Mapping experiences and perspectives of equity in international health collaborations: a scoping review

Nchangwi S. Munung,Jantina de Vries,Marlyn C. Faure,Bridget Pratt,Ntobeko A. B. Ntusi

doi:10.1186/s12939-020-01350-w

Nchangwi S. Munung, Jantina de Vries + Show 3 more

Open Access

https://doi.org/10.1186/s12939-020-01350-w

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Abstract

BackgroundWhilst global health research often involves international collaborations, achieving or promoting equity within collaborations remains a key challenge, despite established conceptual approaches and the development of frameworks and guidelines to promote equity. There have also been several empirical studies documenting researchers’ experiences of inequity and views on what is required to advance equity in global health collaborations. While these empirical studies provide critical insights, there has been no attempt to systematically synthetize what constitutes equity and how it can be achieved. To address this gap, we conducted a scoping review of qualitative studies, opinion and editorial pieces about what equity is and how it can be promoted in international collaborations.MethodsWe conducted a scoping review to explore domains of equity in international health collaborations. This review included qualitative studies and opinion pieces or editorial pieces on equity in international health collaborations. We mapped the data and identified common themes using a thematic analysis approach.ResultsThis initial search retrieved a total of 7611 papers after removing duplicates. A total of 11 papers were included in this review, 10 empirical studies and 1 editorial piece. We conducted our search between October – November 2019. We identified 10 key domains which are important for promoting equity in international collaborations: funding; capacity building; authorship; sample ownership and export; trust; research agreement; acknowledging inequality; recognition and communication.DiscussionOur findings suggest that for international collaborations to be considered more equitable, it must at least consider the 10 domains we highlighted. The 10 domains map onto five key aspects of social justice theory, namely avoiding unequal power relations like subordination, group recognition and affirmation, promoting the well-being of all, inclusion in decision-making and ensuring self-development.

Highlights

Whilst global health research often involves international collaborations, achieving or promoting equity within collaborations remains a key challenge, despite established conceptual approaches and the development of frameworks and guidelines to promote equity
International health collaborations have been steadily increasing since the 1990s [1], often bringing together stakeholders from high-income countries (HICs) situated in the global North, where most funding sources are located, with stakeholders from lower- and middle-income countries (LMICs) located primarily in the global South
The remaining studies (n = 7) included participants based in the global North and South, with some participants being based in both contexts

Summary

Introduction

Whilst global health research often involves international collaborations, achieving or promoting equity within collaborations remains a key challenge, despite established conceptual approaches and the development of frameworks and guidelines to promote equity. International health collaborations have been steadily increasing since the 1990s [1], often bringing together stakeholders from high-income countries (HICs) situated in the global North, where most funding sources are located, with stakeholders from lower- and middle-income countries (LMICs) located primarily in the global South Whilst these collaborations may tackle a range of research questions, they often include questions about conditions that primarily affect people living in the global South [2, 3]. International collaboration in health research may have the effect of increasing clinical and research capacity in global South contexts and afford scientists in resource-poorer countries an opportunity to participate in or lead innovative scientific research and to publish [7, 11, 12] Notwithstanding these potential benefits and driving factors, a range of critiques has been levelled against international health collaborations. While many Northern researchers may not set out to reproduce inequalities based on a colonial past, often collaborations have been seen as paternalistic, creating what Okeke has called, “the little brother effect” [17]

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