In recent decades, the role of ethics in health research has gained global recognition. However, institutional review boards (IRBs) are sometimes seen as obstacles rather than enablers of research. This study focuses on the Philippines, a country where the dynamics of health research ethics and IRBs remain underexplored, offering insights applicable to other low- and middle-income settings. Between July and October 2020, semi-structured interviews were conducted with Filipino health researchers to understand their experiences with IRBs and the ethics approval process. Insights were also gathered from individuals who have worked directly within IRBs.
Across clinical, public health, and social science domains, ethics review emerged as an issue of access and inequality. Researchers outside established institutions, those in regions without accredited IRBs, independent investigators, and those with limited funding or highly specialized topics—especially non-clinical researchers—face disproportionate hurdles. As a result, the research ecosystem tends to favor well-funded investigators and studies that are more likely to attract financial support. Improving fairness in health research requires systemic changes, but immediate steps could enhance equity in the ethics review process. Recommendations include stronger institutional oversight, regulation of IRB fees, and creating a more supportive environment for early-career, student, independent, and non-clinical researchers. The study also reflects on the implications of these findings for the broader research culture.
