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 LSTM’s 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 Participants raised concerns about funder requirements and outdated language in contracting process that hindered equity.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. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial NA ### Funding Statement This research was funded by internal funding within LSTM. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study received approval from the Research Ethics Committee at LSTM (21-060) in September 2021. Participant information sheets were provided, and written consent was obtained for all workshop participants and for those who provided written responses. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Anonymised data can be shared at request. Due to the nature of the research, the transcripts would have to be significantly redacted to remain anonymous as the data contains potentially identifying information.