Health research and clinical audit are fundamental components of functioning health systems as they are important at addressing Millenium Development Goals (MDG) and quality of health service delivery
[1–4]. Clinical research and audit are implicit in all health service functions and contributes to the effectiveness and efficiency of health care
. Low to middle income countries (LMIC) have a disproportionate lack of resources, capacity and personnel leading to poor research output and utilisation
Although there has been agreement by Ministers of Health, accompanied by policy efforts of international agencies such as the World Health Organization, (WHO) to strengthen research system capacity in LMICs
[2, 8, 9] there is evidence that political commitment has not matched the rhetoric as poor research capacity in LMIC persist
There have been rewarding partnerships between funding agencies, research institutions and individuals in high income and LMIC resulting in the generation of successful collaborative models
[11–13]. Successful research capacity building (RCB) programs tend to be located at dedicated research institutions
 and universities although systems and sustainability are often weak where there is no reciprocal local funding
. Such RCB programs are commonly aimed at developing research scientists
 with only a few targeting clinicians
. While many agencies have concentrated efforts at developing research systems capacity from top down, an effort should also be made to develop research capacity from the bottom up
. Such an approach acknowledges the clinicians role in identifying research priorities at the clinical interface
Training clinicians to perform clinical research, in the absence of research scientists, requires a paradigm shift
[21, 22]. Clinicians, who are mostly nurses and doctors, have an advantage as clinical researchers over non-clinical researchers as they are likely to have better understanding of the research questions, are able to collect demographic and patient data, and are more enthusiastic in applying locally derived evidence to patient care
[23, 24]. There is the view that clinicians performing research make better clinicians
There have been only four quasi- experimental studies with different interventions targeting clinicians in LMIC. Lessons from a funded RCB program of rural general practitioners in Australia failed to demonstrate expected outputs, probably due to the lack of time allocated to research and administration support
. Similarly, a RCB for primary care in the United States failed, with evaluators recommending protected time for research and sustained mentoring
. On the other hand, in-service training at teaching hospitals in Vietnam was deemed effective and sustainable
 and an allied health RCB program in Australia was found to be effective in generating research publications
. It seems that successful RCB programs include substantial research training, completion of a project supported by mentors
 and strong scientific leadership
To better understand the nature of individual interventions within a RCB program and the characteristics of the clinician participants required to increase clinical research and audit activity and capacity in LMIC, prospective studies are needed where the literature, professional peers and stakeholders’ perspectives guide the shape of RCB programs
A RCB program in reproductive health in the pacific
As with most LMIC, the 23 small LMIC in the Pacific Ocean have weak health research systems, limited human, infrastructure and financial resources in all disciplines compounded by geographical isolation and burgeoning population growth
[14, 32–35]. Many of these countries are not on track to achieve MDG 4 (reducing child mortality by two-thirds) and 5 (reducing maternal mortality by three-quarters)
. Three women die in the Pacific every day due a pregnancy related problem
Pacific leaders in reproductive health decided at the 2007 meeting of the Pacific Society for Reproductive Health (PSRH) that member clinicians in the discipline are to be encouraged to perform clinical research and audit to improve local evidence in policy, service provision and as a way to address MDG 4 and 5. Research and audit workshops for clinicians commenced in 2009. The PSRH is a Charitable Trust registered in New Zealand with a membership of doctors, midwives, nurses and allied health professionals working in thirteen developing countries of the Pacific. The Building Reproductive health Research and Audit Capacity and Activity in the Pacific islands (BRRACAP) Study will assist the PSRH and policy makers in the Pacific region understand the impact of a RCB program aimed at clinicians and at improving reproductive health outcomes.
Selection of countries
Five Pacific Island countries - Vanuatu, Solomon Islands, Fiji, Samoa and Tonga - were selected and invited purposefully, and a sixth, Cook Islands, was included following a request from their health service. The five independent nations were chosen to represent the diversity of cultures, challenges and systems: Melanesian (Vanuatu, Fiji, Solomon Islands) and Polynesian (Samoa, Tonga) countries; populations that were more than 500,000 (Fiji, Solomon Islands) and smaller populations (Samoa, Vanuatu, Tonga); without a university (Tonga, Solomon Islands); with a medical school (Fiji, Samoa). The Micronesian group of Islands that are further north in the Pacific were not invited due to the anticipated high cost of participation. The Ministries of Health of five countries agreed to participate as a health service and a stakeholder. Discussions with the Fiji National University (FNU) led to their engagement replacing the need to engage the Fiji public health service.
The workshop incorporated 48 hours of seminars, lectures and small group work over 6 days. The content was devised with the aim to teach the basic components of clinical research and audit and included motivational talks aimed to inspire the participants to believe that doing research was possible even for those who had not done this previously. The participants from the same country were encouraged to work together as a team to develop projects they identified as priorities to their service. The program with listed faculty is attached (Additional file
1). The workshop was conducted in Auckland New Zealand to utilise the wealth of experienced Pacific researchers from various academic institutions especially from those at the University of Auckland.
The participants were asked to nominate a preferred research mentor from a list of mentors, which included some of the faculty of the research workshop. All the sixteen research mentors who consented to participate are established researchers and all except five have Pacific research experience. The five mentors without Pacific experience were encouraged to liaise closely with the PI who became the co-mentor to their participants.
A Code of Mentorship for mentors and participants was adapted from Blixen
 to guide the mentor-mentee relationship. It was not meant to be prescriptive and an informal mentoring relationship works better for adult learners
. A participatory action learning philosophy was encouraged where the mentor and participant learn from each other during the research journey. This was done by frequent email reminders to both mentors and participants to exchange ideas and thoughts about research progress, assistance, barriers, enablers and ideas.
The quality of mentoring and the performance of the participants will be evaluated at the conclusion of the formal part of program in August 2014, 18 months after inception.
The main aim therefore of the BRRACAP Study was to determine the impact of a RCB program on research activity amongst selected reproductive health clinicians in the participating countries. The secondary aim was to understand the characteristics of those clinicians who become research successful and the barriers to and enablers of clinical research in the Pacific Islands.