Japan Egypt Sub Saharan Africa The ICCI Story: Training and Networking for Combating Infectious Diseases

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Benjamin Howard
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1 Japan Egypt Sub SaharanAfrica TheICCIStory:TrainingandNetworkingforCombatingInfectiousDiseases Organizations: FacultyofMedicine,FayoumUniversity(FOM/FU),Egypt JapanInternationalCooperationAgency(JICA),Japan CountriesandInstitutions: ProvidersinSouth:FayoumUniversity(FU)&SuezCanalUniversity(SCU)inEgypt Co SponsorinSouth:EgyptianFundforTechnicalCooperationwithAfrica(EFTCA), MinistryofForeignAffairsofEgypt(MOFA) Recipients(insomecases,collaborators):MedicalResearchInstitutions,Universities, MinistriesofHealth,etc.in27Sub SaharanAfrica 1 CollaboratorsinNorth:NationalHospitalOrganizationKumamotoMedicalCenter (KMC)&KumamotoUniversity(KU),NationalInstituteofInfectiousDisease(NIID), Japan TraditionalDonor:JapanInternationalCooperationAgency(JICA) Overview: The story of International Course for Clinical Immunology (ICCI), a triangular cooperation program co financed and jointly implemented by Egypt and Japan for Sub Saharan Africa, illustrates comparative advantages and complementarities of North South and South South cooperation. TheICCICasealsoprovidesuswithpolicyimplicationsonthefunctioningofinformal network of experts in brokering supply and demand for peer learning, as well as the roles of traditional donors and experts from North when Southern initiatives are sprouting out of original North South Cooperation: In the absence of formally structured mechanism, the ICCI process was started by a pure initiative of the southern provider (Egypt) supported by Northern experts based on friendship and 1 Angola,Benin,Burundi,Cameron,Chad,Comoros,Coted Ivoire,Eritrea,Ethiopia, Ghana,Guinea,Kenya,Madagascar,Malawi,Mauritius,Mauritania,Mozambique, Niger,Nigeria,Rwanda,Senegal,Seychelles,Sudan,Tanzania,Uganda,Zambia, Zimbabwe 1

2 mutualtrust,whosharedthesameprofessionalgoal. During 15 years of collaboration, ICCI process is yielding unexpected outcomes and added value activities 2 in addition to training of individual researchers and building institutional capacity of implementers. The case highlights the importance of informal networking and horizontal knowledge sharing which goes beyond the North Southboundaries. Backgroundandset up: 1.ExpectedGoalsofSSCActivity The planned goals of the SSC activity are (i) to enhance clinical immunology and laboratorydiagnosticcapabilitiesinafrica;and(ii)tostrengtheninstitutionalcapacity ofegyptianuniversitiesassscserviceproviders. 2.SettingthePremise Since 1989, there has been a popular medical training course Blood Transmitted Disease Seminar organized at National Hospital Organization: Kumamoto Medical Center (KMC) in Japan (still ongoing). This course is funded by Japan International CooperationAgency(JICA).Thelecturersareselectedfrominternationallywell known bio scientists. The demand for this course has been very high, especially among medical professionals in Africa whose training opportunities are rather limited. However,thenumberoftraineesislimitedtoaround10personsannually. 3.InceptionofSouth SouthLearningIdea Amongtheparticipantsofthistrainingcoursein1992,anEgyptianclinicalpathologist fromsuezcanaluniversity(scu),impressedbythequalityofcoursemanagementand dedication of Japanese experts, took initiative to formulate a similar course in Egypt for Sub Saharan Africa. The idea was that a training course in Egypt, inspired by the course in Japan, but tailored to address specific endemic conditions of Africa, would 2 Theseactivitiesincludejointepidemiologicalresearches,jointtrainingandlecturers exchange,jointfollow upsurveys,experimentalsurveillancesystemforinfectious disease,andacademiccooperationagreementsamongseveralcooperating institutions. 2

3 providemoreappropriatesolutionsforimprovinghealthcareservicesinthecontinent. Inaddition,acourseinEgyptcouldreachmoreyoungresearchersinneedoftraining withmuchlesscosts. 4.NegotiationswithNorthernDonor In early 90 s, JICA in Egypt was supporting four (4) training courses (Third Country Training Program: TCTP) implemented by Egyptian partner institutions under its triangular cooperation program 3. However, SCU had never collaborated with JICA before and its institutional capacity was unknown. This required some negotiations and adjustment so that the training proposal met the donor s basic requirements. Japaneseexpertsinvolvedintheoriginaltrainingplayedacatalyticroleinthisprocess, mediating the negotiation between JICA and SCU. Their support and professional guarantee of the technical capacity of SCU finally convinced the donor. Egyptian MinistryofForeignAffairs(MOFA)alsoextendedpoliticalsupportfortheideaofnew South Southlearning 4. 5.ImplementationofSSC TheTCTP InternationalCourseforClinicalImmunology(ICCI) waslaunchedin1996 atscu.themainthemeofthecourseisclinicalimmunologyandlaboratorydiagnosis of infectious diseases using immunological techniques. The ICCI course continues till date, with continuous improvements and reinforcements of its curriculum and diversitiesoflecturers,whiletheimplementinguniversityshiftedfromscutofayoum University(FU)in Ownershipandmutualaccountability: 1.OwnershipandCapacityDevelopmentofEgyptianInstitutionsasProviders The ICCI course was started by an initiative of Southern partner, but through the projectformulationprocess,consensuswasbuildamongtheallstakeholdersincluding theproviderinsouth(scu),egyptiangovernmentasco sponsor(mofa),collaborators 3 JICAhasstartedThirdCountryTrainingProgram(TCTP)inEgyptsince Laterin1998,GovernmentsofEgyptandJapanhavesignedanagreementon Egypt JapanTriangularCooperationProgramforPromotionofSouth South CooperationinAfrica.In1999,Egypt,undertheEgyptianFundforTechnical CooperationwithAfrica(EFTCA),startedsharingthetrainingbudgetswithJICAupto 15%. 5 Todate,256medicaldoctors,bio scientistsandimmunologistsparticipatedinicci coursealone. 3

4 in North (KMC and others) and traditional donor (JICA), who committed to provide necessarysupportforthecourseimplementation.eachpartyhadsenseofownership totheprojectindifferentroles. The implementation of SSC courses, through learning by doing is considered to have contributed to technical and administrative capacity development of Egyptian universities(firstsuezcanaluniversityandthenfayoumuniversity).undertriangular arrangement, Northern institutions provided continuous support to Egyptian institutionsoncoursemanagementknow how. Oneofthebenchmarkeventswhichindicatesthesustainabilityandownershipforthe Southerninitiativewastheestablishmentof ScientificCenterforHumanResources attached to the office of Vice President of SCU with full time staff supporting the implementation of triangular cooperation courses. The establishment of this center supported the institutionalization process of training management know how within theuniversity,andwiderrecognitionoftheimportanceoftriangularcooperationbyall universitystaffatlarge.italsohelpedstaffmembersworkinginthecentergradually developed strong sense of ownership and professional pride for the training programmes. Thisinstitutionalizationprocesswasofcriticalimportanceforthesustainabilityofthe initiative. When the charismatic leader who initially launched the SSC at SCU was suddenly promoted and transferred to other university as the president, other staff members,alreadybelievingintheimportanceofsslearningexchanges,wereableto carryontheprogrammeandevenexpandit.newyoungleadersareemergingtotake overthecoursemanagementresponsibilities. Inaddition,transferoftheleadertootheruniversityhasresultedintheexpansionof triangular partnership. Fayoum University, learning from already accumulated course management know how from the staff of SCU, has also started new international trainingcourses.currentlyfour(4)ssccoursesareimplementedannuallybythetwo universities. They have altogether trained more than 400 doctors and researchers in AfricaandtheMiddleEast. 2.MutualLearningandKnowledgeExchangethroughSpontaneousNetworking ItwasobservedbyJapaneseexpertswhosupportedthetrainingfromtheonsetthat 4

5 SSC experiences have also brought an attitudinal change of individual Egyptian lecturers, who initially tended to have rather patronizing lecturing approach toward African trainees. As they have realized that development cooperation was a mutual learning process, spirit of equal partnership has been enhanced and horizontal networkingbetweenprovidingandbeneficiaryinstitutionshasbecomemoreactive. Among the beneficiary institutions in Africa for example, Kenya Medical Research Institute(KEMRI)hasconstantlybeensendingresearcherstoICCIcourse.KEMRIitself had received grant aid and technical support from JICA for more than 20 years, and nowhasalsobecomeaproviderofssservicestoneighboringafricancountries.from 1999 to 2003, KEMRI implemented Third Country Training Program (TCTP) Blood Screening for HIV/AIDS and Viral Hepatitis for African countries under triangular arrangementwithjica.notably,someofkemriresearchersparticipatediniccicourse in Egypt were promoted and became training leaders in Kenya, adopting some elementsoficcitotheirowntrainingcourses.inaddition,kemriandsculaterstarted exchanging lecturers in their respective courses. In 2005, SCU and KEMRI formalized suchactivitiesbysigninganacademiccooperationagreement. 3.Establishmentofanexperimentalsurveillancesystemofinfectiousdiseases AstrainingcoursesinJapanandinEgyptarebeingimplementedparallel,aninformal network of training alumni has kept growing and strengthened. Drawing on such invaluable global network of human assets, a pilot project of sentinel surveillance systemforinfectiousdiseasewaslaunchedinapril1998byjapanesecourseorganizers. TheAGSnet(AlumniforGlobalSurveillanceNetwork)consistingofselectedsentinels who once participated in training in Japan was designed to contribute global surveillance of emerging and re emerging diseases. Quarterly reporting system was establishedonselecteddiseasesindevelopingcountries.allsentinelsparticipatedona voluntary basis without any financial incentives, but based on mutual trust and professionalresponsibility. Although such a limited number of sentinel sites 6 was unable to provide a comprehensivepictureoftargetdiseases,aninformalnatureofthenetworkenabled providing of useful, and sometimes quick, information of some unusual outbreaks of infectiousdiseases.sincetheinformationofformalglobalsystemstendtoconcentrate 6 68sentinelsin35developingcountriesinAfrica,AsiaandLatinAmericaactively contributedthesystemasof

6 in industrialized countries, AGSnet proved a potential that such a small and informal networkcouldsupplementglobalnetworks. SCU played an active role as an advisory member of AGSnet. Laboratory diagnosis practices during ICCI course contributed improving accuracy of data sent by African sentinels. SCU also conducted joint epidemiological researches with Japanese researchers 7. In addition, the Egyptian course leader participated in field studies in nine(9)africancountriestofollow upsentinelscontributingtoagsnet. AGSnet proved the importance of personal connections in surveillance network, especially for many laboratory professionals working in isolated conditions in developing countries. Feedback information from the network managers encouraged andenhancedthesentinels senseofresponsibilitybyenablingthemtoreaffirmthat theyweremakingvaluablecontributionsforglobalinfectiousdiseasecontrol. Follow up visits to sentinels, not only by Japanese researchers but leaders of TCTP also workedasencouragementfortheircontinuedcontributions. Practicesthatcaninformglobalpolicies: SSC approaches can be categorized based on how they are initiated, namely (i) structured mechanism driven 8 and(ii)non structured informal network driven.the mechanism driven SSC attracts more attention as their data and achievements are relativelyeasilycollectedandmeaningfullessonsdrawn.however,itisestimatedthat theshareandsheervolumeofsuchssexchangesmayberathersmall. On the other hand, it is estimated that the majority of SS exchanges is taking place through decentralized and informal networking. In the absence of structured mechanismandcentralinformationmanagementsystem,achievementsandlessonsof suchlearningexchangeslargelyremainunrecorded.somearenotevenrecognizedas SSC by the key stakeholders. However, given that such initiatives may comprise the majorityofssc,lessonsshouldbeinstitutionallyrecordedandreflectedinglobalpolicy 7 Suchasjoint researchesonepidemiologyofviralhepatitisc(hcv)andhtlv 1 AssociatedMyelopathy(HAM)inEgypt 8 Underthisapproach,demand supplymatchingforssexchangesisarrangedthrough aframeworkorplatform,whichisoftenmadebycentralaidcoordinationagencies, oftenfacilitatedbynortherndonors(i.e.jarcom)withreadilyavailablefunding. 6

7 formulation process. Comparative analysis of two approaches (i.e. structured mechanism driven and non structured informal network driven) can also provide us withpotentiallyvaluableinspirationsfordesigningmoreinnovativeapproachestossc infuture 9. In case of ICCI, typical of non structured network driven SSC, the project idea was conceived through informal networking of experts formed after the preceding North South cooperation. During the past 60 years of North South development cooperation efforts, abundant global stock of human resource has already been formed. Experts forming such networks include northern or international experts whotravelcountrytocountry,orexpertsfromsoutherncountrieswhoaresometimes the product (former beneficiary) of earlier North to South technical cooperation. Suchexpertsaregeographicallydispersedbuthavehighmobility.Theyoftenactasan agent of demand supply brokerage. International training, technical cooperation projectsorinternationalcongressesofprofessionalsocietiesallfunctionasaninformal matchingvenueforcross regionallearningopportunities. One of the strengths of such frontline experts is their up to date information on the grassroots needs and best available southern resources to be matched with such needs. Sometimes, southern resources are not necessarily found in so called emerging development partners whose collective capacity and resource base are already recognized within international development cooperation community. Nevertheless, pockets of excellencies can always be found even in least developed southern countries, whose experiences cannot be substituted by so called middle income developing countries. Information on such appropriate resources is not easilylocatedundercentrally coordinatedsscmechanism. Rolesofdonors: Undernetwork drivenpeerlearningexchanges,donorsarenotusuallyinvolvedin,or donotatleastplayamajorroleatinceptionstage.ideally,theirmainroleshouldbe creating enabling environment for spontaneous and self sustaining networking of partnersinvolved,aswellastrytoestablishadatabaseof pocketsofexcellencies in anaccessibleform. 9 Moreinnovativeapproachescouldreducehightransactionandcoordinationcostsof mechanism drivensscbyrelyingmoreonexistingnetworks,whileincreasingthe efficienciesofinformalmatchingandcapturingtheiroutputsandlessons. 7

8 Informal matching is often made by chance and thus not necessarily provides a replicable model. However, by providing adequate policy support and facilitation of information exchanges, donors and international community can play a catalytic role topromoteinformalbrokeringforstocktakingsuchassets,toenhancethechancesof best matchingandtocradlenew bornpeerlearninginitiatives. Efforts should be continued to be made, through such a Case Stories approach, to systematically record lessons learned and to establish database of under utilized/undiscovered southern resources accessible by those outside of such expertnetworks. BridgingSouth SouthandNorth South: In ICCI Case, a preceding North South Cooperation supported initial institutional and human capacity development of the southern providers, and functioned as an unintended matching venue, linking the potential recipients (demand), provider (supply) and facilitator (northern donor). The case illustrates that North South and South South Cooperation are not alternatives but complementally, each has its own functionsandadvantages. Egypt has relatively advanced medical care facilities and epidemiological research levels compared to many African countries. At the same time, it has comparative advantagesovernortherntraininginstitutionsinitsrelativeproximityofdevelopment stage and epidemiological setting of Africa. Egypt can offer appropriate technologies and replicable solutions to be easily adapted in Sub Saharan Africa. Combined with geographical and economic conditions, Egyptian universities can provide more cost efficient learning exchanges compared to North South Cooperation in certain aspects. Continued Northern technical inputs (i.e. reinforcement by Japanese lecturers) to South South learning, and parallel implementation of North South and South South trainingcoursesensuressynergiesbetweenthetwoinitiatives.northernexpertsplay atutoringroleinsupportoflearning by doingofegyptianuniversitiesasimplementers of international training courses, and facilitate horizontal learning and global networkingofnorthernandsouthernexperts. 8

9 Feedback from each other (i.e. North South and South South programmes) strengthened comparative advantages of respective courses and clarified their division of roles, thus avoiding duplication but ensuring complementarities. Demarcationoftrainingtargetshasbeenspontaneouslymadebetweenthetwo:While the training in Japan is targeted only to medical doctors holding senior positions, training in Egypt is designed to accommodate both resident to mid career medical doctors and paramedics, reaching more researchers much in need of training and exposurestointernationalstandards. Duration: On goingsince1996(eachtrainingcourseis5weeks) Budget(DivisionofResponsibilities): InICCIProcess,responsibilitiesaredividedandsharedbyallpartnersinvolvedinorder tomaximizefinancial,humanandinstitutionalresourcesmobilized: 1.Financialresources Approximate costs for one training course for 5 weeks in Egypt (including honoraria andtravelcostsoftwointernationallecturersfromjapan): USD8,200/pax (Ref:SimilarclinicaltrainingcourseheldinJapancostsUSD13,000/paxfor3weeks) The training budget (excluding honoraria and travel costs of two international lecturers)issharedbyjica(85%)andbyegyptundertheegyptianfundfortechnical CooperationwithAfrica(EFTCA)(15%). 2.In kindcontributions Egyptian implementing institutions (Fayoum and Suez Canal Universities) provide trainingfacilities,lecturersandadministrativeservices. 3.Othercontributions In addition to this, SCU and FU mobilized external resources (lecturers) from other medical research institutions, universities and international organizations (such as WHO, Pasteur Institute, Federation African Immunological Society (FAIS) and other professionalsocieties,universitiesandresearchinstitutesfromafricaandmiddleeast, etc.).inmanycases,thehonorariaandtravelcostsoftheseexternallecturersareborn 9

10 by these cooperating institutions, adding to more resources to the triangular arrangement. NameofPrimaryContactPerson: Ms.YasukoMatsumi(authorofthecasestory) yasuko Keyplayer(s): Dr.AhmedEl Gohary,M.D. President,FayoumUniversity,Fayoum,Egypt 10

Period of June 2008 June 2011 Partner Country s Implementing Organization: Federal Cooperation

Period of June 2008 June 2011 Partner Country s Implementing Organization: Federal Cooperation Summary of Terminal Evaluation Results 1. Outline of the Project Country: Sudan Project title: Frontline Maternal and Child Health Empowerment Project (Mother Nile Project) Issue/Sector: Maternal and Child