Overcoming structural barriers to sharing power with communities in global health research priority-setting: Lessons from the Participation for Local Action project in Karnataka, India

ABSTRACT

Community engagement is gaining prominence in global health research. But communities rarely have a say in the agendas or conduct of the very health research projects that aim to help them. This paper provides new evidence on how to share power in priority-setting in ways that seek to overcome structural constraints created by the funding environment. The five strategies were identified through case study research on the Participation for Local Action project in Karnataka, India. That project was carried out by researchers in partnership with the Zilla Budakattu Girijana Abhivrudhhi Sangha, an indigenous community development organisation representing the Solega people. The paper describes each identified strategy for sharing power in priority-setting, followed by a report of the pitfalls and challenges that arose when implementing it. Thus, the study also demonstrates that even where actions and strategies are used to address power imbalances, pitfalls will arise that need to be navigated. Given those challenges, considerations to reflect upon before employing the identified strategies are suggested. Ultimately, the paper aims to communicate strategies for sharing power during and after priority-setting and lessons on how to implement them effectively that can be used by global health researchers in the current funding environment.

KEYWORDS:

• Power
• participation
• community engagement
• research
• priority-setting
• global health

Acknowledgements

The authors would like to acknowledge and thank Nityasri S N for her assistance conducting interviews, performing direct observations, and ensuring the accuracy of interview transcripts’ translation from Kannada to English; Natalia Evertsz for her assistance in the thematic analysis of the data; and C Mahadeva for his assistance recruiting interviewees and organising interviews. The authors would also like to thank all study participants who were involved in this case study research project.

Disclosure statement

The authors have not derived any financial interests or benefits from the direct applications of this research. Two of the paper’s co-authors were investigatorson the health systems research project that is the focus of the casestudy in this paper. However, we believe that the nature of their involvementwas not of a kind to raise concerns about the validity of study findings.

Data availability statement

The data that support the findings of this study are available from the corresponding author, BP, upon reasonable request.

Notes

1 In relation to the site of power, ‘level of participation’, Egid et al. (2021) emphasise the need to establish governance structures and processes that share decision-making with community partners and to enable community partners to set the agenda for the research and choose which approaches to implement. In terms of ‘compensation’, Egid et al. (2021) identify co-researcher compensation, both economic and in other forms (recognition and prestige in their community, learning new skills), as an action to address power inequities. In relation to ‘space’, Farr (2018) mentions that using ‘community spaces’ encouraged people who may be deemed ‘hard to reach’ to get involved and contribute their experiences, skills and resources. Farr (2018) has further developed a series of questions to support practitioners considering different power dynamics within co-production processes. These include questions related to the diversity of who from the community is involved and whether changes are made due to their perspectives in a given co-production process. The former relates to the site of power ‘diversity’ and the latter relates to the site of power ‘being heard’.

2 Some current and former funding schemes for global health research support seed funding to put together a full grant proposal or an inception phase for funded projects but these are not common and may emphasise engagement with policymakers as opposed to engagement with marginalised communities and organisations that represent them (Pratt & Hyder, 2018a, 2018b).

3 There are indigenous tribes in Chamarajanagar district other than the Solega, but 90% of indigenous people in the district belong solely to the Solega tribe.

4 A minor change was made to the paper based on the comments received from the Sangha leadership. Specifically, the following sentence was added to the Space sub-section: ‘Within the district Sangha, not speaking may reflect not wanting to speak.’

5 In choosing this topic within the funding call, the principal investigators had done so with the Solega people in mind, drawing on their experience as doctors serving the community:

‘when you’re talking maternal health or when you talk children (yeah) it’s a community issue. So the minute you say pregnancy, you say childbirth or you say children, even the men have an opinion and even they are interested so I realised that maternal health was something that they would engage, come forward as a community.’

Had the PLA project focused on a disease like TB, the researchers thought they would have struggled to get community participation because it’s a disease and the Solega people would assume that only a small population in their villages would actually have it. The underlying causes of poor access to maternal and child health services were the same as other issues facing the community, so the researchers also felt addressing those causes would be attractive to the Solega people.

Additional information

Funding

At the time of this study, BP was supported by an Australian Research Council Discovery Early Career Researcher Award [grant number DE170100414]. PNS is supported by Wellcome Trust/DBT India Alliance Intermediate Clinical and Public Health Research Fellowship awarded to him [grant number IA/CPHI/16/1/502648]. The contents of this article are solely the responsibility of the authors and do not reflect the views of the Australian Research Council.