PLoS Medicine
(Accessed 15 March 2014)
http://www.plosmedicine.org/

Essay
Building Research Capacity in Africa: Equity and Global Health Collaborations
Kathryn M. Chu mail, Sudha Jayaraman, Patrick Kyamanywa, Georges Ntakiyiruta
Published: March 11, 2014
DOI: 10.1371/journal.pmed.1001612
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001612

Summary Points
:: Global health has increased the number of high-income country (HIC) investigators conducting research in low- and middle-income countries (LMICs).

:: Partnerships with local collaborators rather than extractive research are needed.

:: LMICs have to take an active role in leading or directing these research collaborations in order to maximize the benefits and minimize the harm of inherently inequitable relationships.

:: This essay explores lessons from effective and equitable relationships that exist between African countries and HICs.

Introduction
Global health is a growing academic field where high-income country (HIC) faculty and students work in low- and middle-income countries (LMICs), especially in Africa; learn about new cultures, settings, and diseases; and possibly develop an expertise to address existing and emerging challenges in health care [1]. Global health has brought beneficial HIC medical knowledge particularly to African countries: expertise in health policy and planning from high-income settings has improved clinic and hospital infrastructure and practices such as neonatal resuscitation [2],[3]. In addition, research led and supported by HIC researchers has clearly identified preventive and therapeutic interventions for major causes of mortality such as severe malaria, HIV/AIDS, and childhood sepsis [4]–[7].

Worldwide, the highest burden of disease is from LMICs; however, medical research originating from these countries is low [8]. According to one study, sub-Saharan Africa (SSA) produces less than 1% of biomedical publications [9]. Effective research has four pre-requisites: individual research skills and ability, appropriate infrastructure, relevance to national policies, and the ability to contribute to global research and policy needs [10]. African research capacity has not paralleled capacity in HIC for many reasons: few qualified researchers, less funding, poor infrastructure such as laboratories and computers, and lack of expertise in preparing manuscripts for publication [8]. Collaboration with HIC colleagues and institutions has enormous promise to bring expertise, funding, and resources to Africa. However, there is great potential for a power imbalance in these relationships. Much of the research carried out in Africa is led, funded, and published by HIC researchers without equal collaboration from LMIC colleagues. HIC scientists have been accused of extractive research, flying into an LMIC to obtain data or samples and leaving with the recognition and benefits of the publication.

Researchers collecting blood samples for studies have been termed “mosquitoes” or “vampires” [11],[12]. HIC investigators secure most of the funding for global health research projects and often dictate the research agenda [11]. If their values and objectives are different from African partners this can lead to inappropriate projects unrelated to local research needs, and derive conclusions that do not have any direct local benefit [13]. Some participants have commented that these kinds of collaborations leave locals feeling like “prostitutes” [14]. Furthermore, when HIC researchers conduct studies in settings that are unprepared in terms of infrastructure and health workers, research can disrupt local medical and educational services and have a detrimental effect on local health care, usually by taking already overworked health care providers away from their clinical and teaching duties [11],[14],[15].

HIC academics work for universities that typically measure the success of their faculty by research funding and publications. Even if HIC scientists genuinely want to advance African research agendas, building the research capacity of African collaborators may not be an important objective to their institutions [13],[14].

The Challenge
A few questions arise when considering how to engage in equitable global health research:
–       How can African institutions and physicians benefit from international research collaborations without being exploited?
–       How can advancement of African research capacity and academic careers be prioritized while satisfying the “publish or perish” mandate of HIC universities?
–       How do African scientists and governments coordinate the great influx of HIC academics who view the continent as the next frontier in global health research?

This essay describes some of the important steps for African researchers and academic institutions to consider in managing global health research partnerships in their settings…