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Equity in international research partnerships

Kampala, Uganda, cars parked on road with city buildings in the background.

International research partnerships (IRPs) are common models of health research in low- and middle-income countries (LMICs), typically in partnership with high-income country (HIC) institutions.1,2 IRPs can be beneficial – by advancing knowledge on matters important to local populations and increasing LMIC representation in global health research – but also risk being harmful, by inadvertently perpetuating intellectual, scientific, and structural inequalities.3,4 Focused attention to equity between LMIC and HIC partners offers a promising pathway through which the benefits of IRPs can be maximized and risks minimized.5-7


We define equity in the context of IRPs as prioritizing mutually beneficial inputs, processes, outputs, outcomes, and impact8 including LMIC capacity strengthening to narrow power and dependence asymmetries between partners. There are strong theoretical accounts that root IRP equity within principles of social and global justice9-12 and equitable IRPs are prioritized as one of the United Nations’ Sustainable Development Goals.13 The literature is converging on topics and indicators for what constitutes IRP equity14 and there are over a dozen guidelines describing how IRP equity can be protected and promoted within LMIC health research.

Research Aims

Awareness of IRP inequities is common among investigators and research staff, yet are frequently under-acknowledged in professional and academic spaces. Understanding current barriers and facilitators of equity in IRP practices requires capturing the knowledge, experiences, and environment of investigators and research staff. Using Uganda-United States (US) and Uganda-United Kingdom (UK) HIV IRPs, we will use a mixed-methods explanatory quantitative to qualitative sequential design to generate a holistic understanding of IRP equity from the perspectives of Ugandan, US, and UK investigators and research staff.

Project Team

  • Chelsea Modlin, Johns Hopkins Berman Institute of Bioethics
  • Joseph Ali, Johns Hopkins Berman Institute of Bioethics
  • Nelson Sewankambo, Makerere University College of Health Sciences
  • Larry Chang, Johns Hopkins University School of Medicine
  • Arsenii Alenichev, Ethox Centre, University of Oxford
  • Prakriti Shrestha, Johns Hopkins Bloomberg School of Public Health

Image credit; Robin Kutesa on Unsplash

References

1. McMillan JR, Conlon C, Nuffield Council on Bioethics. The ethics of research related to health care in developing countries. J Med Ethics 2004;30:204–6.

2. Emanuel EJ, Wendler D, Killen J, Grady C. What Makes Clinical Research in Developing Countries Ethical? The Benchmarks of Ethical Research. J Infect Dis 2004;189:930–7.

3. Faure MC, Munung NS, Ntusi NAB, Pratt B, de Vries J. Mapping experiences and perspectives of equity in international health collaborations: a scoping review. Int J Equity Health 2021;20:28.

4. 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;37:523–34.

5. Kok MO, Gyapong JO, Wolffers I, Ofori-Adjei D, Ruitenberg EJ. Towards fair and effective North–South collaboration: realising a programme for demand-driven and locally led research. Health Res Policy Syst 2017;15:96.

6. Aslanyan G, Chadwick El-Ali A, Heintz M, Kagirl-Kalanzi A, Kirkland J, Kunaratnam Y, et al. Four Approaches to Supporting Equitable Research Partnerships: ESSENCE and UKCDR Good Practice Document. 2022.

7. National Institutes of Health. Promoting Equity in Global Health Research. Available at: https://grants.nih.gov/grants/guide/notice-files/NOT-TW-22-001.html.

8. World Health Organization. Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies. World Health Organization; 2010.

9. Pratt B, Loff B. A Framework to Link International Clinical Research to the Promotion of Justice in Global Health. Bioethics 2014;28:387–96.

10. London AJ. Justice and the Human Development Approach to International Research. Hastings Cent Rep 2005;35:24–37.

11. Pratt B, Wild V, Barasa E, Kamuya D, Gilson L, Hendl T, et al. Justice: a key consideration in health policy and systems research ethics. BMJ Glob Health 2020;5:e001942.

12. Benatar SR, Singer PA. Responsibilities in international research: a new look revisited. J Med Ethics 2010;36:194–7.

13. United Nations Department of Economic and Social Affairs. Strengthen the means of implementation and revitalize the Global Partnership for Sustainable Development. Available at: https://unstats.un.org/sdgs/report/2017/goal-17/.

14. Monette EM, McHugh D, Smith MJ, Canas E, Jabo N, Henley P, et al. Informing ‘good’ global health research partnerships: A scoping review of guiding principles. Glob Health Action 2021;14:1892308.