Informing ‘good’ global health research partnerships: A scoping review of guiding principles

Figures & data

Table 1. Search strategy answering the question: ‘What sets of principles have been developed to inform equitable global health research partnerships?’

	Search concepts combined using Boolean operator ‘AND’
	Concept #1	Concept #2	Concept #3	Concept #4	Concept #5
Keywords combined using Boolean operator ‘OR’	global	partnerships	research	health	guidelines
	international	collaboration			principles
					model
					framework

Table 2. Summary of inclusion and exclusion criteria with rationale

Inclusion Criteria	Exclusion Criteria	Rationale
Principles must be specifically presented as applicable in a ‘global’ or ‘international’ health context.	Principles are not specified to guide ‘global’ or ‘international’ health partnerships.	This review is meant to inform principles to guide transnational partnerships specifically. Although some guidelines for community or local projects may be deduced as applicable to global health projects, those not specifically applied in an international context were considered out of the scope of this paper.
Principles must be intended to guide research practice.	Principles that are indicated to guide non-research global health programs were not included.	The scope of this paper is to review principles that are intended to have relevance to global health research partnerships and practice.

Figure 1. PRISMA [18] diagram of the review process producing the nine sources included in this review

Table 3. Participation of actors in global North and global South in development of each source

Source	North-South Consultation	Source Authorship
Bill & Melinda Gates Foundation [19]	No	Unknown
Canadian Coalition for Global Health Research (CCGHR) [11]	Yes	Global North only
Costello and Zumla [22]	No	Global North only
Larkan et al. [7]	Yes	Global South-Global North
Netherlands Development Assistance Council (RAWOO) [21]	Yes	Global South-Global North
Raza [16]	No	Global South only
Rethinking Research Collaborative (RRC) [17]	Yes	Global South-Global North
Steenhoff et al. [24]	No	Global South-Global North
Swiss Commission for Research Partnerships with Developing Countries (KFPE) [20]	Yes	Global North only

Table 4. Principles of global health research that are similarly defined can be grouped together into themes

Theme	Principle(s)	Source
Mutual Benefits	Reciprocity	Bill and Melinda Gates Foundation [19]
	Benefit	Larkan et al. [7]
	Writing and publishing together	Raza [16]
	Mutual Benefits	Steenhoff et al. [24]
	Share data and networks	KFPE [20]
	Pool profits and merits	KFPE [20]
	Shared benefits	CCGHR [11]
Agenda Setting	Focus	Larkan et al. [7]
	Setting baseline goals and objectives	Raza [16]
	Setting up future milestones of the project	Raza [16]
	Set agenda together	KFPE [20]
Equity	Equity	Larkan et al. [7]
	Equity	Steenhoff et al. [24]
	Responsiveness to causes of inequities	CCGHR [11]
	Proportionality	Bill and Melinda Gates Foundation [19]
Accountability	Accountability	Bill and Melinda Gates Foundation [19]
	Informing each other and following rules and regulations	Raza [16]
	Account to beneficiaries	KFPE [20]
Capacity Building/ Strengthening	Development of national research capacity	Costello & Zumla [22]
	Enhance capacities	KFPE [20]
	Strengthening capacity for conducting socially relevant research should be a specific aim of the partnership	RAWOO [21]
Sustainability	Sustainability	Steenhoff et al. [24]
	Commitment to the future Invest in relationships	CCGHR [11] RRC [17]
Define Roles	Sharing and assigning responsibilities	Raza [16]
	Clarify responsibilities	KFPE [20]
Engage Stakeholders	Interact with stakeholders	KFPE [20]
	A broad-based consultative process, however painstaking and time-consuming it may be, should proceed any program	RAWOO [21]
Understand the Context	Values	Larkan et al. [7]
	Critically engage with context	RRC [17]
Actionable Research	Emphasis on getting research findings into policy	Costello & Zumla [22]
	Apply results	KFPE [20]
Communication	Communication	Larkan et al. [7]
	Effective communications	Raza [16]
Data Access	Disseminate results	KFPE [20]
	Rules and norms for sharing and handling data	Raza [16]
Humility	Humility	Steenhoff et al. [24]
	Humility	CCGHR [11]
Inclusivity	Inclusivity	Steenhoff et al. [24]
	Inclusion	CCGHR [11]
Mutual Learning	Promote mutual learning	KFPE [20]
	Keep learning	RRC [17]
Social Justice	Social justice	Steenhoff et al. [24]
	Put poverty first	RRC [17]
Transparency	Disclosing financial interests	Raza [16]
	Commit to transparency	RRC [17]
Trust	Authentic partnerships Mutual trust & shared decision making	CCGHR [11] Costello & Zumla [22]
Principles with distinct definitions*	Adapt and respond	RRC [17]
	Leadership	Larkan et al. [7]
	National Ownership	Costello & Zumla [22]
	Prevention of adverse impact	Steenhoff et al. [24]
	Promotion of common good	Bill and Melinda Gates Foundation [19]
	Redress evidence hierarchies	RRC [17]
	The Northern partner should be prepared to relinquish control and accept considerable autonomy on the part of the Southern partner	RAWOO [21]
	Resolution	Larkan et al. [7]
	Respect	Bill and Melinda Gates Foundation [19]
	Respect diversity of knowledge and skills	RRC [17]
	Secure outcomes	KFPE [20]
	Stewardship	Bill and Melinda Gates Foundation [19]

* These principles cannot be grouped into any particular theme; rather, they each have their own distinct meaning and definition

Table 5. Number of sources citing each principle (organized by definition according to theme)

Principle (by theme)	Number of sources that include it
Mutual Benefits	6
Equity	4
Accountability	3
Agenda Setting	3
Capacity Building/Strengthening	3
Sustainability	3
Define Roles	2
Engage Stakeholders	2
Understand the Context	2
Actionable Research	2
Communication	2
Data Access	2
Humility	2
Inclusivity	2
Mutual Learning	2
Social Justice	2
Transparency	2
Trust	2
Adapt and respond	1
Leadership	1
National Ownership	1
Prevention of adverse impact	1
Promotion of common good	1
Redress evidence hierarchies	1
Relinquish Control	1
Resolution	1
Respect	1
Respect diversity of knowledge and skills	1
Secure outcomes	1
Stewardship	1

Table A1. List of global health research funders’ websites hand-searched for grey literature

Organization Name	Website
Bill and Melinda Gates Foundation	www.gatesfoundation.org
Canadian Association for the study of International Development (CASID)	www.casid-acedi.ca
Canadian Coalition for Global Health Research (CCGHR)	www.ccghr.ca
Council on Health Research for Development (COHRED)	www.cohred.org
Centre for Disease Control and Prevention (CDC)	www.cdc.gov
Elhra	www.elrha.org/programme/research-for-health-in-humanitarian-crises/
European Research Council	erc.europa.eu
Ford Foundation	www.fordfoundation.org
Foreign, Commonwealth & Development Office	www.gov.uk/government/organisations/foreign-commonwealth-development-office
German Federal Ministry of Education and Research	www.bmbf.de/en/index.html
Global Affairs Canada	www.international.gc.ca
International Development Research Centre (IDRC)	www.idrc.ca/en
National Institutes of Health	www.nih.gov
Canadian Red Cross	www.redcross.ca
United Nations High Commissioner for Refugees (UNHCR)	www.unhcr.org
United Nations International Children’s Emergency Fund (UNICEF)	www.unicef.org
Wellcome Trust	www.wellcome.ac.uk
World Health Organization (WHO)	www.who.int

Table B1. Principles to guide global health research partnerships

Source	Principles	Definition
Bill & Melinda Gates Foundation [19] “Global Health Data Access Principles”	Promotion of common good	“Data access should enhance the value of research and program effectiveness.” [p.2]
	Respect	“Respect must be given to matters of identity, privacy, and confidentiality as they pertain to the individuals and communities from or about whom data are collected. Respect must also be given to matters of attribution as they pertain to researchers, evaluators, and their collaborators.” [p.2]
	Accountability	“All processes and procedures for data access will be transparent, clear, and consistent with data management standards that ensure quality data, appropriate security, and equitable access.” [p.2]
	Stewardship	“All who produce, share, and use data are stewards of those data. They share responsibility for ensuring that data are collected, accessed, and used in appropriate ways, consistent with applicable laws, regulations, and international standards of ethical research conduct.” [p.2]
	Proportionality	“The needs of investigators must be balanced against those of communities and sponsors that expect benefits to arise from the activities to which they contribute information or resources.” [p.2]
	Reciprocity	“The aim of benefiting the individuals and communities who enable and support inquiry should be furthered to the extent possible and is of particular importance when involving individuals and communities from developing countries.” [p.2]
Larkan et al. [7] “Developing a Framework for Successful Research Partnerships in Global Health”	Focus	“Common goals and minimum common programme … shared interest and vision.” [p.4]
	Values	“ … understanding the organisational culture of each partner and the underlying societal norms within which each partner operates.” [p.4]
	Equity	“ … recognition of, and respect for, differing capacities; and a sharing of resources such that inclusion occurs on an equitable basis.” [p.4]
	Benefit	“ … reciprocal and mutually beneficial relationships among all partners. Such benefits may include the generation of skills, rewarding experiences, knowledge exchange etc.” [p.4]
	Communication	“ … transparent; open; honest; consistent; unambiguous, and effective” [p.4]
	Leadership	“ … delegation of roles and responsibilities, but also management and accountability. In particular, balance and diplomacy, when dealing with all collaborators in the partnership, were identified as essential.” [p.4]
	Resolution	“Firstly, there should be an acknowledgement that partnerships may encounter difficulties, and resolve, perseverance, and determination will be required to deal with any such difficulties. Secondly, while the on-going processes of mediation and conflict resolution may offer solutions, the need for the dissolution of partnerships may still ensue.” [p.4]
Raza [16] “Collaborative Healthcare Research: Some Ethical Considerations”	Effective communication	“Communication should be established at all levels, sharing expertise, data, chemicals and other necessities.” [p.181]
	Setting baseline goals and objectives	“Each partner must lay down his or her contribution to the main goals of the collaborative project.” [p.181]
	Sharing and assigning responsibilities	“Determining clear role of each collaborating team member will reduce stress, enhance performance and clarify mutual expectations.” [p.181]
	Setting up future milestones of the project	“After an initial framework of different activities is set and agreed upon by the team leaders, the next step is to estimate a time limit to each of them and make a tentative timetable for different activities until the termination of the project.” [p.181]
	Rules and norms for sharing and handling data	“The team heads must mutually discuss and decide, set practical rules and communicate to their subordinates the policies related to data ownership, keeping, sharing, disclosure and publication while the project is in progress and after it has ended.” [p.182]
	Writing and publishing together	“ … a mutual understanding about the mechanism as to how they will write and publish together once different team members start doing experiments, generate valid data or perform data-analysis.” [p.182]
	Disclosing financial interests	“ … decide that if any expected or unexpected results lead to financial gain, patent or intellectual property, how the interest will be decided among themselves and those who funded the project.” [p.182]
	Informing each other and following rules and regulations	“The team members in collaboration must respect and follow rules and regulations as set by the funding agencies or grantee institutions or the nature of their research. They should inform each other about their own limitations or claims with regards to handling of materials, use or transfer of equipment, confidentiality of clinical data, budgeting, intellectual property rights etc.” [p.183]
Steenhoff et al. [24] “Partnerships for Global Child Health”	Equity	“ … absence of systematic disparities in controllable or remediable aspects of health between groups with different levels of underlying social advantage with respect to wealth, power, or prestige.” [p.4]
	Inclusivity	“include[s] promoting the involvement and participation of all major stakeholders, particularly communities who may be disadvantaged by poverty, low education, race, or other factors.” [p.6]
	Sustainability	“ … refers to building a long-term vision for strengthening child health while working to conduct successful short-term activities.” [p.6]
	Mutual Benefits	“A reciprocal and mutually beneficial relationship … which may involve outlining reconciling objectives that are not strongly shared while ensuring that objectives are not divergent.” [p.6]
	Prevention of adverse impact	“ … taking steps to minimize adverse outcomes to visiting providers, students, and trainees as well as to patients, communities, local providers, and health facilities in LMICs.” [p.7]
	Social justice	“The principle of social justice calls for partners to work together to value diversity (including gender, religion, age, race, social class, socioeconomic circumstance or disability, and sexual orientation); recognize social, historical, political, economic, and environmental determinants of health; and seek ways to mitigate inequities.” [p.7]
	Humility	“ … calls on stakeholders to dedicate efforts to understand their own assumptions, biases, and differing values and to center the partnership on the act of learning rather than on knowing.” [p.7]
Costello & Zumla [22] “Moving to Research Partnerships in Developing Countries”	Mutual trust and shared decision-making	“Do the partners know each other well and trust each other? Do the partners have regular and easy communications? Do the partners have good access to databases and information from international organisations? Who proposed the research programme? Do all participants understand it? Did people who will be affected by the research participate in developing the research theme? Were users consulted? Are the likely beneficiaries of the research clearly defined?” [p.829]
	National Ownership	“Do national partners have overall administrative responsibility and responsibility for scientific supervision? If not, why not? Is there transparency, with equal access of partners to scientific and budgetary documents and fund allocation decisions? Do the national partners have adequate training and audit systems to take full responsibility for programme implementation? Are there clear and fair rules about who has authority over financial decisions? Will the partners share equally in any findings or potential commercial value, and has an agreement been made?” [p.829]
	Emphasis on getting research findings into policy	“Does the research give due consideration to the social, political, economic, and technical situation of the partners? Is traditional knowledge and custom incorporated into the research plan? Is there a dissemination plan? Does this include publications or reports for the people directly affected by the research and by a wider audience than the scientific community? What is the plan about targeting government and non-governmental policymakers, stakeholders, and opinion leaders? Is authorship of scientific publications balanced? What steps are being taken to ensure that research findings will quickly be put into practice?” [p.829]
	Development of national research capacity	“Does the research fit into existing national or regional research policy? Is the collaboration being monitored and evaluated both internally and externally? Are national partners properly represented in evaluations? How will the partnership develop local research capacity in the field of interest? Who will receive training, where, and for how long? How will South-to-South collaboration be promoted? What will happen to staff when existing research projects finish? Will this research partnership reduce the migration of researchers to the developed world or into the bureaucracies of international agencies? How will the partner institution sustain research and continue research after the programme is finished?” [p.829]
Swiss Commission for Research Partnerships with Developing Countries (KFPE) [20] “A Guide for Transboundary Research Partnerships”	Set agenda together	“Determining research questions, research approaches, and research methods jointly is a first important step towards more equity in cooperation, shared ownership and mutual trust.” [p.3]
	Interact with stakeholders	“Ideally, researchers should involve important stakeholders early on, in the formulation of research questions or even in certain research activities. The more specific the research is in terms of addressing political and societal issues and users’ needs, the more relevant – and likely to be used – the research results will be.” [p.4]
	Clarify responsibilities	“Any partnership ultimately depends on each partner contributing what they are particularly skilled in doing. Dividing the work makes it necessary to clarify and assign the responsibilities of the partners involved and, based on this, their rights and obligations.” [p.5]
	Account to beneficiaries	“Answering to particular expectations of potential beneficiaries of research is thus an obligation, but also an effective means of communication and feedback. Being accountable «downward» to a specific group of beneficiaries can trigger an important echo, leading to enhanced and genuine partnerships, new research questions and, last but not least, to broader and deeper dissemination of results” [p.6]
	Promote mutual learning	“The willingness of those involved to engage in dialogue and learning processes is a crucial precondition for generating added value at the institutional level.” [p.7]
	Enhance capacities	“ … the focus is on increasing both knowledge and know-how, while at the same time fostering the capacities of all parties involved, including all stakeholders and junior scientists. Both processes should enhance each other.” [p.8]
	Share data and networks	“ … in North-South partnerships, as a rule, knowledge and information are not distributed one-sidedly: both sides have information and relationships that are crucial for the success of their joint research project. Negotiating the «give and take» can lead to a win-win situation.” [p.9]
	Disseminate results	“Every researcher must therefore disseminate his or her findings in forms that enable potential users to find, understand, and use them.” [p.10]
	Pool profits and merits	“This includes equal acknowledgement of authors as well as selection of a publication channel that caters to all interests. Profit distribution can be free of conflicts in cases where investors have achieved their goals and researchers have been able to publish their work as desired and agreed upon.” [p.11]
	Apply results	“ … effective implementation of research results means speaking the language of the users and presenting the results in such a way that they have a meaning for users.” [p.12]
	Secure outcomes	“Integration into research networks (including South-South cooperation), targeted capacity development, and enhancing visibility by means of publications are some of many possible entry points for loosening dependencies and creating continuity.” [p.13]
Netherlands Development Assistance Research Council (RAWOO) [21] “North-South Research Partnerships: Issues and Challenges”	Strengthening capacity for conducting socially relevant research should be a specific aim of the partnership	“Strengthening capacity means addressing the management of the research institution, the relationship between researcher and society, and the relationship between the research institution and society. The work plan should describe the concrete activities undertaken for this purpose, such as financial support, training, policy dialogue and advocacy, as well as activities undertaken by Southern partners to ensure recognition in their own society. Training a few PhD students or purchasing some equipment is not sufficient.” [p.29]
	The Northern partner should be prepared to relinquish control and accept considerable autonomy on the part of the Southern partner	“Ideally, the Southern partner plays an autonomous role in shaping the partnership. It chooses its research partners from the North and decides which elements of the programme will require cooperation with Northern researchers. It also decides which type of expertise it wants from the Northern partner, on which scale, and at which level: junior or senior. At the same time, Southern partners have to take into account the demands which the Northern partners are required by their own institutions to meet.” [p.29]
	A broad-based consultative process, however painstaking and time-consuming it may be, should proceed any program	“This process should ensure that the motives for establishing the partnership are clear to all stakeholders and that the objectives of the partnership are well defined and clearly communicated between the collaborating institutions. This paves the way to the development of mutual trust.” [p.30]
Canadian Coalition for Global Health Research [11] “CCGHR Principles for Global Health Research”	Authentic partnering	“Authentic partnering is about ensuring our intentions and actions as global health researchers are aligned around equitable research relationships, processes, and outcomes. It involves creating and maintaining a strong foundation of trust.” [p.4]
	Inclusion	“Commitment to inclusion invites those involved in [global health research] to promote equity by proactively and intentionally providing opportunities for diverse people to be engaged in research processes. The principle of inclusion also challenges those involved in [global health research] to seek diverse perspectives in the definition of research questions, formation of research teams, or creation of research initiatives.” [p.5]
	Shared benefits	“The principle of shared benefits is about collectively striving to share emerging benefits, knowledge, evidence, and innovations in equitable, openly accessible ways. It invites us to find ways to prioritize equity amongst all those involved in research in the distribution of benefits. This extends to all players in research, including trainees and research participants.” [p.6]
	Commitment to the future	“Our commitment to the future is about honouring our global citizenship and investing in a better, more equitable world where human rights, including the right to health, are protected and promoted.” [p.7]
	Responsiveness to causes of inequities	“People involved in [global health research] should be aware of the historical, social, cultural, political, economic, and environmental reasons for health inequities. They should strive to understand health inequities as inseparable from issues of power.” [p.8]
	Humility	“The principle of humility is about positioning ourselves in a place of learning rather than knowing.” [p.9]
Rethinking Research Collaborative (RRC) [17]	Put poverty first	“ … partners need to constantly question how the process and activities of the research are addressing the end goal. This requires a consideration of whose knowledge and agendas count and greater attention to research uptake and use long after initial funding might end.” [p.9]
	Critically engage with context	“A commitment to this principle requires conscientious analysis of the contexts of research governance, implementation and use. This should include a systematic mapping of the relevant stakeholders, as well as consideration of the representativeness of both partnerships and agenda-setting/evaluation committees and review colleges.” [p.9]
	Redress evidence hierarchies	“ … funders, brokers and partners should recognise that different stakeholders (including those from different academic traditions as well as other development professionals) will have different expectations as to what “quality evidence” means to them. This influences whose knowledge is valued, how research is designed and implemented, what types of research outputs are produced and which audiences are considered.” [p.10]
	Adapt and respond	“ … every actor should take an adaptive approach that is responsive to context; constantly review and renegotiate all the research parameters.” [p.10]
	Respect diversity of knowledge and skills	“To live up to this principle requires time to be taken at the outset to explore the knowledges, skills and experiences that each partner brings and contributes to making the partnership greater than the sum of its parts. All contributions should be made explicit and be respected.” [p.11]
	Commit to transparency	“ … a code of conduct or memorandum of understanding that commits each partner to transparency in all aspects of the project administration and budgeting; and that sets out clearly the rights of all partners regarding acknowledgement, authorship, intellectual property and data use.” [p.11]
	Invest in relationships	“ … significant investment in creating spaces for new partnerships to emerge and for existing relationships to develop and sustain through funded time for meaningful communication.” [p.11]
	Keep learning	“ … constant critical reflection and learning within and beyond the partnership.” [p.12]

Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:e1000097.

 PubMed Web of Science ®Google Scholar

Bill and Melinda Gates Foundation. Global health data access principles [Internet] 2011 Apr [cited 2020 Oct 27]. Available from: https://docs.gatesfoundation.org/documents/data-access-principles.pdf

 Google Scholar

Canadian Coalition for Global Health Research. CCGHR principles for global health research [Internet]. 2015 Nov [cited 2020 Oct 27]. Available from: https://www.ccghr.ca/wp-content/uploads/2015/10/CCGHR-Principles-for-GHR-FINAL.pdf

 Google Scholar

Costello A, Zumla A. Moving to research partnerships in developing countries. BMJ. 2000;321:827–829.

 PubMed Web of Science ®Google Scholar

Larkan F, Uduma O, Lawal SA, et al. Developing a framework for successful research partnerships in global health. Globalization Health. 2016;12:17.

 PubMed Web of Science ®Google Scholar

Netherlands Development Assistance Research Council. North-South research partnerships: issues and challenges [Internet] 2001 Sep [cited 2020 Oct 27]. Available from: https://www.ircwash.org/sites/default/files/RAWOO-2001-North.pdf

 Google Scholar

Raza M. Collaborative healthcare research: some ethical considerations. Sci Eng Ethics. 2005;11:177–186.

 PubMed Web of Science ®Google Scholar

Rethinking Research Collaborative. Promoting fair and equitable research partnerships to respond to global challenges [Internet]. 2018 Sep [cited 2020 Oct 27]. Available from: https://rethinkingresearchpartnerships.files.wordpress.com/2018/10/fair-and-equitable-partnerships_research-report-public.pdf

 Google Scholar

Steenhoff AP, Crouse HL, Lukolyo H, et al. Partnerships for global child health. Pediatrics. 2017;140:e20163823.

 Web of Science ®Google Scholar

Swiss Commission for Research Partnerships with Developing Countries. A guide for transboundary research partnerships [Internet]. 2012 [cited 2020 Oct 27]. Available from: http://www.cohred.org/wp-content/uploads/2011/05/A-guide-for-transboundary-research-partnerships.pdf

 Google Scholar