This blog is co-authored by Simon Pickard our Senior Portfolio Manager for the R2HC programme and Gloria Seruwagi a member of our Funding Committee and former grantee, currently working at Makerere University, Uganda.

This blog is the first of a two-part series. In this blog we outline the need to shift the power and why we want to do this.

“Local actors are broadly invisible as funding recipients for humanitarian research and innovation”. This is a stark headline from the Global Prioritisation Exercise report Who Funds What, which laments that actors in High Income Countries (HIC) continue to receive most of the limited available research and innovation funding, and the situation remains unchanged from the similar global mapping exercise published in 2017.

Much has been written recently about the need to change this funding dynamic. The authors of a Lancet-published comment ‘Reform of research funding processes could pave the way for progress in global health’ argue that “the instrumental role of research funders in the perpetuation of the status quo in global health research must be addressed,” outlining the imbalances that contribute to the status quo in global health knowledge production.

Imperatives to act

The benefits of reform are moral, pragmatic and ethical. There is a moral imperative of fair access and equity for researchers in the Global South, despite entrenched barriers including structural, historical, political and technological barriers.

Evidence suggests that inclusion of partners from the countries where work takes place is a key aspect of achieving real and lasting impact from research studies. They know better the localised, effective and sustainable solutions to their own problems. As Catherine Kyobutungi, Executive Director of the African Population and Health Research Center in Kenya, argues in the Global Health Matters podcast, funding should be prioritised for in-country researchers because their responsibilities, mandate and relationships will endure beyond the end of short project cycles. There are also ‘transformative’ capacity benefits that remain after research completion: the additional skills, expertise and experience gained.

This is reinforced in our From Knowing to Doing report which highlighted the lack of relevance to humanitarian actors in the Global South as a barrier to the use of research evidence, and proposed greater funding and support for research led by the Global South. The Feinstein International Center’s recent report ‘Co-investigators but with Different Power’ observed that Global South humanitarian research institutes “emphasize the need for co-production of research with affected populations and returning study results to the participants, with the benefits of reducing survey fatigue and increasing trust in future research efforts.” Analysis of our own grants responding to COVID-19 found that the most successful teams were ‘positioned for impact’ through existing relationships with the target audiences, and understood the evidence needs of operational stakeholders and affected populations from the outset. This in turn delivers on the ethical prerogative:

“Ethical problems are raised if research is being done in and on the people of the Global South with very little impact. Someone or something is literally benefiting from the suffering of others, some of the worst-off people in the world.”

(Gloria Ashuntantang et al).

Challenging the status quo

Without actively challenging the status quo, we reinforce the funding gap for Global South actors which the Grand Bargain committed to reform. As part of our own work to become an anti-racist  and inclusive organisation we have made a commitment to ‘work to improve the accessibility of funding to applicants from lower middle-income countries (LMICs) and ensure our research and innovation programmes and portfolios directly and indirectly support anti-racism’.

Such moves can seem confined to shifting the power within the existing global health research infrastructure, whilst many of the challenges are more fundamental and require changes to the system itself. As argued in the comment piece Why and for whom are we decolonising global health?, “The call to diversify global health leadership, if done within the current structures, runs the risk of repeating the same decolonising mistakes…True transfer of power and equitable partnerships will require investing as much time into rebuilding research infrastructure from the ground up in LMICs as is done in supporting individual careers of global health researchers in LMICs.”

Nevertheless, focusing on improving and expanding access to funding is a first step we are able to take. There are multiple barriers – institutional-person, intellectual, sociocultural, ethical and even political – faced by LMIC actors. These are phased at all stages of the funding cycle – from framing funding calls to assessing impact – meaning that as the stages come along, more and more potentially deserving LMIC actors fall off. This “cements” their ineligibility for that and future funding opportunities.

Beginning to shift the dial

R2HC has found this reflected in our own work. Whilst Global South actors have been well-represented amongst applicants and within funded study teams, they have rarely been in the lead. We’ve undertaken internal analysis to see whether there are significant differences in the content of Global North-led and Global South-led proposals and how they were assessed through our review processes. This found common weaknesses across all applications, and identified some nuanced differences between those submitted by HICs compared to LMICs. Applying a subsequent ‘decolonisation lens’ helped us to reflect on how we could improve our application and assessment . This work was undertaken in collaboration with the London School of Hygiene and Tropical Medicine. Many of these themes are unpacked further in the article How to identify epistemic injustice in global health research funding practices: a decolonial guide.

Through our most recent funding calls we anticipate being able to fund six studies led by institutions or NGOs based in the Global South, three times as many than in previous funding rounds. Many of these sit outside the fairly established ‘giants’ amongst Global South institutions with strong linkages to, or sometimes extension of, Global North equivalents: they are promising institutions or researchers but with currently limited visibility or experience in managing large grants. Across the cohort of 13 new funded studies, over 75% have at least one Principal Investigator based in an LMIC setting, and almost two thirds of all partners involved are LMIC-based organisations. This represents a significant advance for the R2HC programme, achieved not through compromising on research quality or ringfencing funds for LMIC applicants, but through introducing a series of incremental changes. We explore these further in this accompanying blog.

We understand this is only a first step and there is much more to do. However, recognising the importance and value of directly funding LMIC actors is a significant step in the right direction. The actual realisation of this objective to shifting the power is likely to take a while however. Increasing access to funding for LMIC actors is a giant leap, a possibly risky venture and steep learning curve which will offer some key lessons along the way – some uncomfortable, no doubt. It is definitely disruptive but a first crucial and necessary step.