Tilouche Nerissa, Kalichman Beatriz, Dheensa Sandi, Rossi Evelina, Hawcroft Claire, d'Oliveira Ana Flavia, Owda Heba, Bacchus Loraine J
Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
Faculty of Medicine, Sao Paulo University, Sao Paulo, Brazil.
BMJ Glob Health. 2024 Dec 11;9(12):e015376. doi: 10.1136/bmjgh-2024-015376.
There has been much critical reflection among global health researchers about how power imbalances between high-income countries and low- and middle-income country collaborators are perpetuated through research programmes. Research capacity strengthening (RCS) is considered both a mechanism through which to redress structural power imbalances in global health research and a vehicle for their perpetuation. This paper examines the RCS programme of a multi-county study on violence against women, focussing on how it addressed power imbalances between countries and the challenges involved in doing so. It provides specific examples and lessons learnt.
18 semi-structured interviews were conducted online with group members from all five countries involved in the collaboration between April and June 2020. Reflexive thematic analysis, with inductive and deductive approaches was adopted.
Participants articulated their understandings of RCS as an opportunity for (1) mutual learning, understanding and collaboration and (2) personal and team career development. Participants perceived the RCS programme activities to simultaneously reinforce and challenge power asymmetries within global health research. Power dynamics within the RCS programme operated across three levels; the global health research environment, the research group level and within individual country teams. Participants described structural barriers at all three levels, but felt there were more opportunities to challenge power imbalances at the research group level.
Despite a strong commitment to addressing power imbalances through the RCS programme, progress was often hampered by the fact that these inequalities reflected broader structural issues in global health, as seen within Healthcare Responding to Violence and Abuse. The programme faced tensions between enhancing researchers' careers while building capacity under the current model, which sometimes conflicted with creating social value or challenging epistemic and normative structures. Participants clearly expressed concerns about power imbalances within the partnership and were keen to address them through the RCS programme. This led to a steep learning curve and significant adaptations within the RCS programme to navigate these issues within existing structural limitations.
全球卫生研究人员对高收入国家与低收入和中等收入国家合作者之间的权力不平衡如何通过研究项目长期存在进行了大量批判性反思。研究能力加强（RCS）既被视为纠正全球卫生研究中结构性权力不平衡的一种机制，也是其长期存在的一种手段。本文考察了一项关于暴力侵害妇女行为的多国研究的RCS项目，重点关注其如何解决国家间的权力不平衡以及这样做所涉及的挑战。它提供了具体的例子和经验教训。
2020年4月至6月期间，通过在线方式对参与合作的所有五个国家的小组成员进行了18次半结构化访谈。采用了归纳和演绎相结合的反思性主题分析方法。
参与者将他们对RCS的理解阐述为（1）相互学习、理解与合作以及（2）个人和团队职业发展的机会。参与者认为RCS项目活动在强化和挑战全球卫生研究中的权力不对称方面是同时存在的。RCS项目中的权力动态在三个层面发挥作用；全球卫生研究环境、研究小组层面以及各个国家团队内部。参与者描述了所有三个层面的结构性障碍，但认为在研究小组层面有更多机会挑战权力不平衡。
尽管致力于通过RCS项目解决权力不平衡问题，但进展往往受到这些不平等反映了全球卫生中更广泛的结构性问题这一事实的阻碍，正如在《应对暴力和虐待的医疗保健》中所看到的那样。该项目在当前模式下加强研究人员职业发展与建设能力之间面临紧张关系，这有时与创造社会价值或挑战认知和规范结构相冲突。参与者明确表达了对伙伴关系中权力不平衡的担忧，并渴望通过RCS项目解决这些问题。这导致了RCS项目出现了陡峭的学习曲线，并在现有结构限制内进行了重大调整以应对这些问题。
