Academic Perspective · Medicine & Health
Capacity that stays
Thirty years of research infrastructure building in West Africa, and an argument about the difference between capacity-building and capacity-retention.
The vocabulary of international research collaboration is built around the word "building". Capacity is built. Programmes are established. Training is delivered. The grammar is transitive and the subject is usually elsewhere.
An alternative framing, advanced with some persistence from institutions in the receiving position, distinguishes building from retention. Capacity that has been built and then departs with the team that built it was, on this account, never capacity at all. It was a service.
What retention requires. The institutional record suggests three conditions, none of them technical. The first is a doctoral programme, because a research unit without one is dependent on graduates trained elsewhere and subject to their career decisions. The second is resident analytical capability — a data unit that processes national data nationally, which is as much a matter of institutional standing as of computing. The third is methods designed for the conditions in which they will run.
That third point has been the most contested. Surveillance methods designed for intermittent reporting and limited laboratory confirmation are, by the standards of a well-resourced setting, crude. They are also operable. A protocol that requires complete laboratory-confirmed reporting is not a better protocol in a system that cannot supply it; it is an unusable one. Reviewers accustomed to richer settings have not always found this argument congenial.
What the numbers show. A doctoral programme founded in 2004 has produced sixty-three graduates, a substantial majority of whom remain in West African institutions. Surveillance protocols developed for constrained reporting are in operational use in four national systems, and reduced median time-to-alert by around nine days relative to their predecessors. During two regional outbreaks the primary situational analyses used by national response teams were produced regionally.
Each of these is a modest figure. Together they describe an institutional shift that no single grant produced and no visiting team could have.
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