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African Regional Capacity Development for Health Systems and Services Research

Final Report Summary - ARCADE HSSR (African Regional Capacity Development for Health Systems and Services Research)

Executive Summary:
ARCADE HSSR is a collaboration of strong southern universities (Stellenbosch University – SU, Makerere University – MU, Muhimbili University of Health and Allied Sciences – MUHAS, and Malawi University College of Medicine – MA) and northern counterparts (Karolinska Institutet – KI, Institute of Development Studies –IDS, and Kunnskapssenteret – KS). The project has, over four years, focused on building capacity in health systems and services research (HSSR) in sub-Saharan African (SSA) universities.

Aims: The aim was to create research capacity in HSSR through 1) creating training resources 2) institutional capacity development in two high level regional training hubs (Makerere University, MU, in Uganda and Stellenbosch University, SU, in South Africa) to support HSSR and 3) South-South network development for training and research.

Activities: The project engaged in several activities: 1) Needs assessment for high level HSSR training 2) Development of learning modules 3) Delivery of post-graduate blended learning courses 4) ARCADE cross partner research project groups with mentoring 5) Institutional capacity for joint degrees, grant management and dissemination 6) ARCADE output dissemination

Results: The ARCADE HSSR consortium developed 11 blended learning courses and 6 self learning courses. In addition to these, the consortium developed an eBook on implementation research and a MOOC on pragmatic randomized controlled trials. Five of the blended learning courses were delivered in collaboration with more than one university, while the rest were delivered or are scheduled to be delivered only at one partner university. Through delivering these courses, the project has reached nearly 300 masters and PhD students, and exposed them to HSSR training. Importantly, many of these students are women, and many had young children, which meant that those who may not have been able to travel previously to attend training were now exposed to excellent courses.

Through innovative blended learning approaches, students could engage in excellent training without either students or staff having to travel to another university. Importantly, double PhD degree training agreements were signed between SU, MU and SU and KI, creating, together with the existing double degree agreement between MU and KI, a triangle of excellent universities. In addition to training activities, the collaboration has engaged grants offices at hub universities, SU, MU and KI. These universities’ grants offices shared SOPs and best practices, and presented their work at grants management conferences. Students and staff at participating institutions were exposed to communications training, particularly communicating with policymakers and other stakeholders. Through these capacity building activities, and the storage of eight of the courses developed on the online course repository developed by the project, the results of ARCADE HSSR can have a lasting impact on research capacity not only in the SSA region, but globally. 

Project Context and Objectives:
Introduction
ARCADE HSSR is a collaboration of strong African universities and northern institutions that targets PhD and post-doctoral training in Sub-Saharan Africa with the aim of developing a sustainable research environment to foster a new generation of African researchers specializing in health services and health systems research (HSSR).

Project settings
Karolinska Institutet (KI) in Sweden is the coordinator of ARCADE HSSR. In addition to KI, there are six other university partners. Two of these are northern institutions, Institute for Development Studies (IDS) in the UK and the Norwegian Knowledge Centre for Health Services (KS) in Norway. The rest of the universities are based in sub-Saharan Africa (SSA): two hub African universities Makerere University (MU) in Uganda, and Stellenbosch University (SU) in South Africa, and two non-hubs,the Muhimbili University of Health and Allied Sciences (MUHAS) in Tanzania and the University of Malawi (MA), College of Medicine. ARCADE works on the principle of collaboration, with most work packages being led by African institutions. ARCADE HSSR has a sister project, ARCADE RSDH, which is also funded by the European Commission Framework 7 agreement. Each SSA university’s medical faculty is engaged in the project.

Project focus areas
The project centres on creating innovative, blended and e-learning courses for students and staff particularly in sub-Saharan Africa. ARCADE HSSR focused on courses in health systems and services research, to eventually impact on country health systems and to support country policymakers in making evidence-based decisions. The courses were aimed at postgraduate students in SSA and beyond.

Project aims
ARCADE HSSR aims to increase the regional capacity of Sub Saharan Africa to strengthen service delivery and system design by training scientists to conduct relevant research needed to inform these decisions. The aim was to create this capacity through 1) creating training resources 2) institutional capacity development in two high level regional training hubs (Makerere University, MU, in Uganda and Stellenbosch University, SU, in South Africa) to support HSSR and 3) South-South network development for training and research.

Specific objectives

Part 1: Needs assessment for high-level HSSR training

Objectives
1. To describe the demography and flow of students in disciplines related to health services strengthening in SSA partner organisations, and to identify barriers and facilitators to improving the flow of such students into doctoral programmes in relevant disciplines;
2. To identify organisational strengths and areas for capacity development among southern partners;
3. To identify and summarise existing research capacity development activities and projects in sub Saharan Africa, in the disciplines related to strengthening of health services;
4. To identify learning modules needed for research competence in core curriculum of health services and systems strengthening;
5. To review existing learning materials in SSA or elsewhere and describe their coverage, currency, copyright and availability;
6. To identify gaps in learning materials, and describe new modules needed, or identify existing modules for updating or adaptation.

Part 2: Development of learning modules

Objectives
1. To review the identified teaching materials and identify those which appear to have the highest potential for HSSR training;
2. In parallel with the needs assessment in WP2, to determine areas where teaching materials of sufficiently high quality are not available and develop materials to address these areas;
3. Based on the above, to compile training modules, each providing for up to 20 hours of didactic and self-learning materials tuition, covering the planned curriculum described by WP2;
4. To provide key learning materials, exercises and assessment procedures for each module.

Part 3: Delivery of post-graduate blended learning courses

Objectives
1. To facilitate teaching/learning in innovative ways, by using appropriate technology and providing opportunities through decentralised learning;
2. To develop, and implement, a web platform on which modules can be mounted for download, with capacity for student registration, interactive learning, and progress assessment and testing;
3. To develop the capacity of participating faculty and students in the use of ICT to support postgraduate studies;
4. To implement course modules in blended learning approaches with a mix of face-to-face, web based and self-learning courses at each hub university.

Part 4: ARCADE cross partner research project groups with mentoring

Objectives
1. To develop south-south research groups and programmes, led by faculty from southern institutions in order to provide a framework for mentoring students in research;
2. To develop mentoring system of graduates in sandwich model training, where they receive training in hub institutions, and take part in mentored research programmes in their home health services;
3. To create a pipeline of masters students, doctoral students, postdoctoral research fellows with excellent training and mentored research experience to become faculty at partner institutions.

Part 5: Institutional capacity for joint degrees, grant management and dissemination

Objectives
1. To establish joint degree programmes between northern partners and southern partners; and between southern partners;
2. To strengthen institutional grants office capacity at SSA hubs through transfer of standard operating procedures (SOP), and staff exchange between northern and southern, and southern and southern partners;
3. To develop capacity within and between partners in communication, engagement and dissemination to extend the reach of ARCADE;
4. To establish a functional dissemination office in each SSA partner with SOPs and skilled staff.

Part 6: ARCADE output dissemination

Objective
1. To define and connect with key audiences for the course materials;
2. To produce high quality knowledge products in forms which are accessible to target audiences;
3. To maximise impact, influence and uptake of the course materials among target audiences particularly students and policy makers;
4. To design, launch and populate a web space for the capture of project learning and outputs.
Project Results:
Part 1: Needs Assessment for high level HSSR training

MU led data collection for the needs assessment and developed data collection forms to identify resources, capacity and student flow at each university, in order to map the needs that ARCADE HSSR would address. The analysis of the collected data resulted in a needs assessment report that made recommendations for the development of learning modules. The objectives below detail the progress made during the needs assessment exercise.

Objective 1: Describing the demography and flow of students in disciplines related to health services strengthening in SSA partner organisations, and to identify barriers and facilitators to improving the flow of such students into doctoral programmes in relevant disciplines

The data collection forms sent by MU to each partner university’s medical and health science faculties included a questionnaire to past and present PhD students and those who had given up on their studies or had not been admitted to PhD studies. The questionnaire collected demographic information, and barriers and facilitators to PhD studies. Student and faculty demographic data were also collected from academic registers. Focus groups discussions, centering on entry to PhD studies were also conducted at MU. Key informant interviews were conducted to discuss barriers and facilitators to the flow of students into doctoral programmes. The average age of responding students was 39 years (with an average age of PhD admission 37 years); most were married; and the percentage of female PhD students varied widely from 27% at Malawi Medical College to 57% at Stellenbosch, with an overall share of 56%. The results indicated that motivating factors to accessing to PhD training in SSA included: a) commitment of supervisors; b) availability funds to support PhD research; c) stipend or salary support; d) availability of web-mounted freely downloadable PhD modules; and e) sandwich PhD training programmes in which training is shared between home and foreign universities. Barriers to PhD education included: a) procurement delays (for research equipment); b) lack of scholarships; c) family commitments (especially for female students); d) poor Internet connectivity; e) inadequate administrative/institutional support; and f) lack of reading materials/books.

Objective 2: Identifying organisational strengths and areas for capacity development among southern partners

Data for this objective were obtained through reviewing partners’ organizational structure, staffing levels and staff qualifications. Partner infrastructure was assessed through a survey and updated inventories that were provided to the needs assessment team.
The results suggested that most of the professors at participating institutions were male (85% or above), with increasingly more female staff among associate professors and lecturers. The overall share of PhD holders among the faculty was approximately 83%. The infrastructure analysis showed that there were on average 10 computer units with Internet per department. Other infrastructure for training included lecture halls, conference rooms, TV/video systems and LCD projectors, with less availability of video conferencing equipment.

Objective 3: Identifying and summarising existing research capacity development activities and projects in sub-Saharan Africa, in the disciplines related to strengthening of health services

The Makerere team also surveyed existing capacity development activities and projects in Sub-Saharan Africa, such as grants management offices and systems, research training programmes, supervisor/mentor training, Institutional Review Board availability and training, and availability of training grants. The results indicated that there was good institutional capacity to conduct research and capture grants to fund research projects, but minimal focus on HSSR related training at the four SSA institutions. Most of the training in health sciences was in clinical sciences, not in HSSR.

Objective 4: Identifying learning modules needed for research competence in core curriculum of health services and systems strengthening and Objective 5: Reviewing existing learning materials in SSA or elsewhere and describe their coverage, currency, copyright and availability

The team reviewed existing HSSR programme curricula and learning materials. Training course information was obtained from the websites of participating African institutions and northern institutions such as IDS, University of Michigan, and Walden University. The list of courses available at northern HSSR training programmes was compared to the courses at participating SSA universities, and the modules for HSSR capacity development were identified (see box 1 in attachments). The needs assessment process indicated that only a few HSSR related modules are being offered in masters training programs and that no HSSR courses were currently available at PhD level in SSA.

Objective 6: Identifying gaps in learning materials, and describing new modules needed, or identifying existing modules for updating or adaptation

The results of the review of existing learning materials in sub-Saharan Africa were compared with curricula at northern universities, in order to identify possible gaps in learning materials. The comparison indicated that northern universities had HSR-related courses at PhD level, while courses in sub-Saharan Africa were at Master’s level only. Many HSSR courses were not given independently but were included into a public health curriculum. The needs assessment also indicated that freely downloadable web-mounted HSSR related PhD-level training modules were not available in any of the partner institutions in SSA.

Conclusion part 1
The needs assessment identified that online, blended or e-learning modules were needed in SSA on HSSR topics. The partner universities had good infrastructure for training, but less availability of videoconferencing equipment. The human resource capacity at participating instititutions was mostly male, a pattern that was repeated for PhD students at most participating universities. The only exception to this was PhD students at SU, where there were slightly more females in training. The needs assessment successfully identified training courses for development within ARCADE HSSR.

Part 2: Development of learning modules

Based on the skills available within the consortium and the needs assessment, the consortium began to develop learning modules on HSSR topics. This work began with organising a working group of course conveners and setting up communications among this group. The group initially met to focus on course content development, while a parallel group focused on experimenting with software for teaching blended courses. Once training modules were developed, the consortium developed the Online Course Repository (OCR), to store developed modules and courses.

Objective 1: Reviewing the identified teaching materials and reviewing those that appear to have the highest potential for HSSR training

In addition to the course review work conducted as part of the needs assessment, IDS reviewed a number of resourses offering online based courses, such as “Knowledge for Health”, “Coursera”, LSHTM Distance Learning Programme, Johns Hopkins online courses and MEASURE DHS, and identified relevant modules that could be adapted as ARCADE self-study modules. Examples of such modules that were adapted for ARCADE use are Introduction to Health systems and Complex Adaptive Systems online courses developed by the Future Health Systems project in collaboration with John Hopkins University, that were adapted for ARCADE use.

Objective 2: Determining areas where teaching materials of sufficiently high quality are not available and develop materials to address these areas

Box 1 had identified areas where HSSR training courses were needed. These course topics were then mapped against the needs identified in ARCADE HSSR protocol development. The consortium developed courses based on these categories, and based on the skills available in the consortium. Throughout this process, KI and IDS monitored course development. The final list of courses based on the above exercise is presented in table 1. As can be seen from the table, the consortium developed a set of courses that address many facets of HSSR training needs, including both qualitative and quantitative methods and health systems knowledge, including health systems research methods.

Objective 3: To compile training modules, each providing for up to 20 hours of didactic and self learning materials tuition, covering the planned curriculum described by WP2

In the four-year period, ARCADE HSSR developed 11 blended courses and six self learning (eLearning) modules. The hub universities (MU and SU) did most of the course development work, with increased participation by non-hub SSA partners towards the end of the project. One of the key achievements of ARCADE HSSR is the leadership of SSA institutions in the project, with lessening input from northern partners. All of the blended learning courses provide more than 20 hours of didactic teaching material, and most are at least a week long in duration. Table 2 in attachment details the blended learning courses developed by the consortium, including total hours of teaching material.

In addition to the blended courses, ARCADE HSSR together with the partner project, ARCADE RSDH, developed an EdX MOOC (“massive Open Online Course”) on pragmatic randomized trials in health care (https://www.edx.org/course/pragmatic-randomized-controlled-trials-kix-kipractihx).

The course aimed to equip students with an understanding of the principles of pragmatic randomized controlled trials in combination with economic and qualitative methods, be able to apply these to develop research proposals, and to critique research proposals of these kinds of trials.

This process was led by KI, with the main work conducted by Merrick Zwarenstein, Irina Motoc, Salla Atkins and Vinod Diwan. In total, 7646 students signed on for the MOOC. Three of the lecturers participated during the live course by answering student questions posted on the Discussion Board. Irina Motoc and Dr. Zwarenstein also monitored the Discussion Board in order to gain a sense of student development and progression. He noted students' concerns regarding deadlines, self-assessment questions and the weekly assignment (Building Your Own Protocol) and discussed with course staff ways to improve these elements. Immediate concerns were addressed during the course. Dr. Zwarenstein also read a few randomly selected submissions for the Building Your Protocol assignment for every section as the course progressed. He evaluated 15 final Protocol submissions (9% of all submitted Protocols) in order to get an idea of the output of the students. He found that a few submissions were very good, most were well done and the remainder needed improvement. Overall, the Building Your Protocol Assignment component of the course was successful in helping students develop a successful pragmatic RCT Protocol. In the end, 648 students started the class, and 153 received a certificate, that is, successfully completed the coursework. The most students registered per country, based on access IP addresses, were the US, India, and the UK. The course demographics indicated that 54% of participants had a master’s degree, while 4% had a PhD. In total 55% were male, 29% were registered at a university. KI plans to take develop this course further, and deliver it as a blended course locally, while also making it available globally as a self paced MOOC, on the edX platform.

Related to the MOOC topic, Dr Atkins from KI and Dr Lewin from KS also collaborated on a book chapter on qualitative evaluations alongside randomized controlled trials. The chapter was published in a collection of chapters in a book called “Complex interventions in health: An overview of research methods”. This book includes a variety of topics that can help students learn about evaluating complex interventions. In addition to the above blended modules and the MOOC, six self-study modules were also developed by IDS. Some of these were adapted from other research groups and consortia, in some cases by adding voice-overs using Camtasia. These modules have been made available on the Open Course Repository. Table 3 details the modules available.

Due to the existing MOU between IDS and the University of Sussex, the institute was unable to offer jointly accredited courses. As a result IDS instead focused its energy and resources into the development of elearning self- study modules and the ebook on Implementation Research. The courses listed above contain teaching materials that either a student (in self study mode at their own pace) or a teacher (through a blended learning or flipped classroom mode) could use. The Challenges faced by Health Systems module and the mhealth module contains lecture videos, Powerpoint presentations, an etextbook course overview, essential and additional readings and exercises. Both modules will be uploaded to the IDS moodle (currently being developed) and offered as free resources. The further three self study modules are a mixture of lectures and reading materials that would be best used as supplementary teaching materials and have been adapted to serve such a purpose.

In addition to the learning modules listed above, IDS has also published an innovative ebook on Implementation Research. The ebook is available on the OCR as a downloadable resource and it also resides on an external website:
http://canelo.creatavist.com/implementation-research-on-health-systems/. This will allow IDS to update the resource as and when additional content is made available. They content is also freely available to download as an ebook on this website meaning that students/ users will have access to new content as and when it is made available. IDS are also planning to launch the ebook at international Health Systems related events and will be promoting the resource to a number of institutes through its research networks

Objective 4: Providing key learning materials, exercises and assessment procedures for each module

Each course developed by ARCADE HSSR includes key learning materials, exercises and assessment procedures online, either on course leaders’ Moodle platforms or the OCR. The main challenge in uploading courses on the OCR is that in some countries, intellectual property rights remain with the institution instead of the lecturer developing the course. The course materials available online include key readings (scientific articles, links to the book chapters), recorded lectures, self-assessment quizzes, other learning activities such as individual and group assignment (producing a study protocol), as well as formative assessment and final examinations. In addition, the RCT course materials included the Trial Protocol Tool (http://www.practihc.org) developed as part of another EU funded project that provides a range of information based on current research on how to best design and evaluate clinical as well as translational research.

The mounting of courses on course leaders’ Moodle platforms ensures that the courses will be delivered in future, and increases the sustainability of courses. However, these courses require a password to be accessed. To meet the criterion on open access and increase sustainability, the consortium developed the OCR (see http://ocr.arcade-project.org). Any student or professional, or university lecturer, has full access to course materials and is free to use these as long as they attribute the source and do not use the course materials to financial gain. These are the conditions of the Creative Commons Attribution Non-Commercial-ShareAlike 3.0 license. The ARCADE OCR is not password protected. In future the repository will provide a link or contact where the students can enroll in the full course. The OCR hosts both self-learning and blended courses; together with the e-book on Implementation Research. In total 9 courses/modules have been released on the platform (see detail in Table 4)

Conclusion part 2
The work conducted in this part of the project resulted in 11 blended courses and six self-learning modules being developed by the consortium. A particular success of the project is the increased leadership of SSA partners in developing and implementing courses. In order to ensure sustainability, courses/modules have also been uploaded to an online course repository. Of the total courses/modules produced, nine have been uploaded, with the rest remaining on institutional Moodle sites. The main challenge in uploading courses has been that copyright for materials in some countries rests with institutions, instead of with individual lecturers.

Part 3: Delivery of post-graduate blended learning courses

Work for this part of the project started with a technical working group comprising representatives from each ARCADE institution to address technical and infrastructure issues. The group created the framework for experimenting with different software and platform alternatives and delivering the courses developed. As the project progressed, capacity developed at partner universities to a degree where the group no longer needed to meet.

Objective 1: Facilitating teaching/learning in innovative ways, by using appropriate technology and providing opportunities through decentralised learning

In the beginning of the project the consortium experimented with different eLearning platforms, such as Moodle, Blackboard, and the freely available Sakai. The open source Moodle was chosen, as this was already in use in some universities and easy to install (more detail in objective 2 below). Video screen-capture and editing software was seen as a second key software item and here the choices considered were Camtasia Studio, Microsoft Expression Encoder, which is available free of charge to users of the Windows operating system and the open access software, CamStudio. The consortium also experimented with a number of software for linking students across institutions, such as Skype, MSLync, Adobe Connect and GoToMeeting. The disadvantages and advantages of each were listed, and partners chose among these tools depending on the requirements of each course.

Over 277 postgraduate students at partner institutions have benefited from ten ARCADE blended learning courses during the project duration. Globalisation and Health will be delivered at MUHAS later in 2015. Table 5 in attachments details masters and PhD students involved in the different courses during ARCADE HSSR’s four years. In addition to the 270 students, there were also seven postdocs, of whom four were women and three men. The project also reached 67 male and 54 female PhD students or those preparing for a PhD and 74 male and 79 female master’s students. In total, 49,5% of all students reached through ARCADE courses were female.

Six courses were delivered concurrently at multiple HSSR institutions. In addition to these, blended courses were also delivered at single partner universities, offering the courses to their students, or students from other African countries. For example, the Qualitative Evaluation in Health Care course was provided for a student from Nigeria, registered at the University of Oslo; and Health Policy Analysis, a course developed by SU, was delivered at SU but offered to students from other African countries. These examples show how ARCADE has created training opportunities for students from other SSA countries, which the consortium hopes to continue after the project’s conclusion. The collaboration attempted to run all courses collaboratively, but lack of available co-facilitators prevented this. Where this was possible, co-facilitators from partner universities were often junior staff, which resulted in both capacity building and in transferring the teaching and research culture from one institute to another.

Objective 2: Developing and implementing a web platform on which modules can be mounted for download, with capacity for student registration, interactive learning, and progress assessment and testing

SU, MU, KI, MUHAS and MA all have established Moodle web platforms on which modules can be mounted for download. These web platforms have been used both for collaborative courses, where one university has hosted the course; and for courses where the leading partner has offered the course only to their students. All require passwords. The addresses are as follows:
• SU (access for full-time and short course students and staff) http://learn.sun.ac.za/;
• MU http://www.arcade-hssr.mak.ac.ug;
• MUHAS http://elms.muhas.ac.tz; and
• KI (http://phsweb.phs.ki.se/moodle/)

The Moodle platforms at SU, MU and MUHAS are all operational and used by the institutes, while KI’s Moodle platform was specifically designed to be ARCADE’s “sandbox” for course development. Though the KI site was considered a test site, the site has been used for course delivery when other systems have failed. Ownership of these platforms by the universities ensure easy access of local course conveners to updating the materials, support by the local IT, and so encourages sustainability of these courses.

Each Moodle site offers the possibility to register students on courses. The sites are also able to host videos of course materials; or link videos that are available elsewhere (e.g. on YouTube). Students are able to chat and discuss issues on the discussion boards on the Moodle platform. Importantly, there is also the possibility to manage a course on the site by tracking views and student logins. The sites also have an exam and testing functionality, where exams and tests can be set up and multiple-choice questions are automatically marked.

Because the principle of ARCADE HSSR is to deliver open access and sustainable courses, we also developed an Open Course repository (http://arcade02.phs.ki.se/) as detailed in part 3, objective 4 above.

Objective 3: Developing the capacity of participating faculty and students in the use of information and ICT to support postgraduate studies

During the project, the consortium engaged in different capacity building activities for project staff and wider university staff. SU held a workshop on preparing blended courses in 2012 in Cape Town. Staff from MU, KI, IDS and SU participated in this workshop. Agreements were made during this meeting on approaches to be used during the project, module structures and how to start teaching using eLearning tools.

In addition to workshops, ARCADE HSSR developed an open resource for questions and answers on technical issues (i.e. software option, technical configurations, versions) to provide on-going and immediate support and share technical knowledge in the ARCADE network. As this resource was not actively used, most support was provided through email exchange or Skype meetings. The consortium also had available a 10 minute video guide to Moodle, produced by IDS, which explains the e-learning platform and its basic functions.

The systematic data collection and analysis of ARCADE blended courses evaluation allowed for the accumulation of experiences and lessons learned of blended courses delivered across multiple centres. In addition to this, the consortium review meetings allowed for the exchange of experiences. Some practical tips for course conveners are combined in an ARCADE “how to” guide.

Outside of central eLearning activities, ARCADE HSSR also facilitated the capacity building of partner university staff in eLearning. Staff part of ARCADE and the wider faculty at SU took part in eLearning workshops and meetings organised by the new eLearning office that was developed facilitated by ARCADE HSSR. The ARCADE team at SU also took part in the development of a Faculty Policy on E-learning in 2013. Further staff capacity building took place at MUHAS, where in total 69 staff members were trained in open distance material developed during the project period. At Makerere, 142 users including staff and students were trained to use the Makerere Moodle System. The Makerere IT team also supported other partners in setting up Moodle systems.

Student capacity for participating in eLearning was also developed, mainly through courses’ introductory sessions and instructions shared on the online platforms. As ARCADE has also taught in excess of 300 students during the project period, all these students have also been exposed to eLearning environments, received support from faculty at partner universities, and are thus better equipped to undertake eLearning in future. Throughout the project, efforts were made to support both lecturers and students in engaging with eLearning approaches.

Objective 4: Implementing course modules in blended learning approaches- mix of face to face, web based and self-learning courses at each hub university

The unique contribution of ARCADE HSSR was to provide these courses in collaboration with multiple universities. This reduced the need for students to travel and the need for universities to adapt course materials. This approach had its challenges, but the success of the project was that in total six blended courses were delivered with more than one ARCADE HSSR partner participating. In total, eleven courses were delivered in blended fashion, eight involving one of the hubs, and three involving the non-hub university MUHAS. Globalisation and Health will be delivered at MUHAS later in 2015.

Synchronous participation of students at partner universities was made possible through web-based teleconferencing. Each course had its own approach to teaching collaborative courses; some streamed lectures live (e.g. MADAS), with coursework, while others had recorded lectures and met at individual universities to do exercises and group work (e.g. PAQR). The Randomised Controlled Trials course added another innovative element to online learning, in addition to streamed and/or recorded lectures and Moodle resources, where students could access the online resource of the Trial Protocol Tool (http://www.practihc.org) repeated also in the MOOC on pragmatic randomized controlled trials. These approaches were made possible by close collaboration between partners, administrative staff enabling scheduling and IT staff supporting implementation.

Through a collaboration and registration of courses at KI, courses were awarded ECTS status. The Practical Approaches to Qualitative Research course, the Randomised Controlled Trials course and the course on Qualitative Evaluation in Health Care were accredited in the European Credit Transfer system.

In order to ensure continuous improvement of courses, a course evaluation protocol was developed by the consortium. Each implemented course was evaluated using a standard questionnaire, which included student demographics, questions relating to course content and delivery, as well as the usefulness of the eLearning components of the course. The evaluation results suggested that students were in general satisfied with the courses in which they participated – with most survey respondents suggesting they would recommend the course to others. The students’ feedback on the eLearning approaches suggested that there continued to be challenges to implementation, particularly of synchronous courses, because of internet bandwidth and availability; but that as the project progressed, and the consortium became more experienced in course delivery, the online features became more useful and user-friendly.

In addition to the formal course evaluations, KI also recruited a master’s student to complete an economic evaluation of ARCADE courses. She evaluated the cost effectiveness of the Randomised controlled trials course, at KI, MU and SU. Her thesis was passed and a publication prepared and submitted to a special issue in the Global Health Action journal (see abstract in attachments). The evaluation indicated that blended learning could be considerably more expensive than traditional, classroom-based learning. However, the evaluation did not take into account student costs, but only the institutional perspective. The evaluation also could not account for the effect of new staff implementing the course; and that the blended learning was conducted for the first time in the year of the comparison. Results of the thesis were submitted to the Global Health Action special issue, due for publication in 2015.

Conclusion part 3
ARCADE HSSR successfully delivered courses based on the modules developed during the project. These courses were not only delivered at hub universities, but also involved non-hub universities. Nearly 300 students were trained in HSSR topics; and over 200 staff members and students trained on eLearning systems. The consortium secured support from IT personnel, and negotiated through the hurdle of choices in software to use. Through Internet bandwidth continued to challenge course implementation during the project, the consortium successfully delivered five courses synchronously at more than one ARCADE HSSR partner university.

Part 4: ARCADE cross-partner research project groups with mentoring

In this part of the project, the focus shifted to building linkages between universities in research and teaching. MU successfully took the lead in developing mentoring systems for students.

Objective 1: Developing south-south research groups and programmes, led by faculty from southern institutions in order to provide a framework for mentoring students in research

In order to secure funding for research groups and programmes, 18 collaborative proposals with more than one ARCADE partner were submitted for external funding (see table 6), all with provisions for PhD students. In addition to these, ARCADE staff was also active in submitting funding proposals on HSSR issues to other African, Asian, Australasian and European partners. Each of these had built in funding to support PhD research projects in Sub-Saharan Africa.

Unfortunately, few of the large-scale collaborative funding proposals submitted during ARCADE HSSR were successful. Successful proposals are fairly recent and limited in being able to foster south-south research programmes. However, there were some research programmes on the periphery of the consortium that emerged during the project and represented collaboration between the two hubs. The Saving Brains initiative, supported by Canadian grand challenges included both Makerere University College of Health Sciences scientists (Tumwine JK et. al) together with Burkina Faso scientists (Meda N et al) investigated the effect of peer counsellors and exclusive breastfeeding on cognitive function. Data collection ended in October 2014 and data analysis is continuing.

Concurrently with these efforts, SU scientists (Mark Tomlinson et al) carried out similar studies in South Africa on the same Saving Brains initiative. The SU team assessed the long-term effect of an intervention (promotion of mothers' engagement in sensitive, responsive interactions with their infants, to enhance the mother-infant relationship) on cognitive functioning, school attainment and child emotional/behavioural functioning. No results are available yet from these studies supported by Canadian Grand Challenges, but it is expected that work within this area continue both in MU and SU. All these projects engaged junior staff and PhD students. As the relationship between MU and SU deepens, it can be expected that similar research interests will result in close collaboration, and shared PhD students.

In order to further build linkages between universities, MU and SU took the lead in implementing a mentorship programme for young researchers, including masters and PhD students from all four SSA partner universities (see objective 2 below). This programme built linkages between senior researchers, junior researchers, and students. Faculty from MU, SU, MA, and MUHAS attended meetings during which students worked on research protocols, thus also creating research linkages between the staff. The meetings clarified the staff’s research interests, and linked students to staff, both within institution and between institutions. Thus many senior researchers could assist junior researchers and students in developing their research proposals.

Objective 2: Developing a mentoring system of graduates in sandwich model training, where they receive training in hub institutions, and take part in mentored research programmes in their home health services

To strengthen grant-writing capacity, MU and KI organized a one-week course How to write a successful grant application in 2012 for MU students and for MU, SU, MA and MUHAS students in 2014 at MU. This course, led by prof. Olle Söder (KI), covered both academic and practical issues in writing research grant applications. Each participating student (20 in 2012; 14 in 2014) wrote a grant application. Facilitators reviewed these and gave continuing feedback during the course. All participants were PhD students and postdoctoral fellows from ARCADE and other African universities.

In addition to the 2012 grants writing programme, MU and SU took a strong lead in developing the ARCADE HSSR mentoring programme. ARCADE funding was used to sponsor PhD Proposal Writing Fellowships, where students were supported to develop proposals. Sponsorship did not constitute tuition fees or bursaries, but enabled students to attend grant-writing workshops, be connected with mentors, and take part in courses. MU and SU wished to recruit pre-doctoral, doctoral, post-doctoral students and junior faculty in HSSR at the participating institutions. The scholarships were advertised at each institution, and student recruitment took place in 2013-2014. Fifteen prospective PhD students were selected as a part of the competitive process. The application documentation included a standard form (one page), CV and a two-page motivation letter outlining the applicants research proposal in HSSR. These students attended two workshops in 2014, one at SU and one at MU. The first workshop focused on selection and finalisation of research questions, while the second on proposal writing in general. During both workshops, students worked in close consultation with their supervisors/mentors, and could receive cross-institutional research support. The output of this process was a series of inter-institutional workshops in 2014 to support the participants and potential supervisors in developing proposals on topics of common interest within ARCADE HSSR.

34 participants attended the first workshop from MU, SU, MUHAS, MA and KI, while 26 participants attended the second workshop from MU, SU, MUHAS, MA and KI. The faculty mentors from each of the institutions also met during the week to identify collaborative research areas and funding opportunities, and to develop concept proposals for multi-institutional HSSR grants across ARCADE partners.

The programme hoped to support 20 research proposals submitted for PhD registration, research or for grant funding. The programme eventually supported 18 PhD proposals, 3 postdoc proposals and 13 masters project proposals. Of these, two postdocs, seven PhDs and 4 masters level students were female, representing a minority in PhD and masters students but two thirds of postdocs. At the end of the process, 7 students, including one postdoc and 6 PhDs had submitted proposals for funding; 19 students, including one postdoc, 6 PhD students and 12 masters level students had presented their proposals to universities for acceptance in master’s or PhD programmes; and 8 students, including one postdoc, 6 PhDs and 1 masters student continued working on their proposals. Table 7 in attachments details the final list of participants, with proposal stages.

In addition to the proposals submitted above, one student (Chris Makwero) at MA has been accepted and registered for a PhD program after submitting his research proposal developed through the workshops. At MUHAS and at SU one PhD registration each has been completed at the end of the mentorship programme.

Finally, to further experiment with sandwich model training and support, ARCADE HSSR experimented with a concept of ”research clinics” as a means of granting students and staff access to international experts and information about their research. The first Research clinic seminar was held on March 26th, 2013, where a PhD student from the University of MA presented her protocol on "The Feasibility of Male involvement in Prevention of Mother to Child transmission of HIV Services in Blantyre, Malawi". Dr Simon Lewin from KS, was the main discussant. Seven other participants from different countries were able join the discussion. The student reported that the discussion was useful particularly at her stage of work, and had enjoyed taking part in the experiment. Further research clinics have been held in conjunction with ARCADE RSDH, with Asian presenters. HSSR partners have been invited to these seminars.

Objective 3: Creating a pipeline of masters students, doctoral students and postdoctoral research fellows with excellent training and mentored research experience to become faculty at partner institutions

The mentee programme as described in objective 2 above has been instrumental in starting to develop a pipeline of students to become faculty at partner institutions. Through the mentorship programme, students could develop their Master’s and PhD programmes and participate in courses, become familiar with HSSR issues and develop skills in the area. In addition to the active supporting of master’s and PhD students as above, ARCADE also promoted the adoption of HSSR topics for PhDs. At SU, a total of four PhD candidates graduated with HSSR topics during the ARCADE HSSR period; and a further 6 registered at SU with a seventh in the process of finalising a joint registration between SU and KI. ARCADE HSSR has created an enabling environment for students to pursue doctoral studies in HSSR through its various activities such as increasing access to courses, workshops and mentors and networking with peers from partner universities. One success story of student pipelines includes Dr. Tumaini Nyamhanga from MUHAS who participated in the online Qualitative evaluation in healthcare course, and will be pursuing postdoctoral training under the SIDA collaboration addressing human resource for health in rural Tanzania.

The Makerere team conducted a series of meetings in 2013-2014 with the aim of engaging African institutions into mentoring programmes, including recent PhDs and postdocs. Other activities in under this objective included students and faculty exchange between SSA hubs and KI. For example, Dr Aggrey Mukose (MU) offered his course on Introduction to HSR, while visiting SU in February 2014. The first PhD students on KI-SU double degree have visited KI for registration seminars for attending courses.

Additionally, southern institutions will strengthen student and faculty exchange at master-level programmes between SU and MU universities, but also between these universities and MUHAS and MA to potentially increase the flow of PhD candidates into double degree programmes. Joint research projects will contribute toward this objective.

Conclusion part 4
Fostering cross-institutional research programmes proved challenging, particularly seeking funds to develop these. Regardless, the consortium was successful in submitting in excess of 18 research protocols for funding, all of which included funding for PhD students. In addition, 24 student proposals were completed in the project period on HSSR topics, with 7 of these submitted for funding. The relationships built during ARCADE HSSR are likely to continue beyond the project duration, and develop into research and teaching relationships in future.

Part 5: Institutional capacity for joint degrees

Objective 1: Establishing joint degree programmes between northern partners and southern partners; and between southern partners

Within the first project year, substantial progress was made in the negotiations on joint degrees between KI and SU and between SU and MU. A Memorandum of Understanding was signed and joint/double degree agreements between KI and SU and SU and MU were finalized in June 2012. The joint/double-degree agreements created a triangle of two southern hubs and a European university (KI) that opens up for unlimited possibilities for collaboration in education and research, students and faculty exchange. Through the agreements between KI, MU and SU, ARCADE aimed to create an enabling environment for knowledge building and sharing, giving PhD students opportunity to access coursework, engage supervisors and mentors from the three universities and allowing students to meet their needs in HSSR research education.

When the formal agreements between KI-SU-MU were put in place, the more challenging task of streamlining university procedures for PhD admissions started. At SU the need to align the PhD application and registration processes with KI and MU for joint/double degree students has resulted in significant changes that were approved by the Faculty Board in February 2015, to allow students to register without a final proposal. Considerations are also being given to amending the PhD programme from a research thesis only, to include a more structured programme, which has a broader range of academic learning outcomes. The ARCADE HSSR team at SU have been instrumental in contributing to these changes.

Despite initial hiccups in PhD registration procedures, in 2015 three students are registered at both KI and SU, and one SU student recruited for the programme is still only admitted to KI. One student, who is only admitted to KI at the moment, is on leave, but should also register at SU in future. Nine students were registered on the older KI-MU double degree collaboration. No students to date were registered on the MU-SU collaboration, though students have expressed interest in the joint/double degree agreement.

During the ARCADE HSSR period, non-hub institutions also became interested in closer collaboration. Negotiations about further collaboration between MU and MA started during the meeting held at University of Malawi in December 2013. The existing framework for undergraduate training between MUHAS and MU was under discussion for being expanded to Masters and joint PhD training.

As part of double degree negotiations and cross-institutional work, there were a series of decanal and presidential visits conducted. An SU delegation visited KI in June 2013 as guests of the KI International office. The SU delegation met with the researchers from Department of Public Health, and division of Global Health to discuss research collaboration and possibilities of co-supervision of PhD students on SU-KI double-degree doctoral programme. A return visit was conducted by a KI high-level delegation to SU in March 2014, where KI and SU researchers presented their projects and results in areas of TB, HIV, Injuries prevention, Psychiatry and Neurosciences. The research collaboration and double degree programmes were discussed between the Deans of Research and Education of both universities. Following from this, a team of head of units and senior researchers visited SU in August 2014 to hear about different research programmes and to develop collaborations.

Objective 2: Strengthening institutional grants office capacity at SSA hubs through transfer of standard operating procedures (SOP), and staff exchange between northern and southern, and southern and southern partners

The first exchange of grants offices was held at KI’s grants office in 2011. Delegates from MU and SU attended to exchange experiences, SOPs and best practices. A joint mailing list was created to share grants announcement between grants offices. Other cross visits were also conducted - the head of the grant office at IDS visited KI grant office and met with ARCADE team in 2013. Among the issues discussed SOPs and exchange of experience, engaging the IDS and SU grants offices in training other partners and the possibility of participating in future calls/applications together.

In May 2012, a Grants Policy and Management training workshop was held in Kampala, Uganda, by The National Institute for Allergy and Infectious Diseases (NIAID). The three ARCADE hubs (KI, MU and SU) were involved in the design of the workshop agenda and were also responsible for carrying out five sessions. Approximately 120 delegates from countries in the Eastern African region such as Uganda, Kenya, Tanzania, Rwanda, and Malawi attended the workshop. This workshop served as an excellent opportunity to strengthen Grants Office collaboration and capacity, not only within the ARCADE project, but for the whole East African region.

In addition, a team from KI, MU, and SU participated in the Research Administrators in Africa (ARAA) annual conference held on 12th to 14th November 2013 in Nairobi, Kenya. The ARAA conference provided a platform for the ARCADE HSSR project to share and disseminate some of the outcomes of the project in terms of grants administration and management. 
The team facilitated sessions on networking and identifying key issues that institutions can work on to better their research support services. They were also privileged to present on innovative approaches to advancing standards in research administration and management and how to write successful grant applications. The conference brought together a total of 120 participants from 7 African Countries. The theme of the conference was Strengthening Regional Linkages for Effective Research Administration. The MU and SU team members were physically present at the conference and were able to share experiences from their partnership on regional support services, roles of coordinating centres, consortia members and capacity building initiatives and linkages. The presentation was well received by the participants who scored the session highly.

The team from KI, MU and SU presented at the SRA (Society of Research Administrators International) Annual Meeting 2014 (http://srainternational.org/learn/annual-meeting) and gave a presentation about the work done within work package 6. There was a large interest in the presentation and, together with a US colleague; the team has submitted a manuscript for the SRA International Journal Article about international collaboration.

During the final year, the Grants Office teams prepared for participation in H2020. For example, representatives from KI and SU were involved in H2020 applications, and representatives from SU also visited KI to work with the department on a joint application. A joint application between KI and MU to a Swedish funder (SIDA) was submitted and accepted but, though planned, in the end did not involve Grants Office capacity building.

Objective 3: Developing capacity within and between partners in communications, engagement and dissemination to extend the reach of ARCADE and Objective 4: Establishing a functional dissemination office in each SSA partner with SOPs and skilled staff

SU with input from IDS and other partners has developed a communication strategy, defining the key audiences and specifying activities to target them. An overall aim of the communication activities is to ensure that PhD students at ARCADE partner universities are informed of the courses available through ARCADE and can enrol to them during their PhD studies.

All of the institutes involved have functioning communication offices, working at university level. In addition, ARCADE HSSR collaborated closely with the CommHERE project conducted a series seminars to build communications capacity for EU projects at KI, Stockholm. CommHERE and ARCADE prepared a seminar “The value of disseminating EU projects according to the European Commission” jointly. The invited speaker was Charlotte Haentzel, Head of Political Section of European Commission’s Representation in Sweden who presented good practices in EU project communication and dissemination. The seminar was shared with ARCADE partners as a webinar on the ARCADE website. In addition, guidance developed by the EU was sent to ARCADE partners to inform their communications offices
(http://ec.europa.eu/research/participants/data/ref/fp7/146012/communicating-research_en.pdf).

The ResUpMeetUp Symposium and Training Exchange was held in Nairobi, Kenya, to explore emerging issues within and develop a deeper understanding of the evolving concept of ‘research uptake and to develop a range of skills associated with communication and research uptake activities. The Research Uptake Symposium and Training Exchange (ResUpMeetUp) was convened by the Institute of Development Studies (IDS), African Institute for Development Policy (AFIDEP) and Quaternary Consulting from 9-12 February 2015. A total of 118 participants from 76 organisations attended and 23 countries were represented. In total, 13 delegates from ARCADE partners (IDS, MU, KI) attended the training exchange. The sessions and discussions were collated into a detailed and live ‘story’ on Storify. IDS also delivered a blog each day, which was promoted through the ResUP website, the ARCADE website and widely on social media. KI and IDS were also tweeting live from the event.

Conclusion part 5
ARCADE can claim a substantial achievement in being part of the development of double degrees between SU and KI and SU and MU. These three universities collaborating in PhDs means those students have access to expertise from top class universities. The collaboration of grants offices across these and other universities also means that SSA universities are more likely to be able to assist resesarchers in securing grants and their management, thus supporting capacity building in HSSR topics also in future. Finally, supporting research communications in SSA universities can result in universities being better able to communicate their findings and build their reputations as world-class research institutions.

Part 6: ARCADE output dissemination

The final part of the project focused on disseminating ARCADE outputs. These are also detailed in the report (section 4.2.) where publications and dissemination activities are listed.

Objective 1: Defining and connecting with key audiences for the course materials

ARCADE has developed a communication strategy, defining the key audiences and specifying activities to target them. An overall aim of the communication activities is to ensure that PhD students at ARCADE partner universities are informed of the courses available through ARCADE and can enrol to them during their PhD studies.

The ARCADE website (www.arcade-project.org) continued functioning during the third period. In addition, ARCADE has a twitter account (https://twitter.com/ARCADEprojects) and a blog on the website (http://www.arcade-project.org/blog/). As the main website became more active, the need for other websites became reduced. Thus, SU’s website http://arcadehealthsystems.org/ now directs to the Centre for Health Systems and Services Research website at Stellenbosch University’s website.

ARCADE staff were active in promoting the project through conference attendance (e.g. the Health Systems Global conference in Cape Town in 2014), through personal meetings with university staff and online. Pamphlets and presentations were given out at conferences, and at the health systems symposium the project held a stall where delegates to the conference could test ARCADE courses.

Objective 2: Producing high quality knowledge products in forms which are accessible to target audiences

ARCADE has developed a pamphlet to share with target audiences, such as other research groups, policymakers and conference delegates as well as posters and presentations at relevant conferences. In addition to these more traditional knowledge products, the key knowledge product of ARCADE HSSR is courses for students. To communicate this, the collaboration launched the Open Course Repository, available at: ocr.arcade-project.org.

The repository will ensure ARCADE course materials that are released by Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported (CC BY-NC-SA 3.0) are available to the wider public and target audiences. This repository targets both students to use the materials for learning, and teachers who can adapt the materials for their teaching. Table 4 in part 3, objective 4 details the HSSR courses available on the OCR. Between January 2015 and May 2015, 261 persons had accessed this platform globally, with most engaging with the site instead of leaving immediately. The website will be kept active during the duration of the ARCADE RSDH project, and while the ”spin-off” projects of SECTOR EE (Supporting evidence-based policymaking through health research in Eastern Europe) and the Research Links (Enhancing global collaboration in health systems and social determinants of health research) projects are active. The consortium members hope to find other funding to continue updating and keeping the course content relevant.

Objective 3: Maximising impact, influence and uptake of the course materials among target audiences particularly students and policy makers

To strengthen capacity in communication with policy makers, a seminar was conducted by at KI in 2012. In addition, most ARCADE HSSR courses have included communication with stakeholders in coursework; particularly the randomised controlled trials course and qualitative evaluation in healthcare course. ARCADE HSSR staff visited each other and communicated continuously during the project. In addition, the activities part of the 3rd Global Symposium on Health Systems Research brought ARCADE to a group of researchers and policymakers active in HSSR, through an organized session and stand. The conference was well attended, thus resulting in wide exposure for ARCADE HSSR. Courses that have been implemented have also been advertised widely on the ARCADE website, through noticeboards at universities, electronic registration systems where available, and through word of mouth. Where staff has identified a challenge in access to course materials, such as that for bandwidth they have made alternate arrangements, such as providing the course material on a DVD for the student’s use.
Finally, the ARCADE project has been branded with an appropriate and simple logo; its leaflets have been taken to conferences; and staff involved in the consortium has continued to promote course materials in their meetings with students and policymakers.

Objective 4: Designing, launching and populating a web space for the capture of project learning and outputs

Most of the communications activities within ARCADE HSSR have been routed through, or includes afterwards in the project website. This website is kept active by ARCADE HSSR staff, also working with RSDH. The website was developed in the first 6 months, and included the visual identity of the ARCADE projects, including project logos and promotional material. The website, which includes the project calendar, twitter account (@arcadeprojects) feed, information about outputs and deliverables, a blog, a jobs section, and publications and summaries, is available at www.arcade-project.org.

Conclusion part 6
As part of the consortium efforts, the consortium has promoted the work and materials developed during the project. This ensures that the work of the consortium, and the work of the EU, is promoted to students, researchers and policymakers during the project, and beyond.
Potential Impact:
ARCADE HSSR has succeeded in training more than 277 students in sub-Saharan Africa and elsewhere. Of all the students involved in ARCADE HSSR courses, 49,5% was women. This number included 79 female master’s students, 4 female postdocs and 54 female PhD students. Given the gender imbalance at the partner institutes, where all SSA institutes excepting SU had more men than women in PhD level training, and 83% of surveyed faculty were men, it is heartening to note that ARCADE HSSR reached so many female students. While efforts to redress the gender imbalance at SSA institution continues, providing opportunities through eLearning, addressing some of the barriers that may impact the training of women, is an important achievement of ARCADE HSSR: Of a sample of 20 students who responded to course evaluation surveys, half had children under the age of 5 years. As identified in several studies, childcare responsibilities may prevent parents from taking part in research. Particularly, travel to other institutions, perhaps in other countries, is often out of the question. Through providing an innovative form of blended learning ARCADE HSSR has provided excellent courses for caregivers of children, policymakers, and others who are unable to travel distances to partake in cutting edge training.

The duration of ARCADE HSSR has been four years, during which 11 blended courses have been developed and 10 delivered in SSA universities. Though the total student number during these four years is a little less than 300, the courses are available, and will continue to be available, on the open course repository. These courses will therefore be available for lecturers from universities to adapt and deliver, as long as they continue to deliver these courses free of charge. This library of course materials ensures that the capacity building activities started by ARCADE HSSR have the potential to have an impact well beyond the project period. This is a substantial contibution to HSSR training globally.

As identified by our needs assessment, HSSR training is lacking, outside of degree programmes, in SSA institutions. Through our HSSR related course materials students in SSA can engage with HSSR training, learn independently, or even suggest that these materials are incorporated into university curricula. The partner universities in ARCADE HSSR are aware of these materials, have been promoting them during the project period, and will continue to use and update them as deemed necessary. The two projects secured by Karolinska Institutet, the Research Links and the SECTOR EE projects promote these materials even further, to Eastern Europe and South America. ARCADE RSDH also makes these materials available in Asia. Without active promotion outside the 3rd Global Symposium on Health Systems Research, our online library of open access course materials has already had more than 200 users accessing the site from January 2015 to May 2015. These users come from 45 different countries worldwide, with most users after Sweden being from India, US, the UK, Uganda, China, South Africa and Belgium. With these users aware of the site, the materials contained within and their potential, we can expect ARCADE HSSR course usage to increase after the end of the project. In addition to this, one of the partners, IDS will be uploading ARCADE learning modules to an institutional moodle platform that it is currently developing. These materials will therefore be more widely shared with both IDS students but also with a global audience, as all materials will of course be open access.

Through providing courses in an innovative manner, through blended learning, and particularly through the participation of multiple universities in the delivery of five courses, three of which were delivered repeatedly, the project has reduced the need for students to travel to other universities to receive world class training and information. The use of online software has enabled real-time commenting on research proposals between Nordic countries and sub-Saharan Africa. Through making available global experts and global training the project has reduced, and will continue to reduce, the need for students to travel to other countries to receive training. This may represent an actual monetary saving for the students, and for universities and funders, where these may previously have contributed to student travel. However, there is also likely to be an environmental impact, reduced carbon emissions, from students having forgone air travel. Through this project we have shown that it is possible to provide leading HSSR learning through online methods, but also, though bandwidth remains limited, it is possible to join entire classrooms, north and south. This facilitates learning together by students globally, between north and south, and can transfer knowledge and expertise bilaterally. The exposure of northern students to southern students’ perspective, and vice versa, can have a profound impact on the learning of students across settings, and result in a global perspective to health systems issues.

One of the key achievements of ARCADE HSSR has been facilitating a triangle of universities to engage in PhD training. Agreements for joint/double PhD degree training were agreed upon between Stellenbosch University and Makerere University, as well as Stellenbosch University and Karolinska Institutet. The joint degree of Stellenbosch University and Makerere University is a leading example of southern collaboration. This formalised relationship can facilitate close collaboration between the universities in training and research, which is not mediated through northern counterparts. Through this relationship, the two universities can engage in leading research, and utilise complementary skills to provide excellent training and cutting edge research.

In addition to the students trained during courses and the training materials developed, ARCADE HSSR has also impacted on institutional capacity across partner institutes. The project activities not only developed hub grants offices, but also provided information and advice in project communications across all partners in the project. Collaboration across grants offices, sharing best practices and SOPs builds partner universities up to receive and manage large grants. Good grants management at universities can build funders’ confidence to grant funding to these institutions. The larger the grants that a university is able to attract, the more likely that the university will be able to attract good staff. Providing funding in-country has the potential to reduce the ‘brain drain’ to other countries, as skilled researchers can engage in meaningful research in their home health system, with adequate funding. We therefore believe that ARCADE HSSR has contributed towards the retention and building up of skilled health research professionals in SSA. Similarly, training researchers and students and communication professionals in how to communicate the results of ongoing research to academia and other stakeholders builds universities’ reputations. This, in turn, can attract skilled researchers and mentors for younger generations of students.

Mentoring has been one of the key outputs of the programme. The mentoring programme instituted by Makerere University in Uganda, reached 33 mentees, of whom 11 were female. All of these mentees were masters or PhD students, who developed their skills in grant writing. In total, 15 proposals were submitted from these mentees to universities and funders. These mentees, both male and female, can represent the next generation of active health systems researchers in SSA.

Though ARCADE HSSR can boast several successes, there were also ongoing challenges. Competition for research resources is high, and therefore the consortium did not manage to secure as many grants as were hoped. The other main challenge was the continuing challenge of poor infrastructure, particularly where online meetings and online courses were concerned. Areas in Uganda, in particular, suffer from low bandwidth, which hampered students’ participation in courses as well as participation in meetings. This is an area that is likely to improve over the years, as has happened with MUHAS purchasing fibreoptics for their university and thus overcoming some of the bandwidth challenges. Nevertheless, these issues are likely to continue impacting on efforts to provide blended learning in SSA.

Main dissemination activities
The work of ARCADE HSSR was promoted at the 3rd Global Symposium on Health Systems in 2014 in Cape Town, South Africa. During this conference, ARCADE had an organised session, discussing the potential of eLearning and its importance to capacity building. This session had good attendance, with the room full of conference delegates.

In addition to the organised session, ARCADE HSSR organised a stall with its sister project, ARCADE RSDH. This stall allowed conference delegates to hear about ARCADE’s work, and try the best course products on the open course repository.
Further dissemination has been done through obtaining additional funding, through Vetenskapsrådet in Sweden and the Swedish Institute, to engage in capacity building in Eastern Europe, Brazil and Mexico. The partners from these projects have been present at ARCADE’s project meetings, and have been encouraged to engage with ARCADE course products.

ARCADE HSSR together with ARCADE RSDH has an updated, active website which features news, events, courses, a twitter feed and a blog of interesting events.

Finally, the two ARCADE projects have together worked toward a special issue on capacity buidling through eLearning, in the journal Global Health Action. Four papers concerning ARCADE HSSR have been submitted there, with publication hoped for in September 2015 (see abstracts of the papers in the appendix).

Further detail on dissemination activities is given in section 2 of this report.

List of Websites:
http://www.arcade-project.org/