Table 1.

Recurrent themes: Long-standing challenges to health research capacity strengthening

Level	HRCS Challenges	References
Interpersonal Level	• HRCS initiatives are sensitive to sustained trust and personal compatibility of those involved	Lansang and Dennis 2006; Mayhew 2008
	• Barriers arise from language and culturally diverse communication styles	Maina-Ahlberg et al. 1997; Stillman et al. 2006; Marshall-Lucette et al. 2007; Mayhew 2008; Airhihenbuwa 2011
	• Differing expectations regarding appropriate training style (format of training sessions, including speed of progression through training material)	Marshall-Lucette et al. 2007
	• Differing research interests, priorities, and expertise between HRCS partners	Mayhew 2008
	• Over commitment of HRCS partners and trainees due to competing commitments, including teaching, administrative duties, second jobs	Trostle 1992; Stillman et al. 2006; Barrett 2011
Institutional Level	Challenges Related to HRCS Programming:
	• Depending on HRCS project design, potential for the inequitable division of roles (locus of control) and benefits between Northern and Southern partners in HRCS initiatives; expertise assumed to fall with Northern partner	Trostle 1992; Costello and Zumla 2000; Chandiwana and Ornbjerg 2003; Jentsch 2003; Lansang and Dennis 2004; Mayhew 2008; Boshoff 2009; Barrett 2011; Laabes et al. 2011; Nurse 2011
	• Differing ethical standards; need for strengthening ethical review capacity	Edejer 1999; McIntosh et al. 2008; Barrett 2011
	• Varying institutional perspectives on authorship practices	Maina-Ahlberg et al. 1997
	• Differing priorities between HRCS initiative and priorities of partnering institutions	Brown and Gaventa 2010; Barrett 2011
	• Inconsistent commitment to HRCS initiative due to a change in leadership in either institution	Authors’ Observation
	• Limited consensus on and implementation of systematic evaluations of HRCS initiatives; limited validation of HRCS methodologies	Trostle 1992; Cooke 2005; Gadsby 2010; Nurse 2011
	Broader Challenges to Southern Research Agendas:
	• Low remuneration in academic research positions in Southern institutions; recruitment of skilled researchers by competing organizations where independent research is rarely conducted or for consultancies	Trostle 1992; Maina-Ahlberg et al. 1997; Nchinda 2002; Lansang and Dennis 2004; Andruchow 2005; Mayhew 2008; White 2008; Nurse 2011; Oni et al. 2011
	• Varying pathways to career advancement in Northern and Southern partner institutions; lack of a career scientist system in the Southern context; non-merit considerations in promotions	Trostle and Simon 1992; Nchinda 2002; Lansang and Dennis 2004
	• Faculty with no or limited access to course buyouts from teaching commitments in Southern institutions; limited pool of adjunct faculty available to fill teaching positions	Authors’ Observation
	• Limited access to sustainable mentorship within Southern institutions and lack of senior scholars to support future funding applications; long- distance mentorship difficult to sustain	Trostle and Simon 1992; Nchinda 2002; Hyder et al. 2003; Brooks 2010
	• Limited experience with horizontal collaboration in Southern institutions	White 2008
	• Lack of a critical mass of investigators in Southern institution to undertake new research projects that develop through the HRCS initiative	Authors’ Observation
	• Limited access to internet and scientific literature in Southern institutions (sometimes a national problem)	Marshall-Lucette et al. 2007; Ghaffar et al. 2008
	• Limited infrastructure for research administration and financial management in Southern institutions	Trostle and Simon 1992; Maina-Ahlberg et al. 1997
Macro Level	• LImited demand for research by potential users (policymakers and practitioners) in the Southern context; limited interaction between researchers, policymakers and practitioners	Trostle and Simon 1992; Lansang and Dennis 2004; Ghaffar et al. 2008
	• Limited national political commitment to health research funding in the Southern context, which threatens sustainability of HRCS programs; dependence on international funding	Costello and Zumla 2000; Hyder et al. 2003; Ochola 2009; Whitworth 2010; Oni et al. 2011
	• Research agenda in the Southern institutions vulnerable to international funding agency priorities	Andruchow 2005; Ghaffar et al. 2008
	• Limited access for Southern institutions to permanent core funding and indirect funding via international grant mechanisms (funds consequently diverted from research to cover facilities costs)	Trostle and Simon 1992; Ghaffar et al. 2008
	• Researchers in Southern countries compete for international funds against Northern researchers who have more access to tools, training, and guidance	Andruchow 2005
	• Insecurity; political or economic instability at the national level; funding disrupted by unstable currencies and conversion rates globally	Nchinda 2002; Maziak et al. 2004; Marshall-Lucette et al. 2007; Airhihenbuwa 2011
	• Challenges regarding the retention of trained scientists (‘brain drain’) in Southern institutions	Trostle 1992; Nchinda 2002; Pang et al. 2002; Hyder et al. 2003; Lazarus et al. 2010