Documenting our outcomes and publishing our model in the scientific literature is part of our mission of participating in and advancing a global social and scientific movement towards health equity. We must take care, however, to ensure that research only supports our fundamental service obligations to the communities in which we work rather than serving as a distraction.  See also Research Ideas, our wiki page where we list some research ideas and projects. 

 

Vision and Strategy Ethics and Organizational Review Nepal Health Research Council Approval Process External Researchers Collaborative Process Authorship Note on General Interest Pieces, Abstracts, and Commentaries Note on Research Studies Note on Non-Intellectual Contributions Publication Charges

 

Vision and Strategy

Several important points to consider when conceptualizing or evaluating research and research proposals to be conducted in cooperation with Nyaya:

1) Nyaya's mandate is to provide healthcare resources while simultaneously addressing the structural violence experienced by the communities we work in. As a consequence, any research should necessarily prioritize the benefit of our patients, offering a comparative advantage in both its implementation and results.

2) While Nyaya has a responsibility to the communities we work in, the actions of precedent setting and demonstration of evidence through the formal publication of research can result in more widely effective policy changes. As such, publishing our data and insights, soliciting feedback, and encouraging further discussion and analysis, can have broad-based impacts for persons in similar resource-deprived settings that Nyaya does not immediately work with. Therefore, participating in the larger research discourse is within Nyaya's mandate and achieves three aims: 

a) by publishing our data, we solicit feedback and conversation that can enable our own programs to improve through continued critical analysis and peer-review;

b) as with organizations such as PIH or MSF, the publishing of our data provides other organizations, and their own patients, the opportunity to share in Nyaya's evidence-based approach and results, consequently expanding the geographic reach of Nyaya's work; and

c) through publication, we can increase the exposure of Nyaya's work, facilitating further opportunities for future collaborations, volunteers, and funding - all of which can directly benefit the communities in which we work.

 

Ethics and Organizational Review

AT THE OUTSET OF PLANNING OF THE RESEARCH, THE RESEARCHER MUST SUBMIT THE IDEA TO THE GRANTS TEAM AT GRANTS(AT)NYAYAHEALTH(DOT)ORG TO START THE DIALOGUE WITH OUR GRANTS MANAGERS (SEE ALSO GUIDELINES AT Grants).  SUBSEQUENTLY, ALL RESEARCH MUST BE APPROVED BY SUBMISSION TO TEAM(AT)NYAYAHEALTH(DOT)ORG TO ALLOW BOARD MEMBERS TO RAISE OBJECTIONS/REVISIONS TO THE RESEARCH. ALL RESEARCH INVOLVING HUMAN SUBJECTS MUST ALSO BE APPROVED BY THE INSTITUTIONAL REVIEW BOARDS AT THE PRINCIPAL INVESTIGATORS' HOME INSTITUTIONS AND WITH THE NHRC in NEPAL.

 

Nepal Health Research Council Approval Process

These are guidelines for IRB approval from Nepal

1. Start as early in advance as possible. There have been times when the NHRC (Nepal Health Research Council) sits on the application for a month and emails you asking for a cover letter or some similar requirement, not having looked at the content of the application at all). Also, the proposal is rather extensive regardless of what kind of research you want to do (e.g. even if you received exemption from Yale IRB, you may be filling out a 30 page proposal for NHRC).

2. Go to http://www.nhrc.org.np/grant.php and download the "Approval Proposal Format".  >>See SharedNyaya\Clinic\Grants\IRB\NHRC (Nepal) for examples.

3. You will need at least one Nepali citizen as a co-investigator. Will probably be easiest to include Bibhav as one: email him a copy of the proposal.

4. A passport size photograph is required for the PI.

5. Need the signature from the head of department of the PI.

6. After completing the application, contact a Nyaya Kathmandu-based contact to submit a paper copy. You can also try emailing them but best to submit a paper copy. As noted in the instructions, submit an electronic copy as well: either in a CD or floppy disk or via email. Again, CD and paper copy in Kathmandu is best.

7. Follow up by calling them (see contact info below) regarding status of the application.

CONTACT (check website for current info)

http://www.nhrc.org.np/contactus.php

Address: Nepal Health Research Council, Ramshah Path, P.O.Box 7626, Kathmandu, Nepal

Telephone: 977-1-4254220/4227460

Fax: 977-1-4262469/4268284

Email: nhrc@healthnet.org.np

 

External Researchers

While Nyaya is continually interested in expanding our social network, and involving as many new volunteers as we can accomodate, we must adhere to strict principles in considering research collaborations. Nyaya's priority is first and foremost to our patients, and secondly to the global health delivery community and other stakeholders. There is a significant amount of research that falls under this purview, and in acknowledging this, Nyaya is happy to pariticipate and involve external researchers who are interested in research priorities that offer a particular benefit to the organization and its stakeholders. Nyaya does not have the capacity to offer research opportunities that will not directly benefit the community of Achham or other Nyaya stakeholders, and as such encourage any volunteer interested in collaborating in formal research with Nyaya to contact us ahead of beginning any significant planning. In this vein, Nyaya is usually unable to offer opportunities to fulfill educational requirements, but is willing to discuss on a case-by-case basis.

 

Given that proposed research is in line with Nyaya's priorities, Nyaya is open to research collaborations with both students and/or external researchers. The following expectations must be met by investigators for research to take place:

• the investigator takes upon him/herself all responsibilities of proposal and study instrument development;
• Nyaya staff will not be responsible for providing mentorship in the development of research proposals, however expect that any investigator have the support of a formal research institution and mentor;
• all proposals and instruments developed externally are subject to revision and/or rejection by the Nyaya team, and should be submitted for formal review before finalizing any plans for travel/funding;
• all follow-up of research conducted is the responsibility of the investigator and will be agreeed upon ahead of study commencement.

 

Collaborative Process

The process of research should be collaborative and open.  It is encouraged to email team(AT) listserve very early on in your creative process, to engage others, foster an environment of openness and collaboration, and make your own efforts far more efficient.  You should use google docs for collaborative writing and wizfolio for collaborative bibliographies for this purpose; see our collaboration page for more details on how to use these technologies.  Roles should be identified clearly within the google docs; this will eventually be solidified into an honest "authors contribution section".  Once the idea is out over team as a google doc, it is advised to continue to edit/comment directly within the google doc rather than out over the team list, both so we can better catalogue our discussions and so we can reduce the large volume of team(AT) emails.  Try to avoid side-conversations that do not include the other potential collaborators (given the nature of team(AT), this basically means that collaborators should use google docs rather than email.  This strategy incidentally helps us to fight the "myth of multitasking" that drives us into our email inbox rather than our own preconceived task list (duncan will link blog post on the subject once its up).  It is important to be logged in to your google account (whether your personal gmail or nyaya google account) so that people can see who is editing what in the "File...revision history" section.  Otherwise, it will label your work as "guest" which will inevitably mean we can't figure out who edited what.

 

Authorship

We are open within our team about authorship.  Prior to submission of any piece that involves Nyaya's work, the first author will email the submission to our team list.  Any member who would like to comment on the piece may do so.  If a member feels that the research is unethical, misleading, or otherwise misrepresents Nyaya's work, s/he may initiate an open dialogue as to whether the paper should even be submitted at all. 

 

Members will also discuss openly if they feel that they should be included as a co-author.  Only those members who meet international standards for authorship will be co-authors on the piece, as stated by the ICMJE (International Committee of Medical Journal Editors): 

1) substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data;

2) drafting the article or revising it critically for important intellectual content; and

3) final approval of the version to be published. Authors should meet conditions 1, 2, and 3.

See: http://www.icmje.org/index.html#author

 

It is the job of the first author (together, as needed and if applicable, with the senior author) to be the arbiter of authorship.  The first author will decide whether someone who has requested authorship should be a co-author and the order of all the co-authors.  The first author will be courteous and respectful and open in dealing with all potential co-authors, including those who have requested to be co-authors but who the first author has decided does not meet criteria.  Touchy or sensitive discussions should be done in person or over the phone; email is not an appropriate communicative medium for potentially emotional issues.  The first author is also responsible for ensuring that all authors declare any potential conflicts of interests BEFORE submission, which is critical to avoid editorial/acceptance problems subsequently.

 

It is important to note that while this seems somewhat bureaucratic, it really will increase the work load of the first author only minimally, since for the most part members are understanding and saavy and honest about these things.  The key to efficiency is openness and communication from the beginning.

 

Note on General Interest Pieces, Abstracts, and Commentaries

In contradistinction to research studies, general pieces, commentaries, and abstracts can be drafted in near-final form and then sent to the team list. This is because such pieces are typically driven by the first author's time and efforts.  The first author is encouraged to send along ideas early on in any stage of development, and to use the ResearchIdeas page collaboratively.  Inclusive in these pieces are brief abstracts based on analysis of already collected data that have been open-sourced by Nyaya Health and do not require IRB review.  Typically, however, research projects, even involving retrospective open-sourced data, should follow the protocol below in "Note on Research Studies".

The first author will request co-authorship at that time, for example: 

All of us have contributed to making this happen, and I want to encourage anyone who feels that s/he would like to be a coauthor and would meet the criteria on our research page to email me personally to let me know (just email me to avoid cluttering the team list). 

 

Note on Research Studies

Prior to conducting the research, the principal investigator must email the team list (this is also for ethical clearance)  It is at that time that the principal investigator will offer co-authorship, since, unlike commentaries, much of the work of the research is done prior to the writing of the piece.  Members will understand that authorship is assigned at that time, at the onset of the research.  Again, while it is important for the principal investigator to do so, for the most part members will understand what their roles are and will only request authorship/participation if they know they will make a meaningful contribution.  So for the most part this single email is the only added work on the part of the principal investigator, and it will do significant good in maintaining the open and collaborative spirit of the organization. 

 

Note on Non-Intellectual Contributions

The ICMJE recommends and most Principal Investigators practice that they not include research assistants or other staff UNLESS they made substantive intellectual contributions.  This certainly values cognitive contributions over time or physical ones, but that is what professionally the research community has come up with.   We should of course work to engage staff members so they can make such contributions.  Research is a hugely collaborative effort, and the fact that someone is not a co-author does not mean their work is not valued or that it is not meaningful, simply that their contributions do not merit authorship.  

 

Publication Charges

In keeping with our overall open-source mission, we prefer to have publish our work in open-access journals.  This often carries publication fees.  Upon acceptance of our piece, we should request a waiver on the publication fees on the basis of the fact that we work in a resource-denied setting.  This is true  for grant-supported research as well, since research dollars are best spent in Nepal.   In very uncommon circumstances, where for example a very high impact journal has accepted our piece but refuses to waive the fees and there is grant money that cannot be spent in Nepal, then we can consider using those specific, earmarked grant funds to cover publication fees.  Otherwise, we are better off publishing in a different journal; in such cases, our open-access objective would be secondary to our fundamental service and resource redistribution mission within Nepal.