A narrative review of health research capacity strengthening in low and middle-income countries: lessons for conflict-affected areas

Gemma Bowsher,Andreas Papamichail,Nassim El Achi,Abdulkarim Ekzayez,Richard Sullivan,Preeti Patel,Bayard Roberts

doi:10.1186/s12992-019-0465-y

Abstract

Conducting health research in conflict-affected areas and other complex environments is difficult, yet vital. However, the capacity to undertake such research is often limited and with little translation into practice, particularly in poorer countries. There is therefore a need to strengthen health research capacity in conflict-affected countries and regions.In this narrative review, we draw together evidence from low and middle-income countries to highlight challenges to research capacity strengthening in conflict, as well as examples of good practice. We find that authorship trends in health research indicate global imbalances in research capacity, with implications for the type and priorities of research produced, equity within epistemic communities and the development of sustainable research capacity in low and middle-income countries. Yet, there is little evidence on what constitutes effective health research capacity strengthening in conflict-affected areas. There is more evidence on health research capacity strengthening in general, from which several key enablers emerge: adequate and sustained financing; effective stewardship and equitable research partnerships; mentorship of researchers of all levels; and effective linkages of research to policy and practice.Strengthening health research capacity in conflict-affected areas needs to occur at multiple levels to ensure sustainability and equity. Capacity strengthening interventions need to take into consideration the dynamics of conflict, power dynamics within research collaborations, the potential impact of technology, and the wider political environment in which they take place.

Highlights

Capacity strengthening for health research is a central concern for development initiatives undertaken in Low and Middle-Income Countries (LMICs)
Health research capacity is disproportionately located in the global North; a recent analysis of authorship trends in The Lancet Global Health established that only 35% of authors are from and work within LMICs, whilst 92% of articles address interventions in these countries [3]
Rates are likely lower than reported since several phenomena such as “token” authorship, double affiliations and “safari research” are likely to be skewing the current representation of authorship [5]

Summary

Introduction

Capacity strengthening for health research is a central concern for development initiatives undertaken in Low and Middle-Income Countries (LMICs). Health research capacity is disproportionately located in the global North; a recent analysis of authorship trends in The Lancet Global Health established that only 35% of authors are from and work within LMICs, whilst 92% of articles address interventions in these countries [3]. This imbalance is rooted in historical inequalities and colonial exploitation and replicated by persisting macro-. Current capacity for conducting health research in many LMIC countries remains limited and undermines the transformation of health systems into sustainable entities within global communities of scientific knowledge generation able to address both global and local concerns [2]. Rates are likely lower than reported since several phenomena such as “token” authorship, double affiliations and “safari research” (i.e., instrumental inclusion of LMIC authors in order to solicit funding or publication favour) are likely to be skewing the current representation of authorship [5]

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Conclusion