The cost of excellence
As the Infectious Diseases Institute (IDI) starts a new fiscal year, all eyes are fixed anxiously on the budget. IDI is a Center of Excellence, leading the way in defining HIV patient care and treatment through its research activities; but excellence has a certain cost, and IDI’s strategic plan must spell out how that cost will be sustainably met.
The situation is similar for HIV care and treatment in Uganda as a whole; the good news is that national guidelines have been established and anti retroviral drugs (ARVs) are provided free of charge to eligible patients. However ARVs are largely funded by foreign aid, for example the US President’s Emergency Fund for AIDS Relief (PEPFAR) and there are concerns that this is not sustainable and that a mix of government funding and patient copays will be needed longer term to sustain excellent HIV care.
Research excellence requires a certain infrastructure – quality, regulatory, project and grant management. In both universities and research institutes the cost of this infrastructure is typically supported partly by unrestricted government and foundation funding and partly by allowance for overheads in project grants.
A certain portion of IDI’s core research infrastructure costs can be recovered through charging partial overhead and staff costs to grants, but the remainder must be met through revenue-generating activities. How can IDI best balance focusing internally driven research in the areas that matter most, while maintaining the highest quality of research data, and generate sufficient revenue to maintain its core? Any research based organization juggles similar issues - the challenges of meeting quality, cost and productivity goals within the available research budget.
As IDI approaches its tenth anniversary, it will enter a new era as a self-sustaining research institute at a time of austerity in the global funding environment. The changes in IDI’s external environment necessitate a paradigm shift in the way that IDI does business in the future. While there will continue to be opportunities for efficiencies that will bring about incremental cost savings, these may alone not be enough to cover the core costs of maintaining a center of excellence. Filling the gap will require innovation, which is what IDI does best. By focusing on key research areas and emerging market opportunities, and by having flexible staff that can multitask across projects, IDI can sustain excellence for years to come.