Finding the balance between academic productivity and impact: evaluation of the Botswana - University of Pennsylvania partnership over a 5-year timeframe

Abstract

Introduction: There is consensus that global health needs a new power and incentive structure and academia must benefit society more directly. However, there are few metrics to help academic global health partnerships enact these changes.This study evaluates the impact of the Botswana - University of Pennsylvania Partnership (BUP) between July 2018 and June 2023, through the lenses of academic productivity, global health decolonisation and social accountability.

Methods: The data were organised based on BUP's five strategic goals. Alignment with Botswana's burden of disease was calculated through the ratio between the percentage of BUP's funding or activities devoted to 22 Sustainable Development Goals (SDGs) targets and the percentage of total disability-adjusted life years (DALYs) for the same targets.

Results: BUP employed 67 full-time personnel, hosted 263 international personnel and raised US$22.6 million.BUP supported service delivery in public facilities across multiple specialties and trained hundreds of local health workers and 81 local investigators.Research output was 28 publications/year, 30% featuring a local investigator as first/last author.80% of grant funding went to research. Funding and activities were distributed primarily to Gaborone (75% and 69%) and hospitals (60% and 57%). Funding and activities were less for other geographic areas (25% and 31%) and health system levels (40% and 43%).BUP's DALYs alignment was strong for 7/22 SDG targets (ratio ≥80%), intermediate for 7/22 (ratio 40-79%) and weak for 8/22 (ratio <40%). Non-communicable diseases other than cancer, essential health services and determinants of health had weak or intermediate alignment.

Conclusions: BUP had a significant impact in Botswana but also gaps in its portfolio and deliverables (including local first/last authorship and primary healthcare). The study's results can help tailor programming more consistent with local needs. This approach might inform evaluation of and strategic planning for other academic global health partnerships.

Keywords: Global Health; Health Services Accessibility; Health policies and all other topics; Health systems evaluation; Indices of health and disease and standardisation of rates.

Figure 1. Monitoring and Evaluation Framework for BUP. BUP, Botswana - University of Pennsylvania Partnership; CHOP, Children’s Hospital of Philadelphia; SDG, Sustainable Development Goal.

Figure 2. Grant funding sources (A) and funding and international personnel distribution by type of activity (B) between July 2018 and June 2023. CDC, Centers for Disease Control and Prevention; NIH, National Institutes of Health; NIH-CFAR, NIH-Center for AIDS Research; NIH-FIC, NIH-Fogarty International Center; PEPFAR, President’s Emergency Plan for AIDS Relief.

Figure 3. Grant funding and international personnel distribution by geographic area (A)*†; funding or activity alignment with burden of disease by SDG target (B). *Authors unable to determine distribution of 2% international personnel for geographic area. †Population distribution by geographic area: Gaborone city 10% (244,107); Southeast, Southern, Kweneng and Kgatleng districts 36% (842 556) and other districts 54% (1 259 516). **The number in the ‘BUP Finding/Activity alignment’ column is the ratio (as a percentage) between the percentage of BUP funding or activity devoted to each SDG target and the burden of disease associated with the same target. ***For universal health coverage, BUP funding/activity alignment was determined based on the average alignment of 14 SDG targets: five targets with strong alignment (maternal morbidity and mortality; neonatal and under-five morbidity and mortality; HIV, malaria and neglected tropical diseases; tobacco control); three targets with intermediate alignment (malnutrition; tuberculosis; vaccines and essential medicines); six targets with weak alignment (cardiovascular disease, diabetes, renal disease, etc; mental health and substance abuse; sexual, reproductive health services, family planning; air, water, soil pollution; early warning and risk reduction). BUP, Botswana - University of Pennsylvania Partnership; SDG, Sustainable Development Goal.