Capacity Strengthening Research Articles

Experience and evidence building on effective innovative integrated capacity strengthening - Results from the NNN Leprosy Disease Specific Working Group session 21st September 2023

Experience and evidence building on effective innovative integrated capacity strengthening - Results from the NNN Leprosy Disease Specific Working Group session 21st September 2023

Operational Differences between Product Development Partnership, Pharmaceutical Industry, and Investigator Initiated Clinical Trials.

Medicine development is a lengthy endeavour. Increasing regulatory stringency and trial complexity might lead to reduced efficiency, dwindled output, and elevated costs. However, alternative models are possible. We compared the operational differences between pharmaceutical industry sponsored trials, product development partnership trials, and investigator-initiated trials to identify key drivers of inefficiency in clinical research. We conducted an exploratory mixed-methods study with stakeholders, including clinical trial sponsors, contract research organisations, and investigators. The qualitative component included 40 semi-structured interviews, document reviews of 12 studies and observations through work shadowing in research institutions in Burkina Faso, Mali, and Switzerland. The findings were triangulated with an online survey polling clinical research professionals. The operational differences were grouped under five categories: (i) trial start-up differences including governance and management structure; (ii) study complexity; (iii) site structural and organisational differences; (iv) study conduct, quality approaches, and standard operating procedures; and (v) site capacity strengthening and collaboration. Early involvement of sites in the planning and tailored quality approaches were considered critical for clinical operations performance. Differences between the types of trials reviewed pertained to planning, operational complexities, quality approaches, and support to the sites. Integration of quality-by-design components has the potential to alleviate unnecessary process burden.

Effective localization: case study of a faith-based health partnership in Sierra Leone and Zimbabwe

Faith-based organizations (FBOs) and faith-based service providers play a critical role in public health prevention, promotion, treatment, and community development. Effective capacity strengthening efforts through FBO partnerships can make a vital contribution toward effective localization. This case study details the efforts and results of a writing and publishing workshop provided in partnership with Corus International (IMA World Health) and the Africa Christian Health Associations Platform (ACHAP) in March of 2023. This case study also reports on workshop participantsʼ perceptions of the partnershipʼs approach to capacity strengthening. Three major and related themes emerged from the workshopʼs informal Focus Group Discussion transcription: 1) a safe and nurturing environment, 2) openness and shared decision-making, and 3) organizational humility.

Taking stock: Is gene drive research delivering on its principles?

Gene drive technology has been recognized for its potential to provide durable and cost-effective solutions for previously intractable problems in public health, conservation, and agriculture. In recognition of the rapid advances in this field, in 2016 the U.S. National Academies of Sciences, Engineering, and Medicine issued a report making several recommendations aimed at researchers, funders, and policymakers for the safe and responsible research and development of gene drive technology. Subsequently, in 2017 sixteen global organizations self-identifying as sponsors and supporters of gene drive research became public signatories committed to the 'Principles for Gene Drive Research' which were inspired by the report's recommendations. Herein we reflect on the progress of gene drive research in relation to the ethical principles laid out and committed to by the signatories to the Principles. Our analysis indicates high levels of alignment with the Principles in the field of gene drive research. The manuscript also discusses the Gene Drive Research Forum, which had its genesis in the publication of the Principles. Discussions between participants at the latest meeting of the Forum point to the work that lies ahead for gene drive research in line with the Principles. Going forward the gene drive research community can productively focus on: i) safety and efficacy criteria for open release, ii) risk assessment frameworks and methods, iii) more downstream technical, regulatory and policy considerations for field evaluations and implementation, iv) continued transparency and developing mechanisms of accountability, and v) strengthening capacity in locales of potential release and expected drive spread.

Kendala implementasi P5 dengan tema bhinneka tunggal ika di sekolah dasar

<p class="Abstract"><em>This research was conducted to examine the obstacles to implementing P5 with the topic Bhinneka Tunggal Ika at SDN Bumi 1 No. 67 Surakarta starting from the planning stage, implementation, to assessment and efforts made to overcome it. This research uses a qualitative descriptive method approach. The obstacles encountered in the implementation of P5 are due to internal factors and external factors. The obstacles caused by internal factors are the absence of training regarding P5 for teachers, P5 is not well documented due to lack of teacher understanding, and differences in perception between teachers and school principals. Meanwhile, obstacles are caused by external factors such as limited learning media, the lack of role of teachers and school principals in establishing collaboration, and the lack of involvement of committees and supervisors. The solution to overcome these obstacles are to encourage the strengthening of teacher capacity through training to be able to implement P5 in accordance with the guidelines, to equalize perceptions and build communication between teachers and the school principals, to work with the parents of pupils in providing adequate learning media and to optimize the role of the head, teacher, committee, and supervisor to support a collaborative school ecosystem.</em></p>

Understanding Health Inequalities Research Capacities: Insights and Recommendations From Comparing Two High Income Settings.

Generating evidence on health inequalities (HI) is necessary to raise awareness of these issues, describe and monitor their evolution, analyze their causes, and inform interventions aiming to improve health equity. Yet not all cities and countries have the capacity to produce this type of research. Recent research provides new contextual and causal insights into this research production process, and in-depth understanding on why and how this type of research is produced in certain settings. This article aims to analyze two recent case studies that have uniquely explored this process in two high producers of HI research and high-income country settings to identify learning and distil recommendations, which may be insightful for other settings. Expanding and investing in this line of research is critical, particularly in places with lower HI research output and related capacity, in order to identify key contextual conditions and mechanisms that may enable or hinder this process. This new knowledge could guide the development of new HI research capacity strengthening strategies to foster this research in different settings, worldwide. More understanding is also needed on the relationship between HI research, policy, and action in order to tackle HI.

A phased strengthening of laboratory capacity in the Eastern Mediterranean Region during the COVID-19 pandemic.

The Eastern Mediterranean Region (EMR) faces ongoing challenges in its public health system due to limited resources, logistical issues, and political disruptions. The COVID-19 pandemic accelerated the need for stronger laboratory capacities to handle the increased demand for testing. In a phased response, EMR countries utilized the National Influenza Centers to rapidly establish and scale molecular testing for SARS-CoV-2, the causative agent of COVID-19. The expansion of capacity included strong collaborations between public health bodies and private and academic sectors to decentralize and expand testing to the subnational level. To ensure that the quality of testing was not impacted by rapid expansion, national and subnational laboratories were enrolled in external quality assurance programs for the duration of the response. Implementation of genomic surveillance was prioritized for variant tracking, leading to the establishment of regional sequencing reference laboratories and the distribution of MinION sequencing platforms to complex emergency countries who previously had limited experience with pathogen sequencing. Challenges included a lack of technical expertise, including in implementing novel diagnostic assays and sequencing, a lack of bioinformatics expertise in the region, and significant logistical and procurement challenges. The collaborative approach, coordinated through the WHO Eastern Mediterranean Regional Office, enabled all 22 countries to achieve SARS-CoV-2 diagnostic capabilities, highlighting the pivotal role of laboratories in global health security.

Professional societies of obstetrics and gynecology as agents of change in sexual and reproductive health: FIGO's 10-country safe abortion advocacy project in Africa and Latin America.

In 2019, FIGO started implementing its abortion project focusing on advocacy. The Advocacy for Safe Abortion (ASA) Project was conducted in partnership with 10 national professional societies of obstetrics and gynecology in Latin America and Africa. The project aimed to strengthen national societies, support them to be leaders in sexual and reproductive health, and enable them to obtain context-specific advocacy goals that improve access to safe abortion. Innovative monitoring and evaluation methodology enabled tracking of outcomes, consideration of their contribution to success, and cross-country evaluation. The project saw success through some key strategies: institutional capacity strengthening; enhanced work through collaborations; training to increase knowledge and reduce abortion-related stigma with a broad array of stakeholders; and generation and use of evidence to influence decision-makers. This article describes the project and methodology used and provides tangible examples of how societies have been agents of change in their countries and of the need for such important work to continue.

Culture and Economic Development in Late Comers: Comparing China and India

China and India are both late comers to industrialization. Both adopted similar economic development strategies after World War II, but the per capita GDP diverged significantly in the last 40 years. While economic growth and development have many components, we explain the difference in economic performance by emphasizing the difference in state capacity in the two economies. A country’s state capacity is affected by culture and history. China established a unified language and culture two thousand years ago that enabled it to develop strong state capacity. With a strong state capacity, China made crucial investments in infrastructure and in key heavy industries and developed technological capabilities to help start and sustain growth. India, on the other hand, is a country segmented by religion, caste, and language which has hindered the development of effective state capacity, and thus complementary state investments to spur economic growth. Moreover, India has up to now relied more heavily on expansion of its service sector compared to China, which has hindered its exports, a crucial element that helped China’s economy. India’s future industrialization crucially depends on national integration and concomitant strengthening of state capacity.

A One Health approach to fight antimicrobial resistance in Uganda: Implementation experience, results, and lessons learned

Uganda has been implementing the Global Health Security Agenda (GHSA) since 2015 to build its capacity according to World Health Organization (WHO) Benchmarks on International Health Regulations Capacities. The country remains prone to outbreaks, with more than 20 disease outbreaks reported in the past five years, including Ebola virus disease, Crimean-Congo haemorrhagic fever, Marburg haemorrhagic fever, measles, yellow fever, coronavirus disease 2019 (COVID-19), and cholera. Antimicrobial resistance (AMR) is an ongoing challenge. Uganda scored capacity level 3 on infection prevention and control (IPC) and antimicrobial stewardship (AMS) in the 2017 Joint External Evaluation (JEE) assessment. Identified gaps were being addressed after a self-assessment in 2021. This paper describes the technical assistance approaches provided to Uganda by the Medicines, Technologies, and Pharmaceutical Services Program, funded by the United States (U.S.) Agency for International Development, and implemented by Management Sciences for Health. The program, through a One Health approach, supported systematic capacity strengthening based on the JEE’s capacity advancement framework for global health security, specifically relating to AMR. The program’s interventions impacted 32 WHO benchmark actions (7 for AMR multisectoral coordination, 16 for IPC, and 9 for AMS), contributing to Uganda’s strengthened GHSA capacity. Leveraging success built on the AMR platform, the program trained 745 health workers in IPC for the Ebola virus and provided support for simulation exercises by eight district IPC teams. The program also worked with the Ministry of Health to coordinate IPC for the COVID-19 response in five health regions, covering 45 districts and reaching 5,452 health workers at 858 health facilities.

How international organizations can support the development of cardio-oncology in the Latin American and the Caribbean region.

Health problems in the Latin American and the Caribbean (LAC) region are highly concentrated on non-communicable diseases, being cardiovascular diseases (CVDs) and cancer the leading causes of death. Different countries of the region are at different stages of development in addressing CVDs and cancer. Opportunities for training and continuing education in cardio-oncology, as well as active cardio-oncology groups, are primarily limited to large academic institutions in major metropolitan areas. In addition, the development of advanced imaging modalities in LAC faces challenges such as the high cost of equipment, a lack of equipment maintenance and service, as well as insufficient specific training for both imaging specialists and referring clinicians. To contribute to the implementation of actionable strategies ensuring equitable access to care for all, international organizations, such as the International Atomic Energy Agency (IAEA), offer support for the regional development of health projects that address educational needs. In this context, a new IAEA regional cooperation project for LAC titled 'Strengthening of regional capacities on the use of Nuclear Medicine techniques in a Cardio-oncology multimodality approach in patients with cancer' will be developed during 2024-2025. The experience of some centres, as well as national experiences in certain countries of the region, that have been previously involved in other regional projects, can be leveraged for the benefit of the entire region. We present a proposed road map for cross-institutional/countries collaboration in the development of cardio-oncology in the LAC region, contributing to decreasing the barriers to the growth of the subspecialty.

Finite element modelling of reinforced concrete beam strengthening using ultra-high performance fiber-reinforced shotcrete combined with reinforcing bars

Ultra-high performance fiber-reinforced shotcrete (UHPFRS) is advanced concrete material for strengthening and repairing concrete structures, especially in narrow and difficult-to-access places. However, there has been little quantitative analysis of its strengthening capacity for concrete structures. Therefore, this paper develops a Finite Element (FE) model to simulate the structural behavior of reinforced concrete (RC) beams strengthened by a UHPFRS layer. The traction-separation model combined with the concrete damaged plasticity (CDP) model can accurately simulate the structural behavior of the NSC-UHPFRS composite beam by calibrating and validating with experimental results. Based on this FE model, a parametric study is conducted to asset the effect of the height, reinforcement ratio, and fiber orientation of the UHPFRS layer on the strengthening capacity of UHPFRS for the RC beam. The findings show that those parameters significantly impact the composite beam's load-displacement characteristics. It also contributes to a better understanding of applying UHPFRS in strengthening RC beams as well as structures to extend the service life effectively.

Introducing www.epidemic-em.org: A Collection of Online Resources and Training Materials for Strengthening use of Emergency Operations Centers for Epidemic Response.

This work aimed to demonstrate that a website, www.epidemic-em.org, encompassing "static" resources, and videos, as well as other tools, can be used to strengthen public health emergency management capacity during epidemic response. Existing resources were updated and developed for self-directed Emergency Operations Centers' capacity strengthening, in order to encompass current best practices, and to emphasize how public health emergency management concepts can support epidemic response activities. These materials formed the core of the website, launched in June 2020, to which country case studies were added. In 2021, a pilot virtual training program was designed using recorded video lectures and interviews with global experts in addition to the website material, which was delivered to South African responders. The website has been accessed in more than 135 countries, demonstrating widespread reach and interest in online and freely accessible materials to support public health emergency operations. Over 30 people participated in the pilot virtual training, and the evaluation showed improvement in knowledge, confidence in using emergency management concepts for epidemic response, and positive feedback on the virtual modality. Online tools can expand access to materials and resources for public health emergency management capacity strengthening. Virtual modalities can further serve as a powerful complement, and perhaps replacement, for traditional in-person technical assistance, despite some limitations.

Sexual and reproductive health research capacity strengthening programs in low- and middle-income countries: A scoping review.

Sexual and reproductive health (SRH) research capacity strengthening (RCS) programs in low- and middle-income countries (LMICs) are needed to foster the discovery of context-specific solutions to improve patient outcomes and population health. There remains a limited understanding of SRH research strengthening programs to raise skill sets, publications, and infrastructure and ultimately influence health policy and patient outcomes in LMICs. More information is needed to understand how SRH research is sustained after program completion. To inform efforts to implement programs that strengthen SRH research and foster sustainability, we conducted a scoping review to identify and synthesize strategies used in SRH research strengthening programs in LMICs. A literature search of nine scholarly databases was conducted. We synthesized data extracted from included articles and presented results highlighting the format, duration, and topics covered of program interventions to strengthen SRH research in LMICs. We organized information about primary outcomes into themes and summarized how SRH research capacity was sustained after program completion. Twenty-four articles were included in the scoping review. The articles generally focused on outcomes within the themes of advocacy/capacity, education, policy, project life cycle, and writing/publication. Few articles reported metrics or other evidence of long-term program sustainability of SRH RCS projects in LMICs. Results from this scoping review can be used to strengthen SRH research programs in LMICs. More energy must be directed toward correcting power imbalances in capacity strengthening initiatives. To address additional gaps, future directions for research should include an exploration of SRH research mentorship, the cost of SRH RCS interventions, and how to foster institutional support.

A Framework for Assessing Institutional Capacities for Climate Change Adaptation

Climate change is a worldwide profound phenomenon that is expected to continue, especially with ever-increasing GHG emissions. Developing countries are particularly exposed and vulnerable to cross-cutting climate change impacts, making them vulnerable. Such vulnerability is aggravated by their low adaptive capacity, due to high competition for financial and natural resources required for development efforts and their limited institutional capacities. Such institutional capacities are essential for developing and implementing successful adaptation strategies. Assessing such capacities is crucial for identifying opportunities for improvements, through the detection of weaknesses and strengths. This paper aims to propose an integrated framework for assessing institutional capacities for climate change adaptation. For this purpose, the paper begins by reviewing existing literature on institutional capacities approaches, followed by proposing an integrated framework for capacity assessment for climate change adaptation. The proposed framework is then validated in the case of Egypt, which is followed by a conclusion and recommendations. The proposed framework consists of three pillars: governance, mainstreaming adaptation, and capacity strengthening as well as their specific criteria and indicators. The suggested framework application on climate change institutions in Egypt suggested that, despite the existence of a formal institutional structure for climate change in Egypt, with limited capacities and financial resources. Additionally, it is not inclusive and has a low level of accountability and transparency.

Community partner coauthorship for increased implementation science impact: Strengthening capacity and engagement.

Engaging diverse partners in each phase of the research process is the gold standard of community-engaged research and adds value to the impact of implementation science. However, partner engagement in dissemination, particularly meaningful involvement in developing peer-reviewed manuscripts, is lacking. The Implementation Science Centers in Cancer Control are using the Translational Science Benefits Model to demonstrate the impact of our work beyond traditional metrics, including building capacity and promoting community engagement. This paper presents a case example of one center that has developed a policy for including community partners as coauthors. Standard practices are used to foster clear communications and bidirectional collaboration. Of published papers focused on center infrastructure and implementation research pilots, 92% have community partner coauthors. This includes 21 individuals in roles ranging from physician assistant to medical director to quality manager. Through this intentional experience of co-creation, community partners have strengthened implementation science expertise. Community coauthors have also ensured that data interpretation and dissemination reflect real-world practice environments and offer sustainable strategies for rapid translation to practice improvements. Funders, academic journals, and researchers all have important roles to play in supporting community coauthors as critical thought partners who can help to narrow the gap between research and practice.

ІНТЕЛЕКТУАЛІЗАЦІЯ БЕЗПЕКОВОЇ ДІЯЛЬНОСТІ ТОРГОВЕЛЬНИХ ПІДПРИЄМСТВ

COVID-19 and large-scale military operations have given new impetus to the faster transition of commercial enterprises to the e-commerce model. The very process of transformation provokes the emergence of new challenges and risks, with their further implementation into certain threats, which are difficult to counteract due to previously acquired experience. The development of a theoretical basis for the practical implementation of the program of intellectualization of security activities in the conditions of each commercial enterprise becomes relevant. The expected result of such a process should be the strengthening of the mental capacity of the security process participants to generate new knowledge corresponding to the current security situation. In order to find out the content of the process of intellectualization of the security activities of trade enterprises, the following methods were used: induction and deduction, comparison and systematization – in the study of the essential characteristics of the term “intellectualization”; synthesis and analysis – to take into account the specifics of the activity of trading enterprises; morphological analysis – to clarify the target direction of measures in the course of intellectualization of the security activities of a trade enterprise; abstract-logical – for theoretical generalizations and research conclusions. By clarifying the content of intellectualization and taking into account the specifics of the functioning of trade enterprises, the author’s vision of the process of intellectualization of security activities is substantiated. It has been proven that the intellectualization of the security activities of trade enterprises represents the strengthening of the intellectual activity of the participants of the security process due to the implementation of a set of measures that enable the development of mental abilities for the purpose of generating and effectively applying knowledge, as well as the improvement of the technological base, which collectively contributes to the fulfillment of tasks related to maintaining the economic security of the enterprise at the level necessary for the development and realization of economic interests. The differences of the author’s position are as follows: there is a combination of human and technological components, but the emphasis is on the intellectual activity of all participants in the security process (subjects and objects, internal and external); emphasis is placed on the priority formation and application of knowledge that is relevant at a certain moment; the purpose of using such a tool is specified – maintaining the necessary level of economic security of the enterprise.

СТРАТЕГІЧНЕ ПАРТНЕРСТВО УКРАЇНИ ТА ТУРЕЧЧИНИ У ВІЙСЬКОВО-ТОРГОВЕЛЬНІЙ СФЕРІ

The relevance of the research topic arises from the fact that international military-technical cooperation is an important prerequisite for the ability of modern Ukraine to defend itself against Russian military aggression and to protect the sovereignty and independence of Ukraine. The article presents a retrospective analysis, institutional aspects, and the current state of cooperation between Ukraine and Turkey in the military-technical sphere. This article aims to assess the priority directions of military-technical cooperation between Ukraine and the Republic of Turkey in the conditions of the active phase of the Russian-Ukrainian war and to identify the directions for developing this cooperation, taking into account the significant potential of the Ukrainian defense industry. This article is based on the statistical and analytical materials in the domestic and foreign specialized literature, data from international organizations, and analytical and expert centers. During the research, the methods of analysis and synthesis, comparison, grouping, and systematization, as well as elements of the institutional approach, were used. The research results show that Turkey's status, as one of the most important strategic partners of Ukraine in national security matters, is caused by its long-term support in the military-technical field, assistance in unblocking the maritime export routes for Ukrainian grain in the Black Sea, and the implementation of important humanitarian projects. The list of military goods for actual cooperation such as the production of engines, unmanned combat aircraft, digital communication systems, precision weapons, radar systems, and others has been identified. The potential of further intergovernmental cooperation, which will support the strengthening of the export capacities of both countries in the global arms market, was revealed. It was identified that Ukraine's strategic cooperation with Turkey, as one of the most active players in the modern geopolitical environment, can strengthen the ability of our countries to consolidate international forces in support of its aspirations to protect its independence. Prospects for further research may relate to the disclosure of areas of potential cooperation in the conditions of the post-war revival of the Ukrainian economy, Turkey's support for our country's accession to NATO, and the assessment of opportunities for the formation of production and supply chains through the format of international strategic alliances with the participation of Ukrainian and Turkish companies to promote the latest high-tech weapons models in international markets.

Relationship between knowledge transfer and sustainable innovation in interorganizational environments of small and medium-sized enterprises

PURPOSE: The trends promoted for the strengthening of capacities that allow the interaction and valuation of knowledge as an intangible asset, deserve a management based on its transfer as a basis that drives innovation. Based on this, the purpose of the study is to examine the relationships between knowledge transfer (KT) and sustainable innovation (SI) in interorganizational contexts of small and medium-sized companies. METHODOLOGY: A process was carried out through the application of a questionnaire addressed to managers and owners of 109 small and medium-sized companies of activity in management and the development of information and communication technologies in two regions of Colombia. To show the significant differences between the two selected populations, a non-parametric Mann-Whitney test for independent samples was applied. Likewise, an application of the K-means algorithm was used to group the variables into subsets. The study of the data was complemented with the multivariate technique and the principal components analysis (PCA) to validate the contrasting of the declared hypotheses. FINDINGS: The results determine that by means of the Mann-Whitney non-parametric test for independent samples there are significant differences between the two selected populations. Likewise, the positive correlation between the variables of knowledge transfer and innovation is confirmed, as well as designing the interactions and the flow of processes between the components that support the aforementioned variables from the theoretical and empirical approach, whose interaction capacity between them has to promote the innovative potential under sustainability principles in small and medium-sized enterprises. IMPLICATIONS: Based on the results of the research carried out, scenarios are promoted through which it is sought to strengthen the interorganizational management of small and medium-sized enterprises, minimizing the barriers that weaken their stability. As well as promoting new ways of valuing knowledge as an intangible asset that, when transferred, generates effects in innovation management as part of the strengthening and interorganizational sustainability of small and medium-sized enterprises. ORIGINALITY AND VALUE: It is based on the generation of value through the proposal of a design of a system of relations between the components that promote the transfer of knowledge and sustainable innovation. Its structure is based on empirical results that allowed defining five strategic stages that show the relationships between the components that promote interorganizational and competitive management of tangible and intangible assets available in small and medium-sized enterprises.

Developing the Initial Programme Theories on Health Research Capacity Strengthening of African Universities: A Realist Synthesis Protocol

Background: Health research capacity strengthening (HRCS) has been deemed as a complex, multifaceted, and dynamic activity. Despite this, most studies that assess the effectiveness of health research capacity strengthening programmes have not employed complexity-aware approaches and therefore, evidence on how and why such programmes work across different contexts is underdeveloped. This realist study seeks to elicit the initial programme theories (IPTs) that describe how and why the ‘Developing Excellence in Leadership, Training and Science Africa’ (DELTAS Africa) programme – one of the flagship research capacity strengthening programmes in Africa – works to generate research capacity outcomes specifically in the participating African universities. Methods and Analysis: A realist review of the DELTAS Africa programme documents, and relevant published papers that report on similar research capacity interventions will be carried out. This will help to both identify the outcome pathways and underlying assumptions of the DELTAS Africa programme, as well as tacit theories as postulated by other researchers. The review evidence will inform the drafting of the initial programme theories (IPTs). Interviews with the DELTAS Africa programme designing team will be conducted using a realist interviewing technique to unearth ontologically deeper insights on context, mechanism, and outcomes. Using the realist context-mechanism-outcome configurational maps, we will identify how contexts (i.e., within the African universities) shape mechanisms (the processes, reasoning, or behaviours triggered by the HRCS activities) through which the programme brings about an outcome at institutional level. Conclusion: The initial programme theories will describe how and why health research capacity strengthening works, for whom and under what circumstances across the participating African universities. The programme theories will provide policy-relevant insights on the generative causal mechanisms of HRCS; evidence that is critically needed to inform the design, implementation, and evaluation of HRCS initiatives.