Release Date:  April 30, 1998

RFA:  TW-98-003


Fogarty International Center
National Library of Medicine

Letter of Intent Receipt Date:  May 25, 1998
Application Receipt Date:  June 25, 1998


The Fogarty International Center (FIC) and the National Library of Medicine (NLM)
invite applications to establish model training programs in medical informatics
for African scientists and health professionals.  The overall goal of the FIC-NLM
International Training in Medical Informatics (ITMI) Program is to build the
capacity of biomedical scientists, clinicians, librarians and other health
professionals in developing countries to access, utilize and construct computer-
based tools such as automated libraries, on-line communication, databases and
analytical software that may best advance biomedical research and public health
in those countries.  This Request for Applications (RFA) constitutes an initial
effort that will concentrate on Sub-Saharan Africa, and is intended to complement
the efforts of other programs, such as USAID's Leland Initiative, that are
facilitating the establishment of Internet connections on that continent.

Training programs will produce a cadre of experts from Sub-Saharan Africa who
will apply state-of-the-art communications technologies to research and health
surveillance activities or who will function in their home countries as trainers
or leaders in medical informatics.  It is envisioned that trainees will represent
a range of skill levels and responsibilities, as relevant to the specific
objectives of a program and the environment of the home institution. 
Technologies and skills that are transferred must be directly related to
research, surveillance or clinical applications, and capacity-building activities
should be substantially focused on skills beyond basic computer operations.

A variety of approaches will be considered responsive to this RFA, including
U.S.-based training, formal courses and workshops in home countries, and
combinations thereof.  Association of a proposed effort with other
internationally funded research or training efforts in the home country will
significantly enhance the sustainability of any application.  Applicants are
encouraged but not required to include collaborations with research and training
programs currently funded by the FIC, the NLM or other organizations. Efforts
that establish sustainable programs will likely function as models for future
competitive funding efforts in this area.


The Public Health Service (PHS) is committed to achieving the health promotion
and disease prevention objectives of "Healthy People 2000," a PHS-led national
activity for setting priority areas.  This RFA, International Training in Medical
Informatics, is related to several priority areas, including those of
surveillance and data systems.  Potential applicants may obtain a copy of
"Healthy People 2000" (Full Report:  Stock No. 017-001-00474-0 or Summary Report:
Stock No. 017-001-0473-1) through the Superintendent of Documents, Government
Printing Office, Washington, DC 20402-9325 (telephone 202-512-1800).


The grantee institution must be a U.S. non-profit private or public institution
capable of meeting the objectives in the RFA.  Applicant investigators (or co-
investigators) must be a U.S. Principal Investigator of at least one active
relevant grant, contract or cooperative agreement from the NIH or another U.S.
or international organization.  In the interests of building sustainable training
programs the proposed project must be explicitly linked, through either the
principal or a co-investigator of the proposed project, to a funded research or
public health effort in the collaborating country.  Applications associated with
the Multilateral Initiative on Malaria (MIM) are encouraged.

For this RFA eligible collaborating countries are those within Sub-Saharan
Africa.  A subsequent RFA may be broadened to include other developing countries.

The application must demonstrate that the award is relevant to and will enhance
the activities of the related grant, and benefit the research needs and public
health interests of the collaborating country, and of participating scientists
and health professionals.


This RFA will use the international training grants (D43) mechanism.  Awards will
be made for a period of up to 4 years.  Continuing support during this period
will be contingent upon satisfactory progress as demonstrated in annual progress
reports, site visits and meetings of program directors.

Allowable costs:

The following cost categories are eligible for reimbursement under this program. 
The stipends and allowances are maximums and applicants are encouraged to design
the most cost-effective programs: For foreign scientists from developing nations:

- Living allowance (stipend) comparable to scientist's professional level and
compatible with established NIH guidelines, but not to exceed $45,000 per annum
while undergoing training or conducting research in the U.S.;

- Stipend, if necessary and justified, to cover the added time for scientists to
conduct in-country research if not paid for by the home institution at a level
comparable to that received by similar professionals in-country, but also not to
exceed $45,000 per annum;

- Tuition and fees at the U.S. university;

- Round trip economy class air fare between the U.S. and home country (via U.S.
air carrier when possible);

- Allowance for the grantee institution of up to $600 monthly per scientist to
cover health insurance, travel to scientific meetings, and incidental research

- Computer hardware and software for establishment of workstations in the home
country institution, not to exceed $10,000 per trainee;

- Additional research support of up to $15,000 per person to support training-
related project-development or advanced research training in the developing
country (the program director is expected to ensure that projects submitted for
this funding are peer reviewed by the U.S. institution).

Because the ITMI is dedicated to training, the costs to establish and maintain
Internet connection and access fees are not generally allowable expenses under
this award, unless they are required to execute training as outlined in the
proposal.  A number of NIH programs that are likely candidates to satisfy this
RFA's call for a linked research program already pay Internet access fees in
Africa and elsewhere, as a regular cost of doing research.  ITMI payment for such
costs will generally be limited to training expenses and will require prior FIC

For U.S. scientists affiliated with grantee institution:

- Economy class travel (via U.S. carrier) and per diem for the program director
and U.S. faculty colleagues to provide guidance to trainees conducting related
field studies or advanced research training in their home countries;

- Economy class travel (via U.S. carrier) and per diem for U.S. faculty
presenting short-term courses in the foreign country;

- Longer-term support (travel, per diem and pro-rated salary, up to 10 percent
of annual salary or $10,000, whichever is less) to enable U.S. faculty to conduct
informatics training and associated research in-country;

For administrative expenses:

- Only limited funds are available for support of administrative expenses at the
U.S. institution (e.g., salary support for administration of award, secretarial
expenses, etc.).  Such expenses should not exceed 10 percent of the direct costs
of this award.

For related activities with other industrialized nations:

- Support for travel and subsistence of U.S. or foreign investigator(s), and the
exchange of data, materials and supplies, not to exceed 10 percent of direct
costs of this award unless prior approval is secured from the FIC.  As a
condition of this special expenditure, the applicant must indicate that some form
of cost-sharing will be provided by the counterpart institution in an
industrialized nation.

Requests for an administrative supplemental budget will be considered for
increases of up to 20 percent of funded levels in a given budget year.  These
funds may be requested to meet special needs and to take advantage of unusual
opportunities.  Such requests will be reviewed by FIC program staff in
consultation with NLM, and support will depend upon merit and availability of

The grantee institution may request an indirect cost allowance based on 8 percent
of the total allowable direct costs, exclusive of tuition and related fees and
expenditures for equipment.


An estimated $400,000 is available from the FIC to initiate the program in FY
1998, supporting an estimated three new awards.  Approximately $350,000 of
additional funds from FIC will be allocated to this program in FY 1999 to support
two to three additional awards in that year from this competition, contingent on
availability of resources and meritorious applications.  Applicants can propose
budgets of up to $150,000 total costs for year 1, with budget increases of 2% per
year for years 2 through 4.

Contingent upon availability of funds and achievement of strong results during
this first round, recompetition of this RFA is anticipated in the fourth year of
this program.  Results and impact of the program will be determined by a program
evaluation initiated by FIC, working closely with NLM.


Improving our ability to prevent and treat diseases depends fundamentally on
discovery, compilation and subsequent access to scientific information by
researchers, clinicians and public health professionals.  Our ability to manage
and communicate scientific information has increased exponentially in recent
years as computer-based tools have been developed to aid the process of inquiry
and health management.  While computer-based communication and data management
have become central and ubiquitous features of health science and decision making
in the developed world, much of the developing world has gained only very limited
access to these tools and the benefits they are yielding.

This program is intended to address the gap between developed and developing
countries in the area of modern information technologies in order to strengthen
health sciences research and the collaborative relationships between U.S.
scientists and those of developing countries. These efforts will assist
developing country scientists and their U.S. partners to address local and global
health needs through improved access to scientific and clinical information on
health threats and improved research and surveillance capabilities.

Specifically, the program is designed to:

o  Improve the informatics capacity of developing country institutions in order
to advance research and health surveillance activities by training key
researchers and institutional support staff in those institutions in the use and
development of modern informatics technologies in the health sciences;

o  Provide targeted short-term training in informatics and related disciplines
at U.S. institutions and in the home country to develop and disseminate locally
adapted knowledge of the informatics technologies in collaborating countries;

o  Expand and improve ongoing collaborative research between U.S. and African
scientists in prevention, control and treatment of infectious and other diseases.
Types of Training

Emphasis should be given to creating nuclei of experts composed of multiple
highly qualified African nationals at specific African institutions through
combinations of U.S.-based, medium-term (usually a minimum of one year) training
and follow-up supervision and re-entry into home country institutions, as needed
to accomplish the objectives of the program.

Active involvement in on-going research and health surveillance projects is vital
for a successful research and/or public health training experience.  Innovative
ways to involve trainees in research and monitoring projects conducted in their
home countries is especially encouraged.  A significant proportion of trainees
are expected to develop independent or collaborative research, clinical, or
didactic projects to develop, apply and disseminate their new skills in their
home countries.  Examples of such projects are the development of a regional
database to track the incidence of an important disease or a workshop to provide
training on accessing and using available databases on biomedical literature. 
Applicants and trainees should work together to plan and develop projects that
complement the objectives of the linked research or surveillance programs and are
appropriate to local needs and resources.

Applicants are encouraged to develop multi-stage programs that support and track
the progress of trainees and their specific projects for several years following
their initial training.

The following types of training would contribute to satisfying the objectives of
this RFA:

1.  Formal U.S.- based training for African trainees in computer assisted data
analysis and management for biomedical research applications (e.g. biostatistics,
Geographic Information Systems [GIS], epidemiological modeling, database
construction, and access and use of public biomedical databases) which may lead
to an M.S. or the equivalent degree for individuals with degrees in biomedical
or other health related science.  Such training would normally require that
trainees already had basic computer skills and a demonstrated aptitude for
computer use.  The duration of training is expected to range from one to four
academic semesters.  Academic courses will normally be taken in the U.S. 
Associated field studies and research projects could be conducted in the United
States, but to the extent possible, should take place in the trainee's home

2.  Postdoctoral training and research experiences (generally of one to two years
duration) for African health scientists (in the United States).

3.  Practical and applied short-term training (up to three weeks) targeted to
specific needs in support of disease control and prevention research for
scientists, technicians, librarians and allied health professionals, including
training necessary to support development or use of existing local, national or
international medical databases.  An excellent example of such a short course in
the U.S. is the NLM funded Medical Informatics Course at Woods Hole.  This
training could take place at the home institution or at regionally important
centers such as the NLM funded MEDLARS Centers.

4.  Advanced informatics training (generally of one to two years duration) for
current and/or former trainees, including re-entry grants to enable them to
develop projects that apply newly acquired skills in association with ongoing
research or public health efforts.

5.  Follow-up training in the home country using distance learning techniques
where useful and appropriate.

6.  Support to enable U.S. faculty to be involved in advanced research training
activities conducted in-country. Trainees

Trainees shall be individuals who are involved in or are expected to be involved
in biomedical research or health surveillance activities in their home country. 
Applicants are especially encouraged to recruit junior faculty at African
universities or research institutes.  The following categories of individuals are
eligible for training:

1.  Foreign researchers and other health professionals (M.D., D.D.S./D.M.D.,
Ph.D., or equivalent);

2.  Foreign professionals with a bachelors or masters degree in a basic or health

3.  Medical technicians, computer technicians and health care workers;

4.  Allied health professionals such as behavioral scientists, medical
librarians, and nurses;

5.  Highly qualified current or former trainees from other FIC or NIH programs
involved in advanced research training in their home countries.


This program should be directed toward informatics associated with research in
disease prevention, treatment and research capacity-building in developing
countries.  Countries that are eligible to participate are limited to Sub-Saharan
Africa at this time. Inclusion of countries in the program with particularly
severe problems in AIDS, malaria, tuberculosis and other emerging and reemerging
infectious diseases are encouraged.

Before any funds can be expended from this award, the grantee institution must
show evidence of approval for collaborative research between the U.S. and foreign
countries and institutions included in the program through an endorsement from
the Minister of Health or other appropriate government officials as well as from
the collaborating institutions.

The application must include a plan describing the recruitment and selection
procedures for trainees, types of training they will receive, and the locations
of training, including any collaborating U.S. institutions.  A plan should also
outline the process for peer review of training-related and advanced in-country
research (re-entry grants) as well as plans for continued supervision of and
collaboration with former trainees. These re-entry grants should support relevant
in-country research and health monitoring projects with budgets generally not
exceeding $15,000.  Projects exceeding this limit require pre-approval from the

The criteria and mechanisms for review and selection of trainees and research
projects will be reviewed at the NIH at the time the grant applications are
reviewed competitively. After funding, these criteria and mechanisms must be
instituted as described and no further outside review carried out at the FIC or
elsewhere at the NIH will be required during the funding period of the grant,
except for the usual and customary duties of project management at the NIH.

As part of their obligations under this program, awardees are required to design
and implement a system to fully track and document the long-term impact of this
training program on:  (1) the careers of current and former trainees; (2)
research capacity in the home countries of trainees; (3) the contributions to
future collaborations with U.S. scientists; (4) the establishment or
strengthening of model medical informatics centers in the home countries of

Some examples of such impact will include: a) how training received under the
program allows participants to share and apply their new knowledge, and to assume
more responsible positions upon returning home; b) how continuing collaborations
with trainees affects funding for or enhancement of disease control efforts; c)
the number and quality of subsequent health surveillance and research projects
in which trainees have a prominent role; d) the number and quality of
publications, presentations, courses, awards, etc. in which trainees are first
authors or otherwise in a leading position, and which were based upon support
under this program.  This tracking system and the proposed indicators, to follow
trainees at least five years after completion of their training, should be
described in the application.


International Training in Medical Informatics (ITMI) programs should endeavor to
ensure that research results and training innovations are accessible to each
other and to other relevant programs in the home countries and internationally
by: (a) establishing email list-servers among researchers, trainers and trainees
and world wide web sites; (b) sponsoring in-country meetings for all trainees in
a country; and (c) exchanging newsletters, CD-ROMs or other products among
grantees. In addition, FIC will periodically convene network meetings of
grantees.  Up to 10 percent of budgets can be utilized for these purposes and
additional funds can be requested to support these activities.  FIC will
establish an ITMI web site linking all of the individual program web sites.

Protection of Human Subjects and Laboratory Animals

It is not expected that human and animal subjects will be a routine component of
ITMI programs except as related to associated funded research projects.  It is
expected that in those cases where necessary the required assurances will be in
place via the associated research when funded by the NIH or other HHS components.
Applicable provisions for the protection of human research subjects and
laboratory animals in research and training activities must be met in both
domestic and foreign settings.  Title 45 CFR, Part 46, provides guidelines
concerning Department of Health and Human Services regulations for the protection
of human subjects.  The requirements for using animals are detailed in the Public
Health Service Policy on Humane Care and Use of Laboratory Animals.  These are
available from the Office for Protection from Research Risks (OPRR), National
Institutes of Health, 6100 Executive Boulevard, MSC 7508, Rockville, Maryland
20852-7508.  In this regard, applicants must be sure to meet the requirements of
obtaining single project assurances from OPRR for all projects involving human
subjects at foreign sites unless otherwise covered by a multiple project
assurance.  Applicants must also be sure to obtain the necessary assurances
including review at both U.S. and foreign sites for research in which they are
actively materially engaged by virtue of consultancy (for example, resulting in
co-authorship) or for research conducted on biological samples obtained from
scientific colleagues in collaborating countries, if the samples are individually
identifiable to any of the scientists.


It is the policy of the NIH that women and members of minority groups and their
subpopulations must be included in all NIH-supported biomedical and behavioral
research projects involving human subjects, unless a clear and compelling
rationale and justification is provided 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 research involving human subjects should read the
"NIH Guidelines for Inclusion of Women and Minorities as Subjects in Clinical
Research," which have been published in the Federal Register of March 28, 1994
(FR 59 14508-14513), and in the NIH Guide for Grants and Contracts, Volume 23,
Number 11, March 18, 1994.

In this regard, the frame of reference for inclusion of minorities in research
is whether the participants would be considered to be minorities in the U.S.
population and most of the foreign populations under study would be considered
minorities in the U.S.  On a related matter, programs are encouraged to include
representation of women in selecting foreign trainees and to include adequate
representation of women and minorities in selecting U.S. trainees under this


Prospective applicants are asked to submit, by May 25, 1998, a letter of intent
that includes a descriptive title of the proposed training and research programs,
the name, address, and telephone number of the Principal Investigator, the
identities of other key personnel and participating institutions in collaborating
countries, the identity of any associated projects and their sources of funding,
and the number and title of the RFA in response to which the application may be
submitted.  Although a letter of intent is not required, is not binding, and does
not enter into the review of a subsequent application, the information that it
contains allows NIH staff to estimate the potential review workload and avoid
conflict of interest in the review.

The letter of intent is to be sent to:

Joshua Rosenthal, Ph.D.
Division of International Training and Research
Fogarty International Center
31 Center Drive, MSC 2220
Bethesda, MD  20892-2220
Telephone:  (301) 496-2516
FAX:  (301) 402-2056

The letter of intent also will be used to communicate any additional information
that may be developed to prospective applicants, including the location and time
of any meetings that may be convened to answer questions from prospective
applicants as well as the status of discussions and possible agreements with
other potential funding partners.


The NRSA portion of the research grant application form PHS 398 (rev. 5/95) is
to be used in applying for these grants.  These forms are available at most
institutional offices of sponsored research; from the Division of Extramural
Outreach and Information Resources, National Institutes of Health, 6701 Rockledge
Drive, MSC 7910, Bethesda, MD 20892-7910, telephone 301/710-0267, email:; and from the program administrator listed under INQUIRIES.

The RFA label available in the PHS 398 (rev. 5/95) application form must be
affixed to the bottom of the face page of the application.  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.

Submit a signed, typewritten original of the application, including the
checklist, and three signed photocopies, in one package to:

BETHESDA, MD  20892-7710
BETHESDA, MD  20817 (for express/courier service)

At the time of submission, two additional copies of the application and five
copies of any appendices must be sent to:

Dr. Sharee Pepper
Extramural Programs
National Library of Medicine
Bethesda, MD  20894
Telephone:  (301) 496-4253
FAX:  (301) 402-0421

Applications must be received by June 25, 1998.  If an application is received
after that date, it will be returned to the applicant without review.  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 application.  The CSR will not accept any
application that is essentially the same as one already reviewed.  This does not
preclude the submission of substantial revisions of applications already
reviewed, but such applications must include an introduction addressing the
previous critique.


Upon receipt, applications will be reviewed for completeness by the CSR and
responsiveness by the FIC.  Incomplete applications will be returned to the
applicant without further consideration.  If the application is not responsive
to the RFA, the application will be returned to the applicant without review. 
Applications that are complete and responsive to the RFA will be evaluated for
scientific and technical merit by a peer review group convened by the NLM in
accordance with the review criteria stated below.  As part of the initial merit
review, all applications will be discussed, assigned a priority score and receive
a written critique as well as receive a second level review by the FIC Advisory

Review Criteria

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 review, comments on the following aspects of the application will be made
in order to judge the likelihood that the proposed research will have a
substantial impact on the pursuit of these goals.  Each of these criteria will
be addressed and considered in the assignment of the overall score.

Factors to be considered in the scientific evaluation of each application

In general, the likelihood that the applicant institution can meet the goals and
objectives stated in this RFA and specifically considering the following:

(1) Significance

o  The expected public health and scientific contributions of the proposed

o  The demonstrated capacity and/or potential to achieve sustained research and
training efforts and to build the informatics skill base for research and public
health capacity within a country;

o  Strength of the academic and training program.

(2) Approach

o  The appropriate mix of long- and short-term, initial and follow-up training
to achieve the goals of this RFA;

o  Opportunities for trainees to become involved in medical research and disease
control and prevention projects conducted in their home countries;

o  Adequacy of proposed procedures and criteria for 1) recruitment, review and
selection of trainees, and 2) peer review of informatics applications to medical
research, disease control and prevention projects;

o  Demonstrated capacity and/or potential to collaborate with other institutions
and to coordinate program activities with related efforts of other NIH programs,
other federal agencies (e.g., CDC, USAID), international organizations and
programs (e.g., WHO, MIM), and NGOs;

o  Systems for documenting the long-term impact of the program on research and
public health capacity in the home countries of trainees, including the impact
of the program on the careers of current and former ITMI trainees;

o  Effectiveness of plans to disseminate newly acquired medical informatics
skills within institutions and countries of collaborators and trainees;

o  Overall cost-effectiveness of the training and research plan.

(3)  Innovation

o  Adequacy and creativity of plans to build modern information technology
capacity in countries and institutions that may currently have limited resources
and limited access to the internet; and

o  Overall creativity of the training and research plan.

(4) Investigator(s)

o  Qualifications of the program director to lead and the named faculty to
participate in the proposed training and research program; including their
collective depth of experience in the fields of health research and medical
informatics, and research support from the NIH and other sources;

o  Documentation of previous international collaboration with developing country
scientists and institutions included in the proposed program; and

o  Previous success in training scientists and others in medical research and

(5) Environment

o  Demonstration of continued or of future support for the program from
governments and institutions and other non-governmental organizations from
collaborating countries;

o  Demonstrated support for associated research and training from the NIH or
other sources;

o  Training environment in-country as evidenced by 1) the quality of local
teaching and research facilities and other resources; 2) the availability of
high-quality candidates; and 3) past history of success as mentors and
institutional commitments to former trainees in other internationally funded
programs upon returning to their home countries;

o  Training environment in the United States including the institutional
commitment, the caliber of preceptors, the quality of teaching, and research
facilities and resources.

The initial review group will also examine the adequacy of the process for or the
protection of human and animal subjects and the safety of the research
environment where relevant.


Applications will compete for available funds.  In making funding decisions, the
following will be considered: responsiveness to the research and training
objectives, scientific merit as determined by peer review, availability of funds,
and programmatic priorities.


Letter of Intent Receipt Date:     May 25, 1998
Application Receipt Date:          June 25, 1998
Review for Scientific Merit:       August 1998
Review by the FIC Advisory Board:  September 1998
Anticipated Award (Start) Date:    September 30, 1998


Prospective applicants are encouraged to discuss their applications, including
proposed collaborating countries and institutions with FIC program staff before
submitting a formal application.  Potential resources and collaborators including
currently funded research and training programs and their directors, as well as
several other useful links can be found at the following www address:

Programmatic and scientific inquiries, including any requests for further
instructions to prepare applications, may be directed to:

Dr. Joshua Rosenthal
Division of International Training and Research
Fogarty International Center
31 Center Drive - MSC 2220
Bethesda, MD  20892-2220
Telephone:  (301) 496-2516
FAX:  (301) 402-2056

Inquiries related to the review of these applications may be directed to:

Dr. Sharee Pepper
Extramural Programs
National Library of Medicine
Building 38A, Room 5N519
Bethesda, MD  20894
Telephone:  (301) 496-4253
FAX:  (301) 402-0421

Inquiries regarding fiscal matters may be addressed to:

Ms. Silvia Mandes
Division of International Training and Research
Fogarty International Center
31 Center Drive - MSC 2220
Bethesda, MD  20892-2220
Telephone:  (301) 496-1653
FAX:  (301) 402-0779


Awards are made under authorization of the Public Health Service Act, Title III
and Title IV, Part A (Public Law 78-410, as amended by Public Law 99-158, 42 USC
241, 242l and 287b) and administered under PHS grants policies and Federal
regulations 42 CFR 52 and 45 CFR Part 74.  This program is not subject to the
intergovernmental review requirements of Executive Order 12372 or to Health
Systems Agency review.

The PHS strongly encourages all grant and contract recipients to provide a smoke-
free workplace and promote the non-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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