The paper begins by insisting on definitional precision, because co-creation is a term that has been stretched to cover almost any interaction between researchers and outsiders. The authors define it through four dimensions: shared agenda setting, joint knowledge production, power sharing, and community leadership and ownership. Crucially, they distinguish genuine co-creation from its weaker cousins, consultation, stakeholder engagement and partnership, in which outsiders may be informed or even involved but never hold real authority over what is studied, how it is interpreted, or what is done with the results. To make the assessment rigorous, each dimension is scored on a graded scale rather than treated as a binary yes-or-no attribute, allowing the authors to capture the partial, uneven character of participation that binary labels tend to obscure.

But the analytical innovation goes further. The researchers add a second axis to their framework: the reach of co-creation across the entire research-to-policy-to-advocacy interface, and, most provocatively, the condition of the transitions between those segments. This is a subtle but consequential reframing. Most evaluations of participatory research examine a single project or a single phase, asking whether a study was co-designed or whether a policy brief was co-written. The APHRC team argues that the real vulnerabilities lie between phases, in the handoffs where an evidence-generation project must become a policy engagement effort, or where policy work must be converted into public advocacy. These transitions, they find, were often neither designed, nor evaluated, nor even recorded, leaving the continuity of participation to chance.

To test the framework, the authors assessed six cases drawn from the center’s portfolio, spanning evidence generation, policy processes, capacity strengthening and rights-based advocacy. Each case was evaluated against both axes: the depth of co-creation along the four dimensions and the reach of co-creation across the interface and its transitions. The cases are not named as standalone exposés but serve as a structured sample of the different kinds of work a policy-engaged research institution undertakes, from generating data on urban health and wellbeing to feeding evidence into government processes and supporting community-led campaigns for rights and accountability.

The first headline finding is stark: co-creation in this institution’s practice is substantive where knowledge is produced and weak where authority is held. In other words, communities and non-academic partners were genuinely involved in shaping research questions, collecting and interpreting data, and validating findings, but the levers of institutional and financial power remained firmly in the hands of the researchers and their funders. This pattern will be instantly recognizable to anyone who has worked in participatory research anywhere in the world. It is far easier to invite stakeholders into a workshop to refine a survey instrument than to hand them control over a budget line or the final say over institutional strategy.

The numbers behind that finding are telling. Agendas were substantively shared in four of the six cases examined, suggesting that the center has made real progress in opening up the question of what gets studied. But financial resources were substantively shared in none of the six. Money, the analysis implies, is the last and hardest frontier of co-creation. As long as funding flows from external donors to the research institution and only then, if at all, to community partners, the fundamental asymmetry of power remains intact regardless of how participatory the workshops are. The authors treat this not as a failure unique to their institution but as a structural feature of the global health funding architecture, in which grant-making rules, audit requirements and institutional overheads make genuine fiscal sharing difficult even when everyone involved wants it.

The second major finding concerns those transitions. Co-creation, the study concludes, fails at the seams between research, policy engagement and advocacy rather than within them. A project may be co-created from start to finish as a piece of research, and a policy engagement process may be co-created as an exercise in its own right, yet the moment when one hands over to the other is a moment of institutional amnesia. Community partners who shaped the evidence may not be present when that evidence is pitched to policymakers; coalitions formed during advocacy may dissolve when the research cycle restarts. Because these handoffs were not designed as participatory moments, they were also not evaluated, and because they were not evaluated, they were not documented, which means the sector has almost no institutional memory of how its most important work actually gets done. The authors’ insistence on recording and evaluating transitions is one of the most practical contributions of the paper.

The third finding is that different domains of work can realize different dimensions of co-creation, and these differences are systematic rather than random. Community leadership and ownership, the deepest and most demanding of the four dimensions, was substantive only in rights-based advocacy. That makes intuitive sense once stated: advocacy campaigns are typically built around the communities whose rights are at stake, giving them a natural claim to leadership that they rarely possess over a technical research project or a government policy process. Capacity strengthening and evidence generation, by contrast, tended to realize the earlier dimensions, shared agendas and joint production, without reaching full community control. The implication is that funders and evaluators should not expect every type of engagement to achieve every dimension, but should instead be explicit about which dimensions are realistic and appropriate for which kind of work, and honest about the gap between aspiration and feasibility.

From these findings the authors distill practice guidance organized around five themes: governance, funding, community roles, transitions and assessment. On governance, the lesson is that co-creation must be built into institutional structures, advisory boards and decision rights, not left to the goodwill of individual researchers. On funding, the paper points toward financing models that channel resources directly to community partners rather than treating them as beneficiaries of institutional spending. On community roles, the guidance is to define those roles precisely and early, so that participation is a specified commitment rather than a vague aspiration. On transitions, the message is to design, staff and evaluate the handoffs between research, policy and advocacy as deliberately as the phases themselves. And on assessment, the graded, two-axis framework offered in the paper is itself proposed as a tool that other institutions can use to audit their own practice with similar candor.

The authors are equally clear about the limits of what they have done. This is a single-institution insider synthesis, a self-assessment by researchers of their own organization’s record, and they state plainly what such an analysis cannot establish. It cannot claim to be representative of the wider field, it cannot eliminate the biases inherent in practitioners judging their own work, and it cannot substitute for independent evaluation or for the perspectives of the community partners themselves. What it can do, and what makes it valuable, is model the kind of honest self-scrutiny that the co-creation movement rarely applies to itself. In a field where the language of participation has outpaced the practice of power-sharing, a twenty-year institutional audit that admits money was never truly shared, and that the most important moments were never recorded, may do more to advance genuine co-creation than any number of aspirational frameworks. The paper’s quiet conclusion is that the next frontier is not inventing new participatory methods but fixing the plumbing: the budgets, the handoffs and the governance structures that determine whether participation is real or merely performed.

Subject of Research: Co-creation practices in research, policy engagement and advocacy at a African health research institution

Article Title: Co-creation in research, policy engagement and advocacy: Lessons and limits from two decades of practice at the African Population and Health Research Center

Article References: Otukpa, E. O., Ziraba, A. K., & Bain, L. E. (2026). Co-creation in research, policy engagement and advocacy: Lessons and limits from two decades of practice at the African Population and Health Research Center. PLOS Global Public Health, 6(9), e0007405. https://doi.org/10.1371/journal.pgph.0007405

Image Credits: AI Generated

DOI: 10.1371/journal.pgph.0007405

Keywords: co-creation, global health, participatory research, policy engagement, advocacy, power sharing, community leadership, research-to-policy, APHRC, Africa, health research governance, PLOS Global Public Health