Ethical responsibilities of health research funders to advance global health justice

ABSTRACT

Research funders from high-income countries have an ethical obligation to support health research in low and middle-income countries that promotes justice in global health. Conceptual work from bioethics proposes funders should do so through their design of grants programs, investments, and grants management. That work has begun to specify the content of funders’ ethical responsibility with regards to health systems research, but it has thus far not been informed by their practice. As a first step to bridge that gap, this paper focuses on health systems research funders’ design of grants programs. It aims to test the content of funders’ proposed ethical responsibility against recent empirical work describing how they design their health systems research grants programs to help address global health disparities. Based on that analysis, recommendations are made for how to better articulate the content of health systems research funders’ obligation. Such recommendations may be pertinent to funders of other types of international research. The paper also provides an initial picture of how well health systems research grants programs’ designs may align with the ideals of global health justice.

KEYWORDS:

• Ethics
• justice
• donor
• global health
• health systems research
• international research
• low and middle-income countries

Disclosure statement

This study was partially supported by the Future Health Systems consortium, which is funded through the UK Department of International Development (DFID). The authors were members of Future Health Systems; their role was to conduct ethics research relevant to the consortium. While their indirect relationship with DFID is acknowledged, the authors do not believe it is of the kind to raise concerns about the validity of data analysis. DFID played no role in the design of the study or analyses reported in the paper.

Data availability statement

The data supporting the results or analyses presented in the paper can be found at: http://onlinelibrary.wiley.com/doi/10.1111/dewb.12136/abstract.

ORCID

Bridget Pratt http://orcid.org/0000-0002-4934-3560

Adnan A. Hyder http://orcid.org/0000-0002-7292-577X

Notes

1 Traditionally, reflective equilibrium entails working back and forth between theoretical considerations (intuitions, moral principles, theories). It involves testing existing theoretical considerations against new ones, revising and refining until coherence is achieved (Beauchamp & Childress, 2009). However, there are additional versions of the reflective equilibrium approach. In empirical ethics, reflective equilibrium entails testing theoretical considerations against information from practice—namely, the considered judgements of people who perform the studied practice (De Vries & Van Leeuwen, 2010). That approach was utilised in this project and the considered judgements it used were those of research funders.

2 These funders and organisations were selected because senior researchers in the Johns Hopkins Bloomberg School of Public Health identified them as the main organisations supporting HSR in LMICs. These 11 funders and organisations do not encompass all funders that invest in HSR in LMICs. Funders that primarily support HSR as a component of their overall health programming activities such as USAID and World Bank were not interviewed because they usually do not have grant schemes to which general applicants can apply for research funding.

3 Devolving responsibility means a visible change in the balance of responsibilities is achieved over the course of joint projects. For example, where LMIC partners have very little capacity at the start of a collaboration, they might eventually take over the day-to-day implementation of research in their country from high-income country partners (Pratt & Hyder, 2016).

4 Action research is embedded into the operations of health programs and systems and serves as the intervention to foment changes that lead to reduced health inequities (Pratt & Hyder, 2016).

Additional information

Funding

This study was supported by an Australian National Health and Medical Research Council (NHMRC) Early Career Sidney Sax Public Health Overseas Fellowship (Award No. 1052346) to BP. The contents of this article are solely the responsibility of the authors and do not reflect the views of the NHMRC. At the time of this study, BP and AAH were also supported by Future Health Systems, which is funded by the UK Department for International Development.