The overall goal of the centre’s research agenda is to contribute toward prevention and control of CVD in Tanzania and the East African region and eventually decrease morbidity and mortality resulting from these diseases. The immediate main objective is to train a critical mass of researchers to lead research in key strategic areas in order to identify and propose solutions to reduce the CVD burden in Tanzania and the East African region.

Cardiovascular disease cover a broad range of conditions affecting the heart and blood vessels. In Tanzania, hospital data show that highly prevalent CVD include hypertensive heart disease leading to heart failure, hypertensive kidney disease leading to end stage renal failure as well as cerebrovascular diseases presenting as stroke (13–15). Other important CVD include rheumatic heart disease, cardiomyopathies – particularly dilated cardiomyopathy, untreated congenital heart diseases, endomyocardial fibrosis, and cardiovascular complications of sickle cell anemia, tuberculosis and HIV disease (7, 16–18). Although not yet ranking highest in Tanzania, ischemic heart disease is on the increase (19). With time, ischemic heart disease is likely to consume a significant amount of the already inadequate budget on health (20).

Here we define specific CVD research areas that despite existing efforts are still facing significant unmet needs. Epidemiological and scientific knowledge coupled with translation into policy and clinical implementation will have major impact on the society and individual well-being of many Tanzanians. The research priority areas are explained below:

Research undertaking requires human resources, in terms of number, expertise and dedication to lifelong research. In SSA, shortage of human resources for research is a well-recognized barrier to health research output from the region (58–61). The scarcity is in both the number of researchers, as well as the expertise (58, 59). Brain-drain, where young professionals emigrate to HICs for greener pastures (62) compounds the already scarce workforce in the region (63). Furthermore, while the culture of research is strongly embedded (64) and continuously been enhanced (65) in many developed countries, the same is not the case in SSA, where even the career path for a researcher is not well-defined (63). Competing interest with clinical work-load, engagement in private practice for economic reasons and un-interesting research questions (mainly conceived in Western countries), are some of the factors found to influence less interests in research among academic and non-academic health personnel in SSA (63, 66). However, with an increasing number of health care professionals reaching tertiary level education in the region (67), and increasing evidence that Africa-led research undertaking is possible (61) and an effective way to address local health challenges (68), this trend can be changed.

This research agenda will strategically be hosted, implemented, and managed through the existing MUHAS research management systems (Figure 2) and through MUHAS academic programs, its faculty and post-graduate trainees (69). Academic institutions worldwide have traditionally been in the forefront for research, utilizing the dynamic learning environment within them, and the prospect for continuity. The current MUHAS academic profile provides a strong base for current and future research undertakings, taking advantage of relatively many young faculty at the institution (Figure 3).

Furthermore, the scope of researchers for this agenda is not limited to MUHAS as more researchers through collaboration with MUHAS faculty are expected to form part. Here the strategy will be to utilize the existing network of regional and global collaborators in research and faculty/students exchange.

The low level of CVD research output from SSA is partly due to the low number of CVD researchers in the region (58, 59, 61, 63, 70). Furthermore, even with the available numbers, without proper research training, researchers from SSA lack expertise to conduct high caliber research. Proper research training is also a way of creating a culture of research, which has not been a well invested area in most SSA countries (61, 63, 71). Therefore, in order to increase the quantity and quality of research into CVD, there is a need in SSA, to urgently address two issues, i.e., increasing the number of researchers as well as improving their quality in order to produce researchers that will be professionals with in-depth scientific expertise and complementary leadership skills to enable them conduct independent, and internationally recognized CVD research.

Until now MUHAS, through the EACoECVS has made significant progress in increasing CVD specialties’ training (Table 1). Most of the initial training took place abroad including India, South Africa, Germany, United Kingdom, and Ireland as well as locally in Tanzania. This group of specialists in different CVD fields forms a base for current and future CVD researchers for the center. The strategy is to align these future researchers with the planned research agenda for the center.

As part of research training at advanced levels, the EACoECVS has entered into memorandum of understanding with the University Medical Center Utrecht (UMCU) for tertiary CVD research training at the UMCU, through joint Ph.D. supervisions between UMCU and MUHAS. In this initiative, currently five Ph.D. fellows from MUHAS have already been registered with the Julius Global Health Ph.D. program and are doing their research in CVD (Table 2). Participants for this program receive all their formal research training in the Netherlands (both physically and through e-learning platforms), including research methods, epidemiology as well as scientific research writing. All research is done in Tanzania, following the research agenda highlighted.

Research infrastructure refers to facilities that provide resources, spaces and services for conducting research and foster innovation. In medicine these facilities include dedicated research laboratories, space for clinical trials, major scientific equipment, data repositories and archives, computing systems, and communication networks. Systems for supporting research management including quality assurance, monitoring and evaluation systems, financial systems, and physical space for researchers like faculty and scholars’ offices and lecture rooms are also part and parcel of a viable research environment. In SSA, both physical space and dedicated equipment for research have been in chronic shortage, and have been cited as major stumbling blocks for research undertaking in the region (63, 66, 68). This is further compounded by limited research organization at institutional, country or regional level (59). Over-reliance on infrastructure donation often brings lack of continuity when a certain project or research seizes to operate, leaving expensive machines unused.

For this research agenda, most of the physical space will be through the deliberately built and strategically placed multipurpose building for the EACoECVS (Figure 4). This building is located at the new MUHAS Campus (approximately 3,800 acres about 25 km on the outskirts of Dar es Salaam city), and is close to the Mloganzila Hospital, a state-of-the art University teaching hospital for MUHAS. The construction of the multipurpose building for the EACoECVS was completed on 31 December 2021, and is expected to be fully functional in June 2022.

Funding is the backbone of any research endeavor. In developed countries, funding for research is a common practice and has been the driver for major breakthrough in health sciences (72). However, for many SSA countries the culture to fund research is lacking and brings about major challenges (63, 66, 71). Low social economic status of many SSA with competing budget priorities is undeniably the most important factor for poor research funding. However, other factors cited include lack of good governance, corruption and mismanagement of public funds at the higher levels (71). A review of research funding shows many researchers in SSA either self-fund their research or utilize post graduate small-scale dissertation funds to conduct research (63). Recently however, different initiatives have been implemented to facilitate SSA to access global health research funds, mainly by partnering with researchers from developed countries (73). Furthermore, access to other international funders like Bill and Melinda Gates Foundation, the Wellcome Trust, HIV Research Trust, The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), and others have been instrumental to funding research in SSA, mostly in infectious diseases (74). Only recently, funding for NCDs have emerged, although still very insufficient and with stiff competition (75).

This research agenda will not be practical without funding. As custodian of cardiovascular research in Tanzania, efforts to access cardiovascular research funds will be upgraded by equipping current and future generation researchers with skills to write competitive research grants. In publishing this agenda, potential collaborators for research from around the globe are being reached out, for the purpose of forming collaborations regionally and worldwide in order to attain sharing of research resources for a common goal. Locally, efforts to solicit research funding and support from government and non-governmental organizations will continue. This strategy will also involve reaching out to private partners, local philanthropists, businessmen and women as well as industries interested in cardiovascular research.