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Fostering global primary care research: a capacity-building approach
  1. David Ponka1,2,
  2. Megan Coffman3,
  3. Krystle Elizabeth Fraser-Barclay4,
  4. Richard D W Fortier5,6,
  5. Amanda Howe7,
  6. Michael Kidd8,
  7. Robert P Lennon9,
  8. Jeremiah K A Madaki10,11,
  9. Bob Mash12,13,
  10. Sherina Mohd Sidik14,
  11. Chris van Weel15,16,
  12. Kristina Zawaly6,17,
  13. Felicity Goodyear-Smith5,18
  1. 1Besrour Centre for Global Family Medicine, College of Family Physicians of Canada, Mississauga, Ontario, Canada
  2. 2Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
  3. 3Robert Graham Center Policy Studies in Family Medicine and Primary Care, Washington DC, District of Columbia, USA
  4. 4Department of Family Medicine, Georgetown Public Hospital, Georgetown, Guyana
  5. 5General Practice, University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
  6. 6Family Medicine, McGill University, Montreal, Quebec, Canada
  7. 7Primary Care, University of East Anglia Norwich Medical School, Norwich, Norfolk, UK
  8. 8Department of Family and Community Medicine, University of Toronto, Canada and Southgate Institute for Health, Toronto, Ontario, Canada
  9. 9Family and Community Medicine, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, USA
  10. 10Family Medicine, University of Jos, Jos, Plateau, Nigeria
  11. 11Family Medicine, Jos University Teaching Hospital, Jos, Plateau, Nigeria
  12. 12Family and Emergency Medicine, Stellenbosch University, Cape Town, South Africa
  13. 13Stellenbosch University, Cape Town, South Africa
  14. 14Psychiatry, Universiti Putra Malaysia Faculty of Medicine and Health Sciences, Serdang, Selangor, Malaysia
  15. 15Department Primary and Community Care, Radboud Universiteit Nijmegen, Nijmegen, The Netherlands
  16. 16Department of Health Services Research and Policy, Australian National University, Acton, Australian Capital Territory, Australia
  17. 17General Practice and Primary Health Care, The University of Auckland, Auckland, New Zealand
  18. 18University of Auckland, Auckland, New Zealand
  1. Correspondence to Dr David Ponka; dponka{at}


The Alma Ata and Astana Declarations reaffirm the importance of high-quality primary healthcare (PHC), yet the capacity to undertake PHC research—a core element of high-quality PHC—in low-income and middle-income countries (LMIC) is limited. Our aim is to explore the current risks or barriers to primary care research capacity building, identify the ongoing tensions that need to be resolved and offer some solutions, focusing on emerging contexts. This paper arose from a workshop held at the 2019 North American Primary Care Research Group Annual Meeting addressing research capacity building in LMICs. Five case studies (three from Africa, one from South-East Asia and one from South America) illustrate tensions and solutions to strengthening PHC research around the world. Research must be conducted in local contexts and be responsive to the needs of patients, populations and practitioners in the community. The case studies exemplify that research capacity can be strengthened at the micro (practice), meso (institutional) and macro (national policy and international collaboration) levels. Clinicians may lack coverage to enable research time; however, practice-based research is precisely the most relevant for PHC. Increasing research capacity requires local skills, training, investment in infrastructure, and support of local academics and PHC service providers to select, host and manage locally needed research, as well as to disseminate findings to impact local practice and policy. Reliance on funding from high-income countries may limit projects of higher priority in LMIC, and ‘brain drain’ may reduce available research support; however, we provide recommendations on how to deal with these tensions.

  • health services research
  • health systems evaluation

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  • Handling editor Seye Abimbola

  • Twitter @dponka

  • Contributors All authors presented or provided content for a workshop on the same topic at NAPCRG 2019. All authors further developed and drafted the concepts in this paper and accepted the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No additional data are available.

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