2 Build Collaborations
If you’ve ever dreaded a group project, you’re not alone. But here’s the reality: global health research is a team effort. Solo-authored research papers are rare in our field, even for secondary analyses of existing data. The issues that we choose to study are complex, making collaboration essential. Teams often span time zones, disciplinary backgrounds, levels of training and seniority, nationalities, cultures, and perspectives. This makes collaboration rewarding, and our science is better for it, but being a good collaborator takes effort and practice.
This chapter will help you become that collaborator. We’ll start with the hard conversation: global health’s colonial roots and the ongoing calls to decolonize how we work together. From there, we’ll draw on the science of team science—yes, there’s research on this—to explore what makes collaborations thrive: vision, trust, communication, leadership, and more. Then we’ll see these principles in action through a detailed case study of a partnership that changed global health policy—and nearly fell apart along the way. You’ll come away with practical strategies for building collaborations that work.
2.1 Decolonizing Global Health
Today’s global health emphasizes equity in healthcare access and health outcomes, but we can trace some of its lineage back through international health and tropical medicine to European colonization and ‘colonial medicine’—back to a time when the motivation was protecting colonial rulers and promoting national interests, not equity (Holst, 2020). Global health has come a long way since then—as has the health and wellbeing of people everywhere—but some argue that our approach to collaboration in global health has not fully parted ways with its colonial influences (Abimbola et al., 2020).
This is because many collaborations in global health have been, and continue to be, an unequal venture, not a true partnership. In the previous chapter, I noted that the global health research agenda is, in large part, set and carried out by the wealthy. Less than 1% of funding for biomedical research goes directly to scientists in low-income countries (WHO, n.d.), and consequently, authors from the Global North are overrepresented in scientific publications (Kyobutungi et al., 2021).
Calls to ‘decolonize’ global health are not new (Costello et al., 2000), but we’ve witnessed a new urgency in recent years, with students and trainees often leading the way. There is a compelling argument that says the only path to decolonization is radical transformation of institutions (Hirsch, 2021); efforts to improve diversity and inclusion are welcome, but they are not a substitute for dismantling a system that was designed to benefit those with power (Pai, n.d.). Abimbola and Pai frame the aims of the decolonize global health movement as follows:
To decolonise global health is to remove all forms of supremacy within all spaces of global health practice, within countries, between countries, and at the global level. Supremacy is not restricted to White supremacy or male domination. It concerns what happens not only between people from HICs and LMICs but also what happens between groups and individuals within HICs and within LMICs. Supremacy is there, glaringly, in how global health organisations operate, who runs them, where they are located, who holds the purse strings, who sets the agenda, and whose views, histories, and knowledge are taken seriously.
Time will tell whether this moment will lead to institutional reforms, but as individuals we don’t need to wait to reform how we approach collaborations. I suspect student readers wouldn’t have it any other way.
So how do we build collaborations that are equitable, productive, and rewarding? Let’s start with what research tells us about effective teams.
2.2 Team Science
Most modern science, and global health research in particular, is a never-ending series of group projects. This might be a chilling prospect if you haven’t had good experiences with group work, but I’m here to tell you that team science can be very rewarding and productive given the right environment. As it’s very likely that you’ll join many teams in your global health career, we should discuss what makes a team effective and how to prepare yourself to be a good teammate.
The National Cancer Institute of the NIH (U.S.) defines team science as:
a collaborative effort to address a scientific challenge that leverages the strengths and expertise of professionals, oftentimes trained in different fields
Teams span the continuum from small investigator-led ‘labs’ to large, highly integrated groups of professionals sharing leadership responsibilities (Bennett et al., 2018). Increasingly, given the complexity of today’s research problems and a trend toward specialization in research expertise and methods, teams bring together people from different disciplines and locations. While the payoff of creating more diverse and skilled teams can be substantial, so are the challenges.
Recognizing the growing importance of team science, researchers established a new field of inquiry in 2006 called the Science-of-Team-Science to study what makes scientific teams click. Many of the findings have made their way into Collaboration and Team Science: A Field Guide, a handbook published by the NIH in 2010 and updated in 2018. In the following sections, I’ll walk you through each of the Field Guide’s top ten takeaways for getting the most out of team science.
VISION
A strong and captivating vision attracts people to the team and provides a foundation for achieving team goals. Shared vision provides a focal point around which a highly functioning team can coalesce.
Some science collaborations are like the 2001 American heist comedy film, Ocean’s Eleven. In the movie, Danny Ocean, played by George Clooney, is released from prison and immediately begins recruiting a hand-selected, nine-member crew to rob three of the biggest casinos in Las Vegas. One-by-one, Ocean pitches them on the idea and secures their cooperation. Ocean’s vision was simple: steal $150 million in cash without getting caught. Once the team was in place, they worked together to hatch a plan.
Others collaborations are more like the 1995 film, Apollo 13, about America’s third crewed mission to the moon. Fifty-five minutes into the mission, when the spacecraft was about 330,000 km from Earth, there was an explosion in the service module that caused oxygen to leak into space. The lunar landing was aborted, and the three-man crew moved into the lunar module for a dramatic rescue attempt. The team on the ground at mission control and the astronauts in space had to work together to find a way return the spacecraft to Earth before the astronauts ran out of water and oxygen.
In both movies, the teams had a clearly defined and shared vision. Team members understood their roles and how they were to contribute. Research on teams suggests that these factors are key to creating group cohesion. When team members can’t articulate the vision or don’t understand how their contributions fit into the bigger picture, the team’s work often suffers.
But the stories differed in one important way: how the vision was created. In Ocean’s Eleven, the vision belonged to Danny Ocean, and he made a compelling case to prospective team members. In Apollo 13, the team co-created the vision in the context of an ongoing collaboration.
We’ll talk more about how to write a compelling Specific Aims document later in the book. It’s a great format for articulating a vision.
Which model is more common in global health research? Usually Ocean’s Eleven. A lead scientist—the principal investigator—finds a funding opportunity, writes a short concept note, often called a Specific Aims document, and invites collaborators to join the proposal. There is nothing inherently wrong with this model, but the opening of this chapter should lead us to reflect on this privilege. Namely, whose vision becomes reality in global health is driven by whose vision is funded. Funding decisions tend to favor scholars from the Global North, so visions of the Global South are underrepresented in global health research. One way we can promote change is to build lasting collaborations. When collaborators continue to work together over time, visions can come from anyone on the mission.
TEAM EVOLUTION AND DYNAMICS
Research teams form and develop through critical stages to achieve their highest potential (Forming, Storming, Norming, Performing). A positive team dynamic sustains and further strengthens a research team, enabling it to achieve successful outcomes.
The most famous framework for understanding how teams evolve is Tuckman’s 1965 Model of Group Development, as described in Field Guide:
- Forming—The team is established using either a top-down (Ocean’s Eleven) or bottom-up (Apollo 13) approach.
- Storming—Team members establish roles and responsibilities. This process may trigger disagreements or “turf battles” and reveal a reluctance to appreciate the perspectives and contributions of people from different disciplines or training. However, if collegial disagreement is supported and premature pressure to consensus is resisted, people will begin to open up to one another.
- Norming—Team members begin to work together effectively and efficiently, start to develop trust and comfort with one another, and learn they can rely on each other.
- Performing—The team works together seamlessly, focuses on a shared goal, and efficiently resolves issues or problems that emerge.
- Adjourning or Transforming—Once the team accomplishes its goal, it can celebrate the accomplishment and disband or take on a new problem.
A proven way to strengthen team dynamics is to maintain a collegial environment where members are recognized for their contributions and given opportunities to grow.
TRUST
It is almost impossible to imagine a successful collaboration without trust. Trust provides the foundation for a team. Without trust it is nearly impossible to sustain a collaboration.
This sounds obvious, but trust doesn’t appear automatically—especially on new teams where people don’t know each other. So how do you build it? One approach is to establish rules and norms from the start. It’s common for teams to co-create a written charter or collaboration agreement that details how their members will work together, resolve disputes, share the workload, and share the credit. This practice is particularly important when teams bring together people from different backgrounds, disciplinary and otherwise, where the existing norms can differ.
With time and experience, teams can build deeper forms of identity-based trust based on personal connections and a recognition of shared values. This type of trust is often earned through actions and should not be assumed. Creating and maintaining trust takes substantial effort.
COMMUNICATION
Effective communication within and outside a research team contributes to effective group functioning. It depends on a safe environment where team members can openly share and discuss new scientific ideas and take research into new, previously unconsidered directions as well as ensure that difficult conversations can take place.
Trust and communication are reciprocal. Teams that trust each other communicate openly, and open communication builds trust. But effective communication can be challenging for new interdisciplinary teams where members may not share a vocabulary for the science. A recurring theme in this chapter is that successful teams make space for establishing common frameworks, including a shared vocabulary.
This also means creating expectations around logistics: How often will you meet? What’s the format, and how will you give everyone opportunities to be heard? What belongs in email versus a quick message? When should a thread become a phone call?
CONFLICT AND DISAGREEMENT
Conflict can be both a resource and a challenge—a resource because disagreement can expand thinking, add new knowledge to a complex scientific problem, and stimulate new directions for research. A challenge because if it is not handled skillfully, conflict impedes effective team functioning and stifles scientific advancement.
Here’s a counterintuitive idea: conflict isn’t always bad. In fact, effective teams often encourage the type of critical reflection and constructive criticism that makes conflict and disagreement more likely. This is because they know that conflict is a normal part of collaboration and that, when properly managed, conflict can lead to progress and cohesion. Of course, it’s also true that scientific conflict and disagreement can lead to interpersonal conflict and tension that impairs the team’s ability to achieve its vision.
Team leaders play a large role in keeping debate and disagreement productive and in mediating conflicts, but each of us is responsible for our own contributions to the collective dynamic. The Field Guide recommends that we consider the following steps for managing and resolving conflict:
- Understand the culture and the context of conflict—seek out the meaning of the conflict for yourself and/or the other parties.
- Actively listen—assure others you have heard what they said and ask questions to confirm your understanding.
- Acknowledge emotions—they will likely be part of the conflict, but expressing them and hearing them can help lift barriers to resolution.
- Look beneath the surface for hidden meaning—hidden fears, needs, histories, or goals may be the underlying source of the problem.
- Separate what matters from what is in the way—get away from discussing who is right or wrong and focus more on how to satisfy mutual needs.
- Learn from difficult behaviors—let those experiences help you develop your skills in managing difficult situations and having empathy for and patience with others.
- Solve problems creatively and negotiate collaboratively—this also means committing to action.
- Understand why others might be resistant to change—the problem could be an unmet need.
SELF-AWARENESS AND EMOTIONAL INTELLIGENCE
Emotional Intelligence among team members contributes to the effective functioning of research teams. Self awareness gives people greater control over their own emotional reactions to others, improves the quality of their interactions, and helps build other-awareness.
You won’t find much about emotional intelligence in most research methods textbooks, but the ability to reflect and become self-aware is a core skill for team science. Someone who lacks self-awareness has limited options for responding to challenging colleagues. People who can take someone else’s perspective and embrace what makes them different have a superpower in team science.
This is especially important in collaborations that bring together people from different backgrounds. Whether your work takes you to a new neighborhood or halfway around the world, it’s critical to have the humility to listen and learn.
LEADERSHIP
Strong collaborative leadership elicits and capitalizes on the team members’ strengths and is a critical component of team success. Leadership can be demonstrated by every team member, not just the formal leader(s).
I’ve worked with many effective leaders throughout my career. Although they took different approaches, each possessed an ability to encourage and motivate team members, articulate a shared vision, and have difficult conversations. The ineffective leaders I’ve encountered were variously disengaged, timid, defensive, or hostile. You’ll learn from both types. Every scientific collaboration you join as a trainee is an opportunity to observe and practice leadership. Take notes on what works and what doesn’t. Develop your self-awareness and other-awareness. Learn to approach difficult conversations with openness rather than defensiveness.
MENTORING
Mentoring is an indispensable aspect of successful collaboration. A mentor recognizes the strengths of each team member, identifies areas in which newer scientists have the greatest potential to grow, and can help coach people to attain their aspirations. With good mentoring, the development of scientists is synchronous with strengthening team dynamics.
One of the best investments you can make as a trainee is in finding a good mentor. The return should go far beyond leaving with a good letter of recommendation. A good mentor-mentee relationship can set a strong foundation for a scientific career. If you look at the curriculum vitae—or scholarly record—of successful scientists, you’ll likely see the fingerprints of one or more helpful mentors. Mentors can expose you to new collaborations and resources, help to nurture your ideas, steer you around traps, and teach you the ‘hidden curriculum’ of your scientific discipline that you won’t learn in the classroom.
Finding a mentor can be daunting, especially if you are introverted. Even when you get up the courage to reach out to a potential mentor, your email might go unreturned or come back without an offer to meet. Keep trying, but consider this advice:
Do you homework—general requests to learn about a person’s work are less effective than a specific statement of how your interests align
- Attend scientific talks and department events when possible and introduce yourself
- Reach out to the mentor’s other students to learn more about potential opportunities
- Keep your correspondence short with a clear request
RECOGNITION AND SHARING SUCCESS
Individual contributions should be recognized, reviewed, and rewarded in the context of a collaboration. Recognition and reward of all team members should be done thoughtfully and fairly in the context of the team and the institution.
Here’s a tension at the heart of team science: we work in teams, but we’re often evaluated as individuals. Consider the Nobel Prize.
Most years on December 10, going back to 1901, the King of Sweden awards several prizes in fields such as medicine, chemistry, and physics, in honor of Swedish inventor Alfred Nobel. Each prize can be given to a single laureate or shared by no more than three laureates.
In 2015, the Nobel Prize in Physiology or Medicine was divided between three scientists in recognition of two discoveries that shaped treatments in global health. William Campbell and Satoshi Ōmura shared half of the prize “for their discoveries concerning a novel therapy against infections caused by roundworm parasites”, and Tu Youyou received the other half “for her discoveries concerning a novel therapy against Malaria”.
The importance of these discoveries cannot be overstated. Ivermectin (Ōmura and Campbell) and artemisinin (Tu) have helped hundreds of millions of people. These accomplishments deserved to be recognized, and these scientists played significant roles. Tu Youyou even volunteered to be the first human to test her team’s new drug!
That said, these individual awards don’t recognize the teams behind this work. Campbell noted as much in his Nobel Lecture, taking a moment to graciously acknowledge his collaborators (Campbell, n.d.):
There is a question that warrants a slight digression here. In the past few weeks I have often been asked how I felt when I heard that I had won the Nobel Prize. I can say without hesitation that my mind was instantly flooded with two emotions. One was a sense of joy and gratitude. The other was a feeling of sadness—sadness that so many of the people who made this discovery a success could not be named individually. But I represent the research team at Merck & Co., Inc., and in that role I feel honored and grateful beyond imagining.
Despite the growing prevalence of team science, professional recognition and career advancement still depend in large part on individual achievement. This is one reason that it is critical for teams to plan ahead to share recognition and credit.
Depending on your line of research, credit might also come in the form of patents.
One of the clearest records of achievement in science is academic publication. Decisions about who receives recognition as an author of a scientific paper can help to make or break careers. On some research teams, the leader decides who deserves to be an author with little to no input from more junior members. This has the potential to lead to resentment and create competition rather than collaboration. Team science advocates encourage a different approach: creating a transparent plan as soon as possible to identify how members will contribute, be recognized, and share the credit. See ?sec-publishing for additional discussion.
2.3 Collaboration in Practice: The Partnership Pathway
The principles we’ve covered sound straightforward on paper. But what does collaboration actually look like when the stakes are high, the partners span continents, and lives hang in the balance? Let me walk you through a real example, drawn from the book Real Collaboration (Rosenberg et al., 2010), which documents—in the words of the people involved—how global health partnerships succeed, struggle, and sometimes nearly fail.
As you read, notice which principles show up. You’ll see vision hold a partnership together when everything else frays. You’ll see trust erode when turnover disrupts relationships. You’ll see communication failures create confusion that better logistics could have prevented. And you’ll see leadership that excelled at inspiration but struggled with management. What you won’t see much of is conflict—not because it didn’t exist, but because the partners’ challenges were less about disagreement than about coordination.
WHEN COLLABORATION IS A MATTER OF LIFE AND DEATH
In the late 1990s, multi-drug-resistant tuberculosis (MDR-TB) was widely regarded as untreatable at scale in resource-poor settings. The disease is resistant to the two most powerful anti-TB drugs available, and treatment requires simultaneously administering seven or eight expensive second-line drugs for eighteen to twenty-four months. The prevailing wisdom at the World Health Organization was that treating MDR-TB in low-income countries was simply not programmatically feasible—too complex, too expensive, too likely to amplify resistance.
Jim Yong Kim later became President of the World Bank. He credits this collaboration as “the most valuable experience of my life.”
Paul Farmer and Jim Yong Kim of Partners in Health (PIH) disagreed. Working with their Peruvian partner organization Socios en Salud, they had begun treating MDR-TB patients in Lima using community health workers who watched patients take their medications daily and supported them through the brutal side effects. Socios en Salud’s community-based model and local credibility were not an “implementation detail”—they were the engine of the early success. But funding was running out.
What happened next offers a masterclass in how collaborations form, function, and sometimes falter. In 1998, Farmer and Kim approached their former dean at Harvard about funding possibilities. He suggested they contact Mark Rosenberg at the Task Force for Child Survival and Development. Rosenberg, in turn, brought in Bill Foege, who was transitioning to the Bill & Melinda Gates Foundation. When these four met, Foege pushed them to think bigger: don’t just treat patients in Peru—demonstrate that this approach could work in resource-poor settings anywhere. That evidence could change WHO policy worldwide.
That conversation didn’t instantly create a partnership, but it aligned people who already trusted each other around a shared, scalable goal. From this convergence, the Partnership Against Resistant Tuberculosis (PARTNERS) was born, eventually bringing together PIH, the CDC, WHO, the Task Force, and Peru’s Ministry of Health (MINSA), with funding from the Gates Foundation.
THE PARTNERSHIP PATHWAY
Researchers who study global health collaborations have identified a common trajectory that partnerships follow—what Rosenberg and colleagues call the Partnership Pathway. If this sounds familiar, it should: like Tuckman’s model of team development, it maps the stages collaborations move through. But where Tuckman emphasizes interpersonal dynamics, the Partnership Pathway focuses on the operational work of building and sustaining a partnership.
Genesis: Every partnership begins with a realization that individuals can make a difference if they work together. This might be sparked by a breakthrough finding, a funding opportunity, or—as with PARTNERS—a group of like-minded people who trust each other enough to take a risk. The genesis of PARTNERS was a “social organization” of colleagues who had worked together before and shared a vision for what was possible.
The First Mile: This is the critical early phase when partners establish their foundation. Like climbers at base camp preparing for an ascent, partnerships in the First Mile must:
- Choose the right membership
- Develop a truly shared goal
- Select an appropriate governance structure
- Shape a big-picture strategy
- Clarify organizational roles
The First Mile is an opportunity that doesn’t come again. Get these elements right, and you’ve built a foundation for trust. Skip them or handle them poorly, and problems will haunt you throughout the collaboration.
The Journey: Once the foundation is set, partners begin the hard work of implementation. This is when management and leadership become critical—and when many partnerships struggle. External forces constantly push against progress: political changes, funding shifts, personnel turnover, competing priorities.
The Last Mile: The final stage is getting the partnership across the finish line—achieving the goal, transferring knowledge and control, and knowing when to end.
Let’s see how PARTNERS navigated each stage.
FIRST MILE DONE RIGHT
PARTNERS handled their First Mile reasonably well. They kept membership small enough for real collaboration—just five core organizations. Each partner had a clear role:
| Partner | Role |
|---|---|
| Partners in Health / Socios en Salud | Providing treatment and collecting clinical data |
| CDC | Conducting research and setting standards |
| WHO | Implementing the Green Light Committee and setting policies |
| Task Force | Serving as neutral convener and facilitator |
| MINSA (Peru Ministry of Health) | Developing capacity for countrywide expansion |
What was less clear—something the partners only appreciated later—was how those organizational roles translated into day-to-day decision-making among individuals. This distinction would matter.
They developed a shared goal: demonstrate the feasibility of treating MDR-TB in resource-poor settings, which could then change global policy. And they created an innovative strategy—the Green Light Committee—that would negotiate lower drug prices in exchange for oversight of proper use.
With these elements in place, the partnership launched with optimism.
WHERE THINGS GOT MESSY
Here’s where I want you to pay attention, because this is the part that doesn’t make it into most textbooks. PARTNERS achieved their goal—they changed WHO policy and proved that MDR-TB treatment was feasible in resource-poor settings. But the journey was rocky, and the partners were remarkably honest about what went wrong.
Underinvestment in management: The partners discovered that treating patients wasn’t their biggest challenge. Mark Rosenberg later reflected: “We thought our challenge was to bring complex health interventions to resource-poor settings, but we realized the real challenge was delivering complex health interventions to management-poor settings. We didn’t realize how important management was or how big the management deficit was in all of us.”
It wasn’t that management was absent—it was underrecognized and underresourced. Planning happened on the fly. Communication was inconsistent. “Mark and Jim would talk,” recalled one partner, “but sometimes they’d forget to pass it on. Some kind of explicit communication strategy would have helped.”
“It takes courage to say we didn’t always know what we were doing, but it’s necessary if we want to draw lessons from the experience.” —Mark Rosenberg
Leadership mismatched to the phase: Like a mountain climbing team whose leader is more interested in climbing than managing, PARTNERS had visionary leaders who were less focused on the day-to-day work of keeping the partnership cohesive. Jim Kim was brilliant at articulating the vision, but the nine working groups never got traction and were eventually disbanded.
Turnover eroded trust: After the first two years, key members rotated out. Kim left PIH to join WHO. Other representatives changed. The collaborative spirit that had infused the early days diminished. Some partners felt they were “only going through the motions of collaboration.”
External forces: In spring 2003, Peru’s entire Ministry of Health was restructured in a single day. The partners had been working with specific ministry officials to plan for sustainability, and suddenly they didn’t know who was in charge of MDR-TB. A lag in drug supplies compounded the problem. The partnership lacked the cohesiveness to respond with one voice.
WHAT MADE IT WORK ANYWAY
Despite these challenges, PARTNERS succeeded. The approach was applied successfully in Estonia, Latvia, Lima, Manila, and Tomsk, with reported cure rates between 61% and 80%—remarkable for a disease once thought untreatable. In March 2005, WHO passed a resolution integrating MDR-TB treatment into global policy. The Global Fund adopted requirements that all countries using its resources for MDR-TB must receive Green Light Committee approval.
What made the difference?
The goal was clear and compelling. When challenges arose, partners could refocus on what they were trying to achieve. Kim’s vision—enabling MDR-TB patients to “live productive lives in areas where MDR-TB was endemic”—kept people motivated.
Roles were well-defined from the start. Even when collaboration frayed, each organization knew its responsibilities and delivered on them.
Partners learned and adapted. Paul Zintl, who joined PIH during the project, took lessons learned in Peru directly to his next challenge—treating HIV/AIDS in Lesotho. “We went in there not knowing what we were going to find,” he said, “but knowing that much of what we had learned in Peru would be needed.”
The First Mile investments paid dividends. Because they had established the Green Light Committee and clear organizational roles early on, the partnership could weather storms that might have sunk a less prepared collaboration.
LESSONS FOR YOUR COLLABORATIONS
So what can you take from PARTNERS into your own work?
1. Invest heavily in the First Mile. The time you spend establishing shared goals, clarifying roles, and building trust isn’t wasted—it’s the foundation that holds everything together when things get hard. As one WHO adviser put it: “A common problem of many failed programs is they haven’t resolved key components in the first mile. They have unrealistic expectations, no mutually agreed goals, no clear strategy, and too little trust.”
2. Include the people most affected. PARTNERS learned this lesson the hard way when Peru’s health sector reform upended their plans. The Roll Back Malaria partnership had a similar experience when African ministers of health pushed back on recommendations that didn’t account for their practical realities. As one minister told the partnership board: “It is good to give us recommendations, but our problems are multiple. If you are not taking them into account, we will never implement this change in policy.”
3. Management matters as much as vision. Having brilliant scientists and a compelling goal isn’t enough. Someone needs to manage communication, keep partners informed, track progress, and resolve small conflicts before they become large ones. This isn’t glamorous work, but it’s essential.
4. Plan for turnover. People leave. Priorities shift. Governments change. The stronger your foundational agreements and documentation, the better you can weather personnel changes without losing institutional memory and trust.
5. Define success clearly and measure it. PARTNERS benefited from having a measurable goal: demonstrate feasibility, change WHO policy. When your goal is fuzzy, it’s harder to maintain alignment and know when you’ve succeeded.
THE GLUE IS TRUST
At the end of the day, what holds collaborations together? Ian Smith, adviser to WHO’s director-general, put it simply: “The glue of a partnership is trust, yet a lot of partnerships are born out of mistrust. The challenge is to create that trust.”
Trust doesn’t appear automatically. It’s built through the work of the First Mile—clarifying goals, defining roles, establishing norms. It’s reinforced through consistent communication and follow-through during the Journey. And it’s tested when things go wrong, which they inevitably will.
Global health partnerships face what one leader called powerful centrifugal forces—changes in governments, shifts in funding, turnover in membership, and competing organizational agendas. These forces constantly pull partnerships apart. Only trust—what Rosenberg describes as the foundational capital of collaboration—can hold them together.
A HARD LOOK IN THE MIRROR
Before we close, I need to acknowledge something uncomfortable. This chapter opened with a call to decolonize global health—to question who holds power, who sets agendas, and whose knowledge counts. Then I walked you through a case study in which the catalytic convening, funding, and global policy leverage flowed primarily through institutions based in the Global North.
PARTNERS changed policy and saved lives. That matters. But as you read, keep noticing who had the authority to define the problem, to scale the solution, and to declare success. Also notice something more subtle: whose reflections and interpretations are easiest to find in the published record. Even when collaboration is real, the story of collaboration is not evenly owned.
Peru’s Ministry of Health enters this narrative most vividly when a sovereign restructuring disrupted the partnership’s plans. It’s a useful reminder that when a partnership’s center of gravity sits elsewhere, national decisions can be narrated as “external forces” rather than as governance. The Roll Back Malaria example points in the same direction: ministers had to push back on recommendations that didn’t fit their realities—reactive participation rather than co-ownership from the start.
I don’t raise this to dismiss what PARTNERS achieved. The principles in this chapter—vision, trust, communication, defined roles—matter regardless of who leads. But applying those principles inside an inequitable structure doesn’t make the structure equitable. You can have excellent management in a partnership that still concentrates agenda-setting power in the Global North.
So what would genuinely equitable collaboration look like? I don’t have a complete answer, but I suspect it starts earlier than most partnerships do: communities and local institutions setting the agenda; funding flowing directly to local organizations; and success defined first by those most affected, not by validation in Geneva or Boston. That requires those of us with institutional power to give some of it up—not just to “include” others, but to follow their lead.
2.4 Closing Reflection
Remember that group project you dreaded? Global health research doesn’t have to be like that—but it takes intention. The principles in this chapter matter: clarify the vision, invest in the First Mile, communicate openly, build trust through action. These skills will make you a better collaborator wherever you work.
But skill isn’t enough. This chapter asked you to hold two things at once: practical tools for making collaborations work, and critical awareness of who gets to lead them. That tension doesn’t resolve neatly. You’ll need both.
Now that you know how to build a team, you need something for that team to work on. In the next chapter, we’ll explore where research ideas come from, how to find a problem worth studying, and how to transform a vague interest into a focused research question.