Clinical research on neglected tropical diseases is a challenge in low-resource countries,\nand the contribution of clinical and operational research to health system strengthening is poorly\ndocumented. Developing new, simple, safe, and effective treatments may improve the effectiveness of\nhealth systems, and conducting research directly in health structures may have an additional impact.\nThis study describes the process of conducting clinical trials in the Democratic Republic of Congo\n(DRC) in compliance with international standards, and the role of the trials in strengthening health\nsystem functions, including governance, human resources, health information, provision of care,\nand the equipping of health services with the necessary supplies and infrastructure. We conclude\nthat conducting clinical trials in endemic areas has not only reinforced and supported the aim of\nconducting high-level clinical research in endemic countries, but has also brought lasting benefits to\nresearchers, staff, and hospitals, as well as to broader health systems, which have positive knock-on\neffect on patients outside of the clinical trials and their communities. Sustainability, however, remains\na challenge in an underfunded health system, especially with respect to specialized equipment.\nClinical research in most of sub-Saharan Africa is highly dependent on international input and\nexternal technical support; there are areas of weaknesses in trial design and documentation, as well\nas in data management and analysis. Financing remains a critical issue, as African investigators have\ndifficulties in directly accessing sources of international research funding.
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