Grand Challenges in Global Health: Community Engagement in Research in Developing Countries

Policy Forum T he Bill & Melinda Gates Foundation (http: ⁄⁄www. grandchallengesgh.org), the United States National Institutes of Health (http: ⁄⁄grants1.nih. gov/grants/index.cfm), the United Kingdom Wellcome Trust (http: ⁄⁄www.wellcome.ac.uk/funding), and others are increasing funding for research on diseases that affect the world's poor. The goal is to develop superior diagnostic tools, prevention strategies, and interventions to counter the debilitating impact of these diseases. Successful completion of this research and adoption of the resulting technologies will depend on successful engagement with the intended benefi ciaries. Recent research in developing countries, such as the abandoned trials in Cameroon and Cambodia of tenofovir as pre-exposure prophylaxis against HIV infection [1], has shown that even in studies where ethical issues have been addressed, challenges related to community engagement (CE) can still undermine the research. Various CE models exist in the fi elds of public health, community planning [2], governance, and community development. However, there have been few systematic attempts to determine the effectiveness of CE in research. As an advisory service on ethical, social, and cultural (ESC) issues for the Grand Challenges in Global Health (GCGH) initiative, discussed in the fi rst article in this series [3], we are exploring a range of ESC issues identifi ed by the GCGH investigators and developing world key informants, discussed in the second article in this series [4]. The investigators and key informants placed particular emphasis upon the importance of community engagement, and therefore we prepared a conceptual paper on this topic, which we distributed as a working paper to GCGH investigators and program staff at the 2nd Annual GCGH Meeting. In this article, we summarize this conceptual paper. We fi rst examine the concept of CE in research in developing countries, then we describe published models of CE, and fi nally we discuss two relevant examples of CE in research from Africa. There is no standard defi nition of a community. The term " community " has been used to describe interactions among people in primarily geographic terms [5]. But it is now accepted that people who live in close proximity to one another do not necessarily constitute a community, since they may differ with respect to value systems and other cultural characteristics that are more relevant to the social concept of community. Some have argued that the defi ning feature of a community is the common identity shared by its members [6]. Thus, a single …