NN41, December 2008
The New Politics of Partnership: Peril or Promise?
One Size Doesn?t Fit All: Insights from North-South Academic Partnerships in Africa
By Ama de-Graft Aikins, University of Cambridge
Email: ada21@cam.ac.ukKeywords
Academic partnerships, Ghana, Africa, health research, sustainability.
Summary
A fundamental rule of north-south academic partnerships is that one size doesn?t fit all. This piece considers three categories of this rule within the African context: funding, structure and purpose of partnerships.
My first encounter with a north-south academic partnership was in Ghana in 1997. I had arrived from the UK after a psychology MSc to start a year of internship at the University of Ghana Medical School (UGMS) while I developed ideas for my PhD. I was based at the Centre for Tropical Clinical Pharmacology and Therapeutics. The first task I was given by the centre?s director was to write a report on ?Ghana?s Healthcare Infrastructure? for the funders of a research partnership on applied diabetes research. As a new and junior member of the centre, I was not privy to the level of funding the partnership received, but it was clear the ?Ghana Diabetes Project? (GDP) was a significant project. The two medical schools ? UGMS and the Kwame Nkrumah University of Science and Technology Medical School, teamed up with Ghana?s Ministry of Health, the University of Virginia, and the global pharmaceutical company, Eli Lilly, to develop a national programme on diabetes. It involved original empirical research investigating cultural attitudes to diabetes, the state and quality of diabetes care, and policy challenges across the country. Through stakeholder consultations, diabetes education materials were produced for patients as well as health workers. The project ran for a number of years and eventually yielded a number of important publications for the senior researchers (cf Amoah et al, 2000, 2002). Country reports were produced for various stakeholders.
Like all major research projects of this kind ? as I found out subsequently and as is reported in several reflexive accounts of academic and research partnerships (cf Campbell, 2003; Mosse, 2005) ? the process was challenging on a variety of levels: negotiation of roles, data ownership and publishing rights being the most prominent. And, typically, once the funding run out, the programme died, along with its practice and policy benefits. Two years after my involvement with the project I conducted my doctoral research on representations of diabetes in rural and urban Ghana. One of the major findings was a lack of adequate information on diabetes and its management for patients and health workers in both rural and urban settings, including at institutions that had received diabetes training from the GDP (de-Graft Aikins, 2004, 2005).
In the years that followed I have been involved in a variety of other partnerships in different technical capacities and levels of commitment:
? A researcher on an alcohol intervention study in Upper West Ghana with a partnership made up of UGMS?s Department of Psychiatry, the Ministry of Health and the Danish Aid Agency DANIDA.
? An independent reviewer for the Ghana Country Report for the Mental Health and Poverty Project (MHaPP). MHaPP is a DFID-funded partnership of mental health researchers from South Africa (the lead country), Zambia, Uganda, Ghana and the UK (see Doku et al, 2008; Flisher et al, 2007; http://workhorse.pry.uct.ac.za:8080/MHAPP).
? The principal partner of the British Academy funded UK-Africa Academic Partnership on chronic disease in Africa. The partnership is made up of interdisciplinary chronic disease researchers from Ghana, Cameroon, Nigeria, Kenya, the UK and Netherlands
(see http://www.britac.ac.uk/funding/awards/intl/africapartnerships.html).
? A sub-contracted local consultant reviewing the Millennium Villages Project (MVP) in Ghana. The MVP, brainchild of Columbia?s Jeffrey D. Sachs, brings together the Earth Institute (at Columbia University), UNDP, Millennium Promise, and ministries and selected villages of ten African countries (Ethiopia, Ghana, Kenya, Malawi, Mali, Nigeria, Senegal, Rwanda, Tanzania, Uganda) (see http://www.millenniumvillages.org/).
These projects have framed my experiences and perspectives on north-south academic partnerships in Africa over the last ten years. Among the many lessons I have learned is the fundamental one that one size doesn?t fit all in partnerships.
We can speak of at least three categories of ?one size doesn?t fit all?
The first category is level of funding. Funding ranges from small five-figure grants (such as partnership awards by the British Academy, DelPHE, and Leverhulme Trust/Royal Society) to substantial seven to eight-figure sums (such as awards by DFID and Wellcome Trust). While local researchers invest greater effort towards the larger grants, more money does not necessarily translate into successful sustainable outcomes. The Ghana Diabetes Project received more funding than the alcohol intervention project mentioned briefly; neither yielded long-term benefits for their research communities. More money can also be a double-edged sword: it changes the culture and focus of research and creates resource imbalances across institutions. For example, despite a well-documented double burden of communicable and non-communicable disease in Ghana, health research is skewed heavily towards HIV/AIDS, malaria and tuberculosis. This is largely in response to a problematic international health and donor focus on these three conditions cf. (Fuster and Voûte, 2005). The Ghanaian story is shared across the continent.
The second category is structure. The DelPHE application guide describes structural permutations best: north south partnerships can be ?Bilateral (One-to-one / Institution to Institution), Multi-disciplinary (3+ departments), Multi-institutional (3+ institutional partners), Multilateral (3+ countries involved)? (http://www.britishcouncil.org/delphe.htm). At a basic level a smaller partnership means less administrative effort for the leaders; a larger more complex consortium will require more administrative skill and effort. There?s a theory doing the rounds in researcher circles that the move towards huge multi-million dollar funding is the funder?s way of offloading administrative duties to the directors of the new ubiquitous consortiums. Smaller grants mean more groups of fundees and more annual reports to read, evaluate and file away. But structure is important at a conceptual level also. Often partnerships seek to maximise a mix of institutions with a range of skills and expertise, as well as history of involvement in partnerships. In Ghana, for example, one can speak of three kinds of academic institutions existing on a continuum of poor to stellar scholarship. At the poor end of the continuum lies the conservative traditional university department, often of a marginalised discipline in Africa, bogged down by increasing student numbers, minimal resources and university bureaucracy. At the stellar end is the dynamic semi-autonomous institution, often interdisciplinary, but with a core development oriented focus, usually run by dynamic leaders with international exposure, is wired to the world, attracts committed lecturers and researchers and can be categorised as world class. In the middle lies the revamped traditional university department, which despite facing the same structural and cultural problems as our conservative marginalised department, has managed to find a way of thriving under difficult circumstances. The way has often been through north-south partnerships. On Ghana?s Legon campus, African Studies, Linguistics and Geography, for instance, have solidified their status through their associations with the Norwegian Programme for Development, Research and Education (http://siu.no/en/Programme-overview/NUFU-programme). The theory is that by mixing institutions from these three categories together, for instance, one simultaneously elevates and equalizes institutional fortunes. But like funding, larger and more complex partnerships are not necessarily better than smaller partnerships. Small partnerships which replicate the skill mix at intra-institutional individual level will also reap benefits. A quick study of the DELPHE and MHaPP websites will illustrate this point.
The final category is the purpose of the partnership. There is a consensus that African universities are in crisis. African academic institutions were badly hit by the region?s socio-political and economic crises of the 1970s and 1980s. Over the last twenty-odd years they have experienced dwindling funding for academic resources and research, political stifling of bold scholarship, a rise in university student enrolment and the brain drain. In combination these have led to a variety of problems including low productivity, low engagement in global academic discourses and trends, poor or misguided leadership, increased dependence on external sources of funding and a growing inability to set their own research agendas. The proceedings of two recent conferences on Africa?s universities ? the ?Frameworks for Africa-UK Research Collaboration? meeting in Nairobi in September 2008 and the ?University Leaders? Forum? conference in Accra in November 2008 - underscored these points. Within this context partnerships are seen to serve a variety of capacity building purposes. Three dominant themes are building capacity for institutions (e.g improving IT and internet access), teaching (e.g training more PhDs) and research (e.g strengthening intra and inter-disciplinary knowledge on MDGs). Some of the new consortia, such as the ones to be inaugurated shortly through generous ten-year multimillion pound Wellcome Trust funding, aim to achieve multi-purpose functions, thereby creating much needed centres of academic excellence in the region.
References
Amoah, A.G.B, Owusu, S.K., Acheampong, J.W., Agyenim-Boateng K., Asare, H.R, Owusu, A.A., Mensah-Poku, M.F., Adamu F.C., Amegashie, R.A., Saunders, J.T, Fang, W.L., Pastors, J.G.,Sanborn, C., Barrett, E.J., and Woode, M.K (2000). A national diabetes care and education programme: the Ghana model. Diabetes Research and Clinical Practice, 49(2-3):149-57.
Amoah, A.G.B, Owusu, K.O., and Adjei, S (2002). Diabetes in Ghana: a community prevalence study in Greater Accra. Diabetes Research and Clinical Practice, 56: 197-205.
Campbell, C (2003). Letting them die: Why HIV/AIDS prevention programmes fail. Oxford: James Currey.
Doku V, Ofori-Atta A, Akpalu B, Read U, Osei A, Ae-Ngibise K, Awenva D, Lund C, Flisher AJ, Petersen I, Bhana A, Bird P, Drew N, Faydi E, Funk M, Green A, & Omar M (2008). A situation analysis of mental health policy development and implementation in Ghana. Phase 1 Country Report, Mental Health and Poverty Project, Accra.
de-Graft Aikins, A (2004). Social representations of diabetes in Ghana: reconstructing self, society and culture. Unpublished PhD thesis. London School of Economics and Political Science.
de-Graft Aikins, A (2005). Healer-shopping in Africa: new evidence from a rural-urban qualitative study of Ghanaian diabetes experiences. British Medical Journal, 331, 737.
Flisher AJ, Lund C, Funk M, Banda M, Bhana A, Doku V, Drew N, Kigozi F, Knapp M, Omar M, Petersen I, Green A. (2007). Mental health policy development and implementation in four African countries. Journal of Health Psychology 12(3): 505-516.
Fuster, V and Voûte. MDGs: chronic diseases are not on the agenda. Lancet, 2005; 366. Published online: www.thelancet.com
Mosse, David (2005) Cultivating Development: An Ethnography of Aid Policy and Practice. London; Ann Arbor, MI.: Pluto Press.
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