© World Bank/ Tom Perry

By Agnes Binagwaho, Pascale Allotey, Eugene Sangano, Anna Mia Ekström & Keith Martin

The global health enterprise has contributed to improving the wellbeing of people and increasing access to health services. However, deep structural inequities persist between institutions from high-income countries (HICs) and those in low and middle-income countries (LMICs) in access to resources, training, and knowledge. This results in significant health inequities, lack of ownership, lost opportunities, misguided priorities, and wholly insufficient attempts at achieving the Sustainable Development Goals.

Power imbalances are embedded across funding opportunities, research management and coordination, knowledge production and transfer, access to training resources and most technical and political aspects of global health.1 The current pandemic, which has further highlighted these inequities, is an opportunity to acknowledge and rectify these gaps.2 The changes needed include ensuring that partnerships between HIC and LMIC institutions are equitable and that benefits from those arrangements accrue equally to all parties. Collaborations rooted in respect, honesty, equity, as well as commitment to mutual capacity building and health outcomes aligned with the needs of the LMIC partners are essential to reforming global health.

Previous attempts have been made to address this imbalance, but there is a lack of accountability. The following reforms are concrete suggestions, particularly for the academic community, to achieve this objective.

Overcoming the research to policy gap is critical to addressing health challenges.3 However, knowledge generated and reported in scientific publications is largely inaccessible to LMIC researchers even when they play a significant role in the research process.4 HIC research institutions should provide free access to their academic libraries to their LMIC partners. Moreover, research findings must be shared with equity, fairness, and respect for the work of LMIC and HIC collaborators. Results of global health research should be translated into local languages, with plans drawn at the start to ensure dissemination to all stakeholders including communities which are the subject of the research.

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