Table 1. Key considerations and metrics for funders towards more equitable global health.

QUESTIONS	KEY CONSIDERATIONS TO REFLEXIVELY CRITIQUE AND MEASURE THEIR OWN PROGRESS	RECOMMENDATIONS FOR FUNDERS
What should be funded?	Is there a way to collectively create a theory of change (ToC) for the outcomes that a funding call seeks to achieve? Can the projects funded as part of the process be identified on the ToC?2	Transparency in sharing a ToC for potential applicants to be able to navigate the grant specifications and help the funding panel to measure the suitability and selection criteria for applications.
	Who are funders listening to and do they include voices of those with lived experience and expertise from regions where funding is directed to, e.g., low-, and middle-income countries (LMICs)?	Funding bodies’ executive committees, panels, and reviewers must have equitable and diverse representation from LMICs, and individuals from different gender, race, and expertise. For funding calls directed at LMICs, the committees deciding on research priorities and the selection panels should have at least 50% LMIC representation.
	How can we balance inequities in innovation? Simple, organic solutions can be found that are hugely impactful–for example the Friendship Benches to address mental health issues that were first implemented in Zimbabwe [45]. Can we avoid airlifting innovations from one context to another without ensuring they are appropriate to where they are to be implemented or scaled up?	LMIC representation is research prioritisation stage, as above. The evidence gathering for research prioritisation should not be conducted by costly consultancies, but by consultation with LMIC expertise and through evidence-based data. Negative examples include paying hefty sums to consultancies to conduct rapid evidence synthesis, which is often cursory and superficial.
	How do we ensure innovations stem from solidarity and empathy and not sympathy or saviourism?	The need for innovation, the type of innovation, and the point of intervention for innovation needs to be driven by LMIC needs and expertise. All too often it is driven by parachute research, opportunistic researchers in high-income countries (HIC) keen to test their innovations in LMICs. The ultimate aim should be sustainability to end dependency on HIC.
	How can we work towards defining research strategies, proposals and protocols that demonstrate an understanding of context and resource availability and data access incorporating knowledge and innovation already in practice in LMICs, which often deliver same or higher quality care (comparable to high-income countries—HICs) in much more resource-limited settings?	Research proposals need to be scrutinised for use of local data and innovation to inform the research question and design, with specific attention to feasibility in the context they are being implemented.
Who should do the funding?	Where is the source of the funding, whether public, private, or a hybrid form of the two and what are the drivers for the funders to engage with the specific funding call?	Practice transparency in declaring source of financing for research funding and identify potential conflicts of interest of the investors. Develop strategies for separating the investors from the funding process to ensure impartial allocation of funds and research prioritisation.
	What level of effort should LMICs make to reduce the power imbalance?	The funding bodies should proactively engage with LMIC actors including funders earlier in the process to have a voice in prioritisation and allocation of funding.
	How would more LMIC-funded research in global health change the North-South power dynamics?	Establish a transparent process for tracking the progress of funding to evaluate the different models on outcomes, e.g., where funding originates from and who the recipients are and the impact of this on outcomes. Exit interviews with all actors is one way to achieve this.
	Which global North entities (public, private) offer good practices worth emulating by others? How can we have an agreement on these practices?	Investigate the current practices and establish a code of ethics for funders in global health to abide by.
Who should be funded?	How can we create equitable opportunities for LMIC researchers to be principal investigators, e.g., to receive direct funding (without HIC actors or intermediaries)?	Funders to set up more accessible platforms for LMIC principal investigators to be able to participate in funding calls. This may include establishing more direct links with LMIC institutions and societies.
	How can access to funding streams for investigators based in LMICs be improved?	Greater LMIC representation in funding panels and Committees will bring the topics of concern and the barriers to participation for LMIC colleagues to the attention of funders. This, together with improving access to resources for training including LMIC friendly fees to attend courses will increase access. Making funding calls accessible also includes understanding the need to compensate for tuition fees, visa and travel barriers, and provision of training programmes that meet needs of LMIC based researchers which may be different to HIC researchers. Providing funding for HIC institutions to host visiting scholarships.
	How can we support supervisorship and leadership of research predominantly in LMICs erasing bottlenecks in research and mobilising existing knowledge and innovation?	As above. In addition, supporting through funding partnerships between HIC and LMIC institutions which encourages and enables bidirectional scholarships and research visits. Include contribution to institutional capacity (No. of investigators trained over time) as one of the asks.
	How can funders move away from relying on the reputation of select, established investigators and take more risks to fund new investigators in LMICs?	Recognition of the team efforts in grant applications. Stipulating the role of each co-applicant in funding applications in the same way that some journals stipulate authorship contributions. Opening more funding opportunities for new investigators and investing in supporting successful applicants by partnering through mentorship with established teams or institutions.
	What can be other evaluation criteria, which can complement lack of experience in securing big grants or lack of academic publications?	Acknowledging the diversity in knowledge and paradigms, including: Capacity for effective leadership Generation of new research ideas Partnership with established centres e.g., matching new investigators with established centres The diversity of roles of investigators and their impact on their communities through outreach work, engagement and capacity strengthening, social enterprise, and engagement.
How should they be funded?	Where is the money going to? Does the majority of HIC funds remain in HICs?	Have a clear agreement and vision in the ToC on where the funding will be spent. Commit to directly allocating most of global health funding for LMIC research to LMICs. Where funding is to be given to HICs it should be in clear partnerships with LMICs and equitable processes for division of work and outputs agreed to from the beginning of the funding process. Demand to see as part of the evaluation a statement on equitable work ethics and equitable data ownership and publication plans which can be tracked for the duration of the grant.
	Will the funders resource the time and institutional costs of LMIC individuals who are called upon to participate in the process?	Allocate funds for the conceptualisation, writing and submission (and administration) of large grants which will requires substantial effort and time. This is important as not all LMIC institutions recognise the same indicators for academic excellence and many researchers will be working in their own time to write grants, having access to fewer resources and with less experience than HIC partners. For large international collaborations, provide seed funding for bilateral visits to develop research ideas.
	Can ensuring a mix of academic and practitioner experience be a way to balance principal investigators on collaborative and consortia grants? Can we ensure due recognition of leadership of investigators in LMICs e.g., to not facilitate parachute models of research?	Funders should stipulate for evidence of equitable representation and inclusion of LMIC investigators in leadership positions in grants with a transparency declaration on roles in the grant process. Ensure diversity of the LMIC investigators e.g., with respect to age, gender, and experience.
	How can greater representation of LMIC authors on research outputs especially as first and last authors be incentivized? Can being on publications in which they are neither first or last author it be a key consideration for the HIC investigators when securing grants or be on the review panel of grant applications?	Establish standardised rules of conduct for representation. For example, for HIC-LMIC partnerships the authorship and data ownership agreements should be in the application, with one solution that HIC-LMIC authors are equally represented as first and last authors, and this then will define the division of work and labour. Additionally, it will enable a space for new investigators to grow and learn. Data collected in LMICs should generally be owned by LMIC institutions and these institutions should be encouraged to take the lead on writing opportunities for their research staff.
	What can be some metrics that look at value for capacity strengthening beyond high impact publications and which are also valued by academic institutions?	Individual and institutional capacity strengthening criteria should be agreed to and be part of the funding call. The various means of capacity strengthening, and its measurement include: The career progression of LMIC grant participants e.g., fellowships, studentships, promotions through predominantly in-house career plans and mentorship Opportunities for bi-directional learning and travel as visiting researchers to north-south and south-south institutes Presentation in international conferences and meetings Position in authorship Training provided
What to learn?	What mechanisms can be put in place to proactively deal with issues arising due to power asymmetries?	Stipulate a code of conduct and leadership that is equitable for the lifetime of the grant. Establish safe mechanisms for co-applicants to be able to raise concerns regarding abuse of power. This must be anonymous, and impartial and ideally managed by the funder. Conduct exit interviews with awardees to identify any problems for learning for future grant calls. Currently there is no mechanism for providing feedback to funders regarding problems. This needs investment from funders.
	Is there reciprocity in leadership, availability of opportunity for training, access to sites, and knowledge being generated?	The funding criteria must include: Opportunities for bi-directional learning and travel as visiting researchers to north-south and south-south institutes; including funding for LMIC trainees to obtain graduate degrees in HIC institutions. Equal opportunities for representation of the project/study in meetings/conferences. Leadership training for principal investigators and mechanisms for safe feedback to the principal investigators on the health of their teams and partnerships with strategies in place where conflict arises.
	How can reflexivity statement around equitable partnerships be included as part of the regular grant monitoring?	Include this as a criterion in the standardised rules of conduct for representation, evaluation and monitoring of the project.
	Is there a way to include institutional responsibility for an equitable partnership as part of contract agreement?	Identify responsible named individuals within the institutions in LMIC and HIC who are funded and are tasked with monitoring the health of the partnership according to the established rules of conduct.