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Promoting equitable global health research: a policy analysis of the Canadian funding landscape Plamondon, Katrina; Walters, Dylan; Campbell, Sandy; Hatfield, Jennifer Aug 29, 2017

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RESEARCH Open AccessPromoting equitable global health research:a policy analysis of the Canadian fundinglandscapeKatrina Plamondon1,2* , Dylan Walters3, Sandy Campbell4 and Jennifer Hatfield5AbstractBackground: Recognising radical shifts in the global health research (GHR) environment, participants in a 2013deliberative dialogue called for careful consideration of equity-centred principles that should inform Canadianfunding polices. This study examined the existing funding structures and policies of Canadian and internationalfunders to inform the future design of a responsive GHR funding landscape.Methods: We used a three-pronged analytical framework to review the ideas, interests and institutions implicatedin publically accessible documents relevant to GHR funding. These data included published literature andorganisational documents (e.g. strategic plans, progress reports, granting policies) from Canadian and othercomparator funders. We then used a deliberative approach to develop recommendations with the research team,advisors, industry informants and low- and middle-income country (LMIC) partners.Results: In Canada, major GHR funders invest an estimated CA$90 M per annum; however, the post-2008re-organization of funding structures and policies resulted in an uncoordinated and inefficient Canadian strategy.Australia, Denmark, the European Union, Norway, Sweden, the United Kingdom and the United States of Americainvest proportionately more in GHR than Canada. Each of these countries has a national strategic plan for global health,some of which have dedicated benchmarks for GHR funding and policy to allow funds to be held by partners outsideof Canada. Key constraints to equitable GHR funding included (1) funding policies that restrict financial and costburden aspects of partnering for GHR in LMICs; and (2) challenges associated with the development of effectivegovernance mechanisms. There were, however, some Canadian innovations in funding research that demonstratedboth unconventional and equitable approaches to supporting GHR in Canada and abroad. Among the most promisingwere found in the International Development Research Centre and the (no longer active) Global Health ResearchInitiative.Conclusion: Promoting equitable GHR funding policies and practices in Canada requires cooperation and actions bymultiple stakeholders, including government, funding agencies, academic institutions and researchers. Greatercooperation and collaboration among these stakeholders in the context of recent political shifts present importantopportunities for advancing funding policies that enable and encourage more equitable investments in GHR.Keywords: Global health research, Funding, Research policy, Canada* Correspondence: katrina.plamondon@ubc.ca1Research Department, Interior Health, Kelowna, BC, Canada2School of Nursing, University of British Columbia, 3333 University Drive,Kelowna, BC V1V 1V7, CanadaFull list of author information is available at the end of the article© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, andreproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link tothe Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Plamondon et al. Health Research Policy and Systems  (2017) 15:72 DOI 10.1186/s12961-017-0236-2BackgroundGlobal health research (GHR) prioritises health equityand improved well-being for all people worldwide. It in-volves transnational health issues, determinants and so-lutions, involves collaboration across many disciplineswithin and beyond the health sciences, and is under-taken in order to inform (and be informed by) policy atthe local, national and global level [1–3]. Given the cen-tral value and focus of GHR on health equity, equity inresearch-related practices and policies are importantfoundations for this field of research. Between 2013 and2015, people involved in doing, teaching about, support-ing and using GHR in Canada contributed to a series ofdialogue-based studies aimed at articulating a shared vi-sion for action. Among the outputs of this work are thestudy reported here and the creation of a set of equity-centred principles for GHR [4]. These six equity-centredprinciples set an aspirational standard for ethical, equit-able engagement in GHR, including investments andsupports for GHR through funding policies. These prin-ciples, and the shared concerns of participants in theGathering Perspectives Studies, served as the foundationfor the policy analysis presented here.Canadian investments in GHR have, like in other fieldsof health research, been subject to a dynamic policy en-vironment over the last decade. Following the 2008 eco-nomic recession, there was an unprecedentedreorganisation of the GHR funding landscape in Canada.As new global public health threats emerged, majorfunding bodies underwent reform and private investorsexpanded their involvement in research and develop-ment. These shifts occurred amid intensified pressure todemonstrate results and value for money. While the ex-plicit rationale for the structural changes in Canada’sGHR funding landscape was to strengthen its position asa world leader in research, the underlying reasons forchanges are difficult to discern and their future impactsunknown.In 2011, the Canadian Academy of Health Sciencescalled upon Canadians to play a more strategic role inglobal health [5]. The Canadian Coalition for GlobalHealth Research (CCGHR), a network of people inter-ested in promoting better and more equitable healthworldwide through the production and use of know-ledge, responded by leading research1 that invited actorsin the GHR community to engage in dialogue on thestate of health research and practice in Canada. Partici-pants in this research identified a need for tools thatcould support navigation of a changing funding land-scape and inform the evolution of policies and practices.The purpose of this study was to examine the GHRfunding system in Canada and comparator countries tobetter understand the current funding landscape andidentify promising practices that could inform equitableapproaches to GHR funding. The recommendationsstemming from this analysis may inform a dialogue onCanada’s strategic role in enabling equitable and ethicalGHR [5, 6].MethodsThis study involved analysing funding policies for theiralignment with equity-centred GHR, using the CCGHRPrinciples for GHR [4] as an analytical tool to guide as-sessment of equitable and ethical GHR policies andpractices. For the purposes of the study, we defined pol-icy as anything that explicitly or implicitly determinedthe ways in which GHR grants could be prepared, usedor administered, as well as guidelines, statements or dir-ect policies that delineate funding bodies’ investments inGHR. This includes funding practices that may not bedocumented as formal policies, but that constitute a rou-tine or typical way a funding body engages with GHR(e.g. funding agencies’ practices in selecting reviewers ormonitoring competition outcomes for bias or compli-ance with GHR eligibility policies; university norms foradministration of grant monies).Grounded in a reflexive approach [7, 8], this studycentred around three analytical questions – (1) how isGHR conceptualised in funding policies; (2) how areequity-centred principles of GHR reflected (or not) in pol-icies (Table 1); and (3) how are the interests of intendedbeneficiaries considered (or not) in these policies. The ap-proach to policy analysis was guided by the Ideas, Inter-ests and Institutions conceptual framework [9].Two distinct datasets were used for this analysis. Thefirst dataset was generated at a 2013 CCGHR delibera-tive dialogue involving participants who self-identified ashaving some involvement in GHR. Perspectives fromwithin the GHR community that were reflected includedthose from non-governmental organisations, universityadministration, researchers, teachers, students, fundersand private organisations involved in GHR. Participantsat this event voiced concerns about issues of stability,ethics and equity for GHR funding and called on theCCGHR to undertake further policy research. The dataincluded specific reflections on formal and informalfunding policies in Canada. This dataset was re-analysedin this study for content pertaining to this study’s re-search questions. The HealthBridge Research EthicsBoard reviewed and approved the ethics application forthe study in which this deliberative dialogue was held(Certificate Number: HBREB/2013_1). Participants’ con-sent included acknowledgment of the possibility thattheir data may be used for future studies.The second dataset was composed of literature anddocuments relating to selected national funders of GHRin Canada and major global comparators. Inclusion cri-teria for funders involved being an agency with explicitPlamondon et al. Health Research Policy and Systems  (2017) 15:72 Page 2 of 14Table 1 Criteria for assessing equity in funding policiesCCGHR Principles for Global Health Research Description Potential applications infunding policyAuthenticpartneringBuilding equity andreciprocity considerationsinto research partnerships,including the ways in whichresearch partnerships enablefair distribution of resources,power and benefits• Attention to research teams’partnership structures, distributionof resources, degree of participationand/or collaboration (e.g. throughteam composition, budget)• Requiring transparency inintention to adopt equitable,ethical partnering strategies• Setting expectations forGHR to recognise and mitigatepower imbalances (e.g. betweenCanadian researchers and theirLMIC partners)• Requiring the use of partnershipassessment tools or processevaluation, including researchon the use of these toolsInclusion Intentionally providingpeople who have beenhistorically marginalisedopportunities to engagein research processes• Promoting integratedknowledge translation orengaged study designs thatinclude research users inidentifying and defining researchproblems, setting priorities,articulating questions, conductingresearch and designingdissemination products• Setting budget guidelinesfor inclusion of trainees ormentees (e.g. emerging leaders),particularly from partner countriesShared benefits Being attentive to andmitigating the potentialfor research to benefitthe principal investigatormore than the communitiesor partners with whomthey are working• Setting expectations aboutresearch outputs that includebenefits beyond traditionalacademic outputs (i.e. publications)• Requiring documentation ofhow research teams areattempting to achieve reciprocity• Encouraging budget allocationthat prioritises equitable resourcingfor LMIC partners to benefit astrainees and/or attend conferences• Encouraging budget allocationto post-product/post-trialbenefits for communitiesinvolved in randomisedcontrolled trials• Assessing for equity intentionsin access to evidence, includingopen access policies forpublications and in data repositoriesCommitment tothe futureHonouring global citizenshipand humanity’s sharedfuture in the world,including prioritisingresearch that contributesto a better, more equitableworld for future generations• Examining how a particularproject fits within a broaderrelationship or programmeof research• Providing funding formulti-year projects• Inviting research specific to globalsustainability and inherently globalhealth issues such as climatechange or globalisation• Assessinggrants for alignment withhuman rights language and/or work• Encouraging budget allocatedto trainees and mentorship• Funding multi-institutionteams or networks• Investing in harmonisation effortsResponsiveness tocauses of inequitiesRecognising, examiningand interrupting rootcauses of health inequitiesthrough research• Ensuring reviewers are familiarwith the evidence about rootcauses of health inequities• Assessing grants for effortsto recognise, examine andPlamondon et al. Health Research Policy and Systems  (2017) 15:72 Page 3 of 14or implicit investments in GHR, degree of influence overstrategy, and researcher accessibility to documents inEnglish. We selected a heterogeneous set of funding or-ganisations, including overseas development agencies,health research councils, development research centresand philanthropic foundations. We searched for docu-ments that described these organisation’s values, strat-egies, programmes and granting policies. Documentsretrieved were funding bodies’ strategic plans, progressreports and grant management policies relevant to GHR,although these varied widely in terms of scope, time-frame and level of detail. In addition, we searched aca-demic databases, including Medline, PubMed, Scopusand Google Scholar, for peer-reviewed research on thistopic. Key medical subject headings and search terms in-cluded ‘global health research’, ‘funding’ and ‘develop-ment assistance’.Using a content analysis approach [10], and guided bythe Ideas, Interests and Institutions framework, datafrom both datasets were coded for the forces, facilitators,barriers and gaps that shaped the structures, strategies,priorities and policies of the GHR funding landscape inCanada and abroad. Documents were coded with assist-ance from NVivo 10 [11]. Our analysis continued itera-tively with initial findings evolving to inform codingstructures and shaping new questions. The results ofboth the document analysis and secondary analysis ofdata from the deliberative dialogue were synthesised. Wethen used a deliberative approach [12, 13] to review theresults of our analysis, debate about implications andcollectively arrive at a series of recommendations. Forthis deliberative approach, we presented participantswith a summary of our findings and asked them (1) howthe results did or did not resonate with their experience;(2) to identify any gaps in our analysis; and (3) for theirreactions to the series of recommendations. Participantsin these deliberations represented a diverse range ofperspectives in terms of their involvement in GHR, in-cluding people currently or previously involved in aca-demic administration, government agencies, fundingagencies, professorial positions, non-governmental orga-nisations and philanthropic organisations. Perspectivesfrom Canada, the United States of America, Europe, Af-rica and Central/South Asia were reflected among thesecontributors. Participants included the CCGHR Gather-ing Perspectives Study (Phase 2) research team (n = 17)as well as expert informants and stakeholders (n = 5)from Canada, comparator funding countries, and non-Canadian and international research partners represent-ing a broad range of disciplines. In addition, delibera-tions included the CCGHR board (n = 11) and itsUniversity Advisory Council (composed of representa-tives from 23 universities across Canada). Responses tothe questions we posed were provided in both verbaland written format, and were used to strengthen ouranalysis and refine recommendations.Results and DiscussionThis section summarises the key findings from our ana-lysis and provides a snapshot of the funding landscape inCanada and comparison countries.Global context for GHRThe global context of investments in GHR is marked byintense diversity in direction, intent and funding struc-tures. Funders and other GHR stakeholders, both inCanada and abroad, use a varied terminology to describethe activities aligning with our definition of GHR. Thismay be attributable to agencies’ particular objectives andintended beneficiaries of GHR investments, which alsovary widely. The stated rationale for GHR investmentsranged across a wide spectrum, from the pursuit of com-mercialisation opportunities, through the advancementof basic and applied sciences, to eliminating the burdenTable 1 Criteria for assessing equity in funding policies (Continued)interrupt root causes ofhealth inequities• Encouraging applied and/orinterventional research thataims to recognise, examineor interrupt root causes ofhealth inequities• Encouraging research onresearch to illuminate andinterrupt inequitable researchpractices or study designsHumility Positioning researchersin a position of learning,rather than knowing• Encouraging adaptive,responsive or supportivesteps for investing in researchand/or knowledge translation(e.g. formative evaluationsthat open possibilities foradjusting plans)• Inviting integrated knowledgetranslation, action research,applied or engaged study designsPlamondon et al. Health Research Policy and Systems  (2017) 15:72 Page 4 of 14of diseases and poverty or supporting health as a humanright. Similarly, we found that funding originating inwealthy countries flowed to a variety of targeted benefi-ciaries, including local researchers, institutions and pop-ulations, as well as marginalised, indigenous or resource-poor populations globally. This variability is observableamong agencies that directly support GHR (e.g. fundingagencies) and within general investments in globalhealth through development assistance or other pro-grammes that indirectly support GHR (e.g. through in-vestment in evaluation, knowledge translation orinnovation). For example, a major determinant of GHRfunding among Organisation for Economic Co-operationand Development (OECD) countries is the direction andamount of foreign aid for health sector activities, whichis otherwise known as development assistance for health(DAH). DAH globally climbed to a new high of US$31.3billion in 2013, although the 3.9% growth from 2012 to2013 falls short of the average 10% annual increases seenover the 2001–2010 period [14]. Correspondingly, therewas an 18.4% average annual increase in funding for‘global’ activities, which are defined as health research orthe creation of public goods benefiting multiple regionsor the whole world. Canada’s funding for DAH also hada remarkable average annual growth rate of 22.3% be-tween 2000 and 2011 [14]. The variability in this sameperiod among OECD countries is notable, however, ran-ging from 2.3% annual growth rate by France to 17.6%by the United States, which is the highest contributor inabsolute terms. While there may be justification for con-tinued growth based on need and long-term cost-benefit, there is likely more GHR funding availablearound the world at the present time than ever before.This rise of GHR funding may be attributed to in-creased public and political awareness of global vulner-ability to infectious diseases, heightened by the onset ofthe HIV/AIDS pandemic in the 1980s and 90s. TheUnited Nations’ Millennium Development Goals focusedpolitical attention on the inequities between countriesand championed channelling investments into prioritiessuch as HIV/AIDS, malaria and then maternal, neonataland child health (MNCH) [15–19]. Funding for DAHalso surged as public institutions, non-profitorganisations and for-profit companies became inter-ested in undertaking GHR. This interest led to the estab-lishment of the President’s Emergency Plan for AIDSRelief, the Global Fund for AIDS, Tuberculosis and Mal-aria, and the Bill and Melinda Gates Foundation (BMGF)[15, 20]. West Africa’s 2014–2015 Ebola epidemic even-tually captivated the attention of global media, public at-tention and donors, though largely borne out of fear ofcross-continental spread [21, 22], which may have over-shadowed critical messages about the need to invest instrengthening health systems, the health workforce andother fundamental areas of human development inresource-poor countries to prevent epidemics.Canadian fundersCanadian researchers have a long history of involvementin global health initiatives, and are recognised for leader-ship in GHR and practice. Innovations in funding forGHR emerged through the 2001 establishment of theGlobal Health Research Initiative (GHRI), with theirflagship Teasdale-Corti grants, which infused more thanCA$18 million into GHR funding between 2003 and2005 [23]. Growth in academic programmes focusing onglobal (sometimes named international) health hasboomed over the last decade [24, 25]. This growinginterest and investment in GHR came at a time whenheightened awareness of the inherently global nature ofinfectious diseases was amplified by the 2004 SARS cri-sis [26]. Political and economic factors may have furtherinfluenced the direction of research funding agencies.The federal governments’ leadership between 2000 and2015, however, was characterised by a series of short-term minority governments (Liberal then Conservative)that resulted in a high turnover of ministers responsiblefor international development and short-lived strategies,citing unprecedented economic uncertainty as a ration-ale for budget cuts or reorganisation [18, 27].Based on open data sources, the primary GHR fundersbased in Canada at present are Grand ChallengesCanada (GCC), the International Development ResearchCentre (IDRC), and the Canadian Institutes of HealthResearch (CIHR) (see Table 2 for estimated annualTable 2 Overview of primary Canadian funders and their estimated annual investments in global health researchReported global health research funding (in millions, CAD)Agency Data availability 2011–12 2012–13 2013–14 2014–15 2015–16IDRC Spending and results for individual grants 18.663 16.822 16.73 a bGCC Basic information on recipients of grants 13.85 51.83 54.5 50.54 46.34CIHR Overviews of individual grants and spending across grants programmes 27 31 31 30 29Total national estimate 59.51 99.65 102.23 80.54 75.34aIn 2014, IDRC removed the ‘global health policy’ category of research spendingbIn 2015, IDRC removed the ‘global health policy’ programme area from total expendituresCAD Canadian Dollar, CIHR Canadian Institutes of Health Research, GCC Grand Challenges Canada, IDRC International Development Research CentrePlamondon et al. Health Research Policy and Systems  (2017) 15:72 Page 5 of 14funding amounts). It is assumed that Global AffairsCanada (or formerly CIDA, and then DFATD) is also amajor funder of GHR activities that feature under theumbrella of evaluation or innovation, but expendituredata at this level of detail was not openly available at thetime of our analysis.Global Affairs Canada (formerly CIDA, then DFATD)Foreign policy directions and aid budgets both influencethe nature of evaluation and research in global health.Between 2005 and 2015, the federal government over-hauled the research and development funding landscapeand established new funding priorities in line with thepost-recession foreign aid policy directions of the 2009Economic Action Plan [28]. First, the Aid EffectivenessAgenda, which claimed to have untied all food aid, wasimplemented with a focus on 25 priority countries thatwould receive 90% of aid funding [29]. Then, in general,most of Canada’s DAH followed the foreign policy objec-tives in fragile and conflict-affected states (e.g.Afghanistan and South Sudan) and certain humanitariancrises [30]. During this time, new and targeted develop-ment priorities were selected, such as increasing food se-curity, securing the future of children and youth,stimulating sustainable economic growth, advancing dem-ocracy, and promoting stability and security [31, 32].Seizing the opportunity provided by hosting the 36thG8 meeting in 2010, Prime Minister Stephen Harperlaunched 2010’s Muskoka Initiative and its keystonecommitment of CA$5 B over 5 years by member nationstowards improving global MNCH. Again, in 2014,Canada convened world leaders, development financiersand global health experts at a summit to witness a pre-election re-commitment to MNCH, pledging CA$3.5 Bof purportedly ‘new money’ over the next 5 years [30].The long-term commitment to MNCH achieved throughthe 2010 G8 summit was recognised as both an import-ant contribution to meeting “badly lagging MillenniumDevelopment Goals 4 and 5” ([33], p. 186), and a signifi-cant global governance accomplishment. As a leadingnational policy initiative, it both directly and indirectlyinfluenced research agendas of both funders and re-searchers by elevating the perceived importance of in-vestment in MNCH. Further, the Muskoka Initiative hasmerit in its clear focus, sizable evidence for the returnon investment from investing in MNCH as a whole, andthe promotion of evidence-informed cost-effective inter-ventions; however, some critiques point to the less-than-subtle political motives that may have driven the invest-ments in MNCH.The policies of the Muskoka Initiative have been criti-cised as veiled attempts to garner public support by ap-pealing to Canadians’ valuing of universal healthcare intoforeign policy prior to federal elections while failing toaddress the social determinants of health [34], particularlythat of poverty as an underlying cause of maternal andchild mortality [35]. Globally, the initiative has been sub-ject to scrutiny for paternalistic and neo-colonial policiesthat are “highly problematic from a gender and develop-ment perspective” ([35], p. 75). An examination of OECD’sopen data on foreign aid spending reveals a silent budgetcut – the percentage of Canada’s official development as-sistance (ODA) to gross national income (GNI) droppedfrom 0.32% in 2012 to 0.27% in 2013 [36], and is far belowthe internationally accepted standard of 0.7% of GNP sug-gested by former Canadian Prime Minister Lester Pearsonin 1970. Further, Canada’s DAH dropped from CA$542 Mto CA$491 M in 2012–2013 [14]. Canada now ranks fif-teenth among donor nations for ODA/GNI ratio, which ishardly consistent with the government’s projected imageof leadership in the field [36].The government reportedly allowed nearly CA$800 M,or 11%, of the foreign aid budget to expire at the end ofthe 2013 fiscal year [37]. Unfortunately, the publicly dis-closed financial reports and budget plans for DFATD donot contain a year-over-year comparison of expendituresfor the transition period from CIDA in 2012–2013 toDFATD 2013–2014. Analysis of DFATD’s budget projec-tions showed that, after the MNCH funding announce-ments, the annual budget for international povertyreduction remained steady at roughly CA$3.0 B [30, 38].If the 2014 CA$3.5 B MNCH commitment is not actu-ally ‘new money’ relative to historical levels but com-pared to the 2012–2013 level after the budget cut,Canada will be set up to underachieve on its commit-ments proclaimed at the MNCH Summit [39, 40].With a new federal government in power, and afresh rebranding of DFATD as Global Affairs Canada,there are numerous opportunities for the new govern-ment to support a more GHR-friendly environment inCanada. Commendably, Global Affairs Canada hasalready made commitments to raise the limits to per-centage of grant funds that can be used for monitoringand evaluation. In June 2017, Global Affairs Canadalaunched a ‘feminist international assistance’ policythat prioritises a human rights approach and is accom-panied by CA$150 M over 5 years [41]. The currentgovernment’s interest in using evidence to inform pol-icy is also encouraging, as are their efforts to engageCanadians in open consultations that have key rele-vance for global health and GHR (e.g. May–July 2016consultation on international development2). Whilesteps have been taken to report foreign aid spendingin line with international standards [42] and to postopen data spreadsheets of basic project information,transparency on policy decision-making, resource allo-cations, grant review processes and outcome resultscould be drastically improved.Plamondon et al. Health Research Policy and Systems  (2017) 15:72 Page 6 of 14IDRCIDRC’s strategic framework and reports are made publiclyavailable as part of an explicit acknowledgement that thesedocuments are important tools for internal stakeholders toplan and assess their work. Further, the agency states thatthese documents are “also an important tool for communi-cating with and providing accountability to stakeholdersoutside the [IDRC]” ([18], p. 1-1). Historically, this Crowncorporation has enjoyed an excellent reputation amonginternational funders. IDRC continues to hold a broad setof development research priorities such as agriculture andthe environment, economic growth, social policy, scienceand innovation, and global health. The latter commandedCA$16 M or 10% of IDRC’s total budget in 2012–2013[43]. Unfortunately, the budget was reduced in the 2013federal budget, and it has experienced several structuralchanges in recent years that may potentially have a negativeeffect on GHR. In 2014, IDRC launched a new Innovatingfor Maternal and Child Health in Africa programme thatwill fund implementation research teams and health policyresearch organisations on research related to MNCH [44].Both our policy analysis and contributors to delibera-tive processes (including the 2013 dialogue and subse-quent deliberations) indicated alignment between IDRCpolicy and practices and the equity-centred criteria usedin this analysis. This was particularly true for the criteriaof authentic partnering, inclusion, shared benefits andcommitment to the future. One of IDRC’s recognisedstrengths lies in its commitment to “devolve the respon-sibility for coordinating, managing, and administering re-search programs to Southern institutions wheneveropportunity exists” in order to build local capacity in re-search management ([18], p. 2-1). IDRC also declares itsintention to support initiatives through the full-life cycleof programmes, with an estimated 2:1 ratio of fundingfor existing programmes compared to new concepts,and only a 35% portfolio involving Canadians [45]. IDRCshould be applauded for championing this approach andshould be encouraged to build on lessons learned in theimplementation of its new 2015–2020 strategic plan[46]. On the other hand, IDRC does not appear to dis-close results or impact using a results-based framework.Some data is available on its website and, although in-complete, some data on funded projects can be foundon other open data sites. For example, information onfunding recipients of the GHRI is posted on the NationalInstitutes of Health World RePORT [47].CIHRCanada’s largest health research funder, CIHR, continuesto undergo transformations that were initiated in 2014.The CIHR 2010–2014 strategic plan set the lofty goal ofensuring Canada’s ongoing leadership in health research.GHR, particularly research that focuses on the socialdeterminants of global health and global health pro-cesses, was even more concentrated within CIHR when,in 2009, the Social Science and Humanities ResearchCouncil (SSHRC) declared it would no longer fund so-cial sciences-based health research [48]. CIHR hasdeemed topics related to GHR as priority areas for itscompetitions and provided funding contributions tojoint initiatives such as the GHRI and GCC. CIHR iscurrently implementing reforms to its research-fundingmechanisms. Three-quarters of funding will be directedtowards the new ‘foundation scheme’ supporting estab-lished investigators and one-quarter towards a ‘projectscheme’ supporting stand-alone research proposals byCanadian researchers more broadly [48, 49]. The re-forms include the introduction of a new College of Re-viewers in order to address issues with the grant reviewprocess. There may be opportunity to recommend re-viewers with specific expertise in GHR. Unfortunately,the reforms to date have drawn vocal criticism from theresearch community. The urgency of criticisms fromCanada’s scientific community [50] evoked an unprece-dented response from Canada’s minister of health, DrJane Philpott, who called for an emergency meeting inCIHR to address the concerns and inform the Review ofFederal Support for Fundamental Science [51]. These re-cent events present key opportunities for informingfunding policies and practices that prioritise ethical andequitable engagement in GHR.Unlike the United States National Institute of Healthand United Kingdom’s Medical Research Council,there is no institute or division within CIHR dedicatedto GHR, although the Institute of Population and Pub-lic Health emphasises health equity-oriented research[52]. While a report from DFATD indicated that a newCIHR global health strategy was developed in 2012–2013 [30], the only related publicly available documentis an outdated Framework for International Relationsand Cooperation from 2006 [53]. In this document,CIHR reported that “operating grants with an inter-national connection [were] overwhelmingly — about90 per cent — with U.S. collaborators” ([53], p. 5). Be-tween 2005 and 2010, more so than other funders,CIHR’s goals were linked with driving Canadian eco-nomic growth through science and technology andprotecting Canadians from emerging global threatsversus improving population health, reducing healthinequities and building capacity in LMICs. Encour-agingly, following the end of the term of Dr Nancy Ed-wards as the Scientific Director of the Institute ofPopulation and Public Health, her successor, Dr Ste-ven Hoffman, will act as Scientific Lead for GlobalHealth in addition to being the institute’s ScientificDirector. This, as well the recent inclusion of CCGHRPrinciples for CIHR in training materials for the CIHRPlamondon et al. Health Research Policy and Systems  (2017) 15:72 Page 7 of 14College of Reviewers3 are encouraging signs of the de-sire for investing in excellent and equitable GHR.CIHR does not directly publicly disclose the portion ofits CA$1.0 B annual budget contributed to GHR, thoughthe numbers can be indirectly accessed through theCanadian Research Information System and they havealso been featured as part of many past public presenta-tions. A search of this system suggests that CIHR’s an-nual expenditures on GHR grants average CA$14 M, or1–2% of its annual budget [54]. At a recent presentation,Dr Hoffman highlighted the growth in both absolutenumbers and grant dollars among CIHR grant recipientsbetween 2000 and 2015 with relevance to GHR (Dr Ste-ven Hoffman, presentation to CCGHR Ontario CoalitionInstitute participants and facilitators, 2016). Despite thelack of a current, publicly available strategic plan forGHR, CIHR’s current strategic plan briefly mentions aninterest in trainee success within GHR and a continuedinterest in global health issues under the research prior-ity “promoting a healthier future through preventativeaction” ([55], p. 37). These are encouraging signs of a re-ceptive funding environment at CIHR. One importantstep that could be taken by CIHR is toward making re-ports on GHR investments public, particularly as a dem-onstration of transparency and means for incentivisinghigher quality alignment of research proposals. In lightof recent federal developments and the Review of Fed-eral Support for Fundamental Science and open consult-ation on Canada’s international development policies, weare optimistic that CIHR’s next strategic plan will dem-onstrate a more explicit integration of global health andGHR across all of the institutes.These would be welcome shifts, given the concerninglanguage in the current CIHR strategic plan that listedmany of the global health actions as predicated on theneed for new funds [49]. Unlike IDRC, GCC and GlobalAffairs Canada, the current CIHR grants managementpolicies do not disburse grant funds directly to LMIC re-search institutions; however, the policies do enable thetransfer of funds from an eligible Canadian institution toa partner outside of Canada [56, 57]. That CIHR doesnot compensate investigator salaries [56] was perceivedby participants at the 2013 CCGHR deliberative dialogueas a key barrier to enabling GHR, particularly for inhibit-ing the capacity of research institutions in LMICs todedicate their time to an international partnership. Fur-thermore, participants believed that CIHR policies re-strict the capacity to compensate the indirect costsincurred by non-Canadian partners in GHR. Participantsargued that these restrictions were not realistic or equit-able, particularly in the context of multi-country part-nerships and in light of existing international standardsthat provide up to 20% or up to the full economic costof projects. These concerns shed light on thedisconnects between perceived and actual barriers, andpresent an opportunity for CIHR to consider ways inwhich they might clarify their policies and incentiviseuniversities to consider the role academic institutionscan play in enabling equity in GHR partnerships that in-volve LMICs. For these reasons, we found CIHR policiesto show emerging alignment with the equity-centred cri-teria outlined in Table 1.GHRIThe GHRI, created in 2001, was one of the first attemptsat a coordinated approach to GHR funding betweenHealth Canada, CIDA, IDRC, the Public Health Agencyof Canada and CIHR. This initiative, and its flagshipCA$25 M Teasdale-Corti programme, led to new multi-year research partnerships between LMIC- and Canada-based researchers with a focus on building appliedhealth research capacity for researchers in poor coun-tries. Egalitarian partnerships and a concerted effort tobuild local capacity were central to the design of thisnew funding model [23, 58]. However, structural differ-ences in the amount of funding support provided andgrants management policies between the founding part-ners of GHRI created certain complications in GHRI’soperations, and potentially to its absorption into IDRC.Despite these challenges, however, GHRI demonstratedto funders and researchers alike that there was potentialfor unconventional approaches to stimulating GHR inCanada and abroad.GCCIn 2010, the Canadian government created a CA$225 MDevelopment Innovation Fund to be disbursed throughthe new GCC to spur innovation by global health inno-vators in LMICs and Canada [45]. The entity is guidedby IDRC, CIHR and Global Affairs Canada (previouslyDFATD) [59]. GCC’s approach, modelled after theBMGF grand challenges approach, uses funding mecha-nisms that contrast sharply with those of its foundinggovernment bodies. Being an independent entity affordsit the ability to undertake aggressive and unconventionalapproaches to funding innovation [60, 61]. In general, itpromotes biomedical and technology-based research,product development and rapid scale-up. GCC targetshealth gaps in LMICs such as point-of-care diagnostics,improving birth outcomes, brain development and men-tal health. Between 2012 and 2014, GCC was, on aver-age, the largest source of GHR funding in Canada,reaching a peak of CA$54 M disbursed in 2013 [62].It was difficult to find clear evidence of alignment be-tween GCC policies and practices and the equity-centred criteria used in this analysis. The short-termproject focus of GCC grant competitions, combined witha focus on technology and innovation, did not align withPlamondon et al. Health Research Policy and Systems  (2017) 15:72 Page 8 of 14the criteria for responsiveness to causes of inequitiesand raised questions about the possibility of enablingshared benefits. GCC’s strengths lie in its focus on sav-ing lives in LMICs, alignment with the US-based BMGFand United States Agency for International Developmentapproaches, and its ability to engage the public, policy-makers and research institutions in Canada and aroundthe world. Importantly, GCC also has the capacity todisburse funds directly to LMIC researchers followingan institutional assessment of financial managementcapacity [61]. GCC does not have a publicly availablestrategic plan, which inhibits potential partners fromclearly understanding its long-term vision, mission andstrategies. It has recently posted portions of a Results-Based Management Accountability Framework [62], butit neither provides sufficient information on how dataare generated nor shows targets for such indicators.GCC has showcased some examples of project failuresin the 2013–2014 Annual Report, a positive step to-wards sharing important learnings – although it islikely that valuable lessons could be learned from theexperiences of failures that did not fit the profile ofso-called ‘fast failures’. The dynamic and unconven-tional GCC has been a welcome funding boost forbiomedical science and technology researchers inGHR. GCC has the opportunity to truly set a newbenchmark for the level of transparency among fund-ing agencies in Canada and abroad.A disjointed strategy for GHRAfter the launch of the 2010 Muskoka MNCH Initiative,the Canadian Academy of Health Sciences argued that,unlike Norway, the United States and the United King-dom, Canada did not have a unified vision for globalhealth. Through a wide-reaching consultative process,the Academy proposed that a strategic role for Canadain global health should be based on Canadians’ strongvalue for universal healthcare, a vibrant philanthropicsector and strong commitment to MNCH as keystrengths [5]. It was also noted, however, that poor co-ordination among Canadian global health actors, limitedapplication of our understanding of social determinantsof health to policies and actions, and resource con-straints within government, private and civil society sec-tors would be barriers to optimal coordination.Participants involved in deliberative dialogues as partof the 2013–2014 CCGHR Gathering Perspectives Studyraised several concerns for Canada’s approach to GHR.In particular, there was concern for how the current div-ision of roles among Canadian funding bodies seemed tofuel an uncoordinated GHR strategy and contradictorygranting policies. Additionally, the community raisedconcerns of the levels of tied aid4 and research, whichmay not respond to local needs and risks a neo-colonialdevelopment approach, and cautioned that academic in-terests should not usurp benefits from local communi-ties. They called for a unified vision for GHR, for greatercollaboration within Canada and with its partners inother countries, and for a deeper commitment to equity-centred GHR [6].Best practices from international fundersThere are a number of characteristics and best practicesfor funding GHR that were identified from the literature,revealing a sample of government and philanthropicagencies based in Australia, Denmark, Norway, Sweden,the European Union, the United Kingdom, and theUnited States.5 One characteristic of the Canadian inter-national development structure that differs fromAustralia, Norway, Sweden, the United Kingdom and theUnited States is the separation of the development pro-gramming agency or branch (Global Affairs Canada,formerly DFATD and CIDA) and its aid research arm,the IDRC, which may conceivably impede coordinationor gains from synergies. Most comparator countries in-vest proportionately more in GHR than Canada. SeveralScandinavian countries, the Netherlands, and the UnitedKingdom exceed the United Nations target of 0.7%ODA/GNI for aid spending [36].The United States is traditionally the single largestDAH donor nation, although US bilateral assistance fell7.2% from 2011 to 2012 and then a further 3.4% from2012 to 2013, due to budget sequestration [14]. TheUnited States Agency for International Development(USAID) budget alone includes US$5 B for health sectoractivities [20]. It places a high value on strategies thatbuild LMIC ownership and invests in science, technol-ogy and other research activities, including health sys-tems research. In recent years, the agency has placedgreater emphasis on evidence-based strategies and pro-moted dialogue about learning from failure. Similar toDFATD, the agency supported MNCH as a priority. Incontrast, however, USAID supported family planningand sexual reproductive health initiatives as well as aprogramme designed to reach marginalised groups suchas lesbian, gay, bisexual and transgender persons andmen who have sex with men [20, 63]. However, this sup-port is subject to political shifts and may now be underrevision by the current United States government. Thelong-standing Fogarty International Centre has led thecoordination of all NIH-funded GHR and capacity-building activities. It has a clear strategic plan for GHR,which emphasises the importance of implementationand social science research in addition to biomedical,scientific and technological approaches. Further, it en-courages capacity building with LMIC institutions acrossits programmes and, importantly, releases direct fundingto LMIC institutions [64].Plamondon et al. Health Research Policy and Systems  (2017) 15:72 Page 9 of 14The last decade has also seen a dramatic rise in thestrategic and financial influence of private philanthropicorganisations in the United States. The Clinton Founda-tion’s global health budget of US$134 M in 2012 was fo-cused on increasing access to treatment for HIV/AIDS,malaria and diarrheal diseases, along with lowering costsfor essential medicines and supporting health systemsinfrastructure in LMICs [65]. The BMGF, founded in2000, has quickly become the largest philanthropic foun-dation globally and funder of global health activities, in-cluding GHR (up to US$1.8B for global health in 2012)[66]. Both organisations leverage the advantages of beinga private entity, including the ability to invest in high-risk or long-term initiatives as well moving freely be-tween public and private partners. The BMGF openlystates their criteria for investment, and actively disclosesand shares lessons learned from major failures, chal-lenges and lost investments [66]. The BMGF also admin-isters an annual independent grantee survey to learnfrom partners. Additionally, the foundation encouragesgrantees to publish any and all findings from funded ac-tivities [66]. One weakness that the foundation has iden-tified is that the publicly available information ongrantees is not in a format that is easily analysable.In 2012, the European Commission launched a new €80B (CA$115 B) Horizon 2020 research funding scheme. Al-though GHR is not central to the programme, one of itsstrategic directions is framed broadly as “tackling globalsocietal challenges” ([67], p. 4). Horizon 2020 has adopteda novel policy that considers all LMIC researchers as“automatically eligible non-EC applicants” ([67], p. 4) tocompete for funding. This may indirectly spur researchand innovation in LMICs where researchers are consid-ered to be at a disadvantage due to the absence of a criticalmass of researchers and local research-funding infrastruc-ture [68]. The United Kingdom’s primary GHR fundersare the Department for Foreign Affairs and InternationalDevelopment, the Medical Research Council and theWellcome Trust. The Department for Foreign Affairs andInternational Development has an integrated Researchand Evidence division with a substantial budget of £405 Mper year [19, 69]. In this budget, 10% of its DAH, or£50 M per year, is allocated to research. The departments’rationale for a recent research budget increase was to“make sure that research is at the heart of our work to in-fluence the development community, we want to use it tobetter shape our own policy and programmes” ([19], p. 13).The Medical Research Council also has a strategic direc-tion entirely dedicated to global health, with the objectiveof supporting “global health research that addresses theinequalities in health which arise particularly in develop-ing countries” ([70], p. 3).Denmark, Sweden and Norway are proportionally thehighest contributing Development AssistanceCommittee countries, achieving a 0.85%, 1.02% and1.07% ODA/GNI ratio, respectively. These ratios are farabove those of other Development Assistance Commit-tee countries and above the United Nations target of0.7% [36]. Even though they both have much smallerpopulations, Sweden and Norway each made larger totalaid spending (over CA$5 B) than Canada did in 2013.Norway’s Global Health in Foreign Aid and Develop-ment Policy sets an example for others by articulatingthe values, goals, priorities, rationale and approaches thecountry employs in administering a unified national glo-bal health strategy [17]. Central to its approach is theconcept of ‘knowledge-based policy’, which requires thesystematic use of research-based knowledge to evaluatemeasures and continuous monitoring using informationsystems for health data. The policy also recognises that“innovation poses particular challenges for knowledge-based policy formulation” ([17], p. 40) due to the lack ofevidence for new, high-risk initiatives. The SwedishInternational Development Agency strategy emphasisesthe value of the reciprocal benefits of pairing a researchagenda with implementation of development pro-grammes. It uniquely stresses the importance of con-ducting research on an equal footing with LMICpartners, stating that “research support should be de-signed in such a way that it helps prevent the develop-ment of a superior and an inferior status in thisrelationship” ([70], p. 19; [71]). The Danish InternationalDevelopment Agency is the only funder to cite the lim-ited public investment in research by developing coun-tries (0.3% GDP on average) as a rationale for continuedresearch-focused aid. As such, the Danish InternationalDevelopment Agency’s efforts focus on south-driven re-search [72].Finally, the Australian Agency for International Devel-opment is focused on saving lives in low-resource coun-tries in the Asia-Pacific region, and has committed toinvesting over AU$100 M over 5 years in its medical re-search strategy [73]. This agency’s strategic plan detailsits criteria and prioritisation process for funding medicalresearch projects. Also of note is the increasing supportby emerging donor (Brazil, Russia, India and China)countries in DAH, including the transfer of technologyand private investments to low-income countries overthe past few decades. However, “little is known about themagnitude and scope of DAH provided by some of theemerging development assistance partners” ([14], p. 60).Implications for Canadian involvement in GHRThis analysis revealed a complex and dynamic GHRfunding landscape in Canada. Recent funding develop-ments include renewed opportunities for GHR, includ-ing the 2017 SSHRC announcement that health-focusedsocial science research would again be eligible forPlamondon et al. Health Research Policy and Systems  (2017) 15:72 Page 10 of 14funding [74]. Given that both Global Affairs Canada andCIHR (and possibly other agencies) are undergoing re-view in 2016 and 2017, there may be a time-limited op-portunity to enact changes, or even redesign the GHRfunding system, necessary to support a vibrant GHRcommunity in Canada. A meaningful redesign that ad-vances equity as the central goal of GHR can only beachieved with caution, reflection and dialogue on the op-portunities for nurturing promising GHR funding prac-tices among funders, universities and grant seekers.Based on our analysis and deliberative processes, we be-lieve there are important opportunities for key actors tocontribute to elevating equity-centred GHR funding pol-icy and practice (Table 3).Universities have an important role to play in creatingenabling environments for equitable management ofGHR grants and for promoting more equity-centredGHR. Although participants in the CCGHR studies di-rected their concerns at funding agencies, some of thebarriers they described were, in actuality, rooted in thepolicies of their institution’s grants administration. Uni-versities can, for example, examine their internal policiesand practices related to the administration of grants. Inaddition, universities can encourage flag equity as a con-sideration in pre-submission peer review. This could in-volve considering how equity is reflected in differentelements of grant proposals, including budgets that en-able capacity building and compensation for the contri-butions of partners outside of Canada. Tenure reviewprocesses that create a means for assessing equity inGHR are another important policy arena where univer-sities can promote equity-centred GHR, including prin-ciples such as those outlined in the CCGHR Principlesfor GHR [4]. Finally, universities and researchers bothcarry a responsibility for demonstrating excellence andenhancing the visibility of GHR in open funding compe-titions. This means making an explicit effort to identifygrant applications as relevant to GHR by using the terms‘global health’ or ‘global health research’ in abstracts,keywords and the body of grant applications. These stepscould both improve the capacity of funding agencies toconsistently report investments in GHR and improve theoverall competitiveness of GHR.Greater harmonisation between Canada’s research anddevelopment funders on GHR priorities and activitiescould be enhanced through a joint national strategicplan, setting benchmarks for GHR funding, and with along-term commitment to the strategy. A coordinatedGHR strategy, if not more broadly for global health anddevelopment, would need to include Global AffairsCanada, CIHR, IDRC, SSHRC and GCC. Such a strategywould also benefit from contributions from bodies likethe Canadian Academy of Health Sciences, the CanadianSociety for International Health, the CCGHR, the Can-adian Council of International Cooperation, the Canad-ian Network for Maternal, Newborn and Child Health,and major Canadian philanthropic foundations and aca-demic institutions. A unified GHR strategy, and thestrategies of each of its contributors, should have an in-tegrated evaluation framework that incorporates qualita-tive research methods and policy analysis. Additionally,bibliometrics and spending data is needed to measureachievements and discern best practices such as theHealth Economics Research Group payback model rec-ommended by CCGHR [75].Given the fragmentation and partisan influence behindthe funding shifts that followed the 2008 recession, earl-ier calls for attention to the absence of a national strat-egy for global health [5], and continued transformationsin the Canadian funding landscape, this is an opportunetime to re-evaluate Canada’s strategic position and con-tributions to GHR. Participants in both the 2013CCGHR deliberative dialogue and the deliberative pro-cesses used to validate this analysis agreed. This strategycould enable Canada to model the advancement oftransparency in strategic planning, decision-making anddisbursements. Central aims of such a strategy could in-clude greater transparency with partners and stake-holders in LMICs through engagement, better alignmentdeveloping country partner priorities and adherence tothe principles of aid effectiveness established in the 2008Accra Agenda for Action [76], namely ownership, inclu-sive partnerships, delivering results and capacity devel-opment [77]. LMIC researchers who partner withTable 3 Recommendations for funding policies and practicesTarget audiences RecommendationsNational policy bodies (e.g.elected government,governmental committees)National GHR networksDevelop a national strategicplan for GHR Set benchmarksfor dedicated research supportsin Canadian investments inglobal health Promote researchon research, includingpromising practices in GHRFunding agencies (e.g. CIHR,GCC, IDRC)Model transparency in GHRfunding Create consistentGHR-friendly funding structuresand policies Invest in communicationsabout funding policies in ways thatencourage equity-centred grant seekingand administration at the universitylevel Open funding competitionsto LMIC researchersPeople involved in teaching,supporting, using, doing orfunding GHRExplicitly acknowledge a foundationalcommitment to equity in thehealth and well-being of populations,communities and individuals(e.g. guided by theCCGHR Principles for GHR)CCGHR Canadian Coalition for Global Health Research, CIHR Canadian Institutesof Health Research, GCC Grand Challenges Canada, GHR global healthresearch, IDRC International Development Research Centre, LMIC low- andmiddle-income countriesPlamondon et al. Health Research Policy and Systems  (2017) 15:72 Page 11 of 14Canadian institutions or researchers to do GHR face“varying stakeholder expectations, unaligned grant cycles,and highly variable reporting requirements” ([77], p. 1).Canadian funders must strive for a GHR-friendly grantsmanagement policy framework that places LMIC re-searchers on an equal footing. This may also necessitatea review of Global Affairs Canada’s engagement with themining industry in corporate social responsibility pro-grammes [34].Canadian funders should also not limit the scope ofinterventions and research investigations related to suchtopics based on social, religious or political ideologies(i.e. sexual and reproductive health and rights), whichare central to equity-oriented GHR. It is important thatGHR investments remain balanced between research oninnovation of biomedical sciences and technology whilecontinuing to strengthen the fundamentals of health sys-tems and health equity. This kind of balance will also re-quire broad inputs from health policy research andsocial, economic and environmental sciences. Canadianfunders should promote open sharing of knowledge in-cluding failures, an essential aspect of learning. Researchgrantees, aid recipients and evaluators alike should beencouraged to disseminate knowledge and share lessonslearned from both successes and failures with thebroader Canadian and international health community.These structural changes may help reduce some of theunintended consequences of foreign aid and GHR.Lastly, Canada would be wise to rectify the reputationaland operational damage stemming from the 11% foreignaid budget cut in 2012–2013, and ensure that the newMNCH commitment of funds (CA$3.5 B between 2015and 2020, or CA$700 M per year) is truly new money rela-tive to 2011–2012 levels. Global Affairs Canada shouldalso reconsider whether the amalgamation of developmentprogramming with trade and foreign affairs branches pre-sents long-term risks to its effectiveness and ethics in aiddelivery, and take this opportunity to imagine an architec-ture for consolidating all global health and development(including research) funding under one independentagency, free of political influence.LimitationsWe acknowledge certain limitations in conducting this pol-icy analysis. First, the policy analysis was conducted primar-ily using non-peer reviewed government and non-government publications available in the public domain.The content of documents varied by funding body, makingit difficult at times to compare information. This processrequired an assumption that the majority of informationcontained in the documents is accurate. Second, the lack ofinformation on new GHR funders from Brazil, Russia,India, China and the private sector limited the analysis toWestern governments and major philanthropic funders.ConclusionWith a review of strategic planning undertaken in all mainCanadian funders in 2016, there is an important windowof opportunity for the GHR community, in Canada andabroad, to influence policy towards a funding environmentthat is reflective of foundational principles for equity-centred GHR. This analysis of the current GHR fundinglandscape and promising practices internationally has in-formed the development of a core set of recommenda-tions by CCGHR (Table 3). A national strategic plan forGHR would be strengthened by the inclusion of bench-marks or targets for Canadian GHR funding and the pro-motion of research on research. Canadian fundingagencies can enhance their contributions to equitableGHR funding by modelling transparency, clarifying andencouraging equity-centred funding policies, and openingfunding competitions to LMIC researchers. Universitiesand researchers can consider their own roles in placingequity at the centre of their GHR practices and policies,explicitly acknowledging a foundational commitment toequity in the health and well-being of populations andcommunities. Continued demonstration for the import-ance and value of long-term, stable funding (looking to ex-emplars of international comparators) falls to the GHRcommunity and is a critical contribution to the redesignof global health funding systems. Together, the multipleplayers involved in shaping the funding landscape inCanada can realise these recommendations and doing sowill advance Canada’s collective contribution to improvinghealth equity globally.Endnotes1This Gathering Perspectives (GPS1) project wasfunded by the Global Health Research Initiative (GHRI).2For more information, visit: http://international.gc.ca/world-monde/issues_development-enjeux_developpe-ment/priorities-priorites/what_we_heard-que_nous_entendu.aspx?lang=eng3These modules include the global health research andunintentional bias, and are openly accessible (toggle thetab for "Peer Review" to access a complete listing):http://www.cihr-irsc.gc.ca/e/47021.html4Tied aid is the practice of tying official developmentassistance to the trade interests of the donor country by,for example, setting a condition of spending aid on ex-port goods from the donor country.5The research team declares that this analysis is lim-ited by the availability and transparency of informationin documents available in English from donors predom-inantly based in the West.AbbreviationsBMGF: Bill and Melinda Gates Foundation; CCGHR: Canadian Coalition forGlobal Health Research; CIDA: Canadian International Development Agency;CIHR: Canadian Institutes of Health Research; DAH: development assistancePlamondon et al. Health Research Policy and Systems  (2017) 15:72 Page 12 of 14for health; DFATD: Department of Foreign Affairs, Trade and Development;GCC: Grand Challenges Canada; GHR: global health research; GHRI: GlobalHealth Research Initiative; GNI: gross national income; IDRC: InternationalDevelopment Research Centre; LMIC: low- and middle-income country;MNCH: maternal neonatal and child health; ODA: official developmentassistance; OECD: Organisation for Economic Cooperation and Development;SSHRC: Social Sciences and Humanities Research Council; USAID: UnitedSates Agency for International Development.AcknowledgementsWe thank the research teams involved in the CCGHR Gathering PerspectivesStudies (Phase I & II) for their comments and reactions to this policy analysis, inparticular Garry Aslanyan, Dave Heidebrecht, Ian D. Graham, Craig Janes, NancyJohnson, Charles Larson, Vic Neufeld, Kishor Wasan, and Roberta Lloyd. We alsoextend our sincere gratitude to those who played a role as external reviewers inearly reports of the study, particularly those whose expertise in funding for globalhealth research strengthened the interpretive insights of the study. Among otherreviewers, these individuals included Professor John Frank (Chair, Public HealthResearch and Policy, University of Edinburgh & Professor Emeritus, Dalla LanaSchool of Public Health, University of Toronto); Dr. Michael Clark (AdjunctProfessor, Schulich Interfaculty Program in Public Health, Western University; andDr. Joshua Rosenthal (Joshua Rosenthal, Senior Scientist, Division of Epidemiologyand Population Studies, Fogarty International Center, National Institutes of Health).FundingFunding for Phase I of the Gathering Perspectives Study was received fromthe Global Health Research Initiative, and from the InternationalDevelopment Research Centre for Phase II.Availability of data and materialsAll open-source or published literature that served as data for this study areincluded in the reference list for this published article. The reports of dia-logue from the CCGHR Gathering Perspectives Studies that informed theanalysis are available on the CCGHR website (http://www.ccghr.ca/programs/policy-and-advocacy/gathering-perspectives/).Authors’ contributionsDW conducted the literature review, policy analysis and writing of the firstdraft. KP was the principal investigator for the CCGHR GPS1 and GPS2studies, provided methodological guidance, contributed to analysis andinterpretation of results, and took leadership of writing and editing. SCprovided inputs in analysis, interpretation of results, and editing. JH was aco-investigator in the CCGHR GPS1 and GPS2 studies, and provided input tothe interpretation of results, development of recommendations, and editing.KP, JH, and SC were all involved in leading facilitation of deliberative dia-logues for the CCGHR Gathering Perspectives studies. All authors read andapproved the final manuscript.Authors’ informationAll authors have been involved in some way with the Canadian Coalition forGlobal Health Research and, as such, have an explicit commitment tosupporting the development of ethical and equitable practices in this field.Ethics approval and consent to participateThis study was reviewed and approved by the HealthBridge BehaviouralResearch Ethics Board (HBREB/2013_1).Consent for publicationAll participants involved in deliberative dialogues were provided an opportunity toread and ask questions about how their contributions would be used, includingexplicit acknowledgement that the results of the dialogues would be used to createpublically accessible reports of dialogue and to inform publications such as this article.Competing interestsThis study was conducted as part of the Canadian Coalition for GlobalHealth’s (CCGHR) Gathering Perspectives Study (Phases I & II). The CCGHR is anot-for-profit network of individuals involved in global health research andcommitted to research-for-equity.Publisher’s NoteSpringer Nature remains neutral with regard to jurisdictional claims inpublished maps and institutional affiliations.Author details1Research Department, Interior Health, Kelowna, BC, Canada. 2School ofNursing, University of British Columbia, 3333 University Drive, Kelowna, BCV1V 1V7, Canada. 3Canadian Centre for Health Economics, Institute of HealthPolicy, Management and Evaluation, University of Toronto, 155 CollegeStreet, 4th Floor, Toronto, ON M5T 3M6, Canada. 4Independent consultant,Taos, New Mexico, USA. 5Global Health & International Partnerships Office,Cumming School of Medicine, University of Calgary, Dean’s Office, 7th Floor,Teaching Research & Wellness Building, 3330 Hospital Drive NW, Calgary, ABT2N 4N1, Canada.Received: 16 October 2016 Accepted: 28 July 2017References1. 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