Forms of benefit sharing in global health research undertaken in resource poor settings: a qualitative study of stakeholders' views in Kenya.
Forms of benefit sharing in global health research undertaken in resource poor settings: a qualitative study of stakeholders' views in Kenya.
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DOI：
10.1186/1747-5341-7-7
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发表时间：
2012-01-17
期刊：
影响因子：
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通讯作者：
English MC
中科院分区：
文献类型：
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作者：
Lairumbi GM;Parker M;Fitzpatrick R;English MC
在过去十年中，在资源匮乏的环境中开展的全球卫生研究有所增加，但积极的事态发展引起了与潜在剥削有关的伦理问题。解决这些问题的一些建议战略包括呼吁提供普遍的护理标准，合理提供经过验证的干预措施，以及最近促进研究的整体社会价值，特别是在临床研究中。促进研究的社会价值与向参与研究的不同利益攸关方提供公平的利益密切相关。关于什么是公平福利的辩论仍在继续；是解决微观层面的正义问题的辩论，还是关注宏观一级健康的关键决定因素的辩论。然而，这场辩论并没有受益于利益攸关方认为什么是公平利益的实证工作。这项研究探索了肯尼亚参与全球卫生研究的利益相关者的实践经验，即在发展中国家的背景下，哪些好处是公平的。我们深入采访了来自肯尼亚更广泛的卫生研究系统的关键信息者，包括来自主流卫生研究机构、网络和大学、教学医院、政策制定者、机构审查委员会、公民社会组织和社区代表团体的研究人员。利益攸关方阐述的一系列惠益解决了微观和宏观层面对司法的关切，例如，寻求与促进研究的人的利益接触，以及使资源匮乏的环境容易受到剥削的更广泛的系统性问题。我们对这些观点的解读是为了表明，全球卫生研究需要参与这些环境中的人们面临的当前危机，以及产生这些危机的更广泛的系统性问题。全球卫生研究应提供解决微观和宏观层面的司法问题的益处，以防止剥削。然而，在如何在伦理上平衡各种相互竞争的利益/需要方面，特别是在缺乏指导这一进程的结构的情况下，接受这两种利益/需求是具有挑战性的。这一挑战应表明需要加强对话，以促进利益攸关方之间的价值澄清。
Increase in global health research undertaken in resource poor settings in the last decade though a positive development has raised ethical concerns relating to potential for exploitation. Some of the suggested strategies to address these concerns include calls for providing universal standards of care, reasonable availability of proven interventions and more recently, promoting the overall social value of research especially in clinical research. Promoting the social value of research has been closely associated with providing fair benefits to various stakeholders involved in research. The debate over what constitutes fair benefits; whether those that addresses micro level issues of justice or those focusing on the key determinants of health at the macro level has continued. This debate has however not benefited from empirical work on what stakeholders consider fair benefits. This study explores practical experiences of stakeholders involved in global health research in Kenya, over what benefits are fair within a developing world context. We conducted in-depth interviews with key informants drawn from within the broader health research system in Kenya including researchers from the mainstream health research institutions, networks and universities, teaching hospitals, policy makers, institutional review boards, civil society organisations and community representative groups. The range of benefits articulated by stakeholders addresses both micro and macro level concerns for justice by for instance, seeking to engage with interests of those facilitating research, and the broader systemic issues that make resource poor settings vulnerable to exploitation. We interpret these views to suggest a need for global health research to engage with current crises that face people in these settings as well as the broader systemic issues that produce them. Global health research should provide benefits that address both the micro and macro level issues of justice in order to forestall exploitation. Embracing the two is however challenging in terms of how the various competing interests/needs should be balanced ethically, especially in the absence of structures to guide the process. This challenge should point to the need for greater dialogue to facilitate value clarification among stakeholders.