A multi-step analysis and co-produced principles to support Equitable Partnership with Liverpool School of Tropical Medicine, 125 years on

Transboundary health partnerships are shaped by global inequities. Voices from "global South" research partners are critical to understand and redress power asymmetries in research partnerships. We undertook research with Liverpool School of Tropical Medicine (LSTM) partners to inform LSTMs equitable partnership strategy and co-develop principles for equitable partnerships. We applied mixed methods and participatory approaches. An online survey (n=21) was conducted with transboundary partners on fairness of opportunity, fair process, and fair sharing of benefits in partnership with LSTM-Liverpool. We triangulated the survey with key informant interviews (n=12). Qualitative narratives were coded and analysed using the thematic framework approach. These findings were presented in a participatory workshop with transboundary partners to co-develop principles for equitable partnership, which were then refined and validated. Transboundary partners identified being involved in agenda setting from the outset, shaping the design of research projects and theories of change as mechanisms to support fair opportunity however, funding mechanisms that shape power structures was reported as limiting fair opportunities. Fair process was supported by multi-directional, long-term collaborations with opportunities for capacity strengthening. Participants raised concerns about funder requirements and outdated language in contracting process that hindered equity. Fair benefit sharing was facilitated by early discussions on authorship to promote equity and policy influence. Funding also influenced the ability to travel and network, important for benefit sharing and fair opportunity. High paywalls limit sharing of research findings and access to research findings for many "global-South" partners. The co-developed principles are part of ongoing reflections and dialogue to improve and undo harmful power structures that perpetuate coloniality within global health. While this process was conducted with LSTM-Liverpool partners, the principles to strengthen equity are applicable to other institutions engaged in transboundary research partnerships and relevant for funders.