RELEASE DATE:  January 8, 2004
RFA Number:  RFA-TW-04-003 (see addendum NOT-TW-04-001)

Department of Health and Human Services (DHHS)

National Institutes of Health (NIH) 

Fogarty International Center (FIC) 


APPLICATION RECEIPT DATE:  April 21, 2004 (per addendum NOT-TW-04-001)


o Purpose of this RFA
o Research Objectives
o Mechanism of Support
o Funds Available
o Eligible Institutions
o Individuals Eligible to Become Principal Investigators
o Special Requirements
o Where to Send Inquiries
o Letter of Intent
o Submitting an Application
o Supplementary Instructions
o Peer Review Process
o Review Criteria
o Receipt and Review Schedule
o Award Criteria
o Required Federal Citations


This Request for Applications (RFA) solicits projects that examine the 
effects of health on microeconomic agents (individuals, households and 
enterprises) and aggregate growth (cross-country growth analysis), as 
well as explore how health finance and delivery systems are a source of 
variation in health outcomes.  The specific purpose of this RFA is to 
provide an opportunity for the recipients of ISHED developmental awards 
made in this program in 2001 to compete for a full research project.  

Studies pursued must be relevant to populations in low- and middle-
income nations and should preferably be either hypothesis testing or 
hypothesis generating.  Longer-term objectives of the program are as 

o  support socio-economic surveys with rigorous biomedical and 
psychosocial assessments relating to functional performance and other 
measures of productivity; 
o  improve and expand the quality of psychosocial and biological 
epidemiological data that support studies to measure and model economic 
o  examine the connections between health and the social environment at 
the level of the individual and broader community—including the effects 
of social capital and infant/childhood antecedents of adolescent and 
adult well-being; 
o  assist in the development of a system of metrics that equips 
researchers, service providers and policymakers with information needed 
to inform policy and effectively target public health interventions;
o  improve the quality and availability of health and economic data 
including longitudinal and inter-generational data sets; 
o  establish the relative effectiveness of different financing and 
delivery options at community, regional and national levels to enable 
international comparisons;
o  build institutional capacity in low- and middle-income countries to 
incorporate health data in the measurement and modeling of economic 


Background and Significance

Over one hundred years after the industrial revolution, a large portion 
of the world remains impoverished.  In the most compelling instance, the 
Organization for Economic Cooperation and Development indicates that the 
per capita income in Africa in 1992 was equivalent to that of Western 
Europe in 1820, and these disparities are widening.  Correlates to 
economic development have been studied vigorously, but only modest 
attention has been paid to the relationship between health or 
demographic status and economic development.  

Over the past three decades the relationship between education and 
poverty (e.g., measured by wage rates) has been replicated in household 
surveys across numerous nations and now frequently is viewed as a 
"causal fact."  These data have influenced development policies at 
national and multilateral levels.  However, health has never ascended to 
a similar footing as a predictive indicator of economic performance.  
The foundations are now strengthening in support of the widely observed 
correlation between health and prosperity.  Studies linking health and 
economic behavior have incorporated several broad avenues of 
investigation:  macroeconomic studies to examine the relationship 
between country-level growth indicators and health; microeconomic 
studies that explore the dynamics of health and productivity at the 
individual or household levels; and studies that examine the effect of 
alternative health policies on economic outcomes.

At both the macro-and microeconomic levels, the precise mechanisms and 
direction of causality have engaged brisk debate, and remain a key 
conceptual and empirical challenge in studies of the relationship 
between human capital, especially health and economic development.  The 
lack of understanding of these relationships has impeded the development 
of effective forms of intervention.  Causality likely is a virtuous 
cycle:  increased income yields increased investments in health; and 
improved health results in greater economic productivity.  Rigorous 
empirical assessment of these relationships involving both hypothesis 
testing and hypothesis generation will therefore enable us to more 
accurately evaluate the impact of health interventions on society.

Scientific Objectives

The goal of this RFA is to solicit applications for hypothesis testing 
and hypothesis generating studies that will examine the complex linkages 
between health and economic development.  Categories of study may 
include but are not necessarily limited to:

1.  Microeconomic studies that examine the link between health and 
economic growth at the levels of the individual, household and family.  
Examples include:

o  Studies to project the impact of population aging or of a particular 
disease or disability burden on individual or household economic 
activity, output and growth, or small enterprise (e.g. HIV, violence, 
malaria, TB, micronutrient deficiencies, mental health disorders, 
craniofacial disfigurement, visual impairment, chronic diseases).

o  Studies to expand the battery of useful physical and functional 
assessments that can be linked to economic indicators.

2.  Cross-sectional surveys or longitudinal panel hypothesis testing or 
hypothesis generating studies of macroeconomic growth.  Examples 

o  Surveys or natural experiments to examine the relationship between 
investment in human resources, particularly education and health, and 
labor market outcomes.  This might include the addition of a health 
module to an ongoing socio-economic survey or incorporating economic 
indicators in an ongoing health survey. 

o  Studies to determine which factors link with macroeconomic growth, 
for example levels and patterns of educational attainment and 
performance (schooling); health status (life expectancy, mortality 
rates, disease prevalence or age specific biomarkers); population 
growth, density and age structure; personal and government savings 
(investment rates); physical capital stock; trade policy; quality of 
public institutions. 

o  Studies of the impact of nutrition, primary care interventions, 
prevention services, health promotion, etc, on childhood growth and 
development and/or subsequent physical performance and work 

o  Identification of indicator diseases or conditions to detect and 
monitor communities experiencing intense poverty; and the use of these 
indicators to conduct multi-sectoral studies of the cross-cutting 
effects of essential nutrition and adequate sanitation on both health 
and productivity.

o  Studies of the relationship between health and economic effects of 
traumatic events.

3.  Natural opportunities and experimental approaches to examine the 
effects of alternative health policies on health and economic outcomes.  
Examples include:

o  Research to establish the relative impact of different financing 
options, including national and local taxes, user fees and health 
insurance on health outcome.

o  Research to examine the impact and optimal mix of private and public 
funding for health systems upon health outcome.

4.  Research on the impact of decentralization of health systems upon 
health outcome (defined as the transfer of functions, resources and 
authority to local levels of government).  This might include studies on 
the theoretical and conceptual background to understanding 
decentralization, the conditions for effectiveness, the study of 
decentralization to hospitals and local health centers and the operation 
of public-sector markets.

o  Research on the economic impact of preventive health policies (e.g., 
integration of mental/physical health services with other trauma victim 
assistance systems).


This RFA will use the National Institutes of Health (NIH) individual 
research grant (R01) mechanism.  As an applicant, you will be solely 
responsible for planning, directing, and executing the proposed project.  
This RFA is a one-time solicitation.  Future unsolicited, competing-
continuation applications based on this project will compete with all 
investigator-initiated applications and will be reviewed according to 
the customary peer review procedures.  The anticipated award date is 
September 1, 2004.  Applications that are not funded in the competition 
described in this RFA may be resubmitted as NEW investigator-initiated 
applications using the standard receipt dates for NEW applications 
described in the instructions to the PHS 398 application.  

The purpose of this RFA is to stimulate research on the complex dynamics 
of health and productivity in low- and middle-income nations and build a 
theoretical and empirical foundation for future explorations in this 
area.  An applicant may request a project period of up to five years and 
a budget for direct costs of up to $400,000 per year.  Because we 
anticipate that all budget requests will exceed $250,000, the modular 
grants requirements would not apply to this RFA.  Applicants should 
budget funds in their grant application to attend an annual networking 
meeting of awardees.  The meeting may be held either in the Washington, 
D.C. area or in a developing country location to be determined by FIC 
program staff and other participating institutions. 


The FIC intends to commit approximately $1 million in FY 2004 to fund 
competitive continuation grants in response to this RFA.  An applicant 
may request a project period of up to five years and a budget for 
direct costs of up to $400,000 per year.  Because the nature and scope 
of the proposed research will vary from application to application, it 
is anticipated that the size and duration of each award will also vary.  
Although the financial plans of FIC provides support for this program, 
awards pursuant to this RFA are contingent upon the availability of 
funds and the receipt of a sufficient number of meritorious 


This solicitation is open to a limited pool of investigators.  Only 
previous recipients of developmental ISHED R01 awards from the 2001 
competition are eligible to apply.  Questions regarding eligibility 
should be directed to the FIC program contact listed in the RFA. 


This program is designed to generate useful scientific information and 
also to promote collaboration between scientists in the United States 
and low-and middle-income nations with shared interests in the 
consequences of health and health policy for economic development.  In 
this regard, the scientific questions should determine the nature of the 
collaboration.  To achieve this end, eligible proposals must be jointly 
developed and demonstrate a transnational collaboration between a U.S. 
investigator(s) and an investigator(s) from a low- and middle-income 
nation(s). Demonstration of such collaboration will be an explicit 
review criterion. In operational terms, this might take the form of 1) a 
co-investigator and research staff from low- and middle-income nations 
supported under the protocol, and 2) protocol-related material support 
for a host institution in a low- and middle-income nation to stage field 
studies.  (For operational and analytic purposes, the World Bank’s main 
criterion for classifying economies, gross national product per capita, 
will be employed for this RFA.  A listing of countries representing low- 
and middle-income economies which are eligible for this program may be 
found at  

Where appropriate, the design of projects should take into account 
potential sex and gender differences that may affect the questions 
asked and the analyses performed.  These might include different 
responses to and impacts of health interventions, differences in 
physiology, and different behavioral bases for disease prevention 
strategies. Inclusion of gender considerations will be an enhancing 
factor in the review of awards. 

All applications should explicitly state the policy relevance and 
potential use of the anticipated research results. Intended users can 
be local, regional, national or international public or private 
agencies or individuals. Potential policy results may apply to 
microeconomic or macroeconomic problems but must relate to the health 
and development priorities of the country in which the research is 

Moreover, multidisciplinary approaches to examining the dynamics of 
health and productivity are especially encouraged.  Advances are most 
likely to be achieved through collaborations among disciplines of 
economics, epidemiology, demography, sociology, behavioral science and 
basic biological disciplines.  For example, collaboration among economic 
and biomedical and behavioral scientists may result in more refined 
measurements of instrumental variables, including psychosocial factors.

Applicants are encouraged to collaborate with the World Bank’s Global 
Development Network (GDN).  The GDN is a growing association of research 
and policy institutes whose goal is to generate, share, and apply to 
policy knowledge about development.  To this end, GDN seeks to support 
capacity-building activities in developing countries.  Information about 
GDN is available on their web site at  GDN’s 
research network covers all regions of the developing world (see below) 
and may therefore be a useful source of information about potential 
collaborators from developing countries.


We encourage inquiries concerning this RFA and welcome the opportunity 
to answer questions from potential applicants.  Inquiries may fall into 
three areas:  scientific/research, peer review, and financial or grants 
management issues.

o Direct your questions about scientific/research issues to:

Rachel A. Nugent, Ph.D.
Division of International Training and Research
Fogarty International Center
Building 31, Room B2C39
Bethesda, MD  20892-2220
Telephone:  (301) 496-8733
Fax:  301-402-0779

o Direct your questions about peer review issues to:

Sherry L. Dupere, Ph.D.
Chief, Biology of Development and Aging IRG
Center for Scientific Review
6701 Rockledge Drive, Room 5136
Bethesda, MD  20892-7840
(for express/courier service, use zip 20817)
Telephone:  301-435-1021
Fax:  301-480-3567

o Direct your questions about financial or grants management issues to:

Bruce Butrum
Grants Management
Fogarty International Center
Building 31, Room B2/C29
Bethesda, MD  20892
Telephone:  (301) 496-1670
Fax:  301-594-1211


Applications must be prepared using the PHS 398 research grant 
application instructions and forms (rev. 5/2001).  Applications must 
have a DUN and Bradstreet (D&B) Data Universal Numbering System (DUNS) 
number as the Universal Identifier when applying for Federal grants or 
cooperative agreements.  The DUNS number can be obtained by calling 
(866) 705-5711 or through the web site at  The DUNS number should be entered on 
line 11 of the face page of the PHS 398 form.  The PHS 398 document is 
available at in 
an interactive format.  For further assistance contact GrantsInfo, 
Telephone (301) 710-0267, Email:

USING THE RFA LABEL:  The RFA label available in the PHS 398 (rev. 
5/2001) application form must be affixed to the bottom of the face page 
of the application.  Type the RFA number on the label.  Failure to use 
this label could result in delayed processing of the application such 
that it may not reach the review committee in time for review.  In 
addition, the RFA title and number must be typed on line 2 of the face 
page of the application form and the YES box must be marked.  The RFA 
label is also available at:

SENDING AN APPLICATION TO THE NIH:  Submit a signed, typewritten 
original of the application, including the Checklist, and five signed, 
photocopies, in one package to:

Center for Scientific Review
National Institutes of Health
6701 Rockledge Drive, Room 1040, MSC 7710
Bethesda, MD  20892-7710
Bethesda, MD  20817 (for express/courier service)

APPLICATION PROCESSING:  Applications must be received on or before the 
application receipt date listed in the heading of this RFA.  If an 
application is received after that date, it will be returned to the 
applicant without review. 

Although there is no immediate acknowledgement of the receipt of an 
application, applicants are generally notified of the review and 
funding assignment within eight weeks.

The Center for Scientific Review (CSR) will not accept any application 
in response to this RFA that is essentially the same as one currently 
pending initial review, unless the applicant withdraws the pending 


Upon receipt, applications will be reviewed for completeness by the CSR 
and responsiveness by FIC.  Incomplete applications will not be 

Applications that are complete and responsive to the RFA will be 
evaluated for scientific and technical merit by an appropriate peer 
review group convened by CSR in accordance with the review criteria 
stated below.  As part of the initial merit review, all applications 

o Undergo a process in which only those applications deemed to have the 
highest scientific merit, generally the top half of the applications 
under review, will be discussed and assigned a priority score

o  Receive a written critique
o  Receive a second level review by the FIC National Advisory Board. 


The goals of NIH-supported research are to advance our understanding of 
biological systems, improve the control of disease, and enhance health.  
In the written comments, reviewers will be asked to evaluate the 
application in order to judge the likelihood that the proposed research 
will have a substantial impact on the pursuit of these goals.  The 
scientific review group will address and consider each of the following 
criteria in assigning the application’s overall score, weighting them 
as appropriate for each application. 

o  Significance
o  Approach
o  Innovation
o  Investigator
o  Environment

The application does not need to be strong in all categories to be 
judged likely to have major scientific impact and thus deserve a high 
priority score.  For example, an investigator may propose to carry out 
important work that by its nature is not innovative but is essential to 
move a field forward.

SIGNIFICANCE:  Does this study address an important problem?  If the 
aims of the application are achieved, how will scientific knowledge be 
advanced?  What will be the effect of these studies on the concepts or 
methods that drive this field?

APPROACH:  Are the conceptual framework, design, methods, and analyses 
adequately developed, well-integrated, and appropriate to the aims of 
the project?  Does the applicant acknowledge potential problem areas 
and consider alternative tactics?

INNOVATION:  Does the project employ novel concepts, approaches or 
methods?  Are the aims original and innovative?  Does the project 
challenge existing paradigms or develop new methodologies or 

INVESTIGATOR:  Is the investigator appropriately trained and well 
suited to carry out this work?  Is the work proposed appropriate to the 
experience level of the principal investigator and other researchers 
(if any)?

ENVIRONMENT:  Does the scientific environment in which the work will be 
done contribute to the probability of success?  Do the proposed 
experiments take advantage of unique features of the scientific 
environment or employ useful collaborative arrangements?  Is there 
evidence of institutional support?  

ADDITIONAL REVIEW CRITERIA:  In addition to the above criteria, the 
following items will be considered in the determination of scientific 
merit and the priority score:

RESEARCH CAPACITY-BUILDING:  Does the proposed program contribute to the 
capacity of scientists and/or institutions in low- and middle-income 
nations to perform research related to health and economics (e.g. health 
outcomes and economic linkages; microeconomics of health care)?  Does 
the proposed program contain explicit strategies or plans to strengthen 
this capacity through training, career development or other modes?

human subjects and protections from research risk relating to their 
participation in the proposed research will be assessed.  (See criteria 
included in the section on Federal Citations, below).

of plans to include subjects from both genders, all racial and ethnic 
groups (and subgroups), and children as appropriate for the scientific 
goals of the research.  Plans for the recruitment and retention of 
subjects will also be evaluated.  (See Inclusion Criteria in the 
sections on Federal Citations, below).

are to be used in the project, the five items described under Section f 
of the PHS 398 research grant application instructions (rev. 5/2001) 
will be assessed.  

BUDGET:  The reasonableness of the proposed budget and the requested 
period of support in relation to the proposed research.


Application Receipt Date:  February 11, 2004
Peer Review Date:  June/July 2004
Council Review:  September/October 2004
Earliest Anticipated Start Date:  December 2004


Award criteria that will be used to make award decisions include:

o Scientific merit (as determined by peer review)
o Availability of funds
o Programmatic priorities
o Balance among projects to respond to the questions included in this 


HUMAN SUBJECTS PROTECTION:  Federal regulations (45CFR46) require that 
applications and proposals involving human subjects must be evaluated 
with reference to the risks to the subjects, the adequacy of protection 
against these risks, the potential benefits of the research to the 
subjects and others, and the importance of the knowledge gained or to 
be gained. 

policy of the NIH that women and members of minority groups and their 
sub-populations must be included in all NIH-supported clinical research 
projects unless a clear and compelling justification is provided 
indicating that inclusion is inappropriate with respect to the health of 
the subjects or the purpose of the research.  This policy results from 
the NIH Revitalization Act of 1993 (Section 492B of Public Law 103-43).

All investigators proposing clinical research should read the "NIH 
Guidelines for Inclusion of Women and Minorities as Subjects in 
Clinical Research - Amended, October, 2001," published in the NIH Guide 
for Grants and Contracts on October 9, 2001 
a complete copy of the updated Guidelines are available at  
The amended policy incorporates:  the use of an NIH definition 
of clinical research; updated racial and ethnic categories in 
compliance with the new OMB standards; clarification of language 
governing NIH-defined Phase III clinical trials consistent with the new 
PHS Form 398; and updated roles and responsibilities of NIH staff and 
the extramural community.  The policy continues to require for all NIH-
defined Phase III clinical trials that: a) all applications or 
proposals and/or protocols must provide a description of plans to 
conduct analyses, as appropriate, to address differences by sex/gender 
and/or racial/ethnic groups, including subgroups if applicable; and b) 
investigators must report annual accrual and progress in conducting 
analyses, as appropriate, by sex/gender and/or racial/ethnic group 

SUBJECTS:  The NIH maintains a policy that children (i.e., individuals 
under the age of 21) must be included in all human subjects research, 
conducted or supported by the NIH, unless there are scientific and 
ethical reasons not to include them.  This policy applies to all 
initial (Type 1) applications submitted for receipt dates after 
October 1, 1998.

All investigators proposing research involving human subjects should 
read the "NIH Policy and Guidelines" on the inclusion of children as 
participants in research involving human subjects that is available at

NIH policy requires education on the protection of human subject 
participants for all investigators submitting NIH proposals for 
research involving human subjects.  You will find this policy 
announcement in the NIH Guide for Grants and Contracts Announcement, 
dated June 5, 2000, at

The Office of Management and Budget (OMB) Circular A-110 has been 
revised to provide public access to research data through the Freedom of 
Information Act (FOIA) under some circumstances.  Data that are (1) 
first produced in a project that is supported in whole or in part with 
Federal funds and (2) cited publicly and officially by a Federal agency 
in support of an action that has the force and effect of law (i.e., a 
regulation) may be accessed through FOIA.  It is important for 
applicants to understand the basic scope of this amendment.  NIH has 
provided guidance at

Applicants may wish to place data collected under this PA in a public 
archive, which can provide protections for the data and manage the 
distribution for an indefinite period of time.  If so, the application 
should include a description of the archiving plan in the study design 
and include information about this in the budget justification section 
of the application.  In addition, applicants should think about how to 
structure informed consent statements and other human subjects 
procedures given the potential for wider use of data collected under 
this award.

The Department of Health and Human Services (DHHS) issued final 
modification to the “Standards for Privacy of Individually Identifiable 
Health Information”, the “Privacy Rule,” on August 14, 2002.  The 
Privacy Rule is a federal regulation under the Health Insurance 
Portability and Accountability Act (HIPAA) of 1996 that governs the 
protection of individually identifiable health information, and is 
administered and enforced by the DHHS Office for Civil Rights (OCR).  
Those who must comply with the Privacy Rule (classified under the Rule 
as “covered entities”) must do so by April 14, 2003 (with the exception 
of small health plans which have an extra year to comply).  

Decisions about applicability and implementation of the Privacy Rule 
reside with the researcher and his/her institution.  The OCR website 
( provides information on the Privacy Rule, 
including a complete Regulation Text and a set of decision tools on “Am 
I a covered entity?”  Information on the impact of the HIPAA Privacy 
Rule on NIH processes involving the review, funding, and progress 
monitoring of grants, cooperative agreements, and research contracts 
can be found at

proposals for NIH funding must be self-contained within specified page 
limitations.  Unless otherwise specified in an NIH solicitation, 
Internet addresses (URLs) should not be used to provide information 
necessary to the review because reviewers are under no obligation to 
view the Internet sites.  Furthermore, we caution reviewers that their 
anonymity may be compromised when they directly access an Internet site.

HEALTHY PEOPLE 2010:  The Public Health Service (PHS) is committed to 
achieving the health promotion and disease prevention objectives of 
"Healthy People 2010," a PHS-led national activity for setting priority 
areas.  This RFA is related to one or more of the priority areas.  
Potential applicants may obtain a copy of "Healthy People 2010" at

AUTHORITY AND REGULATIONS:  This program is described in the Catalog of 
Federal Domestic Assistance at and is not subject 
to the intergovernmental review requirements of Executive Order 12372 
or Health Systems Agency review.  Awards are made under the 
authorization of Sections 301 and 405 of the Public Health Service Act 
as amended (42 USC 241 and 287b) and under Federal Regulations 42 CFR 
52 and 45 CFR Parts 74 and 92. All awards are subject to the terms and 
conditions, cost principles, and other considerations described in the 
NIH Grants Policy Statement.  The NIH Grants Policy Statement can be 
found at

The PHS strongly encourages all grant recipients to provide a smoke-
free workplace and discourage the use of all tobacco products.  In 
addition, Public Law 103-227, the Pro-Children Act of 1994, prohibits 
smoking in certain facilities (or in some cases, any portion of a 
facility) in which regular or routine education, library, day care, 
health care, or early childhood development services are provided to 
children.  This is consistent with the PHS mission to protect and 
advance the physical and mental health of the American people.

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