By Rebecca Griffin
For far too long, resources and power in global health research have flowed to institutions in the Global North. While this research has led to important advancements, the work has often been extractive, without meaningful inclusion of partners in the countries where research takes place. As Dr. Haile Debas, director emeritus of UCSF Institute for Global Health Sciences, explained, “The causes of inequitable partnerships are many and include ingrained global health colonialism, racism, hierarchical academic structures, asymmetric power, cultural ignorance, and unfair policies.”
Shifting these decades-long dynamics, like any effort to make significant structural change, requires intention, long-term commitment, and resources. Taking up that challenge, a group of leaders at the Bixby Center for Global Reproductive Health and the IGHS launched an effort to collaborate with global health partners to reimagine the way they work together. “Our transformative approach to addressing equity in global health partnerships centers our global health partners’ voices. They are at the forefront of developing the action plan,” noted the Bixby and IGHS team of Carol Camlin, Dilys Walker, Mike Reid, Elizabeth Rojo, and Purba Chatterjee.
The Equitable Global Health Partnerships Initiative began with a survey to partners around the world to better understand their experiences of inequities in research collaborations. The group met virtually in March to look at survey results and case studies and begin the dialogue about what equitable partnerships look like. The planning team group then met with senior UCSF leadership to get their guidance and support and convened UCSF leadership, faculty, and staff to reflect on our partners’ feedback and UCSF’s perspective on equitable global health partnerships. In November, UCSF researchers met with partners from sub-Saharan Africa in Nairobi to build community, establish priorities, and develop an action plan.
The two days of in-person meetings were an important step in building trust and camaraderie and sharing a new vision of what partnerships could look like. Attendee Moses Obimbo Madadi described it as a partnership where “there’s equity in terms of members from the Global North and the Global South, and they have equal power in terms of making decisions, in terms of getting financing for their research work, and also in terms of publications.” Getting to that end goal means having some uncomfortable conversations and exercising humility. Mosa Moshabela, professor and vice chancellor of research at the University of KwaZulu-Natal, pointed out, “The Global North needs to give up power that they think they have.”
“Transparency and integrity: a safe space to unpack what lived collaboration has felt like and what it should look like to meet the goals and aspirations of different partners. This was my take home after the sometimes challenging but always respectful discussions at the meeting,” reflected Dr. Elizabeth Bukusi of Kenya Medical Research Institute, one of the meeting co-facilitators.
The group affirmed 5 major action areas identified in the leadup to the meeting, with an important addition—the ecosystem that creates and promotes an environment to enable equitable partnership, represented by the acacia tree. Small groups did a deep dive in the priority areas, and came up with these priority action steps:
Relationship building: Craft an organizational framework and guiding principles to establish and maintain trust and respect in global health partnerships, beginning with open and honest conversations about our values at the start of any partnership or project.
Education & training & mentorship: Co-develop a training curriculum that addresses decolonizing global health efforts that can be adapted for different audiences.
Authorship & knowledge production: Develop policy and best practices for authorship; including how to ensure authorship equity and inclusivity at the onset of collaborations, and identify strategies for mentorship and collaboration to support global health partners’ authorship and publications
Equity in financial management: Establish an equity review of distribution of research budget to address disparities between high- and low-income countries.
Ethics & community involvement: Develop models for equity in research from the design of research questions to end of project, ensuring that we are asking locally relevant research questions rather than pursuing research primarily for a ‘foreign gaze.’
Now begins the hard work of implementation. The Equitable Global Health Partnerships Initiative will need resources and engagement to make this vision a reality. With a sprawling problem like this that will take time to unravel, identifying immediate action steps is essential. Researchers interested in participating in a workgroup on one of the Big 5 areas can reach out to Purba Chatterjee.
Honoring the expertise and experiences of partners in the Global South, UCSF can help create a new path forward grounded in fairness, transparency, and mutual respect. As Dr. Debas told meeting attendees, “We're most likely to succeed when we join hand in hand and fight this and other injustices together.”
“It was an honor to co-facilitate the Nairobi meeting alongside Dr. Elizabeth Bukusi,” shared co-facilitator LaMisha Hill, PhD, of UCSF. “Witnessing dedicated global health leaders from around the world come together, engage in heartfelt dialogues, and stay grounded in shared goals of respect and equality beautifully mirrors the vision of this initiative that we will continue to strive for.”