• child health
• control strategies
• public health

Global health research is expanding.1 New global health institutions appear in the North, sometimes by relabelling existing entities. Global health journals have been born, and funding schemes with this focus have increased. However, there are insufficient local competencies for research in low-income countries. The capabilities for problem-solving are growing too slowly to close the existing North–South capacity gap.2 Local problems and contexts are not sufficiently taken into account,3 and there is a continued dependency on institutions in the Global North.4 In this commentary, we aim to draw attention to the opportunity for capacity development within international collaboration for global health research. We illustrate this with examples of two collaborative projects in sub-Saharan Africa, where mutual capacity development was embedded as an integral part of the project.

A review of health research capacity development identified a range of strategies but a lack of robust evaluation that resulted in unclear effectiveness and weak learning.5 Only a few global health funders systematically allocate resources to research capacity development.6 Power relations between collaborating partners from the Global North and Global South continue to lead to unfair ownership of data, unfair authorship and other problems that together have been labelled a neocolonialist model of capacity building.6

Countries in sub-Saharan Africa allocate few resources to develop research capacity.7 Further, academic institutions’ research culture in the Global South is often theoretical and even detached from the health system challenges in their own countries.8 With the COVID-19 pandemic, it is evident that low-income and middle-income countries have a great need for robust research and implementation capacity, which is essential for monitoring, managing and overcoming the current challenges. There is a risk that previous funding to develop such ability is disrupted by the pandemic crisis.9 Instead, it should act as a spur to reinforce research capacity development in the Global South.

During the current pandemic, we have been reminded that examples of good public health management may be found in the Global South, in sharp contrast to some of the North.10 The notion of what has been labelled reverse innovation is not new. There are many examples of innovations created in the South that have provided chances for shared learning to the North. An equitable partnership in research offers opportunities for joint innovations and mutual capacity development.11

Our first case study comes from Ethiopia (box 1). Research capacity development was embedded within the evaluation of a community-based intervention in the four most populous regions. The Ministry of Health initiated this effort by creating a consortium that included four universities, the national public health institute, non-governmental organisations supporting programme implementation and an international academic partner. The funder earmarked resources for capacity development, including mentoring and support of the involved PhD students at the Ethiopian universities. The intention was to promote research training focused on ‘real world’ health system questions for doctoral students from the participating academic institutions and regional health bureaux. Students were registered at the Ethiopian universities and received supervision from the local and international partner universities. The selection of research topics for the different PhD studies balanced the intervention project’s evaluation needs and the individual students and supervisors’ research interests. Over time, all students and supervisors were convinced by the concept. They appreciated the broadened collaborating network across academic institutions and health system partners and enhanced health system and implementation science training opportunities.

Our second case study focuses on embedded research capacity development within a programme addressing neglected tropical diseases (NTDs) in the Central African Region (box 2). The project aimed to strengthen innovative NTD control and train a cadre of researchers, so that they became aware of implementation challenges and worked directly with key actors in NTD control and elimination. In the competitive selection of PhD candidates, countries with a weak university infrastructure suggested fewer qualified candidates, and there were considerable language barriers. It was a hurdle to navigate different administrative enrolment regulations. The selected candidates proposed a wide range of relevant research, all addressing priorities in their country’s NTD control programme. Opportunities to interact with public health stakeholders and tailored training courses were very well received. Regular supervision ensured that emerging issues were efficiently addressed, and stipends allowed the candidates to focus on their thesis work. Regular meetings were designed to foster contacts between candidates and establish connections with the existing African Research Network for Neglected Tropical Diseases.

These case studies provide examples of embedding PhD training into research efforts, where the scientific agenda is locally defined, bringing together academic institutions from different countries, and networking with the health system, non-governmental organisations and other stakeholders. Such environments may enhance scientific skills together with local and tacit knowledge. Structures and strategies are needed to manage conflicts and address challenges in such collaborations. Some funders, who would hesitate to embark on isolated long-term capacity development commitments, could be prepared to engage if the capacity development was embedded into the research performed by partnerships of universities, non-governmental organisations and the health system.

Multiple actions are needed to bridge the capacity gap in global health research. Academic institutions and researchers in the Global South and Global North, governments and global health research funders all have obligations to enhance equity in health research capacity.6 Funders have an essential role in promoting and including capacity development as an integrated part of global health research projects. Global North universities need to adjust their promotion policies to enhance equity in global health partnerships.4 Academic institutions in low-income and middle-income countries should prioritise developing local competencies in their health research projects. Governments in the Global South should allocate more resources into research capacity as a vital development investment. We propose that research capacity development be valued as highly as the generation of new scientific knowledge—by the academicians and universities in the Global South and Global North, by global health research funders and by governments.