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      “The way the country has been carved up by researchers”: ethics and power in north–south public health research

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          Abstract

          Background

          Despite the recognition of power as being central to health research collaborations between high income countries and low and middle income countries, there has been insufficient detailed analysis of power within these partnerships. The politics of research in the global south is often considered outside of the remit of research ethics. This article reports on an analysis of power in north–south public health research, using Zambia as a case study.

          Methods

          Primary data were collected in 2011/2012, through 53 in-depth interviews with: Zambian researchers ( n = 20), Zambian national stakeholders ( n = 8) and northern researchers who had been involved in public health research collaborations involving Zambia and the global north ( n = 25). Thematic analysis, utilising a situated ethics perspective, was undertaken using Nvivo 10.

          Results

          Most interviewees perceived roles and relationships to be inequitable with power remaining with the north. Concepts from Bourdieu’s theory of Power and Practice highlight new aspects of research ethics:

          • Northern and southern researchers perceive that different habituses exist, north and south - habituses of domination (northern) and subordination (Zambian) in relation to researcher relationships.

          • Bourdieu’s hysteresis effect provides a possible explanation for why power differentials continue to exist. In some cases, new opportunities have arisen for Zambian researchers; however, they may not immediately recognise and grasp them.

          • Bourdieu’s concept of Capitals offers an explanation of how diverse resources are used to explain these power imbalances, where northern researchers are often in possession of more economic, symbolic and social capital; while Zambian researchers possess more cultural capital.

          Conclusions

          Inequities and power imbalances need to be recognised and addressed in research partnerships. A situated ethics approach is central in understanding this relationship in north–south public health research.

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          Most cited references48

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          What makes clinical research in developing countries ethical? The benchmarks of ethical research.

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            Mapping of available health research and development data: what's there, what's missing, and what role is there for a global observatory?

            The need to align investments in health research and development (R&D) with public health demands is one of the most pressing global public health challenges. We aim to provide a comprehensive description of available data sources, propose a set of indicators for monitoring the global landscape of health R&D, and present a sample of country indicators on research inputs (investments), processes (clinical trials), and outputs (publications), based on data from international databases. Total global investments in health R&D (both public and private sector) in 2009 reached US$240 billion. Of the US$214 billion invested in high-income countries, 60% of health R&D investments came from the business sector, 30% from the public sector, and about 10% from other sources (including private non-profit organisations). Only about 1% of all health R&D investments were allocated to neglected diseases in 2010. Diseases of relevance to high-income countries were investigated in clinical trials seven-to-eight-times more often than were diseases whose burden lies mainly in low-income and middle-income countries. This report confirms that substantial gaps in the global landscape of health R&D remain, especially for and in low-income and middle-income countries. Too few investments are targeted towards the health needs of these countries. Better data are needed to improve priority setting and coordination for health R&D, ultimately to ensure that resources are allocated to diseases and regions where they are needed the most. The establishment of a global observatory on health R&D, which is being discussed at WHO, could address the absence of a comprehensive and sustainable mechanism for regular global monitoring of health R&D. Copyright © 2013 Elsevier Ltd. All rights reserved.
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              Assessing capacity for health policy and systems research in low and middle income countries*

              Background As demand grows for health policies based on evidence, questions exist as to the capacity of developing countries to produce the health policy and systems research (HPSR) required to meet this challenge. Methods A postal/web survey of 176 HPSR producer institutions in developing countries assessed institutional structure, capacity, critical mass, knowledge production processes and stakeholder engagement. Data were projected to an estimated population of 649 institutions. Results HPSR producers are mostly small public institutions/units with an average of 3 projects, 8 researchers and a project portfolio worth $155,226. Experience, attainment of critical mass and stakeholder engagement are low, with only 19% of researchers at PhD level, although researchers in key disciplines are well represented and better qualified. Research capacity and funding are similar across income regions, although inequalities are apparent. Only 7% of projects are funded at $100,000 or more, but they account for 54% of total funding. International sources and national governments account for 69% and 26% of direct project funding, respectively. A large proportion of international funds available for HPSR in support of developing countries are either not spent or spent through developed country institutions. Conclusions HPSR producers need to increase their capacity and critical mass to engage effectively in policy development and to absorb a larger volume of resources. The relationship between funding and critical mass needs further research to identify the best funding support, incentives and capacity strengthening approaches. Support should be provided to network institutions, concentrate resources and to attract funding.
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                Author and article information

                Contributors
                +35314028657 , aislingwalsh@rcsi.ie
                rbrugha@rcsi.ie
                elainebyrne2@rcsi.ie
                Journal
                Int J Equity Health
                Int J Equity Health
                International Journal for Equity in Health
                BioMed Central (London )
                1475-9276
                12 December 2016
                12 December 2016
                2016
                : 15
                : 204
                Affiliations
                [1 ]Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
                [2 ]Institute of Leadership, Royal College of Surgeons in Ireland, Dublin, Ireland
                Article
                488
                10.1186/s12939-016-0488-4
                5153695
                27955670
                27ec37b9-3ccd-4551-8b2c-aaafe0b38090
                © The Author(s). 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 12 August 2016
                : 28 November 2016
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100009099, Irish Aid;
                Categories
                Research
                Custom metadata
                © The Author(s) 2016

                Health & Social care
                zambia,research partnerships,situated research ethics,power,bourdieu
                Health & Social care
                zambia, research partnerships, situated research ethics, power, bourdieu

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