Collection launched: 14 Sep 2020
An extraordinarily important but often unrealized goal in global health is the inclusion of colleagues from low-income and middle-income countries (LMICs) as full partners in scientific research. Virtually all global health research takes place in LMICs with LMIC colleagues playing key research team roles. Yet rarely are these colleagues engaged as full partners and/or their contributions given the merits and recognition they deserve. They contribute, but not plan. They assist but they do not lead. And too often, there is no path available in their home countries that enables these colleagues to grow in experience, gain scientific independence and recognition and become leaders in research.
The reasons for this exclusion and lack of opportunity are many. Some are historical. The field of global health had its origins in ‘tropical medicine’ and even today remains deeply rooted in the colonial legacy. Other reasons are academic. The scientists from high-income countries (HICs) who come to LMICs to lead research control the scientific agenda, are funded from afar, are testing hypotheses formulated elsewhere, and are driven by the academic pressures of publication and promotion. Moreover, these researchers are seldom rewarded for engaging with local collaborators – as a stand-alone essential investment - or creating opportunities for their scientific growth.
Nearly ten years ago, Partners In Health (PIH)/Rwanda set out to break this outmoded and unjust paradigm. With support from their institutional partner, the Department of Global Health and Social Medicine (DGHSM) at Harvard Medical School, PIH/Rwanda built a fully collaborative research training program that embodies the spirit of “accompaniment” that is at core of Partners In Health’s mission. The training team from Harvard and PIH/Rwanda is committed to work side-by-side with Rwandan colleagues, to provide locally relevant and requested necessary support, and to accompany them until the journey is complete as they become independent researchers and form equitable partnerships.
The papers presented in this Special Collection are the fruits of this continuing collaboration. They are led by Rwandan-local program and clinical leaders, individuals who work on the ground and know full well the challenges their programs face and gaps in research and programming that need redress. These leaders know how to translate research findings into meaningful change, and indeed all of the research presented here has already or is in the process of informing clinical practice, program implementation and national policies. Some of these papers identify challenges in programs, such as in supply chain management for decentralized non-communicable disease programs (NCD) or retention of patients in cervical cancer treatment. These challenges are not unique to Rwanda and can inform program design and improvements in other African countries and beyond. Some of these papers describe innovations – such as establishing a heart surgery registry or integrating cancer patient follow-up into NCD clinics – that will inspire new ways to approach entrenched problems.
The individuals leading this work are not academics and most have limited prior formal research training. To support their success, this research was developed in the context of a comprehensive research training and mentorship program that supported them from the inception of an idea, through development of a protocol, and then on to data collection, analysis and publication. These reports – we hope - offer a refreshing break from the traditional foreign-led, top-down paradigm of research in global health.
Very importantly, publication of these papers establishes these leaders’ expertise in the global arena, facilitates their professional growth, builds Rwanda’s institutional research capacity, and enhances Rwanda’s competitiveness for future research funding. The Special Collection also includes three complementary pieces. Zacharia et al describe the links between the PIH/Rwanda training program and the larger SORT-IT initiative at the WHO, emphasizing that these types of training and research programs should be considered a necessity and not a luxury. Murray and Mubiligi describe the long academic-NGO partnership between Harvard and PIH/Rwanda and how this partnership, and specifically this training program, are mutually beneficial. Finally, Odhiambo et al provide more detail on the program itself, including its financing, administrative structure, and the resources needed to support its replication in other settings.
This Special Collection arose out of a visit to Rwanda of a group of DGHSM advisors, who saw innovation not only in the research generated through this program, but also in the program itself. We hope this collection serves as an inspiration to encourage locally driven research, exemplifies how to build strong academic-implementation partnerships, and is call to action to prioritize investments into local teams’ capacities, and speaks to the urgent and essential need for intentional working towards equity in collaboration.
We are grateful to the many individuals who contributed to this work, particularly the Research Department at PIH/Rwanda and the Global Health Research Core at DGHSM. We are especially thankful to Dr. Stephen Kahn and the Abundance Foundation for underwriting the cost of this Special Collection and to Annals of Global Health for providing journal space and complementary funding.
Special Collection Editors: Philip Landrigan, Bethany Hedt-Gauthier, Fredrick Kateera