PU335 Unit 8 Partnership Equity Analysis Example

Who Writes the Grant, Who Holds the Data, Whose Name Comes First: A Unit 8 Analysis of Equity in a Haiti Health Partnership

[Student Name]

Purdue University Global

PU335: Global Health

Unit 8 Global Health Partnerships Analysis

[Instructor Name]

[Date]

The partnership and its members are composite; the frameworks and studies cited are real.

The Partnership

The university provides funding from foundation grants, visiting faculty and students each year and research expertise. The hospital provides clinical staff, patients and local knowledge. The program has trained midwives, opened a maternity waiting home and reduced complications reaching the hospital too late. Both partners describe the relationship as close and mutually respectful. The program began after the 2010 earthquake, when the university's obstetrics department sent volunteer teams to the hospital. Over time the visits became a formal agreement, renewed every three years, and the hospital's maternity ward has grown from twelve to thirty beds. The partnership is regularly cited in university fundraising materials as an example of global engagement.

Why Equity in Partnerships Matters

Boum et al. (2018), writing about research partnerships in Africa, describe how imbalances in funding, leadership and authorship between high-income and low- and middle-income country partners can undermine local capacity and ownership, and recommend changes to address them, including local leadership, fair authorship and investment in local institutions. Abimbola and Pai (2020) go further, arguing that global health must confront the ways it reproduces colonial patterns of power, with decisions and resources concentrated in high-income countries, and that real change means shifting where power sits rather than only adjusting practices. Forman et al. (2025) add a legal dimension, arguing that global health law should be judged by whether it advances justice for the people with least power, which applies as much to a partnership's internal rules as to treaties between states.

Power in This Partnership

Funding. All grants are held by the university, which decides budgets and reports to the funders. The hospital receives funds as a subcontractor.

Decision-making. The program's steering group meets at the university, with Haitian staff joining by video. Strategic decisions, such as which communes to expand into, are proposed by university faculty.

Data. Patient data are stored on university servers, and the hospital needs permission to analyze its own patients' records.

Authorship. Of the program's nine published papers, seven have a university faculty member as first author and two have a Haitian clinician first; Haitian midwives are rarely authors.

Staffing. The program director is a university employee based in the United States. The Haitian deputy director, a senior midwife, earns a fraction of the director's salary.

By every measure of power, the partnership is closer to a program run from abroad with Haitian help than a partnership of equals, whatever both sides say about respect.

Why It Matters for Outcomes

The imbalance has practical costs. When a foundation grant ended in year five, the maternity waiting home nearly closed because the hospital had no independent funding or grant-writing experience. Haitian clinicians' priorities, such as postpartum hemorrhage training, waited behind research questions of interest to the university. And the program's knowledge, recorded in papers led by university authors, builds the reputation of the university more than the hospital's.

The View From the Hospital

Interviews a student might hold with Haitian staff would likely surface concerns that formal reports miss. The deputy director might describe preparing data for papers she is not invited to write. Midwives might note that visiting students gain clinical experience in their wards but that no Haitian midwife has been funded to train in the United States. Hospital administrators might worry that every new project arrives with its own reporting forms. None of these complaints mean the partnership has failed, but each reflects the same pattern: decisions about the program's direction are made where the money is held.

The View From the University

University faculty are also constrained. Funders often require the lead institution to have research offices, audited accounts and experience with large grants, which the Haitian hospital has not yet been able to build. Promotion committees in the United States reward first-author papers, which pushes faculty to lead publications. Recognizing these pressures does not excuse the imbalance, but it shows that change will need support from funders and universities, not only from the individuals in the partnership.

The Case Against Change

Some argue that the university's resources and expertise are what make the program possible, and that shifting control could reduce its effectiveness or funders' confidence. These concerns are real, but they describe a starting point, not a reason to stay there. Boum et al. (2018) note that capacity grows when local partners lead.

Proposed Changes

1. Funding. Within three years, the hospital becomes the lead applicant on at least one major grant, with the university as subcontractor, supported by grant-writing training for hospital staff.

2. Decision-making. The steering group meets in Haiti, chaired by the Haitian deputy director, with university faculty as members.

3. Data. A data-sharing agreement places ownership of patient data with the hospital, stored on a server it controls, with university access by agreement.

4. Authorship. New papers follow a rule that Haitian partners are offered first or last authorship on work from Haitian data, and midwives who contribute are offered authorship.

5. Staffing. The director role transfers to the Haitian deputy director within two years, with salary equity reviewed.

The Role of Funders

Funders can accelerate change by accepting applications led by institutions in low-income countries, budgeting for administrative capacity there and requiring equitable authorship plans. Boum et al. (2018) make similar recommendations, and some major funders have begun to adopt them. The partnership can use those shifts to support the transfer of grant leadership to the hospital.

Measuring Progress

Annual review of the share of funding held by the hospital, the location and chair of steering meetings, data ownership, authorship patterns and leadership roles, reported publicly by both partners. The review should also ask Haitian staff directly, through an anonymous survey, whether they feel their views shape the program's direction, since measurable indicators can improve while day-to-day relationships stay unequal.

Conclusion

A partnership both sides value can still concentrate funding, decisions, data, authorship and leadership in the wealthier partner. Measured against guidance on equitable research partnerships and the argument for decolonizing global health, this program falls short, with real costs for its sustainability. Specific changes in grants, governance, data, authorship and leadership, tracked annually, would move it toward a partnership in fact as well as name.

References

Abimbola, S., & Pai, M. (2020). Will global health survive its decolonisation? The Lancet, 396(10263), 1627-1628. https://doi.org/10.1016/S0140-6736(20)32417-X

Boum, Y., II, Burns, B. F., Siedner, M., Mburu, Y., Bukusi, E., & Haberer, J. E. (2018). Advancing equitable global health research partnerships in Africa. BMJ Global Health, 3(4), e000868. https://doi.org/10.1136/bmjgh-2018-000868

Forman, L., Abdool Karim, S., & Kolawole, O. (2025). Global health "with justice": The challenges and opportunities for human rights in global health law. Journal of Law, Medicine & Ethics, 53(S1), 18-22. https://doi.org/10.1017/jme.2025.1