Striving towards true equity in global health: A checklist for bilateral research partnerships

Interest in global health among high-income country (HIC) institutions is rising, yet power imbalances, racism, and colonial/neo-colonial dynamics persist and are often exacerbated by HIC trainee-led projects in low- and middle-income countries (LMIC). Drawing on published literature and shared experiences, the authors review inequities across research design, implementation, analysis, and dissemination, and offer practical recommendations to improve equity. Key problems include the HIC-centric nature of organizations, limited direct funding for LMIC investigators, HIC-driven priorities over local solutions, dominance of English in scientific publishing, and exploitation of LMIC collaborators. Four foundational principles underpin recommendations: prioritize locally derived and relevant solutions; create paired collaborations between HIC and LMIC institutions at all levels; provide funding for both HIC and LMIC team members; and assign clear, shared roles and responsibilities that value all partners. The authors propose the 20-item Douala Equity Checklist as a practical tool for HIC and LMIC institutions to guide ethical, equitable collaborations throughout the research process.