The description of the research methodology training programme
Table 1 presents the different training courses conducted in terms of location, trainers, participants, basic documents used for the training and cost of the training. It was noted that the trainings all lasted for five days. It was an adult training. Three type of tools were used: i) the WHO/IDRC research was used for trainings held in 2008 (Bobo-Dioulasso) and in 2012 (Lomé); ii) a document developed by a Gambian non-governmental organization (NGO) used in 2009 (The Gambia) and in 2012 (Liberia) and finally iii) a training document developed in Guinea Bissau. These documents were used according to the trainers who were from three groups. These trainers were senior researchers with experience in research and in training young researchers either at the level of the United Nations Joint Programme for Research on Tropical Diseases or at the country level. However, none of them taught health systems research in a university. Three groups of trainers were noted and each group used a different training tool.
The content of the programme revolved around the identification of research problems and questions, the definition of objectives, the development of research methodology, the development of a research timeline, the development of a research budget, selection and analysis of a health problem, ethical issues, and bibliographical references.
The health authorities of the country concerned designated the beneficiaries of these training programmes. They were researchers working in research institutions, programme managers at the level of the ministries of health and health officials at the level of the regions and health districts. The profiles of those trained included doctors, biologists, sociologists, laboratory technicians and nurses.
The training involved 30 persons for the first group in 2008 in Bobo-Dioulasso (Burkina Faso), 6 persons for the second group in 2009 in Banjul (The Gambia), 16 persons for the third group in 2010 in Guinea Bissau, 20 persons for the fourth group in 2012 in Lomé (Togo) and 12 persons in Liberia in 2012 for 84 persons.
The cost of the training varied from one workshop to another. It ranged from US$ 76873 for the 2008 workshop in Bobo-Dioulasso to US$ 24153 in Gambia, 33142 in Lomé, 30629 in Monrovia and 29057 in Bissau with a total cost of US$ 226996. The average cost of training per person trained was US$ 2562 in Bobo-Dioulasso, US$ 4025 in Banjul, and US$ 1816 in Bissau, US$ 1657 in Lomé and US$ 2552 in Monrovia, with an average cost per person trained of US$ 2702.3. The costs of the trainings included motivation costs, per diem of the trainees and trainers, trainers' emoluments, travel costs of the trainees and trainers, room rental and training materials.
Contribution of the training courses
Table 2 presents the training achievements according to the six areas of the Cooke J conceptual framework. It can be noted that the information was obtained for four of the five training courses conducted. The contribution of the training was therefore analysed on the basis of these four training courses. The training in Bissau was the one where information was not available.
Development of participants' knowledge and confidence
We note that the number of people with 50% or more correct answers to the pre-test was less than half of the participants, except in Monrovia where 8 of the 12 participants were scored. This number at the post-test in all countries was more than half of the participants and was 10/12 in Monrovia. Similarly, the average correct pre-test response was less than 50% at each training level except in Liberia where it was 65.11%. In the post-test, it was noted that the average of over 50% correct answers varied in all trainings and ranged from 52% in Banjul to 88% in Monrovia. Generally, these results reflect an improvement in participants' knowledge after the training, which may reflect the acquisition of new knowledge and skills in the field of research. Thus, it can be concluded that the different training courses have contributed to an improvement in the knowledge and skills of the participants.
Continuity and sustainability
During three training workshops (Bobo-Dioulasso, Banjul and Lomé), the development of research protocols was initiated. These protocols should be finalised and, depending on quality, funded. In total, during the 2008 workshop in Bobo-Dioulasso, out of 15 protocols initiated, 13 were finalised and deemed suitable for funding by the trainers. In 2008, in Banjul, out of two protocols initiated, one was finalised and funded. During the 2012 workshop in Lomé, out of 4 protocols initiated, 2 were finalised and financed. At the end of the 2010 workshop in Bissau and the 2012 workshop in Liberia, no research protocol was finalised. These results reflect the confidence of the learners to engage in research at the end of the training. Thus, 54 (64.3%) of the 84 trainees participated in research after their training.
Practice-related training
Out of the 16 protocols funded, 14 have been fully implemented and reported to the West African Health Organisation. These were 11 out of 13 from the 2008 workshop in Bobo-Dioulasso, 1 out of 1 from the 2009 workshop in Banjul and 2 funded projects from Lomé in 2012. The reasons for non-implementation of the two protocols funded after the 2008 Bobo-Dioulasso workshop were the use of funds for another activity and the retirement of the principal investigator associated with financial management difficulties.
The themes of the research protocols were parent-child communication for HIV/AIDS prevention, the importance of tuberculosis in HIV-infected people, the efficacy of artemisinin-based antimalarial drugs, factors associated with high reporting of typhoid fever, and the prevalence of dengue fever, the additional workload through decentralization of the care of people infected with HIV, neonatal infections in maternity wards, dysfunction and acts of non-quality in emergency services, the impact of reforms on the care of the elderly, the contribution of the introduction of financial motivation of health personnel on the supply of services.
Strengthening partnership and collaboration
The training held in 2008 in Bobo-Dioulasso helped create a partnership between programme managers and researchers. Indeed, each country was asked to send one manager and one researcher to the training. During the training, the protocol was initiated based on a problem identified at the programme level. The protocols developed were implemented jointly and contributed to strengthening the partnership and collaboration between researchers and programme managers. In addition, the studies funded after the Banjul and Lomé training were implemented with collaboration between research structures and programme staff.
Adequate dissemination of research results
Following the completion of these various studies, fourteen implementation reports were submitted to WAHO. Two projects were the subject of a workshop for sharing results at the national level, two were the subject of publication of scientific articles and two experiences of use of research results were reported. The first experience is the use of the results to develop a national programme for the control of sickle cell disease in Niger. The second experience of use is the improvement of the organization of emergency services at the level of university hospitals in Côte d'Ivoire.
Strengthening research infrastructure
The teams that implemented the research indicated that they had benefited from institutional support to implement their research. This involved support in managing the funds received, obtaining the necessary authorization and integrating research activities into the structures' programmes of activities.
The appreciation of the training by the learners.
At the end of the 2008 workshop, a questionnaire allowed the final evaluation of the course by the participants. Out of 27 answers, all the participants found the workshop useful because it allowed the reinforcement of skills, the putting into practice of knowledge and will give an impulse to the use of research results. All participants said that the course would be useful once they return home. While most respondents considered the number of facilitators appropriate, some participants, wished to have more facilitators who spoke mainly English because the participants were French, English and Portuguese speakers. The level of the course was deemed adequate by 26 participants and too basic by one participant. The quality of the teaching was judged excellent (9 respondents), very good (13 respondents) and acceptable (5 respondents). Contact and interaction between participants was most often rated as insufficient (5 respondents), satisfactory (17 respondents), and excellent (4 respondents). Contact and exchanges between participants and facilitators were rated satisfactory (15 respondents) and excellent (10 respondents). All participants considered the experience of developing a research proposal useful. Concerning the duration of the course in working days, nine participants felt that it should be 5 days, for nine others it should be 15 days and for seven it should be 7 days. Most participants deplored the lack of Internet access in the training room for conducting the literature review.