Evaluating the Process of Partnership and Research in Global Health: Reflections from the STRIPE Project

"Clear and transparent communication is needed throughout the research process to establish relationships and maintain momentum in the project."

Consortia, a sub-set of partnerships focused on a participatory approach to conducting research in multi-country settings, work to generate knowledge with the ultimate goal of combatting health disparities. One such endeavour is the Synthesis and Translation of Research and Innovations from Polio Eradication (STRIPE) project, which seeks to map, synthesise, and disseminate lessons learned from the global polio eradication effort. STRIPE is a collaboration between the Johns Hopkins University (JHU) and 7 academic and research country partners in the global south (Afghanistan, Bangladesh, Democratic Republic of Congo (DRC), Ethiopia, India, Indonesia, and Nigeria). The first year of the 5-year project consisted of knowledge mapping activities, which included a scoping review, large-scale global survey, key informant interviews (KIIs), and context mapping. STRIPE conducted a process evaluation of this consortium partnership during the first year, focusing on partnership relationships and consortium member experiences in addition to perceptions of the STRIPE project's research activities.

To conduct the evaluation, STRIPE used Blackstock et al.'s framework for evaluating participatory research, which emphasises the relationships between an evaluation's purpose, the criteria selected by which the process will be evaluated, and the methods used to conduct the evaluation. In December 2018, JHU team members submitted written reflections on their experiences (n=9), and calls were held with each consortium member (n= 7). In April 2019, an in-person consortium meeting was held; one member from each institution was asked to join a process evaluation working group. Ultimately, 12 evaluation criteria were defined and applied by each member of the consortium to their experience in the project. These included:

• Access to resources: For example, partner institutions noted challenges with using online data collection software, in terms of inadequate training and capacity and lack of internet in all places. In response, team members recommended providing more time for training and setting up permissions for partner institutions to access the JHU library for literature and other software licenses.
• Expectation setting (shared vision and goals): Partners noted that communication around alterations in timelines and prioritisation of tasks or the addition of new elements was not always effective and resulted in uncertainty and delays. Setting expectations around adaptations and iterations throughout the process, effective communication styles, and more discussion and clarity in early stages were suggested.
• Organisational context: Teams suggested integrating research projects with PhD programmes to avoid high staff turnover and recoup time spent in hiring and training.
• External context: During the study period, for example, Indonesia and DRC experienced the re-emergence of circulating vaccine-derived poliovirus (cVDPV), and insecurity and conflict continued in both Afghanistan and Eastern DRC. These events caused competition for stakeholders' time and attention and made some areas of the country inaccessible for research. Teams suggested greater flexibility in project targets based on the external context and the establishment of formal communication between JHU, local governments, and core Global Polio Eradication Initiative (GPEI) partners about the project.
• Quality of information: For example, country teams recommended they should be given more flexibility to modify the tools and timelines relevant for the country context and that tools could be more focused and precise, derived from the research questions.
• Relationship building and social capital: Trust between stakeholders, including government, GPEI partners, and the research institution, was raised as a challenge for conducting the project. Indonesia particularly noted that some of their stakeholders insisted on national leadership and local ownership, so they had to navigate perceptions of the project being externally driven. Stakeholder engagement prior to data collection was a successful strategy for at least three country teams; regular communication with stakeholders was widely recommended.
• Transparency: Early engagement on tool development, data collection and analysis strategies, and a procedure for defining authorship criteria and processing journal publications and conference presentations was recommended.
• Motivation: Researcher fatigue was reported due to lengthy, detailed processes and tools. Team members recommended additional time dedicated to project planning and training and rapid publication of study results and explicit appreciation to boost researcher motivation.
• Scheduling: Some team members highlighted the importance of country context and recommended it be taken into consideration when scheduling any research activity.
• Adaptation: There were misunderstandings about adapted timelines and work streams; recommendations centred around hiring additional staff, as well as early planning and engagement with teams on tool and process development.
• Communication and engagement: There was confusion on whom to contact within teams for different streams of work, and a lack of common communication platforms. Additional one-on-one meetings were suggested, both via phone and in-person. External communication with country stakeholders was also viewed as a challenge for some. (Editor's note: An externally facing project website to help improve communication has since been established, here).
• Capacity building: Additional training on the tools, analysis, and writing was recommended. Engaging student researchers was a valuable strategy.

Among the lessons to emerge: "How collaboration is started, its early processes, and relationship management are arguably at as least important as the strength of the collaboration's strategic premise....Therefore, buy-in from all partners is needed in early stages of any project to align expectations....While an initial consortium meeting was held prior to the launch of any research activities, more preparation and clarity was needed by partners regarding the mission, vision, goal, and scope of work." Furthermore: "Improved collaborative project management tools are needed for academic consortia to effectively communicate about the partnership and research processes."

The researchers conclude that "[m]ultiyear academic consortia should conduct such evaluations which can provide useful insights for the consortia itself and to those seeking to build and maintain their own cross-country partnerships."