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Global Health Partnerships: Beyond “Best Intentions”

hands protecting earthEditor’s Note: On November 10, 2014, Jennifer Hatfield, Ph.D., associate dean for global health & international partnerships at the University of Calgary, will speak at Albert Einstein College of Medicine’s Global Health Conference. She’ll address ethics in global health partnerships. We asked her to share some of her thoughts on the subject in advance of her appearance.

About 10 years ago, during an international health symposium, an Ethiopian colleague and friend turned to me and said, “The problem with researchers from the ‘North’ [high-income countries] is that you think we in the ‘South’ [low- and middle- income countries] have few resources. But you do not understand that we are rich. We may not have financial resources but we have people, commitment and intellectual capacity.”

This was a turning point for me and set me on a path to change the way we in Canada educate and prepare our students and faculty to engage in global health work.

“North” vs. “South”
My colleague’s sincere sentiment framed the problem and shone a light on a possible direction toward partnerships that are more ethical and more equitable. Whether the interaction involved medical staff arriving to engage in clinical service or training, or researchers seeking international avenues for engagement, the feeling expressed so candidly by my colleague was that much of the work being done in global health research mirrored colonialism. Well-meaning, well-resourced folks from the “North” would come to help, bringing money and resources that were often spectacular compared with what was available locally. That established a dynamic of power over one group rather than collaboration among teams. Despite the best intentions, sometimes the resulting relationships were paternalistic or exploitive.

Creating ethical global health partnerships
Upon investigation, it was clear that the majority of the scholarly work in this area was carried out by institutions in the North. The Swiss Principles and work by the Netherlands RAWOO group clearly articulated a set of principles that should be considered when engaging in global health research. Guidelines calling for respect and equity were well articulated by RAWOO. However, largely absent were the voices from our colleagues in the low- and middle-income countries. A group of us from the Canadian Coalition for Global Health Research (CCGHR) approached the Canadian International Development Research Centre in an attempt to rectify the situation. We were fortunate enough to win a grant allowing us to hold regional dialogues around the world in partnership with BRAC in Bangladesh, the Universidad Andina Simón Bolivar in Ecuador and the Armauer Hansen Research Institute in Ethiopia.

The result of this work was transformational for me and for the way I teach and engage with colleagues globally.

Projects and briefcases
What we heard from the 200-plus researchers, medical professionals, politicians, NGOs, students and donor agencies from more than 15 countries was that there were no fair rules of engagement for partnerships. Those with the cash called the tune, often arriving with a literal or metaphorical “briefcase”; the project designed, intellectual property determined, roles and responsibility set and financial management legislated. Upon completion, the data or reports would go back into the briefcase and limited or minimal translation of the research took place locally.

Of greatest concern was a lack of attention on the part of the “Northern” teams to what was left behind. Few partners from the high-income countries demonstrated a desire to have projects include a long-term vision of building local capacity to strengthen health research.

A tool for ethical partnerships
Fortunately, the results of these consultations yielded a concrete tool to address the central collaborative challenge. The Partnership Assessment Tool was created jointly with our colleagues from around the world as an “engagement mechanism.”

Here’s how it works: The tool lays out the steps for negotiating a multitude of factors that support equitable and ethical partnerships. It has four components to guide dialogue and negotiations across the phases or life cycle of the partnership (Inception, Implementation, Dissemination and Wrapping-Up: “Good Ending and New Beginnings”).

Fundamental to this process is the assessment of each partner’s many capacities and resources and how each contributes to the outcome of the activities or research enterprise.

This project, through three regional consultations (South Asia, Latin America and Africa), has sought to elicit the “Southern” voice on health-research partnerships and to generate substantive tools for significantly improving the way in which they are conducted. For final reports on all three consultations and more information on the CCGHR’s partnership work, please visit www.ccghr.ca or www.ccghr.ca/resources/partnerships-and-networking/.

The tool is a central resource for teaching core competencies in global health engagement, and I am excited to have an opportunity to share this work at Einstein’s Global Health Conference.

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