Tensions and recommendations for building primary care research capacity in LMIC
| Tension | Solution |
| Micro | |
| Lack of mentorship. | Multiple levels of supervision. Clear accountability and processes. |
| Clinical load. | Advocacy at institutional level for dedicated research time. Implementation research (focused on practical improvements at the clinic level). |
| Lack of knowledge and tools. | Formal training. Remote support e-learning. |
| Meso | |
| Mono-disciplinary approaches. | Interprofessional education and collaboration. Cross-appointments across disciplines. |
| Tendency for universities to want trainees to work independently on research. | Encourage residents to work on interlocking projects, continuation of former research. Micro-research approaches (student-generated content for collaborative learning). |
| Tendency for practitioners to be divided from researchers. | Integrate clinicians and researchers in departments. Encourage clinicians to do research including medical education research or smaller scholarly projects. Build communities of practice and research. Practice-based research networks. |
| Macro | |
| ‘Brain drain’ at different levels. | Support rural/remote practitioners, including in research. Train LMIC researchers in LMIC. If LMIC researchers train in HICs, incorporate commitment to return or in some way ‘give back’ as part of training. South–South collaboration. |
| Increased ethical challenges. | Ensure LMIC IRB review and encourage LMIC researcher involvement in partner HIC IRBs. |
| Lack of funding for primary care research, in both LMIC and HIC settings. | LMIC: incorporate capacity building for sustainability into foreign funding paradigm. All: advocate at all levels, creation of consortia of research. |
HIC, high-income country; IRB, institutional review board; LMIC, low-income and middle-income country.