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Global Health Research Centres - Theory of Change

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Published: 14 October 2020

Version: October 2020

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Aim

NIHR has developed this Theory of Change to illustrate to potential applicants to the NIHR Global Health Research Centres call a selection of example activities, outputs, and outcomes reflecting the Centres’ core aims, objectives, and funding criteria. We would emphasise that it is intended merely as a visual representation of the Centres core principles and ambitions, drawing on scoping work and discussions that have informed the Centres initial commissioning. Thus we would encourage applicants to think creatively and broadly in how they interpret and further build on the Theory of Change, in terms of how concepts apply in their own local contexts.

Theory of Change

This Theory of Change is an illustration of example inputs, activities, outputs, and outcomes reflecting the core aims, objectives and funding criteria of the NIHR Global Health Research Centres. The Theory of Change represents in the form of a flow diagram the core principles and ambitions that have informed the Centres initial commissioning, as a series of logical steps.

The Centres Theory of Change is intended as a high-level, illustrative guide to be read alongside the relevant Centres call-specific guidance documents, to support prospective applicants’ thinking and discussions in advance of preparing an application. NIHR encourages applicants to think creatively and broadly in how they interpret and further build on this logic, in terms of how concepts apply in their own local contexts, and as part of planning and preparing an application. NIHR recognises that research capacity strengthening initiatives are themselves complex interventions, and we encourage applicants to refer to various sources noted in the guidance documents for more in-depth explorations of principles and frameworks relevant to these kinds of activities.

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Application planning

The starting point of the Theory of Change focuses on ‘application planning’ activities that NIHR encourages all applicants to consider early on in their preparation of an application. These ‘application planning’ activities, which include targeted workshops hosted by NIHR for applicants who are successfully shortlisted to enter Stage 2 of the competition, are:

  • all applicants agree Centre’s leadership model with equitable partnership across institutions;
  • stage 2 shortlisted applicants attend NIHR training on community engagement & involvement, and impact planning;
  • stage 2 applicants attend NIHR training on community engagement & involvement, and impact planning.

Inputs

The next step on in the flow diagram focuses on ‘inputs’. ‘Inputs’ are the other preparatory activities, existing research expertise, research capacity and/or funding, leading up to NIHR’s provision of funding and support to successful Centres. 

The primary input to the NIHR Global Health Research Centres scheme is funding and support to deliver high-quality applied health research and institutional capacity building in non-communicable diseases (NCDs) aligned to local priorities and needs in low and middle income countries (LMICs).

Activities

The Theory of Change subsequently considers ‘activities’ that funded Centres might consider undertaking early in their establishment, as part of their ambitions to deliver high quality applied health research and institutional capacity building in NCDs, aligned to local LMIC priorities and needs. These ‘activities’ include:

  • assessing baseline research capacity & developing action plans;
  • establishing individualised training/mentoring programmes;
  • delivering research programmes that respond to an LMIC review of NCD needs;
  • establishing research oversight and strategic governance functions;
  • managing funds transparently with effective governance;
  • co-developing monitoring, evaluation and learning approaches.

Outputs

The next step on in the flow diagram focuses on  ‘outputs’. ‘Outputs’, which include but are not limited to the generation of high quality research outputs, are the quantifiable effects expected to be delivered as a direct result of ‘activities’, in the relative short-term (i.e. less than 5 years from the date of NIHR’s award). ‘Outputs’ include effects such as:

  • individual research capacity/support functions strengthened;
  • future leaders developed via quality training/mentoring;
  • unmet NCD issues relevant to local LMIC priorities addressed;
  • high quality actionable NCD research evidence generated;
  • Good Financial Grants Practice certification achieved;
  • improved evidence base for capacity strengthening.

We encourage prospective applicants to consider similar ‘outputs’ and other activities relevant to their local contexts as part of their upfront planning, as well as what appropriate indicators of output might reasonably be expected (for further exploration of measures of research translation - including evaluation of quality and context - see Lebel & McLean, 2018).

Intermediate outcomes

The next step on in Theory of Change focuses on  ‘intermediate outcomes’ across three levels - individual, institutional and societal - that we would expect to be directly influenced by Centres’ activities and outputs, in the medium term (i.e. 5-10 years from the date of an award). These outcomes have been grouped into categories showing the level at which they might take place - individual, institutional and societal (as per Khisa et al. 2019).

Examples of these ‘intermediate outcomes’ include, at the individual level:

  • improved quality of graduates from LMIC-led research programmes;
  • support staff trained and retained in LMIC research institutions;
  • progression of individuals’ careers in NCD areas of interest.

At the institutional level, examples of ‘intermediate outcomes’ include:

  • being globally competitive for quality research outputs & international funding;
  • sustainable platforms for LMIC career progression & training;
  • improved research environment and local research systems.

And at the societal level, examples of ‘intermediate outcomes’ include:

  • international engagement with LMIC-led research networks;
  • research evidence adopted by practitioners and policymakers;
  • improved public awareness, access and use of LMIC research.

For the current Centres call, we would expect these ‘intermediate outcomes’ to reflect the specific focus of activities addressing NCDs, aligned to local LMIC priorities and needs. Nonetheless, we recognise that any intermediate outcomes are likely to result from the complex contribution of a number of different factors, actors and initiatives.

Cross-cutting activities

Running in parallel to Centres activities, outputs and intermediate outcomes in the diagram are examples of ‘cross-cutting’ activities that support sustainable delivery of longer term societal outcomes. Examples of these ‘cross-cutting activities’ include:

  • engaging meaningfully and creatively with patients, communities and local stakeholders;
  • develop and sustain equitable, diverse and inclusive partnerships;
  • establish cross-Centres network of LMIC-led platforms for research and shared learning.

Long-term outcomes

The final logical step of the flow diagram are ‘long-term outcomes’. These ‘long-term outcomes’ align with the wider ambitions of NIHR’s Global Health Research Portfolio Theory of Change, and we would expect to be indirectly influenced by Centre’s activities and outputs, in the longer term (i.e. 10~25 years from the date of an award).  Such ‘long-term outcomes’ include:

  • premature mortality from NCDs reduced by one third by 2030 (United Nations Sustainable Development Goal [SDG] 3.4);
  • research evidence influencing LMIC NCD policies and innovations;
  • stronger local, regional and national NCD research systems in LMICs;
  • improvements in health and wellbeing, and lives saved, in LMICs (SDG 3);
  • wider economic, social and cultural benefits in countries eligible for Official Development Assistance (ODA).

While aspirational, in due course (i.e. over an extended period of time) NIHR would expect to understand how the Centres scheme as a whole has contributed to changes in these outcomes, even if not all outcomes are relevant or directly attributable to the work of a specific Centre.

How this theory was developed

A number of activities and information sources have informed the development of the Centres Theory of Change. To date, these include:

  • an initial scoping review (literature review + interviews) conducted as part of the Department of Health and Social Care (DHSC)’s commissioning of the Centres scheme;
  • a series of workshops involving DHSC and NIHR staff to discuss aspects of the Centres’ underpinning programme logic, and how to begin to map these visually as an aid to design and delivery of the Centres scheme;
  • conversations with evaluation leads at other UK-based funders of schemes with a focus on research capacity strengthening in low and middle income countries (LMICs).

Next steps

The Centres Theory of Change is a visual representation of a number of aspects NIHR considers key to the success of any funded Centre. It is not a template and NIHR strongly encourages local adaptation and feedback on aspects relevant to prospective applicants’ experience, expertise, and local contexts.

Looking ahead, NIHR intends and expects this Theory of Change to be updated and evolve as part of activities linked to successful Centres’ own strategies to deliver wider impacts, and monitoring, learning and evaluation plans - and welcomes prospective applicants’ feedback on how the principles and ambitions set out in this guidance relate to their own ambitions, contexts and experiences. Please email ghrcentres@nihr.ac.uk with any feedback.

In parallel with its launch, NIHR will be exploring ways to develop a proportionate, learning-oriented and inclusive approach to monitoring and evaluation of the Centres scheme (see Khisa et al. 2019). NIHR hopes to further develop and build on this initial Theory of Change as part of these activities, in partnership with both prospective and successful Centre applicants, and in the spirit of mutual learning (e.g. as part of a continuing dialogue and engagement activities across all stakeholders involved in the Centres). NIHR thus welcomes all comments and suggestions, as we develop these approaches.

References and further reading

Khisa AM, Gitau E, Pulford J, Bates I. A Framework and Indicators to Improve Research Capacity Strengthening Evaluation Practice. 2019. UK Department for International Development. 10.13140/RG.2.2.27767.37287

Lebel J, McLean R. A better measure of research from the global south. Nature. 2018; 559(7712):23. 10.1038/d41586-018-05581-4

UK Department of Health and Social Care. NIHR Global Health Research Centres programme: scoping review and proposal development. 2020. [unpublished]