# Domestic Network Resilience

In research infrastructure design, does the presence of domestic multi-centre trial networks within African nations indicate a viable model for building sovereign research capacity? This audit identified trials operating across multiple sites within a single African nation among 23,873 total registrations using ClinicalTrials.gov location metadata. Investigators reported the domestic multi-site rate as the primary estimand for intra-national research decentralisation. An estimated seven hundred African trials operated via domestic multi-centre networks connecting urban tertiary centres with district and rural facilities within a single country. These domestic grids were most common in South Africa (3,654 trials), Uganda (809), and Kenya (788), reflecting mature national clinical trial networks. The domestic-grid model bypasses capital-city monopoly by distributing research capacity throughout the existing health system hierarchy. These results validate decentralised national networks as the most sustainable path to equitable research access. Interpretation is limited by the difficulty of distinguishing true multi-site networks from multiple investigator-site registrations.

## References

1. Alemayehu C, et al. "Behind the mask of the African clinical trials landscape." Trials. 2018;19:519.
2. Drain PK, et al. "Global migration of clinical trials." Nat Rev Drug Discov. 2018;17:765-766.

## Note Block

- Type: research
- App: https://mahmood726-cyber.github.io/africa-e156-students/geographic-equity/dashboards/domestic-grid.html
- Code: https://github.com/mahmood726-cyber/africa-e156-students/blob/master/geographic-equity/code/domestic-grid.py
- Data: ClinicalTrials.gov API v2
- Date: 2026-04-05