Whose voices should shape global health education? Curriculum codesign and codelivery by people with direct expertise and lived experience

Abstract

There are contrasting opinions of what global health (GH) curricula should contain and limited discussion on whose voices should shape it. In GH education, those with first-hand expertise of living and working in the contexts discussed in GH classrooms are often absent when designing curricula. To address this, we developed a new model of curriculum codesign called Virtual Roundtable for Collaborative Education Design (ViRCoED). This paper describes the rationale and outputs of the ViRCoED approach in designing a new section of the Global Health Bachelor of Science (BSc) curriculum at Imperial College London, with a focus on healthcare in the Syrian conflict. The team, importantly, involved partners with lived and/or professional experience of the conflict as well as alumni of the course and educators in all stages of design and delivery through to marking and project evaluation. The project experimented with disrupting power dynamics and extending ownership of the curriculum beyond traditional faculty by codesigning and codelivering module contents together with colleagues with direct expertise and experience of the Syrian context. An authentic approach was applied to assessment design using real-time syndromic healthcare data from the Aleppo and Idlib Governorates. We discuss the challenges involved in our collaborative partnership and describe how it may have enhanced the validity of our curriculum with students engaging in a richer representation of key health issues in the conflict. We observed an enhanced self-reflexivity in the students’ approach to quantitative data and its complex interpretation. The dialogic nature of this collaborative design was also a formative process for partners and an opportunity for GH educators to reflect on their own positionality. The project aims to challenge current standards and structures in GH curriculum development and gesture towards a GH education sector eventually led by those with lived experience and expertise to significantly enhance the validity of GH education.

How to identify epistemic injustice in global health research funding practices: a decolonial guide

“…Research funders have reported lower number of successful proposals from Global South applicants despite the burden of global health challenges being situated in the Global South 4. The resulting asymmetries manifest as both higher access to financial resources for applicants based in the Global North and the generation of inadequate, incomplete or not fit-for-purpose evidence to meet the needs of Global South communities 4 16 18 28…”

“…In reality, health systems challenges are complex and require deeply local perspective to be responsive to local systems and realities 36. Consequently, what is ‘robust’ for generating decontextualised, generalisable knowledge may not be ‘robust’ enough for generating contextualised and necessarily local knowledge 16 28…”

“…Local practices and realities shape the way a project is proposed. The physical proximity or distance of a reviewer can affect the reviewer’s interpretation of what is being proposed 16 28. Global South applicants see the complexities of their setting and are compelled to engage with it given what they know and how they make sense of it 23 25.…”

“…Whereas Global North applicants see from afar and are prone to simplify complex realities in ways that Global South applicants tend not to 16 26. Global South applicants are more likely to go for methods and approaches that allow them to make sense of the full complexity of their setting, system or reality 17 28…”

“…Table 1 presents key questions and considerations that highlight how knowledge equity objectives can be attained by adjusting for epistemological colonisation (eg, absence of collectively legitimised tools), power dynamics (eg, dominance and leadership in research partnerships and authorship order), positionality (eg, diaspora vs ‘local’; Global North vs Global South diploma) and logistical barriers (eg, lack of publications vs systematic barriers of access to academic journals through exclusionist fee policies) 22 28 35 47 49 51…”