Section 1: Introduction
The National Institute for Health and Care Research (NIHR) was established in 2006 to improve the health and wealth of the nation through research and is funded by the Department of Health and Social Care. In 2015, the NIHR Global Health Research portfolio was established to support applied health research for the direct and primary benefit of people in low- and middle-income countries (LMICs) on the Development Assistance Committee (DAC) list, using Official Development Assistance (ODA) from the UK government.
The Global Health Research portfolio is underpinned by three principles which guide development and delivery. These are:
- Meet eligibility criteria asODA, i.e. funded research directly and primarily benefits people in ODA-eligible countries on the DAC-list
- Deliver high-quality applied health research, building on the Principles of the National Institute of Health and Care Research (NIHR): Impact, Excellence, Effectiveness, Inclusion and Collaboration
- Strengthen research capability and training through equitable partnerships
The NIHR has established a substantial portfolio of applied global health research and training in areas that are underfunded or where there is an unmet need. The portfolio aims are delivered through a combination of; researcher-led and thematic calls, funding initiatives to develop and advance global health research career pathways both in LMICs and in the UK, and through partnerships with other major global health research funders. Together these have positioned the NIHR as a key player in supporting high-quality applied global health research.
Further information on the NIHR Global Health Research portfolio is available on the NIHR website.
Section 2: Background
Through the NIHR Research and Innovation for Global Health Transformation (RIGHT) programme NIHR provides research funding to support cutting-edge interdisciplinary applied health research in key areas in ODA-eligible countries where a strategic and targeted investment can result in a transformative impact. Find out more about the research funded by the RIGHT programme.
Building on the NIHR Global Health Research portfolio principles above, the strategic aims across the RIGHT programme are to:
- Deliver applied health research for the direct and primary benefit of LMICs, typically through research in key thematic areas for the prevention of ill health and optimal disease management.
- Strengthen capacity for research and knowledge exchange through equitable partnerships between researchers and institutions involved in the research.
- Promote interdisciplinary approaches to working (including, but not limited to: clinical medicine, health economics, statistics, qualitative and social sciences), to ensure that research objectives can be delivered.
- Generate new research knowledge and evidence on interventions to improve health outcomes of people in LMICs.
In 2018, the Academy for Medical Sciences (AMS) published an international policy report evaluating the growing issue of multiple long-term conditions (MLTC)/multimorbidity as a global health challenge which highlighted the urgent need for research to help better understand and inform care. The priorities set out in the report went on to inform NIHR’s RIGHT Call 3 in 2019/20 which focussed on generating new research knowledge and evidence on interventions to improve outcomes for those affected by MLTC/multimorbidity in ODA-eligible LMICs. The call received a substantial number of high-quality applications, indicating this as an area of unmet need in the funding landscape.
Following RIGHT Call 3, the NIHR published its Strategic Framework for Multiple Long-Term Conditions (Multimorbidity) MLTC-M Research, which highlighted MLTC/multimorbidity as an area of strategic priority for NIHR.
To continue to build on NIHR’s area of strategic focus and ambition to fund high quality research that can have a transformative impact in this area, the NIHR is pleased to launch a sixth RIGHT call for targeted research to prevent, treat and manage multiple long-term conditions in LMICs that will meet the aims set out in the following call specification.
Section 3: Rationale
The terms ‘multiple long-term conditions’ (MLTCs) or ‘multimorbidity’ refer to the existence of two or more long-term conditions in a single individual. The NIHR Strategic Framework uses the definition set out in the 2018 Academy of Medical Sciences (AMS) policy report - Multimorbidity: a priority for global health research:
The co-existence of two or more chronic conditions, each one of which is either:
- A physical non-communicable disease (NCD) of long duration, such as a cardiovascular disease or cancer.
- A mental health condition of long duration, such as a mood disorder or dementia.
- An infectious disease of long duration, such as HIV or hepatitis C.
This definition is consistent with that adopted by the World Health Organization (WHO) and, according to the AMS report, approximates that most frequently used by researchers to date.
There is international recognition that MLTCs are an increasing global health burden. However, most health-related research is focused on the prevention and management of single medical conditions in isolation, which makes it difficult to develop the evidence-based strategies that patients and healthcare systems need to understand the extent of this burden and to treat disease clusters and interactions most effectively.
In LMICs, there is a lack of evidence on interactions between common conditions, on how the co-existence of multiple conditions affects treatment responses, and how services can best be integrated. Many settings face the additional challenges of under-resourced healthcare systems, limited health infrastructure, and limited human health resources. While the risk of MLTCs increases with age in all settings, MLTCs in children and adolescents, driven by poverty, infectious diseases and malnutrition is also a common concern.
Although the rise in multiple long-term conditions is a global issue, it is context-dependent and therefore the research and investment priorities for high-income countries (HIC) are often not directly transferable to LMIC settings. There is generally much less information available about the burden of disease or context-dependent factors associated with clustering of conditions and/or management of MLTCs in LMICs, making the generalisation or extrapolation of issues or needs across countries and regions inappropriate.
Understanding MLTCs and developing patient-centric, context-specific care pathways are important priorities for both HIC and LMIC settings. In contrast to HIC settings, where one of the principal challenges is around change of an existing system, the comparative underdevelopment of health systems in LMIC provides a greater opportunity to develop and invest in new health systems specifically designed to tackle the growing burden of MLTCs.
There is therefore a need for pragmatic intervention studies to reduce the risk of developing MLTCs and mitigate their complications in LMICs.
The AMS report identified a number of research priorities designed to better understand the burden, determinants, prevention and treatment of patients with MLTCs. Of particular relevance to RIGHT Call 6 are research priorities 4, 5 and 6:
- Priority 4 - What strategies are best able to facilitate the simultaneous or stepwise prevention of chronic conditions that contribute to the most common MLTCs?
- Priority 5 - What strategies are best able to maximise the benefits and limit the risks of treatment among patients with MLTCs?
- Priority 6 - Healthcare systems strengthening - How can healthcare systems be better organised to maximise the benefits and limit the risks for patients with MLTCs?
These priorities are reflected in the focus for NIHR RIGHT Call 6.
Section 4: Priorities and focus of RIGHT Call 6 (Scope)
NIHR is seeking applications for RIGHT Call 6 that focus on the development and evaluation of interventions and strategies for improved prevention, treatment and management of multiple long-term conditions, including:
- interventions to prevent stepwise progression of MLTCs once one long-term condition or infection has been diagnosed
- interventions to improve treatment, management and care of patients with infections prevalent in LMICs that have a known association with development or exacerbation of NCDs
- interventions for the treatment and prevention of the development of MLTCs in children and young adults driven by malnutrition, multiple chronic infections and poverty
- scalable treatment and care approaches that integrate the management of MLTCs/disease clusters associated with infection(s) and/or NCD(s)
- new treatment packages, new models of care and community-based interventions
- healthcare systems strengthening: research into health care system improvements for treatment, management and care for those affected by MLTCs in LMICs may be included as a component of the research.
Research that leads to a better understanding of risk factors, cultural attitudes and practices influencing the development of MLTCs can be included provided it is part of a wider programme of work contributing to the implementation or evaluation of one or more interventions.
In recognition that the COVID-19 outbreak continues to impact global health systems, applicants should consider the context of COVID-19 where relevant to their research proposal, both in terms of project planning and the generalisability of outcomes.
Section 5: Budget / Length of Funding
The amount requested and the length of the funding period should be fully justified according to the nature of the proposed research.
Through this call, awards up to £5 million, typical range £1-5 million (maximum of £5 million) over 3-5 years are available for eligible research. Applications in the lower part of this range are welcomed where smaller programmes will still address the aims of the call.
Eligible costs for NIHR RIGHT calls include:
- Direct Costs
- Staff costs
- Travel, Subsistence and Conference costs
- Community Engagement and Involvement
- Risk Management and Assurance
- Training and Development Costs
- External intervention costs
- Monitoring, evaluation and learning
- Other Direct Costs
- Indirect Costs / Overheads (guidance varies according to type of organisation).
Please see the NIHR RIGHT Call 6 Finance Guidance for detailed information.
Proposal and Partnership Development Award
Those applicants that are successful at Stage 1 have been notified of the outcome of their PPDA application at the same time as the RIGHT Call 6 Stage 1 application.
Eligible costs for PPDA and the reimbursement process is described in full in the RIGHT Call 6 Finance guidance.
Please see separate Proposal and Partnership Development Award Guidance for further information.
Section 6: Scope
6.1 Key Criteria for Funding
NIHR RIGHT Call 6 will provide funding to support targeted research on MLTCs in LMICs, as listed on the DAC list of ODA-eligible countries.
The following key criteria for this call encompass the overarching NIHR principles and contribute towards the aims of the NIHR Global Health Research portfolio as a whole. The key criteria for funding are incorporated within the Funding Committee selection criteria which will be used to assess applications at Stages 1 and 2.
Applications for all RIGHT calls are required to describe how they address the following key criteria for funding:
- Relevance of the proposed research: Applications should demonstrate that the proposed research fulfils a significant gap, addresses unmet needs and priorities in ODA-eligible countries and aligns fully with the scope of this call. The proposed research plans should be based on a review of the local context and existing evidence.
- Research quality and excellence: Applications should demonstrate that the planned research is context-specific, needs-driven and will improve outcomes for people living with MLTCs in LMICs. The research plan should be clear and robust, detailing clear research questions/objectives, sound design and detailed methodology to address the questions and meet the objectives, with clear milestones, identification of possible risks, and factoring in ethical considerations.
- Strength and balance of the research team: Applications should demonstrate the research team has a depth of relevant expertise and promotes interdisciplinary approaches to working by including expertise / activities associated with a broad range of disciplines relevant to prevention, treatment and management of MLTCs. The proposed research plans should establish equitable partnerships within and across research teams.
- Impact and Sustainability: There is a clear and implementable strategy for pathways to impact, including research uptake and dissemination, with the potential to improve practice, inform policy, and support implementation and future sustainability of research in partner LMIC countries (i.e. likelihood of significant contribution to the evidence base in the relevant area, pathways to improvement in health, wellbeing, lives saved and economic, social and cultural benefits in ODA-eligible countries).
- Capacity Strengthening: There are clear plans for research and research management capacity and capability strengthening at individual and institutional level.
- Community Engagement and Involvement: Relevant and appropriate stakeholder and community engagement and involvement should be evident throughout all stages of the research, from research priority setting and design, to delivery, dissemination, and impact evaluation activities.
- Equity of partnerships: Equity and collaboration should be demonstrated across all aspects of the research proposal, including; programme leadership, decision-making, capacity strengthening, governance, appropriate distribution of funds, ethics processes, data ownership, and dissemination of findings. Promotion of equality, diversity and inclusion - including but not limited to gender balance - are expected to be strongly reflected in all aspects of the planned research.
- Value for money: Evidence of a clear, well-justified budget that represents good value for money is required. Applications must demonstrate that all planned expenditure is proportionate and appropriate against the planned activities outlined in the application and consider Economy, Efficiency, Effectiveness and Equity (please see the Global Health Research Programmes - Core Guidance for more information on value for money).
6.2 In Scope
NIHR RIGHT Call 6 will support applications which:
- Demonstrate they address the remit (section 4), eligibility and key funding criteria (section 6.1).
- Propose broad, multi-faceted programmes of applied health research that meet the aims of the call and are of primary and direct benefit to people and patients in ODA-eligible countries. This can include randomised-controlled trials (RCTs) of interventions with the potential to have a transformative effect for patients with MLTCs.
- Clearly meets a need identified from within LMICs.
- Address the challenges of prevention, treatment and management of MLTCs.
- Target research areas that will lead to improved outcomes for the most vulnerable.
- Evaluate adaptation of existing technologies and processes or promote use of new technologies to improve outcomes for patients living with MLTCs.
- Evaluate interventions that can reduce differences in health outcomes brought about by socioeconomic inequalities.
- Seek to address issues of equity by incorporating research questions around gender, age, social barriers to health and economic impact.
- Identify problems and outcomes that matter most to patients and carers and take into account how they would like to see services configured to meet their needs
- Delivers research that takes a patient-centred, whole person approach to the treatment and care for people with MLTC, including quality of life and well-being.
- Can inform local and national plans for change.
- Supports and embeds South-South learning and bi-directional South-North learning.
- Include interdisciplinary applied research teams with demonstrated experience and track-record of ensuring research is transferred into benefits for people in LMICs. This can include teams who may want to build new research partnerships.
- Demonstrate equity and collaboration in programme leadership, decision-making, capacity strengthening, governance, appropriate distribution of funds, ethics processes, data ownership, and dissemination of findings.
- Include relevant engagement with policy makers, communities, patients and the public, civil society organisations and charities over the lifetime of the programme.
Additionally, we welcome applications that include elements of methodology research as part of a wider programme of work. Proposed projects must:
- meet a clear methods gap
- contribute to the aims of the award
- have generalised applicability to improve health research methods in LMICs.
Methodology research proposals should not form a significant part of the overall research plans and must not exceed 5% of the overall award value.
6.3 Out of Scope
- Applications that are not clearly relevant to MLTCs.
- Applications that do not propose development and evaluation of one or more interventions or strategies.
- Applications that are not based on research priorities identified in LMIC partner countries.
- Consist solely of one of the following:
- a single randomised-controlled trials (RCTs) of interventions
- epidemiological studies
- evidence synthesis (e.g., systematic reviews)
- environmental determinants of health i.e., pollutants, nutrition, WASH.
- evaluations of existing services, where the programme of work does not include evidence-based development and improvement of these services
- replicating research already undertaken in High-Income Countries – research proposals should be clearly relevant to the LMIC in which the research is being undertaken
- implementation science
(this is a call for broad multi-faceted programmes of applied health research).
- Primarily focus on establishing new biobanks or bio-sample collections or data collection studies (samples or data from existing biobanks, patient registries may be used).
- Primarily focus on observational research, secondary research or health policy implementation.
- Primarily focus on behavioural or lifestyle interventions such as nutrition
- Focus on basic laboratory/discovery research or experimental medicine.
Section 7: Eligibility
7.1 ODA Eligibility
The NIHR Global Health Research portfolio supports high-quality applied health research for the direct and primary benefit of people in low and middle-income countries (LMICs) on the Development Assistance Committee (DAC) list, using Official Development Assistance (ODA) funding.
In order to be eligible to receive NIHR Global Health Research funding, applications must demonstrate how they meet ODA compliance criteria and outline:
- Which country or countries on the OECD DAC list of ODA-eligible countries will directly benefit?
- How is the application directly and primarily relevant to the development challenges of those countries?
- How will the outcomes promote the health and welfare of people in a country or countries on the DAC list?
Where some elements of the research is not undertaken in an ODA-eligible country during the course of the award (including where a country graduates from the DAC list during the lifetime of the award or there is a need for specialist expertise) the application must clearly state the reasons for this with due consideration to the benefit of the research to ODA-eligible countries.
Further information can be found at:
- NIHR ODA Guidance for Researchers
- OECD Factsheet: What is ODA
- OECD DAC Statistical Reporting Directives
- OECD DAC list of ODA eligible countries
7.2 Who can apply
Leadership models can be either:
- LMIC-led: A Principal Investigator (Lead Applicant) employed by an LMIC Higher Education Institution (HEI) or Research Institute.
- LMIC-UK Joint Leads: A Principal Investigator employed by a UK HEI or Research Institute (UK Joint Lead Applicant) to jointly lead with a Principal Investigator employed by an LMIC HEI or Research Institute (LMIC Joint Lead Applicant).
Applicants to state which will be the contracting institution.
Where the contracting organisation is a UK institution with a UK Joint Lead Applicant, it is mandatory for an LMIC Joint Lead Applicant to be included on the application, with the expectation that the joint leadership/partnership is equitable. Where the contracting organisation is an LMIC institution, a UK Joint Lead Applicant is not a mandatory requirement. LMIC Lead Applicants may propose joint leadership partnerships with a Principal Investigator from another eligible LMIC or UK institution, or lead the application without a Joint Lead Applicant.
The contracting institution must be a HEI or Research Institute. An LMIC or UK Research Institute is considered to be a not-for-profit research organisation with a proven track record in the field or discipline in which it is applying for funding, and sufficient research and financial capacity to manage and deliver research and training.
For organisations that have not previously been funded by NIHR Global Health Research funding, additional eligibility and due diligence checks may be undertaken in addition to standard NIHR eligibility and due diligence checks prior to contracting.
Depending on the nature of the partnership, there may be other affiliated Co-applicants and collaborators/project partners including service level providers. No limits will be placed on the number of Co-applicants/Collaborators necessary to effectively deliver the aims of RIGHT awards.
Under this call, an individual cannot be named as Lead/Joint Lead Applicant on more than one application.
There are no restrictions on the number of applications an institution can submit under this call provided they are distinct in their objectives.
Existing NIHR Global Health Research award holders are eligible to apply to this call provided there is assurance they have sufficient plans in terms of time and resources available to them to deliver concurrent awards successfully.
If you are unsure of eligibility, please contact firstname.lastname@example.org.
Please refer to the Global Health Research Programmes Applications – Core Guidance for further supplementary guidance:
- About the Core Guidance
- General Information
- Submissions to more than one NIHR Global Health Research Programme/Call
- Additional information
- Multiple applications to the same NIHR Global Health Research Programme/Call
- Structure of Team and Expertise / Institutional Eligibility
- Structure of the Team
- Team Expertise
- Institutional Eligibility
- Affiliated LMIC/UK organisations
- Non-health research organisations
- Non-Governmental Organisations
- Commercial organisations
- Governmental agencies
- NHS Trusts, arms-length bodies or executive agencies of the UK Government
- Non-LMIC Co-Applicants or Collaborators
- Equitable and Sustainable Partnerships
- Training and Capacity Strengthening
- Programme Management and Governance
- Approach to Risk Management and Assurance
- Financial assurance, ODA compliance, monitoring and auditing of expenditure in ODA-eligible countries
- Fraud, bribery and corruption
- Delivery Chain Risk Maps
- Risk Registers
- Research Contract and Collaboration Agreements
- Intellectual Property
- Regulatory Approvals and Compliance
- Dissemination, Outputs and anticipated Impact
- Reporting requirements
- Equality Diversity and Inclusion
- Guidance for applicants on equality, diversity and inclusion (EDI) for study participants
- Success criteria for and barriers to proposed work
- Community Engagement and Involvement
- Finance - Eligible costs
- Justification of Costs
Section 8: Selection Criteria for Stage 2
RIGHT Call 6 Stage 2 applications will be assessed against all eight key criteria for funding.
- Relevance of the proposed research
- Research excellence
- Strength of the research team
- Impact and sustainability
- Capacity Strengthening
- Community Engagement and Involvement
- Equity of partnerships
- Value for money
Please refer to the key criteria in ‘Key Criteria for Funding’ for details of what is expected to be demonstrated in the application for each of these criteria.
Section 9: Selection Process for Stage 2
All eligible applications at Stage 2 will be subject to independent peer and public review and assessed by an independent international Funding Committee that will make recommendations to the Department of Health and Social Care on which applications should be supported.
DHSC will retain the right to make strategic decisions at the final outcome stage (following stage 2 Funding Committee). DHSC final funding decisions will be based on available budget, overall portfolio balance, alignment with relevant UK Government policies, NIHR strategic priorities, institutional balance and ranking based on scientific quality.
Submissions to more than one NIHR Programme
NIHR will not accept the same or substantially similar applications to more than one NIHR programme. If two similar applications are submitted, once the overlap is identified, the application that is most advanced through the funding process will continue and the second will not be taken further.
Similar applications will only be considered by two programmes concurrently if:
- the aims and research proposals are substantially different;
- if successful, NIHR would be prepared to fund both proposals;
- the successful delivery of one project is not dependent on the other.
Section 10: Timetable
- Call launch – 07 September 2022
- RIGHT Call 6 briefing webinar for applicants - 11 October 2022
- Deadline for receipt of RIGHT Call 6 Stage 1 applications and PPDA Call 6 via the online RMS – 14 December 2022 at 13:00 UK time
- Funding Committee review the applications and make recommendations – 14-15 March 2023
- Applicants notified of outcome of Stage 1 and PPDA – April 2023
- Stage 2 opens for successful Stage 1 applicants – 19 April2023
- Deadline for the RMS registration and Stage 2 remit enquiries* – 05 July 2023
- Deadline for receipt of Stage 2 applications – 19 July 2023 at 13:00 UK time
- Funding Committee review – November 2023
- Applicants notified of outcome of Stage 2 – December 2023
- Expected contract start date - 01 July 2024
*NIHR will not guarantee new RMS accounts (for lead applicants or co-applicants) will be verified and approved before the call close date or queries about the remit or content of applications will be answered after this date. If you have other queries about the application process, please do contact us after this time.
Section 11: Completing your application online
You must complete an online application via the Research Management System (RMS). The closing date for Stage 2 applications is Wednesday, 19 July 2023 at 13:00 UK time.
- Applications will not be accepted if submitted after the exact closing date and time, the system will automatically prevent this from happening.
- It is the applicants’ responsibility to allow sufficient time to submit an application.
- Applicants must contact the NIHR RIGHT Global Health team by emailing email@example.com or calling +44 (0)20 8843 8286 immediately if they think there is a system problem, whilst attempting to continue with their submission.
A Word template of the application form is available on the NIHR website for reference only.