Study Team 2022; Doumbia et al. 2022), research on genetically modified mosquitoes, which leverages gene-drive technology to combat malaria (Roberts & Thizy 2022), and data sciences and genomics research (Koné et al. 2024).

Research ethics capacity in Mali remains limited, with gaps in long-term training and context-specific regulations and guidelines. Addressing these challenges has been deemed essential to support the growing research landscape (Ateudjieu et al. 2010).

Mali’s research ethics system includes multiple institutional committees and a National Ethics Committee; however, gaps in training and infrastructure hinder its effectiveness. Capacity building in research ethics, regulations, and standards is therefore essential to support the country’s expanding research activities (Doumbia et al. 2023).

2.5. Liberia

Liberia’s health system, heavily impacted by civil conflict and the 2014 Ebola outbreak, remains fragile, with high maternal and child mortality rates (Kruk et al. 2015). Infectious diseases continue to dominate, but NCDs are becoming increasingly prevalent (WHO 2023c).

Health research in Liberia is growing, led by institutions like the National Public Health Institute (NPHIL) and supported by international collaborations. However, significant gaps in research ethics training and infrastructure remain, highlighting the need for sustained capacity building (Gbollie & David 2022).

Liberia’s research ethics system, led by the National Research Ethics Board (NREB), faces significant challenges. A recent needs assessment highlights gaps in training, infrastructure, and oversight, underscoring the need for comprehensive capacity-building programs (Gbollie & David 2022).

2.6. Sierra Leone

Sierra Leone, with a population of 8.4 million, faces persistent public health challenges. The country has one of the highest maternal mortality rates globally, and under-5 mortality remains high due to preventable diseases like diarrhea and respiratory infections (WHO 2023d). NCDs such as hypertension and diabetes are on the rise, compounding healthcare challenges (Kargbo et al. 2021).

The Sierra Leone Ethics and Scientific Review Committee (SLESRC) oversees health research. International partnerships are helping to build research capacity, but resource constraints and training gaps hinder progress (Kargbo et al. 2021).

Sierra Leone’s ethics review system, overseen by SLESRC, struggles with resource and training constraints. International collaborations aim to build capacity, but more investment is needed to strengthen ethical oversight and support health research (Kargbo et al. 2021).

2.7. West African PALOP Countries (Cabo Verde, Guinea Bissau, São Tomé and Príncipe)

The Portuguese-speaking West African countries (PALOP)—Cabo Verde, Guinea Bissau, and São Tomé and Príncipe—face health challenges similar to their ECOWAS counterparts. Cabo Verde has made significant progress in healthcare, achieving life expectancy rates of 73 years, but Guinea Bissau and São Tomé struggle with limited resources and fragile healthcare systems (Borges et al. 2019).

Health research capacity in these countries is underdeveloped, with language barriers and limited international investment posing significant challenges. Efforts to strengthen research ethics and capacity rely heavily on international collaborations (Fernandes 2023). Similarly, Cabo Verde, Guinea Bissau, and São Tomé face unique challenges in research ethics due to limited resources and language barriers. Research ethics capacity building relies heavily on international collaborations and investments, emphasizing the need for culturally relevant ethical frameworks (Fernandes 2023).

Taken together, West Africa’s health research and ethics systems are evolving amid significant public health challenges. Strengthening ethics oversight, capacity building, and regional collaboration are critical for promoting ethical research and improving evidence-based health outcomes across the region.

3. Program Descriptions and Rationale

3.0. Regional Overview

The West Africa subregion has been home to eight FIC international bioethics training programs. In chronological order from the year of first award, the programs are:

• West African Bioethics (WAB) Training Program, 2004–17

  • PI: Adebamowo
• Entrenching Training and Capacity in Research Ethics in Nigeria (ENTRENCH) Program, 2017–22

  • PIs: Adebamowo & Ogundiran
• New York University–University of Ghana Research Integrity Training Program (NYU-UG RITP), 2018–28

  • PIs: Laar, Caplan, & Ogedegbe
• United States–Mali Research Ethics Training Program (US-Mali RETP), 2020–24

  • PIs: Hyder, Doumbia, & Ndebele
• Eastern Nigeria Research Ethics Training (ENRICH) Program, 2021–26

  • PIs: Adebamowo, Ezeome, & Ogundiran
• Scaling Up Research Ethics and Research Integrity (SURER) Project, 2022–27

  • PIs: Adebamowo, Adejumo, & Ogundiran
• Gambia Research Ethics and Methodology Training Initiative (GamREMTI), 2022–27

  • PIs: Njie-Carr, Sey-Sawo, & Silverman
• Vanderbilt–Nigeria Research Ethics Training (V-NET) Program, 2024–29

  • PIs: Aliyu, Gordon, & Iliyasu.

Table 1 summarizes these programs. In this section, we describe each program in greater detail and provide the rationale for each.

Table 1:

FIC-funded research ethics training programs in West Africa

Country	Program, grant number	Year of funding	Awardee institutions	Degree Awarded	Duration of diploma program	Format of other training activities
Nigeria	West African Bioethics (WAB) Training Program R25TW007091	2004–2017	University of Ibadan, Nigeria and West African Bioethics	Master of Science degree in Bioethics	18 months	Training to build research ethics capacity in Nigeria.
				Diploma in Research Ethics	3 months	Training of research ethics committee members
Nigeria	Entrenching Training and Capacity in Research Ethics in Nigeria (ENTRENCH) R25TW01514	2017–2022	University of Ibadan, Nigeria, Center for Bioethics and Research, Nigeria and University of Maryland School of Medicine, Baltimore, USA	Master of Science degree in Bioethics	18 months	Research ethics training for human research ethics committees in Nigerian universities and interested individual researchers in global bioethics discourse
				Diploma in Research Ethics	3 months
Nigeria	Eastern Nigeria Research Ethics Training (ENRICH) Program R25TW011811	2021–2026	University of Nigeria, Nsukka, Center for Bioethics and Research, Nigeria and University of Maryland School of Medicine, Baltimore, USA	Master of Science Degree in Bioethics	2 years	Short-, medium-, and long-term training program in research ethics training to faculty members, members of ethics committees and individuals who are identified as potential leaders in bioethics by their institutions in eastern Nigeria
				MPH (Bioethics enriched)	2 years
				Diploma in Research Ethics	3 months
Nigeria	Scaling Up Research Ethics and Research/Scientific Integrity (SURER) R25TW012213	2022–2027	University of Ibadan, Nigeria, University of Maryland School of Medicine, Baltimore, USA Center for Bioethics and Research	Master of Science degree in Bioethics (RCR Concentration)	18 months	Short- and medium-term training program.
				Diploma in Responsible Conduct of Research	3 months	On-site Institutional certificate training in RCR
Nigeria	Vanderbilt-Nigeria Research Ethics Training Program (VNET), R25TW012715	2024–2029	Aminu Kano Teaching Hospital/Bayero University Kano (AKTH/BUK), Vanderbilt University Medical Center (VUMC)	Master of Science in Research Ethics	2 years	Annual research ethics course at VUMC, workshops in Nigeria for IRB/CAB members, quarterly webinars, research ethics consultancy service
Liberia	Collaborative Research Ethics Education Program 3R25TW009722–08S1-supplement	2020–2022	University of Liberia College of Health Sciences	NA	NA	Implementation of a Research Ethics Practicum and workshop series on research ethics, research integrity, and RCR with IRBs in Monrovia, Liberia
Gambia	University of Maryland, Baltimore–Gambia Gambia Research Ethics and Methodology Training Initiative (GamREMTI) R25TW011804	2022–2027	University of Maryland, Baltimore (UMB), University of the Gambia (UTG), Medical Research Council Unit The Gambia (MRCG), LSHTM	Postgraduate Certificate in Health Research Ethics and Methodology (PCHREM)	1 year	Annual workshops in the Gambia for research scholars, graduate students, health professionals, and research ethics committee members
				MSc to start in 2025	2 years
Ghana, Liberia, Sierra Leone	New York University–University of Ghana Research Integrity Training Program (NYU-UG RITP) R25TW010886	2018–2028	NYU Grossman School of Medicine, University of Ghana School of Public Health	Master of Science in Bioethics	1 year	1-year Fellowship Program in Research Integrity comprising 3 courses, practicum experience, and mentored collaborative research projects
						Short-term training for IRB/REC/ERC staff at key institutions in Ghana
Mali	US-Mali Research Ethics Training Program (RETP) R25TW011505	2020–2025	The George Washington University, University of Science Techniques and Technologies of Bamako (USTTB)	MPH with Specialization in Research Ethics	2 years	Diploma for Research Ethics Committee members, workshops, seminars and REC internships.

3.1. Nigeria

WAB was launched in 2004 first with a planning grant followed by a full FIC R25 grant in 2006. This marked the first NIH-funded research ethics training initiative in the country and the subregion. WAB, now the Center for Bioethics and Research (CBR), had as its primary aim to build research ethics capacity in Nigeria. Initially, the program targeted academics, clinicians, and researchers with short-term training sessions to address immediate gaps in knowledge and to integrate the West African subregion into global bioethics. To complement ongoing education and expand access, online portals were established for self-paced training.

WAB’s next major focus was to establish academic pathways in bioethics, including an MSc/MPhil/PhD program at the University of Ibadan and short-term hybrid diploma courses for busy professionals. This effort culminated in 2018 with the formation of the Department of Bioethics and Medical Humanity, the first of its kind in Nigeria.

Academic programs in Ibadan have continued through several funding cycles and evolved in response to changing needs. From 2017 to 2022, WAB’s ENTRENCH grant supported the Master’s program in Ibadan and introduced a new MSc in Bioethics program at the University of Nigeria, Nsukka, while promoting the contributions of Nigerian bioethicists to global discussions.

Currently, CBR implements two training programs in Nigeria in collaboration with the University of Maryland School of Medicine (UMSOM). One is the SURER Program, which commenced in 2022 and is focused on implementing short-, medium-, and long-term Responsible Conduct of Research (RCR) training and creation of Research Integrity Offices for universities in Nigeria. This initiative aims to equip instructional faculty and staff with the skills necessary to manage RCR programs and serve as institutional research integrity officers (RIOs).

The second WAB/CBR/UMSOM program in Nigeria is the ENRICH Program, which aims to align with the national research agenda and build ethics capacity in health research institutions in Eastern Nigeria. By offering layered and blended training approaches, ENRICH addresses the increased demand for research ethics capacity in response to the growing complexity of health research and growing population. ENRICH’s short-term training improves the oversight capabilities of Health Research Ethics Committees (HRECs), while medium-term training collaborates with the Nigerian National Health Research Ethics Committee (NHREC) to ensure institutions meet ethical and scientific standards. Long-term goals include the Bioethics-Enriched MPH program and a flagship MSc training, aiming to produce public health practitioners skilled in research ethics.

V-NET seeks to establish an MSc in Research Ethics program at the Aminu Kano Teaching Hospital/Bayero University Kano, Nigeria (AKTH/BUK). Building on previous collaborations with VUMC, V-NET integrates coursework, skills development, mentoring, and practicum experiences to enhance ethical oversight of genetic and genomic research. Over five years, V-NET plans to train 15 MSc students and host workshops for REC members, focusing on the ethics of genetic and genomic research, training 150 trainees overall. To ensure sustainability, V-NET will create a curricular toolkit tailored to African REC members and coordinate webinars led by global experts. Thus, V-NET will develop a network of leaders capable of advancing ethical research practices in the rapidly developing field of genetic and genomic research in Nigeria.

3.2. Ghana

NYU-UG RITP is a collaborative endeavor between NYU Grossman School of Medicine (GSOM) and the UG School of Public Health (SPH). Its primary goal is to build capacity in bioethics, research ethics, and research integrity within Ghana and the West Africa subregion. RITP comprises two main activities: the NYU-UG Fellowship Program in Research Integrity and the MSc in Bioethics program at UG SPH. The Fellowship consists of three intensive courses: History and Philosophy of Research Ethics, Research Integrity, and Developing a Collaborative Research Output. Each course includes 10–12 modules, weekly synchronous virtual meetings, writing assignments, and a practicum experience at a REC or RIO. This practicum allows fellows to apply their new knowledge and skills in real-world contexts. Additionally, fellows engage in mentored collaborative research projects focused on research ethics or integrity issues relevant to Ghana, fostering a community of practice that will outlive the grant.

Select fellows receive support to pursue master’s degrees in bioethics, preparing them for faculty roles in the new MSc program at UG SPH. In Phase I (2018–2023), five fellows completed MAs in Bioethics at the NYU Center for Bioethics, while Phase II (2023–2028) aims for six fellows to earn MSc degrees at UG SPH. The MSc program will be a sustainable engine for bioethics training and scholarship in Ghana, with particular strengths in research ethics.

Phase II also focuses on building capacity among staff at key institutions involved in Ghana’s research ethics infrastructure, including staff at Ghana’s 25 IRBs, GHS HRCs, and the Food and Drugs Authority (FDA), in partnership with the Ghana Association of Administrators of Research Ethics Committees (GHAAREC). RITP and GHAAREC are conducting a needs assessment to inform the design of short courses and workshops for these staff members, recognizing that many urgent needs can be addressed through targeted, short-term interventions rather than lengthy programs, for which many do not have the luxury.

Moreover, Phase II aims to extend the fellowship’s reach to trainees in Liberia and Sierra Leone, expanding the alumni and faculty network from a Ghana-focused community to a regional one, namely, the West African Research Ethics Network (WAREN). This expansion acknowledges the shared health challenges across the region and promotes international collaboration, allowing countries to benefit from each other’s expertise. For instance, the MSc program in Ghana will gain insights from aforementioned programs in Nigeria.

In summary, the NYU-UG RITP aims to create a robust framework for bioethics education and for strengthening research ethics and research integrity in Ghana, while fostering regional collaboration in the West Africa subregion. By developing local capacity and enhancing educational programs, the initiative seeks to ensure a sustainable future for bioethics scholarship and practice in the region.

3.3. The Gambia

The Gambia is a recent recipient of a FIC grant. The overall goal of the Gambia Research Ethics & Methodology Training Initiative (GamREMTI) is to strengthen leadership capacity and expertise in research ethics and research methodologies for academic researchers, graduate students, health professionals, and REC members. GamREMTI is a collaboration between the University of the Gambia (UTG), MRCG, and the University of Maryland, Baltimore (UMB). The 12-month Post-Graduate Certificate in Health Research Ethics and Methodology Program was launched in October 2023, during the second year of the grant. Themes identified from the annual workshops in 2022 and 2023 were strategically integrated into the postgraduate program curricula and professional development contents. GamREMTI admitted seven trainees as the first cohort starting with an orientation that included regional partners from Ghana and Nigeria. The program recently identified courses for the MSc curriculum, which will be implemented in the fall of 2025. Consequently, the Program will strengthen the research enterprise and contribute to the capacity development efforts in the Gambia through formal training programs (postgraduate certificate and MSc programs), professional development activities, and a structured mentoring program. Finally, The Gambia program was awarded an NIH supplement grant to investigate the challenges associated with pursuing community engaged research in The Gambia.

Through curricula-related activities, GamREMTI strengthened processes and outputs by developing formative evaluations of trainees and follow up on deliverables to ensure a quality and rigorous program. This process will be ongoing as GamREMTI continues to strengthen the program in all its tripartite levels of capacity developmental activities: Individual Capacity, Organizational Capacity, and Enabling-Environment Capacity. Enabling-Environment Capacity is an essential component of capacity development as GamREMTI continues to seek community leaders’ and members’ active participation in the program and envision to contribute to the implementation of a national regulation of ethical standards and governance efforts in the Gambia. The GamREMTI web developer is also the communications director for the Program, and has been instrumental in disseminating valuable information on social media platforms, and radio and television media outlets with strategic efforts to reach rural communities.

3.4. Mali

In response to research ethics demands in Mali, the US-Mali RETP was created in 2020. Its overall goal is to strengthen research ethics education and research in Mali through an innovative model of sustainable capacity development to prepare the next generation of ethics researchers. The program built upon the close collaboration between GWU Milken Institute School of Public Health (GWSPH) and University of Sciences, Techniques & Technologies of Bamako (USTTB). US-Mali RETP aims at realizing USTTB’s vision of becoming a regional focus for research ethics. The program model focuses on using US- and Africa-based expertise to strengthen USTTB’s capacity to develop and lead a new master’s degree specialization in research ethics, promote a sustainable bioethics enterprise at USTTB, and enable dissemination of research ethics training to enhance capacity in Mali and the West African subregion. The specific aims of the US-Mali RETP program include: enhancing the pedagogical and curricular strengths of key USTTB faculty to deliver research ethics courses and mentoring in Mali; developing a research ethics specialization within the existing USTTB MPH program in order to train a core group of professionals with expertise in research ethics in Mali; promoting research around key priorities for research ethics in Mali; and creating a dedicated Research Ethics Unit within USTTB.

The US-Mali RETP aims to strengthen research ethics capacity through three activities: (1) intensive faculty development to design and implement ethics training curricula; (2) development of a research ethics specialization within the existing MPH program; and (3) establishing professional development courses through short-term training workshops and webinars to address research and professional ethics needs. Select faculty from USTTB participate in various programs aimed at strengthening their research ethics teaching skills.

USTTB faculty were also paired with experienced faculty from GWSPH and some Africa-based research ethics experts who had received training through various FIC-funded programs. The program has facilitated the establishment of a research ethics specialization through preparing and submitting to institutional authorities a proposal recommending the establishment of the specialization. The program is also facilitating the development of research ethics courses, including course materials in support of the research ethics specialization. The program is delivering workshops, webinars, and a diploma option at USTTB. By ensuring that research ethics has a permanent home within USTTB, the program will facilitate the establishment of a dedicated research ethics unit at USTTB.

4. Program Outputs to Date

In this section, we describe the programs’ outputs and impacts to date. Although the programs are diverse in their aims and activities, common themes emerge in terms of what they have delivered. The subregion has established multiple sustainable research ethics training programs. These programs have enhanced research ethics systems in ways that repeat or build on the milestones achieved by previous FIC-funded programs (Millum et al. 2013; Millum & Sina 2014), and fostered collaboration between institutions in the region and across the globe. As a result, hundreds of trainees gained knowledge and advanced their careers, multiple international collaborations were formed and remain active, new institutions were born and pre-existing ones were enhanced, trainers and trainees made valuable contributions to the academic literature and conference activity, and impacts on policy and practice, we hope, have been significant and promise to continue. All of this has strengthened research ethics in West Africa.

Readers should recall that programs are different ages and therefore have been in action for different amounts of time, which explains differences in the quantity and significance of what they have achieved and the space allotted to them in this section.

4.1. Nigeria

WAB, now CBR, established in 2004 and continuously supported by FIC ever since (Ndebele et al. 2014), addresses significant gaps in research ethics knowledge through short-, medium-, and long-term training programs in Nigeria. This foundational effort led to the creation of a multi-disciplinary graduate program in bioethics and most recently a Department of Bioethics and Medical Humanities at the University of Ibadan.

The academic programs, including a master’s degree and diploma courses, have produced skilled bioethicists who support various sectors, including universities, research institutes, and government agencies. To date, 62 students have earned master’s degrees, with some pursuing PhDs internationally. Additionally, 220 participants have completed blended diploma programs and over 150,000 online trainings have been delivered in collaboration with Biomedical Research Alliance of New York Collaborative Institutional Training Initiative (BRANY-CITI). Graduates of the training program have organized workshops, incorporated bioethics and research ethics into institutional curricula, and created new or strengthened existing RECs at their home institutions. Other trainees have pursued research ethics or bioethics at the doctoral level in Nigeria and internationally.

A major legacy of this program is the development and strengthening of national research ethics systems in Nigeria. A partnership with the Nigerian Ministry of Health led to the establishment of NHREC, which oversees institutional HRECs (https://nhrec.net/). NHREC is responsible for regulating and managing institutional RECs, setting national research ethics guidelines, reviewing multi-institutional research protocols, and mediating conflicts involving between researchers and HRECs. In collaboration with the Ministry, the program developed the National Code of Health Research Ethics (NCHRE), operational since 2007, which has placed Nigeria among countries with established national ethical guidelines for biomedical research. An online educational module based on the NCHRE was designed and implemented on the CITI platform to enhance understanding and implementation of Nigerian national ethical guidelines and is a required course for all researchers seeking to implement projects in Nigeria.

CBR, in collaboration with UMSOM, currently implements two research ethics training programs in Nigeria. The ENRICH Program and the SURER Project. The ENRICH program, currently in its third year, has trained 16 HRECs with 373 members in in Southeast and South-south Nigeria. The program assisted nine HRECs to register with the NHREC. Additionally, over 30 participants have completed the Blended Diploma in Research Ethics, which includes MPH students with a concentration in bioethics. Currently, seven students have graduated from the bioethics-enriched MPH program, while 15 others are in progress. In the MSc program, eight students have completed their degrees, with 19 at various stages of training. The impact of the program is reflected in its graduates’ achievements: one MSc graduate has published research in a peer-reviewed journal (Uche et al. 2023), while seven others have articles under review. Graduates have also presented their work at international conferences, including the 2023 PRIM&R Conference and the 2024 Oxford Global Health and Bioethics International Conference, demonstrating the program’s role in fostering academic and research excellence in bioethics.

The SURER Program (https://surerproject.net) is the first multi-disciplinary graduate program entirely focused on RCR, conflicts of interest (COI), Safe and Sexual Harassment Free Working Environment (SWSHE) incorporating a Harvard University Program on Negotiation (PON) course on Mediation and Conflict Resolution, and supporting research universities to establish RIOs. In addition to building capacity for RCR, faculty and trainees are building the evidence base for RCR, COI, and SWSHE through targeted research projects. To date, 12 trainees have graduated from the Master’s program and 13 are in training. Some 990 trainees have completed short-term online RCR course, 15 people have completed the course on SWSHE, 453 people have completed the course on COI, 19 people have completed training on how to facilitate RCR training, and 12 people have completed the course on “Navigating Online and Hybrid Teaching” in support of their roles in teaching our hybrid courses.

In summary, we believe that Nigeria’s training programs have made significant strides in training professionals, establishing ethical frameworks, and contributing to scholarly discourse, laying a robust foundation for sustainable research ethics development in the region.

4.2. Ghana

In Phase I, (2018–2023), NYU-UG RITP trained 30 fellows in its Fellowship Program in Research Integrity. Fellows hailed from the country’s different regions and were diverse in terms of age, gender, academic backgrounds, and professional roles. Of those enrolled, 29 fellows not only completed three intensive courses, but also completed a practicum experience at a REC or RIO as well as a mentored collaborative research project. The collaborative research projects have resulted in four peer-reviewed journal articles thus far (Amoakoh-Coleman et al. 2023; Awua et al. 2024; Blankson et al. 2025; Owusu et al. 2022). In addition, fellows have presented their research projects and other work attributable to the program in academic conferences around the world, including WCRI in Cape Town (2023), the Oxford Global Health and Bioethics International Conference in Oxford (2023, 2024), the IAB World Congress of Bioethics in Basel, Switzerland (2022) and in Doha, Qatar (2024), among others.

Also in Phase I, NYU-UG RITP co-created and launched the first graduate program in bioethics in Ghana, the MSc in Bioethics program at UG SPH. The program was approved and accredited by GTEC in AY 2021/22, and has just enrolled its fourth cohort of MSc students. To date, the program has awarded more than a dozen master’s degrees in bioethics. Most MSc students are Ghanaian, but there have also been trainees from The Gambia and other countries in the region. Importantly, NYU-UG RITP provided faculty development pathways to strengthen the curriculum and faculty in the nascent MSc program: five outstanding fellows received full scholarships to attend, albeit remotely due to the COVID-19 pandemic, and complete the MA (Bioethics) program at the Center for Bioethics at NYU School of Global Public Health.

Phase I culminated in the creation and launch of the Ghana Research Ethics Network (GREN). The network is intended to be a sustainable community of practice comprising alumni of the NYU-UG Fellowship Program, students and alumni of the UG SPH MSc in Bioethics program, and collaborating faculty in both programs. GREN held its inaugural conference in March 2023 and its second annual conference in April 2024. Both were well attended and featured presentations from trainees, keynote lectures, panels, and workshops devoted to specific aims of NYU-UG RITP Phase II (2023–28).

In Phase II, NYU-UG RITP is expanding the reach of its fellowship program by enrolling trainees from Liberia and Sierra Leone in addition to Ghana. In two cohorts of twelve, the fellowship program will train 12 fellows from Ghana, 6 from Liberia, and 6 from Sierra Leone. In addition, it has revised the fellowship’s curriculum to reflect its improved understanding of local needs, indigenous normative thinking, lessons learned from COVID-19, and ethical challenges related to climate change. In addition, Phase II will involve the evolution of the country-sized GREN into region-sized WAREN. Like GREN, WAREN will be a sustainable community of practice devoted to the academic study and practical improvement of research ethics and integrity in the West Africa subregion. The transition will occur when the Fellowship produces its first non-Ghanaian graduates (i.e., from Liberia and Sierra Leone), at which point it will invite members from other R25 and D43 FIC programs across the subregion.

4.3. The Gambia

The GamREMTI Program continues to advance as planned, holding its fourth annual workshop in March 2025 on the theme of Ethical considerations when communicating research with local communities. The workshop was hybrid and attracted 163 participants with active participation from community members, further underscoring our mission to engage our communities in all components of our program for sustainability. All workshops are held in the Gambia and serve as a platform to selecting potential candidates for the training programs and, importantly, provide professional development. The GamREMTI faculty holds weekly meetings to discuss progress, challenges, constraints, and recommendations for next steps to ensure the successful implementation of a quality and rigorous program.

The first cohort of GamREMTI Program trainees presented three papers at the World Conference on Bioethics, Doha, Qatar in June 2024. Presently, the trainees are working on three papers, which will be submitted for consideration in peer-reviewed journals. Trainees are assigned mentors for all scholarly projects, through the formal mentorship program, which was launched in November 2023. The second cohort of trainees started their training in September 2024. GamREMTI’s regional collaborators in Nigeria and Ghana are paired with faculty, who are teaching in the program, and trainees. Trainees track their progress using an Individual Development Mentoring Plan (IDMP), which they complete before their initial meeting with their mentors.

In terms of identified gaps, one of the important findings was the identification of teaching needs and support in pedagogical strategies for junior faculty. The Gambia has a huge development gap where individuals are appointed to key leadership positions but lack structured quality mentorship (Republic of The Gambia 2024). Funding from FIC remains essential in addressing this gap and supporting capacity building initiatives in LMICs such as the Gambia. As part of its commitment to academic excellence, the GamREMTI Program has become a subscriber to the CITI Program. As a start, seven training modules were purchased that include Bioethics, RCR, and COI. These modules align with courses offered in the postgraduate certificate program at UTG, where GamREMTI is housed. The UTG administrators have committed to continuing the program, ensuring its sustainability through institutional integration. To further embed the program within national research ethics frameworks, discussions are ongoing to estrablish a national training requirement, which would provide a foundation for long-term sustainability. Efforts are underway to finalize strategic implementation, process details, and evaluation methods.

4.4. Mali

US-Mali RETP has significantly advanced research ethics capacity in Mali already by training faculty and establishing an MPH degree with a specialization in Research Ethics at USTTB. Five Malian faculty members participated in a faculty development phase, including courses at GWSPH and collaborative course development. USTTB now offers seven bioethics courses, enhancing the institution’s capacity in this critical field. Over four years (2020–24), the program has trained 22 individuals and hosted various webinars and workshops involving both Malian and international researchers.

US-Mali RETP established the first research ethics training program in Mali, delivering instruction in both English and French to accommodate local students. The training program’s graduates contribute to the field by taking on roles as research ethicists and lecturers. Faculty members enhance the capabilities of current and former trainees through tutorials and are involved in teaching ethics courses across multiple medical programs, including at the USTTB doctoral school and other medical faculties.

The program has organized annual workshops on RCR, attracting over 140 participants, including some from Guinea. A specialized workshop for new REC members at USTTB engaged 25 participants. Additionally, the program has cosponsored webinars on important topics like “Ethics and COVID-19,” each drawing around 100 attendees, allowing USTTB to gain experience in hosting such events.

Program trainees and faculty have presented or participated in regional conferences and have begun publishing their research, with one paper completed and several others under review (Doumbia et al. 2023). Independent research supported by the program has explored various biomedical ethics issues in Mali, such as community consent and informed consent processes.

To further institutionalize research ethics, a proposal for a dedicated “Research Ethics Unit” at USTTB has been submitted to the university board. This unit aims to facilitate research and training in ethics and to integrate ethical considerations into policies and health programs.

The program has created a pool of master’s-level individuals in research ethics who can serve as trainers, with some planning to pursue PhDs. While the program has faced challenges, including attracting female candidates in a male-dominated environment, these were addressed by showcasing female leaders role models in research and ethics and offering flexible training options. Future plans involve collaborating with other universities to diversify candidate recruitment from multiple disciplines across Mali.

4.5. Liberia

Following a needs assessment, collaborators from Tulane University, UT Southwestern Medical Center, and ULCHS applied for, and were awarded, supplemental funding from FIC to develop a Research Ethics Practicum and Workshop Series on research ethics, research integrity, and RCR, targeting REC committee members in Monrovia.

Initial activities focused on ethics education and administrative training for REC directors and members already in leadership positions. Training targeted members with the authority to shape the ethical review processes of biomedical research in Liberia and to define the ethical standards of the Liberian research enterprise. First, there was a two-part, in-depth Practicum in Research Ethics at ULCHS (four days each) that included the director and 2–3 additional members of each of the 4 identified RECs. The goal of the first Practicum was to establish a strong common knowledge base and understanding of fundamental concepts of research ethics and best practices in the protection of human subjects in research among the leadership of the four targeted Liberian RECs. The goal of the second practicum was to hold a week-long working session among REC members to harmonize processes across the Liberian RECs as appropriate.

These activities resulted in the following outputs: (1) an Operational Guideline Document for each REC describing its guiding regulations, functioning of the REC, schedule of meetings, and instructions for protocol submission; (2) harmonized templates for investigators to use including protocol templates, informed consent and assent documents, data sharing and sample sharing agreements; (3) solidifying the establishment of the ULCHS IRB as the REC of record for UL, which included the absorption of the JFK IRB into ULCHS and the adaptation of the UL-PIRE IRB name to the Atlantic Center for Research and Evaluation (ACRE) IRB, thus eliminating confusion over naming; and (4) creation of a master list of REC member expertise, for possible sharing of technical reviewers amongst the different RECs as needs arise.

5. Impact

Over the past decade, the West African subregion has made significant strides in bolstering its research ethics capacity, addressing the unique ethical challenges posed by its complex health landscape. These advancements have been driven by the establishment of training programs, the creation of regulatory frameworks in some countries, and the development of a critical mass of ethics professionals capable of navigating ethical issues arising from research in the region. The establishment of these initiatives was critical in a region where health disparities, endemic diseases, and emerging global health threats converge, necessitating robust ethical oversight (Adebamowo 2007; Ndebele et al. 2014; Laar et al. 2020).

Collaborative efforts between local institutions and international partners, mainly US collaborators, have been instrumental in expanding the reach and impact of these initiatives. Programs funded by entities such as the FIC, NIH, Wellcome Trust, the European Union, and the Bill and Melinda Gates Foundation have not only provided the necessary financial support but have also facilitated two-way transfer of knowledge and skills through various training programs. These efforts have been contributing to developing and equipping a new generation of African bioethicists with the tools needed to address the ethical dimensions of contemporary biomedical research, contributing significantly to the global bioethics discourse. Mentoring, like international collaboration, remains a cornerstone of these training programs, as seen in both global and West African contexts (Loue & Loff 2013).

In summary, these programs have made significant progress in strengthening research ethics capacity in West Africa. Like the FIC programs before them (Kass et al. 2016), these training programs have also had significant positive impact on individual trainees’ careers and professional accomplishments. The region has laid a solid foundation through education, regulation, and collaboration, positioning itself as a critical player in the global bioethics community.

6. Challenges and Lessons Learned

Despite these achievements, challenges remain, mirroring broader trends observed in sub-Saharan Africa (Ndebele et al. 2014). The region continues to grapple with disparities in research capacity, limited resources, and the need for more comprehensive and contextually relevant ethical guidelines. For instance, while countries like Nigeria and Ghana (Laar et al. 2020) have made substantial progress, others still face significant hurdles in establishing and maintaining effective ethical oversight mechanisms. While the evolution of research ethics training in West Africa aligns with broader efforts in the Global South to create culturally relevant curricula, as seen in other FIC-supported programs (Matar et el. 2014), training programs in the region continue to encounter challenges familiar to those working in LMICs.

These challenges underscore the importance of sustained investment in bioethics education, infrastructure, and ethics review systems to ensure that the gains made are not only maintained but also expanded upon (Bates et al. 2006). African governments need to recognize the critical role of research ethics in safeguarding scientific integrity and public trust and take steps to institutionalize and financially support research ethics capacity building rather than relying predominantly on foreign donors. Sustainable investment in national ethics infrastructure, training programs, and regulatory frameworks will strengthen local oversight mechanisms, enhance ethical research practices, and ensure long-term self-governance in Africa’s rapidly evolving research landscape.

Other challenges include a lack of awareness and understanding among potential collaborators and stakeholders, as bioethics is often narrowly viewed as solely a medical discipline, leading other faculties to avoid engagement. There is also a lack of clear career pathways for bioethicists in public employment, compounded by a shortage of faculty members with expertise in the field across regional institutions.

Additionally, trainees face difficulties in dedicating time to classes. The use of online learning in West African training programs reflects a broader trend in research ethics education (Silverman et al. 2013). However, poor internet connectivity and limited access in some countries, such as The Gambia, further hinder participation. Retention of trainees is another significant problem, as some programs report cases of trainees struggling to remain in the program after receiving initial incentives. Moreover, there is a need for greater collaboration with stakeholders and policymakers to create employment opportunities for trainees following successful completion of their training. By collaborating with these other actors to ensure that trainees can meaningfully employ their new capacities, programs will scale up and sustain their impact.

Another key issue is the language of instruction and ability of coordination between Anglophone, Lusophone, and Francophone countries. While collaboration across all programs may be desirable, those operating in a non-English or bilingual context have both a higher degree of challenge and are responsive to a higher need. Finally, inadequate funding—particularly, local funding—remains a pervasive issue that affects all aspects of advancing bioethics in the region.

Continued efforts are necessary to address the remaining challenges and to sustain and build upon the successes achieved so far. By continuing to reinforce and build upon the foundational work already done, West Africa can emerge as a leader in research ethics within the global bioethics community, contributing unique perspectives and solutions to the ethical challenges posed by contemporary biomedical research.

7. The Future of Bioethics in West Africa

Looking forward, the field of bioethics in West Africa stands at a critical juncture, poised to expand its influence and impact across the region and beyond. However, its future will hinge on several key factors with the potential to deepen and expand the field’s impact. Central to this progression is the need for continuous capacity building, particularly in the training of bioethicists who can lead the ethical oversight of increasingly complex research landscapes. The region must prioritize the development of advanced academic programs in bioethics and training in research ethics, which not only address current ethical dilemmas but are also adaptable to emerging global health challenges, such as the rise of artificial intelligence in healthcare, the ethical implications of genomic research, and the current and future health impacts of climate change.

Second, enhancing the robustness of research ethics frameworks and review systems across the subregion is also crucial. This will involve not only harmonizing existing guidelines to ensure consistency and coherence but also fostering an environment that is responsive to the dynamic nature of biomedical research. Such frameworks should be informed by the cultural, social, and political contexts of West Africa, ensuring that ethical oversight is both rigorous and locally relevant (Nuffield Council on Bioethics 2002; Ndebele et al. 2014). The development of these frameworks will be essential for supporting cross-border research collaborations and addressing regional health challenges effectively.

The integration of bioethics into public health policy and practice represents another significant opportunity for advancing the field. As the region continues to navigate the dual burden of infectious and noncommunicable diseases, and as climate change begins to take an increasing toll on human health, the ethical dimensions of evidence-based public health interventions must be at the forefront of policy development and implementation. This integration will require close collaboration between bioethicists, research ethicists, public health professionals, and policymakers to ensure that ethical considerations are woven into the fabric of health research governance and health systems.

Advancing the field in the ways outlined will necessitate a deepened engagement with global bioethics networks, stakeholders, and actors including academia, policymakers, and industry. By fostering international collaborations, West African bioethicists can contribute to and draw from the global pool of bioethical knowledge, ensuring that the region’s unique perspectives are represented in international discourse. These collaborations will not only enrich the global bioethics community but also provide West African bioethicists with the opportunity to influence global ethics standards.

Establishing a regional Bioethics Centre of Excellence or Network—or national networks with a regional remit—could serve as a cornerstone for training, research, and networking, connecting all FIC programs in the region and maintaining relationships with trainees. Regular regional conferences, training sessions, mentorship networks, webinars, and meetings will help reach countries without established programs and create a platform for shared learning and innovation. Streamlining admission criteria to attract genuinely interested candidates and increasing flexibility through online modules will make bioethics and research ethics education more accessible.

By focusing on capacity building, enhancing research ethics systems, integrating bioethics into public health policy, and engaging with the global community, the region can continue to strengthen its bioethics capacity, deepen its impact, and make significant contributions to the global discourse on research ethics. The next decade will be crucial for determining the trajectory of bioethics in West Africa, with the potential to set a standard for ethical research practice that can serve as a model for other LMICs and regions facing similar challenges.

Authors’ Biographical Sketches

Shehu Usman Adamu, PhD, is a Professor of Public Health, Dean of Faculty of Health Sciences and Chairman University Ethics Committee at the National Open University of Nigeria (NOUN). His research areas are Public Health Epidemiology, control of Neglected Tropical Diseases, and Bioethics. He is the site PI for two MSc/PhD programs at National Open University of Nigeria in collaboration with the Center for Bioethics and Research, and others. One of the programs is an MSc/PhD Public Health with specialization in Bioethics for “Massive Open Online Research Ethics Training in Nigeria (MOORETIN Program)” while the other is an MSc/PhD program for“Strengthening Surgical Scientists Capacity for NCD-Lifespan Research (SSSCAR)”. He contributed to writing and editing the manuscript.

Clement Adebamowo, BM, ChB Hons, FWACS, FACS, ScD, FASCO, is Professor of Epidemiology and Public Health, University of Maryland School of Medicine (UMSOM); Associate Director for Population Science and for Inclusion, Diversity, Equity, and Accessibility at the Greenebaum Comprehensive Cancer, UMSOM. He established the West African Bioethics (WAB) Training Program, an NIH-funded initiative, now the Center for Bioethics and Research, Nigeria. He was pioneer Chair of the Nigerian National Health Research Ethics Committee (2007 – 2017) and a recipient of the PRIM&R Lifetime Service Award. He is currently PI of several research ethics training and research grants including the Scaling Up Research Ethics and Research Integrity (SURER) Project, the Eastern Nigeria Research Ethics Training (ENRICH), and the Bridging Gaps in the ELSI of Data Science Health Research in Nigeria (BridgELSI). He has developed 2 new training programs in Nigeria in collaboration with the National Open University of Nigeria (NOUN). One of the programs is an MSc/PhD Public Health with specialization in Bioethics for “Massive Open Online Research Ethics Training in Nigeria (MOORETIN Program)” while the other is an MSc/PhD program for “Strengthening Surgical Scientists Capacity for NCD-Lifespan Research (SSSCAR)”. He contributed to the drafting and revising of the paper, and reviewed and approved the final version.

Adebayo O. Adejumo, RN, MHSc, PhD, is a Professor of Health Psychology and Bioethics at University of Ibadan, and Center for Bioethics and Research, Nigeria. He Chairs the Social Sciences and Humanities Research Ethics Committee for his University, and is also a pioneer member of the National Health Research Ethics Committee for Nigeria. His research interests are in psycho-social bases of health and illness, as well as research and clinical ethics issues, especially among the vulnerable in resource-limited settings. Since 2006, he is a foundation member and facilitator at the West African Bioethics (WAB) Training Program, an NIH-funded initiative, now transformed into the Center for Bioethics and Research, Nigeria. He is a Co-PI in the National Institutes of Health/Fogarty International Center (NIH/FIC)-funded Scaling-Up Research and Research Integrity (SURER) in Ibadan. Prof. Adejumo contributed to writing the first draft, participated in the revision of the manuscript, and reviewed and approved the final version.

Olusegun Emmanuel Adeyemo is the Program Administrator at the Center for Bioethics and Research (CBR) Nigeria. He oversees the implementation of all CBR programs and manages the day-to-day activities of the Center. He is currently overseeing the implementation of several research ethics training and research grants including the Scaling Up Research Ethics and Research Integrity (SURER) Project, the Eastern Nigeria Research Ethics Training (ENRICH), and the Bridging Gaps in the ELSI of Data Science Health Research in Nigeria (BridgELSI). Mr. Olusegun contributed to writing the first draft and contributed to the review of the manuscript.

Samuel A. Adeyemo is a Research Associate at the Center for Bioethics and Research and a faculty in the Department of Bioethics and Medical Humanities, University of Ibadan. He is the program coordinator for the NIH funded Scaling Up Research Ethics and Research/Scientific Integrity (SURER) project. His current project is on Responsible Conduct of Research. Mr. Samuel contributed to writing the first draft and contributed to the review of the manuscript.

Christopher O. Agulanna, PhD, is a Professor of Philosophy and Head, Department of Bioethics and Medical Humanities, University of Ibadan, Nigeria. He specializes in moral and social philosophy, and bioethics. He has been involved in bioethics training in Nigeria and the West African sub-region for close to two decades. He is an active faculty member of the NIH-funded Scaling Up Research Ethics and Research/Scientific Integrity (SURER) program, which aims to promote Responsible Conduct of Research among Nigerian researchers. Dr. Agulanna contributed to writing, editing and the revision of the manuscript.

Muktar H. Aliyu, MD, DrPH, is Professor of Health Policy and Medicine at Vanderbilt University Medical Center (VUMC) and Director of the Vanderbilt Institute for Global Health. He also holds the Directorship in Global Health at VUMC. His research interests are in strengthening care services and preventing comorbidities in people with HIV by exploring implementation science approaches to delivering quality, sustainable care in resource-constrained settings. He leads several National Institutes of Health/Fogarty International Center (NIH/FIC)-funded research and training grants, including serving as contact Multiple Principal Investigator of the Vanderbilt-Nigeria Research Ethics Training Program (V-NET). Dr. Aliyu contributed to writing the first draft, participated in the revision of the manuscript, and reviewed and approved the final version.

Isabel Inês Monteiro de Pina Araújo, MSc, PhD, is Professor at the Faculty of Science and Technology (FCT) of Cabo Verde University (Uni-CV), in Public Health, Epidemiology, and ethics in undergraduate and postgraduate studies. Coordinates the master programme in public health, and is a member of the coordination committee and chair of the pedagogical Committee for the master in Field Epidemiology at FCT/Uni-CV. She is a member and participates in several national and international health research and training teams, and represents the Uni-CV on various bodies, such as National of the Committee for Ethics in Health Research. She is the director of oNe hEalth reSearch cenTer – Cabo Verde, supervise Bsc, master and PhD students and promotes science training and dissemination events. She conducts research on communicable and non-communicable diseases and Antimicrobial resistance. Dr. Araújo contributed to writing the first draft.

Imran Bari, BDS, MSc, MPH, is Senior Research Associate in the Department of Global Health and Manager for the Center on Commercial Determinants of Health at the Milken Institute School of Public Health, George Washington University, USA. He coordinates several NIH-Fogarty funded training and capacity development programs, including: research ethics in Mali, Zimbabwe, Pakistan, and the Democratic Republic of Congo; injury/trauma in Pakistan and Zambia; and NCDs in Zambia. Dr. Bari conducts research in low- and middle-income countries on road safety, non-communicable diseases, violence prevention, and the economic costs of communicable and non-communicable diseases. His expertise extends to the fields of demography and ethics, contributing to a comprehensive understanding of the socio-demographic and economic determinants of health and the ethical frameworks necessary for global health research. Dr. Bari reviewed the draft and edited sections on Mali.

Arthur L. Caplan, PhD, is currently the Drs. William F and Virginia Connolly Mitty Professor and founding head of the Division of Medical Ethics at NYU Grossman School of Medicine in New York City. Prior to coming to NYU, Dr. Caplan was the Sidney D. Caplan Professor of Bioethics at the University of Pennsylvania Perelman School of Medicine in Philadelphia, where he created the Center for Bioethics and the Department of Medical Ethics. Caplan has also taught at the University of Minnesota, where he founded the Center for Biomedical Ethics, the University of Pittsburgh, and Columbia University. He received his PhD from Columbia University. Dr. Caplan is the author or editor of thirty-five books and over 865 papers in peer reviewed journals. Dr. Caplan contributed to the analysis and interpretation of data for the work. He also reviewed and approved the final version.

Seydou Doumbia, MD, PhD, is Professor of Epidemiology and Public Health, Director of the University Clinical Research Center (UCRC) and Honorary Dean of the Faculty of Medicine and Odontostomatology the University of Sciences, Techniques and Technology of Bamako-(USTTB), Mali. Dr. Doumbia Chair the West African Consortium for Clinical research on Epidemic Pathogens, a network including Mali, Guinea Conakry, Liberia and Sierra Leone to support sub-regional epidemic preparedness and response. Dr. Doumbia is Program Director/Principal Investigator of several NIH funded research grants including the West Africa International Center of Excellence in Malaria Research (ICEMR), Tropical Medicine Research Center (TMRC) Program. He has been involved in several capacity building initiatives in Africa through NIH Fogarty supported D43/R24/U2R research training grants that contributed to strengthening to Master and Ph.D. training in public health, bioinformatics and Data Sciences in Mali and Guinea. He is PI of the United States-Mali Research Ethics Training Program (US-Mali RETP) that created a research ethic concentration in the MSPH program, enhanced Faculty ethic research capacity, and established a University Diploma courses in biomedical ethics. Dr. Doumbia reviewed the draft and edited sections on Mali.

Emmanuel R. Ezeome, MBBS, MA Bioethics, FWACS, is a Professor of Surgery and Consultant Surgical Oncologist. He is the Director of the Bioethics Unit, Institute of Public Health, University of Nigeria, Enugu, Nigeria. He is a member of the University of Nigeria Teaching Hospital Health Research Ethics Committee and a collaborating Faculty with the Center for Bioethics and Research (CBR), Ibadan Nigeria. He is MPI in the Eastern Nigeria Research Ethics Training (ENRICH) program; an NIH/FIC grant supported program for Research Ethics Training in Nigeria. Currently, he leads the University of Nigeria site implementation of the ENRICH program. He contributed to the drafting and revising of the manuscript, and reviewed and approved the final version.

Euzebus Chinonye Ezugwu, MBBS, MSc (Bioethics), FWACS, is a Professor of Obstetrics & Gynaecology, Director of the Institute of Maternal and Child Health, University of Nigeria Nsukka and Chairman, University of Nigeria Teaching Hospital Health Research Ethics Committee, Enugu state, Nigeria. His research areas are Maternal Health, sexual & Reproductive health, Infertility and Bioethics. He is a member of the Eastern Nigeria Research Ethics training ( ENRICH) programa; NIH/FIC grant supported program for Research Ethics Training in Nigeria. He contributed to writing and editing of the manuscript.

Kyle Ferguson, PhD, is Assistant Professor of Philosophy at Hunter College of the City University of New York, and Faculty Affiliate of the Division of Medical Ethics in the Department of Population Health at NYU Grossman School of Medicine. He specializes in moral and social philosophy, bioethics, and environmental ethics. His current work focuses on how we should understand and respond to various ethical challenges related to climate change adaptation and resilience. He is Co-Investigator for the NYU–University of Ghana Research Integrity Training Program (FIC, NIH). Dr. Ferguson co-led the conceptualization and design, contributed to writing the first draft, and led the revision of the manuscript. He also reviewed and approved the final version.

Elisa J. Gordon, PhD, MPH, is Professor in the Department of Surgery, and the Center for Biomedical Ethics and Society at Vanderbilt University Medical Center, Nashville, TN. Dr. Gordon is a medical anthropologist, and trained in clinical medical ethics and in Community Health. Her scholarship focuses on bioethical issues in organ transplantation and donation. Dr. Gordon’s research entails developing and evaluating culturally targeted interventions to improve informed consent, health equity, and treatment decision-making using implementation science and qualitative and mixed-methods. Dr. Gordon is the multiple Principal Investigator for the Vanderbilt-Nigeria Research Ethics Training Program, V-NET (Fogarty International Center, NIH). Dr. Gordon contributed to writing the first draft, participated in the revision of the manuscript, and reviewed and approved the final version.

Elizabeth Heitman, PhD, is Professor in the Department of Psychiatry and Program in Ethics in Science and Medicine at the University of Texas Medical Center in Dallas, Texas, USA. Dr. Heitman is a clinical and research ethicist who focuses on designing, providing, and evaluating educational programs in clinical and research ethics, research integrity, and responsible conduct of research (RCR), particularly in multidisciplinary and international settings. She is Multiple Principal Investigator for the NIH Fogarty International Center’s UEM Collaborative Research Ethics Education Program in Mozambique (FoCEP) and a related supplement-funded REC capacity-building program in Liberia, as well as the parallel Research Ethics in latinAmerica (RETAMA) Program in Peru. Dr. Heitman contributed to writing the first draft of the manuscript and participated in its revision.

Adnan A. Hyder, MD, MPH, PhD, is Senior Associate Dean for Research & Innovation, Professor of Global Health and Chair of the Bioethics Interest Group at the Milken Institute School of Public Health, George Washington University, USA. He has extensive experience of running global training initiatives and is PI of several NIH-Fogarty funded D43/R25 training programs including on: research ethics in Mali, Pakistan and Zimbabwe; injury/trauma in Pakistan and Zambia; and NCDs in Zambia. Dr. Hyder conducts empirical research in low-middle income countries related to ethical review, standards of care, equity, health systems ethics, and institutional capacity development. He has served as advisor on Bioethics commissions in Bangladesh, Uganda and Pakistan; served with the Council of International Organizations for Medical Sciences and the Global Forum for Health Research. Dr. Hyder reviewed drafts and edited sections on Mali and overall sections.

Zubairu Iliyasu, MBBS, MD, PhD, FAS, is a distinguished Nigerian bioethicist, professor of Public Health at Bayero University Kano (BUK), and former Chair of Nigeria’s National Health Research Ethics Committee (NHREC). He currently chairs Nigeria’s National Polio Certification Committee and oversees several training initiatives at Aminu Kano Teaching Hospital (AKTH) and BUK, including the postgraduate training program at the College of Health Sciences and the Continuing Professional Development Committee. Dr. Iliyasu has held numerous leadership roles in grant-funded projects. He serves as Multiple Principal Investigator (MPI) on a Fogarty/NIH infrastructure grant aimed at building research administration capacity in Nigeria and as MPI or co-Investigator (co-I) on three NIH-funded pediatric neurology research and training grants. He has also led significant public health research efforts, including serving as Principal Investigator (PI) for WHO/CDC-funded polio seroprevalence surveys in Kano and a trial investigating transfluthrin for malaria prevention. Additionally, he co-led the Emergency Preparedness response to the 2009 meningitis outbreak in northern Nigeria. As a mentor, Dr. Iliyasu is actively involved in a Fogarty/NIH training grant designed to build physician-scientist capacity in HIV clinical trials in Kano, Nigeria. Recognized for his expertise in mentorship, he was a lead faculty resource for the Fogarty/NIH-supported Mentoring the Mentors in Global Health Research Workshop held in Ghana in 2018. Dr. Iliyasu has contributed to the drafting and revision of this paper as well as reviewing and approving the final version.

Amos Laar, PhD, is Professor of Public Health Nutrition at the University of Ghana School of Public Health, and Faculty Affiliate of the Center for Bioethics, University of Minnesota, Minneapolis, MN, USA. He has expertise in mixed-methods research, public health policy analysis and policy evaluations. Currently, his research explores the connection between food environments and diet-related non-communicable diseases; as well as how social forces, commercial influences, and structural violence affect the realization of health. He is the Principal Investigator for the NYU–University of Ghana Research Integrity Training Program (Fogarty International Center, NIH). Dr. Laar co-led the conceptualization and design, contributed to writing the first draft, and participated in the revision of the manuscript.

Troy D. Moon, MD, MPH, is the William G. Vincent Professor of Tropical Medicine at the Tulane University Department of Tropical Medicine and the Division of Pediatric Infectious Diseases. Fluent in Portuguese, Dr. Moon is an established implementation science researcher and educator with 17 years of experience conducting implementation research in sub-Saharan Africa. For the past 10 years Dr. Moon has been the contact-PI of the FIC funded FoCEP research ethics education program in Mozambique (R25TW009722), and a supplement-funded REC capacity building program in Liberia. He has developed lectures and workshops on research ethics, research integrity, and the responsible conduct of research (RCR), in both English and Portuguese, that have been incorporated into formal modules within the Master’s degree program at University Eduardo Mondlane in Maputo and as training materials for researchers and REC members from Mozambique and Liberia. Dr. Moon contributed to writing the first draft, participated in the revision of the manuscript, and reviewed and approved the final version.

Paul Ndebele, PhD, is an Assistant Director in the Office of Research Excellence and Professorial lecturer in the Department of Global health at the Milken Institute School of Public Health at The George Washington University in Washington DC. He is an alumnus of two FIC funded training programs (FABTP at Johns Hopkins University in Baltimore, Maryland as well as SARETI at University of KwaZulu Natal in Pietermaritzburg, South Africa). He has also served as a scholar in the Erasmus Mundus Bioethics program at Padova University in Italy and Ethox centre at Oxford University, United Kingdom. He specializes in Research Ethics as well as Public Health Ethics and teaches various Ethics Courses in the Department of Global health. He has been involved in Bioethics capacity strengthening grants in West Africa, Southern Africa and Pakistan. He is also involved in various research capacity strengthening programs in Armenia, Zambia as well as within the USA. Dr Ndebele contributed to the first draft and revisions of this manuscript and approved the final version that was submitted for publication.

Veronica P.S. Njie-Carr, RN, ACNS-BC, PhD, FWACN is a professor and academic nurse researcher in the School of Nursing at the University of Maryland, Baltimore. Her research program reflects the changing trends in HIV prevention and care, and the intersection of HIV and intimate partner violence (IPV) among women of African descent. Her most recent work includes 1) evaluating the feasibility and preliminary efficacy of a community-based, technology-enhanced intervention for older African American Women with HIV to improve health outcomes, and 2) investigating the experiences of immigrant and refugee women survivors of IPV to increase safety and improve mental health outcomes. Dr. Njie-Carr’s global work focuses on collaborating with multidisciplinary teams to develop leadership capacity in education, research, and bioethics for research scholars and health professionals. She is the principal investigator for the “Strengthening Capacity in Health Research Ethics and Methodology in The Gambia (R25TW011804), the GamREMTI Program. Dr. Njie-Carr contributed to the first draft, revisions, and approval of this manuscript.

Olugbenga Ogedegbe, MD, MPH, a physician, is Professor of Population Health & Medicine, Chief Division of Health & Behavior and Director Center for Healthful Behavior Change in the Department of Population Health at NYU Grossman School of Medicine. He is a leading expert on health disparities research; his work focuses on the implementation of evidence-based interventions for cardiovascular risk reduction in minority populations. He is Principal Investigator on numerous NIH projects, and has expanded his work globally to Sub-Saharan Africa where he is funded by the NIH to strengthen research capacity (including via the the NYU–University of Ghana Research Integrity Training Program) and reduce the burden of noncommunicable diseases. He has co-authored over 250 publications and his work has been recognized by receipt of several research and mentoring awards including the prestigious John M. Eisenberg Excellence in Mentorship Award from the Agency for Healthcare Research and Quality, and the Daniel Savage Science Award. Dr. Ogedegbe contributed to the analysis and interpretation of data for the work.

Temidayo Ogundiran, MBBS, MHSc, FWACS, FACS, FAS, is Professor in the Department of Surgery in the College of Medicine and in the Department of Bioethics and Medical Humanities, Faculty of Multi-disciplinary Studies, University of Ibadan, Nigeria. His academic, professional and research interests are in general surgery, surgical oncology, bioethics education, research ethics and responsible conduct of research (RCR). His main research focus is on genetics of breast cancer in Blacks in Africa and in the diaspora. Dr. Ogundiran is a foundation member and the Academic Director of the West African Bioethics (WAB) Training Program, an NIH-funded initiative, now the Center for Bioethics and Research, Nigeria. The WAB established a postgraduate program in Bioethics in 2007 at the University of Ibadan, which has grown into a full Department of Bioethics and Medical Humanities with Dr. Ogundiran serving as its pioneer Head of Department. He is a former Dean of the Faculty of Clinical Sciences, and the current Provost of the College of Medicine, University of Ibadan. He has been involved in many funded projects either as co-Investigator or co-PI. Currently he is an MPI on NIH funded Bridging Gaps in the ELSI of Data Science Health Research in Nigeria (BridgELSI), Eastern Nigeria Research Ethics Training (ENRICH), and Scaling Up Research Ethics and Research Integrity (SURER) Projects. Dr. Ogundiran contributed to writing the first draft and participated in the initial revision of the manuscript.

Thomas Senghore, Ph.D., serves as a Senior Lecturer at the University of The Gambia. He is actively involved as an investigator and faculty member in The Gambia Research Ethics and Methodology Training Initiative (GamREMTI), which focuses on building capacity in health research ethics and methodology within The Gambia. He is an alumnus of the inaugural cohort of the University of Ghana MSc. bioethics program. His current research centers on non-communicable disease epidemiology and research ethics capacity building. Dr. Senghore contributed to the drafting, reviewing, and revising of the paper.

Jainaba Sey-Sawo, RN, BSc, MSc, FWAPCNM, PhD, is a senior lecturer and head of department, Nursing and Reproductive Health, School of Medicine and Allied Health Sciences, University of the Gambia. She is a member to the Gambia Government/Medical Research Council Joint Ethics Committee. Dr Sey-Sawo is a Co-Principal Investigator to the grant “Strengthening Capacity in Health Research Ethics and Methodology in The Gambia (#1R25TW011804–01A1)”, awarded by the National Institutes of Health, Fogarty International Center, USA 2022–2027. She is an alumna of the first cohort of the MSc. bioethics program, University of Ghana, Ghana. Her research interest is in community health, reproductive health and research ethics. She contributed to drafting the section on the Gambia and approved the final version.

Henry J. Silverman, MD, MA (Bioethics), is Professor of Medicine and Bioethicist at the University of Maryland School of Medicine. Dr. Silverman has spearheaded successful Fogarty programs in the Arab Middle East and Myanmar and is a co-principal investigator on a Fogarty grant in The Gambia. His mentorship has launched the careers of numerous Fogarty Scholars who have occupied pivotal leadership roles across their respective countries. Dr. Silverman teaches online courses in research ethics and directs an online certificate degree in research ethics at the University of Maryland Baltimore.. Dr Silverman has authored the section on The Gambia, assisted in editing the other sections, and approved the final version.

Jonathan C. Taylor, MA, MTS, is a Social Scientist. He is Professor in the School of International Affairs and Vice President for Graduate Studies and Research at the University of Liberia. He also currently serves as Chair of the University of Liberia Institutional Review Board (UL-IRB). His background is in international politics, peace and conflict resolution with research interest focusing on ethnic and communal conflicts, religious and other identity-based conflicts in Africa. Professor Taylor contributed to writing of the draft on Liberia.

Effua Usuf, MBChB, MSc, PhD, FWACP, is an Associate Professor at the Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine (MRCG @ LSHTM). She serves as a member of the joint Gambia Government MRCG Ethics Committee, the Gambia Medical and Dental Council, and LSHTM Council. Dr. Usuf trained as a medical doctor partly in Sierra Leone and Ghana, and obtained her Masters and subsequently PhD both at LSHTM. Her research, which aims to generate evidence to influence public health policies & decisions, has focused on epidemiological studies on pneumococcal carriage and COVID-19, costs associated with pneumococcal diseases, and surveillance and diagnostics of febrile illnesses. She contributed to the establishment of an in-country postgraduate certificate programme in research ethics and methodology. Effua is a member of several boards within and outside the Gambia. Dr. Usuf contributed to drafting and reviewing the section on The Gambia.