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Dine RD, Elkheir LYM, Raimi MO, Alemayehu M, Mohamed SY, Turzin JK, Arogundade FQ, Ochola EA, Nasiyo AM, Mwawanga RQ, Yabo YA. Ten simple rules for successful and sustainable African research collaborations. PLoS Comput Biol 2024; 20:e1012197. [PMID: 38935617 PMCID: PMC11210762 DOI: 10.1371/journal.pcbi.1012197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024] Open
Affiliation(s)
| | | | - Morufu Olalekan Raimi
- Department of Environmental Management and Toxicology, Faculty of Sciences, Federal University Otuoke, Otuoke, Nigeria
| | - Micheal Alemayehu
- Department of Emergency and Critical Care, Tiruneshi Beijing General Hospital, Addis Ababa, Ethiopia
| | - Salem Youssef Mohamed
- Internal Medicine Department, Gastroenterology and Hepatology Unit, Zagazig University, Zagazig, Egypt
| | - Justice Kwadwo Turzin
- Department of Biomedical Sciences, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Femi Qudus Arogundade
- Department of Non-communicable Diseases and Environmental Health, Public Health U–The Ulrich and Ruth Frank Foundation, Bethel, Minnesota, United States of America
| | | | - Alex Mukungu Nasiyo
- Department of Management Science, Project Monitoring and Evaluation, Kenyatta University, Nairobi, Kenya
| | | | - Yahaya Abubakar Yabo
- Department of Veterinary Physiology and Biochemistry, Usmanu Danfodiyo University Sokoto, Sokoto, Nigeria
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Karuga R, Steege R, Chowdhury S, Squire B, Theobald S, Otiso L. A multi-step analysis and co-produced principles to support equitable partnership with Liverpool School of Tropical Medicine, 125 years on. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002091. [PMID: 38820344 PMCID: PMC11142479 DOI: 10.1371/journal.pgph.0002091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 04/10/2024] [Indexed: 06/02/2024]
Abstract
Transboundary health partnerships are shaped by global inequities. Perspectives from the "global South" are critical to understand and redress power asymmetries in research partnerships yet are not often included in current guidelines. We undertook research with partners working with the Liverpool School of Tropical Medicine (LSTM) to inform LSTM's equitable partnership strategy and co-develop principles for equitable partnerships as an entry point towards broader transformative action on research partnerships. We applied mixed-methods and participatory approaches. An online survey (n = 21) was conducted with LSTM's transboundary partners on fairness of opportunity, fair process, and fair sharing of benefits, triangulated with key informant interviews (n = 12). Qualitative narratives were analysed using the thematic framework approach. Findings were presented in a participatory workshop (n = 11) with partners to co-develop principles, which were refined and checked with stakeholders. Early inclusion emerged as fundamental to equitable partnerships, reflected in principle one: all partners to input into research design, agenda-setting and outputs to reflect priorities. Transparency is highlighted in principle two to guide all stages including agenda-setting, budgeting, data ownership and authorship. Principle three underscores the importance of contextually embedded knowledge for relevant and impactful research. Multi-directional capacity strengthening across all cadres is highlighted in principle four. Principle five includes LSTM leveraging their position for strategic and deliberate promotion of transboundary partners in international forums. A multi-centric model of partnership with no centralised power is promoted in principle six. Finally, principle seven emphasises commitment to the principles and Global Code of Conduct values: Fairness, Respect, Care, Honesty. The co-developed principles are part of ongoing reflections and dialogue to improve and undo harmful power structures that perpetuate coloniality within global health. While this process was conducted with LSTM-Liverpool's existing partners, the principles to strengthen equity are applicable to other institutions engaged in transboundary research partnerships and relevant for funders.
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Affiliation(s)
- Robinson Karuga
- Department of Research and Strategic Information, LVCT Health, Nairobi, Kenya
| | - Rosie Steege
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Shahreen Chowdhury
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Bertie Squire
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Lilian Otiso
- Department of Research and Strategic Information, LVCT Health, Nairobi, Kenya
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3
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Kumar R, Khosla R, McCoy D. Decolonising global health research: Shifting power for transformative change. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003141. [PMID: 38656955 PMCID: PMC11042701 DOI: 10.1371/journal.pgph.0003141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Recent debates on decolonizing global health have spurred interest in addressing the power asymmetries and knowledge hierarchies that sustain colonial ideas and relationships in global health research. This paper applies three intersecting dimensions of colonialism (colonialism within global health; colonisation of global health; and colonialism through global health) to develop a broader and more structural understanding of the policies and actions needed to decolonise global health research. It argues that existing guidelines and checklists designed to make global health research more equitable do not adequately address the underlying power asymmetries and biases that prevail across the global health research ecosystem. Beyond encouraging fairer partnerships within individual research projects, this paper calls for more emphasis on shifting the balance of decision-making power, redistributing resources, and holding research funders and other power-holders accountable to the places and peoples involved in and impacted by global health research.
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Affiliation(s)
- Ramya Kumar
- United Nations University-International Institute for Global Health, Kuala Lumpur, Malaysia
- Department of Community and Family Medicine, Faculty of Medicine, University of Jaffna, Jaffna, Sri Lanka
| | - Rajat Khosla
- United Nations University-International Institute for Global Health, Kuala Lumpur, Malaysia
| | - David McCoy
- United Nations University-International Institute for Global Health, Kuala Lumpur, Malaysia
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Chikwari CD, Tadesse AW, Shanaube K, Shepherd A, McQuaid CF, Togun TO. Achieving equitable leadership in Global Health partnerships: barriers experienced and strategies to improve grant funding for early- and mid-career researchers. BMC GLOBAL AND PUBLIC HEALTH 2024; 2:17. [PMID: 38737620 PMCID: PMC11078704 DOI: 10.1186/s44263-024-00047-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 02/07/2024] [Indexed: 05/14/2024]
Abstract
Calls to decolonize global health have highlighted the continued existence of colonial structures in research into diseases of public health importance particularly in low- and middle-income countries (LMICs). A key step towards restructuring the system and shaping it to local needs is equitable leadership in global health partnerships. This requires ensuring that researchers in LMICs are given the opportunity to successfully secure grant funding to lead and drive their own research based on locally defined priorities. In February 2022, the London School of Hygiene and Tropical Medicine hosted a workshop aimed at bringing together funders and early- and mid-career researchers (EMCRs) to identify funder initiatives that have worked to improve equitable leadership, to better understand barriers faced by researchers, and collectively brainstorm approaches to overcome these barriers. The workshop transcript was analyzed using a deductive thematic approach based on the workshop topic to identify key emerging themes. Barriers identified were the lack of individual and institutional level support and flawed funding structures for EMCRs in LMIC settings. Strategies on how equitable leadership can be further facilitated include institutional reforms for funders to facilitate equity, diversity, and inclusion in their partners through consultative engagement and in addition, reshaping how research priorities are defined; diversified funding streams for research organizations, building partnerships and dedicated funding for capacity building of EMCRs. Intentional advances to overcome funding barriers in global health speak directly to its decolonization. Urgently required and complex changes in practice must be intentional and do require uncomfortable shifts which will take time. Supplementary Information The online version contains supplementary material available at 10.1186/s44263-024-00047-4.
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Affiliation(s)
- Chido Dziva Chikwari
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Amare Worku Tadesse
- TB Centre, and Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health London School of Hygiene & Tropical Medicine, London, UK
| | | | - Anna Shepherd
- TB Centre, and Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health London School of Hygiene & Tropical Medicine, London, UK
| | - Christopher Finn McQuaid
- TB Centre, and Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health London School of Hygiene & Tropical Medicine, London, UK
| | - Toyin O. Togun
- TB Centre and Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- Medical Research Council Unit The Gambia at the London School of Hygiene & Tropical Medicine, Atlantic Boulevard, Banjul, The Gambia
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Modlin C, Sugarman J, Chongwe G, Kass N, Nazziwa W, Tegli J, Shrestha P, Ali J. Towards achieving transnational research partnership equity: lessons from implementing adaptive platform trials in low- and middle-income countries. Wellcome Open Res 2023; 8:120. [PMID: 38089903 PMCID: PMC10714106 DOI: 10.12688/wellcomeopenres.18915.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 02/01/2024] Open
Abstract
Background Use of adaptive clinical trials, particularly adaptive platform trials, has grown exponentially in response to the coronavirus disease (COVID-19) pandemic. Implementation of these trials in low- and middle-income countries (LMICs) has been fostered through the formation or modification of transnational research partnerships, typically between research groups from LMICs and high-income countries (HICs). While these partnerships are important to promote collaboration and overcome the structural and economic disadvantages faced by LMIC health researchers, it is critical to focus attention on the multiple dimensions of partnership equity. Methods Based on informal literature reviews and a meeting with leaders of one of the multinational COVID-19 adaptive platform trials, we describe some important considerations about research partnership equity in this context. Results We organize these considerations into eight thematic categories: 1) epistemic structures, 2) funding, 3) ethics oversight, 4) regulatory oversight, 5) leadership, 6) post-trial access to interventions, data, and specimens, 7) knowledge translation and dissemination, and 8) research capacity strengthening and maintenance. Within each category we review normative claims that support its relevance to research partnership equity followed by discussion of how adaptive platform trials highlight new dimensions, considerations, or challenges. Conclusion In aggregate, these observations provide insight into procedural and substantive equity-building measures within transnational global health research partnerships more broadly.
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Affiliation(s)
- Chelsea Modlin
- Berman Institute for Bioethics, Johns Hopkins University, Baltimore, MD, 21205, USA
- Division of Infectious Diseases, Johns Hopkins Medicine, Baltimore, Maryland, 21205, USA
| | - Jeremy Sugarman
- Berman Institute for Bioethics, Johns Hopkins University, Baltimore, MD, 21205, USA
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, Maryland, 21205, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA
| | - Gershom Chongwe
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Nancy Kass
- Berman Institute for Bioethics, Johns Hopkins University, Baltimore, MD, 21205, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA
| | - Winfred Nazziwa
- Uganda National Council for Science and Technology, Kampala, Uganda
| | - Jemee Tegli
- Family Health International Clinical/Partnership for Research on Vaccines and Infectious Diseases in Liberia, Monrovia, Liberia
| | - Prakriti Shrestha
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA
| | - Joseph Ali
- Berman Institute for Bioethics, Johns Hopkins University, Baltimore, MD, 21205, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA
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Kienzler H. Ethical spaces in imperfect global health collaborations. A commentary on Keynejad's research, education and capacity building initiative to address gender-based violence in the Global South. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1773-1775. [PMID: 34997840 DOI: 10.1007/s00127-021-02213-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 12/05/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Hanna Kienzler
- Department of Global Health & Social Medicine, King's College London, Bush House (NE) 3.15, 40 Aldwych, London, WC2B 4BG, UK.
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Young J, Xie M, Choi S, Osazuwa I, Robbins J, Bain PA, May C. Authorship Patterns in the Orthopaedic Journals of Low-Income and Lower-Middle-Income Countries. JB JS Open Access 2023; 8:e23.00072. [PMID: 38028376 PMCID: PMC10642905 DOI: 10.2106/jbjs.oa.23.00072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Background Extensive research collaborations exist between researchers from high-income countries (HICs) and those from low-income countries (LICs) and lower-middle-income countries (LMICs). Previous research has suggested that authors from LICs and LMICs are underrepresented as first and last authors in the orthopaedic literature on local populations, particularly in LICs. We present a bibliometric analysis of authorship solely in studies published in orthopaedic journals that are based in LICs and LMICs. Methods The Global Index Medicus was queried, and all articles published from January 1, 2010, to December 31, 2021, in journals with a focus on orthopaedic surgery that were based in an LIC or an LMIC were included. Logistic regressions were calculated to assess the predictors of local authorship. Results Over 92% of studies included in our analysis had first or last authors from LICs or LMICs. In terms of study type, the majority (89%) of studies were clinical, although largely of low-level evidence (78% of clinical studies were case reports, case series, or descriptive studies). None received funding. LIC or LMIC first authorship and last authorship were less likely for most types of nonclinical studies. LIC or LMIC first authorship was more likely when there were more study authors. LIC or LMIC first authorship and last authorship were less likely when there were more countries affiliated with the study authors. Finally, when compared with studies with only LIC or LMIC authors, those with a combination of HIC and LIC or LMIC authors had significantly lower rates of LIC or LMIC first authorship (93.3% versus 62.5%) and last authorship (97.7% versus 70.8%). Conclusions Our study presents one of the first analyses to assess authorship patterns in the orthopaedic literature of locally published journals in LICs and LMICs. Future studies are needed to contextualize our findings within a broader bibliometric landscape in order to better address the ongoing challenges to building research capacity in LICs and LMICs. Clinical Relevance Our study highlights important observations regarding authorship in international, collaborative research in orthopaedics.
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Affiliation(s)
- Jason Young
- Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts
| | | | - Soy Choi
- Harvard College, Boston, Massachusetts
| | | | | | - Paul A. Bain
- Harvard Medical School, Boston, Massachusetts
- Countway Library of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Collin May
- Harvard Medical School, Boston, Massachusetts
- Boston Children’s Hospital, Boston, Massachusetts
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8
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Amegee Quach J, Valea I, Bates I, Pulford J. Factors affecting African postdoctoral researcher capacity development within 'learn-by-doing' international research partnerships: findings from the 'Partnership for Increasing the Impact of Vector Control (PIIVeC)'. BMJ Glob Health 2023; 8:e012626. [PMID: 37678937 PMCID: PMC10496693 DOI: 10.1136/bmjgh-2023-012626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/06/2023] [Indexed: 09/09/2023] Open
Abstract
INTRODUCTION The Partnership to Increase the Impact of Vector Control sought to develop the research and leadership capacity of 10 African postdoctoral vectorborne disease scientists via a 'learn-by-doing' approach. We identified factors that either supported or hindered their development and, drawing on this information, determined key lessons for future programmes with similar objectives. METHODS A longitudinal qualitative study encompassing focus group discussions and semistructured interviews conducted with the cohort of African postdoctoral fellows, programme leadership, supervisory and research support staff (N=28). Data analysis was informed by a general inductive approach. RESULTS Numerous supportive and hindering factors were identified. Supportive factors were primarily structural or attitudinal in nature, whereas hindering factors were primarily operational or contextual. None of the supporting or hindering factors were specific to vectorborne disease research. Four key lessons for future programme implementation emerged, including: the value in exposing postdoctoral fellows to a diverse work-mix and training-mix to improve understanding of the broad skillset needed for scientific career advancement; recognising and managing the potentially competing interests of different partnership members to ensure everyone benefits from participation; ensuring equity of opportunity and rewarding engagement; and ensuring flexibility in support provision. CONCLUSION Our study highlights numerous factors that may be readily incorporated into early career researcher capacity strengthening initiatives based on a learn-by-doing approach. Many of these factors are supported by a growing weight of evidence and would be appropriate to research capacity strengthening programmes both within and outside of a vectorborne disease context.
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Affiliation(s)
- Jessica Amegee Quach
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Innocent Valea
- Unité de Recherche Clinique de Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Imelda Bates
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Justin Pulford
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Ahmed A, Al-Khatib A, Boum Y, Debat H, Gurmendi Dunkelberg A, Hinchliffe LJ, Jarrad F, Mastroianni A, Mineault P, Pennington CR, Pruszynski JA. The future of academic publishing. Nat Hum Behav 2023:10.1038/s41562-023-01637-2. [PMID: 37443268 DOI: 10.1038/s41562-023-01637-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Affiliation(s)
- Abubakari Ahmed
- Department of Urban Design and Infrastructure Studies, SD Dombo University of Business and Integrated Development Studies, Wa, Ghana.
| | - Aceil Al-Khatib
- Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan.
| | - Yap Boum
- Institut Pasteur de Bangui, 9HFF+GFH, Bangui, Central African Republic.
- Faculty of Medicine and Biomedical Science, University of Yaoundé I, Yaoundé, Cameroon.
| | - Humberto Debat
- Instituto de Patología Vegetal - Centro de Investigaciones Agropecuarias - Instituto Nacional de Tecnología Agropecuaria (IPAVE-CIAP-INTA), Córdoba, Argentina.
| | | | | | - Frith Jarrad
- Conservation Biology, Society for Conservation Biology, Melbourne, Victoria, Australia.
| | | | | | | | - J Andrew Pruszynski
- Department of Physiology and Pharmacology, Western University, London, Ontario, Canada.
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10
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Modlin CE, Kankaka EN, Chang LW, Sewankambo NK, Ali J. Exploring HIV/AIDS investigator perceptions of equity within research partnerships between low-and middle-income and high-income countries: a pilot survey. Health Res Policy Syst 2023; 21:32. [PMID: 37127604 PMCID: PMC10152781 DOI: 10.1186/s12961-023-00977-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/27/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Recommendations for research partnerships between low- and middle-income countries (LMICs) and high-income countries (HICs) stress the importance of equity within the collaboration. However, there is limited knowledge of the practical challenges and successes involved in establishing equitable research practices. This study describes the results of a pilot survey assessing key issues on LMIC/HIC partnership equity within HIV/AIDS research collaborations and compares perspectives of these issues between LMIC- and HIC-based investigators. METHODS Survey participants were selected using clustered, random sampling and snowball sampling. Responses were compared between LMIC and HIC respondents using standard descriptive statistics. Qualitative respondent feedback was analyzed using a combination of exploratory and confirmatory thematic analysis. RESULTS The majority of categories within four themes (research interests and resources; leadership, trust, and communication; cultural and ethical competence; representation and benefits) demonstrated relative consensus between LMIC and HIC respondents except for 'lack of trust within the partnership' which was rated as a more pronounced challenge by LMIC respondents. However, subcategories within some of the themes had significant differences between respondent groups including: equitable setting of the research agenda, compromise within a partnership, the role of regulatory bodies in monitoring partnerships for equity, and post-study access to research technology. CONCLUSIONS These efforts serve as a proof-of-concept survey characterizing contemporary issues around international research partnership equity. The frequency and severity of specific equity issues can be assessed, highlighting similarities versus differences in experiences between LMIC and HIC partners as potential targets for further discussion and evaluation.
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Affiliation(s)
- Chelsea E Modlin
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Johns Hopkins Berman Institute for Bioethics, Baltimore, MD, USA.
| | - Edward Nelson Kankaka
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Rakai Health Sciences Program, Rakai, Uganda
| | - Larry W Chang
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nelson K Sewankambo
- Rakai Health Sciences Program, Rakai, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joseph Ali
- Johns Hopkins Berman Institute for Bioethics, Baltimore, MD, USA.
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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11
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Modlin C, Sugarman J, Chongwe G, Kass N, Nazziwa W, Tegli J, Shrestha P, Ali J. Towards achieving transnational research partnership equity: lessons from implementing adaptive platform trials in low- and middle-income countries. Wellcome Open Res 2023. [DOI: 10.12688/wellcomeopenres.18915.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Background: Use of adaptive clinical trials, particularly adaptive platform trials, has grown exponentially in response to the coronavirus disease (COVID-19) pandemic. Implementation of these trials in low- and middle-income countries (LMICs) has been fostered through the formation or modification of transnational research partnerships, typically between research groups from LMICs and high-income countries (HICs). While these partnerships are important to promote collaboration and overcome the structural and economic disadvantages faced by LMIC health researchers, it is critical to focus attention on the multiple dimensions of partnership equity. Methods: Based on informal literature reviews and meetings with leaders of one of the multinational COVID-19 adaptive platform trials, we describe what can be learned about research partnership equity from these experiences. Results: We organize these considerations into eight thematic categories: 1) epistemic structures, 2) funding, 3) ethics oversight, 4) regulatory oversight, 5) leadership, 6) post-trial access to interventions, data, and specimens, 7) knowledge translation, and 8) research capacity strengthening and maintenance. Within each category we review the normative claims that support its relevance to research partnership equity followed by discussion of how adaptive platform trials highlight new dimensions, considerations, or challenges. Conclusion: These observations provide insight into procedural and substantive equity-building measures within transnational global health research partnerships more broadly.
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12
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Hodson DZ, Etoundi YM, Parikh S, Boum Y. Striving towards true equity in global health: A checklist for bilateral research partnerships. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001418. [PMID: 36963065 PMCID: PMC10021183 DOI: 10.1371/journal.pgph.0001418] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Interest in "global health" among schools of medicine, public health, and other health disciplines in high-income countries (HIC) continues to rise. Persistent power imbalances, racism, and maintenance of colonialism/neocolonialism plague global health efforts, including global health scholarship. Scholarly projects conducted in low- and middle-income countries (LMIC) by trainees at these schools in HIC often exacerbate these problems. Drawing on published literature and shared experiences, we review key inequalities within each phase of research, from design through implementation and analysis/dissemination, and make concrete and practical recommendations to improve equity at each stage. Key problems facing global health scholarship include HIC-centric nature of global health organizations, paucity of funding directly available for LMIC investigators and trainees, misplaced emphasis on HIC selected issues rather than local solutions to local problems, the dominance of English language in the scientific literature, and exploitation of LMIC team members. Four key principles lie at the foundation of all our recommendations: 1) seek locally derived and relevant solutions to global health issues, 2) create paired collaborations between HIC and LMIC institutions at all levels of training, 3) provide funding for both HIC and LMIC team members, 4) assign clear roles and responsibilities to value, leverage, and share the strengths of all team members. When funding for global health research is predicated upon more ethical and equitable collaborations, the nature of global health collaborations will evolve to be more ethical and equitable. Therefore, we propose the Douala Equity Checklist as a 20-item tool HIC and LMIC institutions can use throughout the conduct of global health projects to ensure more equitable collaborations.
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Affiliation(s)
- Daniel Z Hodson
- Yale School of Medicine, New Haven, CT, United States of America
| | - Yannick Mbarga Etoundi
- Douala Military Hospital, Douala, Cameroon
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | - Sunil Parikh
- Yale School of Medicine, New Haven, CT, United States of America
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States of America
| | - Yap Boum
- Epicentre, Yaoundé, Cameroon
- Faculty of Medicine and Biomedical Science, University of Yaoundé I, Yaoundé, Cameroon
- Institut Pasteur of Bangui, Bangui, Central African Republic
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Abouzeid M, Muthanna A, Nuwayhid I, El-Jardali F, Connors P, Habib RR, Akbarzadeh S, Jabbour S. Barriers to sustainable health research leadership in the Global South: Time for a Grand Bargain on localization of research leadership? Health Res Policy Syst 2022; 20:136. [PMID: 36536392 PMCID: PMC9761652 DOI: 10.1186/s12961-022-00910-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 09/15/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Strong Global South (GS) health research leadership, itself both dependent on and a requisite for strong health research systems, is essential to generate locally relevant research and ensure that evidence is translated into policy and practice. Strong GS health research systems and leadership are important for health development and in turn for strong health systems. However, many GS countries struggle to produce research and to improve performance on widely used research metrics measuring productivity and reflecting leadership. Drawing on literature from a rapid review, this viewpoint paper considers the barriers to GS health research leadership and proposes strategies to address these challenges. FINDINGS GS researchers and institutions face numerous barriers that undermine health research leadership potential. Barriers internal to the GS include researcher-level barriers such as insufficient mentorship, limited financial incentives and time constraints. Institutional barriers include limited availability of resources, restrictive and poorly developed research infrastructures, weak collaboration and obstructive policies and procedures. Structural barriers include political will, politicization of research and political instability. External barriers relate to the nature and extent of Global North (GN) activities and systems and include allocation and distribution of funding and resources, characteristics and focus of GN-GS research collaborations, and publication and information dissemination challenges. CONCLUSIONS Strengthening GS health research leadership requires acknowledgement of the many barriers, and adoption of mitigating measures by a range of actors at the institutional, national, regional and global levels. Particularly important are leadership capacity development integrating researcher, institutional and systems initiatives; new GN-GS partnership models emphasizing capacity exchange and shared leadership; supporting GS research communities to set, own and drive their research agendas; addressing biases against GS researchers; ensuring that GS institutions address their internal challenges; enhancing South-South collaborations; diversifying research funding flow to the GS; and learning from models that work. The time has come for a firm commitment to improving localization of research leadership, supported by adequate funding flow, to ensure strong and sustainable research systems and leadership in and from the GS. Just as the humanitarian donor and aid community adopted the Grand Bargain commitment to improve funding flow through local and national responders in times of crisis, we strongly urge the global health research community to adopt a Grand Bargain for research leadership.
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Affiliation(s)
- Marian Abouzeid
- grid.22903.3a0000 0004 1936 9801The Lancet-American University of Beirut Commission on Syria, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon ,grid.22903.3a0000 0004 1936 9801Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon ,grid.1021.20000 0001 0526 7079Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Burwood, VIC Australia ,grid.1021.20000 0001 0526 7079Centre for Humanitarian Leadership, School of Humanities and Social Sciences, Deakin University, Burwood, VIC Australia
| | - Ahlam Muthanna
- grid.22903.3a0000 0004 1936 9801The Lancet-American University of Beirut Commission on Syria, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Iman Nuwayhid
- grid.22903.3a0000 0004 1936 9801The Lancet-American University of Beirut Commission on Syria, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon ,grid.22903.3a0000 0004 1936 9801Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Fadi El-Jardali
- grid.22903.3a0000 0004 1936 9801Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Phil Connors
- grid.1021.20000 0001 0526 7079Centre for Humanitarian Leadership, School of Humanities and Social Sciences, Deakin University, Burwood, VIC Australia
| | - Rima R. Habib
- grid.22903.3a0000 0004 1936 9801Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Shahram Akbarzadeh
- grid.1021.20000 0001 0526 7079Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Burwood, VIC Australia
| | - Samer Jabbour
- grid.22903.3a0000 0004 1936 9801The Lancet-American University of Beirut Commission on Syria, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon ,grid.22903.3a0000 0004 1936 9801Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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14
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Jones T, Enria L, Lees S, Marchant M, Tulloch O. Changing gear: Experiences of how existing qualitative research can adapt to an unfolding health emergency. FRONTIERS IN SOCIOLOGY 2022; 7:958861. [PMID: 36386857 PMCID: PMC9650412 DOI: 10.3389/fsoc.2022.958861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/10/2022] [Indexed: 06/16/2023]
Abstract
Long-term research projects are not always able to adapt to a new crisis and incorporate characteristics and approaches of rapid research to produce useful data quickly. Project AViD was a programme of research that ran between 2018 and 2022 to examine factors that shape vaccine confidence. The project initially focused on five country case studies looking at vaccines for Ebola, Measles, Rift Valley Fever and Zika. The COVID-19 pandemic emerged during this time and provided an opportunity to contribute to the pandemic's 'million-dollar question'-how to deploy COVID-19 vaccines. Drawing on our experience as researchers, and specifically from AViD, we propose seven factors that can influence when and how longer-term qualitative research projects can adapt and contribute to the response to an unfolding health emergency. These include: (1) the phase of research in which the emergency hits; (2) the relative significance of the emergency in the research setting; (3) the specific methods and research team capacities; (4) existing operational links; (5) supportive ecosystems; (6) flexibility in research contracting and funding; and (7) the research team attitude and approach. We close with two considerations for longer-term research projects that find themselves having to "change gear" amid a public health emergency-the need to re-assess risks and benefits and the need to protect equitable partnerships.
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Affiliation(s)
| | - Luisa Enria
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Shelley Lees
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mark Marchant
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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15
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Voller S, Chitalu CCM, Nyondo-Mipando AL, Opobo T, Bangirana CA, Thorogood N, Schellenberg J, Chi P. "We should be at the table together from the beginning": perspectives on partnership from stakeholders at four research institutions in sub-Saharan Africa. Int J Equity Health 2022; 21:111. [PMID: 35978323 PMCID: PMC9387072 DOI: 10.1186/s12939-022-01707-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background Global health research partnerships have been scrutinised for how they operate and criticised for perpetuating inequities. Guidance to inform fair partnership practice has proliferated and the movement to decolonise global health has added momentum for change. In light of this evolving context, we sought in this study to document contemporary experiences of partnership from the perspective of stakeholders in four sub-Saharan African research institutions. Methods We conducted qualitative interviews with 20 stakeholders at research institutions in four countries in anglophone eastern and southern Africa. Interview questions were informed by published guidance on equitable research partnerships. Data was analysed through an iterative process of inductive and deductive coding, supported by NVivo software. Results Early-career, mid-career and senior researchers and research administrators from four sub-Saharan African research institutions described wide-ranging experiences of partnership with high-income country collaborators. Existing guidelines for partnership provided good coverage of issues that participants described as being the key determinants of a healthy partnership, including mutual respect, role clarity and early involvement of all partners. However, there was almost no mention of guidelines being used to inform partnership practice. Participants considered the key benefits of partnership to be capacity strengthening and access to research funding. Meanwhile, participants continued to experience a range of well-documented inequities, including exclusion from agenda setting, study design, data analysis and authorship; and relationships that were exploitative and dominated by high-income country partners’ interests. Participants also reported emerging issues where their institution had been the prime recipient of funds. These included high-income country partners being unwilling to accept a subordinate role and failing to comply with reporting requirements. Conclusions Insights from stakeholders in four sub-Saharan African research institutions suggest that contemporary global health research partnerships generate considerable benefits but continue to exhibit longstanding inequities and reveal emerging tensions. Our findings suggest that long-term support targeted towards institutions and national research systems remains essential to fulfil the potential of research led from sub-Saharan Africa. High-income country stakeholders need to find new roles in partnerships and stakeholders from sub-Saharan Africa must continue to tackle challenges presented by the resource-constrained contexts in which they commonly operate. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-022-01707-3.
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Affiliation(s)
- Shirine Voller
- Epidemiology and Demography Department, KEMRI Wellcome Trust Research Programme, Kilifi, Kenya.
| | | | - Alinane Linda Nyondo-Mipando
- Department of Health Systems and Policy, School of Global and Public Health, Kamuzu University of Health Sciences (Formerly College of Medicine), Blantyre, Malawi
| | - Timothy Opobo
- The AfriChild Centre, College of Humanities and Social Sciences, Makerere University, Kampala, Uganda
| | - Clare Ahabwe Bangirana
- The AfriChild Centre, College of Humanities and Social Sciences, Makerere University, Kampala, Uganda
| | - Nicki Thorogood
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Joanna Schellenberg
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Primus Chi
- Health Systems and Research Ethics Department, KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
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17
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Fowler Z, Dutta R, Kilgallon JL, Wobenjo A, Bandyopadhyay S, Shah P, Jain S, Raykar NP, Roy N. Academic Output in Global Surgery after the Lancet Commission on Global Surgery: A Scoping Review. World J Surg 2022; 46:2317-2325. [PMID: 35849172 PMCID: PMC9436886 DOI: 10.1007/s00268-022-06640-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2022] [Indexed: 11/30/2022]
Abstract
Background The Lancet Commission on Global Surgery (LCoGS) published its seminal report in 2015, carving a niche for global surgery academia. Six years after the LCoGS, a scoping review was conducted to see how the term 'global surgery' is characterized by the literature and how it relates to LCoGS and its domains. Methods PubMed was searched for publications between January 2015 and February 2021 that used the term ‘global surgery’ in the title, abstract, or key words or cited the LCoGS. Variables extracted included LCoGS domains, authorship metrics, geographic scope, and clinical specialty. Results The search captured 938 articles that qualified for data extraction. Nearly 80% of first and last authors had high-income country affiliations. Africa was the most frequently investigated region, though many countries within the region were under-represented. The World Journal of Surgery was the most frequent journal, publishing 13.9% of all articles. General surgery, pediatric surgery, and neurosurgery were the most represented specialties. Of the LCoGS domains, healthcare delivery and management were the most studied, while economics and financing were the least studied. Conclusion A lack of consensus on the definition of global surgery remains. Additional research is needed in economics and financing, while obstetrics and trauma are under-represented in literature using the term ‘global surgery’. Efforts in academic global surgery must give a voice to those carrying the global surgery agenda forward on the frontlines. Focusing on research capacity-building and encouraging contribution by local partners will lead to a stronger, more cohesive global surgery community. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-022-06640-8.
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Affiliation(s)
- Zachary Fowler
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Surgery, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Rohini Dutta
- Christian Medical College and Hospital, Ludhiana, Punjab, India
- WHO Collaborating Centre for Research in Surgical Care Delivery in Low-Middle-Income Countries, Mumbai, India
| | - John L Kilgallon
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Adili Wobenjo
- WHO Collaborating Centre for Research in Surgical Care Delivery in Low-Middle-Income Countries, Mumbai, India
- Department of Surgery, Kenyatta University, Nairobi, Kenya
| | - Soham Bandyopadhyay
- Nuffield Department of Surgical Sciences, Oxford University Global Surgery Group, University of Oxford, Oxford, UK
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Samarvir Jain
- WHO Collaborating Centre for Research in Surgical Care Delivery in Low-Middle-Income Countries, Mumbai, India
- Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Nakul P Raykar
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
- Division of Trauma, Emergency Surgery, Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nobhojit Roy
- WHO Collaborating Centre for Research in Surgical Care Delivery in Low-Middle-Income Countries, Mumbai, India.
- Department of Public Health Systems, Karolinska Institute, 171 77, Stockholm, Sweden.
- The George Institute of Global Health, New Delhi, India.
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18
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Aiyenigba A, Abomo P, Wiltgen Georgi N, Bates I, Pulford J. Enabling research capacity strengthening within a consortium context: a qualitative study. BMJ Glob Health 2022; 7:bmjgh-2022-008763. [PMID: 35764358 PMCID: PMC9240891 DOI: 10.1136/bmjgh-2022-008763] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/07/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction We explore how health research consortia may be better structured to support research capacity strengthening (RCS) outcomes. The primary research questions include: in what ways do consortium members perceive that they and their respective institutions’ research capacity is strengthened from said membership? And, drawing on member experiences, what are the common factors that enable these perceived gains in research capacity to be realised? Methods A qualitative study set within the ‘Developing Excellence in Leadership, Training and Science’ (DELTAS) Africa initiative. Semi-structured interviews were completed with 69 participants from seven institutions across six African countries belonging to three DELTAS Africa consortia. Data were analysed thematically via a general inductive approach. Results A diverse array of perceived individual and institutional benefits of RCS consortium membership were reported. Individual benefits included access to training, resources and expertise as well as research and research leadership opportunities. Many institutional-level benefits of consortium membership were also driven through investment in individuals. Four enabling factors presented as especially influential in realising these benefits or realising them to a greater extent. These included: (1) access to funding; (2) inclusive and engaging leadership; (3) a diverse array of facilitated interactions for consortium members; and (4) an efficient interface between a consortium and their respective member institutions. Conclusion Many reported benefits of RCS consortium membership were realised through funding access, yet attention to the other three enabling factors may further amplify the advantages conferred by funding access or, when funds are insufficient, ensure worthwhile gains in RCS are still achieved.
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Affiliation(s)
- Abiola Aiyenigba
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Pierre Abomo
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Neele Wiltgen Georgi
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Imelda Bates
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Justin Pulford
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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19
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Tupetz A, Quirici M, Sultana M, Hoque KI, Stewart KA, Landry M. Exploring the intersection of critical disability studies, humanities and global health through a case study of scarf injuries in Bangladesh. MEDICAL HUMANITIES 2022; 48:169-176. [PMID: 35501122 PMCID: PMC9185814 DOI: 10.1136/medhum-2021-012244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 06/14/2023]
Abstract
This article puts critical disability studies and global health into conversation around the phenomenon of scarf injury in Bangladesh. Scarf injury occurs when a woman wearing a long, traditional scarf called an orna rides in a recently introduced autorickshaw with a design flaw that allows the orna to become entangled in the vehicle's driveshaft. Caught in the engine, the orna pulls the woman's neck into hyperextension, causing a debilitating high cervical spinal cord injury and quadriplegia. The circumstances of the scarf injury reveal the need for more critical cultural analysis than the fields of global health and rehabilitation typically offer. First, the fatal design flaw of the vehicle reflects different norms of gender and dress in China, where the vehicle is manufactured, versus Bangladesh, where the vehicle is purchased at a low price and assembled on-site-a situation that calls transnational capitalist modes of production and exchange into question. Second, the experiences of women with scarf injuries entail many challenges beyond the injury itself: the transition to life with disability following the rehabilitation period is made more difficult by negative perceptions of disability, lack of resources and accessible infrastructure, and cultural norms of gender and class in Bangladesh. Our cross-disciplinary conversation about women with scarf injuries, involving critical disability studies, global health and rehabilitation experts, exposes the shortcomings of each of these fields but also illustrates the urgent need for deeper and more purposeful collaborations. We, therefore, argue that the developing subfield of global health humanities should include purposeful integration of a humanities-based critical disability studies methodology.
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Affiliation(s)
- Anna Tupetz
- Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Marion Quirici
- Thompson Writing Program, Duke University, Durham, North Carolina, USA
| | - Mohsina Sultana
- Directorate of General Health Services (DGHS), Government of Mohakhali, Dhaka, Bangladesh
| | - Kazi Imdadul Hoque
- Physical Rehabilitation Program (PRP), International Committee of the Red Cross, Cox's Bazar, Bangladesh
| | | | - Michel Landry
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Hordaland, Norway
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Cassola A, Baral P, Røttingen JA, Hoffman SJ. Evaluating official development assistance-funded granting mechanisms for global health and development research that is initiated in high-income countries. Health Res Policy Syst 2022; 20:55. [PMID: 35578289 PMCID: PMC9109198 DOI: 10.1186/s12961-022-00859-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 04/13/2022] [Indexed: 12/03/2022] Open
Abstract
Background Several countries allocate official development assistance (ODA) for research on global health and development issues that is initiated in the donor country. The integration of such research within domestic research systems aligns with efforts to coordinate ODA investments with science, technology and innovation policies towards achieving the Sustainable Development Goals (SDGs). Methods Through a document synthesis and interviews with research funders in ODA donor and recipient countries, we evaluated the performance of this funding approach across seven donor-country programmes from five donor countries and examined the institutional design elements that increase its chances of advancing development goals and addressing global challenges. Results We found that carefully designed programmes provide a promising pathway to producing valuable and contextually relevant knowledge on global health and development issues. To achieve these outcomes and ensure they benefit ODA-receiving countries, programmes should focus on recipient-country priorities and absorptive capacity; translate research on global public goods into context-appropriate technologies; plan and monitor pathways to impact; structure equitable partnerships; strengthen individual and institutional capacity; and emphasize knowledge mobilization. Conclusions Global health and development research programmes and partnerships have an important role to play in achieving the SDGs and addressing global challenges. Governments should consider the potential of ODA-funded research programmes to address gaps in their global health and development frameworks. In the absence of concrete evidence of development impact, donor countries should consider making increases in ODA allocations for research additional to more direct investments that have demonstrated effectiveness in ODA-receiving countries. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-022-00859-6.
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Affiliation(s)
- Adèle Cassola
- Global Strategy Lab, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto, ON, M3J 1P3, Canada
| | - Prativa Baral
- Global Strategy Lab, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto, ON, M3J 1P3, Canada.,Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, 21205, USA
| | - John-Arne Røttingen
- Norwegian Institute of Public Health, 0213, Oslo, Norway.,Blavatnik School of Government, Oxford University, Oxford, OX2 6GG, UK.,Ministry of Foreign Affairs, 0032, Oslo, Norway
| | - Steven J Hoffman
- Global Strategy Lab, York University, 4700 Keele Street, Dahdaleh Building 2120, Toronto, ON, M3J 1P3, Canada. .,Dahdaleh Institute for Global Health Research, School of Global Health and Osgoode Hall Law School, York University, Toronto, M3J 1P3, Canada. .,Department of Health Research Methods, Evidence & Impact and McMaster Health Forum, McMaster University, Hamilton, L8S 4L8, Canada.
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21
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Larson CP, Plamondon KM, Dubent L, Bicaba F, Bicaba A, Minh TH, Nguyen A, Girard JE, Ramdé J, Gyorkos TW. The Equity Tool for Valuing Global Health Partnerships. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00316. [PMID: 35487557 PMCID: PMC9053142 DOI: 10.9745/ghsp-d-21-00316] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/15/2022] [Indexed: 11/15/2022]
Abstract
There is a need to more comprehensively identify and respond to equity in global health partnerships. The Equity Tool can support dialogue at any stage of a partnership, by individuals at any level. This assists partnerships to embrace ways of recognizing, understanding, and advancing equity in all their processes. Global health partnerships (GHPs) involve complex relationships between individuals and organizations, often joining partners from high-income and low- or middle-income countries around work that is carried out in the latter. Therefore, GHPs are situated in the context of global inequities and their underlying sociopolitical and historical causes, such as colonization. Equity is a core principle that should guide GHPs from start to end. How equity is embedded and nurtured throughout a partnership has remained a constant challenge. We have developed a user-friendly tool for valuing a GHP throughout its lifespan using an equity lens. The development of the EQT was informed by 5 distinct elements: a scoping review of scientific published peer-reviewed literature; an online survey and follow-up telephone interviews; workshops in Canada, Burkina Faso, and Vietnam; a critical interpretive synthesis; and a content validation exercise. Findings suggest GHPs generate experiences of equity or inequity yet provide little guidance on how to identify and respond to these experiences. The EQT can guide people involved in partnering to consider the equity implications of all their actions, from inception, through implementation and completion of a partnership. When used to guide reflective dialogue with a clear intention to advance equity in and through partnering, this tool offers a new approach to valuing global health partnerships. Global health practitioners, among others, can apply the EQT in their partnerships to learning together about how to cultivate equity in their unique contexts within what is becoming an increasingly diverse, vibrant, and responsive global health community.
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Affiliation(s)
- Charles P Larson
- Canadian Association for Global Health (formerly Canadian Coalition for Global Health Research), Ottawa, Canada.
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
| | - Katrina M Plamondon
- Canadian Association for Global Health (formerly Canadian Coalition for Global Health Research), Ottawa, Canada
- School of Nursing, Faculty of Health and Social Development, University of British Columbia, Okanagan, Canada
| | - Leslie Dubent
- Canadian Association for Global Health (formerly Canadian Coalition for Global Health Research), Ottawa, Canada
| | - Frank Bicaba
- Société d'Études et de Recherche en Santé Publique, Ouagadougou, Burkina Faso
| | - Abel Bicaba
- Société d'Études et de Recherche en Santé Publique, Ouagadougou, Burkina Faso
| | - Tran Hung Minh
- Center for Creative Initiatives in Health and Population, Hanoi, Vietnam
| | - An Nguyen
- HealthBridge Vietnam, Hanoi, Vietnam
| | - Jacques E Girard
- Canadian Association for Global Health (formerly Canadian Coalition for Global Health Research), Ottawa, Canada
- Direction en Santé Mondiale, Faculté de Médecine, Université Laval, Québec, Canada
| | - Jean Ramdé
- Canadian Association for Global Health (formerly Canadian Coalition for Global Health Research), Ottawa, Canada
- HealthBridge Vietnam, Hanoi, Vietnam
| | - Theresa W Gyorkos
- Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
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Chillo P, Mashili F, Kwesigabo G, Ruggajo P, Kamuhabwa A. Developing a Sustainable Cardiovascular Disease Research Strategy in Tanzania Through Training: Leveraging From the East African Centre of Excellence in Cardiovascular Sciences Project. Front Cardiovasc Med 2022; 9:849007. [PMID: 35402575 PMCID: PMC8990919 DOI: 10.3389/fcvm.2022.849007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/01/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Cardiovascular disease (CVD) contribute the largest mortality burden globally, with most of the deaths (80% of all deaths) occurring in low and middle-income countries (LMICs), including Tanzania. Despite the increasing burden, to date, CVD research output is still limited in Tanzania, as it is for many sub-Saharan Africa (SSA) countries. This trend hinders the establishment of locally informed CVD management and policy changes. Here, we aim to review the existing gaps while highlighting the available opportunities for a sustainable CVD research strategy in Tanzania. Methods A rapid review of available literature on CVD research in SSA was conducted, with emphasis on the contribution of Tanzania in the world literature of CVD. Through available literature, we identify strategic CVD research priorities in Tanzania and highlight challenges and opportunities for sustainable CVD research output. Findings Shortage of skilled researchers, inadequate research infrastructure, limited funding, and lack of organized research strategies at different levels (regional, country, and institutional) are among the existing key bottlenecks contributing to the low output of CVD research in Tanzania. There is generally strong global, regional and local political will to address the CVD epidemic. The establishment of the East African Centre of Excellence in Cardiovascular Sciences (EACoECVS) offers a unique opportunity for setting strategies and coordinating CVD research and training for Tanzania and the East African region. Conclusion There is a light of hope for long-term sustainable CVD research output from Tanzania, taking advantage of the ongoing activities and plans for the evolving EACoECVS. The Tanzanian experience can be taken as a lesson for other SSA countries.
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Affiliation(s)
- Pilly Chillo
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- East African Centre of Excellence in Cardiovascular Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- *Correspondence: Pilly Chillo, ;
| | - Fredirick Mashili
- East African Centre of Excellence in Cardiovascular Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gideon Kwesigabo
- East African Centre of Excellence in Cardiovascular Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Paschal Ruggajo
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Appolinary Kamuhabwa
- East African Centre of Excellence in Cardiovascular Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Jensen N, Kelly AH, Avendano M. Health equity and health system strengthening - Time for a WHO re-think. Glob Public Health 2022; 17:377-390. [PMID: 33427084 PMCID: PMC8820375 DOI: 10.1080/17441692.2020.1867881] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/11/2020] [Indexed: 11/16/2022]
Abstract
The pursuit of health equity is foundational to the global health enterprise. But while moral concerns over health inequities can galvanise political commitment, how such concerns can or should translate into practice remains less clear. This paper reviews evolving ways that equity goals have featured in key World Health Organization (WHO)-related policy documents, before discussing the heuristic value and empirical traction that the concept of equity can bring to the health system strengthening (HSS) agenda. We argue that while health equity is often presented as the overarching goal of HSS, in practice this is typically circumscribed to the provision of healthcare services. Although healthcare equity is important, we suggest that this narrow focus risks losing sight of the structural political, social and economic drivers of health and health inequities, as well as the broader contexts of care and complex socio-political mechanisms through which health systems are strengthened. Drawing on new lines of empirical inquiry, we propose that broadening the equity lens for HSS -offers exciting opportunities to put health systems at the heart of a more ambitious equity agenda in global health.
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Affiliation(s)
- N. Jensen
- Department of Global Health and Social Medicine, King’s College London, North East Wing, 40 Aldwych, London, WC2B 4BG, UK
| | - A. H. Kelly
- Department of Global Health and Social Medicine, King’s College London, North East Wing, 40 Aldwych, London, WC2B 4BG, UK
| | - M. Avendano
- Department of Global Health and Social Medicine, King’s College London, North East Wing, 40 Aldwych, London, WC2B 4BG, UK
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, USA
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Sant Fruchtman C, Bilal Khalid M, Keakabetse T, Bonito A, Saulnier DD, Mupara LM, Iqbal S, de Almeida A, da Silva H, de Jesus D, Prytherch H, Mokalake E, Cobos Muñoz D, Zafar S. Digital communities of practice: one step towards decolonising global health partnerships. BMJ Glob Health 2022; 7:bmjgh-2021-008174. [PMID: 35110274 PMCID: PMC8811579 DOI: 10.1136/bmjgh-2021-008174] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/29/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- Carmen Sant Fruchtman
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland .,University of Basel, Basel, Switzerland
| | | | | | - Antonio Bonito
- World Health Organization Country Office for Timor-Leste, Dili, Timor-Leste
| | - Dell D Saulnier
- Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Shahid Iqbal
- Child Advocacy International, Islamabad, Pakistan
| | | | | | | | - Helen Prytherch
- University of Basel, Basel, Switzerland.,Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Ellen Mokalake
- Public Health, Institute for Development Management, Gaborone, Botswana
| | - Daniel Cobos Muñoz
- Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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25
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Voller S, Schellenberg J, Chi P, Thorogood N. What Makes Working Together Work? A Scoping Review of the Guidance on North-South Research Partnerships. Health Policy Plan 2022; 37:523-534. [PMID: 35089994 PMCID: PMC9006068 DOI: 10.1093/heapol/czac008] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/29/2021] [Accepted: 01/28/2022] [Indexed: 11/14/2022] Open
Abstract
At their best, research partnerships provide a mechanism to optimize each partner’s strengths, make scientific discoveries and achieve development goals. Each partner stands to gain from the relationship and perceives it to be fair. However, partnerships between institutions in the global North and the global South have been beleaguered by structural inequalities and power imbalances, and Northern stakeholders have been criticized for perpetuating paternalistic or neo-colonial behaviours. As part of efforts to redress imbalances and achieve equity and mutual benefit, various principles, guidelines, frameworks and models for partnership have been developed. This scoping review maps the literature and summarizes key features of the guidelines for North–South research partnerships. The review was conducted between October 2020 and January 2021. Three academic journal databases and Google were searched, and additional resources were identified through a hand search of reference lists and expert recommendation. Twenty-two guidelines were identified published between 1994 and 2021 and originating predominantly in the fields of international development and global health. The themes addressed within the guidelines were aggregated using NVivo qualitative analysis software to code the content of each guideline. Topics featuring most prominently in the guidelines were: partner roles, responsibilities and ways of working; capacity strengthening; motivation and goals; resource contributions; agenda setting and study design; governance structures and institutional agreements; dissemination; respect for affected populations; data handling and ownership; funding and long-term commitments. The current study reinforces many of the themes from two recent scoping reviews specific to the field of global health, but gaps remain, which need to be addressed: Southern stakeholders continue to be under-represented in guideline development, and there is limited evidence of how guidelines are used in practice. Further exploration is needed of Southern stakeholder priorities and whether and how guidelines are operationalized.
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Affiliation(s)
- Shirine Voller
- *Corresponding author. Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK. E-mail:
| | - Joanna Schellenberg
- Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Primus Chi
- Health Systems and Research Ethics Department, KEMRI Wellcome Trust Research Programme, CGMRC, PO Box 230-80108 Kilifi, Kenya
| | - Nicki Thorogood
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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26
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Sobngwi-Tambekou JL, Jones CM, Wenham C, Ratsimbason M, Ratsimbazafy MR, Andriamizarasoa FA, Juma P, Mijumbi-Deve R, Parkhurst J. [Health research in Madagascar: state-of-the-art, challenges and perspectives]. Pan Afr Med J 2021; 39:36. [PMID: 34422159 PMCID: PMC8356933 DOI: 10.11604/pamj.2021.39.36.27462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/23/2021] [Indexed: 11/11/2022] Open
Abstract
The evolution and contemporary challenges of health research (HR) in Madagascar are poorly documented. We aim to gain insights on the factors that shape Madagascar's National Health Research System (NHRS) to better understand their influence. We conducted a qualitative case study, which included a documentary review and semi-structured interviews with 38 key informants. We carried out a thematic analysis and used the WHO/AFRO NHRS Barometer to structure the presentation of the results. There is no legislative framework to support HR activities and institutions. There is, however, a policy document outlining national priorities for HS. Human resources for HR are insufficient, due to challenges in training and retaining researchers. International collaboration is almost the only source of HR funding. Collaborations contribute to developing human and institutional capacity, but they are not always aligned with research carried out locally and the country's priority health needs. Incomplete efforts to improve regulation and low public investment in research training and research implementation reflect an insufficient commitment to HR by the government. Negotiating equitable international partnerships, the availability of public funding, and aligning HR with national health priorities would constitute a solid basis for the development of the NHRS in Madagascar.
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Affiliation(s)
- Joëlle Laure Sobngwi-Tambekou
- London School of Economics (LSE) and Political Science, LSE Health, London, United Kingdom.,Recherche Santé et Développement (RSD Institut), Yaoundé, Cameroun
| | - Catherine Marie Jones
- London School of Economics (LSE) and Political Science, LSE Health, London, United Kingdom
| | - Clare Wenham
- London School of Economics and Political Science, Department of Health Policy, London, United Kingdom
| | - Michel Ratsimbason
- Centre National d´Application de Recherches Pharmaceutiques, Antananarivo, Madagascar
| | - Marie-Rolland Ratsimbazafy
- Service d´Appui à la Recherche et à la Gestion des Connaissances, Direction de la formation et de la Recherche, Institut National de Santé Publique et Communautaire, Antananarivo, Madagascar
| | - Fidelis Adolphe Andriamizarasoa
- Direction des Études, de la Planification et du Système d'Information, Ministère de la Santé Publique, Antananarivo, Madagascar
| | - Pamela Juma
- London School of Economics (LSE) and Political Science, LSE Health, London, United Kingdom
| | - Rhona Mijumbi-Deve
- London School of Economics (LSE) and Political Science, LSE Health, London, United Kingdom.,Centre for Rapid Evidence Synthesis, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Justin Parkhurst
- London School of Economics and Political Science, Department of Health Policy, London, United Kingdom
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27
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Voss M, Swart O, Abel L, Mahtani K. Capacity-building partnerships for surgical post-graduate training in low- and middle-income countries: a scoping review of the literature with exploratory thematic synthesis. Health Policy Plan 2021; 35:1385-1412. [PMID: 33159525 DOI: 10.1093/heapol/czaa075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2020] [Indexed: 11/14/2022] Open
Abstract
In recent years, international surgical programmes have moved away from vertical service delivery and towards collaborative, capacity-building partnerships. The aim of this review was to provide a map of the current literature on international surgical training partnerships together with an exploration of factors influencing their implementation. Three bibliographic databases were searched for peer-reviewed reports of surgical training partnerships between organizations in high- and low or middle-income countries to July 2018. Reports were sorted in an iterative fashion into groups of similar programmes, and data were extracted to record the intervention strategies, context, financing, reported results and themes around implementation. Eighty-six reports were grouped into five types of programme: full residency training, bi-institutional twinning partnerships, diagonal/sub-specialist programmes, focused interventions or courses and programmes using remote support. Few articles were written from the perspective of the low-middle income partner. Full residency programmes and some diagonal/sub-specialist programmes report numbers trained while twinning partnerships and focused interventions tend to focus on process, partners' reactions to the programme and learning metrics. Two thematic networks emerged from the thematic synthesis. The first made explicit the mechanisms by which partnerships are expected to contribute to improved access to surgical care and a second identified the importance of in-country leadership in determining programme results. Training partnerships are assumed to improve access to surgical care by a number of routes. A candidate programme theory is proposed together with some more focused theories that could inform future research. Supporting the development of the surgical leadership in low- and middle-income countries is key.
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Affiliation(s)
- Miranda Voss
- Harris Manchester College, Savile Road Oxford, Oxford OX1 3TZ, UK
| | - Oostewalt Swart
- Department of Surgery, Worcester Hospital, Murray Street, Worcester 6840, South Africa
| | - Lucy Abel
- Nuffield Department of Primary Healthcare Sciences, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
| | - Kamal Mahtani
- Nuffield Department of Primary Healthcare Sciences, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, UK
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28
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Jenkins C, Hien HT, Chi BL, Santin O. What works in global health partnerships? Reflections on a collaboration between researchers from Vietnam and Northern Ireland. BMJ Glob Health 2021; 6:bmjgh-2021-005535. [PMID: 33827794 PMCID: PMC8031016 DOI: 10.1136/bmjgh-2021-005535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Chris Jenkins
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Ho Thi Hien
- Faculty of Medicine, Hanoi University of Public Health, Hanoi, Viet Nam
| | - Bui Linh Chi
- Faculty of Medicine, Hanoi University of Public Health, Hanoi, Viet Nam
| | - Olinda Santin
- Queen's University Belfast School of Nursing and Midwifery, Belfast, UK
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29
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Monette EM, McHugh D, Smith MJ, Canas E, Jabo N, Henley P, Nouvet E. Informing 'good' global health research partnerships: A scoping review of guiding principles. Glob Health Action 2021; 14:1892308. [PMID: 33704024 PMCID: PMC7954413 DOI: 10.1080/16549716.2021.1892308] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Several sets of principles have been proposed to guide global health research partnerships and mitigate inequities inadvertently caused by them. The existence of multiple sets of principles poses a challenge for those seeking to critically engage with and develop their practice. Which of these is best to use, and why? To what extent, if any, is there agreement across proposed principles? Objective: The objectives of this review were to: (1) identify and consolidate existing documents and principles to guide global health research partnerships; (2) identify areas of overlapping consensus, if any, regarding which principles are fundamental in these partnerships; (3) identify any lack of consensus in the literature on core principles to support these partnerships. Methods: A scoping review was conducted to gather documents outlining ‘principles’ of good global health research partnerships. A broad search of academic databases to gather peerreviewed literature was conducted, complemented by a hand-search of key global health funding institutions for grey literature guidelines. Results: Our search yielded nine sets of principles designed to guide and support global health research partnerships. No single principle recurred across all documents reviewed. Most frequently cited were concerns with mutual benefits between partners (n = 6) and equity (n = 4). Despite a lack of consistency in the inclusion and definition of principles, all sources highlighted principles that identified attention to fairness, equity, or justice as an integral part of good global health research partnerships. Conclusions: Lack of consensus regarding how principles are defined suggests a need for further discussion on what global health researchers mean by ‘core’ principles. Research partnerships should seek to interpret the practical meanings and requirements of these principles through international consultation. Finally, a need exists for tools to assist with implementation of these principles to ensure their application in research practice.
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Affiliation(s)
| | - David McHugh
- School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, Canada
| | - Maxwell J Smith
- School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, Canada
| | - Eugenia Canas
- Faculty of Information and Media Studies, University of Western Ontario, London, Canada
| | - Nicole Jabo
- Center for One Health, University of Global Health Equity, Butaro, Rwanda
| | - Phaedra Henley
- Center for One Health, University of Global Health Equity, Butaro, Rwanda
| | - Elysée Nouvet
- School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, Canada
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30
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Abas MA, Weobong B, Burgess RA, Kienzler H, Jack HE, Kidia K, Musesengwa R, Petersen I, Collins PY, Nakimuli-Mpungu E. COVID-19 and global mental health. Lancet Psychiatry 2021; 8:458-459. [PMID: 34023013 PMCID: PMC9764874 DOI: 10.1016/s2215-0366(21)00155-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 01/01/2023]
Affiliation(s)
- Melanie Amna Abas
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK.
| | - Benedict Weobong
- School of Public Health, College of Health Sciences, Department of Social and Behavioural Sciences, University of Ghana, Accra, Ghana
| | | | - Hanna Kienzler
- Department of Global Health and Social Medicine, King's College London, London SE5 8AF, UK
| | - Helen E Jack
- Department of Medicine, University of Washington, Seattle, WA, USA
| | | | - Rosemary Musesengwa
- Wellcome Centre for Ethics and Humanities, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Inge Petersen
- Centre for Rural Health, College of Health Sciences, Howard College, University of KwaZulu-Natal, Durban, South Africa
| | - Pamela Y Collins
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Etheldreda Nakimuli-Mpungu
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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31
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Odeny B. A call for diversity, equity, and inclusion: Highlights from the Consortium of Universities for Global Health 2021 conference. PLoS Med 2021; 18:e1003607. [PMID: 33857154 PMCID: PMC8084182 DOI: 10.1371/journal.pmed.1003607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 04/29/2021] [Indexed: 11/18/2022] Open
Abstract
Beryne Odeny reports from the CUGH 2021 virtual conference.
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Affiliation(s)
- Beryne Odeny
- Public Library of Science, San Francisco, California, United States of America and Cambridge, United Kingdom
- * E-mail:
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32
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Urassa M, Lawson DW, Wamoyi J, Gurmu E, Gibson MA, Madhivanan P, Placek C. Cross-cultural research must prioritize equitable collaboration. Nat Hum Behav 2021; 5:668-671. [PMID: 33737733 DOI: 10.1038/s41562-021-01076-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Mark Urassa
- National Institute for Medical Research, Mwanza, Tanzania.
| | - David W Lawson
- Department of Anthropology, University of California Santa Barbara, Santa Barbara, CA, USA.
| | - Joyce Wamoyi
- National Institute for Medical Research, Mwanza, Tanzania
| | - Eshetu Gurmu
- Centre for Population Studies and Institute of Development and Policy Research, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mhairi A Gibson
- Department of Anthropology and Archaeology, University of Bristol, Bristol, UK
| | - Purnima Madhivanan
- Public Health Research Institute of India, Mysore, India.,Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Caitlyn Placek
- Department of Anthropology, Ball State University, Muncie, IN, USA
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33
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Eichbaum QG, Adams LV, Evert J, Ho MJ, Semali IA, van Schalkwyk SC. Decolonizing Global Health Education: Rethinking Institutional Partnerships and Approaches. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:329-335. [PMID: 32349015 DOI: 10.1097/acm.0000000000003473] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Global health often entails partnerships between institutions in low- and middle-income countries (LMICs) that were previously colonized and high-income countries (HICs) that were colonizers. Little attention has been paid to the legacy of former colonial relationships and the influence they have on global health initiatives. There have been recent calls for the decolonization of global health education and the reexamination of assumptions and practices under pinning global health partnerships. Medicine's role in colonialism cannot be ignored and requires critical review. There is a growing awareness of how knowledge generated in HICs defines practices and informs thinking to the detriment of knowledge systems in LMICs. Additionally, research partnerships often benefit the better-resourced partner. In this article, the authors offer a brief analysis of the intersections between colonialism, medicine, and global health education and explore the lingering impact of colonialist legacies on current global health programs and partnerships. They describe how "decolonized" perspectives have not gained sufficient traction and how inequitable power dynamics and neocolonialist assumptions continue to dominate. They discuss 5 approaches, and highlight resources, that challenge colonial paradigms in the global health arena. Furthermore, they argue for the inclusion of more transfor mative learning approaches to promote change in attitudes and practice. They call for critical reflection and concomitant action to shift colonial paradigms toward more equitable partnerships in global education.
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Affiliation(s)
- Quentin G Eichbaum
- Q.G. Eichbaum is professor of pathology, microbiology and immunology, and director, Vanderbilt Pathology Program in Global Health, Vanderbilt University Medical Center, as well as professor of medical education and administration, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Lisa V Adams
- L.V. Adams is associate dean for global health, associate professor of medicine and epidemiology, and director, Center for Global Health Equity, Geisel School of Medicine at Dartmouth and Dartmouth College, Hanover, New Hampshire; ORCID: http://orcid.org/0000-0002-1303-2154
| | - Jessica Evert
- J. Evert is assistant clinical professor, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, and executive director, Child Family Health International, Oakland, California; ORCID: http://orcid.org/0000-0002-3669-7693
| | - Ming-Jung Ho
- M.-J. Ho is professor, Department of Family Medicine, Georgetown University School of Medicine, associate director, Center for Innovation and Leadership in Education, Georgetown University Medical Center, and director of education research, MedStar Health, Washington, DC
| | - Innocent A Semali
- I.A. Semali is senior lecturer, Epidemiology, Hubert Kairuki Memorial University, Dar es Salaam, Tanzania
| | - Susan C van Schalkwyk
- S.C. van Schalkwyk is professor, Health Professions Education, and director, Centre for Health Professions Education, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa; ORCID: http://orcid.org/0000-0003-1596-6791
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34
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How will COVID-19 transform global health post-pandemic? Defining research and investment opportunities and priorities. PLoS Med 2021; 18:e1003564. [PMID: 33705396 PMCID: PMC7951893 DOI: 10.1371/journal.pmed.1003564] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Michael Reid and co-authors introduce a Collection on the global health in the post-COVID-19 era.
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35
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Coordination and planning of clinical research on a national and global level. Fertil Steril 2021; 113:1100-1106. [PMID: 32482245 DOI: 10.1016/j.fertnstert.2020.04.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 12/11/2022]
Abstract
In reproductive medicine, the needs and desires of infertility patients drive future research, with the most important outcome being live birth of a baby. Large, multicenter, randomized clinical trials are considered the best research tool to evaluate the effectiveness of medical interventions, but they can often take a long time to find definitive answers. Advances in individual participant data (IPD) and network meta-analysis have enabled research questions to be answered more quickly, but better planning could streamline this process further. To harmonize research findings that are taking place globally in this way, it is crucial that the same outcomes are collected in clinical trials conducted in reproductive medicine. Furthermore, the conduct of clinical trials often requires collaboration on an international scale; however, individual countries have their own processes for research prioritization and delivery. We describe the perspective of high- and low-resourced settings and industry as well as the mechanisms of prioritization and coordination that are in place in different settings. In addition, we discuss the importance of the patient perspective, which can help shape the research question, clinical trial design, and the logistical operations of trial delivery. The need for increased global collaboration and coalitions within and between stakeholders is evident for the research community to accelerate advances and maximize benefits in reproductive medicine.
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36
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Nabyonga-Orem J, Asamani JA, Makanga M. The state of health research governance in Africa: what do we know and how can we improve? Health Res Policy Syst 2021; 19:11. [PMID: 33482839 PMCID: PMC7821686 DOI: 10.1186/s12961-020-00676-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/21/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The developments in global health, digital technology, and persistent health systems challenges, coupled with global commitments like attainment of universal health coverage, have elevated the role of health research in low- and middle-income countries. However, there is a need to strengthen health research governance and create a conducive environment that can promote ethics and research integrity and increase public trust in research. OBJECTIVE To assess whether the necessary structures are in place to ensure health research governance. METHODS Employing a cross-sectional survey, we collected data on research governance components from 35 Member States of the World Health Organization (WHO) African Region. Data were analysed using basic descriptive and comparative analysis. RESULTS Eighteen out of 35 countries had legislation to regulate the conduct of health research, while this was lacking in 12 countries. Some legislation was either grossly outdated or too limiting in scope, while some countries had multiple laws. Health research policies and strategies were in place in 16 and 15 countries, respectively, while research priority lists were available in 25 countries. Overlapping mandates of institutions responsible for health research partly explained the lack of strategic documents in some countries. The majority of countries had ethical committees performing a dual role of ethical and scientific review. Research partnership frameworks were available to varying degrees to govern both in-country and north-south research collaboration. Twenty-five countries had a focal point and unit within the ministries of health (MoH) to coordinate research. CONCLUSION Governance structures must be adaptive to embrace new developments in science. Further, strong coordination is key to ensuring comprehensiveness and complementarity in both research development and generation of evidence. The majority of committees perform a dual role of ethics and scientific review, and these need to ensure representation of relevant expertise. Opportunities that accrue from collaborative research need to be seized through strong MoH leadership and clear partnership frameworks that guide negotiations.
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Affiliation(s)
- Juliet Nabyonga-Orem
- Inter-Country Support Team for Eastern and Southern Africa, UHC Life Course Cluster, World Health Organization, 82-86 Enterprise/Glenara Roads, Highlands, P.O Box CY 348; Causeway, Harare, Zimbabwe
| | - James Avoka Asamani
- Inter-Country Support Team for Eastern and Southern Africa, UHC Life Course Cluster, World Health Organization, 82-86 Enterprise/Glenara Roads, Highlands, P.O Box CY 348; Causeway, Harare, Zimbabwe
| | - Micheal Makanga
- The European & Developing Countries Clinical Trials Partnership (EDCTP), Anna van Saksenlaan 51, 2593 HW The Hague, The Netherlands
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37
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Chang AY, Laker-Oketta M, Coates SJ. Prioritizing equity and inclusion in global health dermatology. Int J Womens Dermatol 2021; 7:154-157. [PMID: 33937482 PMCID: PMC8072506 DOI: 10.1016/j.ijwd.2020.12.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Aileen Y. Chang
- Department of Dermatology, University of California, San Francisco, CA, United States
- Corresponding author.
| | - Miriam Laker-Oketta
- Infectious Diseases Institute, Kampala, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Sarah J. Coates
- Department of Dermatology, University of California, San Francisco, CA, United States
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38
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Erondu NA, Peprah D, Khan MS. Can schools of global public health dismantle colonial legacies? Nat Med 2020; 26:1504-1505. [PMID: 32860007 DOI: 10.1038/s41591-020-1062-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Ngozi A Erondu
- Centre for Universal Health, Chatham House, The Royal Institute of International Affairs, London, UK.
| | - Dorothy Peprah
- Institute of Women and Ethnic Studies, New Orleans, LA, USA
| | - Mishal S Khan
- Centre for Universal Health, Chatham House, The Royal Institute of International Affairs, London, UK.,London School of Hygiene and Tropical Medicine, London, UK.,Aga Khan University, Karachi, Pakistan
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39
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Osier FHA, Mwandumba HC, Gray CM. Turning Discoveries into Treatments: Immunology in Africa. Trends Immunol 2020; 41:1051-1053. [PMID: 33160840 DOI: 10.1016/j.it.2020.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/09/2020] [Indexed: 11/15/2022]
Abstract
An exemplar outcome of an immunology-based intervention is vaccine development; the current COVID-19 pandemic is a case in point. Can we build an immunology research ecosystem in Africa that nurtures discovery and enables translation? We see African immunologists as key agents of change and discuss obstacles and opportunities.
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Affiliation(s)
- Faith H A Osier
- Centre of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany; KEMRI Wellcome Trust Research Programme, Centre for Geographic Medicine Research-Coast, Kilifi, Kenya.
| | - Henry C Mwandumba
- Malawi Liverpool Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi
| | - Clive M Gray
- Division of Immunology, Institute of Infectious Disease and Molecular Medicine and Department of Pathology, University of Cape Town, Cape Town, South Africa
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40
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González-Alcaide G, Menchi-Elanzi M, Nacarapa E, Ramos-Rincón JM. HIV/AIDS research in Africa and the Middle East: participation and equity in North-South collaborations and relationships. Global Health 2020; 16:83. [PMID: 32943058 PMCID: PMC7499968 DOI: 10.1186/s12992-020-00609-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 08/11/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND HIV/AIDS has attracted considerable research attention since the 1980s. In the current context of globalization and the predominance of cooperative work, it is crucial to analyze the participation of the countries and regions where the infection is most prevalent. This study assesses the participation of African countries in publications on the topic, as well as the degree of equity or influence existing in North-South relations. METHODS We identified all articles and reviews of HIV/AIDS indexed in the Web of Science Core Collection. We analyzed the scientific production, collaboration, and contributions from African and Middle Eastern countries to scientific activity in the region. The concept of leadership, measured through the participation as the first author of documents in collaboration was used to determine the equity in research produced through international collaboration. RESULTS A total of 68,808 documents published from 2010 to 2017 were analyzed. Researchers from North America and Europe participated in 82.14% of the global scientific production on HIV/AIDS, compared to just 21.61% from Africa and the Middle East. Furthermore, the publications that did come out of these regions was concentrated in a small number of countries, led by South Africa (41% of the documents). Other features associated with HIV/AIDS publications from Africa include the importance of international collaboration from the USA, the UK, and other European countries (75-93% of the documents) and the limited participation as first authors that is evident (30 to 36% of the documents). Finally, the publications to which African countries contributed had a notably different disciplinary orientation, with a predominance of research on public health, epidemiology, and drug therapy. CONCLUSIONS It is essential to foster more balance in research output, avoid the concentration of resources that reproduces the global North-South model on the African continent, and focus the research agenda on local priorities. To accomplish this, the global North should strengthen the transfer of research skills and seek equity in cooperative ties, favoring the empowerment of African countries. These efforts should be concentrated in countries with low scientific activity and high incidence and prevalence of the disease. It is also essential to foster intraregional collaborations between African countries.
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Affiliation(s)
| | - Marouane Menchi-Elanzi
- Department of Internal Medicine, General University Hospital of Alicante, Alicante, Spain
| | - Edy Nacarapa
- Infectious Disease Division, Carmelo Hospital of Chókwè - Daughters of Charity, Saint Vincent of Paul, Chókwè, Gaza Province, Mozambique
- Tinpswalo Association, Research Unit, Vincentian Association to Fight AIDS and TB, Chókwè, Gaza Province, Mozambique
| | - José-Manuel Ramos-Rincón
- Department of Internal Medicine, General University Hospital of Alicante, Alicante, Spain.
- Department of Clinical Medicine, Miguel Hernandez University of Elche, Alicante, Spain.
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Stallwood L, Adu PA, Tairyan K, Astle B, Yassi A. Applying equity-centered principles in an interprofessional global health course: a mixed methods study. BMC MEDICAL EDUCATION 2020; 20:224. [PMID: 32664903 PMCID: PMC7362565 DOI: 10.1186/s12909-020-02141-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 07/06/2020] [Indexed: 05/21/2023]
Abstract
BACKGROUND Medical students, practitioners and other health professionals are commonly unprepared to address the many complex issues that emerge while conducting research in the Global South. As a response to identified deficiencies in global health education, a hybrid online/face-to-face multi-institutional credit course was developed based on the equity-centered principles advanced by the Canadian Coalition for Global Health Research (CCGHR), namely Authentic partnering, Inclusion, Shared benefits, Commitment to the future, Responsiveness to causes of inequities, and Humility. This study aimed to analyze the extent to which the course was effective in fortifying attitudes consistent with the CCGHR principles; identify successes and challenges; and assess how a course such as this can fill an identified gap. METHODS This interprofessional course was offered to 25 graduate and postgraduate students in various health professions and public health. Faculty were drawn from medicine, public health, nursing and social sciences from four universities in Western Canada. A pre-post retrospective survey, key informant interviews and participant observation were used to gather data for this study. RESULTS Findings showed that student attitudes regarding global health research and practice significantly evolved towards views consistent with the principles articulated. The multiple instructors and hybrid course format created both opportunities and challenges; the interprofessional nature of the cohort was considered a strong asset, as was the fact that many students came from the Global South. Some students suggested that the course could be further strengthened by concretely partnering with institutions in the Global South rather than offered solely to learners registered in universities in the Global North. CONCLUSIONS While weaknesses were identified, results support the conclusion that a course focused on the CCGHR principles could be useful in preparing the next generation of global health researchers and practitioners to mitigate historical limitations in this field. Longitudinal follow-up is warranted to provide more definitive conclusions.
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Affiliation(s)
- Lisa Stallwood
- Faculty of Health Science, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada
| | - Prince A Adu
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada
- British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada
| | - Kate Tairyan
- Faculty of Health Sciences, Simon Fraser University, 8888 University Dr, Burnaby, BC, V5A 1S6, Canada
| | - Barbara Astle
- School of Nursing, Trinity Western University, 7600 Glover Rd, Langley, BC, V2Y 1Y1, Canada
| | - Annalee Yassi
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada.
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Comparing Approaches to Research in Global and International Health: An Exploratory Study. Ann Glob Health 2020; 86:47. [PMID: 32377512 PMCID: PMC7193757 DOI: 10.5334/aogh.2799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Global health is a term often used interchangeably with international health due to overlapping similarities and unclear distinctions. While some international health supporters argue that global health as a field is unnecessary as it is simply a duplicate of international health, global health supporters argue that global health is unique; for instance, it actively includes elements of empowerment and promotes cross-border collaboration. Objective: To investigate differences and similarities in research representing the fields of global and international health. Methods: We analyzed all the articles published in 2017 in two comparable academic journals representing the fields of global health (Annals of Global Health, AGH) and international health (International Health Journal, IHJ). Abstracted data included: research design and methods, income status of country of study, empowerment recommendations for practice, participation and research collaboration. Findings: Most studies in both AGH and IHJ used quantitative research methods but were significantly more common in IHJ (70%) compared to AGH (48%), whereas mores studies in AGH (17%) than IHJ (9%) used mixed methods. The majority of studies in both journals focused on low- or lower-middle income countries whereas more AGH studies (16%) focused on high-income countries compared to the IHJ studies (4%). It was more common in the AGH studies to make empowerment recommendations (90%) and to include stakeholders/users in the study (40%) compared to the IHJ studies (75% empowerment recommendations and 18% stakeholder/user participation). No difference was observed regarding cross-border research collaboration. Conclusions: This study does not show great differences between global health and international health research; however, there are still some differences indicating that global health emphasises different aspects of research compared to international health. More research is necessary to understand whether and how the distinctions between the definitions of global and international health are applied in real life, in research and beyond.
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Jansen-van Vuuren J, Aldersey HM, Lysaght R. The role and scope of occupational therapy in Africa. Disabil Rehabil 2020; 43:3639-3651. [PMID: 32223568 DOI: 10.1080/09638288.2020.1743779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: Occupational therapy (OT) is a global health profession that promotes participation in meaningful occupations to enhance well-being, particularly for persons with disabilities. Occupational therapy is relatively new in many African countries and there is limited research regarding the role of OT in this region. Thus, this study aims to understand the role and scope of OT in Africa by exploring its unique contribution to healthcare and cultural considerations for practicing OT in various African contexts.Methods: We conducted an exploratory qualitative descriptive study involving semi-structured interviews with 15 occupational therapists from 11 African countries. Interview questions focused on participants' work activities, rewards and challenges of their work, and perceived contribution to healthcare. We audio-recorded and transcribed interviews followed by inductive thematic analysis.Results: All participants described maintaining multiple roles. Four main themes (with sub-themes) emerged: advocacy (clients and the profession), collaboration (multi-disciplinary team, professional support, and internationally), maintaining core OT principles (occupation, function, participation, empowerment, and holistic practice), and contextual considerations (community-based services, practice approaches, sustainability, cultural norms, and spirituality).Conclusions: Occupational therapists working in African contexts have a unique and challenging role involving advocacy and collaboration. They need to maintain core OT values whilst addressing contextual considerations to ensure culturally relevant practice.Implications for RehabilitationOccupational therapists have an important role in promoting health and well-being; however, practice is influenced by the cultural context.Occupational therapists in Africa maintain multiple roles, including advocacy for their clients and the profession, and collaboration within a multidisciplinary team, for professional support and internationally.African occupational therapists need to be rooted in core OT principles whilst considering their unique context to ensure culturally relevant practice.
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Affiliation(s)
| | | | - Rosemary Lysaght
- Department of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
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Mweemba O, Matenga TFL, Corbin JH. Authorship and partnerships in health promotion research: issues of erasure, ownership and inequity in knowledge production. Health Promot Int 2019; 34:1071-1077. [DOI: 10.1093/heapro/daz117] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Oliver Mweemba
- Department of Health Promotion and Education, School of Public Health, Ridgeway Campus, University of Zambia, USA
| | - Tulani Francis L Matenga
- Department of Health Promotion and Education, School of Public Health, Ridgeway Campus, University of Zambia, USA
| | - J Hope Corbin
- Department of Health and Community Studies, Western Washington University, USA
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Gilmore B. Realist evaluations in low- and middle-income countries: reflections and recommendations from the experiences of a foreign researcher. BMJ Glob Health 2019; 4:e001638. [PMID: 31749993 PMCID: PMC6830045 DOI: 10.1136/bmjgh-2019-001638] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 09/06/2019] [Accepted: 09/11/2019] [Indexed: 11/04/2022] Open
Abstract
Realist evaluation, a methodology for exploring generative causation within complex health interventions to understand 'how, why and for whom' programmes work, is experiencing a surge of interest. Trends indicate that the proliferation in the use of this methodology also applies to research in low- and middle-income countries (LMICs). The value of using realist evaluation for project evaluation is also being noticed by non-governmental organisations (NGOs) and other programme implementers within such contexts. Yet, there is limited exploration of the use of realist evaluations in LMICs, especially their use by foreign researchers. This paper draws on the author's experience of conducting two realist evaluations across three different sub-Saharan African settings: Mundemu, Tanzania; Kabale, Uganda and Marsabit, Kenya. The realist evaluations were used as an operations research methodology to study two NGO community health programmes. This paper highlights four main challenges experienced by the author throughout the methodological process: (1) power imbalances prevalent during realist interviews, (2) working through translation and what this means for identfying Context-Mechanism-Outcome Configurations, (3) limited contextual familiarity and being an 'engaged researcher' and (4) the use or dependence on 'WEIRD' theories (i.e. theories based on the study of Western, Educated, Industrialized, Rich, Democratic people) within testing and refinement. Realist evaluation's enticing and straightforward slogan of finding 'what works, for whom and why' is in contrast to the complexity of the methodology used to generate these results (and often to the results themselves). Striking a balance between theory and pragmatism, while adhering to realist ontological underpinnings of generative causation and retroduction, is no easy task. This paper concludes by providing concrete recommendations for those who want to undertake a realist evaluation, with particular attention to cross-cultural settings, in light of the aforementioned challenges. In doing so, it aims to foster improved methodological rigour and help those engaging in this research methodology to work towards more appropriate and contextually relevant findings.
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Affiliation(s)
- Brynne Gilmore
- Centre for Global Health, Trinity College Dublin, University of Dublin, Dublin, Ireland
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Hedt-Gauthier BL, Jeufack HM, Neufeld NH, Alem A, Sauer S, Odhiambo J, Boum Y, Shuchman M, Volmink J. Stuck in the middle: a systematic review of authorship in collaborative health research in Africa, 2014-2016. BMJ Glob Health 2019; 4:e001853. [PMID: 31750000 PMCID: PMC6830050 DOI: 10.1136/bmjgh-2019-001853] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/26/2019] [Accepted: 09/28/2019] [Indexed: 11/04/2022] Open
Abstract
Background Collaborations are often a cornerstone of global health research. Power dynamics can shape if and how local researchers are included in manuscripts. This article investigates how international collaborations affect the representation of local authors, overall and in first and last author positions, in African health research. Methods We extracted papers on 'health' in sub-Saharan Africa indexed in PubMed and published between 2014 and 2016. The author's affiliation was used to classify the individual as from the country of the paper's focus, from another African country, from Europe, from the USA/Canada or from another locale. Authors classified as from the USA/Canada were further subclassified if the author was from a top US university. In primary analyses, individuals with multiple affiliations were presumed to be from a high-income country if they contained any affiliation from a high-income country. In sensitivity analyses, these individuals were presumed to be from an African country if they contained any affiliation an African country. Differences in paper characteristics and representation of local coauthors are compared by collaborative type using χ² tests. Results Of the 7100 articles identified, 68.3% included collaborators from the USA, Canada, Europe and/or another African country. 54.0% of all 43 429 authors and 52.9% of 7100 first authors were from the country of the paper's focus. Representation dropped if any collaborators were from USA, Canada or Europe with the lowest representation for collaborators from top US universities-for these papers, 41.3% of all authors and 23.0% of first authors were from country of paper's focus. Local representation was highest with collaborators from another African country. 13.5% of all papers had no local coauthors. Discussion Individuals, institutions and funders from high-income countries should challenge persistent power differentials in global health research. South-South collaborations can help African researchers expand technical expertise while maintaining presence on the resulting research.
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Affiliation(s)
- Bethany L Hedt-Gauthier
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Nicholas H Neufeld
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Atalay Alem
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Oromia, Ethiopia
| | - Sara Sauer
- Department of Biostatistics, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Yap Boum
- Epicentre, Médecins Sans Frontières, Yaoundé, Cameroon
| | - Miriam Shuchman
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jimmy Volmink
- Department of Global Health and Dean's Office, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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Abimbola S. The foreign gaze: authorship in academic global health. BMJ Glob Health 2019; 4:e002068. [PMID: 31750005 PMCID: PMC6830280 DOI: 10.1136/bmjgh-2019-002068] [Citation(s) in RCA: 187] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 10/09/2019] [Indexed: 11/21/2022] Open
Affiliation(s)
- Seye Abimbola
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- The George Institute for Global Health, Sydney, New South Wales, Australia
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48
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Academic Partnerships in Global Surgery: An Overview American Surgical Association Working Group on Academic Global Surgery. Ann Surg 2019; 271:460-469. [PMID: 31592897 DOI: 10.1097/sla.0000000000003640] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
: Most surgeons from high-income countries who work in global surgery will do so through partnerships between their institutions and institutions in low- and middle-income countries (LMICs). In this article, the American Surgical Association Working Group for Global Surgery lays out recommendations for criteria that contribute to equitable, sustainable, and effective partnerships. These include ethically engaging with the LMIC partner institution by putting its interests first and by proactively seeking to be aware of cultural issues. Formally structuring the partnership with a memorandum of understanding and clearly designating leaders at both institutions are important criteria for assuring long-term sustainability. Needs assessments can be done using existing methods, such as those established for development of national surgical, obstetric, and anesthesia plans. Such assessments help to identify opportunities for partnerships to be most effective in addressing the biggest surgical needs in the LMIC. Examples of successful high-income countries-LMIC partnerships are provided.
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Fish M, Parkes J, Dharsee N, Dryden-Peterson S, Efstathiou J, Schnipper L, Chabner BA, Parikh AR. POETIC (Program for Enhanced Training in Cancer): An Initial Experience of Supporting Capacity Building for Oncology Training in Sub-Saharan Africa. Oncologist 2019; 24:1557-1561. [PMID: 31182656 DOI: 10.1634/theoncologist.2019-0207] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/14/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa is simultaneously facing a rising incidence of cancer and a dearth of medical professionals because of insufficient training numbers and emigration, creating a growing shortage of cancer care. To combat this, Massachusetts General Hospital and Beth Israel Deaconess Medical Center partnered with institutions in South Africa, Tanzania, and Rwanda to develop a fellowship exchange program to supplement the training of African oncologists practicing in their home countries. METHODS In its initial year, 2018, the Program for Enhanced Training in Cancer (POETIC) hosted a pilot cohort of seven fellows for 3-week observerships in their areas of interest. Researchers distributed questionnaires for program evaluation to participants prior to arrival and upon departure; additionally, three participated in semistructured interviews. RESULTS Five themes emerged from the qualitative data: expectations of POETIC, differences between oncology in the U.S. and in sub-Saharan Africa, positive elements of the program, areas for improvement, and potential impact. Fellows identified several elements of Western health care that will inform their practice: patient-centered care; clinical trials; and collaboration among medical, radiation, and surgical oncologists. From the quantitative data, feedback was primarily around logistical areas for improvement. CONCLUSION POETIC was found to be feasible and valuable. The results from the pilot year justify the program's continuation in hopes of strengthening global health partnerships to support oncology training in Africa. One weakness is the small number of fellows, which will limit the impact of the study and the relevance of its conclusions. Future research will report on the expansion of the program and follow-up with former participants. IMPLICATIONS FOR PRACTICE This work presents a novel model for fellowship exchange between lower- and higher-resourced areas. The program is a short-term observership with tumor boards and didactic teaching sessions incorporated. By attracting oncologists who aim to practice in their home countries, it facilitates international collaboration without contributing to the preexisting lack of medical professionals in low- and middle-income countries.
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Affiliation(s)
- Madeleine Fish
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jeannette Parkes
- Division of Oncology, University of Cape Town, Cape Town, South Africa
- Groote Schuur Hospital Observatory, Cape Town, South Africa
| | - Nazima Dharsee
- Ocean Road Cancer Institute, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Scott Dryden-Peterson
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jason Efstathiou
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Lowell Schnipper
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Beth Israel Deaconess Medical Center Cancer Center, Boston, Massachusetts, USA
| | - Bruce A Chabner
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Aparna R Parikh
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Simpkin V, Namubiru-Mwaura E, Clarke L, Mossialos E. Investing in health R&D: where we are, what limits us, and how to make progress in Africa. BMJ Glob Health 2019; 4:e001047. [PMID: 30899571 PMCID: PMC6407556 DOI: 10.1136/bmjgh-2018-001047] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 12/31/2018] [Accepted: 01/04/2019] [Indexed: 11/19/2022] Open
Abstract
Global research and development (R&D) pipelines for diseases that disproportionately affect African countries appear to be inadequate, with governments struggling to prioritise investment in R&D. This article provides insights into the sources of investment in health science research, available research capacity and level of research output in Africa. The African region comprises 15% of the world’s population, yet only accounted for 1.1% of global investments in R&D in 2016. There were substantial disparities within the continent, with Egypt, Nigeria and South Africa contributing 65.7% of the total R&D spending. In most countries of the Organisation for Economic Co-operation and Development, the largest source of R&D funding is the private sector. R&D in Africa is mainly funded by the public sector, with significant proportions of financing in many countries coming from international funding. Challenges that limit private sector investment include unstable political environments, poor governance and corruption. Evidence suggests various research output and research capacity limitations in Africa when considering a global context. Metrics that reflect this include university rankings, number of researchers, number of publications, clinical trials networks and pharmaceutical manufacturing capacity. Within the continent there are substantial regional disparities. Incentivising investment is crucial to foster current and future research output and research capacity. This paper outlines some of the many commendable initiatives under way. Innovative and collaborative financing mechanisms can stimulate further investment. Given the vast inequalities across Africa in R&D, strategies need to reflect the different capacities of countries to address this disparity.
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Affiliation(s)
- Victoria Simpkin
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | | | - Lorcan Clarke
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, London, UK.,Institute of Global Health Innovation, Imperial College London, London, UK
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