Stuck in the middle: a systematic review of authorship in collaborative health research in Africa, 2014–2016

Abstract

BackgroundCollaborations are often a cornerstone of global health research. Power dynamics can shape if and how local researchers are included in manuscripts. This article investigates how international collaborations affect the representation of local authors, overall and in first and last author positions, in African health research.MethodsWe extracted papers on ‘health’ in sub-Saharan Africa indexed in PubMed and published between 2014 and 2016. The author’s affiliation was used to classify the individual as from the country of the paper’s focus, from another African country, from Europe, from the USA/Canada or from another locale. Authors classified as from the USA/Canada were further subclassified if the author was from a top US university. In primary analyses, individuals with multiple affiliations were presumed to be from a high-income country if they contained any affiliation from a high-income country. In sensitivity analyses, these individuals were presumed to be from an African country if they contained any affiliation an African country. Differences in paper characteristics and representation of local coauthors are compared by collaborative type using χ² tests.ResultsOf the 7100 articles identified, 68.3% included collaborators from the USA, Canada, Europe and/or another African country. 54.0% of all 43 429 authors and 52.9% of 7100 first authors were from the country of the paper’s focus. Representation dropped if any collaborators were from USA, Canada or Europe with the lowest representation for collaborators from top US universities—for these papers, 41.3% of all authors and 23.0% of first authors were from country of paper’s focus. Local representation was highest with collaborators from another African country. 13.5% of all papers had no local coauthors.DiscussionIndividuals, institutions and funders from high-income countries should challenge persistent power differentials in global health research. South-South collaborations can help African researchers expand technical expertise while maintaining presence on the resulting research.

The foreign gaze: authorship in academic global health

“…Because without naming this problem, we cannot have holistic discussions on imbalances in the authorship of academic global health publications. Recent bibliometric analyses3–6 (some of which have been published in BMJ Global Health 7–9) confirm patterns that are largely explained by entrenched power asymmetries in global health partnerships—between researchers in high-income countries (often the source of funds and agenda) and those in middle-income and especially low-income countries (where the research is often conducted). But we cannot talk about authorship without grappling with who we are as authors, who we imagine we write for (ie, gaze ), and the position or standpoint from which we write (ie, pose ).…”

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“…9 10 There are ongoing debates on decolonisation of global health, and the role of high-income country researchers in studies conducted in LMICs. [12][13][14][15] These debates argue that global health has its roots in colonial or tropical medicine and that there is an inherent unequal power dynamic between the partners from richer and poorer settings, in terms of funding, roles and responsibilities and research outputs. 13 15 This dynamic can result in both 'parachute' and 'parasitic' research in international collaborations, where Northern researchers drop into Southern settings to undertake research without equitable treatment of Southern partners.…”

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