Health research capacity strengthening (RCS) is widely recognized as a major unmet need, particularly in low- and middle-income countries (Lansang and Dennis 2006). It has been high on both national and international agendas for the past 20 years, as evidenced by a steady stream of peer-reviewed and grey literature, training tools, programmes, grants, workshops, task forces and conferences. Defined as ‘. . . the ongoing process of empowering individuals, institutions, organizations and nations to define and prioritize problems systematically, to develop and scientifically evaluate appropriate solutions, and share and apply the knowledge generated’ (Lansang and Dennis 2004), RCS encompasses a broad and complex spectrum of activities, including training programmes, tools and grants. In addition, anyone embarking on an RCS programme needs to address broader issues of which and whose capacities to strengthen, to do what, in which context and with which purpose.