Towards inclusive priority-setting for global health research projects: recommendations for sharing power with communities

Global health research priority-setting is dominated by funders and researchers, often from high-income countries. Engaging communities that are considered disadvantaged and marginalized in priority-setting is essential to making their voices and concerns visible in global health research projects' topics and questions. However, without attention to power dynamics, their engagement can often lead to presence without voice and voice without influence. Global health research priority-setting must be designed to share power with such communities to ensure that research projects' topics and questions reflect the health care and system inequities they face. To better understand what sharing 'power over' priority-setting requires, 29 in-depth, semi-structured interviews and one focus group were undertaken with researchers, ethicists, community engagement practitioners and community-based organization staff. The study shows that, before moving ahead with priority-setting for global health research projects, it is vital to assess whether contextual factors necessary for meaningful engagement between researchers and marginalized communities are present or can be built in the research setting. Study findings describe several such contextual factors and 12 features of priority-setting that affect how processes are run, who participates in them, and who influences their outputs. During priority-setting for global health research projects, it is essential to implement ways of sharing power with communities in relation to these features. Study findings describe a multitude of such strategies that are employed in practice. After priority-setting, it is important to demonstrate respect and accountability to communities.