Power, potential, and pitfalls in global health academic partnerships: review and reflections on an approach in Nepal

Abstract

Background: Global health academic partnerships are centered around a core tension: they often mirror or reproduce the very cross-national inequities they seek to alleviate. On the one hand, they risk worsening power dynamics that perpetuate health disparities; on the other, they form an essential response to the need for healthcare resources to reach marginalized populations across the globe. Objectives: This study characterizes the broader landscape of global health academic partnerships, including challenges to developing ethical, equitable, and sustainable models. It then lays out guiding principles of the specific partnership approach, and considers how lessons learned might be applied in other resource-limited settings. Methods: The experience of a partnership between the Ministry of Health in Nepal, the non-profit healthcare provider Possible, and the Health Equity Action and Leadership Initiative at the University of California, San Francisco School of Medicine was reviewed. The quality and effectiveness of the partnership was assessed using the Tropical Health and Education Trust Principles of Partnership framework. Results: Various strategies can be taken by partnerships to better align the perspectives of patients and public sector providers with those of expatriate physicians. Actions can also be taken to bring greater equity to the wealth and power gaps inherent within global health academic partnerships. Conclusions: This study provides recommendations gleaned from the analysis, with an aim towards both future refinement of the partnership and broader applications of its lessons and principles. It specifically highlights the importance of targeted engagements with academic medical centers and the need for efficient organizational work-flow practices. It considers how to both prioritize national and host institution goals, and meet the career development needs of global health clinicians.

Patterns of authorship on community health workers in low-and-middle-income countries: an analysis of publications (2012–2016)

“…North–south research collaborations vary in their willingness to reflect on their partnership practices, 28 and donors may differ in the extent to which they prioritise local ownership and leadership of research. For example, Crane et al , 13 in a case study of an US-Ugandan research partnership, point to the common practice of establishing ‘shell’ non-profit organisations in LMICs in order to meet US federal government fiscal requirements, rather than channelling funds through local universities.…”

Improving Pediatric Academic Global Health Collaborative Research and Agenda Setting: A Mixed-Methods Study

“…14 Partnerships between LMIC and HIC investigators are sometimes paternalistic, and academic global health collaborations may unequally benefit HIC investigators when compared with LMIC investigators. 15,16 Case studies and opinion pieces describing challenges and successes in single partnerships between LMIC and HIC investigators have been published previously, 8,[17][18][19][20] and policies have been put forth to establish guidelines for equitable academic global health collaborations. [21][22][23] However, previously published studies on perceptions of academic global health collaborations have been limited to single partnerships, and policies for equitable academic global health collaborations have been based on a paucity of evidence.…”

Repurposing NGO data for better research outcomes: a scoping review of the use and secondary analysis of NGO data in health policy and systems research

“…However, it is not true of all NGO data [148]; for example, the NGO, Reproductive Health Uganda, provides training on data collection, storage and reporting to ensure minimum data standards across their network of 17 health clinics [69]. Entering into collaborations with NGOs working in the field of interest can benefit both partners in their shared aim of improving health outcomes [11,17,167]. NGO data and NGO-academic collaboration can be particularly valuable in action research, especially within the contexts of refining approaches to achieve the SDGs and developing research methods to collect high quality data in challenging settings [48,49,52].…”

“…NGO-collected data are especially valuable for research in developing countries, on populations under-served by the national health system, and where there may be a data gap due to inadequate national data collection and monitoring infrastructure [6,13,14]. The analysis of NGO data presents an opportunity for researchers to conduct relevant, timely and relatively cheap secondary research that has the potential to improve health outcomes [6,[15][16][17]. However, there is a dual problem of these data being ignored by researchers and not made available by NGOs for secondary analysis [6,18,19].…”