Annual Review

Title: Research for Health in Humanitarian Crises (R2HC)
Programme Value £ (full life): £22,475,468	Review date: 24/09/2020
Programme Code: 300966	AMP start date: 25/06/2019	AMP end date: 31/03/2022

Summary of Programme Performance

Year	2020
Overall Output Score	A+
Risk Rating	Moderate

DevTracker Link to Business Case:	https://devtracker.fcdo.gov.uk/projects/GB-COH-213890-82603979
DevTracker Link to results framework:	Under development, see recommendations

A. SUMMARY AND OVERVIEW

Description of programme

Research for Health in Humanitarian Crises (R2HC) funds high-quality research on the effectiveness of health interventions in humanitarian crises, thus supporting responses to humanitarian challenges to be appropriate, effective, and the best value for money. The programme aims to improve the evidence base for prevention and response mechanisms in disasters, leading to more efficient and effective health interventions, health systems and emergency response programming. Ultimately, the objective is to save lives and improve health outcomes in natural and humanitarian emergencies.

The R2HC programme is currently the only existing global mechanism solely dedicated to increasing the evidence base for health in humanitarian settings. The programme also provides a flexible research commissioning mechanism to respond rapidly to emerging humanitarian crises, including global epidemic disease threats such as Ebola and COVID-19. It supports effective responses in these fragile environments through research to drive real-time improvements and maximise value for money of development funds.

The programme contains two core components:

Support to R2HC to generate a rigorous body of evidence on what works to improve health outcomes in humanitarian settings. This includes annual calls for investigator-led research questions, thematic research calls on areas of strategic importance, and rapid response calls for emerging crises.

Expert knowledge management/brokering to support the first component. This stream will support the identification of priority questions and development of a clearly structured process to feedback research findings into policy development and practice to ensure impact.

R2HC is run by Elhra and co-funded by FCDO, Wellcome Trust, and, since 2018, the National Institute of Health Research (NIHR) through the Department of Health and Social Care. This programme represents FCDO’s support for Phase 4 of the initiative, and the first time it has been a stand-alone programme for the department.

Summary supporting narrative for the overall score in this review

Overall, and against the backdrop of a challenging year, R2HC has exceeded expectations. The programme has adapted quickly to the outbreak of COVID-19, not only maintaining its regular activities but rapidly running one of its largest funding calls in response. This has included using innovative approaches to replace fact-to-face events, truncate but not compromise their funding call process, and continue effective outreach to the humanitarian and health communities.

Over the last 15 months, R2HC has awarded funding as part of their 7th annual funding call, launched their 8th annual call, and run two response calls to support the Eastern DRC Ebola and COVID-19 crises. The Responsive Research Mechanism, a unique modality for funding short-term research to feed into a response, has proven to be invaluable. Specifically, they have commissioned five additional studies as part of the Ebola response and 15 focused on COVID-19. They have far exceeded their targets and continue to provide timely, topical, and robust evidence to support the humanitarian sector.

On the knowledge brokering side, positive feedback received from attendees at R2HC’s second Research Forum, held in September 2019, demonstrated the value of bringing together the humanitarian public health research community for the sharing of experience and lessons learned, as well as networking purposes. Elhra has continued to effectively build on this momentum in 2020, successfully adapting activities to be conducted online, and continuing to grow their presence, with, for example, increasing numbers visiting their website and joining their mailing list.

Major lessons and recommendations for the year ahead

Key lessons:

The Rapid Research Mechanism has proven adaptable to two very different outbreaks. There is value in taking the time to confirm the research priorities, specific priorities, and special requirements when in complex contexts, but the mechanism can also be employed rapid fashion if time outweighs the benefit of additional scoping (e.g. COVID-19).

Key recommendations:

Programme management:

As a priority, finalise the logframe with agreed milestones for the full duration of the programme.

Calls for proposals:

Continue to work with the R2HC Advisory Group and other key stakeholders to identify crises where rapid research can inform a humanitarian response through utilisation of the Responsive Research Mechanism.

Explore opportunities to run thematic calls, to build specific bodies of evidence in priority areas.

Engagement with Southern research organisations:

Continue providing partnership guidance and seed funding to support equitable research partnerships; pilot brokering of Northern researchers to collaborate with Southern research applicants at EOI seed funding stage; and encourage co-development of budgets and use of partnership agreements.

Identify experienced Southern researchers to sit on the Funding Committee (FC) and pilot an initiative to enable an early career Southern researcher to sit on the FC in a learning capacity.

Showcase Southern-led success stories through R2HC communications.

Explore establishment of an alumni association or network of ex-grantees to facilitate networking between researchers in different countries and regions.

Information and guidance:

Prioritise providing additional guidance and support on research methods, ethics, community engagement, and uptake.

Engagement and convening:

Continue to forge relationships with the health clusters and with WHO technical leads to identify priority research gaps.

Support research priority exercises, including requests to build on earlier WASH and SRH research prioritisation exercises, and to explore doing similar with the GBV community.

B: THEORY OF CHANGE AND PROGRESS TOWARDS OUTCOMES

Theory of change

R2HC has four defined outputs:

Priority research needs are identified in response to demand from humanitarian health practitioners and policy makers;

Collaborative research partnerships are funded to generate research addressing priority health evidence gaps and supported to achieve uptake of findings (including through changes to policy and practice; networks; capacity and knowledge);

Knowledge and learning from the R2HC portfolio of work is synthesised and shared in response to demand from practitioners and policy makers; and

Key humanitarian stakeholders have access to and are informed of key new evidence, through strategic engagement and communications.

The underpinning logic is that these will lead to two intermediate outcomes; specifically, an increased demand for R2HC evidence and expertise from humanitarian decision-makers, as well as, increased capacity of decision makers to incorporate the new evidence into programming. These in turn will lead to achieving the overall expected outcome, which is that the evidence generated positively influences the public health policies and practices of key humanitarian actors, increasing the effectiveness of aid during current and future humanitarian crises.

The expected impact of the programme is that mortality, morbidity and suffering is reduced in humanitarian crises through demonstrated improvements in humanitarian and public health interventions.

We believe this logic remains valid and there are no major changes required. There are a number of key assumptions underpinning this logic:

Well-funded, world class research advances the global knowledge-base and improves ethical and methodological approaches to conducting health research in operational humanitarian contexts;

New evidence will be adopted and will lead to improved health outcomes;

Effective partnerships between academic research institutions in the Global North and Global South, with humanitarian practitioner organisations, lead to an improved health evidence base that is more likely to be used and applied by policy makers and humanitarian practitioners in decision-making; and

Collaboration with key decision makers, researchers, and practitioners to work on priority jointly identified evidence gaps, will facilitate addressing the systemic barriers that inhibit the uptake of new evidence into policy and practice.

Progress towards outcomes and impact

Whilst some of the specific outcome targets need to be finalised in the complete logframe, the programme has made progress against key indicators, which suggests it is on track to achieve its expected outcomes and impact.

R2HC Outcome: Evidence from R2HC funded research positively influences the public health policies and practices of key humanitarian actors including national governments. Indicators and performance:

Number of key individuals in humanitarian organisations reporting shifts in organisational policy and/or practice:

Cumulative total of 12, including Sphere, ICRC, and UNHCR.

Percent of closed studies reporting uptake of evidence by humanitarian actors:

76.5% (against a target of 80%).

As of this coming year, Elhra will also be capturing case studies that demonstrate R2HC funded research is used and applied by humanitarian policy makers, practitioners and other relevant stakeholders in decision making (target of 5 per year) and the number of times R2HC funded research is referenced in humanitarian policy guidelines.

Now that the R2HC programme is maturing, there is early evidence of health in humanitarian settings policy and practice being informed by findings generated through R2HC-funded research. The 2018 Wellcome review noted that the influence and uptake of R2HC research already appears quite high considering the portfolio is still relatively new. Below are recent examples of impact:

Call	Research title & grantee	Impact
2	A new evidence base for respiratory health interventions in volcanic eruptions – Durham University	• PAHO-WHO have committed to update global guidelines on disaster response in line with study protocols; • Through PAHO, nine Latin American countries have committed to update disaster response plans to reflect guidance on face masks
2	Menstrual Hygiene Management Toolkit – IRC & Columbia University	• Use of MHM toolkit in the field reported by UNHCR, UNICEF, IFRC, Norwegian Church Aid and Oxfam in emergency settings (Cox's Bazaar, South Sudan)
1	Longer-term mental health, developmental and systems impact of Child Friendly Space (CFS) interventions in humanitarian emergencies – World Vision & Columbia University	• CFS research findings have resulted in multi-agency collaboration – including involvement of UNICEF, Save the Children, Mercy Corps & AVSI - to provide guidance and support on implementation of CFS for the humanitarian community, and have informed cluster policy and programming discussion. • World Vision is working with the protection cluster and alliance organisations to develop Codes of Practice and operational guidance on CFS. • Child Protection Working Group of the Global Protection Cluster and the IASC MHPSS Reference Group have identified research on child friendly spaces as a high priority.
4	Development, Piloting and Evaluation of a Phone-Delivered Psychological Intervention (t-CETA) for Syrian Refugee Children in Lebanon – Queen Mary University	• The researchers quickly pivoted to use their findings to support agencies during COVID by developing new guidance on ‘delivering psychosocial treatment to children via phone’. The free online guidance was promoted and disseminated widely through humanitarian mental health practitioner networks and uploaded to humanitarian resource hubs including MHPSS.net and ALNAP. The team engaged directly with agencies and partners to support field use through 1:1 support and webinars. The Lebanese Ministry of Public Health, which has been continually engaged in the study, supported dissemination of the guidance.
4	Overcoming challenges to accessing quality post‐abortion care in humanitarian crises – Columbia University	• The International Medical Corps have committed to adapting and shaping provision of PAC in their programming in response to the study findings. • In South Sudan, the study team have been invited to collaborate on the development of national PAC guidelines led by UNFPA.
5	Optimizing a community-based model for case identification, monitoring, and prevention of hypertension and diabetes among Syrian refugees in Jordan – International Rescue Committee and University of California	• In response to the pandemic, the co-PIs rapidly documented guidance and recommendations to inform IRC’s programme adaptations. Headline learnings were shared in a letter published in ‘Conflict and Health’. IRC have implemented rapid programme adaptions for community health interventions with Syrian refugees in Jordan based on the study teams’ guidance and recommendations.

Intermediate Outcome A: Increased demand for, and utilisation of, R2HC evidence and expertise from key humanitarian decision-makers. Indicators and performance:

Number of (unsolicited) requests for Elrha/R2HC support to address significant research gap analyses:

Cumulative total of 3, with one new request from ICRC to conduct a Situational Analysis and Review on Violence Against Healthcare Workers (currently underway).

Number of requests for Elrha/R2HC to contribute to high level events:

Unfortunately, in light of COVID-19, most foreseen 2020 events have been postponed or cancelled. This includes the House of Lords Launch of the Nuffield Report on Ethical Research in Humanitarian Settings, which had a speaking role for the CEO. The programme has contributed to three ethics initiative related to COVID-19.

Informal consultations undertaken July-September 2019 with research uptake focal points from key humanitarian INGOs, showed that they increasingly invest time and resource into research production, use, and uptake but there is opportunity for R2HC to further support these efforts. These findings have been used to strengthen outreach in 2020.

As of this coming year, Elhra will also be tracking the number of R2HC funded research outputs made available on/in the communications or publications of other stakeholder institutions.

Intermediate Outcome B: Public health researchers using R2HC evidence-based guidance on conducting research in humanitarian contexts to inform design and implementation of quality studies. Appropriate processes for measuring the indicators need to be developed, but indicatively:

Number of researchers reporting use of publications/guidance/case studies generated through R2HC by topic:

A new template has been developed to capture this information in the coming year.

R2HC has developed several tools and guidance documents, which are frequently viewed and downloaded (e.g. the Research Ethics Toolkit has been viewed over 226 times).

Number of researchers reporting value of participation in R2HC convened events:

In late 2019, R2HC convened two events: the 2019 Research Forum and Skills Building Day. 120 people participated in the Research Forum and feedback generated through Sli.do and an online survey, suggested that the Forum met its objectives of facilitating sharing of lessons learned and good practice in conducting humanitarian health research, networking and guiding the future direction of R2HC support to the research community.

Feedback from the Skills Building Day indicated an average score of 4.1/5 when asked if participants planned to use what they had learned and showed an increase in pre- and post-scores across all sessions of 25% (from 3.25 to 4.05/5).

Additionally, on average 80% of R2HC COVID-19 grants are represented in the voluntary R2HC-convened monthly community of practice calls, with up to 23 participants in each (this is taken as a proxy for researcher satisfaction).

Number of citations of R2HC developed guidance:

This will be captured in an endline evaluation survey. However, the guidance are often cited in proposals to R2HC and the Research Ethics Toolkit has been included in several organisation’s guidance, such as DFID’s Ethical Guidance on Research, Evaluation and Monitoring (October 2019).

Justify whether the programme should continue, based on its own merits and in the context of the wider portfolio

The programme continues to see increasing impacts from the evidence it has generated. Additionally, it has exceeded expectations over the last 15 months with, in particular, the Responsive Research Mechanism providing useful support to the Ebola response and rapidly mobilising to commission essential research to feed into the COVID-19 response. R2HC continues to provide excellent value for money and play a vital role in both the health and humanitarian research team portfolios. For these reasons, the R2HC programme should continue.

C. DETAILED OUTPUT SCORING

Output Title	Priority research needs identified in response to demand from humanitarian health practitioners and policy makers
Output number:	1	Output Score:	A
Impact weighting (%):	10	Weighting revised since last AR?	N/A

Indicator(s)	Milestone(s) for this review	Progress
1.1 No. of Elrha/R2HC-commissioned reviews of the public health evidence-base that inform priority areas for new research calls for proposals (by thematic area/topic) or that inform the humanitarian health evidence-base more widely	i. Sexual and reproductive health (SRH) & innovation situation analysis commissioned ii. Mental health and psychosocial support (MHPSS) research prioritisation commissioned	Met. Both studies have been commissioned and final reports are due in early 2021.
1.2 No. of R2HC convened events that seek inputs from key stakeholders on research prioritisation and/or share outcomes of research prioritisation exercises	i. Meeting to share outcome of MHPSS research priority setting	Partially met. The meeting is scheduled for end of November 2020

Briefly describe the output’s activities and provide supporting narrative for the score

R2HC has established working relationships with a number of WHO technical working groups, the humanitarian clusters (Health, WASH, Nutrition, the Gender-based Violence Area of Responsibility under the Protection cluster), the Sphere Project and selected thematic communities of practice including the MHPSS Inter-Agency Reference Group, Inter-agency Working Group on Reproductive Health in Emergencies (IAWG) and, Emergency Nutrition Network, and BRANCH (Building Research and Action in Conflict Settings, Sick Kids Canada).

During this reporting period, two analyses have been commissioned to better understand the available evidence on sexual and reproductive health (SRH) and mental health and psychosocial support (MHPSS). The final reports for both are due in early 2021 and will be widely shared with the relevant working groups and clusters. R2HC will also be convening an event on research priorities in MHPSS, linked to the ongoing review, in November 2020.

R2HC’s work with the WASH Cluster to support research prioritisation in the WASH sector and encourage research applications resulted in 12 EOIs submitted to Call 7, of which 1 was invited to develop a full proposal, but none were ultimately funded. Further work needs to be done to engage with thematic sectors where the evidence base is lacking, and Elhra is exploring the availability of funds, across donors, to run thematic research calls.

For 2021, plans are underway to update the Humanitarian Health Evidence Review (HHER) and prioritisation of Sphere Standards review.

This output has been scored an A to reflect the consistent progress being made in identifying priority research areas for practitioners and policymakers.

Assess the VfM of this output compared to the proposition in the Business Case, based on performance over the past year

The work under this output supports the programme to be effective by building the relationships and evidence base to ensure that commissioned research is directly relevant for policy and programming. This will increase the uptake, and therefore impact, of research funded by R2HC. This is one of the key pillars in achieving value for money as ensuring grants are well targeted will drive both cost-efficiency

and wide uptake. Based on the above performance, this output supports the programme to provide value for money.

Describe any changes to this output during the past year, and any planned changes as a result of this review.

This is the first annual review for Phase 4 of the programme. As part of developing the proposal, a new results framework was developed and used for this annual review. This was updated based on learning from the first 6 years of implementation, providing more clearly defined outputs and indicators, and bringing it in-line with the future vision of the programme. However, this needs to be finalised and targets for all indicators agreed. This should be a prioritised for completion by end of 2020.

Lessons learned this year and recommendations for the year ahead

Key recommendations:

Continue to forge relationships with the health clusters and WHO technical leads to identify priority research gaps. This includes the Advisory Group’s recommendation to engage with new strategic partners and potential funders.

Support research priority exercises, including requests to build on earlier WASH and SRH research prioritisation exercises, and to explore doing similar with the GBV community.

Explore opportunities to run thematic calls, to build specific bodies of evidence in priority areas.

Output Title	Collaborative research partnerships funded and supported to generate high quality ethical research addressing priority health evidence gaps and supported to achieve uptake of findings
Output number:	2	Output Score:	A++
Impact weighting (%):	60	Weighting revised since last AR?	N/A
Indicator(s)	Milestone(s) for this review	Progress
2.1 No. of calls launched, and studies funded addressing clear needs/gaps in priority areas	i. Minimum 1 call launched ii. Minimum 15 seed funding grants ii. Minimum 7 studies funded	i. Exceeded. 2 calls launched – 1 responsive to COVID-19 and 1 annual call (Call 8). ii. Exceeded. 24 seed fund grants (Call 7). iii. Significantly exceeded. 28 studies funded – 20 responsive (15 COVID-19 and 5 Ebola) and 8 annual studies (Call 7).
2.2 No. of studies recommended for funding by the Funding Committee (per call);	i. At least 7 studies recommended for funding per annual call	i. Significantly exceeded. 8 studies funded for Call 7 and 15 studies funded as part of the COVID-19 responsive call.
2.3 No. and type of institutions awarded grants, and no. and type of partners within a research team	i. At least 3 partners per grant	i. Met. Mean of 4.1 partners per grant. The number and type of institutions leading new grants: 15 academic (incl. 1 LMIC),7 NGOs (incl. 1 LMIC), and 1 UN agency. The number and type of other partners on new grants: 29 academic (incl. 17 LMIC), 30 NGOs (incl. 15 LMIC), 4 government entities, and 8 UN agencies.
2.4 Percent of funded studies in the ACAPS category of crisis severity at time of award	i. At least 10% of studies in very high severity contexts and at least 30% in high severity	i. Met. For Call 7, 10% were very high severity, 40% high, and 20% medium. For the COVID-19 call, 11% were very high, 32% high, and 57% medium.

Briefly describe the output’s activities and provide supporting narrative for the score

It has been a highly productive period for R2HC with the Responsive Research Mechanism proving its value through two special calls. During this period, R2HC has funded 28 new studies; this includes 8 studies funded through annual (open) call 7, five in response to the Ebola outbreak in DRC, and 15 in response to COVID-19. Across the studies, there is a good mixture of partners, representing different types of organisation and including a significant proportion from low- and middle-income countries (LMIC), including a few led by LMIC partners such as Makerere University.

As part of this, the COVID-19 call demonstrated R2HC’s extensive global reach, with 465 applications submitted in a brief five-week window (70% from LMIC settings), and significant demand for funding to conduct rapid humanitarian research. The call provided the opportunity for R2HC to partner with 14 lead organisations that had not previously been lead grantees for R2HC. A total of 52 organisations are part of these research teams, 20 from LMICs. To launch initiatives quickly, a truncated proposal review process was employed. However, through four Funding Committee (FC) meetings, rapid funding decisions were made whilst maintaining the expected high level of rigour in review process through in-depth technical and FC reviews. Whilst the COVID-19 call has highlighted known challenges with contracting organisations in LMICs, it has provided an opportunity to explore additional risk mitigation mechanisms to overcome these. For example, we worked closely with the OPT country office to ensure appropriate enhanced due diligence processes were in place, and Elhra worked closely with the University of Science and Technology of Bamako after they scored high-risk (e.g. providing additional support on anti-terrorism checks and adopting missing policies from their partner organisations).

In May 2019 R2HC launched a rapid call for proposals to support the Eastern DRC Ebola crisis. Five studies were approved: four seeking to improve understanding of community behaviour and uptake related to prevention and response interventions, and one focusing on a clinical intervention. Final reports for all projects were received in December 2019/January 2020, with a synthesis report due for publication shortly. Rather than undertaking this rapidly (as with COVID-19), the 6-month consultation process before the launch enabled R2HC to identify priority research gaps and essential applicant requirements - namely the importance of having operational in-country partners and security plans in place - and to establish contact with in-country coordination mechanisms. The value, whenever possible, of making contact with on-the-ground partners who can facilitate uptake of findings has been emphasised.

The R2HC portfolio has also generated 22 new peer-reviewed articles and 10 new grey literature products. This brings the cumulative totals to 108 and 46 respectively, substantially increasing the body of evidence from only 133 high-quality articles identified in the Humanitarian Evidence Review (2015). R2HC is conducting further work to ensure that all articles are published open access (in 2019, the proportion was 87%) and that this includes open dates whenever possible. They are working with partners to understand the challenges in making data sets available and developing further guidance.

This output has been scored an A++ to reflect the large number of high-quality, and highly-relevant, studies that have been funded over the last 15 months.

The appointment of a Research Impact Manager has enabled R2HC to substantially increase the support provided to grantees to develop and deliver research impact plans. Whilst COVID-19 disrupted plans for in-person events, Elhra converted their Research Impact Toolkit Workshops to be held online to ensure grantees continued to have access to that support. They have also run two online kick-off calls and regular support group meetings for the COVID-19 call. Utilising the findings from the 2019 Review of R2HC Research Partnerships, a workshop focusing on strengthening partnership support, specifically focusing on the value of developing MOUs to ensure equitable partnerships, was conducted at the Skills-Building Workshop after the Research Forum. The Skills-Building Workshop also provided training on stakeholder engagement, operational challenges and risk mitigation, plus a talk delivered by a Lancet editor on how to write a publishable peer-reviewed article.

In terms of adapting for COVID, it is also worth noting that the Annual Call Funding Committee process was also adapted to be done online with 2 days’ notice. R2HC also rapidly assessed the individual needs, and potential pandemic impacts, of all currently open grants; provided grantees with guidance to mitigate financial impact, and non-financial support to keep studies on track; and modified processes to enable post-grant closure uptake activities to take place once conferences and external events are possible post-COVID-19.

Assess the VfM of this output compared to the proposition in the Business Case, based on performance over the past year

This output captures the core function of R2HC, which is to fund high-quality research on health in humanitarian contexts. Given that the targets for number of studies funded and peer-reviewed publications have been substantially exceeded, this indicates the programme is performing better on effectiveness than expected and, therefore, providing value for money.

It is also appropriate to discuss equity here. Elhra is committed to equitable partnerships and the diversity of partners and organisations across the grants reflects this. They continue to take steps to bring in more partners from LMICs, such as requiring from Call 7 onwards that at least one Global South research organisation is included in consortia. Nearly half of research team members are female and a similar percentage are from LMICs. Additionally, all applicants are required to address gender and social inclusion in their proposals. During this period, 4 new studies have been commissioned that are targeting priority groups. For example, this is very important for women and girls who are disproportionately affected by humanitarian crises; so far R2HC has funded 14 studies that specifically focus on them.

Describe any changes to this output during the past year, and any planned changes as a result of this review.

As mentioned above, this is the first annual review for Phase 4 of the programme, and a priority must be finalising a complete logframe.

Lessons learned this year and recommendations for the year ahead

Key lessons:

The Rapid Research Mechanism has proven adaptable to two very different outbreaks.

In the case of Ebola, the long lead-in time (6 months) ensured confirmation from the humanitarian response community on research priorities, specific requirements with respect to in-country partnerships and security plans, and also enabled collaboration with in-country coordination mechanisms. Lessons learned have shown that in complex contexts extra time is generally needed to ensure the relevance and appropriateness of the call, and to obtain all the necessary clearances.

Conversely, in the case of COVID-19, the call was run very rapidly, and it is now clear that this is a feasible approach. Whilst this allows for less targeting of the research, emerging findings and final reports will be completed whilst countries, and specifically humanitarian contexts, are still tackling COVID-19.

Across both calls, further delays can be anticipated in-country when seeking ethical approvals. When launching responsive calls for proposals it is important to be realistic about the timeframes.

Continue to work with the R2HC Advisory Group and other key stakeholders to identify crises where rapid research can inform a humanitarian response through utilisation of the Responsive Research Mechanism.

Key recommendations:

Continue exploring the potential use of secondary data analysis to increase the evidence base (a specific recommendation from the Advisory Group).

Explore feasibility of introducing formative research grants which will enable researchers to develop study protocols and test research approaches before applying for longer grants. The hope is this will make grants more accessible for researchers from the Global South.

Continue providing partnership guidance and seed funding to support equitable research partnerships; pilot brokering of Northern researchers to collaborate with Southern research applicants at EOI seed funding stage; and encourage co-development of budgets and use of partnership agreements.

Identify experienced Southern researchers to sit on the Funding Committee (FC) and pilot an initiative to enable an early career Southern researcher to sit on the FC in a learning capacity.

Explore establishment of an alumni association or network of ex-grantees to facilitate networking between researchers in different countries and regions.

Output Title	Knowledge and learning from R2HC-funded research is captured, synthesised and shared through communications & engagement activities
Output number:	3	Output Score:	A
Impact weighting (%):	20	Weighting revised since last AR?	N/A

Indicator(s)	Milestone(s) for this review	Progress
3.1 No. of communications products/ publications generated from grantees research outputs for stakeholder community by R2HC or in collaboration with others	i. 1 research snapshot per completed study ii. Co-author ODI Humanitarian Exchange Ebola Special iii. Review of MHPSS interventions iv. Synthesis of Ebola 2019 call outputs	i. Partially met. For 20 completed studies, 11 research snapshots have been completed and a further 8 are anticipated by end of 2020. ii. Met. This was published in March 2020. iii. Met. This report was published in 2020. iv. Partially met. Forthcoming. Additionally, 3 reports on operational challenges, research methodology, and R2HC partnerships have been published. This exceeded expectations.
3.2 No. of reviews, guidance products, and tools developed to improve quality and effectiveness of public health research and its uptake.	i. Research impact toolkit (RIT) course available online ii. Call for proposals for a review of responsive research mechanism launched iii. Call for proposals for a paper on Pathways to Uptake launched	i. Met. RIT course is available online. ii. Met. Call for proposals launched and report due in early 2021. iii. Met. Call for proposals launched and report due in early 2021. Additionally, contributed to development of guidance on conducting ethical research during COVID-19, which therefore exceeded expectations.
3.3 Biennial Research Forums convened to support programme objectives and engage key stakeholders	i. 2019 Research Forum	i. Met. Research Forum held in September 2019.

Briefly describe the output’s activities and provide supporting narrative for the score

Elhra have continued to increase their support for research dissemination and uptake. Last year, R2HC developed a research ‘snapshot’ template to help research teams summarise their findings in an easily digestible and plain-language manner that is useful for communicating with policy-makers. Of the 20 studies completed in 2020, 19 have either published snapshots or will do so by the end of the year. Reports synthesising findings on Ebola and mental health and psychosocial support (MHPSS) interventions. Additionally, they completed three reports on:

Research methodologies used in humanitarian crises – recommendations from which include monitoring how methodologies evolve in the field; establishing a neutral platform to share learning; encouraging the use of mixed-methods; introducing checklists for each methodology for the Funding Committee; valuing contribution of local researchers; and supporting the piloting of new methodologies.

Research partnerships – recommendations from which are being used to inform Partnership Workshops and develop new tools (e.g. a non-binding ‘ways of working’ MOU template).

A quantitative study on the operational challenges and risk management in humanitarian research – the findings of which are being turned into a series of practical briefing sheets to guide readers through key challenges and mitigating strategies based on real grantees experience.

R2HC has also moved their Research Impact Toolkit workshop online, which has allowed it to remain accessible to grantees during COVID-19. They have also contributed to the development of guidance on conducting ethical research during COVID-19 through collaboration with external stakeholders. They have also launched two calls for a review of the responsive research mechanism and pathways for uptake that will inform future guidance for themselves and grantees to increase the impact of their research.

Finally, R2HC held its second Research Forum in September 2019. During the 3-day event 120 people from the humanitarian health research community had the opportunity to share good practice and lessons learned, and to address key issues of relevance to conducting humanitarian research. Key focuses of the Forum were equity and inclusion, humanitarian research methodologies, ethical dilemmas in humanitarian contexts and research impact, with a cross-cutting focus on improving engagement with researchers and institutions in the global South. The Forum also presented a unique networking opportunity enabling invaluable connections to be made. Attendees at the Forum came from funding and strategic partners including DFID, NIHR, Fogarty, Wellcome, ALNAP, Evidence Aid, Nuffield Council on Bioethics and the Sphere Project, UN agencies including UNHCR, UNICEF and WHO, the ICRC, and from academic institutions from the global North and South and key international humanitarian organisations. Breakout sessions generated guidance and practical suggestions on how the R2HC might engage strategically with national level stakeholders, the clusters and humanitarian organisations to ensure uptake of research findings to inform policy and practice.

This output has been scored an A to reflect that overall R2HC has continued to achieve its communication and engagement goals, experiencing some delays but also exceeding expectations in other areas. This is impressive performance given the challenging year and impact COVID-19 has had on events and convening.

Assess the VfM of this output compared to the proposition in the Business Case, based on performance over the past year

The work conducted under this output supports the overall programme achieving its value for money objectives by facilitating research quality and uptake (and therefore effectiveness). To achieve value for money there needs to be effective investment in research uptake which the above indicators, such as the production of research snapshots and evidence syntheses, demonstrates. The additional guidance and learning provided to the research community also strengths the quality of the evidence base and research produced under output 2. Given the high performance of this output, investment in it continues to provide value for money.

Describe any changes to this output during the past year, and any planned changes as a result of this review.

As mentioned above, this is the first annual review for Phase 4 of the programme, and a priority must be finalising a complete logframe.

Lessons learned this year and recommendations for the year ahead

Key lessons:

Now that grantees are becoming familiar with support offered through the Research Impact Toolkit and related workshops, there is an increasing demand for it. Demand for practical assistance goes beyond the development of strategic engagement plans, to also include requests for support in translation of research findings and development of communication tools to promote uptake.

R2HC’s unique role as a convenor of the humanitarian health research community was demonstrated by the success of the 2019 Research Forum, confirming that the Forum is the only event of its kind, bringing together academics and practitioners from the global North and South to discuss topics of relevance to conducting public health research in humanitarian settings.

Over the past year demand for the package of support made available through the R2HC programme has increased. At the Forum, interest was expressed in the R2HC facilitating partnership brokering again, so this will be re-explored. Additionally, the Skills-Building Workshop received positive feedback and generated demand for similar learning opportunities in the future, including facilitation of peer-to-peer support.

Key recommendations:

Continue to develop, refine and roll out the package of support we offer grantees and the research community.

Prioritise providing additional guidance and support on research methods, ethics, community engagement, and uptake.

Increase the emphasis placed on the importance of engaging strategic stakeholders with synthesised evidence and tools.

At the next Research Forum (expected in 2021), research findings generated through R2HC should be shared alongside discussion of cross-cutting issues.

Output Title	Key humanitarian stakeholders have access to and are informed of key new evidence, through strategic engagement and communications
Output number:	4	Output Score:	A
Impact weighting (%):	10	Weighting revised since last AR?	N/A

Indicator(s)	Milestone(s) for this review	Progress
4.1 R2HC strategic engagement plan delivered	i. Plan in place and key 2020 activities delivered with priority stakeholders ii. Plan activities for 2021	i. Met. Strategic engagement plan in place. Activities delivered as planned with 2020 in-person activities adjusted to be on-line due to Covid-19, where feasible. ii. Met. Plans for 2021 activities sufficiently developed and to be finalised over end of year.
4.2 No. of key events R2HC has been engaged with / convened with key stakeholders to disseminate knowledge generated through the programme	i. Mental health and psychosocial support (MHPSS) community of practice meeting	i. Met. Meeting of the MHPSS IASC Reference Group foreseen for end of November 2020.
4.3 No. of key communications outputs published	i. 4 newsletters per year ii. 4 impact newsletters per year iii. 4 publications newsletters per year iv. 4 blogs per year	i. Met. 3 R2HC newsletters circulated with a 4th due in October 2020. Additional mailers related to the annual and responsive funding calls have also been sent ii. Met. 4 impact newsletters circulated. iii. Partially met. 3 publications newsletters circulated (Q1 & 2 were combined). iv. Significantly exceeded. R2HC published 2 blogs on “research uptake in a COVID-19 world” and “our insights into COVID-19 rapid research”, whilst grantees published a further 10.
4.4 Engagement metrics generated through R2HC Website and Social media	N/A – no target set for this year	There was a huge influx of traffic to the website in April – June 2020 with 58,272 users, including 45,785 viewing the COVID-19 responsive funding call page.

Briefly describe the output’s activities, and provide supporting narrative for the score

R2HC have continued to proactively reach out to, and engage with, the health and humanitarian sectors. They successfully adapted their strategic engagement plan so that most 2020 activities were able to proceed online. They are currently finalising their plans for 2021. As part of this they are convening the mental health and psychosocial support (MHPSS) community of practice in November 2020. R2HC/Elrha was also requested to contribute towards various other knowledge-sharing events in the humanitarian sector during this period, including:

Global Mental Health Research Ethics Symposium, Liverpool School of Tropical Medicine, September 2019 - Head of R2HC attended and contributed to review of inter-disciplinary theoretical framework to enhance ethical engagement.

Mortality Surveillance Systems in Humanitarian Settings, UNICEF/Save US, October 2019 – Invited but unfortunately unable to attend.

R2HC have sent out 11 newsletter this year. During the period while the COVID-19 Responsive Funding Call was open, they received 600 new R2HC newsletter subscribers: an increase of 17% based on the previous quarter, and significantly higher than their average new monthly subscribers of 199 per month.

They also published two blogs following the COVID-19 call on ‘research uptake in a COVID-19 world’ and ‘our insights into COVID-19 rapid research’, which to date have received nearly 800 reads. This is indicative of the respected role and effective outreach they have within the humanitarian community. Grantees have published an additional 10 blogs based on their research, including on ethical challenges in situations of extreme violence, using participatory community mapping to better understand migration in southern Somalia, and why Syrian refugees do not use available mental health services.

Finally, the website has continued to grow in strength. There was a huge influx of traffic to the website during April - June 2020 with 58,272 users, which R2HC believe to be due to the popularity of the COVID-19 Responsive Funding Call. This page received 45,785 views following its launch on 30 March, with 8,212 ‘apply’ clicks to the grant application site. As a comparison, after the website launched in January 2019, there were 33,000 unique visitors over the first 9 months. The COVID-19 funding call page remains their highest performing page to date.

Overall, this output has been scored an A as R2HC is achieving its objectives to strategically engage with key health and humanitarian stakeholders.

Assess the VfM of this output compared to the proposition in the Business Case, based on performance over the past year

As with outputs 1 and 3, effective outreach to key players in the health and humanitarian sectors is key to having R2HC research used to inform policy and practice, and therefore have its intended impact (i.e. effectiveness). Elhra have invested effectively to build their profiles and networks; the growth in the number of visitors to their website, as well as significant number reading their blogs, indicate they are achieving this. Between the various outreach mechanisms, the findings from R2HC studies are reaching a wide audience. For this reason, this output continues to provide effective value for money.

Describe any changes to this output during the past year, and any planned changes as a result of this review.

As mentioned above, this is the first annual review for Phase 4 of the programme, and a priority must be finalising a complete logframe.

Lessons learned this year and recommendations for the year ahead

Key recommendations:

Showcase Southern-led success stories through R2HC communications.

Facilitate further engagement of Elrha and grantees with humanitarian coordination networks.

D: RISK

Overview of risk management (rating: moderate)

The programme has an established risk register which is reviewed regularly by the SRO and programme manager. Risk mitigation strategies for the programme include the following:

All grant applications will include a risk log, and successful grant applicants will be required to update this regularly throughout the projects.

As part of the due diligence process, all grantees will be vetted against proscribed lists and their financial arrangements and key policies examined at the application stage.

Once underway, ongoing formal reporting and informal monitoring will seek to uncover and head off any potential problems.

Elrha will be required to hold a full risk register for each project, reviewed on an annual basis. It will be updated and reviewed on an ongoing basis by the senior leadership team.

Elrha will be required to have comprehensive policies and strong reporting mechanisms in place in relation to safeguarding, including the requirement for all staff to conduct safeguarding training.

Although there are no ‘high likelihood, high impact’ risks identified, the following overarching programme-level risks have been identified and are proactively managed:

Risk Description	Category	Likelihood	Impact	Gross Risk	Mitigation Strategy	Residual Risk
Humanitarian Situations are always risky and unpredictable	Reputational	Possible	Severe	Severe	Continued internal engagement on funding - highlighting this risk.	Severe
Security concerns	Context	Likely	Moderate	Major	The R2HC team conducts monitoring visits where they feel the risk level warrants it. Additionally, regular monitoring calls have been made to individual grantees where there have been particular concerns.	Major
COVID-19 pandemic effects the ability of suppliers to conducts the research and this causes delays in delivery or even stops projects	Delivery	Likely	Moderate	Major	R2HC has rapidly assessed the individual needs of, and potential pandemic impacts for, all currently open grants; provided grantees with guidance to mitigate financial impact, and non-financial support to keep studies on track; and modified processes to enable post-grant closure uptake activities to take place once conferences and external events are possible post-COVID-19.	Moderate
There is a risk that a project might fail to meet outputs or milestones due to inadequate project management within the project team.	Delivery	Possible	Moderate	Major	Elrha requests all applicants to include in their application form an outline of the key risks for their study and their plans to mitigate these.	Moderate
The programme is in the process of moving from one team to another. Work required on all fronts (technical, PM, financial, relationship-building) to keep it all running smoothly	Operational	Possible	Moderate	Major	Regular meetings with R2HC, increased oversight - extra calls on finances and forecasting etc. Extra attention than others in portfolio	Moderate
In humanitarian research the risk is high for safeguarding, given the vulnerable setting	Safeguarding	Possible	Major	Major	As part of due diligence, Elrha checks there is a robust security system in place and that each grantee has appropriate insurance for all project activities. The grant conditions also stipulate Elrha needs to be informed of any serious incident that takes place during the project lifetime, which ensures Elrha can troubleshoot/support as necessary.	Moderate

The overall risk level for the programme is judged to be ‘Moderate’, within RED’s high appetite for intellectual/innovation risk. The research work itself has a high context risk, given it will work in less stable environments – for example countries/regions with chronic conflicts such as South Sudan or Afghanistan. It is also addressing high risk disease threats such as the ongoing Ebola outbreak in North Kivu DRC and potentially also the new coronavirus (COVID-19) outbreak. Unstable contexts may require adaptation of research portfolios or delays, which may alter expected programme outputs. This will be considered at all stages and levels of work.

E: PROGRAMME MANAGEMENT: DELIVERY, COMMERCIAL & FINANCIAL PERFORMANCE

Summarise the performance of partners and FCDO, notably on commercial and financial issues, and including consideration of VfM measures of economy and efficiency.

Financial performance

The programme has an overall budget of £22,475,468. The expenditure and forecast so far is appropriate for this being the first year of the programme. In light of budgetary constraints due to COVID-19, some spend had to be reprofiled to outer years, but this has not impacted delivery. Overall, the financial performance against monthly forecasts has been acceptable.

Date of last narrative financial report	15/11/2019	Date of last audited annual statement	22/10/2019

Value for money

The core of R2HC’s proposition is that the quality research will deliver greater impact and better value for money from humanitarian activity. We achieve this in three ways:

Operational Value for Money: Elrha has the people, processes and infrastructure to deliver R2HC to a high quality, cost-effectively;

Value for Money in Targeting Grants: We ensure that every award maximises impact, and our proposals drive both cost-efficiency and widest possible uptake;

Added Value: Our highly-respected position within the sector means that we can influence and co-ordinate with other initiatives for greater impact.

Operational Value for Money

Elrha ensures value for money across all operational functions through a combination of programme design and the adherence to established protocols and procedures.

Staffing: staffing represents 9.5% of the overall budget for the programme. Staffing inputs cover both the effective grant management processes and the wider work undertaken by R2HC and Elrha to position the programme effectively with the humanitarian system, support the development of partnerships with the research community and prepare it for the absorption of new evidence produced through the programme. All staff salaries are benchmarked within the sector to ensure they employ high quality staff at appropriate levels.

Global expertise: R2HC draws on the time of world leading experts through our Funding Committee and our pool of technical reviewers. This ensures that the programme benefits from rigorous and robust peer review and delivers against our objective of funding world leading, high impact research. The Funding Committee and technical reviewers provide further added value by representing and promoting the programme through their wider networks. Funding Committee members and reviewers are paid token fees.

Advisory Group: Elrha has established an R2HC Advisory Group (AG), a small group of independent experts that report to the Elrha Board and provide guidance and direction for the programme. The AG comprises individuals with expertise in areas related to humanitarian public health and research. They provide their services on a voluntary basis. An observer from FCDO represents our government funders on the AG and Wellcome also has observer status.

Grant management platform: Elrha uses a unique on-line grant management platform service that has been benchmarked against other providers, and which delivers significant savings when compared with traditional custom-built services. The platform enables quality management and oversight of the service without paying for system enhancements. Without requiring additional upfront costs for system building that in-house systems require, the platform can be quickly and easily expanded to suit grant functionality and to launch new windows; it could also be used to manage reports from applicants and grantees, although they currently do not use this last function.

Subsidiary: Elrha became a subsidiary of Save the Children UK in May 2018. This provides a strong foundation for Elrha to achieve greater autonomy, transparency and independence as it works to fulfil its mission to improve outcomes in humanitarian crises. In due course, we anticipate that subsidiary status will give Elrha the ability to achieve operational efficiency savings by reducing the management overhead of using Save the Children for some aspects of the operational services.

Economy - in addition to the above:

Economy in funded projects: Elrha closely scrutinises the budgets of all successful proposals for value for money before finalising grant awards. Close attention is paid to budget structures: staffing details, including day rates and allocations; and to travel costs and other costs where excess can accumulate. They have created guidance for grantees on eligible costs for grants, which also explains the principles of economy we expect grantees to follow. Elrha does not support Full Economic Costings (FEC) for projects and aims to ensure overheads on grants will not exceed 10%, Elrha also actively pursues the return of unspent funds.

Efficiency - addition to the above:

Due Diligence and Contracting: The efficiency and effectiveness of the due diligence and contracting processes is under constant review. Keeping in mind the ultimate objective of supporting their grantees in their research, which is often time-sensitive, they are continuously reassessing the balance between facilitating a quick turn-around on one hand, while ensuring that all risks are appropriately considered and mitigated, on the other. Detailed information is provided upfront to applicants about the processes they will be expected to comply with, and key information is collected at the application stage, enabling due diligence checks to begin as soon as an application is successful. The level of due diligence conducted is risk-based, depending upon both the size of the grant and key characteristics of the grantee. A standard contract is in place for all subgrantees that builds in the requirements of all our donors. Changes are not accepted that are not in line with donor requirements.

Commercial considerations

Over the past 7 years, R2HC has built a wealth of experience in how to tackle the challenges which make this area so unique. Elrha has gained experience of relationship-building between NGOs and research institutions, to deliver high quality research in complex settings. Bringing together these stakeholders requires bringing agencies into sync that have varied agendas and very different timelines (NGOs work in the immediate term, whereas researchers may need to plan long periods in advance). Elrha has been successfully delivering this programme and has commissioned over 40 research proposals, many of which are still in progress. In addition, Elrha has developed and fine-tuned the rapid response mechanism to become more reactive and accessible.

Delivery against planned timeframe

R2HC report their finances accurately and against the timeframes we have set up for reporting. They have managed changes to programmes and budgets whilst keeping to timescales.

Asset monitoring and control

R2HC provide timely asset registers in line with the AG requirements.