This post is part of a series of discussions about ethical dilemmas in global health, with responses from one global health leader in the Global South and one in the Global North. The post was originally featured as part of the Global Health Diaries, from the Global Health Program at the University of Vermont Robert Larner M.D. College of Medicine and the Western Connecticut Health Network.
Dr. Stephen Winter, Director of Global Health at Norwalk Hospital, and Dr. Robert Kalyesubula, cofounder of the African Community Center for Social Sustainability, in Nakaseke, Uganda
There are many collaborations between the Global South and Global North, each with their own interests that must be met in order to make the collaboration fruitful. What are the key ingredients of a balanced collaboration, and what must both sides consider before setting one up?
Dr. Winter: The central theme must be a shared commitment to bidirectional collaboration with a clear expectation for each partner to foster the interests and goals of the other. Key ingredients must include mutual respect centered on shared intellectual capacity, anchored to a deep desire and sincere effort to gain bidirectional cultural competence and understanding. Before any partnership is established, there must be a clear delineation of financial responsibilities, research collaborations, and attribution and authorship as well as communication systems that allow rapid response to problems and administrative structures that ensure mutual accountability.
Dr. Kalyesubula: The ingredients should include a mutual understanding of the needs of each partner, ideally based on a needs assessment. There should be stakeholder engagement from both sides such that each partner appreciates and embraces the needs and benefits of the collaboration. This allows for fast growth of the collaboration and greater ease of implementation. The partnership should be bidirectional from the outset so that neither partner feels they are giving too much. Partnership components should be geared towards capacity building and resource sharing from both sides with the goal of developing long-term citizens of global health at different levels.
Issues to consider rotate around values, finances, human resource commitment, and availability of leadership structures to maintain and coordinate the collaboration. A Memorandum of Understanding should clearly stipulate the roles of each partner, and be referred to for guidance in future interactions. It should be understood that most collaborators from the Global South may not have the funds to match their colleagues from the Global North. This should by no means be a temptation for those with greater funds to dictate or manipulate the terms of the relationship in their favor. If this matter is well discussed, collaborators from the Global South will have many other means of contributing to an equal partnership.
Capacity building in human resources, as well as medical education and service to the underserved, should be pillars of any partnership between the Global South and Global North. Describe how these pillars can be established.
Dr. Winter: Capacity building must first be rooted in a shared understanding that knowledge flow must be bidirectional. Just as the Global North may have new procedures and processes to share with partners in the Global South, the Global South has much to offer in the creativity and intellectual depth required to deliver outstanding care in a resource-constrained setting. It must first be acknowledged that both sides will be learning from each other. True capacity building requires that time be taken to understand the needs and interests of our partners instead of simply imposing our own systems and approaches on theirs. The intersections of interest and ability must be found. Mutual respect for cultural, clinical, intellectual, and procedural differences is fundamental.
Dr. Kalyesubula: It all begins with first understanding the needs of each partner and conducting a thorough baseline needs assessment. The results should divulge into three components: human resources, medical education, and services for the underserved. Once established, these pillars form the basis for the Memorandum of Understanding. This way, current and future leaders can follow through the implementation with the needs guiding the priorities.
Key players should be involved from the outset and have a buy-in for the collaboration to make resource allocation easier while ensuring sustainability of the collaboration. Lessons learned from each of the two sides should be shared such that partners appreciate the value and benefits of the collaboration.