Striving towards true equity in global health: A checklist for bilateral research partnerships

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.

Lessons learned in implementing the Low Birthweight Infant Feeding Exploration study: A large, multi‐site observational study

“…That decision to change the research approach and design emerged in a 2‐day meeting held in Boston, USA, where investigators from all partners/institutions attended and presented their opinions. Those collaborative meetings for study design and development were only achieved through mutual respect, trust, partnership and transparency, aligned with the four principles recently highlighted by Hodson and colleagues on equitable partnerships 20 …”

“…Those collaborative meetings for study design and development were only achieved through mutual respect, trust, partnership and transparency, aligned with the four principles recently highlighted by Hodson and colleagues on equitable partnerships. 20 Secondly, through protocol development and training curricula, we were able to ensure that consistent approaches were being used across the study. In July 2019, we conducted standardised training across all partners focused on ethics and data collection with didactic sessions including role play.…”

The implications of decolonization on China’s academic global health: a dialogue with Stephen Gloyd at the Luhu Global Health Salon

“…However, as Gloyd argued, major aspects of colonialism are still evident, and global health can sometimes be just a new label for old practices [ 11 ]. The persistent power imbalances, socio-economic inequities, racism, and new colonialism contribute to global health inequities [ 12 ]. HICs in the North are often viewed as centers for top-quality global health education, training, and research.…”

“…Kumar et al emphasized the need for increased transparency in funding for global health research and for researchers in recipient countries to take a leadership role in controlling funds and resources [ 16 ]. Hodson et al suggested prioritizing direct funding for researchers in LMICs and establishing mechanisms for LMIC institutions and researchers to lead direct funding [ 12 ]. These recommendations not only support Gloyd’s observations but also offer practical guidance for future Chinese endeavors.…”

“…Hodson et al highlighted the importance of pairing Principal Investigators (PIs) from HICs and LMICs as co-PIs to provide local solutions to local issues. This approach enables LMIC institutions to take ownership of and manage the activities [ 12 ]. Abouzeid et al suggested a sustainable system to strengthen global health leadership in the Global South at various levels, including researcher, institutional, and organizational.…”