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Breaking the Mold: Rethinking Global Health Through a Co-Creation Lens

By guest contributors Danielle Marie Agnello, Haika Monica Osaki, and Oritseweyinmi Erikowa-Orighoye

Determinants of health are a complex range of biological, social, economic, environmental, and political factors that transcend national boundaries and governments. This creates complex problems with global processes profoundly influencing how we understand and approach health challenges. As these occur in a webbed, dynamic, and interdependent fashion, health can be viewed as a complex issue, with traditional top-down approaches often falling short in addressing pressing issues. This is possibly due to an overemphasis on generating universal knowledge through theory-building and testing in controlled conditions. An alternative approach, called co-creation, involves developing interventions within specific contexts, fostering collaborative knowledge generation, and establishing equitable and sustainable partnerships.

Furthermore, efforts to improve health in low-and-middle-income countries (LMIC) are often ad hoc with stakeholders arriving for a brief tour in a LMIC and then departing without having created a sustainable human and material infrastructure. This results in the development of outcomes that may fail to meet the needs of the population and consequently are unsustainable, which is at minimum a waste of resources, and at its worst, it may create a type of ‘colonialism’. Co-creation is seen as a way to address existing hierarchies, enhance value for all partners, and demonstrate an understanding of the context-specific systems and their influencing factors, particularly in LMIC settings.

Collective Intelligence

In the realm of global health, the one-size-fits-all approach often fails to account for the intricacies of different communities and their unique needs. Co-creation, however, thrives on diversity, drawing upon the collective knowledge of stakeholders ranging from healthcare professionals to policymakers and local communities. Co-creation aims to democratize and accelerate research impact and innovation and can advance the development of solutions that align with stakeholder needs and preferences. By fostering collaboration and tailoring interventions to specific contexts, co-creation holds the promise of generating impactful, sustainable solutions. Collective knowledge and shared decision-making leverages the combined insights of both researchers and communities, resulting in more meaningful and actionable findings. To achieve this, it is crucial to uphold mutual respect for the diverse types of knowledge exchanged during co-creation and incorporate them throughout the process. Researchers and communities must actively and equally engage in honest communication to discuss achievable solutions that are context-specific and appropriately address community interests and needs.

Co-Creation Can Be Challenging

Co-creation is a powerful catalyst for sustainable change in global health and can significantly enhance the effectiveness and impact of health interventions. However, implementing co-creation is a complex, time-consuming process. One major challenge is the lack of guidance on its implementation and evaluation in global health settings. If co-creation is not properly applied, it can lead to poor coordination among key stakeholders and donors, creating major obstacles to integrating tailored interventions into an organized health system or institutional framework. Additionally, there may be missed opportunities to address critical community issues, such as ethical concerns like exploitation or insufficient knowledge transfer and capacity building among researchers and participating communities. Nevertheless, with thoughtful and methodological considerations, we can address these challenges and ensure that co-creation delivers its intended benefits, preventing the replication of the consequences of traditional approaches.

Co-creation champions equal participation, however, people often face the challenge of grappling with detrimental power dynamics and conflicting motivations and objectives among stakeholders. Similarly, within global health efforts, collaborative accountability involves navigating diverse stakeholders with varying degrees of influence. These dynamics vary across programs and institutions, each characterized by its own policy frameworks, structures, and power asymmetries. While these challenges can be daunting, they can be addressed. Power dynamics and inequities among co-creators must be identified, thoroughly discussed and actively addressed throughout the co-creation process.  Engaging in this approach can bring us closer to true collaboration to address some of the most pressing global health challenges.

Advancing Co-creation for Global Health

Various methodological approaches for research in global health emphasize the development, implementation, and evaluation of interventions, however, the literature on the co-creation process in these areas is fragmented. To advance this methodology in the field of global health, there is a need for more in-depth discussion and documentation on how co-creation is implemented in practice and what successful and unsuccessful co-creation endeavours look like. Health CASCADE, a Marie Skłodowska-Curie Innovative Training Network, are working diligently to do just that. The aim is to ensure co-creation is a trustworthy evidence-based methodology, developed through rigorous research. As a European Union’s Horizon 2020 research project, the network focuses on collaboratively creating resources that are open-access, user-friendly, and accessible to a wide audience of researchers and practitioners. These resources range from decision support tools, a guideline for designing and reporting your co-creation, evaluation frameworks, method selection tools, and a set of enabling technologies.

We Can Only Do This Together

As we navigate the complexities of global health, co-creation can be a powerful tool and a beacon of hope. By embracing diverse perspectives and fostering collaboration across sectors, we can unlock innovative solutions that resonate with the communities they serve. Stakeholders across sectors need to unite to unleash the transformative power of co-creation in designing innovative, sustainable and adaptable solutions to complex and wicked global health challenges.  By fostering inclusive, respectful partnerships and prioritizing equitable and meaningful engagement of stakeholders, we can harness the collective wisdom and resources necessary to build resilient health systems and ensure better outcomes for all. Let us embrace the spirit of co-creation and embark on a journey towards a healthier, more equitable world.

About the Authors:

Danielle M. Agnello is a Global Health specialist and a Marie Curie PhD Fellow based in the School of Health and Life Sciences, Glasgow Caledonian University. Her research focuses on co-creation for public health intervention design, exploring the most effective methods for various contexts and their impact on the co-creation process. Additionally, she investigates iterative evaluation techniques for co-creation. Danielle is part of Health CASCADE, a Marie Skłodowska-Curie Innovative Training Network funded by the European Union’s Horizon 2020 research and innovation programme, and also an Advisory Board member of the global non-profit, Global Health Mentorships.

Haika M. Osaki is a social scientist and PhD Fellow at the Department of Public Health, University of Copenhagen. Her PhD research is part of the PartoMa project, which collaborates with frontline healthcare providers in Tanzania to co-create clinical guidelines to support childbirth care. Haika’s research explores the dilemmas of co-creation within the context of clinical guidelines and strategies for supporting co-creation in this setting.

Oritseweyinmi Erikowa-Orighoye is a qualified Pediatrician and early career researcher with a focus on the environmental and public health of coastal communities in the Niger Delta region of Nigeria. She serves as director of programs for an NGO called Coastal and Marine Areas Development Initiative (CMADI). She is an Associate Lecturer at Arden University, the United Kingdom.

Disclaimer: Views expressed by contributors are solely those of individual contributors, and not necessarily those of PLOS.

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