Strengthening capacities and resource allocation for co-production of health research in low and middle income countries

Agyepong, Irène Akua; Godt, Sue; Sombié, Issiaka; Binka, Charity; Okine, Vicky; Ingabire, Marie-Gloriose

doi:10.1136/bmj.n166

Cited by 20 publications

(26 citation statements)

References 16 publications

(15 reference statements)

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“…Furthermore, contemporary knowledge systems on power are dominated by Western authors and modes of thinking, 31 32 evidenced by a recent study found that most co-production of health research has been conducted in highly developed settings, with less than 2% of co-production literature examining low- and middle-income countries (LMICs). 2 Engaging with perspectives of participatory health researchers—particularly those from the Global South—and considering how experiences vary across countries, disciplines and income contexts, will help to produce more nuanced understandings of power in real-world settings, providing a platform for voices that are often missing from the research scholarship on power. The qualitative data generated from exploration of these perspectives can be used to develop concrete actions to address power inequities in PHR partnerships, and to validate the ‘Social Ecology of Power’ framework described above, which at present draws only from peer reviewed literature and the experiential knowledge of it's author.…”

Section: Introductionmentioning

confidence: 99%

‘You want to deal with power while riding on power’: global perspectives on power in participatory health research and co-production approaches

et al. 2021

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IntroductionPower relations permeate research partnerships and compromise the ability of participatory research approaches to bring about transformational and sustainable change. This study aimed to explore how participatory health researchers engaged in co-production research perceive and experience ‘power’, and how it is discussed and addressed within the context of research partnerships.MethodsFive online workshops were carried out with participatory health researchers working in different global contexts. Transcripts of the workshops were analysed thematically against the ‘Social Ecology of Power’ framework and mapped at the micro (individual), meso (interpersonal) or macro (structural) level.ResultsA total of 59 participants, with participatory experience in 24 different countries, attended the workshops. At the micro level, key findings included the rarity of explicit discussions on the meaning and impact of power, the use of reflexivity for examining assumptions and power differentials, and the perceived importance of strengthening co-researcher capacity to shift power. At the meso level, participants emphasised the need to manage co-researcher expectations, create spaces for trusted dialogue, and consider the potential risks faced by empowered community partners. Participants were divided over whether gatekeeper engagement aided the research process or acted to exclude marginalised groups from participating. At the macro level, colonial and ‘traditional’ research legacies were acknowledged to have generated and maintained power inequities within research partnerships.ConclusionsThe ‘Social Ecology of Power’ framework is a useful tool for engaging with power inequities that cut across the social ecology, highlighting how they can operate at the micro, meso and macro level. This study reiterates that power is pervasive, and that while many researchers are intentional about engaging with power, actions and available tools must be used more systematically to identify and address power imbalances in participatory research partnerships, in order to contribute to improved equity and social justice outcomes.

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Section: Introductionmentioning

confidence: 99%

‘You want to deal with power while riding on power’: global perspectives on power in participatory health research and co-production approaches

et al. 2021

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“…Several PEA approaches that are participatory in nature could be considered and, when possible, adopted. Despite the fact that these methods still require more theoretical and practical conceptualization, such approaches do follow the principles of coproduction in research [ 48 – 51 ]. In addition to these general principles, examples of specific methods, borrowed from other disciplines (such as system thinking and social sciences), that are participatory in nature and that can be perfectly suitable for conducting and complementing PEA research include participatory stakeholder mapping jointly conducted with stakeholders [ 52 ], participatory power mapping [ 53 ], group model-building [ 54 ], and mixed-methods approaches to social network analysis [ 55 , 56 ].…”

Section: Discussionmentioning

confidence: 99%

Political economy analysis of universal health coverage and health financing reforms in low- and middle-income countries: the role of stakeholder engagement in the research process

Loffreda

Bello

Kiendrébéogo

et al. 2021

Health Res Policy Sys

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Background Progress towards universal health coverage (UHC) is an inherently political process. Political economy analysis (PEA) is gaining momentum as a tool to better understand the role of the political and economic dimensions in shaping and achieving UHC in different contexts. Despite the acknowledged importance of actors and stakeholders in political economy considerations, their role in the PEA research process beyond “study subjects” as potential cocreators of knowledge and knowledge users has been overlooked so far. We therefore aimed to review the approaches with reference to stakeholder engagement during the research process adopted in the current published research on the political economy of UHC and health financing reforms, and the factors favouring (or hindering) uptake and usability of PEA work. Methods We reviewed the literature to describe whether, when and how stakeholders were involved in the research process of studies looking at the political economy of UHC and health financing reforms, and to identify challenges and lessons learned on effective stakeholder engagement and research uptake. We used a standardized search strategy with key terms across several databases; we screened and included articles that focused on PEA and UHC. Additionally, we conducted a short survey of the authors of the included studies to complement the information retrieved. Results Fifty articles met the inclusion criteria and were included in the analysis. We found overall little evidence of systematic engagement of stakeholders in the research process, which focused mostly on the data collection phase of the research (i.e., key informant interviews). Our study identifies some reasons for the varying stakeholder engagement. Challenges include PEA requiring specific skills, a focus on sensitive issues, and the blurriness in researchers’ and stakeholders’ roles and the multiple roles of stakeholders as research participants, study subjects and research users. Among the approaches that might favour usability of PEA work, we identified early engagement, coproduction of research questions, local partners and personal contact, political willingness, and trust and use of prospective analysis. Conclusions Stakeholder engagement and research uptake are multifaceted concepts and complex processes, particularly when applied to PEA. As such, stakeholder engagement in the research process of PEA of UHC and health financing reforms is limited and underreported. Despite the challenges, however, stakeholder engagement remains key to ensuring relevance, usability and research uptake of PEA studies. More efforts are required to ensure engagement at different stages of the research process and better reporting in published articles.

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“…This near real-time aspect of embedded IR is recognized as one of the advantages as research results can be available within planning cycles for decision making and program adaptation. While the research projects themselves generally require limited funding, building local capacity to run the studies, both for the implementers and local researchers, often requires additional resources beyond the actual research costs for training and technical assistance during the studies, consistent with building capacity of research co-production as discussed by Agyebong and colleagues [ 8 ].…”

Section: Embedded Implementation Research At Unicef: Experiences 2015–2019mentioning

confidence: 99%

“…This paradox demonstrates the urgent need to focus on implementation research (IR) to identify barriers and effective strategies to implementation of existing proven interventions. Evidence of the effect of long-term consistent investments in embedded IR on improved service coverage and efficient use of routine health system resources has recently emerged from Ghana [ 7 , 8 ] and Latin America and the Caribbean [ 9 ].…”

Section: Introduction: Need For Actionable Knowledge To Improve Programs For Childrenmentioning

confidence: 99%

Closing the know-do gap for child health: UNICEF’s experiences from embedding implementation research in child health and nutrition programming

Jackson

Shahabuddin

Sharkey

et al. 2021

Implement Sci Commun

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UNICEF operates in 190 countries and territories, where it advocates for the protection of children’s rights and helps meet children’s basic needs to reach their full potential. Embedded implementation research (IR) is an approach to health systems strengthening in which (a) generation and use of research is led by decision-makers and implementers; (b) local context, priorities, and system complexity are taken into account; and (c) research is an integrated and systematic part of decision-making and implementation. By addressing research questions of direct relevance to programs, embedded IR increases the likelihood of evidence-informed policies and programs, with the ultimate goal of improving child health and nutrition.This paper presents UNICEF’s embedded IR approach, describes its application to challenges and lessons learned, and considers implications for future work.From 2015, UNICEF has collaborated with global development partners (e.g. WHO, USAID), governments and research institutions to conduct embedded IR studies in over 25 high burden countries. These studies focused on a variety of programs, including immunization, prevention of mother-to-child transmission of HIV, birth registration, nutrition, and newborn and child health services in emergency settings. The studies also used a variety of methods, including quantitative, qualitative and mixed-methods.UNICEF has found that this systematically embedding research in programs to identify implementation barriers can address concerns of implementers in country programs and support action to improve implementation. In addition, it can be used to test innovations, in particular applicability of approaches for introduction and scaling of programs across different contexts (e.g., geographic, political, physical environment, social, economic, etc.). UNICEF aims to generate evidence as to what implementation strategies will lead to more effective programs and better outcomes for children, accounting for local context and complexity, and as prioritized by local service providers. The adaptation of implementation research theory and practice within a large, multi-sectoral program has shown positive results in UNICEF-supported programs for children and taking them to scale.

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Strengthening capacities and resource allocation for co-production of health research in low and middle income countries

Abstract: and colleagues share experiences and ideas to strengthen capacity for health research co-production in low and middle income countries on 21 February 2021 by guest. Protected by copyright.

Cited by 20 publications

References 16 publications

‘You want to deal with power while riding on power’: global perspectives on power in participatory health research and co-production approaches

‘You want to deal with power while riding on power’: global perspectives on power in participatory health research and co-production approaches

Political economy analysis of universal health coverage and health financing reforms in low- and middle-income countries: the role of stakeholder engagement in the research process

Closing the know-do gap for child health: UNICEF’s experiences from embedding implementation research in child health and nutrition programming

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