A framework for fair financial compensation to transform community led global health research

Abstract

Community engagement has become an institutional imperative in global health research. However, it often extracts unpaid labour from those in precarity while technical experts are compensated at market rates. This ‘unfunded mandate’ creates high opportunity costs that exclude the most vulnerable—particularly in low-resource settings—leading to selection bias and elite capture in co-design. We argue that lived experience constitutes specialised expertise that demands financial recognition to ensure scientific validity. By contrasting the rigorous payment standards for Patient and Public Involvement (PPI) in the Global North with the ‘volunteer’ models imposed on the Global South, we expose a pervasive ethical double standard. This paper proposes a practical Community Compensation Decision-Matrix to guide payment levels across engagement intensities. We outline three pillars of reform: benchmarked compensation, mandatory ethics board audits, and flexible payment systems for informal economies. Operationalising financial equity as a non-negotiable budget line item moves beyond ‘participation-washing’ to enable truly representative research.