Why research struggles in the places where it is needed most—and what TIMER-2C helps us see differently

By guest contributors Beryne Odeny*,¹ Ucheoma Nwaozuru,² Dorothy Mangale,³ Nadia A. Sam-Agudu,^4,5,6 Dhananjaya Sharma^5,6,7

¹Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA

²Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA

³Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA

⁴ International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria

⁵Department of Pediatrics and Child Health, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana

⁶Global Pediatrics Program and Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, USA

⁷Department of Surgery Government NSCB Medical College, Jabalpur, Madhya Pradesh, India

*beryne@wustl.edu

There is a familiar paradox in the field of global health; the places bearing the heaviest disease burden and impact are also where locally led research struggles most to flourish. Why is this the case?

In our recent study published in PLOS Global Public Health (ref), we interviewed healthcare professionals across West Asia and Africa who are actively implementing research while delivering clinical care, teaching, and navigating fragile systems. What emerged was a set of interacting forces that shape research productivity and culture. This set of forces informed our development of the TIMER-2C framework for Research Culture (Time, Instability, Interest & Infrastructure, Means of Funding, Expertise & Experience, Recognition, Collaboration and Culture).

Global health has no shortage of well-intentioned capacity-building initiatives to promote research.  Yet, many clinicians and researchers repeatedly get their capacity built only to return to workplaces where nothing fundamentally changes. The problem is that capacity building is often imagined as an individual deficit: train the person, and productivity will follow.

Our interview findings suggested otherwise. Research productivity is dependent on research culture which  interacts simultaneously with time, instability, interest and infrastructure, money, expertise, recognition; and cutting across all of these, collaboration.

Figure 1. The TIMER-2C framework (ref)

Time

Almost every participant spoke of time – not just as a scheduling issue, but as a structural dilemma. When patient and teaching volumes are overwhelming and staffing is thin, research feels indulgent, even irresponsible. Protected time is a signal that research is valued as part of care and teaching, not in competition with it. For Time, measurable indicators might include the proportion of staff with formally allocated protected research time, supporting staff to which researchers can delegate research or non-research tasks, average weekly hours dedicated to research, or changes in documented clinical workload distribution.

Instability changes what is possible and what feels reasonable

Political and economic instability are powerful forces in research productivity. In contexts shaped by conflict, economic sanctions, or other chronic uncertainty, research is often displaced by more urgent priorities. Even when interest in research exists, fragile infrastructure, unreliable internet, inefficient and incomplete data systems, and delayed ethics approvals can drain enthusiasm. Several participants described doing research despite instability, driven by passion and a sense of responsibility. For Instability, Interest & Infrastructure programs could track research intention among clinicians and students, availability and functionality of core infrastructure, and continuity indicators such as proportion of research-involved staff retained during periods of political or economic disruption.

Money matters, but in complicated ways

Funding predictably featured as a major barrier, but the story was nuanced. Some researchers self-funded studies; others deliberately avoided donor funding to preserve local relevance. The question is not only “How do we increase funding?” but also “How do we create funding ecosystems that support continuity, trust, retention of local talent, and local leadership?” For Means of Funding, metrics might include the number and size of grants submitted and awarded, diversity of local and external funding sources, institutional grant management capacity, and timeliness of fund disbursement.

Expertise, mentorship, and the long arc of becoming a researcher

Many participants described self-taught research skills: learning research skills through online non-degree courses, observation, trial and error. Formal training and continued upskilling helped, but mentorship is a foundational pillar in research that should not be underestimated. Good mentors did more than teach methods; they legitimized research as a career path. At the same time, authoritarian academic cultures and exploitative mentorship were openly acknowledged. These experiences alienate talented individuals from research, contributing to the very “brain drain” that global health laments. Regarding measurement metrics, Expertise and Experience can be assessed through tracking mentorship engagement (number of early career researchers with a mentor), number of trainees progressing from co-authorship to first or senior authorship, and acquisition of independent investigator status.

Recognition is not vanity; it is reward that builds infrastructure

Recognition emerged as one of the most underestimated determinants of research productivity. Among clinician-scientists, when research is poorly compensated, rarely promoted, and invisible to society, it becomes rational to prioritize clinical work. Recognition also intersects with gender, language, and geography. Women described disproportionate barriers. Non-English speakers spoke of diminished confidence. Researchers from low- and middle-income countries described being sidelined in global collaborations, even when their scientific and contextual knowledge was central. Recognition may be measured as a construct that encompasses promotion criteria that reward research, inclusion in institutional, national, or international committees, institutional visibility, and exploring cultural perceptions of scholarly recognition.

Why culture and collaboration sit at the center

The “2C” in TIMER-2C—Collaboration and Culture—is intentional. These two build research capacity and create a sustainable pipeline of researchers; without them, investments in training, funding, or infrastructure tend to produce short-lived gains. Collaboration and Culture can be evaluated using network analysis of interpersonal relationships, co-authorship and cross-institutional partnerships and tracking and comparing perceptions of research climate among early and established career researchers.

How might TIMER-2C be used?

Research institutions can use this framework to interrogate why failed research initiatives failed. Funders can use it to explore whether their programs strengthen culture or merely count outputs. Educators can use it to think beyond courses and toward career pathways. Institutional and policy leadership and policymakers can ask uncomfortable but necessary questions about what their systems truly reward.

TIMER-2C can also serve as a practical framework for designing, measuring, and evaluating research capacity–building programs. These metrics will be continuously refined to optimize practicality and functionality. Most importantly, it compels the global health field to move away from blaming individuals and examining systems that impede health professionals’ research output.

Future work in this area will include evaluating the TIMER 2-C framework through a gender lens to understand how it applies or may be extended to account for the unique experiences female researchers face as they navigate social and structural factors that impact their research productivity. We further welcome other researchers and practitioners to test this framework in their contexts.

We offer TIMER-2C not as a finished theory or a universal solution, but as an evolving approach to reframe conversations about advancing research.

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