Monitoring equity and research policy

An update on Wellcome’s anti-racism programme
Farrar J: Wellcome, August 2022

In this statement the Director of Wellcome Jeremy Farrar reports that two years ago, Wellcome made a commitment to developing anti-racist principles and an anti-racist programme, and to an external evaluation of progress at the institution. An evaluation has now been reported. While it found some progress, such as improvements in the racial diversity of the workforce and some positive behavioural and practice shifts, it reached a clear conclusion that Wellcome continues to fall short of the commitment to anti-racism, both as a funder and as an employer. Farrar accepted and apologised for this and announced two measures to addressing inequity in Wellcome research funding in 2023, including a set of positive action principles applied to funding decision-making processes and the establishment of a dedicated stream of funding available exclusively to researchers who are Black and people of colour, targeted at the career stages where this will have the greatest benefits for diversity.

Using a theory of change in monitoring, evaluating and steering scale-up of a district-level health management strengthening intervention in Ghana, Malawi, and Uganda – lessons from the PERFORM2Scale consortium
Kok M; Bulthuis S; Dieleman M; et al: BMC Health Services Research 22:1001, 2022

This consortium did work to understand the benefits and challenges of using a theory of change (ToC) -based approach for monitoring and evaluating the scale-up of health system strengthening interventions. The consortium held annual ToC reflections that entailed multiple participatory methods, including individual scoring exercises, country and consortium-wide group discussions and visualizations, capturing the reflections around an initiative for strengthening district health management teams, to improve health workforce performance and service delivery at scale. The annual ToC reflections proved valuable in gaining a nuanced understanding of how change did happen and strategizing on actions to further steer the scale-up the intervention. It also led to adaptations of the ToC over time. Based on the experience the authors suggest that ToC-based approaches are useful, should include a variety of stakeholders and require their continued commitment to reflection and learning on intervention implementation and scale-up. ToC-based approaches can help in adapting interventions as well as scale-up processes to be in tune with contextual changes and stakeholders involved, to potentially increase chances for successful scale-up.

Developing context relevant and inclusive course outlines and reading lists
Teaching Health Economics Special Interest Group: Webinar online, Online: June 9, 2022

The Teaching Health Economics Special Interest Group (THE SIG) has organized a series of virtual workshops during 2022. This workshop provides an overview of curriculum development and writing powerful learning outcomes for health economics courses and the importance of identifying topics and readings that are most relevant to the local context. The workshop considers how to ensure courses are inclusive and contain diverse perspectives, and information shared on how academics in low- and middle-income countries can directly access a wide range of publications to use in their teaching programs at no (or low) cost.

‘Working relationships’ across difference - a realist review of community engagement with malaria research
Vincent R; Adhikari B; Duddy C, et al: Wellcome Open Research, 7(13),, 2022

The authors conducted a realist review to understand how and why community engagement with health research contributes to the pattern of outcomes observed, with a focus on malaria research. Community engagement was found to rely on the development of provisional ‘working relationships’ across differences, primarily of wealth, power and culture that bring tangible research related benefits. Contextual factors that affect these working relationships were reported to include the research organisation commitment to and resources for engagement, while a prevailing ‘dominant health research paradigm context’ was reported to undermine working relationships, as did differences of wealth and power between research centres and local populations and health systems; histories of colonialism and vertical health interventions; and external funding and control of health research. Accommodation of such ethically problematic characteristics in the dominant health research paradigm can undermine community engagement and reproduce this paradigm rather than challenge it with a different logic of collaborative partnership.

Health Equity Tourism: Ravaging the Justice Landscape
Lett E; Adekunle D; McMurray P; et al: Journal of Medical Systems 46 (17), 2022

“Health equity tourism” is described as the process of previously unengaged investigators pivoting into health equity research without developing the necessary expertise for high-quality work. In this essay, the authors define the phenomenon and provide an explanation of the antecedent conditions that facilitated its development. They outline its consequences as recapitulating systems of inequity within the academy and diluting a landscape carefully curated by scholars who have demonstrated sustained commitments to equity research as a primary scientific discipline and praxis. The authors provide a set of principles to guide equity researchers.

Female adolescents living with HIV telling their story through ‘my story’ book in Malawi: A visual methodology innovation
Mwalabu G;, Mbendera I; Petrucka P; Manjanja V: PLoS ONE 16(10), e0257126, 2021

Female adolescents living with Human Immunodeficiency Virus (HIV) face lifelong challenges in reproductive and sexual health ranging from relational, social and legal-ethical considerations. A visual method and storybook research innovation was used with young female adolescents in Malawi that initiate sex as early as 15 years, mostly with adult partners, given their reluctance to discuss sexual matters through more direct questions during interviews. The researchers thus used invoke youth-friendly research approaches to address these issues and enable these vulnerable individuals to articulate their experience and advocate their preferred changes.

Intervention – “Impermanence: On Frantz Fanon’s Geographies”
Aguiar J; Chowdhury A; Falk M; et al: Antipode Online, August 2021

This 'cartographic' and political economy analysis of Frantz Fanon’s ‘geographies’ points to a series of narrative maps that draw attention to the differential geographies of racism and colonialism, using geography, landscape, cartography, architecture, space, place, and borders, to make sense of blackness and oppression and liberation. Fanon’s envisions anti-colonial geographies as always in flux, nested in, yet cannot be fully defined by, the colonial imperative. Stasis – even the street or the walls of the clinic – is impossible. Colonial geographies are thus identified as unsustainable because, even in their heaviness, they are impermanent, in flux, and alterable.

Mapping Algorithms Are Failing to Address Urban Inequalities in the Global South
Costa-Lima M; Freitas C; Farias S: Failed Architecture, 2021

Algorithms act according to what they are trained for, and human beings are the ones training them. Therefore, when algorithms are clearly reinforcing existing inequalities, it is crucial to question who writes these algorithms, and in whose interests they are writing them. More importantly, these people should be held accountable for the socio-spatial effects of their products. As local governments have failed to build a good spatial data infrastructure for informal settlements, other stakeholders are stepping in and the authors raise the threat posed by algorithms moderated by big tech corporations deciding the boundaries ad features of neighbourhoods.

Strengthening Research and Practice in Community Health Systems: A Research Agenda and Manifesto
Tetui M; Hurtig A-K; Jonsson F; et al: International Journal of Health Policy and Management, doi: 10.34172/IJHPM.2021.71, 2021

While there have been increased calls for strengthening community health systems (CHSs), key priorities for this field have not been fully articulated. This paper seeks to fill this gap, presenting a collaboratively defined research agenda, accompanied by a ‘manifesto’ on strengthening research and practice in the CHS. Eight domains of research priorities for CHSs were identified: clarifying the purpose and values of the CHS, ensure inclusivity; design, implementation and monitoring of strategies to strengthen the CHS; social, political and historical contexts of CHS; community health workers (CHWs); social accountability; the interface between the CHS and the broader health system; governance and stewardship; and finally, the ethical methodologies for researching the CHS.

Health research knowledge translation into policy in Zambia: policy-maker and researcher perspectives
Malama A; Zulu J; Nzala S; et al: Health Research Policy and Systems 19(42), 1-11, 2021

The authors explored how health research knowledge is translated into policy in Zambia, and what facilitates or hinders this, from document review and key informant interview. While the document review suggested policy efforts to promote knowledge translation, the interviews raised challenges in coordination and linkages between knowledge and policy-making processes, attributed to lack of research knowledge translation capacity, limited resources and lack of knowledge hubs. However, the authors suggest that emerging local research leadership and a stock of underused local health are an opportunity to enhance knowledge to policy links, if supported.