Barriers to sustainable health research leadership in the Global South: Time for a Grand Bargain on localization of research leadership?

Exploring the landscape of essential health data science skills and research challenges: a survey of stakeholders in Africa, Asia, and Latin America and the Caribbean

Background

Data science approaches have been pivotal in addressing public health challenges. However, there has been limited focus on identifying essential data science skills for health researchers, gaps in capacity building provision, barriers to access, and potential solutions.

Objectives

This review aims to identify essential data science skills for health researchers and key stakeholders in Africa, Asia, and Latin America and the Caribbean (LAC), as well as to explore gaps and barriers in data science capacity building and share potential solutions, including any regional variations.

Methods

An online survey was conducted in English, French, Spanish and Portuguese, gathering both quantitative and qualitative responses. Descriptive analysis was performed in R V4.3, and a thematic workshop approach facilitated qualitative analysis.

Findings

From 262 responses from individuals across 54 low- and middle-income countries (LMICs), representing various institutions and roles, we summarised essential data science skills globally and by region. Thematic analysis revealed key gaps and barriers in capacity building, including limited training resources, lack of mentoring, challenges with data quality, infrastructure and privacy issues, and the absence of a conducive research environment.

Conclusion and future directions

Respondents' consensus on essential data science skills suggests the need for a standardised framework for capacity building, adaptable to regional contexts. Greater investment, coupled with expanded collaboration and networking, would help address gaps and barriers, fostering a robust data science ecosystem and advancing insights into global health challenges.

Current global vitamin and cofactor prescribing practices for primary mitochondrial diseases: Results of a European reference network survey

Primary mitochondrial diseases (PMD) account for a group of approximately 400 different genetic disorders with diverse clinical presentations and pathomechanisms. Although each individual disorder is rare, collectively they represent one of the largest groups in the field of inherited metabolic disorders. The complexity of PMD results in a continued lack of therapeutic options, necessitating a predominantly symptomatic treatment approach for affected patients. While a subset of diseases responds exceptionally well to treatment with specific vitamins or cofactors, for most PMD systematic reviews were not able to show significant benefit. This is in discrepancy to their continued frequent use among specialists. To gain further insight into the current clinical practice of vitamin and cofactor supplementation among clinicians treating children and adults affected by PMD, we conducted a worldwide cross-sectional questionnaire study exploring the choice of substances and the specific diseases where they are applied. To our knowledge, this is the first global study exploring this topic and featuring a high response rate from paediatricians. The vast majority (95%, 106/112) of responding specialists recommended the use of vitamins and cofactors, either in an agnostic approach irrespective of the specific PMD or directed to the treatment of specific diseases or phenotypes. Our study highlights significant regional and specialty-specific differences in supplementation practices. We provide some preliminary insights into specialist-based opinions regarding the use of vitamins and cofactors in PMD and highlight the need for more rigorous clinical and preclinical investigations and/or clear consensus statements.

Research utilization competency development in the health workforce pipeline: Design and formative evaluation of learning objectives for health professions students

BACKGROUND

It is widely recognized that use of research evidence to guide health policy and practice could lead to adoption of life-saving interventions and more effective resource allocation. However, the skills around research utilization are often assumed and rarely taught, particularly in low- and middle-income country contexts. Here we present a set of competency areas and learning objectives developed for institutionalization of research utilization across health professions schools in Liberia. Ahead of implementation and to gauge their perceived value and utility, a participatory formative evaluation was undertaken.

METHODS

Focus group discussions were held to gain feedback on a set of research utilization learning objectives and the proposed implementation approach. Focus group participants were drawn from faculty and students at the University of Liberia College of Health Sciences (ULCHS), which houses the country's only medical and pharmacy schools, along with schools of public health and nursing and midwifery. ULCHS serves an essential role in the health workforce pipeline.

RESULTS

Findings from the focus group discussions identified a limited understanding of research utilization at the ULCHS but a demand for stronger understanding of research methodology and evidence. Participants identified clear examples of how the skills represented in the learning objectives could help specifically their personal careers as well as more broadly the health sector of Liberia. Potential challenges were noted around the incorporation of research utilization learning objectives into existing courses and tended to be logistical (for example, poor internet connectivity and low digital literacy) or around lack of foundational understanding and skills (for example, lack of experience with literature searches and reviews). However, the approach was generally perceived as contextually aware since it would not add new courses, which come with credit fees and extra time commitment, and would focus on practical skills-building rather than theoretical content.

CONCLUSIONS

Integrating research utilization learning objectives into existing curricula in health professions schools is expected to enhance uptake and application of research evidence in the Liberian health sector, as students emerge from the workforce pipeline to fill positions in clinical and policy settings. The success of the approach will warrant ongoing evaluation, along with mentorship of faculty, to increasingly incorporate skills and content of local relevance into courses.

Factors Influencing Interest and Engagement in Biomedical Research Among Community Medicine Residents in India: A Descriptive Cross-Sectional Study

Introduction Medical science must be based on sound and scientific evidence and requires continuous research. Engaging in research allows students and faculty to explore new frontiers, question existing paradigms, and discover innovative solutions to medical challenges. As a specialty, community medicine plays a pivotal role in addressing public health issues. However, the engagement of community medicine residents in biomedical research remains suboptimal, which may impede the generation of evidence-based practices tailored to the Indian context. This study was conducted to find the interest and engagement of community medicine residents, and factors influencing their interest in biomedical research. Methods An online survey was conducted among community medicine residents of Uttar Pradesh, from February to April 2024, using Google Forms having a semi-structured, pretested questionnaire. Results One hundred and ninety-six residents participated in the study, where females (52.6%; 103/196) outnumbered males (47.4%; 93/196). The majority of participants were third-year residents (40.8%). Most participants seemed interested in biomedical research (83.2%) and thought that Basic Course in Biomedical Research (BCBR) helps conduct research projects (75%). Around half had previous experience in research projects, with cross-sectional studies being the most common (75.9%) study design. Enhancing research skills and a desire to contribute to medical knowledge emerged as primary motivators. On the other hand, the lack of time due to being overburdened with academic and educational activities was seen as the most common barrier to conducting research. Conclusions The majority of participants were found interested in research activities. The opportunity to improve research skills, desire to serve the medical fraternity, and a positive impact on resumes were the leading motivating factors for conducting research. Difficulty in sparing time, little knowledge, and poor support from mentors were found as important barriers.

Masculinities and sexual and reproductive health and rights: a global research priority setting exercise

Engaging men and boys in sexual and reproductive health and rights (SRHR) and doing so in a way that challenges harmful masculinities, is both neglected and vital for improving the SRHR of both women and men. To address this gap, WHO commissioned a global research priority setting exercise on masculinities and SRHR. The exercise adapted the quantitative child health and nutrition research initiative priority setting method by combining it with qualitative methods. Influenced by feminist and decolonial perspectives, over 200 diverse stakeholders from 60 countries across all WHO regions participated. The exercise forges a collaborative research agenda emphasising four key areas: gender-transformative approaches to men's and boys' engagement in SRHR, applied research to deliver services addressing diversity in SRHR among men and women and to generate gender-equality, research designs to support participation of target audiences and reach to policy makers, and research addressing the priorities of those in low-income and middle-income countries.

Missing in action: a scoping review of gender as the overlooked component in decolonial discourses

INTRODUCTION

Race and gender were intimately intertwined aspects of the colonial project, used as key categories of hierarchisation within both colonial and modern societies. As such, true decolonisation is only possible when both are addressed equally; failure to address the colonial root causes of gender-based inequalities will allow for the perpetuation of racialised notions of gender to persist across the global health ecosystem. However, the authors note with concern the relative sidelining of gender within the decolonising global health discourse, especially as it navigates the critical transition from rhetoric to action.

METHODS

A scoping review was conducted to locate where gender does, or does not, appear within the decolonising global health literature. The authors reviewed the decolonising global health literature available on Scopus and PubMed online databases to identify peer-reviewed papers with the search terms "(decoloni* or de-coloni*) OR (neocolonial or neo-colonial) AND 'global health'" in their title, abstract or keywords published by December 2022.

RESULTS

Out of 167 papers on decolonising global health, only 53 (32%) had any reference to gender and only 26 (16%) explicitly engaged with gender as it intersects with (de)coloniality. Four key themes emerged from these 26 papers: an examination of coloniality's racialised and gendered nature; how this shaped and continues to shape hierarchies of knowledge; how these intertwining forces drive gendered impacts on health programmes and policies; and how a decolonial gender analysis can inform action for change.

CONCLUSION

Historical legacies of colonisation continue to shape contemporary global health practice. The authors call for the integration of a decolonial gender analysis in actions and initiatives that aim to decolonise global health, as well as within allied movements which seek to confront the root causes of power asymmetries and inequities.

Barriers to Decolonizing Global Health: Identification of Research Challenges Facing Investigators Residing in Low- and Middle-Income Countries

The practice of global health is plagued by power structures favoring high-income countries. Efforts to decolonize global health must consider the systemic limitations that LMIC investigators face at local, national, and international levels.

Reflective questioning to guide socially just global health reform: a narrative review and expert elicitation

Recent research has highlighted the impacts of colonialism and racism in global health, yet few studies have presented concrete steps toward addressing the problems. We conducted a narrative review to identify published evidence that documented guiding frameworks for enhancing equity and inclusion in global health research and practice (GHRP). Based on this narrative review, we developed a questionnaire with a series of reflection questions related on commonly reported challenges related to diversity, inclusion, equity, and power imbalances. To reach consensus on a set of priority questions relevant to each theme, the questionnaire was sent to a sample of 18 global health experts virtually and two rounds of iterations were conducted. Results identified eight thematic areas and 19 reflective questions that can assist global health researchers and practitioners striving to implement socially just global health reforms. Key elements identified for improving GHRP include: (1) aiming to understand the historical context and power dynamics within the areas touched by the program; (2) promoting and mobilizing local stakeholders and leadership and ensuring measures for their participation in decision-making; (3) ensuring that knowledge products are co-produced and more equitably accessible; (4) establishing a more holistic feedback and accountability system to understand needed reforms based on local perspectives; and (5) applying systems thinking to addressing challenges and encouraging approaches that can be sustained long-term. GHRP professionals should reflect more deeply on how their goals align with those of their in-country collaborators. The consistent application of reflective processes has the potential to shift GHRP towards increased equity.

Guiding the emerging primary care researcher: A report of research capacity-building workshop

There is an escalating interest in research capacity building across the globe. Research is an integral part of the continuous improvement process, clinical decision making and health system strengthening and should be embedded into the health system. The South African Family Practice Journal editorial team held a workshop on 19 August 2022 at the 24th National Family Practitioners Congress in Cape Town, with the aim of supporting primary care clinicians in their development from early-career researchers to established clinician-scientists. Small group and plenary discussions yielded valuable insights into the lived experiences of early career researchers and highlighted critical action areas to build the landscape of clinician-led research in the South African context.Contribution: This article contributes to current literature by providing insight into the lived experiences of early-career researchers and explores opportunities for research capacity-building.

Mental health and psychosocial support in humanitarian settings: research priorities for 2021-30

We describe an effort to develop a consensus-based research agenda for mental health and psychosocial support (MHPSS) interventions in humanitarian settings for 2021-30. By engaging a broad group of stakeholders, we generated research questions through a qualitative study (in Indonesia, Lebanon, and Uganda; n=101), consultations led by humanitarian agencies (n=259), and an expert panel (n=227; 51% female participants and 49% male participants; 84% of participants based in low-income and middle-income countries). The expert panel selected and rated a final list of 20 research questions. After rating, the MHPSS research agenda favoured applied research questions (eg, regarding workforce strengthening and monitoring and evaluation practices). Compared with research priorities for the previous decade, there is a shift towards systems-oriented implementation research (eg, multisectoral integration and ensuring sustainability) rather than efficacy research. Answering these research questions selected and rated by the expert panel will require improved partnerships between researchers, practitioners, policy makers, and communities affected by humanitarian crises, and improved equity in funding for MHPSS research in low-income and middle-income countries.

The implications of decolonization on China's academic global health: a dialogue with Stephen Gloyd at the Luhu Global Health Salon

The call for decolonization in global health is growing alongside China's increasing involvement in the field. This perspective paper presents and extends with a further literature review of a dialogue with Stephen Gloyd, a global health professor from the University of Washington, conducted in July 2022 at the Luhu Global Health Salon. Drawing from Gloyd's four decades of experiences in low- and middle-income countries, as well as his role in creating the University of Washington's global health department, the doctoral program in implementation science, and the non-governmental organization, Health Alliance International, this paper delves into the concept of decolonization in global health and explores how Chinese universities can expand their participation in global health while striving for equity and justice. Focusing on China's academic global health research, education, and practice, the paper proposes specific recommendations for building an equity-focused global health curriculum, addressing power imbalances and inequalities in university-affiliated organizations, and strengthening South-South cooperation in practice. The paper offers implications for Chinese universities on expanding future global health cooperation, promoting global health governance, and avoiding recolonization.