Release Date:  March 4, 1999 

RFA:  TW-99-003


Fogarty International Center
National Library of Medicine

Letter of Intent Receipt Date:  March 20, 1999
Application Receipt Date:  May 20, 1999


The Fogarty International Center (FIC), in collaboration with the National
Library of Medicine (NLM), invites applications for the establishment of model
training programs in medical informatics for developing country scientists and
health professionals.  The overall goal of the  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,  public health and
clinical practice in those countries.  This RFA follows an initial RFA
(TW-98-003) directed towards Sub-Saharan Africa.  This program will continue
with an emphasis on Sub-Saharan Africa but will also consider meritorious
applications focusing on Latin America and the Caribbean.

Each training program will produce a cadre of experts in one or two developing
country institutions.  The objective is to train individuals  who will apply
state-of-the-art information and communication technologies to research and
health surveillance activities and who will function in their home
institutions as trainers or leaders in this application. Technologies and
skills that are transferred must be directly related to research or
surveillance applications, and capacity-building activities should be
substantially focused on skills beyond basic computer operations.  Within that
context, it is envisioned that trainees will represent a range of skill levels
and responsibilities, as relevant to the specific research objectives of a
program and the environment of the home institution.

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 is
required, as it is likely to enhance the sustainability of the program. 
Applicants are encouraged but not required to include collaborations with
research and training programs currently funded by the NIH.  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 Request for Applications (RFA),
International Training in Medical Informatics, is related to one or more of
the priority areas. Potential applicants may obtain a copy of "Healthy People
2000" at


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

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 training effort in the collaborating country. 
Applications associated with the Multilateral Initiative on Malaria (MIM) are
especially encouraged.

For this RFA eligible collaborating countries are those within Sub-Saharan
Africa, Latin America and the Caribbean. 

Only one application will be considered from any single institution.  Those
institutions that are currently holding an ITMI award from the previous
competition are excluded from this competition.  A list of current awardees
can be found on the internet at:


This RFA will use the international training and research 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

Allowable costs:

Applicants can propose budgets of up to $150,000 per year total costs (Direct
and Indirect combined).  The following cost categories are eligible for
reimbursement under this program.  The allowances are maximums and together
add up to much more than the total $150,000 award available for any one year. 
Applicants are encouraged to design the most cost-effective programs in this
context. 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;
- Applicable 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 workstation;

- Additional research support of up to $15,000 per person to support training-
related project-development or advanced research training in the home country
(the program director is expected to ensure that projects submitted for this
funding are peer reviewed by the U.S. institution). - Costs to establish and
maintain Internet connection, including telephone and Internet service
provider fees, not to exceed $5,000 per year. 

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
- 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.  FIC program staff in consultation with NLM will review such
requests, and support will depend upon merit and availability of funds. 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 $600,000 is available to support four new awards in FY 1999. 
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.  


Improving our ability to prevent and treat diseases depends fundamentally on
discovery, compilation, analysis 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 analysis.  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

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

o  Expand and improve ongoing collaborative research between U.S. and
developing country scientists in the prevention, control and treatment of
diseases of public health relevance in the home country.

Types of Training

Emphasis should be given to creating nuclei of experts composed of multiple
highly qualified developing country nationals at their home institutions.  A
useful model to consider combines U.S.-based, medium-term (usually a minimum
of one year) training with follow-up supervision and collaboration for re-
entry into home country institutions.  Creative use of electronic distance
learning methods, using the very tools being taught, is highly desirable.

Integration of training with on-going research and health surveillance
projects in the home country is a fundamental and required aspect of this
program and innovative approaches to this objective are encouraged.  Medium
and long-term trainees are expected to develop independent or collaborative
research projects to deepen, 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 analytical research
utilizing data from a genome sequence database on a disease agent such as
Plasmodium falciparum or  M. tuberculosis.  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.  FIC will work with awardees to develop and
implement a standardized tracking system to assess the impact of the overall
program.  Evaluation of these programs will focus on the productivity of the
trainees, their sustained commitment to research careers, and their ability to
act as consultants to other local investigators and further disseminate the
lessons learned.

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

1.  Formal U.S.- based training for developing country scientists 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 such as GenBank or PubMed) 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 country. 

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

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 also take place at the home institution or at regionally
important centers in the developing country.

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.


Trainees shall be individuals who are currently involved or will be involved
in biomedical research or health surveillance activities in their home
country.  A research institutional base for trainees to return to is an
integral part of the eligibility of the trainees.  The U.S. applicants are
especially encouraged to recruit junior faculty at participating developing
country 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 science; 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 pathogenesis, prevention, or treatment, and toward research capacity-
building in developing countries.  Countries that are eligible to participate
are limited to Sub-Saharan Africa, Latin America and the Caribbean.  Inclusion
of countries in the program with particularly severe endemic or epidemic
malaria, HIV/AIDS, tuberculosis, or a growing burden of chronic, non-
communicable diseases is 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, Education, 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 FIC.

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

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; and (4) the establishment or
strengthening of model medical informatics centers in the home countries of
trainees.  As noted above, a standardized reporting system for the entire
program will be developed utilizing the model systems developed by awardees.

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 means such as: (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.  Provision of additional funds is
always subject to availability.  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 the responsibility of the P.I.  to ensure that all required assurances will
be in place for the associated research, whether or not 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 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 was published in the Federal Register of March 28, 1994 (FR
59 14508-14513) and in the NIH Guide for Grants and Contracts, Vol. 23, No.
11, March 18, 1994, available on the web at:

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 program.


It is the policy of NIH 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 was published in the NIH Guide for
Grants and Contracts, March 6, 1998, and is available at the following URL

Investigators also may obtain copies of these policies from the program staff
listed under INQUIRIES. Program staff may also provide additional relevant
information concerning the policy.


Prospective applicants are asked to submit, by March 20, 1999, a letter of
intent that includes a descriptive title of the proposed research, the name,
address, and telephone number of the Principal Investigator, the identities of
other key personnel and participating institutions, 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
FIC staff to estimate the potential review workload and avoid conflict of
interest in the review.

The letter of intent is to be sent to:

Dr. Joshua Rosenthal
Division of International Training and Research
Fogarty International Center
BETHESDA, MD  20892-2220
Telephone:  (301) 496-1653
FAX:  (301) 402-2056


The NRSA portion of the research grant application form PHS 398 (rev. 4/98) 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

The RFA label available in the PHS 398 (rev. 4/98) 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. Joshua Rosenthal
Division of International Training and Research
Fogarty International Center
BETHESDA, MD  20892-2220

Applications must be received by May 20, 1999.  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, CSR will review applications for completeness and FIC will
review them for responsiveness to this RFA.  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 Board.

Review Criteria

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, the following criteria:

(1) Significance

o  The expected scientific and public health 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  Quality of 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  Quality of 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. AWARD CRITERIA

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 program-level considerations, including scientific and geographic


Letter of Intent Receipt Date:     March 20, 1999
Application Receipt Date:          May 20, 1999
Review for Scientific Merit:       August 1999
Review by the FIC Advisory Board:  September 1999
Anticipated Award Date:            September 30, 1999


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

Programmatic and scientific inquiries may be directed to:

Dr. Joshua Rosenthal
Division of International Training and Research
Fogarty International Center
BETHESDA, MD  20892-2220
Telephone:  (301) 496-1653
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
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
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 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

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