Health research projects funded by the UK aid budget are a great opportunity to bring innovative technologies to the world’s most underserved populations, but funding must be accompanied by appropriate ethical guidance if collaborations are to avoid power imbalances and build long-term community engagement.

This is the finding of a new study, published this month in Developing World Bioethics. It follows on from a project that saw researchers from the University of Bath develop a cost-effective, 3D‐printed, laboratory-grade microscope intended for use in lower- and middle-income countries (LMICs).

The precision microscope was designed to diagnose malaria (among other things) and the project was funded by UK Aid. The objective was for the fully automated microscope to be both manufactured and maintained in Tanzania. Tanzania is among the 10 countries with the highest malaria cases and deaths, with 93% of the population living in malaria transmission areas.

Science and engineering collaborations between the UK and LMICs became more common between 2016 and 2021 under the Global Challenges Research Fund (GCRF) – a five-year, £1.5-billion government funding stream established to pay for meaningful and equitable research partnerships. However, guidelines to run projects with openness and equity were in short supply, according to the authors of the new paper.

“For researchers from a high-income country, there’s a real lack of guidance on how to fulfil your commitments towards openness and achieving equity in project hierarchies,” said Dr Julian Stirling, study co-author and Physics researcher at Bath.

He added: “To fund these collaborations without appropriate guidance and training leaves researchers trying to teach themselves how to do development work whilst on the job.”

The OpenFlexure microscope: affordable and built to last

As a result of the collaboration between Bath and a STICLab (a small Tanzanian company), the 3D-printed OpenFlexure microscope was developed from a prototype to a robust design suitable for use in Tanzanian clinics. During the course of the project, over 100 microscopes were built in Tanzania at a fraction of the price of a commercial microscope.

Before the launch of the OpenFlexure project, the academics from the Department of Physics at Bath had little experience collaborating with partners in LMICs. They used the project as a cultural/ethical learning opportunity – both for themselves and their own future collaborations, and for other academics from high-income countries planning to work with partners in LMICs.

Dr Stirling said: “Before we started, we only had a sketchy understanding of the challenges we’d face. We put a lot of effort into learning how to work together, and how to navigate the inherent power imbalance that happen between researchers in a well-funded UK institution and partners in a small company in Tanzania.”

As the project drew to an end, the research team wished to capture what they had learned, with a view to giving guidance not just to researchers but also to the project’s funders. They enlisted the help of Dr Louise Bezuidenhout, a sociologist at the University of Oxford (now working for Data Archiving and Networked Services (DANS) in The Hague, Netherland). Dr Bezuidenhout interviewed the participants of the collaboration to build a detailed picture of the collaboration and any insight acquired from it.

Dr Richard Bowman, Bath physicist and study co-author, said: “For a lot of engineers and physical scientists, GCRF projects represented the first time we had worked with collaborators in the Global South. While we understood the technical challenges well, working across cultural, language, and administrative divides was a huge challenge.

“Even negotiating the research contract took a large fraction of a year, due to the very different ways of working between the UK university system and our partners in Tanzania, and the lack of parity in financial and administrative resources. We had to work very hard to adapt this, and support from NGOs was invaluable.”

A key outcome of this work was the recognition that health-technology research urgently needed to be integratred into the current dialogue on research ethics. Many researchers working in the area of health technology come from fields that are not engaged in medical ethics discourse and are unable to draw on expertise that would help them both navigate power dynamics in collaborative projects and build long-term community engagement.

While this study highlights lessons learned, and how they should be put into practice by funders and new collaborations, it is released under the backdrop of recent cuts in the UK aid budget that Dr Stirling describes as "devastating". Dr Stirling and his team had hoped to extend the microscope project across 10 countries in sub-Saharan Africa, but the budget cuts mean they won’t be eligible for additional aid funding for the foreseeable future.

Dr Stirling said: “We have spent years now building trust with our collaborators, and now these cuts have pulled the rug out from beneath us. It’s hard to see how the wider project can survive. In theory, the budget will go back up in a few years’ time, but the trust we have built may remain broken forever.”

This study was funded by the Royal Society and the Engineering and Physical Sciences Research Council.