health research grant for developing countries 2023

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2023 Stanford Global Health Seed Grants - Call for Proposals

The Stanford Global Health Seed Grant program encourages the development of innovative solutions to global health and planetary health challenges. It supports scientific and clinical research, implementation science, and development of new innovations in health care implementation or delivery. The program seeks to enable Stanford’s vibrant global health community, support global health training opportunities for Stanford trainees and students, and build capacity with international partners. Research projects that have strong potential to generate solutions and impact, and/or scale up into larger initiatives are encouraged to apply.

The Center for Innovation in Global Health believes that local is global; we are committed to improving health equity among all populations, including in the United States.

Program Priority Areas

Preference will be given to research teams that include more than one discipline and reflect the Center for Innovation in Global Health’s major initiatives and funders’ priorities:

Global Health : Interdisciplinary, solutions-oriented research that seeks to improve health in low-resourced settings
Research that addresses the health implications of climate change or other forms of environmental degradation
Projects that explore the ways in which conservation efforts can impact human health
Global Maternal and Child Health : Solutions-oriented research that seeks to improve maternal and child health in low-resource settings
Global Emergency Medicine : Projects that support innovative research in emergency medicine in low-resource settings
Global Surgery : Projects to develop or support educational programs, research, or innovations that improve global surgical care
Global Ophthalmology : Projects that support research to improve global eye health
Global Psychiatry and Behavioral Sciences : Projects that support research to improve global mental health
Local Health Equity : Solutions-oriented research that seeks to improve health equity in the San Francisco Bay Area
Refugees and Displaced Populations in the United States : Projects that strengthen relationships with existing community partners, build capacity for health outcomes, and/or deliver clinical or other health, wellness or educational services

Eligibility

All Stanford Faculty with PI eligibility may apply. This call is open to Faculty from all seven schools. Post-doctoral fellows, clinical trainees, instructors, and research scientists/scholars must identify a faculty mentor and then may be included as co-PIs.
Projects that create new interdisciplinary collaborations are encouraged. Teams may include investigators in off-campus partner institutions, including in Low- or Middle-Income Countries. Teams may also partner with nonprofit organizations, industry or government officials.

* At this stage, you do not have to prepare a PIF, a PDRF form or work with your institutional representative (RPM or OSR)

Selection Criteria

The Stanford Center for Innovation in Global Health and funders will review proposals based on:

Scientific merit of the proposal, with quality, innovation and creativity balanced by likelihood of success
Interdisciplinary nature of the project and research team, including international collaborations where appropriate
Likelihood that results or solutions will lead to improved health among vulnerable populations
A persuasive case that results would lead to scale-up, and/or catalyze further funding from external sources
Involvement of Stanford trainees and/or students; global health career development
Alignment between the proposal’s goals and the program priority areas (outlined above)

Submission Guidelines

All documents should be in pdf format, single-spaced, Arial 11-point font, with one-inch margins.

Submissions must not exceed 3 pages , exclusive of cover page, citations, budget, and biographical information.

To be considered, all elements of the proposal must be collated into one PDF file and uploaded.

Each proposal must include:

Project title
One-paragraph summary
Priority Area(s)
Each team member’s name, email, professional title, and department and school affiliation(s)
Introduction
Specific aims
Preliminary data (if available)
Proposed project design and methods
how the multi-disciplinary team will work together
the history of your relationship with any external/community partners
Description of potential for impact and follow-on funding
Literature cited
Itemized budget with brief budget justification
Short (150 words max) bio-sketches for team members

Key Dates :

March 30, 2023: Proposals due via online application (11:59 PM Pacific)
May 16, 2023: Award letters are sent out
June 15, 2023: Grants begin. Awards will be for 18 months or less. All grantees are eligible for one no-cost extension if necessary.

Research Administration and Reporting Requirements:

Once grants are awarded, the project team must submit a PDRF form via SeRA to set up their seed grant PTA.
If research includes Human subjects, projects will need to obtain IRB approval prior to incurring any costs related to the human subjects phase of research.
All grantees must submit annual progress reports by December 1, 2023, and a final report 45 days after the work has been completed.
All seed grantees must also apply to present their funded research at the annual Stanford Global Health Research Convening, typically held every January.

Amount of funding

$10,000 - $50,000 for 18 months.

We encourage investigators to consider submitting requests for less than the maximum, as this will enable us to award more grants.

Funders include:

the Stanford Center for Innovation in Global Health
the Woods Institute for the Environment
the Maternal and Child Health Research Institute
the Stanford Health Care Office of Research & Health Equity
the Stanford Office of Community Engagement
the Stanford School of Medicine (SOM) Departments of Surgery, Psychiatry and Behavioral Sciences, Ophthalmology, and Emergency Medicine

Budget Guidelines

Award amounts are based on analysis of a detailed budget request.

Funds may be used for salary support of faculty, graduate students, post-docs, and other research staff.
Eligible budget items include: operating supplies, equipment items, communications expenses, meeting costs, prototyping expenses, imaging time, and travel directly associated with the research activity.
The grants will not support general (non-research-related) staff, administrative support, or tuition.
No indirect charges need be included in your budget.

Questions? Contact: S. Jill Mueller: [email protected]

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Through calls for research proposals, we fund projects that aim to foster climate-resilient food systems, global health, education and science, democratic and inclusive governance, and sustainable and inclusive economies in developing countries. Gender equality and inclusion are also central to our strategy and the research we support.

Browse our open calls and learn about the experiences of some of our past Research Awardees , or browse our rich portfolio of active and completed research projects to learn more about the work we do.

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Archived calls, which offer a sense of the types of calls IDRC manages, are kept on the site for one year.

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Health-Related Research and Development (R&D), FY 2023

The U.S. Agency for International Development (USAID) submits this report pursuant to Section 7019(e) of Public Law 117-328, the Department of State, Foreign Operations, and Related Programs Appropriations Act, 2023, which incorporates by reference the requirements of the FY 2023 Joint Explanatory Statement (JES).

JES: Not later than 60 days after the date of enactment of the act, the USAID Administrator shall update the report required under this heading in Senate Report 116–126 on USAID’s health-related research and development strategy. Such report shall include details on USAID’s research and development of antibiotics. The Committee recognizes that drug-resistant bacterial infections are increasing globally and that lower-income countries experience the highest rates of antimicrobial resistance related deaths.

Senate Report 116-126: The Committee recognizes USAID’s role in health-related research and supports continued investments in new global health technologies across each of USAID’s health related programs to address longstanding and emerging global health challenges. Not later than 60 days after enactment of the act, the USAID Administrator shall submit the annual report to the appropriate congressional committees on USAID’s health-related research and development strategy, which shall include: (1) specific health product development goals, including timelines for product development; (2) details about ongoing and planned investments in drugs, vaccines, diagnostics, and devices, including collaboration with other Federal agencies as well as private sector partners; (3) a detailed description of the mechanisms for collaboration and coordination in support of global health product development between Federal agencies; (4) an assessment of any critical gaps in product development for global health; and (5) recommendations for filling such gaps to ensure that U.S. investments in global health research are efficient, coordinated, and effective.

Introduction

USAID’s Global Health Research and Development (R&D) Strategy (2023 - 2028) outlines the Agency’s approach to ensuring research is translated into timely action to improve health, well-being, and resilience of people around the world. To achieve this vision, USAID focuses on: the development of new technologies, tools, and approaches; and implementation science, knowledge management, and research utilization. Cross-cutting these research areas, USAID continues a long-standing focus on partnerships and collaboration, while aiming to develop ethical, locally-led R&D systems. While USAID’s Global Health R&D strategy outlines broad approaches to meeting these objectives, this report highlights key developments and collaborations in FY 2022, and areas of focus for FY 2023. Accompanying appendices report USAID’s estimated FY 2022 funding levels for health-related research and development (Appendix I) and a detailed list of USAID-supported product R&D (Appendix II).

Reports to Congress

Every year Congress asks the U.S. Agency for International Development (USAID) to submit a series of reports on various matters of concern. In an effort to provide a maximum of transparency to the general public, these reports are now being made available at this web site.

Health-Related Research and Development (R&D), FY 2023

Related Reports

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Progress to Strengthen Disaster Resilience in the Caribbean Region, FY 2024

Disaster resiliency in central america, fy 2024, share this page.

health research grant for developing countries 2023

Funding opportunity: Applied global health research: stage one

Apply for funding to support applied research that will address global health challenges and inequities.

We will accept applications of all sizes, including large research projects and small to medium-scale applications.

We are looking to develop a portfolio of high-quality global research which will be diverse, promote multidisciplinarity and strengthen global health research capacity. We encourage applications from project leads based in:

low and middle-income countries (LMICs)
UK, working in equitable partnership with LMIC researchers

The start application link will be available to select from 9:00am 20 August 2024.

Who can apply

Before applying for funding, check the Eligibility of your organisation .

UK Research and Innovation (UKRI) has introduced new role types for funding opportunities being run on the new UKRI Funding Service.

For full details, visit Eligibility as an individual .

Who is eligible to apply

To be eligible to apply for this funding opportunity you must:

be eligible as an individual
research organisation in a low or middle-income country (LMIC), with degree-awarding powers recognised by the government in which the organisation is based
research-focused institute based in an LMIC either funded by the government of the country in which the organisation is based, or by a not-for-profit organisation
research-focused not-for-profit organisation based in an LMIC with dedicated research capacity

Medical Research Council (MRC) particularly encourages applications from:

researchers based in LMICs
UK-based researchers who are eligible to apply for MRC funding and work in equitable partnership with LMIC researchers
LMIC countries, as defined by the Development Assistance Committee list of official development assistance recipient countries

The board recognises that applied global health research requires the involvement of a diverse range of collaborating organisations in order to affect sustainable change.

Applications involving a not-for-profit organisation based in an LMIC will be eligible to be named project co-lead (international). This can include grass-roots organisations and community groups.

If you do not have a contract of employment for the duration of the proposed project, by submitting an application the research organisation is confirming, if it is successful:

contracts will be extended beyond the end date of the project
all necessary support for the project and the applicants will be provided, including mentorship and career development for early career researchers

Who is not eligible to apply

You are not eligible to apply if:

you are based in a high-income country (does not include UK project leads, who are eligible), or in India, you are not eligible to be project lead, but may be eligible to be project co-lead (international)
you are based in China. You are not eligible to be project lead, but may be eligible to be either a project partner or project co-lead (International) with £0 cost. The researcher should only be included where expertise cannot be found either in the UK or a DAC listed country

It is expected that researchers from India and any high-income countries make a significant contribution to their own research costs, including covering their own overheads. Where India is included in a project there must be at least two other LMICs involved in the project.

UKRI is unable to support ODA research and innovation activities taking place in China, or where China is the direct beneficiary. This means the ODA compliance statement submitted by applicants should not identify China as part of the project’s rationale/justification. Providing no UK funding flows to China, it is permissible for China-based researchers to be involved in UKRI funded activities, when part of a consortia of internationally based researchers. China-based researchers are not eligible to lead applications.

Equality, diversity and inclusion

We are committed to achieving equality of opportunity for all funding applicants. We encourage applications from a diverse range of researchers.

We support people to work in a way that suits their personal circumstances. This includes:

career breaks
support for people with caring responsibilities
flexible working
alternative working patterns

Find out more about equality, diversity and inclusion at UKRI .

What we're looking for

We’re looking to fund research projects that will lead to tangible change in health policy and practice in the near future through practical, impact focused research.

We aim to support a diverse portfolio and examples of the types of research we will support, include:

feasibility studies which include evaluation of impact and stakeholder engagement
late-stage intervention development and testing, which can include global health trials from phase 2b (efficacy) onwards
implementation and scale-up research
health economic research as part of a broader health intervention project
the impact of policy changes or other similar interventions on health, particularly with a multisectoral lens
environmental (including climate change), cultural and social approaches within health focused projects
applied modelling

Proposals with a specific health systems focus may prefer to consider applying to the National institute for health and care research schemes .

We welcome cross-sector research combining expertise to meet a global health challenge. For example, an application may include aspects of urban planning, health policy and non-communicable disease (NCD) research. The research question might involve different disciplines and approaches from outside the health sector, but the primary objective must be to improve health.

You can apply for funding to address any health topic of relevance in the context where the research will be conducted. Examples of projects we have funded to date include infections, climate, ageing, NCDs, snakebite and anti-microbial resistance.

Explore previous Applied global health research board funding decisions .

If you are unsure whether your application fits the remit described, please send a one-page summary of your application to [email protected]

The MRC partners with the Foreign, Commonwealth and Development Office (FCDO) to support global health research projects. Some of the projects funded through the Applied Global Health Research Board (AGHRB) in specific strategic areas of mutual interest such as climate and health, women and girls’ reproductive health, early childhood development and epidemic preparedness will be funded under this partnership.

Through our investments in global health research, we aim to:

innovation in study design
multi-disciplinarity to address global challenges
diverse health topics: prioritise local relevance with potential for global impact
prioritise equitable partnerships
invest in research capacity strengthening
promote co-design and co-production with communities, policy-makers and health practitioners

Strengthening research capacity as part of your application

We are committed to strengthening research capacity within low and middle-income countries (LMICs) and the UK. All applicants are required to develop plans to strengthen research capacity within their application, which will be assessed by expert reviewers and inform funding decisions.

We encourage you to start discussing capacity strengthening priorities as early as possible, in consultation with key stakeholders, both within and outside of your project team. For example:

researchers
laboratory technicians
data collectors
field workers
practitioners
policymakers
research management offices

We take a broad view of where capacity strengthening activities could be targeted, however plans must be directly linked to the proposed project. Activities could target the individual, institutional or contextual level, or span multiple levels, and plans should be proportionate to the scale of the project, with larger projects expected to be more ambitious.

Examples of capacity building include, but are not limited to:

building leadership skills amongst early career researchers
opportunities for mutual learning across the project team, such as through staff exchanges (for example, the wider health context, engagement with policymakers and research management)
building capacity to work collaboratively, across disciplines and across practice-research boundaries (for example, with policymakers, managers, and practitioners in the system)
providing mentoring to improve the capacity of less-experienced researchers to generate new knowledge and achieve policy impact
team members attending training courses to develop specific expertise or obtain relevant qualifications (excluding master’s and PhDs)
opportunities for staff and associated health managers to author or co-author journal and conference papers and participate in national and international conferences
building organisational capacity (for example, in management, finance or communications)
the formation of LMICs research networks

Find further resources, tools and guides on strengthening research capacity provided by the UK Collaborative on Development Research .

Although new investigator research grants are not available through the AGHRB, we are committed to supporting early career researchers in applied global health. The board will consider each applicant’s career stage and proposed mentorship arrangements during funding discussions.

Areas we will not fund

We will not fund:

discovery research or research that includes an applied component that fits within a current MRC remit, programme or priority . This includes early translation and feasibility studies in the remit of the Developmental pathway funding scheme (DPFS) . Applicants wishing to do early translational or pilot studies should carefully consider whether the proposed work fits the remit of these other panels first before submitting to AGHRB
observational or prevalence studies
studies where the focus is on surveillance, unless the proposed work is applied research into novel methods for surveillance research
stand-alone capacity strengthening applications without clear links to high-quality applied research programmes
early phase clinical trials (phase 1 and 2a)

Board opportunities

These opportunities represent areas of specific strategic focus that help to inform discussions at funding meetings, but you can submit research applications that focus on any applied global health topic.

Maternal and neonatal health

The MRC maternal and neonatal health area of investment aims to provide funding for innovative applied research to address the global burden of maternal and neonatal mortality and morbidity.

Early childhood development

The board supports research in early childhood development, which encompasses the physical, socio emotional, cognitive, and motor development of children from birth to eight years of age.

Early childhood development is the outcome of the nurturing care for early childhood development report . This is a range of education, health, nutrition and social protection inputs and environments. Applications in this area will be jointly funded by FCDO as part of a coordinated effort to increase and scale up the evidence base for early childhood development interventions.

Read more about the early childhood development area of investment .

Adolescent health

The adolescent health area of investment aims to fund innovative applied research to improve adolescent health in LMICs.

Implementation science

Maximising impact from research remains a priority for MRC. To ensure that we meet this priority, we are funding research to address the implementation gap and progress interventions towards real-world impact.

We expect this research to ensure that evidence-based health interventions are implemented in an accessible and fair way for the most vulnerable populations.

Read more about the implementation science area of investment .

We will fund projects lasting up to five years, although projects typically last three to four years.

Funding available

The resources you request should be appropriate for the objectives of your application. We will accept applications of all sizes from £150,000 up to approximately £2 million MRC contribution. MRC typically fund 80% of full economic cost, excluding eligible international costs, which are funded as exceptions (100%). We will take value for money into account when assessing applications.

Equitable partnerships, including financial equity, are a key principle of the board. Applications in which the majority of the funding is allocated to the UK, plus any high-income countries (or India), will be rejected.

What we will fund

You can request funding for costs such as:

a contribution to the salary of the project lead and project co-leads (UK)
100% salary costs for project leads and project co-leads (international), based within an LMIC
support for other posts such as research and technical
research consumables
travel costs
data preservation, data sharing and dissemination costs
estates and indirect costs
research capacity strengthening activities (excluding Masters/PhD fees and stipends)
LMIC publication costs can be requested, where all the authors are from LMICs

Please note: total costs attributed to international high income countries (those not on the Organisation for Economic Cooperation and Development Assistance Committee (DAC) list of official development assistance recipients), or India, must not exceed 30% of the full economic cost grant value. There is no cap on eligible funds attributed to international project co-leads from DAC list countries.

What we will not fund

master’s and PhD studentships
UK publication costs
funding to use as a ‘bridge’ between grants

Team project partners

You may include project partners that will support your research project through cash or in-kind contributions, such as:

access to equipment
sites or facilities
the provision of data
software or materials

Where there is engagement from individuals based in government agencies, international intergovernmental organisations (for example, the World Health Organization), or other stakeholder organisations (for example, industry collaborators), applicants should include them as a named project partner.

You are not required to provide project partner letters (or emails), of support for stage one of the application process (they will need to be provided at stage two).

If your application involves industry partners , you are not required to provide additional information if the team project partner falls within the industry collaboration framework (information will need to be provided at stage two).

Find out more about subcontractors and dual roles .

Who cannot be included as a team project partner

Any individual included in your application with a core team role cannot also be a project partner.

Any organisation that employs a member of the application core team cannot be a project partner organisation, this is incudes other departments within the same organisation.

If you are collaborating with someone in your organisation, consider including them in the core team as project co-lead, or specialist. They cannot be a project partner.

Supporting skills and talent

We encourage you to follow the principles of the Concordat to Support the Career Development of Researchers and the Technician Commitment .

Trusted Research and Innovation (TR&I)

UK Research and Innovation (UKRI) is committed in ensuring that effective international collaboration in research and innovation takes place with integrity and within strong ethical frameworks. TR&I is a UKRI work programme designed to help protect all those working in our thriving and collaborative international sector by enabling partnerships to be as open as possible, and as secure as necessary. Our TR&I Principles set out UKRI’s expectations of organisations funded by UKRI in relation to due diligence for international collaboration.

As such, applicants for UKRI funding may be asked to demonstrate how their proposed projects will comply with our approach and expectation towards TR&I, identifying potential risks and the relevant controls you will put in place to help proportionately reduce these risks.

See further guidance and information about TR&I , including where applicants can find additional support.

Find out about getting funding for international collaboration .

How to apply

We are running this funding opportunity on the new UK Research and Innovation (UKRI) Funding Service so please ensure that your organisation is registered. You cannot apply on the Joint Electronic Submissions (Je-S) system.

The project lead is responsible for completing the application process on the Funding Service, but we expect all team members and project partners to contribute to the application.

Only the lead research organisation can submit an application to UKRI.

If you are based in an LMIC research organisation, you can register your organisation by contacting [email protected] and provide your organisation name, country and city.

If the lead research organisation is an NHS organisation, check it is available in the Funding Service. You are encouraged to check this early as there may be additional steps for the organisation to be set up before you can apply.

Two grant types are available, ‘research’ and ‘ partnership ’. Before you select ‘Start application’, check you are applying for the appropriate grant type. Applications submitted to the incorrect grant type will be rejected.

You will be able to select ‘start application’ near the beginning of this Funding finder page, from 9:00am (UK time), on 20 August 2024.

Confirm you are the project lead.
Sign in or create a Funding Service account. To create an account, select your organisation, verify your email address, and set a password. If your organisation is not listed, email [email protected] Please allow at least 10 working days for your organisation to be added to the Funding Service. We strongly suggest that if you are asking UKRI to add your organisation to the Funding Service to enable you to apply to this funding opportunity, you also create an organisation Administration Account. This will be needed to allow the acceptance and management of any grant that might be offered to you.
Answer questions directly in the text boxes. You can save your answers and come back to complete them or work offline and return to copy and paste your answers. If we need you to upload a document, follow the upload instructions in the Funding Service. All questions and assessment criteria are listed in the How to apply section on this Funding finder page.
Allow enough time to check your application in ‘read-only’ view before sending to your research office.
Send the completed application to your research office for checking. They will return it to you if it needs editing.
Your research office will submit the completed and checked application to UKRI

Where indicated, you can also demonstrate elements of your responses in visual form if relevant. You must:

use images sparingly and only to convey important information that cannot easily be put into words
insert each new image onto a new line
provide a descriptive legend for each image immediately underneath it (this counts towards your word limit, so must not be included in the image)
files must be smaller than 5MB and in JPEG, JPG, JPE, JFI, JIF, JFIF, PNG, GIF, BMP or WEBP format

Watch our research office webinars about the new Funding Service .

For more guidance on the Funding Service, see:

how applicants use the Funding Service
how research offices use the Funding Service
how reviewers use the Funding Service

Applications should be self-contained, and hyperlinks should only be used to provide links directly to reference information. To ensure the information’s integrity is maintained, where possible, persistent identifiers such as digital object identifiers should be used. Assessors are not required to access links to carry out assessment or recommend a funding decision. Applicants should use their discretion when including references and prioritise those most pertinent to the application.

References should be included in the appropriate question section of the application and be easily identifiable by the assessors for example, Smith, Research Paper, 2019.

You must not include links to web resources to extend your application.

Medical Research Council (MRC) must receive your application by 3 December 2024 at 4:00pm UK time.

You will not be able to apply after this time.

Make sure you are aware of and follow any internal institutional deadlines.

Following the submission of your application to the funding opportunity, your application cannot be changed, and applications will not be returned for amendment. If your application does not follow the guidance, it may be rejected.

Personal data

Processing personal data.

MRC, as part of UKRI, will need to collect some personal information to manage your Funding Service account and the registration of your funding applications.

We will handle personal data in line with UK data protection legislation and manage it securely. For more information, including how to exercise your rights, read our privacy notice .

Publication of outcomes

MRC, as part of UKRI, will publish the outcomes of this funding opportunity at Applied global health research board – funding decisions .

If your application is successful, we will publish some personal information on the UKRI Gateway to Research .

Word limit: 550

In plain English, provide a summary we can use to identify the most suitable experts to assess your application.

We usually make this summary publicly available on external-facing websites, therefore do not include any confidential or sensitive information. Make it suitable for a variety of readers, for example:

opinion-formers
the wider research community

Succinctly describe your proposed work in terms of:

goals to be addressed, please identify a concise and clearly articulated ultimate aim of the research
its context
the global health challenge the research addresses and its potential impact
its aims and objectives
its potential applications and benefits

List the key members of your team and assign them roles from the following:

project lead (PL)
project co-lead (UK) (PcL)
project co-lead (international) (PcL (I))
researcher co-lead (RcL)
grant manager
professional enabling staff
research and innovation associate
visiting researcher

Only list one individual as project lead.

Project leads can be from eligible UK or LMIC research organisations.

We expect all applications to this opportunity to include project co-lead (international), based at LMIC research organisations.

Find out more about UKRI’s core team roles in funding applications .

Application questions

Word limit:10

Provide up to five keywords that describe your application.

What assessors are looking for in your response

Provide up to a maximum of five keywords, for example: maternal health, malaria, implementation science, sub-Saharan Africa.

This is for administrative purposes to help with the initial application processing and will not affect the overall assessment of your application.

Word limit: 1,000

What are you hoping to achieve with your proposed work?

What the assessors are looking for in your response

Explain how your proposed work:

has a clearly articulated main research question
is of excellent quality and importance within or beyond the field(s) or area(s), and has the potential to advance current understanding, generates new knowledge, thinking or discovery within or beyond the field or area
is timely given current trends, context and needs
impacts world-leading research, society, the economy or the environment in LMICs
is driven by the needs of populations in the LMIC where the research is taking place
is generalisable beyond the research setting
includes LMIC researchers in the intellectual design and the setting of the research agenda and its ongoing strategic direction
ensures that partnerships are equitable

Within the Vision section we also expect you to:

consider issues such as burden of disease and priority for the relevant local, regional, and national health services
provide evidence that the answer to your research question is needed and wanted by relevant users, policymakers or both
identify the evidence-gap that the research will fill
describe the changes that might be implemented as a result of the project, and by whom

References may be included within this section.

You may demonstrate elements of your responses in visual form if relevant. Further details are provided in the Funding Service.

Word limit: 1,500

How will you deliver your proposed work?

Explain how you have designed your work so that it:

is innovative, effective and appropriate to achieve your objectives
is feasible, and comprehensively identifies any risks to delivery and how they will be managed
will maximise translation of outputs into outcomes and impacts
describes how your, and if applicable your team’s, research environment (in terms of the place, its location, and relevance to the project) will contribute to the success of the work
ensures an equitable role for the LMIC researchers in setting the research agenda and strategic direction of the research partnership
includes appropriate engagement plans with users, key stakeholders and target populations, and the appropriate communication and knowledge exchange plans
if applicable, summarises the previous work and describes how this will be built upon and progressed
provide details of the methodological approaches, study design and techniques that will be used. Enough detail must be given to show why the research is likely to be competitive in its field. Particular care should be taken to explain any innovation in the methodology or where you intend to develop new methods
briefly describe any pilot or preliminary data you have available to help the reviewers assess the feasibility of the proposed project
if applicable, clearly explain the intervention you will be testing, what it consists of and why
if applicable, demonstrate that you have carried out a datasets review, and explicitly state why currently available datasets are either appropriate or inadequate for the proposed research

Within the Approach section we also expect you to:

outline how co-production with relevant stakeholders, such as end-users, health care workers, policymakers and implementers, is embedded throughout the design and delivery of the project
identify the research participants and the setting(s) in which the research will take place. Where a particular setting is proposed which excludes the most vulnerable, for example the school setting, considerations should be made to include vulnerable groups or justify the choice not to
fully justify the target population identified application, with clear consideration of the potential for differences according to socioeconomic status, ethnicity, gender, age group or other characteristics. Refer to the MRC embedding diversity in research design policy (if applicable)
explain the proposed timeline including milestones and a diagrammatic workplan, such as a Gantt chart, which can be embedded within the text box

Research capacity strengthening

Word limit: 250

What are your capacity strengthening plans for the research project?

Explain how you have embedded appropriate capacity building activities within the proposed work. Explain how your capacity strengthening activities:

are appropriate to the LMIC research needs and the objectives of the project
will benefit the LMIC researchers and communities involved

Within this section we expect you to:

detail research capacity building needs, opportunities and planned activities
explain who will participate in delivering these activities and who will benefit from them

Applicant and team capability to deliver

Word limit: 1,650

Why are you the right individual or team to successfully deliver the proposed work?

Evidence of how you, and if relevant your team, have:

the relevant experience (appropriate to career stage) to deliver the proposed work
the right balance of skills and expertise to cover the proposed work
the appropriate leadership and management skills to deliver the work and your approach to develop others
opportunities for LMIC leadership and management
contributed to developing a positive research environment and wider community

The word count for this section is 1,650 words: 1,150 words to be used for R4RI modules (including references) and, if necessary, a further 500 words for Additions.

Use the Résumé for Research and Innovation (R4RI) format to showcase the range of relevant skills you and, if relevant, your team (project and project co-leads, researchers, technicians, specialists, partners and so on) have and how this will help deliver the proposed work. You can include individuals’ specific achievements but only choose past contributions that best evidence their ability to deliver this work.

Complete this section using the R4RI module headings listed. Use each heading once and include a response for the whole team, see the UKRI guidance on R4RI . You should consider how to balance your answer, and emphasise where appropriate the key skills each team member brings:

contributions to the generation of new ideas, tools, methodologies, or knowledge
the development of others and maintenance of effective working relationships
contributions to the wider research and innovation community
contributions to broader research or innovation users and audiences and towards wider societal benefit

Provide any further details relevant to your application. This section is optional and can be up to 500 words. You should not use it to describe additional skills, experiences, or outputs, but you can use it to describe any factors that provide context for the rest of your R4RI (for example, details of career breaks if you wish to disclose them).

Complete this as a narrative. Do not format it like a CV.

UKRI has introduced new role types for funding opportunities being run on the new Funding Service.

For full details, see Eligibility as an individual .

Project partners

Add details about any project partners’ contributions. If there are no project partners, you can indicate this on the Funding Service.

A project partner is a collaborating third party organisation who will have an integral role in the proposed research. This may include direct (cash) or indirect (in-kind) contributions such as expertise, staff time or use of facilities.

The individual named as the project partner contact, cannot be included in your application as a member of the core team, in any core team role .

The project partner organisation cannot be an applicant organisation, where any member of the core team is based. For example, you cannot include a different department based within the applicant organisation as a project partner.

If an individual or organisation outside the core team is responsible for recruitment of people as research participants or providing human tissue for this project, list them as a project partner.

Add the following project partner details:

the organisation name (searchable via a drop-down list or enter the organisation’s details manually, as applicable)
the project partner contact name and email address
the type of contribution (direct or in-direct) and its monetary value

If there are specific circumstances where project partners do require funding for minor costs such as travel and subsistence, these project partner costs should be claimed and justified within the resources and costs section of your application.

If a detail is entered incorrectly and you have saved the entry, remove the specific project partner record and re-add it with the correct information.

For audit purposes, UKRI requires formal collaboration agreements to be put in place if an award is made.

Letters or emails of support are not required from project partners at stage one of the application process (they will be required if you are invited to apply to the full application stage two).

If your stage one application includes industry project partners, you are not required to complete the Industry Collaboration Framework (ICF) review, until the stage two application process is relevant to your proposed work. Find out more about ICF .

Ethics and responsible research and innovation (RRI)

Word limit: 500

What are the ethical or RRI implications and issues relating to the proposed work? If you do not think that the proposed work raises any ethical or RRI issues, explain why.

Demonstrate that you have identified and evaluated:

the relevant ethical or responsible research and innovation considerations
how you will manage these considerations

Consider the MRC guidance on ethics and approvals .

Financial information and equity

Provide a high-level indication of how much each research organisation will need.

Provide a breakdown of the funding requested for each eligible organisation, by copying and pasting the table provided into the text box. You should then add the cost figures relevant to each organisation involved. The table has separate column headings, which will allow you to clearly define the costs you are claiming for each participating organisation, depending on where they are based:

non-UK high income countries (HIC) and India

Important note: a narrative justification of your costs is not required during stage one of the application process.

Applications in which the majority of the budget is allocated to the UK will be rejected.

Further organisation finance guidance

Low and middle-income countries (lmic).

LMICs are defined as those on the Organisation for Economic Cooperation and Development (OECD) and Development Assistance Committee (DAC) list .

You must include costs associated with LMIC organisations as exceptions (100%).

Important note: You can claim an additional 20% on top of the total LMIC exception costs for each specific LMIC organisation. These additional funds are a contribution towards indirect costs incurred by the LMIC overseas organisation over the duration of the project (excluding India).

Important note: There is no cap on eligible funds attributed to international project co-leads from DAC list countries, excluding India.

UK based research organisations costs

All UK based costs must comply with the principles of full economic costing (FEC) of applications and claimed accordingly (if the application is successful, we would typically fund 80% of the UK based costs claimed).

High Income Country based international organisation (including India) costs

An HIC international organisation based overseas, including India, will not be on the OECD DAC list of official development assistance recipients and is therefore not defined as an LMIC.

Costs associated with HIC international organisations must be claimed as an exception (100%).

All costs attributed to international HICs, including India, must not exceed 30% of the total FEC costs claimed.

Do not include indirect costs for organisations based within any HIC international organisation, as these are not permitted. Do not claim the 20% extra costs as this is for LMIC based organisations only (excluding India).

Provide a breakdown of the funding request per organisation by completing the table provided in the Funding Service.

Related applications

Word limit: 800

Is this application related to another application to MRC or other funding organisation?

If your application is not related to another, you will be able to indicate this in the Funding Service.

If yes, state your previous reference number and explain how this new application is related to the other application.

If the related application was submitted to another funder, you should identify the name of the funder and when you applied.

If this is a resubmission, describe how it differs from the previous application and how feedback on the previous application has been considered and acted on.

How we will assess your application

Assessment process.

We will assess your application using the following process.

Peer review

Your outline application will be reviewed by independent board members and MRC’s global health faculty of experts.

Shortlisting

We will review the comments and scores for each application. Shortlisted applications will be invited to submit a stage two application.

We aim to complete the stage one assessment process within four months of receiving your application. The funding decision will be made on applications invited to stage two approximately six months from then.

We will give feedback with the outcome of your application.

Principles of assessment

We support the San Francisco declaration on research assessment and recognise the relationship between research assessment and research integrity.

Find out about the UKRI principles of assessment and decision making .

We reserve the right to modify the assessment process as needed.

Assessment areas

The assessment areas we will use are:

vision of the project
approach of the project
capacity strengthening plans of the project
capability of the applicant or applicants and the project team to deliver the project
ethical and responsible research and innovation considerations of the project
value for money and equity of the project

Find details of assessment questions and criteria under the ‘Application questions’ heading in the ‘How to apply’ section.

Contact details

Get help with your application.

If you have a question and the answers aren’t provided on this page

Important note: The Helpdesk is committed to helping users of the UK Research and Innovation (UKRI) Funding Service as effectively and as quickly as possible. In order to manage cases at peak volume times, the Helpdesk will triage and prioritise those queries with an imminent opportunity deadline and/or a technical issue. Enquiries raised where information is available on the Funding Finder opportunity page and should be understood early in the application process (for example, regarding eligibility or content/remit of an opportunity) will not constitute a priority case and will be addressed as soon as possible.

For help and advice on costings and writing your proposal please contact your research office in the first instance, allowing sufficient time for your organisation’s submission process.

For questions related to this specific funding opportunity please contact [email protected]

For general questions related to MRC funding including our funding opportunities and policy email: [email protected]

Any queries regarding the system or the submission of applications through the Funding Service should be directed to the helpdesk.

Email: [email protected] Phone: 01793 547490

Our phone lines are open:

Monday to Thursday 8:30am to 5:00pm
Friday 8:30am to 4:30pm

To help us process queries quicker, we request that users highlight the council and opportunity name in the subject title of their email query, include the application reference number, and refrain from contacting more than one mailbox at a time.

Find information on submitting an application .

Sensitive information

If you or a core team member need to tell us something you wish to remain confidential, email [email protected]

Include in the subject line: [the funding opportunity title; sensitive information; your Funding Service application number].

Typical examples of confidential information include:

individual is unavailable until a certain date (for example due to parental leave)
declaration of interest
additional information about eligibility to apply that would not be appropriately shared in the ‘Applicant and team capability’ section
conflict of interest for UKRI to consider in reviewer or panel participant selection
the application is an invited resubmission

For information about how UKRI handles personal data, read UKRI’s privacy notice .

Additional info

Webinar for potential applicants.

We held a webinar on 7 December 2023 to provide more information about the funding opportunity and a chance to ask questions.

Watch the webinar (Zoom)

Passcode to access the recording: H6RXwk@i

Research disruption due to COVID-19

We recognise that the COVID-19 pandemic has caused major interruptions and disruptions across our communities. We are committed to ensuring that individual applicants and their wider team, including partners and networks, are not penalised for any disruption to their career, such as:

breaks and delays
disruptive working patterns and conditions
the loss of ongoing work
role changes that may have been caused by the pandemic

Reviewers and panel members will be advised to consider the unequal impacts that COVID-19 related disruption might have had on the capability to deliver and career development of those individuals included in the application. They will be asked to consider the capability of the applicant and their wider team to deliver the research they are proposing.

Where disruptions have occurred, you can highlight this within your application if you wish, but there is no requirement to detail the specific circumstances that caused the disruption.

This is the website for UKRI: our seven research councils, Research England and Innovate UK. Let us know if you have feedback or would like to help improve our online products and services .

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Global engagement /

Impact Grants for Regional Priorities

The Impact Grants fund implementation research on infectious diseases of poverty that leads to health improvement of the population as well as strengthened research capacity of individuals and institutions in low- and middle-income countries. It also encourages cooperation between the research teams with national and international partners. The initial Small Grants Scheme run from 2015 to 2021.

Overall objectives

Strengthen the research capacity of relevant individuals and institutions in countries.
Generate new knowledge, solutions and implementation strategies that can be applied by countries for the control and elimination of infectious diseases.
Encourage intersectoral dialogue and one health approach.

A joint initiative with WHO regional offices

The Impact Grants are a joint initiative between TDR and WHO regional offices under the current TDR Strategy 2018–2023 .

Projects are carried out by researchers in developing countries, while the grants are implemented and managed by the WHO regional offices for Africa, the Americas, South-East Asia, Europe, the Eastern Mediterranean and the Western Pacific.

Since 2014 the Scheme’s focus has been on implementation research and each region has taken more responsibility for jointly identifying with TDR the research priorities to be funded. The scheme has included all WHO regions since 2016.

How much funding is available?

These are small grants of US$ 10 000–US$ 15 000 per grant.

What does the initiative support?

Impact Grants encourage health care workers and researchers to apply for grants, including those working in institutions such as regional or national tropical/communicable disease control programmes in ministries of health, academic institutions, research institutes, and nongovernmental organizations, and professional societies or civil service organizations involved in tropical disease research.

Applications that promote cooperation between researchers in different institutions, especially from more than one country are strongly encouraged.

How are applications assessed?

Proposals are selected based on a competitive evaluation by WHO staff in the relevant regional office and TDR. Scoring evaluates each project’s scientific merit and planned public health impact.

Publications resulting from the supported projects and data are made available as global public goods following the TDR Open Access policy.

Outputs by region (2019)

Small Grants Research Scheme project results 2014–2019

table showing 44 countries and diseases studied

Research projects

Research projects addressed several common themes across WHO regions

maternal and child health
using GeneXpert – TB molecular diagnostic tool
household burden of TB – catastrophic costs
malaria treatment/control strategies
leishmaniasis and vector control
hepatitis C virus economic analysis
antimicrobial/multi-drug resistance.

Policy and l earning m aterials produced by projects

Many project teams developed practical approaches and materials that they used to inform and educate their policy-makers, public health officials, students, health care professionals, and local health advocacy groups. These materials were used to inform national public health programmes, build partners’ capacity and share research results with decision-makers.

Tools and practices with transfer potential

Many small grants principal investigators have suggested tools and practices from their projects that they feel are worth sharing. These are outputs with potential for transfer for use by other public health and research professionals to address neglected tropical diseases.

Knowledge briefings

Several "knowledge briefs" have resulted from the small grants research. They synthesize work done by several projects on common themes, to encourage wider sharing of project experience on tropical disease treatment and control:

decentralizing TB care: transition from in-patient to out-patient model
approaches to Leishmaniasis detection, prevention and control
molecular diagnostics for rapid TB detection (Gene Xpert)
reducing the impact of catastrophic TB costs for households.

Publications

Small Research Grants Scheme

TWAS-ICCBS Postgraduate Fellowship Programme

Twas-iccbs postdoctoral fellowship programme, twas-ncp postdoctoral fellowship programme, twas-sn bose postdoctoral fellowship programme, twas-sn bose postgraduate fellowship programme, research and project grants.

TWAS research grants are awarded to both individual scientists and research groups

TWAS research grants fund several programmes that support:

Researchers in developing countries, allowing them to purchase specialized equipment and consumable supplies, and
Support Master of Science students.

The calls for 2024 TWAS Research Grants in Basic Sciences—one for individuals and one for groups —closed on 3rd April 2024.

Under this scheme, grants are awarded to promising high-level research projects in biology, chemistry, mathematics and physics carried out by individual scientists in one of the S&T-lagging countries identified by TWAS.

Swedish International Development Cooperation Agency

The Swedish International Development Cooperation Agency ( Sida ) provides essential support to TWAS, OWSD and GenderInSITE. Sida-supported programmes focus on research grants and PhD fellowships in 66 S&T-lagging countries , and support the TWAS Regional Offices and its science diplomacy programme. Sida is a government agency working under the Swedish Foreign Ministry. It administers approximately half of Sweden's budget for development assistance to developing countries.

Under this scheme, grants are awarded to promising high-level research projects in biology, chemistry, mathematics and physics carried out by research units in the S&T-lagging countries identified by TWAS.

Under this scheme, grants are awarded to high-level scientists for interdisciplinary research projects. Each grant supports a collaborative project jointly carried out by two Principal Investigators (PIs) in the S&T-lagging countries identified by TWAS.

Under this scheme, grants are awarded to past grant recipients of the TWAS Research Grant programme who procured equipment through the grant in one of the S&T-lagging countries identified by TWAS.

With the support of the German Federal Ministry of Education and Research (BMBF), UNESCO-TWAS launched a new programme to strengthen the capacity of African countries lagging in science and technology. The programme is aimed at young scientists who are getting established in their country or are about to return home to an academic position. Grants are awarded to promising high-level research projects in Agriculture, Biology, Chemistry, Earth sciences, Engineering, Information Computer Technology, Mathematics, Medical Sciences and Physics carried out in African countries lagging in science and technology identified by TWAS.

German Federal Ministry of Education and Research (BMBF)

The German Federal Ministry of Education and Research (BMBF) promotes education, science and research.

The COVID-19 pandemic is a global crisis, affecting human health as well as economies and societies worldwide. TWAS and the Islamic Development Bank (IsDB) are offering a competitive grant for research collaboration. Technologists and researchers from IsDB Member Countries are invited to submit research and innovation proposals that can help address challenges related to post COVID-19 pandemic.

Islamic Development Bank

The Islamic Development Bank , founded in 1974, works to foster the economic development and social progress of member countries and Muslim communities in accordance with the principles of Islamic Law. It has made significant investments in areas related to science and science capacity, as well as in infrastructure and education. IsDB, based in Jeddah, Saudi Arabia, has 57 member countries. It has regional offices in Rabat, Morocco; Kuala Lumpur, Malaysia; Almaty, Kazakhstan; and Dakar, Senegal. It also has country gateway offices in Ankara, Turkey, and Jakarta, Indonesia, plus field representatives in 14 member countries.

Under this scheme, grants are awarded to teams of 2-5 women for action-based projects which, although scientific in nature, will take them outside the lab to promote practical and tangible change under the umbrella of the “climate action” SDG in their local context. The principal applicant and project leader is a woman scientist, holding a PhD, living and working in a science and technology lagging country (STLC). Co-applicants are either scientists or technical experts in a field relevant to the project, from any developing country.

The Elsevier Foundation

The Elsevier Foundation provides grants to knowledge centered organizations around the world, with a focus on diversity and inclusion in science, technology and health, research in developing countries and global health. Since 2006, the Foundation has awarded more than 100 grants worth over $6 million to non-profit organizations working in these fields. The Elsevier Foundation is a US based, corporate not-for-profit 501(c)(3), funded by Elsevier , a leading scientific, technical and medical information solutions provider.

The DECIMALS fund has been set up to provide grants to small research teams in developing countries, allowing them to analyze the impacts that Solar Radiation Management might have in their regions. It was launched in response to a common concern voiced at SRMGI’s engagement workshops, where local participants often proposed and widely supported the idea that scientists in developing countries should undertake research on the potential local impacts of SRM, noting that there is typically very little funding available to support research in this area.

Solar Radiation Management Governance Initiative

The Solar Radiation Management Governance Initiative is an international, NGO-driven project that seeks to expand the global conversation around SRM geoengineering research and its governance. The initiative is neutral on whether SRM should ever be used, and seeks to engage new voices in discussions of the underlying societal and scientific issues. A global pioneer in bringing developing country voices into SRM discussions, SRMGI co-organised the first major SRM discussion meetings in China, Ethiopia, India, Jamaica, Senegal, Brazil, and many other countries of the Global South, always in concert with local partners.

The Organization for Women in Science for the Developing World (OWSD) offers fellowships for women who have completed their PhDs in science, technology, engineering and mathematics subjects and are employed at an academic or scientific research institute in a science and technology lagging country. Early Career fellows will be supported to establish an environment at their institution where they can maintain an international standard of research and attract scholars from all over the world to collaborate.

International Development Research Centre

IDRC supports research in developing countries to create real and lasting change. This knowledge can be used as a tool for addressing pressing global challenges.

Part of Canada’s foreign affairs and development efforts, IDRC invests in knowledge, innovation, and solutions to improve the lives of people in the developing world.

Research calls and grants

Many of our cooperation partners regularly announce research calls and grants with support from Sida. Here you find a selection.

Joint Programming Initiative on Antimicrobial Resistance (JPIAMR)

JPIAMR is a global collaborative platform to curb antimicrobial resistance (AMR) with a One Health approach. JPIAMR coordinates national public funding to support joint transnational research and network calls, seeking new knowledge and supporting solutions to decrease the burden of AMR. Sida supports participation of researchers from a number of countries in sub-Saharan Africa.

Open and upcoming calls at the JPIAMR website

Artificial Intelligence for Development in Africa (AI4D Africa)

The AI4D initiative provides opportunities within capacity building, innovation and policy research within the field of AI, including PhD fellowships, postdoc grants, as well as larger grants for the coordination of policy and innovation networks, and setting up state of the art university AI-labs. The AI4D program, funded by Sida and International Development Research Centre (IDRC), is dedicated to a future where Africans across all regions create and use artificial intelligence (AI) to lead healthier, happier and greener lives.

Open, and upcoming, calls on the official AI4D Africa website

The Organization for Women in Science in the Developing World (OWSD)

OWSD provides PhD fellowships and Early Career fellowships for women scientists from Science and Technology-Lagging Countries. The fellowships are offered for PhD research or to pursue research in the natural, engineering and information technology sciences.

Fellowships at the OWSD web page

World Academy of Sciences for the Advancement of Science in Developing Countries (TWAS)

TWAS provides grants to individual scientists and research groups in basic Sciences (biology, chemistry, mathematics and physics) from science and technology lagging countries, to enable them to purchase the research facilities they need to enhance their productivity.

Research grants at the TWAS web page

International Foundation for Science (IFS)

IFS provides individual research grants for early career researchers from low income or lower middle income countries for projects within 1. biological resources in terrestrial systems 2. water and aquatic resources and 3. food security, dietary diversity and healthy livelihoods. Calls are normally announced twice a year.

International Foundation for Science web page

The African Economic Research consortium (AERC)

AERC runs a collaborative PhD programme in economics with the aim to strengthen teaching and research capacity in sub-Saharan Africa, to increase the pool of potential researchers and policy analysts. Applications have two deadlines per year. AERC also have other post-graduate training opportunities.

Arab Council for the Social Sciences (ACSS)

ACSS runs a number of fellowships and grants programmes with support from Sida. These offer opportunities for junior and senior social scientists in the Arab region, encouraging the production of independent, high-quality research.

ACSS website

Alliance for Health Policy and Systems Research (AHPSR)

AHPSR (hosted by WHO) issues calls for research proposals and bids on a regular basis targeted towards institutions from low- and middle-income countries.

Alliance for Health Policy and Systems Research at the WHO website

The European & Developing Countries Clinical Trials Partnership (EDCTP)

EDCTP funds research for prevention and treatment of poverty-related infectious diseases in sub-Saharan Africa and regularly announces calls for proposals and nomination for prizes.

United Nations University World Institute for Development Economics Research (UNU-WIDER)

Visiting PhD Fellowship Programme at UNU-WIDER (United Nations University World Institute for Development Economics Research) in Helsinki, Finland.

Visiting PhD Fellowship Programme at the UNU-WIDER website

International Network for Advancing Science and Policy (INASP)

INASP lists sources of funding and keeps an updated forum on funding opportunities.

Funding opportunities at the AuthorAID website

Science and Development Network (SciDev.Net)

SciDev.Net has a regularly updated noticeboard with science and development related jobs, events, announcements and grants.

Noticeboard at the SciDev.Net website

Updated: December 27, 2022

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GCF, UNDP and WHO join forces to ramp up climate health support for developing countries

New partnership to develop global climate and health co-investment facility.

The Green Climate Fund (GCF), the United Nations Development Programme (UNDP) and the World Health Organization (WHO) have launched an ambitious new initiative that will ramp up support for developing countries to mitigate and respond to the impacts of climate change on health in 14 countries in Africa, Asia and Southeastern Europe.

The latest IPCC report highlights that climate change is a serious threat to human well-being and planetary health, and developing countries with weak health infrastructure are particularly vulnerable. Yet, countries have identified insufficient finance as a barrier to implementing their national health and climate change plans. The climate health nexus has been underfunded from available climate related funding pots, with only 2 per cent of adaptation funding and 0.5 per cent of multilateral climate funding allocated to projects that protect or improve human health. Additionally, there is fragmentation of efforts towards financing this nexus.

To address this gap, GCF, UNDP and WHO have come together in a crosscutting partnership and committed funding to support the development of an ambitious global climate and health investment programme initially seeking to deploy US$ 122 million in financing. With a US$ 1.5 million grant from GCF’s Project Preparation Facility and matching funding of US$ 1.56 million from UNDP and WHO, this programme will establish the Climate and Health Co-Investment Facility.

This unique financing mechanism will leverage public and private capital to promote climate resilient, sustainable, and low-carbon health systems and assist countries to implement their health commitments made at COP26 and through the WHO's Alliance for Transformative Action on Climate and Health (ATACH), an alliance using the collective power of WHO Member States and other stakeholders to realize the COP26 ambition of building climate resilient and sustainable health systems.

“Climate and health are intertwined challenges, and we must respond accordingly. Climate finance has an important role in preparing health systems to be better equipped to respond to climate impacts. The Climate and Health Co-Investment Facility is a powerful new instrument for healthier, more resilient communities in frontline nations,” said Mafalda Duarte, GCF Executive Director.

The announcement was made at the World Climate Action Summit’s Leaders’ Event on Health, which spotlights the progress made on climate and health and aims to galvanize public and private sector momentum for climate and health at COP28.

"The climate crisis is a clear and present danger to public health. With the clock ticking, we must urgently build climate-resilient, sustainable, and low-carbon health systems — this initiative, forged in collaboration between the Green Climate Fund, UN Development Programme and the World Health Organization, will convene public and private sector partners and leverage the resources at scale to do just that, and in some the world’s most vulnerable countries," said Srilata Kammila, UNDP Head of Climate Change Adaptation.

Health at COP28

Environment, Climate Change and Health

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Small Grants

Building the evidence base to identify best practices in health and improve health outcomes requires investments in research, as well as use of data. Yet in developing countries, capacity to conduct needed public health research, from both a technical and financial point of view, is overstretched or lacking.

Small grants are one solution to promote research capacity. In line with USAID’s vision of sustainability and the Global Health Initiative (GHI) principles, small grants can support an effective country-led platform by giving local research groups in low- and middle-income countries needed support to investigate local issues.

Building on the experiences and lessons learned from the small grants program under the MEASURE Evaluation Population and Reproductive Health (PRH) Associate Award, MEASURE Evaluation is building local research and evaluation capacity and addressing knowledge gaps in health through its small grants program. MEASURE Evaluation funded 32 small grants as well as providing ongoing one-on-one technical assistance to the sub-grantee teams. Results from these studies from around the world are disseminated directly to stakeholders where the research can inform and influence policies and programs.

Afya Research Africa : Family Planning Services in Kenya during a Transition: Utilization Trends across Counties

Matibabu Foundation : Integrating Family Planning Data in Kenya's DHIS 2

Association for Reproductive and Family Health : Use of Routine Health Information to Inform Budgetary Allocations for Reproductive Health in Cross River State, Nigeria

Equitable Health Access Initiative: The Strongest Motivators for Using Routine Health Information in Family Planning: A Prospective Study in Lagos, Nigeria

Rivers State of Nigeria Primary Health Care Management Board: Use of Technology to Manage Health Data in Rivers State, Nigeria: A Qualitative Study on Family Planning and Routine Health Information Systems

Health Promotion Tanzania: Enhancing Use of Routine Health Information for Family Planning to Influence Decision Making in Tanzania

Department of Population Studies, Makerere University: Facilitators, Best Practices and Barriers to Integrating Family Planning Data in Uganda’s Health Management Information System

University of the Punjab, Institute of Social and Cultural Studies: Routine Health Information System in Punjab Province, Pakistan: Exploring the Potential for Integrating Health Information Systems for Family Planning Data

Centre of Population, Health and Nutrition Services: Improving Family Planning Service Delivery in Ghana

Access Global Ltd.: Uganda’s Resources to Finance Family Planning Commodities: Implications for a Total Market Approach

Integrated Health Initiative: Integrating Family Planning Data from Public and Private Health Facilities in Malawi: How Current Approaches Align with FP2020 Goals

Governance Links Tanzania: Strengthening Tanzania's Routine Health Information System: Incorporating Family Planning Quality Assessment Indicators

Zambia Association of Gynaecology and Obstetrics, University Teaching Hospital: Adolescent-Friendly Health Services in Public Health Facilities in Lusaka, Zambia

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Centre of Excellence in Health Monitoring and Evaluation, Mzumbe University : Creating a Culture of Data Use in Tanzania: Assessing Health Providers’ Capacity to Analyze and Use Family Planning Data

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Community Health Promotion Kenya : Evaluating the role of clinical officers in providing reproductive health services in Kenya

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School of Medicine and Pharmacy, State University of Haiti : Implementation analysis of continuous quality improvement initiatives to improve quality of care for people living with HIV/AIDS in health institutions in Haiti

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Institute of Development Studies at the University of Dar es Salaam : Investigating Risky Sexual Behaviours among Youth in the Context of the HIV Epidemic in Mbeya Region, Tanzania

Wambura & Jacque Company Ltd. : Effective linkage from point of HIV testing to care and treatment in Tanga region, Tanzania

Jerusha (T) Limited : How Access to Smartphones Affects HIV Risk among Students in Tanzania: A Case Study of Selected High Schools in the Dar es Salaam Region

Governance Links Tanzania : Women’s Property and Inheritance Rights and HIV in Farming Communities around Lake Victoria, Northwestern Tanzania – A Quantitative Analysis

Development Studies Institute at Sokoine University of Agriculture : How Gender Affects Adherence to Antiretroviral Therapy in Tanzania

Tanzania Health Promotion Support (THPS): Enhancing HIV Retention and Clinical Outcomes in Tanzania through Pediatric- and Adolescent-Friendly Services

Seeds of Hope: Prevention Needs and Priorities among Vulnerable Female Populations Living with HIV

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Mmakija Survey Management: Attrition from HIV Care and Treatment Services in Tanzania: Magnitude and Reasons

Pima Uishi kwa Matumaini (PIUMA): The Children Left Behind: Barriers to Testing and Enrolling Children in HIV Care and Treatment in Njombe Region, Tanzania

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Introduction
Conclusions
Article Information

Dark blue bars indicate number of refugees admitted; light blue line indicates number of grants.

eTable 1. Reasons for Exclusion of Grants With Keyword Matches With Examples

eTable 2. Median and Interquartile Range (IQR) of Refugee Health Research Funding from 2000 to 2020

eFigure 1. STROBE Flow Chart

eFigure 2. Average Duration of Grants in Years by Type of Grant

eFigure 3. Percentage of Grants Funded by Location of Research

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Kaur M , Bridi L , Kaki D, et al. Funding for Refugee Health Research From the National Institutes of Health Between 2000 and 2020. JAMA Netw Open. 2024;7(1):e2350837. doi:10.1001/jamanetworkopen.2023.50837

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Funding for Refugee Health Research From the National Institutes of Health Between 2000 and 2020

1 Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles
2 School of Medicine, University of California, San Diego, La Jolla
3 School of Medicine, University of California, San Francisco
4 Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
5 Department of Neurology, Harvard Medical School, Boston, Massachusetts
6 Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco

Question What is the status of refugee health research funding within and across all the National Institutes of Health (NIH) over 20 years?

Findings This cross-sectional study found a total of 78 grants that focused on researching refugee health; almost half of this research focused on mental health (46%), with the National Institute of Mental Health funding most grants (33%). The total amount spent was $81.2 million (2000 to 2020); for context, the NIH spent less than 0.01% of its 2020 budget on refugee health research.

Meaning Despite a plethora of documented health disparities among refugees and an exponentially growing population of refugees, these findings suggest the NIH provided minimal funding to support refugee health research.

Importance The US has historically resettled more refugees than any other country, with over 3.5 million refugees since 1980. The National Institutes of Health (NIH) is the largest public funder of biomedical research and development, but its role in mitigating many health disparities refugees experience through its funded research remains unknown.

Objective To examine the NIH’s research funding patterns on refugee health research over the last 2 decades.

Design, Setting, and Participants Secondary analysis of NIH-funded grants between 2000 and 2020 using a cross-sectional study design. The NIH Research Portfolio Online Reporting Tools database was used to find relevant grants. Data were analyzed from November 2021 to September 2022.

Main Outcomes and Measures NIH grants awarded by year, state, grant type, research area, funding institute, grant duration, and amount funded.

Results Of 1.7 million NIH grants funded over the 20-year study period, only 78 addressed refugee health. Funded grants were mostly training grants (23 grants [29%]), followed by hypothesis-driven research (R01 grants; 22 grants [28%]), pilot or preliminary investigation proposals (13 grants [17%]), and other types of grants (20 grants [26%]). The most studied research domain was mental health (36 grants [46%]), followed by refugee family dynamics and women’s and children’s health (14 grants [18%]). A total of 26 grants (33%) were funded by the National Institute of Mental Health and 15 (19%) were funded by the National Institute of Child Health and Human Development. Most grants were US-based (60 grants [76%]) and the state of Massachusetts received the greatest amount of funding ($14 825 852 [18%]). In 2020, the NIH allocated about $2.3 million to refugee health research, or less than 0.01% of its $42 billion budget that year. The number of grants funded in each time period did not always reflect changes in the number of refugees resettled in the US over the years.

Conclusions and Relevance This cross-sectional study found that there remain significant gaps in the understanding of and interventions in the health research needs of refugees locally and along the migratory route. To close these gaps, the NIH should increase its investments in comprehensive studies assessing the physical, mental, and social well-being of this expanding population. This can be achieved by ensuring that all NIH institutes allocate budgets specifically for refugee health research and extend support for the training of refugee researchers.

One in 74 people in the world are forcibly displaced, which includes 40.7 million refugees and asylum seekers, roughly equivalent to the population of Canada. 1 Over the past decade alone, the number of refugees worldwide has more than doubled, resulting in 108.4 million forcibly displaced people, the highest number on record. 1 , 2 This number is expected to grow due to ongoing geopolitical turmoil, climate-induced migration, and rising economic inequality. The United Nations High Commissioner for Refugees (UNHCR) defines a refugee as a person who was forced to leave their own country because of war, persecution, or widespread violence. 3 All refugees were asylum seekers at one point, having sought protection from persecution while waiting to receive a decision on their asylum claim. These distinctions are legal ones, but both encompass the similar experience of seeking refuge in a new country because they are at risk of persecution in their home country.

Refugees have the human right to health, and countries have obligations to provide refugees and forcibly displaced people health care services. This is delineated in the 1951 Convention Relating to the Status of Refugees and its 1967 Protocol, 4 and is important as prior research has shown a higher prevalence of various neuropsychiatric disorders such as posttraumatic stress disorder (PTSD), depression, and head trauma as well as chronic diseases such as cardiovascular disease. 5 - 7 Yet despite both these protections and known health needs, they experience significant health disparities. 8 They face health care barriers including lack of access and interrupted health care coverage, difficulty navigating complex systems, lack of culturally and linguistically concordant care, discrimination, and poor health care utilization. 9 - 13 These health care barriers are compounded by a heightened exposure to premigratory, midmigratory, and postmigratory mental and physical trauma, loss of social networks, barriers to accessing care along the migratory route, and other stressors that contribute to cycles of health disparities. 14 There is growing literature demonstrating the transgenerational transmission of health disparities from refugees to their children. 15 - 17 Yet many questions remain about how best to care for this highly trauma-exposed population given a dearth of evidence-based clinical guidelines and interventions. 18

Conducting refugee health research is particularly challenging because few public health systems collect data on migration history and experiences. Refugee populations are often studied within their racial and ethnic groups without inquiry into their displacement history or considering race as a social construct. 19 - 22 Designing novel health interventions to address health disparities in the minoritized refugee population requires a deep understanding of various contextual factors such as wars or other trauma exposure in the country of origin, experiences during migration, resettlement community politics and capacities, education level, and social support systems, among others. Refugee health research is needed to assess these interplaying factors and formulate evidence-based recommendations allowing for achieving optimal health over the life course. 23 - 26

The National Institutes of Health (NIH), which invests almost $48 billion in health research every year, is the largest public funder of health research in the world and provides a lifeline pathway for rectifying this knowledge gap. 27 Within the lens of a human rights framework, the NIH’s research mission should elevate not only research that considers the public interest within a broader, international context but also with a focus on those marginalized and at risk of human rights violations domestically and globally. This is aligned with their larger mission to support research on health disparities and health inequities. 28 Yet, to date, there has been no formal evaluation of NIH funding allocated toward refugee health research in the US, which has welcomed almost 3.5 million refugees since the Refugee Act of 1980, and in 2021 received the largest number of individual refugee applications worldwide. 29 , 30 This study seeks to address this gap in the literature and assess NIH research funding for refugee health from 2000 to 2020. This study was designed to (1) conduct a detailed analysis of NIH funding in refugee health research over the last 2 decades and (2) identify important future research directions, including the role of the NIH in establishing and funding a refugee health research agenda.

A cross-sectional study was performed in October 2021, following the Strengthening the Reporting of Observational Studies in Epidemiology ( STROBE ) reporting guideline. 31 The Institutional Review Board at the University of California San Diego determined that no ethical approval was required. Informed consent was not required because there were no human participants in this study. We defined refugee health research as any study that explicitly addresses the health or health care of people who identify as asylum seekers, refugees, and refugees resettled in the US. We used the NIH Research Portfolio Online Reporting Tools (RePORT), a publicly available database, to analyze all refugee health research grants between 2000 and 2020. We used the search terms refugee , asylum seeker , forced migration , migrant , emigrant , refugee , and United States separately to find all the relevant grants. The first author (M.K.) conducted all the searches separately and only combined the terms refugee and United States to look for grants specifically funded in the US. These terms were chosen based on commonly used terms for refugees according to the United Nations definition of displaced communities and consensus of all coauthors who are experts in the field (T.A., A.S., C.A.M.).

Grants were excluded if they mentioned the keywords but did not study refugee health (eg, grants that mentioned refugee populations as examples but were not the intended study group). Similarly, projects that returned nonrelated topics were also excluded (eg, the keyword migrant yielded grants that were related to migratory cells in the human body) (eTable 1 in Supplement 1 ). Additionally, grants that only had their title but were missing abstracts and/or funding information on the database were also excluded.

We recorded the grant number, grant type, NIH institute or center, grant title, dollar amount awarded, state of the institute that received funding, and grant abstract. Using the abstract, we also recorded the grant’s primary research area designation, type of data collection, involvement of community engagement practices, and whether it was spent locally or internationally. Community engagement was defined as an approach specifically designed to interact with groups of people that are related by affiliation, geography, or a shared interest to address issues affecting their well-being. 32 , 33 Therefore, community engagement was determined based on whether the researchers collaborated directly with the refugee group they were studying or had partners from that community that assisted with the research process. Two authors independently determined the relevance of each grant and abstracted the data, and any disagreements were resolved by a third author (M.K., B.A., N.B., and T.A.). Data on the number of refugees admitted yearly were combined using the yearly admissions data by the Migration Policy Institute which were then trended over the 20-year period to compare with the number of grants. 34 All data were collated into a database in Excel, version 16.79.2 (Microsoft) for data management and analysis.

Grants were categorized according to the following 6 primary research areas: (1) mental health; (2) refugee family dynamics and women’s and children’s health; (3) HIV and/or substance use; (4) health care delivery, including intervention and implementation science; (5) health disparities with other immigrants or the host population as comparison groups; and (6) chronic disease. These categories were determined based on the common research areas that emerged from the abstracts of all the selected grants. Studies that spanned multiple research areas were categorized according to their primary research area based on their main study aim. We summarized the total number of grants funded by each NIH institute or center, the number of each type of grant, the amount of money allotted to each grant, the number of grants by primary research area, type of data collection (primary vs secondary), involvement of community engagement practices, and the location (state) of the institute that received funding along with the location of the research project (local or international). Data were analyzed from November 2021 to September 2022.

Our keyword search on the NIH RePORT database returned 768 unique refugee health research grants out of more than 1.7 million NIH projects funded between 2000 and 2020. Of those, only 78 grants met the inclusion criteria (eFigure 1 in Supplement 1 ). The rest were excluded for various reasons including grants citing refugee health research conducted previously; using the keyword refugee but not actually studying refugees in the research aims; grants funding centers, cores, and conferences for refugee health but not directly doing refugee health research; and more (see eTable 1 in Supplement 1 ). Notably, multiple grants used the identifiers refugees or migrants interchangeably, despite legal differences between these 2 populations. Our study also identified multiple grants misusing the identifier of refugee health research when not conducting research with or for refugee populations based on the information the researchers provided in their abstract. To date, the number of refugee-related grants varied by funding period, with the largest number (8 grants) funded in 2012, and the smallest number (0 grants) funded in 2006 ( Figure 1 ). The cumulative number of refugees admitted in the US since 2000 was 1 130 479. The number of grants funded each year did not always reflect changes in the number of refugees resettled in the US over the years ( Figure 1 ).

Of the 78 funded grants, the primary research focus was mental health in 36 grants (46%), refugee family dynamics and women’s and children’s health (including intergenerational studies) in 14 grants (18%), HIV and/or substance use in 8 grants (10%), health care delivery (including interventions) in 8 grants (10%), and 12 grants (15%) in other topics. Other research areas included health disparities (8 grants [10%]) and chronic disease (4 grants [5%]) ( Table 1 ). Of the 78 funded grants, the majority conducted primary data collection (70 grants [90%]) and integrated community engagement practices engaged in their research (69 grants [89%]).

The National Institute of Mental Health (NIMH) and the National Institute of Child Health and Human Development (NICHD) together funded over 50% of all selected grants ( Table 2 ). The NIMH funded 26 grants (33%) and the NICHD funded 15 grants (19%). Sixteen other institutes and centers funded at least 1 refugee health research grant. Of the 78 grants, 13 (17%) were pilot grants (small exploratory grants), 22 (28%) were R01s (grants funding hypothesis-driven health research), 28 23 (29%) were junior training grants (small grants funding early career investigators), and the remaining 20 (26%) were other types of research grants, which included P20 grants that fund interdisciplinary programs or centers ( Table 2 ). 35 , 36 The average duration of a grant varied based on the type of grant. Research grants such as the T37 (18 years) and U54 (15 years) had the longest duration of funding as opposed to junior training grants such as the T32, which had an average duration of 6 years. Investigator-initiated research grants had the shortest duration (R01: 4 years; R03, R21, and R34: 2 years) (eFigure 2 in Supplement 1 ).

Most grants were US-based (60 grants [76%]). Overall, the state of Massachusetts received the highest amount of funds for refugee health research (18%), followed by California (15%) and Washington (9%) ( Figure 2 ). Sixty grants (77%) funded refugee health research domestically and 18 grants (23%) were conducted outside of the US (eFigure 3 in Supplement 1 ).

The total amount of funding for all 78 grants between 2000 and 2020 was $81.2 million ( Table 2 ). Of this, $25.8 million (32%) was granted by NIMH and $18.4 million (23%) was granted by NIMHD ( Table 2 ). This is in comparison with $5.4 trillion NIH funding spent from 2000 to 2020 on all research grants, research career awards, and training grants. 37 Most recently in 2020, a total of about $2.3 million was invested by NIH in refugee health research, less than 0.01% of their $42 billion annual budget for medical research. 38 Of the $2.3 million, 88% was funded by NICHD, and 71% was spent on refugee family dynamics and women’s and children’s health (including intergenerational studies). Overall, the median (IQR) amount funded through the 2-decade period was $491 314 ($291 708-1 530 130) (eTable 2 in Supplement 1 ). Individually, the year 2016 had the highest median (IQR) amount funded as compared with other years ($2 512 213 [990 189-3 383 886]) (eTable 2 in Supplement 1 ).

The forced displacement and refugee crisis is one of the defining public health challenges of our time. Spanning over 2 decades that witnessed multiple wars, natural disasters, a global pandemic, and economic inequality driving an unprecedented rate of mass displacement, our results highlight that this challenge is minimally addressed by scientific research funded through the NIH, a major public funder of biomedical research globally. Funding for refugee health research was consistently low and did not always align with the growing number of refugees resettled in the US. The cumulative number of refugees resettled over the years has grown, and given that the refugee lifetime experience is something that is carried with a person over the life course, NIH funding should have reflected that.

Our study also revealed that more than half of the refugee health research grants focused on mental health as their primary research without equal emphasis on other aspects of health among refugees, including chronic and infectious diseases. 39 , 40 US-resettled refugees have a high burden of chronic noncommunicable disease and face major barriers to managing these conditions compared with native-born populations. 41 - 44 Our study underscores the need to expand NIH-funded refugee health research beyond focusing only on mental health, which comprised the main topic area of almost half of all NIH-supported refugee health research. Although the mental health of refugees is important, the lack of funding for other aspects of well-being, particularly chronic illnesses, is concerning. The refugee population often has exposures that increase the risk of chronic illness and poor self-management behaviors or access to culturally concordant care, particularly as refugees age in exile. 45 - 48 In fact, US health care spending on chronic manageable diseases such as hypertension and diabetes surpasses $600 billion annually and is a public health priority, including for refugee groups. 42 , 49 , 50 Improving the management of chronic disease and barriers to health care among refugees could prevent inappropriate reliance on emergency departments or late presentation of disease that results in poor health outcomes and high costs to the health care system. 51

We also found that most refugee health research grants were investigator-initiated research grants, followed by training grants, with few center grants, and 2 of the NIH institutes funded more than half of the grants. An increase in funding for refugee health research must involve all 28 centers and institutes to ensure a comprehensive understanding of refugees’ health needs and opportunities to develop interventions accordingly. Expanding the funding of refugee health with a focus on creating opportunities within each center or institute, including notices of special interests and opportunities that center community needs and priorities, would align with NIH’s recent intentions toward promoting health equity across its centers and institutes. 52 , 53

Low levels of NIH investment in refugee health research may also be impacted by the lack of refugee representation among investigators or NIH reviewers or the lack of consideration of refugee investigators as minorities underrepresented in health sciences. Scientist-researcher pipeline programs may be useful in supporting investigators with lived refugee experience, who may have better access to target research populations to conduct this work in more professional capacities. 54 , 55 Prior research has also identified a lack of diversity and expertise in health disparities research among reviewers in NIH peer review panels, which could contribute to the dearth of funding in this area. 56 , 57 More work is also needed to understand how biases about refugees, influenced by negative media portrayal and political discourse around refugee populations, 13 may translate into fewer allocated funds and stricter restrictions for refugee health research.

Our study also identified multiple grants that reflected a lack of knowledge or nuance regarding the terms used to describe forcibly displaced populations, confusing refugees with migrants and using these terms interchangeably, denoting a lack of understanding of the refugee and forced displacement experience. This is evident in the excluded abstracts which used words such as refugees , immigrants , or migrants interchangeably. Many grant abstracts in our sample used refugee health tags in their applications or keywords without including refugee populations in their study samples. Although other minoritized and migrant populations share similarities with refugee groups, and some research findings may be applicable across groups, there are specific aspects of forced displacement and its resettlement process that set this group apart, lead to particular care gaps, and dictate unique care needs. 58 - 60 This highlights the need for NIH to invest in seminars, workshops, and language in their announcements that educate readers on the differences in terms and the importance of using the correct ones.

The NIH is well-positioned to lead the development of better interventions to improve the health of people who have refugee life experience and their families. A human rights perspective necessitates that we realize the inherent dignity of forcibly displaced people, including their right to health, and requires prompting research that addresses migration as a social determinant of health and leverages participatory action research methods to reduce existing disparities. Increased community-centered research is especially important as it integrates a human rights perspective that recognizes people as key actors in their own development, rather than passive recipients of service, thereby involving them in the research process as partners from inception to dissemination. Additional recommendations to expand the refugee health agenda include the following: first, solicitations of investigator-initiated research applications (R series grants) dedicated to refugee health ( Table 3 ). 61 Second, the NIH could develop incentive programs for early-stage researchers by establishing more training and career development awards specifically studying refugee health, especially in geographic areas with high rates of refugee resettlement such as California and Texas. 62 Third, the NIH could support mentorship opportunities for refugee health mentors to train and support future researchers interested in refugee health research. 63 , 64 Fourth, the NIH could partner with multilateral organizations such as the United Nations, International Monetary Fund, and the World Bank to fund refugee health research as these organizations are the majority contributors to international humanitarian efforts. 65 Finally, the NIH could highlight current initiatives and new developments in refugee health research on its science highlights webpage to call attention to the important work being done in the field. 66

Despite our important findings, this study has some limitations. First, our search terms may have omitted grants related to refugee health research that were not captured by our search strategy or that were omitted from the NIH online reporting system. Moreover, the RePORT system only provides minimal information about the grant proposals, such as abstracts and keywords. Second, we do not know the total number of refugee health research applications submitted to the NIH that were not funded, given that the RePORT database only lists funded projects. It is also possible that high volumes of refugee health research applications were submitted, but few were actually funded. Third, this study does not capture changes beyond 2020 which future studies can include for a more comprehensive perspective. Potential changes following 2020 include mass displacement from the war in Ukraine, multiple wars in Israel-Palestine including the most recent October 2023 conflict in Gaza, and increased attention to health equity across NIH institutes followed by the murder of George Floyd, all of which could influence the refugee health research landscape. Although these limitations may have affected our final results, our methods and approach followed previously set guidelines on using RePORT data to assess NIH funding parity. 67 Additionally, some contextual factors that could influence funding levels may exist (eg, NIH budget cuts) and can be examined in future research, but our study was limited to cross-sectional data to characterize overall NIH funding.

To our knowledge, this is the first research paper determining the amount of NIH funding spent on refugee health research, a critical first step in assessing lacunae in refugee health research. The NIH must spearhead refugee health research in a new and accelerated direction in response to the unprecedented rates of forced displacement. Given the upcoming 2023 NIH budget is $62.5 billion (35% higher than the previous year), more money should be allocated to studying health disparities among refugees. 38 Increased NIH funding for refugee health research would fill important research, clinical, and population health gaps as well as support the recruitment of new researchers invested in addressing health inequities in a rapidly growing US-based and global population.

Accepted for Publication: November 20, 2023.

Published: January 10, 2024. doi:10.1001/jamanetworkopen.2023.50837

Corresponding Author: Tala Al-Rousan, MD, MPH, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92037 ( [email protected] ).

Author Contributions: Ms Kaur and Dr Al-Rousan had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors have reviewed the manuscript and approved it for submission.

Concept and design: Kaur, Al-Rousan.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Kaur, Bridi, Kaki, Albahsahli, Bencheikh, Al-Rousan.

Critical review of the manuscript for important intellectual content: Bridi, Kaki, Albahsahli, Bencheikh, Saadi, Bandoli, Anderson, Bernstein, Al-Rousan.

Statistical analysis: Kaur, Bencheikh.

Obtained funding: Al-Rousan.

Administrative, technical, or material support: Kaur, Kaki, Albahsahli, Bandoli, Anderson.

Supervision: Kaki, Bencheikh, Bernstein, Al-Rousan.

Conflict of Interest Disclosures: Dr Al-Rousan reported receiving a grant from the National Heart, Lung, and Blood Institute. Dr Saadi reported receiving grants from the National Institutes of Health/National Institute of Neurological Disorders and Stroke during the conduct of the study. No other disclosures were reported.

Data Sharing Statement: See Supplement 2 .

Additional Contributions: We also want to thank Dr Brie Williams, MD (University of Calfornia, San Francisco), for her help with the conceptualization of this paper. She was not compensated for her contributions.

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Open access
Published: 01 August 2024

Developing research priorities for palliative care in Colombia: a priority setting partnership approach

Tracey McConnell 1 , 2 ,
Cindy V. Mendieta 3 , 4 ,
Esther de Vries 3 ,
Jose A. Calvache 5 , 6 ,
Gillian Prue 2 ,
Sam Ahmedzai 7 &
Joanne Reid 2

BMC Palliative Care volume 23 , Article number: 194 ( 2024 ) Cite this article

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A recent Lancet commission called for more research on palliative care in low- and middle-income (LMIC) countries such as Colombia. A research priority setting approach has been recommended by The Global Forum for Health Research to address the huge gap in research output between LMIC and high-income countries, with influential health service bodies recommending the active involvement of non-research expert stakeholders in establishing research priorities to address service user needs.

Priority setting partnership (PSP) following the four stages of the James Lind Alliance methodology; establishing the partnership, identifying evidence uncertainties, refining questions and uncertainties, and prioritization. Data from MS forms were analysed using descriptive statistics.

A total of 33 stakeholders attended an online PSP workshop and completed the Mentimeter exercise in Microsoft Teams. A total of 48 attended the subsequent in person prioritisation exercise in urban Bogota ( n = 22) and rural Popayan ( n = 25). The stakeholders were a diverse group of health professionals (physicians, medical students, nurses, dentists, physiotherapists, nutritionist, occupational and speech therapists), financial and administrative staff and patients with life-limiting illness and caregivers. Top research priorities included patient and caregiver needs, service provider education and training, and better integration of palliative care with cancer and non-cancer services. The key challenges included a lack of interest in palliative care research, along with funding, time and resource constraints. Key solutions included collaboration across disciplines and settings, highlighting benefits of palliative research to help secure adequate resources, and multicentre, mixed method research, with patient involvement from the research development stage.

The findings of this PSP should be disseminated among palliative care associations worldwide to inform international multicentre studies, and among governmental and nongovernmental organisations that promote research in Colombia. A focus on patient and family caregiver palliative care needs in Colombia should be prioritised.

Peer Review reports

The World Health Organization (WHO) acknowledges access to Palliative Care (PC) as a human right for children, adults, and their families to prevent and relieve suffering from a range of life-limiting illnesses, from point of diagnosis to end-of-life [ 1 ]. PC is a holistic approach which assesses and treats the whole person’s physical, psychosocial, and spiritual needs [ 1 ]. Early access to PC for those with life limiting illness (cancer and non-cancer) improves symptoms and quality of life for patients and informal carers and reduces financial burden on both families and health systems [ 2 , 3 , 4 , 5 ].

However, inadequate access to PC persists worldwide, with only 14% of the global population receiving PC when needed [ 1 ]. A large proportion (estimated at 78% of adults) requiring PC reside in low- and middle-income countries (LMIC) such as Colombia, situated in South America [ 1 ]. Colombia has approximately 50 million residents, with 77% living in cities, 7.1% in small municipal settlements (villages) and 16% across scattered rural areas [ 6 ]. The Lancet Commission on Palliative Care and Pain Relief estimated up to 250,000 adults in Colombia require PC per year [ 7 ], yet a recent health policy and systems analysis show that PC services fall short of meeting these population needs [ 8 ], and most PC services are individual efforts, institution-based and centralized in the main cities. Although up to 83% of adults who died from chronic illnesses in Colombia required PC, up to 30% died without receiving it [ 9 ]. Some departments in Colombia, particularly those in the Orinoquia and Amazonia regions, lack well-developed palliative care (PC) services [ 9 ]. In contrast, most PC services are concentrated in three main areas: Bogotá D.C., the Center, and the Caribbean [ 10 ]. For paediatric patients, there are only ten hospital services and five outpatient services, primarily located in the main capital cities of Bogotá, Cali, Medellín, and Neiva [ 9 ]. Colombia is currently developing an action plan: ‘Building a positive environment: the road to palliative care—Colombia 2026’, which includes among its pillars the identification of needs that form the basis for the design and implementation of programmes of comprehensive PC [ 11 ].

There have been calls to prioritise PC research in LMIC, where a large proportion of the population could benefit significantly from it [ 12 ]. Researchers, research institutions and funding agencies have traditionally decided on the research question(s) to be asked [ 13 ]. However, influential health service bodies such as the World Health Organization (WHO) [ 14 ], and the United Kingdom’s National Institute for Health Research (NIHR) [ 15 ] are increasingly recommending the active involvement of non-research expert stakeholders in establishing research agendas, and research priority setting exercises based on their individual needs.

Research priority setting [ 16 ] involves any activity where stakeholders identify, prioritise, and reach agreement on subjects, issues, or questions they believe need to be addressed through research [ 17 , 18 ]. This is particularly important at the beginning of the research process, prior to deciding what to research, and has been shown to increase the uptake and implementation of research evidence [ 19 ], and decrease “research waste” [ 20 ] by promoting the overall applicability and acceptability of research to policy and practice [ 17 ].

The implementation of integrated PC into cancer and non-cancer services has proven difficult despite a strong research evidence base [ 21 , 22 ]. PC is also a sensitive, cultural issue, requiring a particular approach that considers diverse experiences, especially for those in LMIC such as Colombia. Acknowledging these cultural differences is essential for developing relevant health policies and clinical practice [ 12 ]. However, fundamental components of PC, such as the physical, psychological, spiritual and social needs of patients and informal carers; meanings tied to the illness; broader issues around end-of-life suffering, including decisions and preferences around place of death, are all under researched in LMIC [ 23 , 24 ].

The Global Forum for Health Research [ 25 ] has condemned the huge gap in research output between LMIC and high-income countries (HIC), known at the 10/90 gap, representing the fact that under 10% of funds for health research are spent on health issues in LMIC, even though they have 90% of disease burden globally. A key strategy agreed by the Global Forum for Health Research was to encourage more research priority setting, an approach that we take in this paper to improve PC in Colombia.

The overall aim is to conduct a research PSP exercise to provide a service user and service provider informed roadmap for future PC research in Colombia.

Work with key stakeholders (service users and carers, allied health and social care providers (AHSCPs), and healthcare insurance providers) to identify PC research priorities in Colombia,

Work with key stakeholders to identify barriers and facilitators to PC research in Colombia.

Study design

The PSP followed the James Lind Alliance (JLA) methodology which involves four stages ( https://www.jla.nihr.ac.uk/jla-guidebook/downloads/JLA-Guidebook-Version-10-March-2021.pdf ). This is the recommended framework in the Reporting guideline for priority setting of health research (REPRISE) [ 17 ].

Setting and attendees

Stage 1: establishing the partnership.

The first author, Tracey McConnell (TM) secured funding from Queen’s University Belfast (QUB) in 2022 to build on existing partnerships within Colombia and conduct this research priority setting exercise. Recognising the contextual differences between the UK and a middle-income country in South America, the key aim was to find out what the priority research questions and topics were for those requiring and providing PC in Colombia. TM established links with colleagues (co-authors, Joanne Reid (JR) and Gillian Prue (GP)) from the School of Nursing and Midwifery, QUB who had a history of working and publishing around improving palliative care with colleagues from Pontificia Universidad Javeriana (PUJ) and Universidad del Cauca (CU) in Colombia [ 22 , 26 ]. This active PC working group was formed focusing on how to better integrate PC within the care continuum for cancer and non-cancer patients in Colombia.

Data collection

Stage 2: identifying evidence uncertainties.

Unanswered research questions for service users and carers, AHSCPs, and healthcare insurance providers were collated via Mentimeter during an online Microsoft Teams (MS Teams) PSP workshop held 25 January 2023. We held online seminars prior to this workshop to promote knowledge exchange and partnership building: The participants represented several regions of Colombia, representative of the country’s social and economic diversity. They included urban and rural universities, hospitals (PC providers and nurses), patients, carers and policy makers (PC observatory, Colombian League Against Cancer) to ensure the PC research priorities and recommendations for conducting the research are appropriate/suitable for the diverse Colombian contexts. The following broad questions were asked to help identify the evidence uncertainties: 1. What are the priority research questions for improving access to PC services in Colombia? 2. What are the challenges to conducting research in this area? 3. What are the possible solutions?

The second author, and international collaborator, Cindy Vanesa Mendieta (CVM) is bilingual and translated the questions from English to Spanish. When the exercise was completed, CVM translated the responses from Spanish to English for analysis. This translation was subsequently revised by additional bilingual international research partners (Esther de Vries (EdV) and Jose A Calvache (JAC)).

Stage 3: refining questions and uncertainties

This stage of the priority setting partnership involved an online survey using Microsoft Forms (see supplementary file 1) to refine initial questions and uncertainties. The survey had three key sections divided up in relation to research priorities, challenges and solutions to research in this area. Each section had a further list of questions developed from responses to the Stage 2 Mentimeter exercise. CVM again translated the questions from English to Spanish, and in the Mentimeter exercise they were presented in Spanish. Stakeholders were asked to rank the research questions/topics most important to them by using the arrow function or by clicking on the question/topic to move it up or down in order of what was most important, starting with the top priority down to the lowest priority.

Stage 4: prioritisation

Four final in-person PSP workshops took place in Bogota (capital city) and Popayan (small rural city) from the 13th to 16th February 2023. Two workshops were held in each urban and rural city: in the morning for service users and carers, and in the afternoon for AHSCPs as these times were most convenient for the two groups. The workshops adhered to the JLA methodology, which uses a Nominal Group Technique to encourage discussion, ranking and agreement by consensus.

The JLA method values creating an opportunity to prioritise the top questions via stakeholder discussion and knowledge exchange. The workshops were chaired and facilitated by CVM, EdV and JAC who are bilingual. CVM is a PhD student in Clinical Epidemiology with prior experience of facilitating research workshops. EdV is a Professor of Clinical Epidemiology with recent experience in qualitative studies in the field of palliative care in Colombia. JAC is a senior clinical academic in Epidemiology, Anaesthesiology and Pain Management/Palliative care. TM has prior experience of priority setting for health care research and oversaw the running of the workshops. A professional translator was also present to translate from Spanish to English for the QUB partners, and from English to Spanish for the participants. A QR code was generated for the MS form, and stakeholders could complete the ranking exercise either on their own devices or on a tablet provided by the research team. Stakeholders worked in small groups to rank the questions, discuss their decision making, and reach a consensus. This process was especially challenging for service users and carers as many of them had very low literacy levels and little understanding of what was meant by the term research. As such, their participation required individual support from the bilingual colleagues, the QUB team and translator. Given the challenges encountered during this first service user and carer workshop in Bogota, the service user and carer workshop in Popayan focused only on the first list of questions around the research priority topic area which was reframed as ‘what is most important to you in terms of improving your care?’ The second and third set of questions around challenges and solutions to research were removed as service users and carers really struggled with these topic areas in the first workshop. Participants were invited to provide verbal feedback on what they felt worked well, and on where improvements could be made at the end of each workshop. We chose not to use feedback forms due to the low literacy rates among the workshop participants.

Data analysis

Data from the Mentimeter exercise were collated and used to inform the questions for the MS Form online and in-person prioritisation ranking exercise. The data from the MS Form prioritisation exercise were analysed using descriptive statistics.

A total of 33 stakeholders attended the online workshop and completed the Mentimeter exercise in MS Teams. The Mentimeter results from this workshop can be found in supplementary file 2, showing what stakeholders regarded as the most important unanswered questions in relation to palliative care in Colombia. The top PC research priority from this exercise was patient and family caregivers PC need.

A total of 48 attended the subsequent in person PSP exercise; 22 in Bogota and 26 in Popayan. The stakeholders were a diverse group of health professionals (physicians, medical students, nurses, dentists, physiotherapists, nutritionist, occupational and speech therapists), financial and administrative staff and patients with life-limiting illness and caregivers.

Figure 1 represents a high-level summary of the stakeholder’s priority research topics ranked in order of what is most important to them. Of the 48 stakeholders, three did not provide a response. All stakeholder groups (HCPs n = 10, patients and caregivers n = 9) in urban (Bogota) and rural (Popayan) settings considered the exploration of patient and family caregivers’ needs as the top research priority. Palliative care education and training for AHSCPs was the second priority topic for all stakeholder groups (HCPs n = 5, patients and caregivers n = 3), and again this was observed across urban and rural settings. Better integration of palliative care to address fragmentation between services came a close third in terms of research priorities, with slightly more support for this topic among stakeholders in Bogota (HCPs n = 2, patients and caregivers n = 3), compared to those in rural Popayan (HCPs n = 1, patients and caregivers n = 1). Fewer stakeholders overall rated understanding barriers to accessing palliative care as most important, with similar responses across both locations. Only two AHSCPs in Bogota ranked patient involvement in their palliative care treatment and care decisions as a top research priority. There were four remaining topic areas, including facilitators to integrated palliative care, barriers to communication, paediatric palliative care, and research in remote areas which were not ranked as priorities by any stakeholder groups.

Priority research topics for improving access to palliative care services in Colombia

Figure 2 shows what AHSCP stakeholders rank as the main challenges to developing palliative care research in Colombia. There were no responses from patients and caregivers as they had little understanding of what was meant by the term research. Having a lack of interest in palliative care research was ranked as the main challenge by AHSCPs in urban and rural locations. This had a higher rate of responses from those in Bogota, but this could also be explained by the higher number of participating stakeholders ( n = 22) compared to Popayan ( n = 12). The next main challenge was about funding, time, and resources which were ranked similarly in urban and rural locations. Only three other challenges were rated as important by a low number of AHSCPs in both locations, and included high participant dropout rates and other difficulties in follow-up, stigma and fear around palliative care, and being able to form palliative care interprofessional special interest groups. Several issues identified in the first online priority-setting exercise were not deemed as priority challenges to address by in-person stakeholders. These included a lack of available data, conducting research with vulnerable populations, language/communication barriers, and having few qualified researchers.

Challenges to conducting research in palliative care according to allied health and social care professionals

Figure 3 shows what AHSCP stakeholders rank as the main solutions for conducting palliative care research in Colombia. Collaborative and interdisciplinary work was highlighted as one of the main solutions in urban and rural locations. The second priority solution was to ensure research protocols were co-designed with patients, although this was viewed as a higher priority in urban Bogota ( n = 5) compared to rural Popayan ( n = 1). However, values such as passion were viewed as a higher priority solution in rural areas compared to urban areas. Having palliative care research studies across several centres, highlighting the benefits of palliative care research, having internal and external funding, and mixed method research were also ranked as priority solutions. Possible solutions that were not ranked as priorities included having a research mentor, methodological rigour, and research visibility.

Possible solutions to conducting research in palliative care according to allied health and social care professionals

Feedback on the priority setting exercise

Feedback was positive overall, especially from service users who felt empowered by the opportunity to have their voice heard in relation to what is important to them in relation to their care. Service users did however report that they found it difficult to prioritize methods of research because of their lack of knowledge on research and the low literacy of the users and carers.

This research priority setting exercise provides a service user and service provider informed roadmap for future research in Colombia. The findings included the perspectives of an interdisciplinary group from rural and urban Colombia, which could be useful for PC organisations, research funders, and local governments to inform and develop PC research strategies and focus resources into what really matters to both service providers and service users with a potential for impact on policy making.

An overlap was noted between our research priorities and recommendations from a recent Delphi study by Paiva et al. in 2023 with 18 palliative care AHSCP experts focused on how to advance palliative care research in South America [ 27 ]. Top priorities from our work and their recommendations included the need for more collaborative PC research and practice, PC education and training and highlighting the benefits and importance of palliative care to funders, such as governmental bodies, to secure time and resources for research in this area.

It is unsurprising that PC education and training was one of the top priorities for research. A recent social mapping study involving a diverse stakeholder group such as AHSCP, patient, caregiver organisations across Colombia identified limited formal and specialised PC education and training as a key barrier to PC access [ 28 ]. Stakeholders in this study identified the need for PC education in both the undergraduate medical and nursing curriculum, and in postgraduate medical, nursing, social work and psychology education. In Colombia, the availability of PCs well-structured and specialized services are found in the main cities of the country while there are many regions without provision of PC. In addition, PC training programmes are not mandatory or available for health personnel or are provided mainly for medical and nursing programmes. Thus, PC training for AHSCP is even more limited [ 29 ]. Although intermediate (diploma courses) and advanced speciality level training courses in PC are offered by the PC society in Colombia for both adults and children, professionals must self-fund this training. This links closely with other top priorities from this priority setting partnership and the social mapping study [ 28 ], namely the need for more collaborative working, and highlighting the benefits and importance of PC. For example, PC education is crucial to address both of these key priorities as lack of understanding and knowledge of PC prevents joint working between AHSCPs, patient organisations and community care providers [ 29 , 30 ]. Palliative education is also critical to address poor understanding and awareness of PC among the public, which in turn impacts on community support, and lack of awareness among the public about when PC [ 31 ] is needed. Previous studies have also supported the need for PC education among primary care providers, along with the importance of service providers, academic institutions, and policy makers highlighting the benefits of palliative care to the media and in policy areas in order to promote access to PC for those who need it [ 7 , 30 , 32 ].

The final top priority, in relation to better integration of palliative care, was also a key recommendation in the previous social mapping study. Again, this is not surprising given the fragmentation of PC in Colombia [ 30 , 33 ]. This high fragmentation can be explained by the lack of specialized PC providers or lack of training on basic PC for primary care physicians or health care providers in rural areas, especially those in the most remote areas, deemed to have high risk safety issues for health personnel [ 32 , 33 ]. This further highlights the need to lobby for the importance of PC to health insurance providers to improve PC coverage in Colombia, and to government bodies so they see the need to improve the safety of healthcare providers in remote areas [ 28 ]. Improving early detection and initiation of PC, even in rural areas by accessing basic PC, may reduce costs while positively increasing the quality of life and decision making in patients with life-limiting diseases [ 34 , 35 , 36 , 37 ]. Through timely symptom management, psychosocial support, and Advance Care Planning, individuals may experience fewer hospitalizations, emergency room visits, and unnecessary medical interventions, thereby alleviating the financial burden associated with prolonged and aggressive treatments. Moreover, by integrating palliative care into the continuum of care from the outset of illness and starting PC in rural areas by primary care physicians or trained health care providers, patients and their families are empowered to make informed decisions aligned with their needs, values, preferences, and goals.

In terms of enabling PC research, Paiva et al.’s Delphi recommendations were similar to those of our stakeholders, who saw establishment of multicenter studies as a priority, to support greater research collaboration not only between institutes, but also across countries, and disciplines, which may also go some way to addressing fragmentation of services. Previous research has provided further support for this priority, demonstrating that multicenter studies with international collaborators tend to have higher citations, greater participation, more generalisable results, and stronger research designs compared to those without international collaboration [ 38 ].

Our research priority partnership is to our knowledge, the first to include the top priorities for AHSCPs, patients and carers in South America, specifically Colombia which is among the lowest ranking countries for quality of death and dying [ 31 , 39 ]. We identified priorities not included in the recommendations from the previous Delphi study. For example, patient and family caregiver needs were rated as the top priority overall and highlights the importance of including service users as well as service providers in this type of exercise to ensure priorities address the needs of those services are designed for [ 14 , 15 ]. Similarly, one of the top solutions for developing palliative care research in Colombia was co-production of research with patients from the early protocol development stage, which has been supported in previous research as a key strategy for producing research to meet patient need in real-world practice [ 40 , 41 ].

Our research team are now actively planning a programme of research to address patient needs in Colombia through feasibility testing of the recently translated (into Spanish) and cross-culturally validated SPARC holistic patient needs assessment tool for use in Colombia—SPARC-Sp [ 42 , 43 ].

Strengths and limitations

Limitations of this study include a limited geographical and cultural coverage of stakeholders: only stakeholders from the regions close to Popayan and Bogota could participate in the on-site workshops. However, in the first online rounds there were also participants from other parts of the country. Unfortunately, it was not feasible to include the research methods prioritisation exercise with patients and caregivers, for a lack of understanding amongst most of them on what research is – and therefore hampering an evaluation of gaps and recommendations for improvements. This however, is also a finding in itself: in Colombia, patient and public involvement in research is in its infancy [ 26 ] and many people in Colombia have low literacy rates. This, in combination with the little research being done in the area of palliative care, makes it impossible for patients and caregivers to understand and therefore prioritise. This lack of understanding about research, and low literacy should be taken into consideration to support involvement of service users in PC research in Colombia [ 26 ] Strengths of this study include the diverse backgrounds of the participating stakeholders, moreover from both large urban and more rural and remote settings. The fact that patients and caregivers were given a voice in this study is an important novelty – their voices are largely overlooked in Colombia and Latin America in general.

Implications

The findings of this PSP exercise could be disseminated among PC associations worldwide, with similar characteristics to the Colombian context, to inform international multicentre studies, and among governmental, nongovernmental organisations and funding bodies that promote research in Colombia. A focus on patient and family caregiver palliative care needs in Colombia should be prioritised by researchers, funding bodies and current policies.

Conclusions

Research priorities to improve palliative care in Colombia were identified using a priority setting partnership approach. Top priorities included patient and caregiver needs, service provider education and training, integration of palliative care and collaboration across disciplines and settings, highlighting benefits of palliative research to help secure adequate resources, and multicentre, mixed method research involving patients throughout.

Availability of data and materials

Data are provided within the manuscript or supplementary information files.

Abbreviations

Palliative Care

Allied Health and Social Care Professionals

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Acknowledgements

We gratefully acknowledge the patients, informal carers and AHSCPs who kindly participated in online and in-person PSP workshops. We feel privileged to have worked with you all and feel humbled by your warmth and gratitude.

Travel to facilitate this project was funded by the Global Research Training Programme at Queen’s University Belfast. Researchers time was kindly paid for by their employers. For the purpose of open access, the author has applied a Creative Commons Attribution (CC BY) licence to any Author Accepted Manuscript version arising from this submission.

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Tracey McConnell, Gillian Prue & Joanne Reid

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Cindy V. Mendieta & Esther de Vries

Department of Nutrition and Biochemistry, Faculty of Science, Pontificia Universidad Javeriana, Bogota, Colombia

Cindy V. Mendieta

Department of Anesthesiology, Faculty of Health Sciences, Universidad del Cauca, Popayan, Colombia

Jose A. Calvache

Department of Anesthesiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands

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TM and JR conceptualised the study, developed the methodology and analytical plan. TM, CVM, EdV and JAC undertook data collection. CVM undertook preliminary analysis assisted by TM. All authors including GP and SA contributed to final analysis and interpretation of the data. All authors read and approved the final manuscript.

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The PSP workshops were conducted as PPI events, and this was confirmed by all the institutions involved. Research governance at Queen’s University Belfast, Universidad del Cauca and Pontificia Universidad Javeriana institutional guidance on PPI involvement was followed. As such ethical approval was waived by Queen’s University Belfast. Workshop attendance was voluntary, and stakeholders were free to leave at any time. All stakeholders participating in the online and in-person workshops were informed that the results of the survey and workshop outputs would be published. Responses to the online survey specified implied consent, and informed consent was obtained from participate prior to commencement of the in-person workshops. Individual answers were anonymized in analysis and publication. Understanding the difficulties in travelling to the in-person-workshops, as well as the time invested by the stakeholders, we provided a voucher of approximately 12 dollars per stakeholder.

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McConnell, T., Mendieta, C.V., de Vries, E. et al. Developing research priorities for palliative care in Colombia: a priority setting partnership approach. BMC Palliat Care 23 , 194 (2024). https://doi.org/10.1186/s12904-024-01534-z

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NIH Launches Community-Led Research Program to Advance Health Equity

Awards to community organizations will enable examination of structural drivers of health

September 28, 2023 • Press Release

The National Institutes of Health is funding a first-of-its-kind community-led research program to study ways to address the underlying structural factors within communities that affect health, such as access to safe spaces, healthy food, employment opportunities, transportation, and quality health care. Through the NIH Common Fund Community Partnerships to Advance Science for Society (ComPASS) program, NIH made 26 awards to community organizations and a coordinating center, totaling approximately $171 million over five years, pending the availability of funds. Through these awards, ComPASS will enable research into sustainable solutions that promote health equity to create lasting change in communities across the nation.

NIH is directly funding research projects led by community organizations. Leaders from the organizations will work in collaboration with their research partners at academic institutions and other organizations in all phases of the research process. ComPASS projects study social determinants of health — the social, physical, and economic conditions where people are born, grow, live, work, age, and play — that contribute to health inequities.

"The ComPASS research model harnesses diverse perspectives and expertise to examine systemic factors that impact the health of individuals, communities, and populations," said NIH Acting Director Lawrence Tabak, D.D.S., Ph.D. “We are excited to see how results from these awards exemplify the transformative power of community-driven research."

The projects will examine underlying conditions and environments that influence health outcomes by enabling the development, implementation, and assessment of structural interventions. Structural interventions are meant to alter social determinants of health by changing factors that create differences in opportunities to achieve optimal health.

Each award will foster the design of strategies to improve health outcomes through innovative structural interventions to address community concerns, such as economic development, social and community context, neighborhood characteristics, health care access and quality, and nutrition and food environment. Community organizations and their research partners will work together to develop a structural intervention, launch it within their communities, and then assess whether the intervention improves health outcomes. Several examples of ComPASS-supported research projects, which focus on populations that experience health disparities , include:

Supporting access to healthy food in underserved rural communities through the delivery of food boxes to local stores and individuals, and facilitating local food harvesting, processing, and distribution in the community. The project will measure whether these interventions reduce hunger, improve diet quality, promote healthy weight, and protect people against chronic diseases such as diabetes and cardiovascular disease.
Assessing whether early childcare strategies improve mental health for children and their parents and guardians. This project will develop and examine community strategies that increase access to public early childcare, education, and programming to support young children and families in areas with limited access to childcare.
Enhancing access to health care through individualized travel information and resources along with a transportation stipend for health care and related trips. The project will assess whether improved transportation access can reduce emergency department readmissions and secondary infections, decrease hospital costs, and improve disease management.
Improving access to quality health care for older adults from sexual and gender minority populations by creating culturally appropriate and inclusive protocols in the local health system. The project will measure how these changes in the local health system affect overall physical and mental health.
Assessing whether enhancing telehealth models in rural communities can improve preventative screening and disease management for cancer, depression, diabetes, high blood pressure, and other chronic diseases among agricultural workers. The project will improve telehealth by transforming the workers' access to affordable, reliable high-speed broadband internet.

NIH will gain valuable experience and insight into how to support successful future community-led health research. Each project will also contribute valuable data to a growing body of knowledge about social determinants of health and structural inequities.

The ComPASS program is funded by the NIH Common Fund and managed collaboratively by NIH staff from the Common Fund; National Cancer Institute; National Institute of Mental Health; National Institute on Minority Health and Health Disparities; National Institute of Nursing Research; National Heart, Lung, and Blood Institute; and NIH Office of Research on Women's Health, with many of the NIH Institutes Centers and Offices providing input and participating in program development and management. More information is available on the ComPASS program website: https://commonfund.nih.gov/compass .

To learn more about ComPASS, watch this brief video :

About the NIH Common Fund: The NIH Common Fund encourages collaboration and supports a series of exceptionally high-impact, NIH-wide programs. Common Fund programs are managed by the Office of Strategic Coordination in the Division of Program Coordination, Planning, and Strategic Initiatives in the NIH Office of the Director in partnership with the NIH Institutes, Centers, and Offices. More information is available at the Common Fund website: https://commonfund.nih.gov .

About the National Institute of Mental Health (NIMH): The mission of the NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery and cure. For more information, visit the NIMH website .

About the National Institutes of Health (NIH) : NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit the NIH website .

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Official development assistance (ODA)

Official development assistance (ODA) is government aid that promotes and specifically targets the economic development and welfare of developing countries. ODA has been the main source of financing for development aid since it was adopted by the OECD’s Development Assistance Committee (DAC) as the “gold standard” of foreign aid in 1969. The OECD is the only official source of reliable, comparable, and complete statistics on ODA.

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Key messages, supporting the economic development and welfare of low- and middle-income countries.

ODA is financial support from official providers to aid recipients (low- and middle-income countries) in areas such as health, sanitation, education, and infrastructure. It mainly consists of either grants or “soft” loans and it makes up over two thirds of external finance for least-developed countries.

Defining which countries and territories are eligible to receive ODA

The DAC List of ODA-eligible recipients shows all countries and territories meeting the criteria to receive ODA. These consist of all low- and middle-income countries based on gross national income (GNI) per capita as published by the World Bank, with the exception of former G8 members, EU members, and countries with a firm date for entry into the EU. The list also includes all of the Least Developed Countries (LDCs) as defined by the United Nations (UN). It is reviewed every three years by the OECD’s DAC.

Monitoring ODA for better targeting and results

The DAC tracks and monitors ODA so that individual donor efforts are measured alongside the broader development finance landscape. The OECD ensures that providers adhere to the primary objective of ODA (the economic development and welfare of aid recipients) and inform them about where their ODA should go relative to existing needs.

International aid rises in 2023 with increased support to Ukraine and humanitarian needs

International aid from official donors rose in 2023 to a new all-time high of USD 223.7 billion, up from USD 211 billion in 2022, as provider countries increased aid flows to Ukraine and directed more humanitarian assistance to developing countries. This aid amounted to 0.37% of DAC countries’ combined gross national income.

ODA for gender equality dropped for the first time in a decade

The share of development finance for gender equality decreased after a decade of progress—from 45% in 2019-20 to 43% in 2021-22. Less than 1% of ODA is aimed at ending violence against women and girls.

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988 Suicide & Crisis Lifeline: Two Years After Launch

Heather Saunders Published: Jul 29, 2024

On July 16, 2022, the federally mandated crisis number , 988 , became available to all landline and cell phone users at no charge. This three-digit number connects users–via phone, text, or chat–to a network of over 200 local and state-funded crisis call centers, providing access to the 988 Suicide & Crisis Lifeline for crisis counseling, resources, and referrals. Federal investments supported the launch and implementation of 988, but ongoing funding of local call centers, as well as the development of other core components of the behavioral health crisis continuum, largely falls to state and local governments.

Over half a million lives (500,399) were lost to suicide between 2012 to 2022, with suicide rates rising nationally and in most states over this period (Appendix Table 1). Reflecting rising suicide rates, 9 in 10 adults believe the United States is amid a mental health crisis. Firearms are the predominant suicide method, involved in over half of all suicides, and increases in firearm suicides drove the total suicides to a record high in 2022.

This brief examines 988 two years after implementation using the most recent data available through May 2024 from Lifeline , including: 988 performance metrics nationally and by state, state efforts to fund local 988 call centers, emerging policies and initiatives that may indicate future trends, and a look at data that may be helpful in ongoing monitoring and development of 988.

Key takeaways from this KFF analysis of Lifeline data include the following:

Since launch in July 2022, 988 has received 10.8 million calls, texts, and chats. In May 2024, monthly contacts exceeded half a million, up about one-third from a year ago and 80% since May 2022. Despite increased demand for 988 services, national answer rates improved and wait times decreased, though some gains slipped in the second year.
State-level call volume and in-state answer rates vary widely across states. Monthly call volume increased in all states—ranging from 25% to 185% since launch — and the most recent in-state answer rates range from 64% to 97% in May 2024.
Ten states have added telecom fees to provide more sustainable funding for local 988 crisis call centers, which may help centers keep up with the rising call volumes.
Developments in 988 policy and crisis service policy include potential changes in 988 routing (georouting), continued expansion of mobile crisis and short-term crisis stabilization facilities, enhanced technology and infrastructure to connect 988 with other crisis and emergency services, and growth of specialized services for certain populations.
988 metrics are available online through Lifeline, though these data tend to be somewhat limited. Some states are using dashboards to provide additional data that may help to inform efforts to address suicide rates in their state.

What do we know about 988 utilization and awareness?

Since launch in July 2022, 988 received nearly 10.8 million contacts, including 1.4 million to the Veteran’s Crisis Line (VCL), with the remaining contacts consisting of 6.4 million calls, 1.4 million chats, and 1.6 million texts. SAMHSA reports that over 10 million calls, texts and chats have been answered by crisis counselors since launch, including those to the VCL. Detailed data for the VCL is not publicly available, so the remainder of the brief will not include that data. Calls are the most common mode of 988 contact, accounting for about two-thirds (68%) of total contacts to 988. Text messages and chats make up the remaining one-third of total contacts, accounting for 17% and 15%, respectively. Lifeline metrics provide only a partial picture of total crisis hotline contacts, as fewer than half of all crisis call centers (about 200 of 544) participate in the Lifeline network.

988 contacts (calls, texts, and chats) exceeded half a million in May 2024, up about one-third from a year ago and 80% since May 2022. Text message volume saw the highest relative increase, growing more than 11-fold since launch, compared to nearly 2-fold for calls. In contrast, chat volume decreased, possibly because text communication via cell phone is preferred over browser-based chat (Figure 1).

Since launch, national answer rates improved and wait times fell, even with substantial rises in contact volume—though some gains slipped in year 2. Overall answer rates rose from 70% in May 2022 (before launch) to 89% two years later, and wait times fell from 2 minutes and 20 seconds to 1 minute and 31 seconds. While these do represent improvements since launch, they are somewhat lower than they stood at one year after 988’s launch—where answer rates were higher, at 93% and wait times were lower, at 35 seconds. The decline in some performance metrics in year 2 may be due to continued rise in 988 contacts (Table 1).

KFF polling indicates that public awareness of 988 is generally low, with 18% of adults reporting they have heard a lot or some about it. As of mid-2023, fewer than 2 in 10 adults reported familiarity with 988 and its services, though awareness may have increased since then. Despite generally low awareness, those with high psychological distress , adults who speak English very well, and White adults are more likely to report familiarity with 988. In contrast, awareness is lower among Black, Hispanic, and Asian adults and among those who do not speak English very well (Figure 2). Federal awareness campaigns set to launch in mid to late 2024, along with proposed legislation introduced to Congress late last year, aim to boost public awareness of 988 and its services. As knowledge of 988 rises, so could the demand for its services.

How does implementation vary by state?

Call volume increased in all states, with increases up to 185%. State-level data is available through Lifeline for calls to 988, but not for text or chat. Nationally, call volume rose by 95% from pre-launch to two years later, but this varied widely across states, from a low of 24% in Idaho to a high of 185% in Oklahoma. The variation in growth rates across states may be influenced by the development of 988 infrastructure and public awareness campaigns

Although nearly all states have maintained or improved their in-state answer rate since 988’s launch, answer rates continue to vary across states and range from 64 to 97% as of May 2024. 988 routes calls based on the caller’s area code to the nearest crisis center. An “in-state answer rate” measures the percentage of calls answered in the state that aligns with the caller’s area code. In May 2024, in-state answer rates ranged from a low of 64% in Nevada up to 97% in Mississippi, Montana, and Rhode Island. Calls not answered in-state are either transferred to one of Lifeline’s national backup centers or abandoned by their caller. Long wait times or local crisis center unavailability can lead to a call being redirected to national backup centers, where counselors will answer the crisis call, but may be less familiar with local resources. These calls count toward the national answer rate but not toward the answer rate of the state where the Lifeline backup center is located. Nationally, about 6% of state calls are transferred to a federal overflow facility and 10% are abandoned in-state, though these rates also vary by state. Per SAMHSA , calls may be abandoned by their user due to a technical reason (e.g. internet or mobile connection strength or service interruptions, etc.) or because the person seeking assistance ends the contact before a counselor answers, which could also happen for a range of reasons, such as they had to wait too long or decided they were not comfortable discussing their experience.

Ten states have added telecom fees to provide more sustainable funding for local 988 crisis call centers, which may help local crisis centers keep up with rising demand for the service. Although federal investments support 988 nationally and help to support state implementation , states are largely responsible for long-term funding of the local 988 crisis call centers, which have historically received minimal funding from the federal government. Under the National Suicide Hotline Designation Act of 2020 , states can collect cell phone fees to help sustainably fund their local 988 call centers (similar to how 911 is funded). So far, ten states have enacted legislation to fund crisis services through telecom fees, including Virginia, Colorado, Washington, Nevada, Minnesota, California, Oregon, Delaware, Maryland, and most recently Vermont . Additionally, four other states have pending telecommunications fee legislation. Early adopters of telecom fees, such as Virginia and Washington, collected between $10.9 to $30.4 million in 988 telecom fees during FY 2022, according to an FCC report . Other sources of 988 funding include trust funds and general fund appropriations, and 5% crisis services set aside from mental health block grant funds. Insurer payments can help financially sustain 988 and other crisis services, with some states billing Medicaid or other payers and several states also passing laws requiring insurers to cover crisis care services.

What are new developments related to 988 and the crisis continuum, more broadly?

Proposals to improve 988 routing aim to mirror certain 911 standards, including georouting and requirements for cell phone carriers to route 988 calls during service interruptions. Currently, 988 routes calls based on the caller’s area code, which can be problematic for people with area codes not reflective of their current location, resulting in connections to distant crisis centers with counselors unfamiliar with the local resources near the caller. Unlike 911, which uses precise geolocation data, the proposed 988 georouting would direct calls to the nearest crisis center without disclosing the caller’s exact location, helping to address technical, privacy, and legal concerns. In April of this year, the Federal Communications Commission (FCC) issued a notice proposing rulemaking for wireless carriers to adopt 988 georouting and requested comments on extending this to text messages and specialized services like LGBTQ+ and Spanish services, which are not available at all local crisis center locations. Separate legislation proposed late last year aims to improve 988 access by requiring carriers to allow 988 calls during service disruptions and ensuring multi-line systems, such as those in hotels, recognize 988 calls directly without additional steps like dialing 9 first.

Similar to 988, mobile crisis units and short-term crisis stabilization facilities are core components of the behavioral health crisis continuum , though their development and availability varies across states. Mental health professionals staff these services and provide alternatives to emergency departments and law enforcement during mental health emergencies. States are at different stages of establishing mobile crisis and short-term crisis stabilization services, and some states have leveraged Medicaid and Medicaid-focused provisions in the American Rescue Plan Act to support mobile crisis development. Most states have some form of mobile crisis, but short-term crisis stabilization facilities are less common. Even among states that have mobile crisis units, these units are often not available 24/7 or statewide. Compared to 988, other components of the crisis response system have little federal coordination, which may result in more variation in their development and structure across states.

States are investing in technology to improve infrastructure and coordination across crisis services and other emergency and health services. For example, some states are developing infrastructure to enable coordination and call diversion for mental health calls from 911 to 988 . However, technical and logistics challenges, such as the presence of multiple local 911 call centers per area code and the need to develop operational rules and agreements for each, have slowed progress . Other technological developments include service registries to track bed availability, facility capacity, and appointment scheduling. GPS-enabled mobile crisis dispatch systems and tools for crisis staff to view and schedule mental health appointments are also being developed. Recent CMS guidance clarifies how Medicaid may help support some of these efforts. Additionally, the federal government’s action plan , part of the HHS’s 2024 National Strategy for Suicide Prevention , proposes funding a mobile crisis locator for use by 988 crisis centers.

Specialized services to meet the unique needs of various populations, including LGBTQ people, Spanish speakers, American Indian and Alaska Native (AIAN) people, older adults, and others, are being developed at both federal and state levels. In March 2023, Lifeline expanded its LGBTQ+ services, providing 24/7 text and phone access to affirming counseling for those under age 25. This line accounted for nearly 10% of all 988 contacts over a four-month period, but had higher abandonment rates and longer wait times than the general 988 line. Additionally, 988 offers options to route Veterans, people who speak Spanish, and people who have difficulty hearing to specialized services. Certain states are building targeted services for older adults (staffed with older adult peer supports) and launching youth-specific initiatives, including mobile crisis services for youth. Efforts are being made to provide culturally competent services for AIAN populations and other racial and ethnic groups, to address the unique needs of rural and remote areas, and to support individuals with co-occurring mental health and substance use needs.

What data beyond Lifeline could help inform implementation and improvement efforts?

Additional state and national crisis center metrics may help inform the 988 implementation and future program improvements. Call volume, wait times, and other metrics from Lifeline provide some insights into accessibility and demand for 988, but they don’t tell the whole story. For example, without additional data, it’s not possible to answer questions about the conditions or circumstances that prompted the 988 calls, the resolution of these calls and whether they connected to additional crisis or outpatient services, and user experience across different demographics and geographies. Comprehensive metrics can help policymakers and researchers evaluate 988’s effectiveness, identify gaps, and develop targeted interventions. Table 2 lists metrics that could be helpful for understanding 988’s implementation.

Some states or crisis call centers already track and display detailed crisis metrics through regularly updated dashboards. These online dashboards display key metrics of crisis call data, refreshed at regular intervals. In Arizona, the Solari Crisis Response Network displays aggregate data for crisis call centers in two regions. Similarly, the University of Utah summarizes Utah’s crisis data in a dashboard and in crisis services annual reports ( 2021 and 2020 ). South Dakota ’s only crisis line displays detailed aggregate data on a publicly accessible dashboard, including historical data and breakouts by age, race, and gender . Data presented on these dashboards are more detailed than Lifeline data, containing metrics on accessibility, referral source, reason for the call, and some outcomes, but many do not contain historical summaries. Wisconsin’s dashboard is an exception, as it provides monthly snapshots and downloadable historical summary data.

If you or someone you know is considering suicide, call or text the 988 Suicide & Crisis Lifeline at 988

Mental Health

Also of Interest

Utilization of the 988 Suicide & Crisis Lifeline’s LGBTQ Service
A Look at the Latest Suicide Data and Change Over the Last Decade
A Look at State Take-Up of ARPA Mobile Crisis Services in Medicaid

COMMENTS

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