Spiegel et al in BMC International Health and Human Rights

Reviewed by Patricia Polo & Karen Pesse

This is an informative short paper about the experience of creating and maintaining a north/south academic partnership led by University of British Columbia- Canada, with participation of four Ecuadorian universities and support from Mexican and Cuban universities. The project led to interesting top-down results and outcomes, such as the design of master’s programs being based on the Ecohealth framework by Ecuadorian universities and the work of some graduated students holding leading posts at academic and local development institutions. However, the paper mentions links with policy makers, but does not explain them, leaving the reader with questions on how they were established and whether or not they are still functional.

The bottom-up results and outcomes, illustrated by case studies, are useful because they increase understanding of how problems and strategies were conceptualized, implemented and worked out. But also in this part, we miss the link with policy makers and practitioners. The authors describe one important, but particular case in which three types of stakeholders – community, policy makers and practitioners – were involved. This was a dengue control project  and it was particular, because the main researcher happened to also be the provincial head of the vector disease control program.

The article address a large range of themes, from the brief description of the Ecosystem Approach to Human Health and its advantages over other forms of analyzing and managing environmental health risks, to the creation, development and sustainability of a Community of Practice (CoP) and new forms of pedagogy and research. This width is also its weakness. The ambitious scope might be the cause of some issues not being developed in depth, as for example the real and possible level of community participation at the research projects developed by master’s course students or the indicators used for action research impact´s measurement. Tensions between local reality and needs at one hand, and academic requirements at the other, are mentioned but not described in detail; it would be interesting to know how these problems were solved.

It is worthy to read that results of the master theses were shared with the communities participating at these research projects. Sharing of results with beneficiaries and participants should be part and parcel of any ethically sound research proposal, including appropriated funds to realize this. If results are not shared with the people who allow researchers to come to their communities, enter their houses and take some of their precious time, then: what is the use of doing research?

We consider it a pity that the impact of the project – health outcomes at community level – is shortly mentioned, but not developed in-depth. It would be illustrative if the authors could share their experiences on community interventions and involvement in an extended paper, so we can learn, not only about the impacts themselves, but also how they were measured. This last point represents a key element of any action research proposal, but from experience we know that it can be very difficult to define and obtain accurate data for this purpose.

We believe that main focus of the article is on establishing a CoP, which the authors define the as “group of people sharing a concern…”, who at the same time have other, non shared interests, knowledge, expertise, institutional backgrounds, etc. We miss a more detailed description of each of these issues and especially of the process of sharing information, a main element for the analysis of a network. As it is presented in the paper, exchange seems to be somehow unidirectional, with Ecuador mostly receiving information and support coming from other countries. The role of Mexican and Cuban academic institutions in creating and maintaining this CoP is not explained, so this might contribute to our (false?) perception about power imbalances within the network. Moreover, the authors’ emphasize the achievements of the CoP´s in terms of academic programs set into place, research projects implemented, leaving the process itself a bit aside. All this reinforces the idea of this CoP being understood and managed as a cooperation project between academic institutions and not as an actual network.

Nevertheless, to read about this successful experience on creating north/south links is quite interesting; we all, from north and south, might learn a lot from it. Collaboration and networking means to acknowledge, value, and use, all options made possible by the richness of differences among its members. We ought to congratulate the mentors for their efforts in implementing these kind of proposals that benefit universities, researchers and students, but also communities, policy makers, and health practitioners… hopefully not only from the South.


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