Table 3.

Challenges faced by country RCB programs and recommended solutions

Challenges	Level of challengea	Solutions
Trainee backgrounds
Language barriers	1.0	Develop/strengthen internal resources: - Strong English speakers on the team to review/edit materials - Work with trainees/ teams to improve English skills - Support groups / workshops e.g. writing workshop, analysis clinic Adjust according to trainee background: - Re-orient training priorities to match trainee baseline skills - Have a spectrum of activities for different skills levels so trainees can start at appropriate levels and grow in the program - Use those with advanced in skills as Research / Training Assistants or trainers Increase publication success: - Seek journals that welcome operational research - Increase writing mentorship to get to publication quality - Pair trainees with mentors for intensive support - Publish in local language then translate to English
Mismatch between participants capabilities and training priorities	1.2
Difficulty managing groups of different academic levels	0.8
Difficulty for participants to publish in international journals	1.6
Mentorship, teaching and trainee support
Inability of mentors to follow-up due to high need of mentorship	1.4	Prioritize mentorship: - Recruit and fund mentors primarily for RCB activities - Build mentorship into RCB activities - Leverage long distance mentors through phone / skype meetings and email reviews but ideally still have periodic face to face mentorship Make mentorship efficient: - Encourage group mentorship e.g. writing retreats - Project managers/coordinators to track mentorship needs to reduce stalling of projects that need further help
Participant drop out due to lack of mentorship	1.0
Poor communication between participants and supervisors	0.6
Infrastructure and logistics challenges
Difficulty in securing adequate space for RCB activities	0.0	Prioritize funding infrastructure / logistics - Rent training space/ build training center - Pay for participants transport - Budget for necessary materials e.g. portable internet modems, satellite internet installation, data analysis software
Difficulty for participants in accessing training location	0.0
Inadequate materials for participants to complete research	0.8
Poor internet for participants	1.2
Poor internet for facilitators/mentors	0.4
Institutional support and buy-in
Difficulty getting buy-in for RCB activities from institutions	0.6	Make RCB integrated with a budget line and dedicated staff Cultivate RCB as organizational core ethos - Develop research guidelines that outline capacity building as a component for all research activities - Train leaders to be consumers of research Seek support from the Ministry of Health for increased collaboration and support of employee participation
RCB initiatives blocked by leadership	0.0
Competing work responsibilities for participants	1.4
Sustainability and funding challenges
Participant drop out due to changing employment	1.6	Employ trainee retention strategies - Invest in professional development such as scholarships - Allow continued involvement despite attrition as long as trainee stays meaningfully engaged Use trainee involvement strategies - Pay for percent time for research - Align research to be seen as part of work Broaden network of support / funding - Seek and advocate for government support/funding - Develop training programs within established institutions such as universities - Seek for specific funding pools that support RCB - Plan for long-term training programs
Dependence on external institutions or donors for funding	1.6
Donors don’t want to fund these types of activities	0.8

^aReported as an average of the country responses. Each country reported 0 = Not a challenge; 1 = Minor challenge and 2 = Major challenge. Higher score indicates the issue was identified as a bigger challenge or by more countries as a challenge