Using a rapid environmental scan methodology to map country-level global health research expertise in Canada

Background Many countries are currently rethinking their global health research funding priorities. When resources are limited, it is important to understand and use information about existing research strengths to inform research strategies and investments and to drive impact. This study describes a method to rapidly assess a country’s global health research expertise and applies this method in the Canadian context. Methods We developed a three-pronged rapid environmental scan to evaluate Canadian global health research expertise that focused on research funding inputs, research activities and research outputs. We assessed research funding inputs from Canada’s national health research funding agency and identified the 30 Canadian universities that received the most global health research funding. We systematically searched university websites and secondary databases to identify research activities, including research centres, research chairs and research training programmes. To evaluate research outputs, we searched PubMed to identify global health research publications by Canadian university-affiliated researchers. We used these three perspectives to develop a more nuanced understanding of Canadian strengths in global health research from different perspectives. Results Canada’s main global health research funder, the Canadian Institutes of Health Research, invested a total of $314 M from 2000 to 2016 on global health research grants. This investment has contributed to Canada’s wealth of global health research expertise, including 12 training programmes, 27 Canada Research Chairs, 6 research centres and 30 WHO Collaborating Centres across 27 universities. Research activities were concentrated in Canada’s biggest cities and most commonly focused on health equity and globalisation issues. Canadian-affiliated researchers have contributed to a research output of 822 unique publications on PubMed. There is an opportunity to build global health expertise in regions not already concentrated with research activity, focusing on transnational risks and neglected conditions research. Conclusions Our three-pronged approach allowed us to rapidly identify clear geographic and substantive areas of strength in Canadian global health research, including urban regions and research focused on health equity and globalisation topics. This information can be used to support research policy directives, including to inform a Canadian global health research strategy, and to allow relevant academic institutions and funding organisations to make more strategic decisions regarding their future investments.


Background
The global health research funding landscape is complex, with multiple public and private groups that vary greatly in their financing capacities and research interests. Despite the variation, a large proportion of health research funding comes from funding bodies in high-income countries [1]. As national priorities shift and funders explore new ways of setting research agendas [2], it is important that strategies are informed by knowledge of the relevant jurisdiction's current strengths and future opportunities. Building on strengths is particularly beneficial when aiming to maximise limited research funding [3] and identifying existing research strengths in global health can assist countries in effectively leveraging these domestic assets in their foreign policy and international development efforts [4].
In the Canadian context, research funders are estimated to collectively invest C$90 million per year in global health research activities [5]. Yet, despite this sum, the Canadian funding landscape for global health has been criticised for being uncoordinated and inefficient [5]. Box 1 describes the roles of Canada's main global health funders; however, as a 'middle power', Canada cannot meaningfully invest in all areas of global health research concomitantly. Identifying existing strengths in research expertise may prove difficult, especially for countries with limited resource capacity. Despite the range of literature on programme implementation and evaluation frameworks, to the best of our knowledge, there is no existing framework that can be used to capture research expertise at the national level. We sought to fill this gap by developing a framework that provides a systematic approach to identifying expertise by drawing upon a range of research inputs, activities and outputs. In this manuscript we aimed to (1) summarise and critically evaluate the available evidence on global health research expertise at Canadian universities through research inputs, activities and outputs (Fig. 1), and (2) assess Canada's overall global health research expertise using strengths in select research inputs, activities and outputs [6,7].

Methods
We developed a three-pronged analytic framework that includes research inputs, activities and outputs. For this assessment, research 'inputs' were global health research funding from Canadian Institutes of Health Research (CIHR)the Canadian funder with the largest focus on domestic global health research capacity. Research 'activities' included research training programmes in academic institutions, programmes aimed at recruiting top research talent in the country (e.g. Canada Research Chairs (CRC) Program), research centres at these institutions and formal research partnerships with multilateral health organisations (e.g. WHO Collaborating Centres). To varying degrees, these activities contribute to research 'outputs' such as published literature [11][12][13].

Study definitions, sample and qualitative coding
We defined global health research as research focusing on health, health systems, health inequities and health policy challenges facing populations living in conditions of vulnerability in both low-and middle-income countries (LMICs) and high-income countries [7]. We identified research activities by systematically searching for research training programmes, research centres and research chairs focused on global health. We mapped research outputs by identifying highly cited authors, their affiliated universities and their  [7]. Database and web searches were conducted in March 2018. When applicable, we coded activities and outputs using a previously developed system of 13 research areas and four research themes (Box 2), which are consistent with the CIHR's mandates, research pillars and institutes [7,14]. When activities and outputs pertained to multiple foci, they were coded using the most-fitting primary focus. Activities and outputs were coded as 'other' when there was inadequate information.

Identifying research activities Global health research training programmes
We defined research training programmes as any research-focused graduate education programmes that explicitly focused on global health. An explicit focus on global health was indicated by the words 'global health' or 'international health' in the name of the programme, or any of its concentrations or specialisations. Indicators of a research-focused programme (as opposed to a professional focus) included a requirement or option to complete a thesis or major research project (as opposed to an internship, practicum or coursework-only programme).
We conducted three sets of systematic searches (Fig. 2) to identify global health research training programmes. The first systematic search focused on the main websites of the 30 most funded universities from our dataset of CIHR funding, while the second focused on the specific graduate studies websites of all 30 universities. Both types of websites were searched for the following terms: 'global health', 'international health', 'santé mondiale', 'santé internationale' and 'santé globale'. The first 100 results of each search were manually reviewed; this number was selected to balance the relevance of the result to the research question and screening feasibility. To supplement internet searches, a third systematic search used an administrative database on Canadian university programmesthe Universities Canada Database [15]. The aforementioned terms were used to search this database as well. The combined results of these searches were revisited and available programme descriptions were consulted to yield a list of global health research training programmes.

Canada Research Chairs in Global Health
The Canada Research Chairs (CRC) Program is a federal initiative that funds 2000 university professorships to attract and retain top research talent [16,17]. We searched profiles in the CRCP Database for individuals conducting global health research using the following terms: 'global health', 'international health', 'population health' and 'health equity'. This database contained information such as the Chair's name, title, tier, host university, biography and research discipline.

Research centres and WHO Collaborating Centres
Global health research centres were defined as organised groups or units conducting research on global health that have been officially recognised as such by their host universities. We conducted two sets of systematic searches of the 30 universities' websites to identify relevant centres (Fig. 2). First, we searched the internal websites of these universities using the same key terms as our searches for research training programmes and reviewed the first 100 results. Second, we conducted an This tab led to webpages that listed all research centres hosted by the university. We reviewed the lists available on these web pages to identify centres that conducted global health research. WHO Collaborating Centres are institutions or groups that conduct activities in support of WHO's various initiatives [18]. Designated by WHO's Director-General, Collaborating Centres can often partake in activities like research, training and education, advising WHO staff on specific topics, and collecting and collating information and resources [18]. We searched the WHO Collaborating Centres Database for information on the title of the centre, the designated parent institution (i.e. usually a university), the subjects of focus and the types of activities conducted [18,19]. This information allowed us to understand which Canadian universities were involved and in what capacity, including which subject areas and what types of activities.

Identifying research outputs Prominent focus areas of publications
We searched PubMed using a structured search query combining the Medical Subject Heading (MeSH) term 'Global Health' and Author Affiliation 'Canada' for articles published recently, from January 1, 2013, to March 1, 2018. We exported the search results and qualitatively coded abstracts to identify the foci of each global health research publication involving Canadian-affiliated authors as either as primary authors or as co-authors [7].

Quantity of publications at 30 universities
We conducted an additional search of PubMed for publications from April 1, 2000, to March 31, 2016, to identify the quantity of global health publications produced by authors affiliated with the 30 universities. We used this time period to match the fiscal-year funding period data provided by CIHR. In these searches, we used the Global Health MeSH term and, for the Affiliation field, we searched the names of each of the 30 universities.

Results
Our search shows that universities have developed their capacity in global health research to varying degrees. Canadian universities have a diverse range of global health research activity -12 global health research training programmes, 26 CRCs in global health, 6 research centres in global health and 30 WHO collaborating centres (Table 1). Canadian global health research outputs include 822 unique citations with a Global Health MeSH in the PubMed database, with authors primarily belonging to universities in urban areas and research topics primarily focusing on 'health equity' and 'globalization'.

Global health research training programmes
We identified 12 global health research training programmes at 8 universities as described in Table 2; 4 universitieslocated in Toronto, Montreal, Alberta and Londonhosted two programmes each, while the other 4 universities each hosted a single programme. Among the 12 programmes, 9 were Masters degree programmes, while 3 were doctoral programmes.

Canada Research Chairs in Global Health
Searching the CRC Database identified 26 individual chairs in different research disciplines at 10 universities and in 1 non-sample university (Table 3). Most CRCs in this search are at institutions in Montreal, Toronto, Vancouver and Ottawa, with 5 chairs in Montreal and 4 each in Toronto, Vancouver and Ottawa.
The majority of these CRCs conducted research that fits under CIHR's population health research pillar (65%) and 38% specifically focused on globalisation. The   Funding data obtained from Canadian Institutes of Health Research. Publication counts include duplicates whenever records were co-authored by researchers at more than one of the 30 universities; there were 822 unique publications programme supports both "exceptional emerging researchers" and "outstanding established researchers", given the Tier 2 and Tier 1 title, respectively [16]. More than half are Tier 2 CRCs (58%), while the remaining 42% are Tier 1 CRCs. Women made up 34% (n = 9) of the CRCs in global health.

Research centres and WHO Collaborating Centres
There are 6 officially recognised groups dedicated to conducting global health research (  [20][21][22]. Within health equity, publications were focused on issues pertaining to child and maternal health, with research involving sex workers, adolescents and Indigenous peoples appearing less often [23,24]. Publications on neglected conditions included studies on malaria, polio and tuberculosis in LMIC contexts, while publications on transnational risks looked at infectious diseases with pandemic potential [25].  (Table 6). These 30 researchers were primary authors or co-authors on at least four or more of the 822 publications; 3 of 26 CRCs also appeared on this list. The second PubMed search of  published literature yielded a total of 1069 citations. Each of these citations has at least 1 author with an affiliation at 1 of the 30 universities and the search showed that university-affiliated researchers that were situated in urban areas (Toronto and Montreal) produced the most publications classified with the Global Health MeSH term.

Discussion
This study developed a three-pronged approach to map a country's global health research strengths and expertise using research inputs, activities and outputs. The rapid environmental scan employed publicly available administrative datasets to paint a picture of the current landscape of Canada's global health research expertise. Methods such as these can help shape policy when there is an urgent or time-sensitive need to assess strengths using an efficient, yet simple and resource-friendly approach. Our findings can continue supporting strategic and evidence-informed funding policies for Canada's global health research stakeholders.

Global health research in Canada
Our searches show that the main global health research strengths in Canada are health equity and globalisation. Health equity was the most common focus of research funded by CIHR grants. This research tended to focus on maternal and child health in LMICs and reflects Canada's international development assistance priorities over the past decade [6]. Globalisation also emerged as the most common focus of CRC research interests and the focus of publications captured in the PubMed search. Future studies should explore this finding in greater detail. Our approach suggests that Canada's global health research expertise may be highly concentrated within a few urban areas. Based on the measures used in this scan, global health research activity appears to be flourishing in Toronto and Montreal, with the strongest contributions from 2 universities (Fig. 3). These 2 particular universities received the most CIHR global health research funding, which translated to the greatest global health research activity out of the 30 universities. We hypothesise that urban regions generallyand these universities in particularmay be benefiting from a positive feedback loop involving higher research funding levels, more CRCs, and increased research training opportunities and reputations for overall research excellence. The benefits of being situated in urban areas may include larger networks of researchers and society/government partners and better access to physical resources like high-containment biohazard labs and large teaching hospitals.
While global health research expertise is concentrated in Toronto and Montreal, at least some expertise is found in nearly all research-intensive universities across the country. Specifically, 27 of 30 universities studied here are involved in global health research through different combinations of activities. Interestingly, some universities had research centres devoted specifically to global health, but we could not identify any global health training programmes. Alternatively, universities can be less engaged with global health research training programmes, CRCs and published research contributions, while still hosting WHO Collaborating Centres.

Strengths and limitations
This rapid environmental scan methodology allowed us to summarise existing data on Canada's global health research expertise. Strengths of the method include its careful integration of a logical framework (one that considers a variety of inputs, activities and outputs), the use of publicly available data, and both methodological and data triangulation. The logical framework ensures that research inputs can be systematically attributed to research activities and research outputs that are relevant to each individual country. Using publicly available data reduces the barriers that arise from a lack of access. For example, other inputs include grants from industry yet, due to privacy laws, this type of information is not available publicly. The methodological triangulation and data triangulation ensure built-in redundancies that can help verify and challenge findings. A limitation of this rapid environmental scan methodology is that it relies heavily on web searches and databases, which are only as accurate and up to date as the information posted on websites and databases. Institutions may be slow to update their websites; therefore, some of the information found may be outdated and could bias the findings to only the most recent items Table 6 The 30 authors with the greatest quantity of publications coded with the Global Health MeSH and Canadian affiliations from January 1, 2013, to March 1, 2018 [27]. Web-based searches are also limited in their ability to identify webinars and other similar training sessions, typically biasing the findings to only the most recent training sessions. Databases may not follow a standard data collection protocol; for example, when applying this method to the Canadian context we found that some CRCs may not have been captured in our search because the CRCs did not have any information beyond their name or chair title uploaded for our search string to pick up. Additionally, relying on the Global Health MeSH in the PubMed database may skew the assessment of research productivity in favour of certain kinds of research outputs. The MeSH captures "research on improving health and achieving equity in health for all people" but would not capture all of the biomedical, clinical, health systems and epidemiological research relevant to the field of global health. Developing a better, optimised PubMed search string for global health research that was both highly sensitive and specific would have been better but was beyond the scope of this rapid scan.

Conclusions
This study sought to develop a rapid environmental scan methodology to map where a country's global health research expertise lies, both geographically and substantively. Our framework and three-pronged approach was highly effective in responding to the real-time evidence needs of decision-makers in Canada. Other researchers can build on this approach to map expertise and research strengths in other settings and, where timelines allow, may consider adding more indicators (e.g. global health conferences/workshops as activities or registered patents as outputs) or incorporating additional data sources, including surveys of universities and keyinformant interviews with stakeholders.
Additional file 1. Workflow diagram of inputs, activities and outputs.