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

Co-creation is widely advocated in global health research and inconsistently practiced. This paper offers a reflective, practice-based synthesis of two decades of co-created research, policy engagement and advocacy at the African Population and Health Research Center (APHRC).We define co-creation through four dimensions; shared agenda setting, joint knowledge production, power sharing, and community leadership and ownership. We distinguish it from consultation, stakeholder engagement and partnership, and assess each dimension on a graded scale. To this we add a second axis: the reach of co-creation across the research-to-policy-to-advocacy interface, and the condition of the transitions between its segments. Six cases spanning evidence generation, policy processes, capacity strengthening and rights-based advocacy are assessed against both axes. Three findings emerge. Co-creation in this institution's practice is substantive where knowledge is produced and weak where authority is held. Agendas were substantively shared in four of six cases and financial resources in none. It fails at the transitions between research, policy engagement and advocacy rather than within them, at moments that were neither designed nor evaluated nor recorded. And the domains of co-creation differ systematically in the dimensions they can realize, with community leadership substantive only in rights-based advocacy. We draw practice guidance on governance, funding, community roles, transitions and assessment, and state what a single-institution insider synthesis cannot establish.