We present the results in three parts. We start by showing how, in the early 90s in the Netherlands, a vision for a new approach to North–South research collaboration was developed, which, together with Ghanaian policymakers, researchers, and health sector and NGO representatives, was turned into a proposal for a programme for demand-driven and locally led research in Ghana. In the second part, we focus on the functioning of the research programme and the efforts and dynamics involved in increasing its performance. In the third and final part, we show how the research programme came to an end after changes in development policy led to the collapse of its sponsorship constellation in the Netherlands.
1990–2001: translating a vision into a research programme
The development of the HRDP started in the early 90s in the Netherlands. At the time, numerous scholars from Dutch universities were involved in health research in low-income countries. Most of this research focussed on specific diseases such as malaria, tuberculosis and leprosy. This research was mainly funded through the Science Councils of the Netherlands Organisation for Scientific Research (NWO), which was funded by the Ministry of Education, Culture and Science. The NWO Science Councils represented the interest of Dutch academia and focussed on scientific excellence, which was described as publishing new insights in leading academic journals.
Problematising existing research collaboration
The origin of the new approach to North–South collaboration can be traced back to the late 80s, when the success of development aid, including the contribution of health research to development, was problematised [33]. In 1990, the newly appointed Minister for Development Cooperation in the Netherlands asked the RAWOO to study problems with existing research collaboration and provide advice on how the focus of health research for development could be geared more towards the needs of the South. In several reports, the RAWOO laid out why traditional research collaboration contributed little to health and development in low-income countries [34]. The main problems were that research for health in the South was mostly driven by the priorities of funders in the North, matched poorly with local needs and had a narrow focus on specific diseases. Research was mostly initiated and led by foreign researchers, there was little funding for locally specific, social and health systems research and there was little attention for the local dissemination and use of results [34, 35]. Within the South, research was often geared towards the interest of the elite, instead of the more marginalised. Due to the dependence on external funding, local research talent had to focus on international priorities and was turned away from national needs and local networks (RAWOO 1996). North–South research cooperation had helped to train researchers in the South, but had contributed little to the development of national institutions that were required for demand-driven and locally led research.
In response to these problems, the RAWOO formulated a vision in which health research for development should be (1) demand-driven, geared towards national priorities of countries in the South; (2) participatory, including all stakeholders in the South, especially the more marginalised; (3) strengthen local capacities of individuals, networks and institutions; (4) societal, multi-disciplinary research was required to deal with issues such as health; and (5) context specific, i.e. to be applicable, knowledge had to relate to local circumstances.
The Netherlands Minister for Development Cooperation supported this new vision and asked the RAWOO to collaborate with the NWO Science Councils to jointly translate these ideas into a new type of research programme that would generate demand-driven, locally led and nationally embedded research for health in a low-income country.
Struggle during the preparatory stage
The translation of this new vision into an actual research programme resulted in a long struggle in the Netherlands between the Science Councils and the development-oriented RAWOO. In June 1995, the RAWOO proposed a four-step process to develop a research programme together with a partner country in the South. The steps were to (1) identify and shortlist potential partner countries in the South; (2) map the health research situation and potential for collaboration in selected countries; (3) set up a local Steering Committee for a priority-setting process in the selected country; and (4) based on this country-specific research agenda, invite Dutch researchers to jointly develop a plan that would result in a programme for demand-driven and locally embedded research.
To facilitate the programming process in the Netherlands, a Programme Study Committee was set up with representatives of the RAWOO, the Science Councils and other stakeholders. At the first meeting of this new committee, representatives from the Science Councils started to question the approach that was proposed by the RAWOO. Science Council members claimed that a new programme should focus on scientific excellence and argued that engaging local stakeholders in the South would be very complicated. Instead of asking stakeholders in the South about their needs for research, Science Council representatives proposed that research priorities should be identified in the Netherlands before selecting a partner country in the South. The RAWOO members defended their ideas for a new approach by arguing that research for development should be demand-driven, locally led and embedded within a national infrastructure that would facilitate its use. Since health policies were mostly made within national systems, health research for development should be embedded in national structures, and not just be linked to a theme [2].
Selecting a partner country
While the discussions in the Netherlands between the Science Councils and RAWOO were ongoing, a partner country in the South had to be selected. To protect their existing research collaborations, Science Council members insisted that the new programme should start in a country in which they were not very active. After extensive consultations, Mozambique, Benin and Ghana were selected as potential partner countries. From March to April 1996, a Dutch research team interviewed 59 participants in these three countries to map the present state of health research, ongoing research activities, capacity-building needs and the potential for collaboration [2].
The mapping study provided further evidence for the problems with existing research collaboration and showed the need for a demand-driven approach. The report of the mapping study provides some illustrative quotations [3]. The Vice-Minister of Health in Mozambique confirmed the influence of the North on the research agenda: “Research is influenced by donors’ fashion, donors’ interest. We are heavily dependent on donors”. Another informant pointed to the consequences of the lack of local funding: “Each institute is developing towards isolation. We have not enough State funding”. Others addressed the difficulties with accessing scientific articles, and pointed to the mutual dependency that reproduced the existing system: “It is a kind of trade: they need the field, we are getting some funding”.
Based on the mapping study, Ghana was invited to jointly develop a new research programme. The Dutch were eager to collaborate with the Ghanaians because they had met with enthusiastic research advocates at the Ghanaian Ministry of Health, who aimed to make health research more useful for national development and had decentralised research to three health research units that were located in the north, centre and south of the country, with a coordinating research unit in the capital Accra [36]. While the Ghanaian government funded this research infrastructure, it provided no significant funding for demand-driven and locally led research. Local researchers generally depended on foreign funders, collaboration with foreign partners and international research priorities, and were keen to initiate and lead their own studies.
While the Ghanaians were invited to collaborate, the struggle between the Science Councils and the RAWOO continued. Science Councils representatives tried to change the way the programme was developed by suggesting that the Ghanaian research priorities should be taken as starting point for developing a thematic programme for the region. Next, they proposed to restrict priority setting in Ghana to areas in which Dutch researchers had considerable expertise. Difficult negotiations and strong support from the Netherlands Minister of Development Cooperation were required to continue the preparatory process.
Agenda-setting workshop in Ghana
In August 1996, a local steering committee was set up in Ghana, which was tasked with organising an agenda-setting workshop. Three groups of research stakeholders, which were referred to as ‘the three voices’, were identified to be engaged in the process. These were (1) health policymakers at all levels, (2) the research community, and (3) end-users, including health workers and NGO representatives who would serve as proxies for the more marginalised in Ghanaian society.
In March 1997, the first agenda setting workshop was held in Ghana. Over 100 participants from the government, health sector, research community and NGOs gathered for the first time to discuss the research needs of the Ghanaian health sector. A Ghanaian researcher later recalled the meeting and the diversity of participants: “everyone was together, from the ministry, policy, from research, many, you know, from NGOs […] I was surprised to see the people who were at the meeting. Some of them were from very grass root organisations who are operating small projects in the Volta Region and decided to come out. […] It was demystifying research as something that just academics do”.
The workshop resulted in a list of principles for a research programme within a North–South Collaboration:
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1.
The research agenda should be based on national needs
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2.
Ghanaians should take the lead in research projects and in choosing partners
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3.
Research should be inter-disciplinary and engage stakeholders throughout the process
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Research should be integrated with capacity-building
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5.
Research cooperation should be based on mutual respect
Programme development workshop in the Netherlands
The next step in the development of the programme was to organise a workshop in the Netherlands to discuss how the Dutch research community could contribute to the Ghanaian research needs. The Dutch researchers were keen to draw up a list of research topics that they could focus on. The Ghanaian representatives were more interested in how the programme would be organised and emphasised that agenda setting should be an ongoing process that would be driven by local needs. In the end, participants recommended to set up a Joint Programme Committee with Ghanaian and Dutch representatives who would guide the development of the programme and the priority-setting process.
Drawing up the final programme
In the Netherlands, the struggle between the Science Councils and RAWOO continued until the final programme proposal was submitted to the Minister in November 1997. For several months, representatives of the Science Councils refused to support and sign the programme proposal. They argued that the Dutch researchers had not been treated as equals during the design of the proposal and insisted that the research programme should be based on themes instead of national priorities and scientific quality criteria instead of societal needs. They demanded a Dutch steering committee that could overrule the Joint-Programme Committee. At its last meeting, the Programme Study Committee could not agree on how the programme should be led and asked the minister to decide.
In February 1998, the minister decided to fund a pre-implementation stage in which the Joint Programme Committee could set up and oversee task forces that would develop a first research priority agenda, identify capacity-building needs, draw up a strategy for enhancing research use and design an organisational structure. Soon after, elections were held in the Netherlands and a new minister for Development cooperation was installed, which delayed the process on the Dutch side. In 1999, the results from the taskforces were brought together and a 5-Year Programme of Work was drafted, which was submitted to the new Dutch Minister for Development Cooperation, who approved it at the start of 2001.
The Ghanaian-Dutch health research for development programme
The 5-Year Programme of Work describes the strategy of the research programme, its organisational structure and the expected outputs. It stated that the research programme had three pillars, namely (1) to better attune health research to the needs of the public policymakers and end-users or beneficiaries in Ghanaian society at large, thus making it more demand-driven; (2) to put greater emphasis on the need to strengthen national capacity for health research, and to enhance local ownership by empowering the Ghanaian research partners and local stakeholders; and (3) to redress imbalances in North–South collaborative research by promoting genuine research cooperation between Dutch and Ghanaian researchers, which should be based on mutual trust, joint learning and equal say, and influence in decision-making and programme management.
Organisational structure of the HRDP
The research programme followed a demand-driven programme cycle (Fig. 2). The research programme was managed by the existing Health Research Unit of the Ghana Health Service in Accra and formally led by the Joint Programme Committee, which was made up of three Ghanaian and three Dutch members. A separate secretariat in the Netherlands facilitated the process of involving Dutch researchers and would fund their work from a separate budget. For the first 5 years of the research programme, US$3.4 million was made available by the Netherlands Minister of Development Cooperation.
In this first part, we trace the 10-year preparatory process in which a new vision for North–South collaboration was developed and translated into a research programme for which a sponsorship constellation was established. The development of this programme started with problematising the contribution of research to health and development in the South and the traditional power relations that favoured the interest of researchers from the North. This problematisation inspired a new Minister for Development Cooperation in the Netherlands, who asked an expert committee to develop a vision for a more equal and effective approach to North–South research collaboration. Meanwhile, in Ghana, engaged policymakers were decentralising health research to three units and were aiming to orient research to the needs of the health sector. While Ghanaian and Dutch representatives set out to develop a more equal and effective research programme, representatives from science organisations in the Netherlands opposed the plan to use development funding for research that would focus on Southern needs and would be led by Southern researchers. A series of meetings and a thorough priority-setting process in Ghana confirmed the need for a demand-driven and locally led approach and was essential for developing the programme proposal that was eventually funded in 2001. The decision to approve and fund the 5-Year Programme of Work stabilised the sponsorship constellation in the Netherlands and allowed the demand-driven research programme in Ghana to start.
2001–2006: making a demand-driven research programme work
In this second part, we describe how the research programme functioned during the 5 years in which it was fully operational and funded 79 locally led studies in Ghana.
Research priority setting
The priority setting process showed there was a true need for demand-driven research in Ghana (Box 1). The national research agenda was very different from the priorities of foreign researchers and international funders. The four-page priority agenda did not mention any specific diseases, which used to be the main focus of research driven by the North. Besides different themes, participants in the agenda-setting process also emphasised the need for locally specific research. Examples include health beliefs among Ghanaians, reasons for enrolling in health insurance, local problems with antimicrobial resistance and differences in prices between the public and the private sector.
Box 1 The four themes and topics of the research agenda
1)
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Communication and community participation Specific needs: health education approaches in Ghana, beliefs relating to health and prevention, evaluation of existing communication approaches and related interventions in the field of the Priority Health Service Interventions, piloting community involvement in policy formulation, planning, implementation and evaluation at district level, and institutionalising community involvement.
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2)
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Quality of healthcare Specific needs: staff attitude, referral system, assurance of technical skills of providers, drugs and logistics management, and monitoring and confronting antimicrobial resistance.
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3)
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Financing of healthcare Specific needs: managing internally generated funds, improving management, formal and informal charges, pricing of drugs and services, introducing standardised pricing, comparative prices in private and public sectors, exemptions, especially for the poorest and most vulnerable, and cultural- and gender-sensitive mechanisms to target the truly indigent and most vulnerable clients.
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4)
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Decentralisation of healthcare Specific needs: multi-sector coordination, integrating funding and balancing national and local priorities.
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Participants were positive about the diversity of stakeholders that participated in the agenda-setting process. Policymakers had lobbied for issues related to health financing, decentralisation and quality of care that lay at the core of the 2001–2006 Health Sector Programme of Work of the Ghana Health Service. The academic community advocated for more biomedical issues, such as the status of antimicrobial resistance, and NGO representatives emphasised themes such as community engagement and access to care for the most vulnerable, poorest of the poor and truly indigent. Participants reported that, besides articulating priorities, the agenda-setting process was also useful for learning about ongoing research and policy processes and building a diverse national network of people engaged with demand-driven research.
Generating and selecting research proposals
In the first years of the programme, it proved more difficult than expected to generate locally led research proposals. In response to the first call for proposals in 2001, only 13 Letters of Intent were submitted and their methodological quality was below expectations. The disappointing number and quality of the proposals raised questions about whether sufficient local research capacity existed. The Joint Programme Committee insisted on keeping up its scientific standards and invited only six research teams to submit a full research proposal, of which it considered five good enough to be funded.
In response to the disappointing start, the programme secretariat tried in different ways to increase the number and quality of the proposals that were submitted. To reach more potential applicants, the secretariat advertised the second call for proposals in two national newspapers and promoted the programme in professional networks and during health sector meetings. To improve the quality of the proposals, the secretariat organised workshops in which applicants with good ideas could learn how to write a robust research proposal. In the subsequent years, both the number and quality of the letters of intent and full research proposals improved substantially, with 94 Letters of Intent and 31 funded studies in 2005 (Fig. 3).
The rapid growth of the number and quality of the research proposals showed that a substantial, but partly latent reservoir of research capacity existed (Fig. 4). In total, 304 Letters of Intent were submitted by 242 different lead applicants in response to the five calls for proposals. Only 5% of the 242 applicants submitted a Letter of Intent in the first year and 19% in the second year, and 71 eventually led a study.
When we asked those who submitted a research proposal about their involvement in research, several of them said that they did not consider themselves to be a ‘researcher’, as they worked primarily in a different role, such as policymaker or district health director. Many applicants had heard from others about the opportunities that the research programme offered and became involved because there was funding available to study issues that were related to their own concerns, experiences and aims in the health sector, such as improving vaccination coverage, adherence to tuberculosis treatment or managing health professionals.
Supporting research and strengthening capacities
The programme management experimented with different approaches to monitor the quality of research and support research teams. In the first years of the programme, two research coordinators travelled throughout the country to monitor the ongoing studies and provide hands-on support. Due to the growing number of studies, this support on location became too time-consuming. To increase efficiency, newly funded researchers were invited to an orientation meeting in which they were briefed about the programme guidelines. Researchers were asked to present their work at a mid-term review and, if further support was needed, teams could request technical advice from experienced researchers from their own area.
To strengthen research capacities, the programme organised workshops that focussed on specific skills, such as qualitative data analysis and report writing. In the first years, these workshops did not seem efficient, because the number of researchers was small and they had very different needs. A programme coordinator who ran the workshops explained: “it varies a lot […] we had qualitative people that could barely design tables, and those highly technical who could not bring it down to a practical level”. While the increasing number of researchers in the subsequent years made the workshop strategy more successful, it remained difficult to engage the most influential health sector professionals in the workshops. “We have tried a lot, but we haven’t been able to solve it. You want the key people who can conceptualise, write up and follow through until the presentation. Those key people are busy”.
The functioning of the research projects
Interviews with the research teams provided some insight into how the programme contributed to the functioning of health research in Ghana. Participants consistently described that, without the HRDP, their studies would not have been conducted because there was no other source of funding. An investigator explained “it is the only funding source available […] there are no alternative sources for doing our own research, so we rely on the programme”.
Besides funding research, the research programme also helped to strengthen local research capacities. For about half of the principal investigators, it was the first time they had initiated and led their own funded research project. These investigators often emphasised how beneficial it was to them to formulate and lead their own study and be responsible for the results. “I have gained a lot of skills from being in the lead. Writing a proposal and doing the reports, it has so much improved me”.
Several of these researchers said that leading their own study had helped them to build their confidence and inspired them to pursue a career in research: “I would not have moved into research. It is the first well-funded project I had. I would have put my ambition on the shelf. The research centre that I am building right now all started with this project”.
More experienced investigators described that the programme allowed them to study issues that they had long cared about. A regional health director provides an example: “The quality of the staff at the sub-district level is something that has bothered me for a long time and this enabled me to do some research on it. […] The fact that I am able to come up with a research report makes me stronger in the discussions when I raise these issues.”
An important challenge for these more experienced investigators was finding the time to conduct their research. Many of these investigators had influential functions or advisory roles in the health sector. Their experience and networks helped them to link research to needs, but their busy agendas made it difficult for them to allocate the time for research and programme activities. Several of these investigators described that they tried to engage more junior researchers in their studies and build teams that could support them in future projects. “We still have some of them working with us as a result of the training they received for this study”.
In addition to strengthening the capacity of individuals, participants said that the research programme contributed to the emergence of a more conducive research environment in Ghana. “Health research is getting bigger. More people are involved and there seems to be an emerging research culture”. Another investigator confirmed this: “It is helping to involve people in research and helping to keep some people in Ghana”.
The involvement of researchers from the Netherlands was less than anticipated. Ghanaian researchers could invite Dutch researchers to collaborate with them. These Dutch researchers were funded from a different budget. Even though most Ghanaian investigators said that they liked the idea of international collaboration, Dutch researchers were involved in only 14 of the 79 funded studies. Several Ghanaian investigators said that it was not necessary to bring in a foreign researcher for their specific study. Others said it was difficult to find a partner. When we asked why they engaged Dutch researchers in their proposals, Ghanaian participants said that they hoped to benefit from specific technical expertise, sharing of experience and perhaps new opportunities for future research through international collaboration. While some Dutch researchers were happy to play a supportive role in the Ghanaian-led studies, others said that they were not very interested because they did not like the more supportive role and could not do the research that they were most interested in.
External review of programme performance
An external review of the HRDP in 2005 confirmed that the programme succeeded in its aim of generating and supporting demand-driven and locally led research. The review was requested by the Joint Programme Committee, who asked independent reviewers to assess whether the programme had achieved its objectives and suggest how the results could be sustained into the future. The review team concluded that, in Ghana, a well-functioning set of institutions had been developed for setting a national research agenda, generating and selecting research proposals, and supporting research on location. In the report, the research agenda was described as “inclusive and consistent with the formal health sector priorities”. The system for short-listing Letters of Intent and reviewing proposals was described as “effective and highly commendable” and the organisational structure, relations and procedures for assessing and supporting research were described as well functioning. The reviewers concluded that, overall, the HRDP had generated a research cycle that was not only demand-driven but had actively involved the Ghanaian community. Mutual trust, respect and transparency had been developed between the Ghanaian and Dutch partners and provided a solid foundation for the future.
Assessing the use of research
Besides the functioning of the programme, the Joint Programme Committee was also interested in whether the programme strategy increased the likelihood that results were used. In March 2005, Dutch researchers were asked to start mapping the use and impact of the funded research. This first assessment was to include all 16 studies of which a final report had been submitted to the secretariat, and should focus on whether and how the results were translated into action and explore how this related to the strategy of the research programme.
The impact assessment revealed that, within 12 months after finalisation, the results of 10 of the 16 studies had been used to contribute to action [30]. The mapping study provides some insight into the kind of studies that were funded and the way that results were used. Some studies contributed to the functioning of existing health programmes. One example is a study that assessed the quality of the immunisation programme at the district level. The study showed several shortcomings in the vaccination process and a lower than reported coverage. Several recommendations were formulated and implemented, such as a new strategy for communicating with communities, better reporting and supervision, and a policy to abolish the illegal sale of medicine and food products by health workers at vaccination sites, which prevented the poorest of the poor from having their children vaccinated. A second study showed that essential medicine and consumables needed for preventing maternal mortality were often not available in rural clinics in northern Ghana. Participants described how the results were used to improve the distribution and supplies of consumables and strengthen the documentation system. A third study showed that distance to the clinic and the costs of transportation were important reasons why tuberculosis patients did not finish their treatment [37]. The results were used to open five new tuberculosis treatment spots and decide where they should be located.
Research also contributed to the development and implementation of new health programmes. One study focussed on ways to improve quality of care in health districts. The results were used to establish indicators and quality teams for monitoring and improving quality at the district level. Another study assessed how the new Community-based Health Services and Planning Initiative could be implemented. The results were used to develop a support package for implementing this planning initiative, which was used in districts throughout the country [38].
Three studies contributed to the design and implementation of the National Health Insurance Scheme, which was a key priority of the Ghanaian government [39]. One study had shown that the poorest community members were less likely to participate in district health insurance than others and were difficult to identify [40]. The results were used to adapt a method for identifying the poor and improve the local implementation of the insurance. A second study had focussed on the perception of, and the need for, community health insurance in northern Ghana. The results were used to identify structures for collecting premiums and organise a targeted campaign to increase participation in urban districts.
A challenging question was whether the use of research was related to the demand-driven strategy of the research programme. The systematic analysis of research and translation processes showed that the priority setting and proposal selection process led to the funding of studies which were from the outset closely aligned with health sector priorities. What seemed even more important, in terms of the eventual use of the results, was that research was initiated and conducted by people who aligned research to local needs and circumstances and tried to play a role in translating results into action [30].
Between 2001 and 2005 the research programme was thus increasingly successful in generating, funding and supporting demand-driven and locally led research. During these years, there was little attention for the sponsorship constellation that supported the programme. The approval and funding of the 5-Year Programme of Work by the Netherlands government in 2001 provided, at least temporarily, a protected space that allowed those involved to focus on the functioning of the research programme and the actual research projects. The external programme review and impact assessment showed that the HRDP succeeded in generating and supporting demand-driven and locally embedded research, of which the results were translated into action.
2006–2008: collapse of the sponsorship constellation
In early 2005, changes in the sponsorship constellation of the HRDP started to create uncertainty about its future. The first 5-Year Programme of Work would end in June 2006 and the expectation had always been that the Netherlands government would fund another 5-year period.
A number of changes heralded the breakdown of the sponsorship constellation that supported the research programme. In the Netherlands, a new Minister for Development Cooperation had been appointed who was less interested in research and disbanded the RAWOO, which had always supported the HRDP. A second change was that decision-making about development programmes was decentralised from the Ministry of Foreign Affairs in the Netherlands to the local embassies in recipient countries. In addition, the official at the Dutch embassy in Ghana, with whom the programme secretariat had always interacted, was replaced by someone else.
The new embassy official was initially very critical of the HRDP. The new official was unfamiliar with the RAWOO and had little knowledge about the origin and functioning of the research programme. In an interview about the programme, the new official started out with arguing that health research in countries such as Ghana was much too oriented towards international scientific publications, instead of local needs and contributing to action. Soon after, the new official announced that the embassy would not continue to fund the HRDP in its current format because it had to focus on Ghana itself and did not consider the funding of a North–South research collaboration as part of its mission.
While the future of the HRDP was uncertain and no new call for proposals was permitted, the programme was allowed to use the remaining budget to continue to support the ongoing research cycles. The 31 studies that were selected for funding in 2005 started in 2006. Research teams were invited to an orientation workshop, received targeted on-site support and could participate in workshops for data analysis and report writing and final reports were printed and disseminated.
In September 2008, the curtain finally fell on the HRDP. A 2-day dissemination meeting was held in the capital Accra. The programme management invited journalists to cover the event and asked the Ghanaian Minister of Health to speak about health research in Ghana. The Dutch evaluation team that had continued to assess the use of research was invited to present their results and an official from the Dutch embassy would explain its decision about the financial support for the research programme.
The 2-day meeting showed that the HRDP had helped to further develop the Ghanaian research community and strengthen the role of health research in Ghana. The meeting was attended by nearly 200 participants and over 40 studies were presented and discussed by researchers, policymakers and other research stakeholders. In his speech, the Minister of Health emphasised the importance of health research in Ghana and leading national newspapers covered the event. Participants at the meeting described how, during the past years, the perception of research within the health sector had changed. A policymaker told how research was increasingly valued within the Ministry of Health: “People start to recognise that research is critical”. A director of the Ghana Health Service, who was interviewed at the meeting, described something similar: “It is making a difference, because it is there, now there is a focus. You now see a group of people who put appreciation and a premium to research. So already we are beginning to see a research culture, a growing idea that research is relevant to the system. Without this programme this would not be there. People are interested in PhDs and the HRU [Health Research Unit] has got a very positive image”.
The assessment of the use of research provided further evidence of the success of the research programme. Within 12 months after their finalisation, the results of 20 of the 30 assessed studies were translated into action [30]. Compared to other research programmes, this number seemed high. Analysis of how and why research had been used suggested that the programme strategy, with its emphasis on demand-driven and locally led research, was an important factor behind this success rate.
While the new official at the Netherlands embassy had become more positive about the research programme and recognised its success, he still announced that the Netherlands government would end the direct funding of the HRDP. The new official described the 2005 Paris declaration on Aid Effectiveness as the main reason for not continuing the direct funding. Central to the Paris declaration was the commitment to help the governments of developing countries formulate and implement their own national development plans, according to their own national priorities, using, wherever possible, their own planning and implementation systems. Keywords were ownership, alignment and harmonisation. Aid had to be pooled in support of a particular strategy led by a recipient country – a national health plan, for example – rather than being fragmented into multiple individual projects. For the new embassy official, this meant that the HRDP should no longer be funded as a separate programme. Instead, all funding should be provided to the Ghanaian government as part of multi-donor budget support for the health sector. National priorities should determine if the money was to be allocated to health research. This decision brought an end to the formal existence of the Ghanaian-Dutch HRDP.
The official of the Netherlands embassy presented this decision as a new phase in the development of health research in Ghana. Ghanaian researchers were critical in their response to the idea that this was a new phase. They pointed out that, for years, local researchers had lobbied with the government for a reasonable budget for research. The Ministry of Health had always welcomed the idea, and even pledged to allocate 5% of the budget of the Ghana Health Service to research, but had so far not provided additional funding. At the 2008 dissemination meeting, an official of the Ministry announced that it would establish a budget line for research and was planning to play a larger role in health research. When, at the meeting, a critical researcher asked about the budget plans of the Ministry, the official admitted that it was unlikely that new funding would be allocated to research in the 2009 budget plan.
During an interview in early 2009, we asked two officials from the Ministry of Health why the Ministry had not increased its funding for research. The participants explained that, while research was seen as important, senior staff at the ministry considered research a domain for which a lot of international funding was available. “Before the Dutch, we had the British and the Swedes, and now there is a lot of American funding, you know, USAID, Gates. There is the WHO and Global Fund and there are many others”. The participants explained that, while funding for research seemed available, the Ministry was constantly struggling with a lack of resources and an uncertain stream of donor-driven funding and changing development trends. As a result, those in charge at the ministry had a strong preference for investing in concrete projects with clear short-term results.
Without a realistic budget for demand-driven and locally led research, the organisational arrangements that were set up to run the demand-driven research programme were not maintained. Core staff of the programme continued to lead the existing Health Research Units, secured new research grants from international and donor agencies, and moved on to new positions and other organisations.