Whenever possible, we at ARC West Midlands try to apply lessons that we learn to our work in low- and middle-income countries (LMICs). We also apply lessons learnt abroad to our work here in the UK. In both contexts we like to evaluate interventions prospectively.
This is because a prospective study enables data to be collected that cannot be harvested retrospectively (including qualitative data), and because it enables the evaluation to be built around a study design such as a cluster RCT. The problem lies in who might fund the intervention. In the ARC West Midlands, the service funds the intervention in the form of co-funding. In global research, the NIHR allows a proportion of the research budget to be allocated to funding the intervention. There is a problem here, however. The intervention evaluated has to be inexpensive to fit within the constrained research budget. Therefore, either the intervention must be inexpensive (so that it can be funded from grant money) or the investigator must be lucky, such that the intervention is programmed to be rolled out at a time that coincides with the award of the grant. Therefore, as a general rule, the global programme does not evaluate big structural changes covering things like water and sewage, re-housing or cash transfers. These have to be left to funders like the Bill and Melinda Gates Foundation; their intervention WASH trials cost ~$100m.
So, my proposal is to establish a reactive fund, to enable researchers to evaluate interventions prospectively following rapid assessment applications. This would enable an evaluation to be put in place rapidly when an intervention is planned. In this way, research could accommodate the service imperative.
There will be a lot of opposition to this proposed rapid response policy from finance and possibly also from the Foreign Commonwealth Development Office because:
- The funding would have to be released rapidly – the whole point is to get the evaluation in place before the intervention goes live, so it would be necessary to create a rapid, single stage, grant appraisal process. This in turn would require a more curtailed (and therefore risky) assessment process – akin to the Advanced Research and Invention Agency set up by the UK government in 2021.
- It would be very hard to set a budget, since there would be no guarantee that any (or how many) fundable projects would be submitted over any one financial year.
However, bureacracy should not trump expediency – the proposal should be tried. A mechanism to fund opportunistic reactive research would enable the global programme to evaluate really interesting things. No more community theatre or soup kitchens – they never endure beyond the funding envelope. Indeed, there are serious questions to be asked about the sustainability of any intervention that is a cost to a research grant. Yes, the application will bristle with letters from this and that policy maker. But such policy-makers are not psychologically invested to the degree of a policy maker who ‘owns’ the intervention and is using their department allocation to fund it.
Richard Lilford, ARC West Midlands Director