Co-creation worked where knowledge was built, and stalled where authority was held
Co-creation has become a favored term in global health, yet the term often hides a wide gap between shared language and shared power. A reflective synthesis from two decades of practice at the African Population and Health Research Center (APHRC) separates those two realities with unusual clarity. The paper treats co-creation as more than consultation or routine stakeholder engagement, and measures it across four dimensions: shared agenda setting, joint knowledge production, power sharing, and community leadership and ownership. It then follows those dimensions across the path from research to policy engagement to advocacy.
The result is blunt. Co-creation was substantive when the work centered on generating knowledge, but weak when authority or control over resources entered the frame.
Six cases formed the basis of the review, spanning evidence generation, policy processes, capacity strengthening, and rights-based advocacy. Across those cases, agendas were substantially shared in four, while financial resources were shared in none. Community leadership appeared meaningfully only in rights-based advocacy, where community ownership was more compatible with the work’s purpose and structure. In other settings, the language of co-creation outpaced the distribution of decision-making power.
Where APHRC’s practice gained traction and where it did not
The analysis does not treat co-creation as a single yes-or-no condition. Instead, it grades each case across the four dimensions and places it on a second axis: how far co-creation reached across the research-to-policy-to-advocacy interface, and how well the transitions between those segments were managed. That structure matters because many collaboration models appear successful inside a project phase while collapsing at the handoff point, where evidence must become policy, and policy must become action.
The sharpest weakness was not inside the individual segments. It emerged at the seams. Transition points between research, policy engagement, and advocacy were often neither designed, evaluated, nor recorded. In practice, that meant the most consequential moments were also the least visible. The paper treats this as a structural failure of process, not an isolated operational glitch.
One sentence captures the imbalance: co-creation was strong where knowledge was produced and weak where authority was exercised.
That divide is familiar to anyone who has watched participatory language travel farther than participatory power. Research teams may invite community input, align on priorities, and jointly interpret findings, but funding decisions, institutional control, and policy leverage often remain centralized. The APHRC synthesis shows that financial power was not shared in any of the six cases, a finding that helps explain why agenda setting could be more collaborative than governance.
The four dimensions expose what is shared and what remains centralized
By distinguishing shared agenda setting from actual power sharing, the framework avoids a common trap in global health writing: mistaking attendance for authority. Joint knowledge production can be genuine even when communities do not control resources or institutional decisions. But if the full arc of co-creation is the goal, the distinction becomes unavoidable. A project can be co-produced without being co-governed.
The paper’s graded approach also makes a separate point about community leadership and ownership. These were not evenly distributed across all settings. They became substantive only in rights-based advocacy, where the political logic of the work was aligned with community leadership from the start. In more conventional research or policy processes, community roles were present but less central, which suggests that some domains are structurally better suited to co-creation than others.
That finding has practical consequences for teams designing partnerships across sectors. A research consortium that expects identical forms of co-creation in evidence generation, policy negotiation, and advocacy is likely to overpromise and underdeliver. Each segment carries different incentives, timelines, and power relationships. The APHRC cases show that co-creation should be planned with those differences in mind rather than treated as a uniform ideal.
Policy engagement exposed the limits of participatory rhetoric
Policy engagement is often described as the place where evidence meets decision-making, but this synthesis shows how easily the relationship can remain asymmetrical. When the institution helped translate findings into policy processes, co-creation could persist in the form of shared agenda setting and collaborative knowledge use. Yet the deeper control over outcomes, financing, and institutional authority remained elsewhere.
This is not a minor methodological detail. It changes how success should be judged. If the transition from research into policy is not designed as part of the co-creation process, the work can appear inclusive while preserving the same old hierarchy at the point where influence matters most. In other words, the project may be participatory at the bench and conventional at the ballot box.
The paper is careful not to claim more than it can show. It is a single-institution insider synthesis, and it cannot establish generalizable effect sizes or causal impact across global health practice. What it can do is map the internal logic of two decades of work and show where co-creation held up, where it was partial, and where it failed outright. That kind of practice-based evidence is especially useful in a field that often celebrates collaboration without measuring how power actually moves.
Funding, governance, and evaluation remain the unresolved tests
Three practical lessons emerge from the synthesis. First, governance has to be explicit if co-creation is meant to be more than rhetorical. Second, funding cannot be treated as a neutral backdrop, because resource control shapes who can define priorities and who can sustain ownership. Third, transitions between research, policy, and advocacy need to be designed, monitored, and documented as deliberate workstreams rather than left as informal handoffs.
The absence of shared financial resources across all six cases is especially revealing. Money is often where collaborative language meets institutional reality. If communities and partners do not share control over resources, their role may remain advisory even when the project is described as co-created. The APHRC experience suggests that genuine power sharing cannot be inferred from co-authorship, meetings, or consultation alone.
The paper also leaves a clear boundary around what this synthesis cannot do. It does not prove that co-creation improves outcomes in every setting, nor does it establish a universal model for scaling it. Instead, it shows that co-creation is uneven across domains, strongest in knowledge production, and most fragile at the junctures where authority, money, and accountability converge. For global health researchers and advocates, that is the more demanding lesson: the work is not only to include people in the process, but to decide where they will hold power, and to record whether that promise survives the handoff from research to policy to advocacy.