The bridge between two worlds: Global South researchers' journeys through Global North academic training and beyond.

Equity in Global Health Research.

Ways to strengthen research capacity in developing countries: effectiveness of a research training workshop in Pakistan

Reform of research funding processes could pave the way for progress in global health

The International Collaboration for Research methods Development in Oncology (CReDO) workshops: shaping the future of global oncology research.

Health is global – what does that mean for the United Kingdom?

A transformation of global health research is urgently needed if it is to eliminate long-standing structural inequities within the field and help reduce global health disparities. Ethics has a key role to play in fostering such a transformation: it can help identify what the transformation should entail. Yet, ethics scholarship linking global health research to greater equity and social justice has limited authority and capacity to do so for two related reasons: it largely fails to apply theories and concepts of justice from the global South and it says little about whether or how to address the coloniality and epistemic injustices inherent within global health research. This paper develops a multidimensional social justice lens using social justice and decolonial theory from the global North and global South. This lens identifies five core dimensions of social justice: power, recognition, harmony, inclusion, and well-being. This paper then applies the multidimensional lens to the global health research context. For each dimension of social justice, several key ways to transform global health research are identified and described. They include shifting control of global health research funding, education, conduct, and publishing away from the global North and making knowledge from the global South visible and valued. To conclude, potential objections are considered.

Migration, health, and ethics.

Nursing migration to other countries has led to a reduction in the nursing workforce in Italy, resulting in increased workload and burnout for remaining staff. To evaluate the perceptions and experiences of Italian nurses who decided to work abroad. A cross-sectional study was conducted using an ad hoc online questionnaire. This study explored the perceptions and experiences of 244 Italian nurses working abroad. The primary motivations included personal growth, economic dissatisfaction in Italy, and exposure to new cultures. Most participants worked in Europe, particularly England and Germany. Although 71% found the documentation process straightforward, 23% faced adjustment challenges, often citing cultural differences and language barriers. Nurses abroad reported high job satisfaction (mean score=135.13), linked to better salaries and career opportunities. Most participants (93%) recommended working abroad but emphasised systemic reforms in the Italian healthcare system, including competitive salaries, recognition of qualifications, and improved recruitment processes, to retain skilled nurses and prevent 'brain drain'. The Italian healthcare system must learn from the successful models adopted abroad to improve working conditions and counter the migration of skilled professionals. Beyond economic incentives, this study highlights the need for greater recognition of nurses' roles, both socially and professionally. Improving work environments and fostering respect and empowerment can reduce migration and ensure the sustainability of healthcare services while preparing future generations to deliver high-quality care.

Global impacts of climate change have been investigated around the world; however, the discussion in academic literature has generally focused on the work of scientists in the Global North (Corbera et al. 2016). We suggest that this focus may be due in part to adversity faced by scientists in the Global South when attempting to publish in high-impact, Open Access (OA) journals. Language and financial barriers can limit the options of scientists in the Global South, resulting in them publishing in their native language journals, or in journals with lower publication costs. If these journals have a lower impact score, paywalls, or are published in a language other than English, the work of these researchers may not be thoroughly disseminated. This limited dissemination is a major concern when researching climate change, as this is a global issue. To better understand climate change, other global issues, and recognize the work of underrepresented scientists, we call on the whole aquatic science community to increase awareness and support of research conducted in the Global South. The phrase “publish or perish” is used to describe the pressure scientists face to publish their research—employment, promotion, tenure, grants or other funding opportunities can often be contingent on the number of articles published in high impact journals. However, trying to publish in high impact journals can be expensive due to article processing charges. The recent push for OA science, now a requirement for federally funded research in the United States, makes science more accessible to the public, but comes at expense to the researcher, with some journals charging fees over US$4000 (Audrey et al. 2022). Such publication costs may prove challenging to scientists in the Global South where research programs may not be as well funded. For perspective, US$69.6 billion was spent on basic research in the United States in 2017 (https://www.nsf.gov/statistics/2019/nsf19321/overview.htm), compared to US$898 million in Brazil (Angelo 2017). A similar trend exists for many countries in the Global South where funds for research and development (as a function of percent gross domestic product; GDP) is much lower relative to countries in the Global North (Fig. 1). Beyond North America, there are some countries like the Republic of Korea and Israel with a research and development expenditure of 4.81% and 5.44% of GDP respectively, driving up the global average. In areas where science is often under-funded, it becomes difficult for research groups to afford publishing their results in high impact, OA journals. The exorbitant costs of publishing alone are likely part of the reason we do not have a fuller picture of climate change impacts around the globe. Scientists in the Global South may encounter another barrier: publishing in English. Most high impact journals are published in English, yet less than 17% of the world's population are native English speakers. English is often learned as a second language, a feat impressive in itself, but writing a manuscript that meets the standards of an English-based journal may prove challenging. Many research groups may find themselves needing to hire a translator, adding yet another major expense to publishing. Resources like AuthorAID (https://www.authoraid.info/) can provide free or affordable support for researchers in low- and middle-income countries to help with checking and improving the quality of their writing in English, but that will not always be enough to overcome such ingrained barriers. We can increase inclusivity in the scientific community by supporting, searching for, citing, and promoting science conducted by researchers from the Global South. Increasing awareness of these publications will have the dual benefits of providing a better understanding of the impacts of global issues like climate change and amplifying the work of underrepresented scientists from the Global South that may otherwise go unnoticed. With many scientists in the Global South working in regions with limited financial support for their research or being non-native English speakers, they face extraordinary challenges to publish their work in high impact, OA journals. In our push toward inclusivity and bettering our understanding of global issues, we must work to eliminate these financial and language barriers. Only with a united understanding between the Global North and South can we effectively understand the future of aquatic ecosystems under a changing climate.

From 2014–2019, the University of Hawai‘i (UH) at Manoa offered a National Institutes of Health funded Minority Health International Research Training (MHIRT) Program for undergraduate research experiences in infectious diseases. The goal of the program was to immerse undergraduate students in conducting global infectious diseases research to train a new generation of scientists to combat future global pandemics. The MHIRT program trained educationally underrepresented groups unique in Hawai‘i: Native Hawai‘ians and other Pacific Islanders, and underrepresented Asian Americans, e.g., Filipinos and Vietnamese. A 12-member Advisory Committee guided the program development, implementation, recruitment strategies, recruitment, retention, and program evaluation. The program provided an eight-month classroom and field based international research training. Students learned about “8 steps of research” and cultural competency, experienced a hands-on research project abroad, and presented their results to the research community in the host country and at UH. Students’ research topics focused on ongoing projects of UH faculty including those with international collaborations in infectious disease and tropical medicine. Students spent two months on an international research mentor’s project at an international site under the mentorship of a Hawai‘i based research faculty. After eight months, students graduated from the program by presenting their research to family, friends, mentors, and UH faculty and administrators. Trainees in this program pursued academic graduate or professional health degrees. The majority of students pursued further studies related to infectious diseases contributing to workforce development in infectious disease health research. The UH-MHIRT program provides an example of student immersion in international infectious disease research to foster future interest in global health research providing potential benefits for the student and faculty and their research efforts.

IntroductionThe movement to decolonize global health encompasses efforts to dismantle historically inequitable structures and processes in global health research, education, and practice. However, despite increasing literature on the decolonization of global health, gaps between action and knowledge exist in assessments of knowledge production. In this Perspective, we will outline potential biases in current approaches to assessing knowledge production and propose a systems-focused guide to improve the interrogation of knowledge production in this field.MethodsWe leverage the “Inner Setting” and “Outer Setting” domains of the Consolidated Framework for Implementation Research (CFIR), a well-established, commonly-used implementation science framework to critically assess the status quo of decolonization and to develop criteria to help guide decolonization efforts in academic contexts. We defined the Inner Setting as academic and research institutions leading and participating in global health research collaborations, and the Outer Setting as the funding, editorial, and peer review policies and practices that influence knowledge production in global health. Research institutions in the Inner organizational domain continually interact with the Outer policy domains. We categorize the levels at which decolonization may occur and where action should be focused as follows: (1) North–South, (2) South–South, (3) Local South, and (4) Local North. Using CFIR domains and the levels of action for decolonization, we propose a multi-level guide to improve on the standardization, granularity, and accuracy of decolonization assessments in global health research.Conclusion and expected impactThe proposed guide is informed by our global health research expertise and experiences as African scientists with extensive exposure in both global North and global South research contexts. We expect that the proposed guide will help to identify and address the biases identified and will lead to better knowledge-driven action in the process of decolonizing global health research.

The surgical workforce in sub-Saharan Africa is insufficient to meet population needs. Therefore, medical students should be encouraged to pursue surgical careers and "brain drain" must be minimized. It is unknown to what extent foreign aid priorities influence medical student career choices in Uganda. Medical students in Uganda completed an online survey examining their career choices and attitudes regarding career opportunities and funding priorities. Data were analyzed using descriptive statistics, and responses among men and women were compared using Fisher's exact tests. Ninety-eight students participated. Students were most influenced by inspiring role models, employment opportunities and specialty fit with personal skills. Filling an underserved specialty was near the bottom of the influence scale. Women placed higher importance on advice from mentors (p = 0.049) and specialties with lower stress burden (p = 0.027). Men placed importance on opportunities in non-governmental organizations (p = 0.033) and academia (p = 0.050). Students expressed that the most supported specialties were infectious disease (n = 65, 66%), obstetrics (n = 15, 15%) and pediatrics (n = 7, 7%). Most students (n = 91, 93%) were planning a career in infectious disease. Fifty-three students (70%) indicated plans to leave Africa for residency. Female students were more likely to have a plan to leave (p = 0.027). Medical students in Uganda acknowledge the career opportunities for physicians in specialties prioritized by the Sustainable Development Goals. In order to avoid "brain drain" and encourage students to pursue careers in surgery, career opportunities including surgical residencies must be prioritized and supported in sub-Saharan Africa.

Global health research funding applications: brain drain under another name?

Research and its equitable use are an integral part of WHO's work. The Organization's Constitution says that "the extension to all peoples of the benefits of medical, psychological and related knowledge is essential to the fullest attainment of health" (1). Knowledge produced by health research has been called a global public good (2). It is undoubtedly one of the main driving forces for improving the performance of health systems and ultimately the health of individuals and populations. Four of the United Nations Millennium Development Goals (formulated in the year 2000) require health research for their achievement. These goals concern: reducing child mortality; improving maternal health; combating HIV/AIDS, malaria, tuberculosis and other diseases; and eradicating extreme poverty and hunger. A fifth, also inseparable from health research, is to build a global partnership for development, which provides the main means of working towards these other goals. Much has been said about the importance of global health research mechanisms for bridging the health gap between rich and poor countries (3, 4). The Commission on Macroeconomics and Health has advocated a substantial increase in global health research investments (5). Some commentators have recently lamented that progress has been slow (6, 7), that the gap between those who own knowledge and those who need it has actually widened (8), and that research may actually divert resources away from more important public health priorities (9). Brain drain, lack of research culture, the digital divide, shortage of resources and other such obstacles are often cited to account for slow progress, but a systematic analysis has yet to be made. The foundations of an effective global health research endeavour must be in strong national health research capacities, together with commitment to reducing inequalities both within and between countries. The results of research are global resources, but the people and institutions producing and using them are national resources (10). The clearest need is for a system within which the disparate elements involved can work together to achieve a common goal. Practitioners know that health research is too often a fragmented, competitive, highly specialized, sectoral activity. Typically, biomedical researchers, clinicians, epidemiologists, health systems researchers, social and behavioural scientists, and health economists work in isolation. Often there is little communication between the producers of research findings and those who will use and ultimately benefit from them (11). Very few formal attempts have been made to name, define and investigate comprehensively the various inputs and outputs of health research systems. A rational framework that pulls together all of the actors, resources and stakeholders involved would clarify interdependencies and common goals. WHO is working with its Member States to define such a framework for health research systems (HRS). We define an HRS as the people, institutions and activities whose aim is to generate detailed and reliable knowledge that will be used to promote, restore or maintain the health status of populations. Our definition includes all the actors involved primarily in knowledge generation in the public and private sectors. In this preliminary framework, the advancement of scientific knowledge and its utilization to improve health and health equity are the goals of the system. Its four principal functions are stewardship (making optimal use of all the elements involved), financing, building up human and physical resources, and research. …

BackgroundIn recognition of the need for long-term planning for global health research, and to inform future global health research priorities, the United Kingdom Department for International Development (DfID) carried out a public consultation between May and June 2015. The consultation aimed to elicit views on the (1) the long-term future global health research priorities; (2) areas likely to be less important over time; (3) how to improve research uptake in low-income countries; and (4) how to build research capacity in low-income countries.MethodsAn online consultation was used to survey a wide range of participants on global health research priorities. The qualitative data was analysed using a thematic analysis, with frequency of codes in responses tabulated to approximate relative importance of themes and sub-themes.ResultsThe public consultation yielded 421 responses. The survey responses confirmed the growing importance of non-communicable disease as a global health research priority, being placed above infectious diseases. Participants felt that the key area for reducing funding prioritisation was infectious diseases. The involvement of policymakers and other key stakeholders was seen as critical to drive research uptake, as was collaboration and partnership. Several methods to build research capacity in low-income countries were described, including capacity building educational programmes, mentorship programmes and research institution collaboration and partnership.ConclusionsThe outcomes from this consultation survey provide valuable insights into how DfID stakeholders prioritise research. The outcomes from this survey were reviewed alongside other elements of a wider DfID consultation process to help inform long-term research prioritisation of global health research. There are limitations in this approach; the opportunistic nature of the survey’s dissemination means the findings presented may not be representative of the full range of stakeholders or views.