Patterns of authorship on community health workers in low-and-middle-income countries: an analysis of publications (2012-2016)

Abstract

Introduction: Studies of authorship provide a barometer of local research capacity and ownership of research, considered key to defining appropriate research priorities, developing contextualised responses to health problems and ensuring that research informs policy and practice. This paper reports on an analysis of patterns of research authorship of the now substantial literature on community health workers (CHWs) in low-and-middle-income countries (LMICs) for the 5-year period: 2012-2016.

Methods: A search of five databases identified a total of 649 indexed publications reporting on CHWs in LMICs and meeting the inclusion criteria. The country, region and income classification of studies, affiliations (country, organisation) of lead (first) and last authors, proportions of all authors locally affiliated, programme area (eg, maternal child health) and funding source were extracted.

Results: The 649 papers reported experiences from 51 countries, 55% from middle-income countries (MICs) and 32% from low-income countries (LICs), with the remaining 13% multicountry studies. Overall, 47% and 54% of all the papers had a high-income country (HIC) lead and last author, respectively. Authorship followed three patterns: (1) a concentrated HIC pattern, with US-based authors numerically dominating LIC-based and multicountry studies; (2) an MIC pattern of autonomy, with a handful of countries-India, South Africa and Brazil, in particular-leading >70% of their CHW publications and (3) a pattern of unevenness among LICs in their lead authorship of publications varying from 14% (Malawi) to 54% (Uganda). Region, programme area and funding source were all associated with the distribution of authorship across country income categories.

Conclusion: The findings in this analysis mirror closely that of other authorship studies in global health. Collectively these provide a common message-that investments in global health programmes in the Millennium Development Goal era may have benefited health but not necessarily capacity for knowledge generation in LMICs.

Keywords: descriptive study; health services research; health systems.

Figure 1

Search and review strategy.

Figure 2

Distribution of publications on community health workers by country income category and year (n=649). LIC, low-income country; MIC, middle-income country.

Figure 3

Percentage distribution of lead and last authorship of community health worker publications by income classification (n=649). HIC, high-income country; LIC, low-income country; MIC, middle-income country.

Figure 4

Box plots (showing medians, 25%–75% quartile range and distribution) of total numbers of authors on publications by country income (n=649) and the proportion of local authors by country income of last author (n=593).