The Power of Networking: But Who Benefits? Exploring Equity in Global Collaborative Evidence Networks

Author: Bianca Pilla

In 2023, we reached the halfway point for the United Nations’ Sustainable Development Goals (SDGs) and the global commitment to ‘leave no one behind’. In the same year, the World Health Organisation (WHO) celebrated 75 years by advocating Health for All. Now, as we approach World Evidence-Based Healthcare Day, focusing this year on Evidence & Global Health Equity, I have had much food for thought regarding the importance of focusing on equity for collective impact in evidence ecosystems. This includes the role of building more equitable Collaborative Evidence Networks. 

The ambitious, all-encompassing global SDG agenda sets targets to address the interconnected crises of poverty, health, climate change, conflict and sustainable economies. The 2030 agenda is a compelling vision of what the future could look like, with the commitment to ‘leave no one behind’ as a core principle putting equity at its centre. One of the strengths of the SDGs is that they provide a globally shared vocabulary that can connect different actors, sectors and levels of society – from local to global.

The recent COVID-19 pandemic and ensuing regression of many SDG targets have highlighted the importance of evidence to address societal challenges, including global health priorities and other social determinants of health. However, the success of this global agenda depends on individuals and organisations working together within a functioning evidence ecosystem. 

Collaborative Evidence Networks, like JBI, Cochrane, Campbell, GIN, the Africa Evidence Network, and many others, play a crucial role in bringing together key stakeholders from across the evidence ecosystem. These networks facilitate multi-, trans- and interdisciplinary research, dissemination, knowledge-sharing and translation of evidence into healthcare policy and practice. The last 30 years have seen each of these networks make a profound impact on the evidence-based healthcare agenda.

However, the rapid growth in the number and scale of international collaborative evidence networks, described as the ‘Fourth Age’ of global health research, does bring together complex historical, political and socio-economic partnerships. This has led to the parallel emergence of several ethical challenges not previously encountered. Many of these challenges were discussed in the 2022 World Evidence-Based Healthcare Day Campaign, ‘Partnerships for Purpose’, through blogs, vlogs and a webinar on ‘Equity in Global Health Partnerships’. 

At the very tip of the iceberg, some of these challenges include: 

• Funding: Research collaborations can reproduce relationships/conditions that disproportionately favour high-income countries and institutions. Moroever, funding schemes incentivise the rapid development of short-term, project-based partnerships, which do not cover all costs. This means that under-resourced LMIC partners often face sustainability challenges. 
   
• Power: These include authorship and unfair acknowledgement of contribution; tendency to make decisions for others and not with others (research agendas, funding decisions, policy changes, etc.). Power also influences which types of evidence and knowledge are valued, and consequently, how research is designed and implemented, as well as the type of outputs that are produced and for which audiences. 
   
• Systemic: and structural constraints for accessing databases (information), the outputs/results of research or suitable research dissemination channels. Moreover, discriminatory systems and structures within networks can drive inequitable policies, budgets and services.

(In)equity in Building Collaborative Evidence Networks
The need to build equitable Collaborative Evidence Networks can be understood in the context of global health research. Specifically, the 10/90 Gap, first acknowledged by the Independent Commission on Health Research for Development in 1991, points to significant inequity in health research investment between the Global North and the Global South. It states that only 10% of health research funds are directed towards health issues facing 90% of the world’s population. 

Guidance on how global Collaborative Evidence Networks should be structured, managed and governed to advance health equity is lacking. Yet the governance of Collaborative Evidence Networks plays a key role in whether they help reduce global health disparities to ‘leave no one behind’ or whether they perpetuate existing structural and systemic inequities. For example, if priority-setting processes for networks are organised in ways that restrict the voice of LMIC researchers, they may be less likely to generate research priorities that address health inequities within LMICs (perpetuating the 10/90 gap). 

Managing a network is often a complex effort, involving the coordination of both activities and partners (individual and institutional) that are, in turn, embedded in additional structures and systems. The evidence base to support the navigation of this complex endeavour is neither well-defined nor sufficiently understood, particularly when it comes to issues of equity, diversity and inclusion.

Inequities are not just the result of what happens when systems ‘fail’. Rather, inequities are often the result of – and are refracted through – the way systems (or in this case, networks) are set up and operate.

Equity and the JBI Collaboration: Lessons Learned 
There have been significant challenges, successes and lessons learned by JBI and the JBI Collaboration (JBIC) in its growth over 27 years (some of which are outlined here). These include the need to consistently address longstanding equity and diversity challenges with geographical, socioeconomic and language barriers to collaboration and participation and accessing or receiving benefits from the network. 

For example, in 2015, the JBIC co-developed the JBIC Matrix Framework in response to the JBI Strategic Business Review that highlighted the inequities of the former operational framework (i.e. the number of activities that were not recognised by JBI, the inequitable criteria and the expected output of different partner types [synthesis, transfer, translation], as well as the criteria for activity funding).

In 2019, we conducted a follow-up analysis of JBIC activity outputs and funding, stratified by the World Bank income scale, language and region. This analysis demonstrated that while activity output and funding had increased across the JBIC under the Matrix Framework, partners receiving funding were still largely from high-income, English-speaking countries. In response, JBI and the JBIC co-created a new funding model, the JBIC Brighter Futures Grant Program, which aims to provide opportunities for internal and external collaboration, capacity-building in LMICs and support for multilingual activities within and across the JBIC. The ultimate aim is to build a more equitable and sustainable network.

Networks grow and change over time: much is taken for granted or not discussed; initial strategies may not be revisited; and members/partners may have very different experiences with (in)equity, diversity and inclusion. JBI has learned that it is important to build transparent and accountable monitoring, evaluation and feedback mechanisms that enable partners to communicate openly about their experiences. The JBIC does this through:

• bi-annual (3-day) business meetings with dedicated Q&A sessions on the JBIC operational framework, concrete action items for concerns and suggestions, followed by anonymous surveys and reporting on mechanisms for addressing concerns; 
   
• annual evaluation of the JBIC Activity Matrix Framework, including the progress of JBIC Entities in meeting KPIs and outputs stratified by language, income scale and region; 
   
• remote annual drop-in sessions with the JBI Executive Director; 
   
• ensuring that all significant governance changes (such as changes to key membership/activity requirements, decision-making frameworks, funding or resource arrangements) are co-created with members; piloted (or soft-launched); have Q&A drop-in sessions in different time zones; frequent monitoring and evaluation of the progress/success of changes; and 
   
• pausing, when required, to re-evaluate and reflect on current challenges and opportunities (i.e. JBI paused new JBIC applications for 12 months in 2015 to address internal governance and sustainability challenges through a stakeholder analysis, and again in 2020–2021 to address external/remote support structures for the network during COVID-19).

Where to Now?
Responding to World EBHC Day’s call for strengthening evidence ecosystems to advance global health equity requires wider collaboration among multiple stakeholders from different origins. This is because the changes needed for fostering and embedding equity within and across evidence ecosystems exceed the capacity and capability of any individual actor. To this end, the SDG agenda highlights the need for partnerships in developing rapid evidence-informed responses, streamlining global efforts, reducing research waste and ensuring the best-available evidence is accessible, transparent and understood. 

However, we must address the ongoing concern about making partnerships equitable for, and beneficial to, all partners. This includes integrating an equity-centred approach to building, evolving, maintaining and managing Collaborative Evidence Networks. Equity-focused practices – that is, the regular, routine things that partners do intentionally to make partnerships within and across the network work well – must be placed at the centre of what we do. 

The above strategies and initiatives to address and embed equity within and across the JBIC are by no means the end of the road. From 2024–2026, JBI will be undertaking a significant collaborative research project to develop guiding principles and best practices for building and governing equitable Collaborative Evidence Networks. We will be working with Cochrane and Campbell to achieve this goal. 

There are also promising initiatives driven by other Collaborative Evidence Networks, including Cochrane’s Listening and Learning Agenda for Equity, Diversity and Inclusion across their network.  

Collaborative Evidence Networks are influential and important actors within the global evidence ecosystem; however, we need to collectively challenge ourselves to push for equity-centred approaches; to create systems that encourage a diversity of perspectives, address power imbalances and cultural competence; and most importantly, continually assess and improve to make sure that equity principles AND practices are consistently upheld within and across our networks.  

References

Adams, J. (2013). The fourth age of research. Nature, 497(7451), 557-560. https://doi.org/10.1038/497557a

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Global Commission on Evidence to Address Societal Challenges. (2023). Evidence Commission update 2023. McMaster Health Forum. https://www.mcmasterforum.org/docs/default-source/evidence-commission/update-2023.pdf

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Pilla, B., Jordan, Z., Christian, R., Kynoch, K., McInerney, P., Cooper, K., Wu, Y., Porritt, K., Lockwood, C., & Munn, Z. (2022). JBI series paper 4: The role of collaborative evidence networks in promoting and supporting evidence-based health care globally: Reflections from 25 years across 38 countries https://www.sciencedirect.com/science/article/abs/pii/S0895435622000920

SDGs Synthesis Coalition. (2023). Synthesis of the Partnership Pillar of the SDGs - The Full Report. https://www.sdgsynthesiscoalition.org/sites/default/files/2023-09/Synthesis%20of%20the%20Partnership%20Pillar%20of%20the%20SDGs%20-%20The%20Full%20Report.pdf

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World Evidence-Based Healthcare Day Steering Committee. (2023, April 25). Equity in global health partnerships. https://worldebhcday.org/blog/2023/equity-global-health-partnerships

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To link to this article - DOI: https://doi.org/10.70253/BESX1583

Conflict of Interest
Bianca is the Chair of the World EBHC Day Steering Committee

Disclaimer
The views expressed in this World EBHC Day Blog, as well as any errors or omissions, are the sole responsibility of the author and do not represent the views of the World EBHC Day Steering Committee, Official Partners or Sponsors; nor does it imply endorsement by the aforementioned parties.