The Workforce Question: Who Actually Runs High-Quality Trials in Africa?

Africa carries roughly a quarter of the world’s disease burden, yet in 2023 just 1.1% of clinical trials initiated globally were hosted on the continent (1). The infrastructure argument, regulatory gaps, ethics review timelines, laboratory Capaci, is familiar and well-rehearsed. The workforce argument is not. Behind every enrolled participant, every clean case report form, and every protocol deviation properly documented, there is a named person doing that work. Who they are, whether they are trained and retained, and whether the system treats their role as a profession or a stopgap; these questions determine whether high-quality trial conduct in Africa is replicable at scale. 

What the Situation Looks Like Now 

The clinical research workforce at an African trial site typically spans several distinct functions: the principal investigator who holds regulatory responsibility, clinical research coordinators (CRCs) who manage day-to-day participant visits and data collection, research nurses who administer study procedures and assess safety signals, data managers, pharmacists, and quality assurance staff. The literature recognizes that there are no standard definitions of the different profiles involved in clinical trials, an overlap of functions, and a lack of specific training for the professionals involved (2). This is not unique to Africa, but its consequences are more acute in settings where institutional scaffolding professional development is thinner. 

IQVIA, a leading clinical research organization, is currently partnering with over 5,000 investigators in Africa across 3,630 sites, and the number continues to grow (3). That is a substantial footprint. What it does not tell us is how many of those sites have a dedicated, full-time CRC with a defined job description, and a clear trajectory for advancement. Across much of the continent, coordination and monitoring functions are absorbed by clinicians and nurses whose primary contract is with a hospital or public health facility. Research duties are added informally and rarely reflected in formal career records. 

A lack of overall coordination and ecosystem-wide weaknesses mean that individual investments in areas such as capacity strengthening and retention, digital infrastructure, trial design, and network strengthening have often yielded transactional gains that cannot be sustained over time, a conclusion drawn by sixty experts convened by Africa CDC and AUDA-NEPAD (4). The pattern is consistent: training happens; competence improves, and then the trained person leaves, either for a higher-paying role with a CRO or international sponsor, or out of the research sector entirely. 

The retention data from the broader health workforce underscores the systemic pressure. In 2023, African nations experienced a loss of between 4,000 and 20,000 healthcare personnel to countries in Europe and America (5). On average, 42 percent of healthcare workers in sub-Saharan Africa have intentions to migrate to another country in the future (6). Research-specific staff, who are often more qualified and more internationally marketable than their peers, face the same pull, sometimes a stronger one. 

Why This Matters for Africa and for Global Outcomes 

The 2024 Access to Medicine Index found only 27.5% of late-stage R&D projects from 20 top pharmaceutical companies analyzed included one or more African country (7). Sponsors and CROs routinely cite site readiness as a barrier to placement decisions. Site readiness, in practice, is substantially a workforce question: Does this site have personnel who can maintain protocol compliance across a multi-year study? Can they respond to a regulatory inspection? Can they manage safety reporting in real time? 

When the answer is uncertain, sponsors move to sites where the answer is known. This perpetuates a cycle in which African sites are overlooked not because participants are unavailable, they are, in large numbers, but because the operational infrastructure, including the people who constitute it, does not signal sufficient reliability. 

The consequences are not only commercial. Most trials in Africa are focused on infectious diseases and restricted to phases III and IV, remaining consistent with clinical research trends over the last 15 years (3). The phase I and II landscape, where treatment pathways are shaped and product development decisions are made, remains almost entirely outside the continent’s reach. That reflects, in part, a workforce credentialing gap: early-phase trials require staff with specific pharmacokinetics training, intensive adverse event monitoring competencies, and regulatory familiarity that takes years to build, and that walks out the door when an experienced coordinator leaves. 

The current clinical research professional workforce lacks cultural diversity, which can result in a downstream negative impact on participant recruitment for clinical trials. A professionalized African research workforce does not merely serve African trials (4). It expands the genetic and phenotypic diversity of data used globally to approve treatments that are then deployed worldwide. The scientific validity argument for African trial participation is therefore inseparable from the workforce sustainability argument. 

What Clinical Research and Implementation Evidence Can Change 

Two practical shifts are supported by current evidence. 

First, the transition from ad hoc training to structured competency frameworks. The Joint Task Force Clinical Trial Competency Framework (JTF Framework) has been established to educate, train, and support the clinical research workforce. Its 8-domain structure, which covers scientific concepts, operational implementation, participant safety, data management, ethics, regulatory compliance, leadership, and communication (8), provides a transferable scaffold that African institutions can adopt or adapt rather than build from scratch. The ClinOps programme, developed for African study coordinators and evaluated in a 2025 peer-reviewed study, demonstrates that structured, merit-based training delivered at continental scale is feasible: applications were open continent-wide and evaluated based on merit, with selection criteria including prior experience as a study coordinator, investigator, co-investigator, or study manager (9).  

Second, the recognition that role clarity directly predicts retention. The inclusion of human resource departments and clinical research operational leaders in the creation of competency-based, standardized job titles, descriptions, and career progression has resulted in promising enhancements in the professionalism of these roles through better-defined upward mobility, professional development pathways and significantly reduced turnover (10). This is a structural fix, not a training fix. African research institutions that have established full-time CRC positions with defined promotion pathways, report stronger continuity on multi-year studies and more consistent inspection readiness. 

What Needs to Happen Next 

1. Funders should require workforce sustainability plans.Grant applications for African trial activity should include a named workforce plan: who fills each role, at what percentage of their time, under what contract terms, and with what retention mechanisms. This mirrors what funders already require for data management and ethics review.
2. Research institutions should create dedicated, ring-fenced CRC and research nurse positions.Medical institutions should set up independent clinical research positions,establish a professional title promotion channel parallel to existing clinical sequences, and implement a clear division of labor and collaboration mechanism to improve the efficiency and quality of clinical trials (11). Where hospitals and universities lack the budget, this is a case for co-funding from sponsors who place studies at those sites. 
3. Sponsors and CROs operating in Africa should invest in site staff directly, not just through per-visit payments.Sponsors continue to rely on sites as the engine of trialexecution yet rarely invest in stabilizing the workforce that drives performance (12). Long-term embedded support models, where sponsor co-funds a dedicated coordinator attached to a specific portfolio, have shown results in other regions. The logic applies to Africa. 
4. African research networks shouldstandardizejob titles and credential recognition across countries. A CRC trained in Ghana should be able to demonstrate equivalence when joining a site in Kenya. The absence of common credentialing currently fragments the talent pool and makes it harder for African professionals to build portable, recognized careers. Frameworks such as the Clinical Trials Community Africa Network (CTCAN), which aims to develop a clinical trial preparedness framework to assess site and laboratory capabilities and any potential quality and operational gaps, offer a platform for this harmonization work (13). 
5. Trainingprogrammesshould include career pathway mapping, not just technical content. A coordinator who completes a GCP certification and has no route to a senior CRC, project manager, or regulatory affairs role will reasonably exit the field or migrate. Training that ends at certification is a short-term input. Training embedded in a defined career arc is a long-term investment. 

Conclusion 

The question of who runs high-quality trials in Africa is not a background question. It sits at the center of whether African sites can deliver on the scientific, regulatory, and operational standards that sponsors, ethics committees, and regulators require. The gap between current practice, where research functions are frequently absorbed into already-full clinical roles on an informal basis, and what a professionalized workforce looks like is not primarily a funding gap, though funding matters. It is a governance gap: the absence of structures that define, reward, develop, and retain people who do this work as their central professional identity. 

The continent has a growing pool of trained, motivated clinical research professionals. Investigators in many African countries are exceptionally trained and eager to participate in clinical development. The task is to build the systems around them that make that training durable and that make their careers worth staying for. 

 

References 

1. World Economic Forum [Internet]. 2025 [cited 2026 Mar 30]. Clinical trials are key to improvingmedicinesaccess in Africa. Available from: https://www.weforum.org/stories/2025/07/healthcare-access-africa-clinical-trials/ 
2. Peralta G, Sánchez-Santiago B. Navigating the challenges of clinical trial professionals in the healthcare sector. Front Med. 2024 Jun 3;11. doi:10.3389/fmed.2024.1400585
3. World Economic Forum [Internet]. 2024 [cited 2026 Mar 30]. Howscaling upclinical research in Africa can benefit society and the economy. Available from: https://www.weforum.org/stories/2024/08/africa-scaling-up-clinical-research-benefit-society-economy/ 
4. Meeting Report:OptimizingEfficiency and Impact in the African Clinical Trials Ecosystem. Africa CDC [Internet]. [cited 2026 Mar 30]. Available from: https://africacdc.org/download/meeting-report-optimizing-efficiency-and-impact-in-the-african-clinical-trials-ecosystem/ 
5. 26) Brain Drain Africa: Evaluating Strategies to Reverse Health-Worker Migration Trends in Africa | LinkedIn [Internet]. [cited 2026 Mar 30]. Available from: https://www.linkedin.com/pulse/brain-drain-africa-evaluating-strategies-reverse-health-worker-gjwlf/
6. Sub-Saharan Africa’s healthcare worker shortage | McKinsey [Internet]. [cited 2026 Mar 30]. Available from: https://www.mckinsey.com/industries/social-sector/our-insights/overcoming-sub-saharan-africas-health-workforce-paradox
7. World Economic Forum [Internet]. 2025 [cited 2026 Mar 30]. Clinical trials are key to improvingmedicinesaccess in Africa. Available from: https://www.weforum.org/stories/2025/07/healthcare-access-africa-clinical-trials/ 
8. Joint Task Force for Clinical Trial Competency [Internet]. [cited 2026 Mar 30]. Home. Available from: https://mrctcenter.org/clinical-trial-competency/
9. Ejigu DA, Fekadu A, Whitty J,ManyazewalT, Nebeta P, Conradie A, et al. Development, implementation, and evaluation of an innovative clinical trial operations training program for Africa (ClinOps). BMC Med Educ. 2025 Jan 24;25:119. doi:10.1186/s12909-025-06733-7 PubMed PMID: 39856664; PubMed Central PMCID: PMC11760708. 
10. Jones CT, Johnson E, Bierer BE, Snyder DC, Smith HA, Akuffo E, et al. Editorial: Building the clinical research workforce: challenges,capacitiesand competencies. Front Pharmacol. 2024 Jul 16;15. doi:10.3389/fphar.2024.1446908 
11. Cao X, Xu J, Li M, Zheng L. An exploration and analysis of the role positioning, duty comparison, and career development path of clinical research nurses in developed and developing countries. Front Med. 2026 Jan 5;12. doi:10.3389/fmed.2025.1708032
12. SCRS. Fixing the Foundations: A New Model to Solve Clinical Site Staffing and Retention Challenges. Society for Clinical Research Sites [Internet]. 2025 Apr 23 [cited 2026 Mar 30]. Available from: https://myscrs.org/resources/new-model-clinical-site-staffing-retention-challenges/
13. Clinical Trials Community Africa Network (CTCAN) | Science for Africa Foundation [Internet]. [cited 2026 Mar 30]. Available from: https://scienceforafrica.foundation/clinical-trials-community-africa-network