Session report: Institutional capacity to support equitable partnerships in health systems research
Recent calls to decolonise global health have resulted in an overdue but critical reflection of power sharing in partnerships. Many partners have adopted their own agendas to support this goal, yet cross learning and sharing between partners has been limited owing to a lack of knowing ‘what works’ to support equitable partnerships in practice. While several guidance documents exist to help build organisational and network capacity, it is often challenging to know how to implement equity in practice. There has also limited opportunity to bring together a diverse range of partnerships to share learnings on this important topic together. For example, there is a need to consider partnerships beyond traditional research consortia – including how to engage equitably with communities and prioritize a range of knowledge value systems.
Enhancing the Equity of our Research Partnerships: The evidence base and LSHTM’s approach
Catherine Goodman, Shirine Voller, Ginny Bond
The terminology of decolonisation entered the global health discourse over 30 years ago and it challenged the ‘old ways’ of doing research in developing countries and in neo-colonial and paternalistic ways. Some of the changes it pushed for include:
- Increase in capacity of southern research institutions leading to the distribution of power
- Growing awareness on the role of High Income Countries in perpetuating inequities
- Decolonising global health movement and bringing these issues into the spotlight
Some of the issues for partnerships include the differential access to funding, knowledge, expert networks and development opportunities. There are also unbalanced roles and hierarchy, problems with authorship, and a lack of transparency and accountability. Similarly, unequal influence agenda setting, administration and budget management, project design and ethics and managerial standards beset global health partnerships. Healthy partnerships have many benefits which include but are not limited to capacity strengthening, access to funds and exposure to opportunities. Some of the factors that have been identified as good promoters of partnerships are: early involvement of all partners, mutual respect and recognition, clear roles and responsibilities, strong communication, joint decision making, understanding challenges of operating in resource-limited settings and long term relationships. The rest of the presentation gave a detailed account of LSHTM’s approach to their Equitable Partnerships Action Plan.
Equitable Partnership Strategy and Principles
Robinson Karuga, Rosie Steege, Shahreen Chowdhury, Bertie Squire, Sally Theobald and Lilian Otiso
The aim of this study was to co-develop an equitable partnership strategy to support meaningful and equitable engagements. UKCDR defines partnership as a process in which there is mutual participation, trust, respect, benefit and equal value placed on each partner’s contribution at all stages of the research process. Using Liverpool School of Tropical Medicine as a case study collaboration between partners has evolved over time including, joint partnership in advisory panels and informal interactions in conferences and multi-country research networks. The nature of collaboration takes different forms: research, capacity building and teaching and research uptake, advocacy and publishing.
Agenda setting is usually defined mutually in a participatory process; and decisions made fairly and respectfully. The response focusses on local needs and the agenda setting is underpinned by global funding calls global agenda setting. LSTM allows for innovation from Low and Middle Income Country’ partners.
Budget allocations are discussed transparently and collaboratively. Some of the impacts and outputs of equitable partnership strategy and principles include research uptake being led by partners at local and national level. Authorship is fair and transparent and language around data ownership a key issue. The presenters gave recommendations on what the future of partnerships is. The process is guided by a set of values listed in the presentation.
Insights from an ethical toolkit for “Sharing Power with Communities in Priority-Setting for Health Research Projects”
Dr. Bridget Pratt shared the toolkit which is a reflective project planning aid for use before priority-setting is undertaken for a health research project. It helps both researchers and community members share power more evenly. The toolkit is a set of four worksheets: selecting a partner, deciding to partner, deciding to engage with the wider community and designing the priority-setting process. Engagement has four components: the person that initiates (leadership), for what purpose (instrumental vs. empowerment), who participates (diversity within the community and representation) and how they participate (stage, level, space, ground rules, facilitation, listening, being heard and compensation). These were discussed at length during the presentation. Stakeholders must appreciate that there are a lot of considerations involved when seeking to share power with communities in setting research topics and questions and in decision-making in health research projects. The ethical toolkit is helpful to think through these considerations. Nonetheless, ethical dilemmas will arise when trying to share power and to address the ethical considerations in the toolkit. People must remember that sharing power is complicated but ethically essential.
Framework for Equitable Management of Health Research Capacity Strengthening Consortia: Lessons from Southern-led Consortia
Nadia Tagoe from Kwame Nkurumah University outlined the benefits and challenges of consortia. The nature of health is complex, multidisciplinary and global and requires joint effort. There are many common challenges that are experienced and consortia provide an opportunity to exchange ideas. Pooling expertise (synergy) and resources for consolidating efforts is a big plus in consortia. Cross fertilization and shared learning and capacity strengthening are also great merits. Some demerits include: inequity, power imbalance and skewed agenda setting. Nadia highlighted the drivers of inequities and power asymmetries in consortia. She mentioned:
- Capacity differentials (expertise, experience, physical, network)
- Wider research eco system and political economy
- Accepted practices (academia, ranking, impact factor, indexing)
- Consortium ownership (how and when joined)
She expounded on the drivers of consortium management practices in detail which are: structural determinants, guiding ethos, decision drivers, strategies and management practices. Purpose, strategy and outcomes are key elements of a framework for managing HRCS consortia. Change is layered across these levels:
- Definition of research capacity and research capacity strength
- Funder requirements
- Research culture
- Reflexivity and questioning
Caesar Atuire, a lecturer at the University of Ghana and the University of Oxford discussed transformation for health policy and systems research from a solidarity perspective. He shared tenets of a project with colleagues at Wellcome Trust. Some of the major global health challenges the world is facing today comprise: inequality, pandemics, antimicrobial resistance, climate change and migration. They are major challenges and so no single entity can solve them by themselves. They require collaboration and solidarity. Slogans such as the recent popular one coined during COVID-19, ‘No one is safe until we are all safe,’ show the need to come together to resolve these problems as a human community. However, the discourse of solidarity in global health reveals three important gaps: conceptual ambiguity, epistemic injustice and absence of tools for enactment. There is a lack of clarity on what it means to practice solidarity. Epistemic injustice is about the conceptualization of solidarity emanating only from a certain part of the world which is usually the Global North. There are a lack of measurable tools to be able to monitor how solidarity is being enacted. Their project tries to address these gaps and is based on three guiding concepts: pluriversality, convergence on actionable goals, co-creation and engagement. Their main goal is to shift the understanding of solidarity within global health and trigger processes that will allow to measure and make solidarity become part of the main discourse in global health.