The state of international collaboration for health systems research: what do publications tell?

AIM: International collaboration for health system development has been identified as a critical input to meet pressing global health needs. North-South collaboration has the potential to benefit both parties, while South-South collaboration offers promise to strengthen capacity rapidly and efficiently across developing countries. There is an emerging trend to analyze the fruits of such collaboration. This paper builds on this trend by applying an innovative concept-based bibliometric method to identify the international scope of collaboration within the field of health policy and systems research. Two key questions are addressed: to what extent are papers comparing developing countries as against reporting on single country studies? To what extent are papers in either case being produced by researchers within their respective countries or through North-South or South-South collaboration? METHODS: A total of 8,751 papers published in Medline between 1999 and 2003 with data on health systems and policies in developing countries were identified and content-analyzed using an innovative concept-based search technology. A sample of 13% of papers was used to identify the corresponding institution and countries covered. The sampled data was then analyzed by income group. RESULTS: Papers with an international, cross-country focus account for only 10% of the total. Just over a third of all papers are led by upper middle income country authors, closely followed by authors from high income countries. Just under half of all papers target low income countries. Cross-country papers are led mostly by institutions in high income countries, with 74% of the total. Only seven countries concentrate 60% of the papers led by developing country institutions. Institutions in the United States and the United Kingdom concentrate between them as many as 68% of the papers led by high income countries. Only 11% of all single-country papers and 21% of multi-country studies are the product of South-South collaboration. Health Financing is the topic with the greatest international scope, with 26% of all papers in the topic. Topics such as Costing and Cost Effectiveness, Finance, Sector Analysis and Insurance, regardless of their national or international scope, are led in 38% to 54% of cases by high income authors. CONCLUSION: While there is modest health systems research capacity in many developing countries for single country studies, capacity is severely limited for multi-country studies. While North-South collaboration is important, the number of international studies is still very limited to produce the kind of knowledge required to learn from experiences across countries. The fact that lead institutions as well as study countries are concentrated in a handful of mostly middle income countries attests to great disparities in research capacity. However, disparities in research capacity and interest are also evident in the North. It is urgent to build cross-country research capacity including appropriate forms of South-South and North-South collaboration

Using knowledge: the dilemmas of 'bridging research and policy'

The 'knowledge agenda' has become a central part of development discourse. This paper addresses one aspect of this discourse - the use of policy research in the social sciences - and the dilemmas that have been encountered by both development agencies and researchers in communicating and making use of that research. Development agencies as well as NGOs have initiated work to evaluate and document the effectiveness of research partnerships, knowledge capacity building and (social) science policy impact. As a multilateral initiative, the Global Development Network (GDN), and especially its 'Bridging Research and Policy' project, provides a vehicle to address issues related to research impact. Twelve perspectives on improving research and policy linkages are outlined to reveal that how the problem is defined shapes policy responses. Taken together, these explanations provide a multifaceted picture of the research-policy nexus indicating that there are many possible routes to 'bridging' research and policy. These diverse perspectives will be categorised into three broad categories of explanation: (i) supply-side; (ii) demand-led; and (iii) policy currents. However, knowledge is part of the solution to many development problems but not of itself a panacea

Developing health systems research capacities through north-south partnership: An evaluation of collaboration with South Africa and Thailand

BACKGROUND: Over the past ten years, calls to strengthen health systems research capacities in low and middle income countries have increased. One mechanism for capacity development is the partnering of northern and southern institutions. However, detailed case-studies of north-south partnerships, at least in the domain of health systems research, remain limited.This study aims to evaluate the partnerships developed between the Health Economics and Financing Programme of the London School of Hygiene and Tropical Medicine and three research partners in South Africa and Thailand to strengthen health economics-related research capacity. METHODS: Data from programme documents were collected over five years to measure quantitative indicators of capacity development. Qualitative data were obtained from 25 in-depth interviews with programme staff from South Africa, Thailand and London. RESULTS AND DISCUSSION: Five years of formal partnership resulted in substantial strengthening of individual research skills and moderate instituonalised strengthening in southern partner institutions. Activities included joint proposals, research and articles, staff exchange and post-graduate training. In Thailand, individual capacities were built through post-graduate training and the partner institution developed this as part of a package aimed at retaining young researchers at the institution. In South Africa, local post-graduate teaching programs were strengthened, regular staff visits/exchanges initiated and maintained and funding secured for several large-scale, multi-partner projects. These activities could not have been achieved without good personal relationships between members of the partner institutions, built on trust developed over twenty years. In South Africa, a critical factor was the joint appointment of a London staff member on long-term secondment to one of the partner institutions. CONCLUSION: As partnerships mature the needs of partners change and new challenges emerge. Partners' differing research priorities (national v international; policy-led v academic-led) need to be balanced and equitable funding mechanisms developed recognising the needs and constraints faced by both southern and northern partners. Institutionalising partnerships (through long-term development of trust, engagement of a broad range of staff in joint activities and joint appointment of staff), and developing responsive mechanisms for governing these partnerships (through regular joint negotiation of research priorities and funding issues), can address these challenges in mutually acceptable ways. Indeed, by late 2005 the partnership under scrutiny in this paper had evolved into a wider consortium involving additional partners, more explicit mechanisms for managing institutional relationships and some core funding for partners. Most importantly, this study has shown that it is possible for long-term north-south partnership commitments to yield fruit and to strengthen the capacities of public health research and training institutions in less developed countries

Developing a postgraduate dual-award in educational leadership : a Russian pelican meets an English rose

Using analytic autoethnography, this paper discusses the influences and outcomes that shaped a 30-month project between a Russian and an English university trying to develop a dual-award in educational leadership. It explores the drivers, benefits, hindrances and affordances of international collaboration, before critiquing the literature on contemporary Russian culture. It then maps how various factors including money, language, hospitality, trust, commitment and flexibility affected the project. It concludes that unequal partnerships can result in shared learning, but that programme validation is harder to achieve if either institution imposes unrealistic financial constraints, lacks flexibility, or fails to recruit a high-level champion

Beyond partnerships: embracing complexity to understand and improve research collaboration for global development

While there is a burgeoning literature on the benefits of research collaboration for development, it tends to promote the idea of the ‘partnership’ as a bounded site in which interventions to improve collaborative practice can be made. This article draws on complexity theory and systems thinking to argue that such an assumption is problematic, divorcing collaboration from wider systems of research and practice. Instead, a systemic framework for understanding and evaluating collaboration is proposed. This framework is used to reflect on a set of principles for fair and equitable research collaboration that emerged from a programme of strategic research and capacity strengthening conducted by the Rethinking Research Collaborative (RRC) for the United Kingdom (UK)’s primary research funder: UK Research and Innovation (UKRI). The article concludes that a systemic conceptualisation of collaboration is more responsive than a ‘partnership’ approach, both to the principles of fairness and equity and also to uncertain futures