Strengthening ethical community engagement in contemporary Malawi

Abstract

Although community engagement is increasingly promoted in global health research to improve ethical research practice, there is sometimes a disconnect between the broader moral ambitions for community engagement in the literature and guidelines on the one hand and its rather narrower practical application in health research on the other. In practice, less attention is paid to engaging communities for the ‘intrinsic’ value of showing respect and ensuring inclusive participation of community partners in research design. Rather, more attention is paid to the use of community engagement for ‘instrumental’ purposes to improve community understanding of research and ensure successful study implementation. Against this backdrop, we reviewed the literature and engaged various research stakeholders at a workshop to discuss ways of strengthening ethical engagement of communities and to develop context-relevant guidelines for community engagement in health research in Malawi.

Community Engagement in Cutaneous Leishmaniasis Research in Brazil, Ethiopia, and Sri Lanka: A Decolonial Approach for Global Health

“…Community engagement is fundamentally about building and sustaining relationships ( 31 , 56 , 60 ). Familiarity, credibility, and trust are indispensable in any research team-community relationship ( 61 , 62 ).…”

Stakeholder engagement in the health policy process in a low income country: a qualitative study of stakeholder perceptions of the challenges to effective inclusion in Malawi

“…To facilitate the engagement of stakeholders with different levels of education, policy literacy and in marginalised groups, including socioeconomically disadvantaged and rural communities, comprehensive stakeholder engagement will always require the deployment of multiple techniques. In this, guidance and resources developed by NGOs, donors and academics could prove valuable (3,28), such as toolkits to enable effective engagement with stakeholders and the use of engagement techniques such as Bwalo forums and CARE scorecards (9,17,(29)(30)(31)(32)(33)(34). There are also lessons on how to increase citizen engagement in policy-making from the Mwananchi project which sought to enhance social accountability to deliver pro-poor policy changes in Africa by changing citizen-government relations (35).…”

“…For stakeholder engagement in the development of health policy in Malawi to be more fully inclusive and meaningful, those with the responsibility and power for drafting and nalising the policy must be inclusive in their approach and responsive to all stakeholder contributions (4,36). A shift in citizengovernment relations which includes the fostering of deeper two-way trust and communication inclusive of marginalised groups is needed (21,33). Inclusive engagement approaches must combine with political advocacy activities if local level stakeholders are to achieve sustainable and meaningful engagement in national decision-making (35,42,43).…”

A Formative Qualitative Study on the Acceptability of Deferred Consent in Adult Emergency Care Research in Malawi

“…However, broad consultation is still required. Nyirenda et al (2018) propose a community engagement model of collaboration, consultation, and communication. They argue that researchers should move beyond “the use of community engagement for ‘instrumental’ purposes,” and instead “the ‘intrinsic’ value of showing respect and ensuring inclusive participation of community partners in research design.” We agree with the suggestions that Nyirenda et al (2018) put forward including the use of the following: (a) guidelines and checklists for planning community engagement, (b) training in community engagement at institutional level, (c) attention to community engagement within national policy on health research, and (d) explicit demands for descriptions of community engagement plans during REC reviews.…”

“…However, broad consultation is still required. Nyirenda et al (2018) propose a community engagement model of collaboration, consultation, and communication. They argue that researchers should move beyond "the use of community engagement for 'instrumental' purposes," and instead "the 'intrinsic' value of showing respect and ensuring inclusive participation of community partners in research design."…”