Where theory and practice of global health intersect: the developmental history of a Canadian global health initiative

Abstract

ObjectiveThis paper examines the scope of practice of global health, drawing on the practical experience of a global health initiative of the Government of Canada – the Teasdale-Corti Global Health Research Partnership Program. A number of challenges in the practical application of theoretical definitions and understandings of global health are addressed. These challenges are grouped under five areas that form essential characteristics of global health: equity and egalitarian North–South partnerships, interdisciplinary scope, focus on upstream determinants of health, global conceptualization, and global health as an area of both research and practice.DesignInformation in this paper is based on the results of an external evaluation of the program, which involved analysis of project proposals and technical reports, surveys with grantees and interviews with grantees and program designers, as well as case studies of three projects and a review of relevant literature.ResultsThe philosophy and recent definitions of global health represent a significant and important departure from the international health paradigm. However, the practical applicability of this maturing area of research and practice still faces significant systemic and structural impediments that, if not acknowledged and addressed, will continue to undermine the development of global health as an effective means to addressing health inequities globally and to better understanding, and acting upon, upstream determinants of health toward health for all.ConclusionsWhile it strives to redress global inequities, global health continues to be a construct that is promoted, studied, and dictated mostly by Northern institutions and scholars. Until practical mechanisms are put in place for truly egalitarian partnerships between North and South for both the study and practice of global health, the emerging philosophy of global health cannot be effectively put into practice.

The Interplay between Participatory Health Research and Implementation Research: Canadian Research Funding Perspectives

“…It is, however, no easy feat and may in fact not be fully realized in practice given preexisting power asymmetries within teams, including those between researchers from different disciplines and decision-makers and communities, and across country contexts. Not only are preexisting power differences challenging to overcome in North-South partnerships, but they can also inadvertently undermine the ability to achieve an equitable orientation in research programming [ 36 ]. In an analysis of a Canadian-led global health research funding program, the authors argued that “the donor's finance and grant administration systems favored lower-risk Canadian institutions over generally higher-risk LMIC grantees and placed less restrictions on Canadian institutions than it did on LMIC ones” [ 36 , p8].…”

“…Not only are preexisting power differences challenging to overcome in North-South partnerships, but they can also inadvertently undermine the ability to achieve an equitable orientation in research programming [ 36 ]. In an analysis of a Canadian-led global health research funding program, the authors argued that “the donor's finance and grant administration systems favored lower-risk Canadian institutions over generally higher-risk LMIC grantees and placed less restrictions on Canadian institutions than it did on LMIC ones” [ 36 , p8]. Although inequitable fiscal relationships may adversely affect partnerships, other features of international partnerships can thrive.…”

Balancing the personal, local, institutional, and global: multiple case study and multidimensional scaling analysis of African experiences in addressing complexity and political economy in health research capacity strengthening

“…We have seen a wide range of more and less successful initiatives in an equally wide range of settings. Our reflections lead us to agree with analyses emphasizing complexity and emergence in thinking about and working to enhance organizational capacity for social change [ 29 , 40 ]. However, we are concerned that enthusiasm for the much greater ‘face validity’ and explanatory power of complex adaptive systems thinking as an alternative to linear and ‘engineering’ models of organizational development not efface attention to the realities of political economy.…”

“…What we have found promising in response to this tension is an increasing, and progressively nuanced, recognition and understanding of the existence, causes, and implications of the uneven global health research and institutional playing field. This is marked by an apparently growing willingness to explore coherent, pragmatic models that try to balance these competing imperatives [ 21 , 29 , 30 , 39 ]. This approach to global HRCS acknowledges globalization and mobility of knowledge and its producers, but with respect to a complex and unequal landscape both within and between countries and institutions.…”

Promoting equitable global health research: a policy analysis of the Canadian funding landscape

“…This initiative, and its flagship CA$25 M Teasdale-Corti programme, led to new multi-year research partnerships between LMIC- and Canada-based researchers with a focus on building applied health research capacity for researchers in poor countries. Egalitarian partnerships and a concerted effort to build local capacity were central to the design of this new funding model [ 23 , 58 ]. However, structural differences in the amount of funding support provided and grants management policies between the founding partners of GHRI created certain complications in GHRI’s operations, and potentially to its absorption into IDRC.…”