Jim Campbell

Jim Campbell, January 28, 2013

The Global Maternal Health Conference in Arusha, Tanzania had many highlights, including the closing plenary presentation from Dr. Mahmoud Fathalla (watch the presentation here and see Karen Beattie’s blog for more), and the GMHC2013 manifesto proposed by Richard Horton (see Anne Starr’s blog for more).

An article in this week’s Lancet (Lancet Offline: 107 602 707 791) also reports on the plenary discussions on a proposed new Code of Conduct for health research in low-income countries. Richard Horton, Editor of The Lancet, reports:

The meeting in Arusha was opened by Agnes Binagwaho, Rwanda’s Minister of Health. She argued passionately that research and ethics must be more closely bound together. She spoke about the theft of data from Africa and the new enslavement of Africans. She called for a Code of Conduct for research in low-income countries. Here is a draft of a Code – a set of principles – assembled from a debate between Agnes Binagwaho, Wendy Graham, Rafael Lozano, and Marleen Temmerman.

  • No ethics committee, funder of research, or medical journal should approve, support, or publish research about a low-income country without joint authorship from that country.
  • In any research project in a low-income setting, local scientists must be included as co-principal investigators.
  • Before starting research in a low-income country, western authors and institutions must define a clear plan for how they will transfer research skills back to that country.
  • Medical journals and their publishers must ensure that all global health research is free at the point of use in countries.
  • Western journals must facilitate language translation of research, either themselves or by enabling local journals to republish freely.”

I was fortunate to attend the plenary discussion in Arusha. Richard Horton provided a provocative performance as Chair, and the panelists were excellent in their responses.

However, little mention was given to WHO’s ongoing process, where ‘all the goals concern all Member States and all individuals, communities, institutions and organizations involved in the production and/or use of research, including WHO’.

World Health Organization, 2009. WHO’s role and responsibilities in health research: Draft WHO strategy on research for health(WHA62/12), Geneva, Switzerland.

Paragraph 25 discusses the issue of standards: “No country is self-sufficient in its research capacity, so Member States need to be able to share research outputs. Effective and equitable sharing requires internationally agreed norms and standards for research; with this in mind, the standards goal concerns the promotion of good practice in research by means of work to establish agreements on good practices, scientific benchmarks, ethical guidelines and accountability mechanisms. The achievement of this goal is essential for winning public support and confidence“.

The principles from Arusha are sound, and the debate will no doubt continue. But live, Q&A sessions in plenary will not always allow for panelists to critically think through the implications of their intuitive responses. Caution is needed, with consideration of the inadvertent effects that may arise.

Several examples in relation to the points proposed:


  • A PhD researcher (from the global north), applying for ethics approval at their host University for their independent, original research is immediately in breach of the first point. Is it feasible that Harvard, Yale, Oxford, Cambridge, the LSE etc, etc would change their academic standards of research to insist that all research in LMICs is a joint endeavor – unless you happen to be from the global south?
  • The World Bank/IBRD is a funder of research (often at the country’s expense) but would they shift to this principle on all their publications? Including those that inform their financing decisions with a country? They are after all, a Bank.
  • is not just “medical” journals that need to heed the call. Aspirations for effective coverage and quality of care for all (i.e. Universal Health Coverage) require many types of health workers. Public health, midwifery, nursing, management, pharmacy and other journals should all be included.

More reflection is needed, and perhaps the WHO is best placed to steer a future code? In the meantime, we should all continue to encourage “health” journals to ensure that health information is available for all.

Horton, R., 2013. Offline: 107 602 707 791. The Lancet, 381(9863), p.278. Available at: http://linkinghub.elsevier.com/retrieve/pii/S0140673613600999 [Accessed January 28, 2013].

Jim Campbell is the Director of the Instituto de Cooperacion Social, Integrare (ICS Integrare) based in Barcelona, Spain. He was a co-author of the State of the World’s Midwifery report in 2011, works extensively in the field of Human Resources for Maternal and Newborn Health with research interests in urban/rural and socio-economic inequities in access to MNH services.

Code of conduct for research in low-income countries
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