New Support Center Boosts Health Research Capacity in Low- and Middle-Income Countries

A carefully designed technical support center has shown that research capacity in low- and middle-income countries can be strengthened when the people being supported are the ones shaping the support. In a study published in Health Research Policy and Systems, researchers describe how they built, delivered and evaluated a Technical Support Centre for the RAISE initiative — short for Research to Enhance the Adaptation and Implementation of Health Systems Guidelines in LMICs — run by the World Health Organization’s Alliance for Health Policy and Systems Research. The results offer one of the most detailed accounts to date of what it actually takes to help research teams in resource-constrained settings turn global health systems guidelines into practical, locally adapted policy.

The problem the initiative set out to address is structural. Health policy and systems research is an interdisciplinary field focused on how health systems shape and implement policy, and it is considered critical to achieving the United Nations Sustainable Development Goals. Unlike clinical practice guidelines, which target care for individual patients, health systems guidelines aim to improve the efficiency, equity and quality of care across an entire system. Yet there is a persistent gap in the availability and quality of such guidelines designed within low- and middle-income countries. As a result, health system stakeholders in these settings often rely on guidelines produced by the World Health Organization or by high-income countries — documents that are frequently not adapted to local needs, contexts or political realities, and that often clash with the priorities of the policymakers expected to implement them.

To close this gap, the WHO Alliance for Health Policy and Systems Research funded six research teams from Colombia, Ghana, India, Mozambique, Nigeria and Zambia through the RAISE portfolio. Each team was required to partner with at least one policymaker or knowledge user — someone positioned to use research results to make informed decisions — to support the practical uptake of the guidelines. The projects were strikingly diverse: home visit guidelines in Ghana, prioritization of WHO guidelines in Colombia, antenatal care guidelines in tribal communities in India, cholera control guidelines in Zambia, a WHO digital intervention guideline for mental health system strengthening in Nigeria, and guidelines to reduce primary care waiting times in Mozambique. Selection followed a rigorous peer review process in which 21 eligible proposals out of 27 submissions were scored by 16 reviewers on team qualifications, methods quality, engagement strategy, impact potential, innovation, feasibility and value for money, with scores ranging from 45.00 to 90.67 before an international adjudication panel made the final choices.

Following a competitive process, the Alliance selected the Knowledge Translation Program at St. Michael’s Hospital–Unity Health Toronto, in partnership with the South African Cochrane Centre and the WHO Ethiopia country office, to act as the Technical Support Centre. Crucially, the centre’s approach was rooted in integrated knowledge translation, a methodology in which the knowledge users themselves — the RAISE researchers, trainees and policymakers — were engaged in designing the content and delivery of the support program. This matters because integrated knowledge translation is known to improve buy-in, increase evidence uptake and reduce research waste. It stands in deliberate contrast to the one-size-fits-all or so-called blueprint models that have dominated past capacity-strengthening efforts, which systematic reviews suggest are often driven by high-income country actors pursuing their own spotlight topics rather than the priorities identified by LMIC actors themselves.

The design process began with a needs assessment. In August 2019, 22 participants from the six countries — 10 men and 12 women, including seven principal investigators, six co-investigators, two knowledge users and six research staff — completed a survey with a 63 percent response rate. All teams reported difficulty identifying their specific methods needs before their projects had begun, but six teams requested rigorous training in evidence-based implementation methods, with additional requests covering barrier and facilitator assessments, stakeholder engagement and qualitative analysis. The resulting program had several components: a mandatory three-day in-person inception workshop in Istanbul, Turkey in September 2019; seven pre-recorded webinars delivered between November 2019 and January 2021 through the Canvas online learning platform; online discussion boards; virtual workshops held from April to July 2021 after the COVID-19 pandemic forced the cancellation of planned in-country visits; and ongoing one-to-one coaching calls and email support from methods experts.

The inception workshop covered the full methodological arc of guideline work: introduction to knowledge translation and health policy and systems research, identifying health system gaps, appraising guideline quality using established tools, prioritizing recommendations through Delphi processes, adapting guidelines, mapping barriers and enablers to implementation strategies, and evaluating implementation quality alongside ethical considerations. Participants rated the workshop a mean 6.30 out of 7, praising the quality and applicability of the content and the opportunity to collaborate across teams. The webinars were also well received, rated between 4 and 5 out of 5, with the session on the AGREE II approach to guideline development, evaluation and adaptation drawing the highest engagement. The on-demand format proved essential for teams working across time zones and, as it turned out, through a pandemic.

The evaluation used a mixed-methods design across three phases, applying the Durlak and Dupre process evaluation framework, validated self-efficacy surveys administered at baseline, 12 and 24 months, and semi-structured exit interviews coded thematically with inter-rater reliability checks. The headline quantitative finding was encouraging but nuanced: mean scores for eight of nine research capacity outcomes improved over time, and the improvement in researchers’ ability to develop evidence-based knowledge translation interventions reached statistical significance between 12 and 24 months (Z = −2.93, p < 0.05). The absence of significant change in the other outcomes was attributed to relatively high baseline scores, the small sample size, staff turnover and pandemic-related disruptions to participation. Twenty-one participants responded at baseline, eleven at 12 months and fourteen at 24 months, with only five completing all three time points — an attrition pattern the authors acknowledge as a limitation that may have introduced response bias.

The qualitative findings may prove the most valuable for the field. Teams identified consistent barriers to adapting and implementing health systems guidelines: competing health system structures and stakeholder interests, lack of available data, poorly maintained field equipment for data collection, and insufficient training among staff tasked with implementation. The COVID-19 pandemic compounded these with project delays, reduced human resources, difficulty engaging stakeholders virtually and community fears that study personnel might spread the virus. Yet the enablers the teams identified form a practical playbook. Partnering with health system stakeholders at project inception rather than at study end sustained engagement and buy-in throughout. Employing a multi-sectoral approach that reached beyond the health sector, allocating financial resources for data collection and partnership strengthening, adopting rapid analysis methods to keep qualitative work moving, and building the competencies of the implementation team — a role the Technical Support Centre itself played — all helped projects survive and, in many cases, thrive.

Participants were candid about the program’s friction points as well. Some felt overwhelmed by the sheer number of supports and activities, struggling to balance capacity-strengthening sessions with actual research implementation. Quarterly monitoring templates were seen as helpful for accountability but time-consuming and repetitive. Knowledge user participation in the evaluation was limited by turnover, heavy workloads and pandemic constraints, and internet connectivity varied enough by country that on-demand resources were not equally accessible — page view statistics likely undercount viewership because teams downloaded webinars and watched them together offline. These honest appraisals are part of what makes the study useful: it documents not just what worked but where the model strained.

The authors conclude that the Technical Support Centre offers a replicable model for supporting health policy and systems research capacity in LMICs, with three defining features: a user-driven approach that lets stakeholders determine priorities and activities, flexibility to adapt supports as needs evolve, and multi-modal delivery that extended benefits beyond the core teams to their networks, trainees and associated institutions. Participants recommended sustaining the network of RAISE teams and connecting WHO regional and in-country offices to keep the collaboration alive. As health systems worldwide continue to grapple with pandemic aftershocks and competing priorities, the study’s central lesson resonates well beyond its six countries: capacity strengthening works best when it is not something done to researchers in low- and middle-income countries, but something built with them, on their terms, from the very beginning.

Subject of Research: Implementation and evaluation of a technical support center for health systems guideline research capacity strengthening in low- and middle-income countries

Article Title: Implementation and evaluation of a technical support center for the Research to Enhance the Adaptation and Implementation of Health Systems Guidelines in LMICs [RAISE] initiative

Article References: Fahim, C., Pratt, J., Purewal, A., Marsot-Shiffman, L., de Launay, K. Q., Baddeliyanage, R., Davenport-Huyer, L., Yangchen, S., Gebregiorgis, A. H., Wiysonge, C. S., Tricco, A. C., Puchalski-Ritchie, L., Pham, B., Tuncalp, O., Langlois, E. V., Marten, R., & Straus, S. E. (2026). Implementation and evaluation of a technical support center for the Research to Enhance the Adaptation and Implementation of Health Systems Guidelines in LMICs [RAISE] initiative. Health Research Policy and Systems, 24(S1), Article 73. https://doi.org/10.1186/s12961-026-01462-9

Image Credits: AI Generated

DOI: 10.1186/s12961-026-01462-9

Keywords: health policy and systems research, capacity strengthening, LMICs, knowledge translation, guideline adaptation, implementation research, WHO Alliance for HPSR, RAISE initiative, technical support centre, integrated knowledge translation, health systems guidelines, COVID-19