By Rachel Cox and Anne Wolf
What’s a researcher to do when she needs to hire study coordinators, therapists and several short-term, part-time employees to screen study participants in Kenya?
Without strong local support, it can be a nearly impossible.
With the help of a UCSF Global Programs Office in Kisumu, Kenya, Susan Meffert, MD, MPH, associate professor in the UCSF Department of Psychiatry, was able to do just that.
The Kisumu Global Programs Office is one of eight offices in five African countries that the UCSF Institute for Global Health Sciences (IGHS) has established on behalf of UCSF to provide researchers a turnkey operation that includes financial management, procurement, logistics and compliance services, as well as local technical expertise.
Meffert works with the Kenya office in Kisumu to conduct the Mental Health HIV and Domestic Violence (MIND) study, a randomized controlled effectiveness-implementation hybrid trial that treats mental disorders in women with HIV who have experienced domestic violence, using local non-specialists to deliver evidence-based care in a large HIV clinic.
She said the Kenya team has provided her “massive help” with hiring. “That allowed me to have a much more complex workforce for my study and save money.”
Hiring and logistics are just some of the challenges of conducting research outside the US. Other challenges include navigating local rules and regulations, banking and finding work space, to name just a few.
“These offices are here to make it easier for UCSF scientists to conduct international research,” said Jane Drake, MPH, co-director with Kyle Pusateri of Global Programs Operations at IGHS. “The legal requirements for conducting research are changing, and we ensure researchers are compliant, including helping them avoid risks they may not be aware of.”
Currently, 175 local employees work in offices in Tanzania, Uganda, Kenya, Mozambique and Namibia. An office in South Africa is pending. Namibia and Kenya are the largest offices by employment, accounting for more than 150 of the employees. Kenya and Mozambique support the most projects: 12 in Mozambique and 17 in Kenya, including the Sustainable East Africa Research in Community Health (SEARCH) project, under Diane Havlir, and the Bixby Center’s Family AIDS Care and Education Services (FACES) project.
In countries without this type of office, researchers often must subcontract work to an NGO or other organization or try to do it on their own.
“I used to work on my own with refugees in Egypt and earthquake survivors in China,” Meffert said, “and can say that not having that infrastructure at least triples the workload.” And, with less time to travel and be on the ground than she used to have, “The infrastructure the offices provide is a key factor in being able to continue my global health research. They are an incredible resource.”
Elizabeth Butrick, MPH, MSW, senior program manager for the East Africa Preterm Birth Initiative, agrees. She works with the offices in Uganda and Kenya, and said “working in Kenya is challenging, so the office adds real value. Both teams there are amazing. They are very committed to helping people get the work done.”
“There are clear and transparent rules and more financial transparency than other organizations we’ve worked with,” she added.
Butrick travels to Kenya and Uganda twice a year but meets weekly by phone with each team. “Having a direct, accountable team that ensures effective implementation of activities on the ground is a real advantage.”
In-country offices also benefit the University by attracting additional projects and funding. For example, last spring the Global Strategic Information group at IGHS received a new grant from the Global Fund to Fight AIDS, Tuberculosis, and Malaria to design the data management solution for Mozambique’s first National Tuberculosis Prevalence Survey. One key factor in winning the grant was UCSF’s in-country presence.
UCSF researchers had been working in Mozambique for almost 10 years and developed a strong relationship with the Ministry of Health and the National Institute of Health before the local office opened. “Our relationships in the country are now bearing fruit,” said Makini Boothe, MPH, UCSF’s representative in Mozambique and director of epidemiology and surveillance. “The establishment of an office provides a ripe opportunity to absorb other projects.”
The Mozambique office also now supports a UCLA project focusing on training medical residents in pediatric and family medicine. “UCLA approached us because it didn’t make sense for their project funding to go through another organization rather than a UC campus,” Drake said.
In addition to administrative services, the Global Programs Offices also offer the services of the IGHS Informatics Hub, a group of local and UCSF-based professionals who provide start-to-finish data systems development, training and technical assistance to transform data into visualizations that inform evidence-based decision-making and strategic planning.
By training cadres of in-country health informatics professionals, the Global Programs Offices are helping build local capacity to provide context-specific solutions. This approach ensures the presence of technical expertise where the demand is, even when UCSF researchers aren’t visiting. “It makes more sense to have people located there in the office rather than sending people from IGHS in San Francisco,” Drake said. “They are a very strong team, and they are able to support one another on similar work or when one office has a large project.”
As global health research at UCSF increases, this type of collaboration may expand within UCSF and with other University of California campuses. The UC Office of the President (UCOP) initially delegated authority to the Institute to establish and operate the Global Programs offices back in 2011. The first office opened in Tanzania in 2012. Now that eight UC offices in Africa are operational and rapidly expanding, UCOP may ask IGHS to coordinate more projects from other UC campuses working in the same places. And, IGHS may establish future offices based on where other UCSF researchers are working.
By providing valuable in-country infrastructure, services and technical expertise, the Global Programs offices provide new opportunities for UCSF researchers to work closely with the populations they serve.