Bridging the global health divide: reflections of scholars in the global south

 

The agenda to decolonize global health has gained prominence internationally as a movement against the systematic dominance of former colonizing nations in research, policy and practice. A balanced composition of member representatives from different world bank regions seeks to address growing inequalities between nations. Scholarship programs have done a tremendous job harnessing resources for students from low-middle income countries to access high-quality education.

However, while such genuine North-South partnerships exist, disparities fostered by racism, socioeconomic status and colonial legacies persist to undermine the potential of scientists from LMIC. Within the current global health research and practice ecosystem, traditional strategies derived from LMIC sociocultural frameworks are rarely integrated into research and development and have no place in what is considered a modern intellectual domain. It is possible that such research is discounted prematurely due to reviewers’ and editors’ preference for HIC sources.

As scholars in the global south who have had the opportunity to learn alongside colleagues in the global north and network with leading experts in the field, we often share similar future career aspirations, seek to co-create and feel well prepared to take on complex global health challenges. However, the lived experiences are rather divergent. As our HIC colleagues go on to serve as lead technical advisors in prestigious international organizations or principal investigators on foundational research studies, we take on the role of data capturers and implementers of those priorities. Abimbola would categorize our HIC peers as aspiring to be the “helpers,” while we aspire to be effective as the “helped”. The helpers, he says, have power and resources that translate into technologies, methods, and approaches while the helped have critical information. In view of the challenging and yet pragmatic definition of global health by King and Koski, students from HIC find themselves “practicing public health elsewhere” while those from LMIC, operating in their home countries on the same projects, are not necessarily looked at as GH practitioners. In certain instances, the helpers get accreditation more quickly than the “helped” for the same kind of research.

Although the scenarios described above have real career advancement implications, a few well thought out approaches can level the playing ground. First, while it is relatively easy for professors from HIC to do research in LMIC and receive accolades both at home and abroad, it is not the same for their LMIC counterparts. HIC schools and faculty could increase the visibility of their partner LMIC researchers by inviting them to contribute to program and curriculum development.

Secondly, many donor agencies, particularly the Global Fund, have increased the representation of LMIC at every level of their organizations. The appointment of Ambassador Nkengasong to oversee the PEPFAR program is a step in the right direction. However, more effort could be directed toward equitable representation at bilateral agencies such as USAID and CDC that implement global health elsewhere. One initiative would be to provide internships and entry level positions to students from LMIC learning at HIC global health institutions.

Lastly, South-South partnerships that tend to be more equitable than North-South ones can leverage the African successes against Ebola and the COVID-19 pandemic to decolonize GH. During the COVID-19 response, the support given to Africa CDC from the global north was strategic and not prescriptive, in that it allowed the African Union to explore ways of achieving South-South partnerships. Africa CDC’s decision-making matrix significantly involved member states in collaboration with ministries of health that coordinated a continent-wide response to the pandemic. This concerted strategy fostered the uptake of prevention measures, mitigated community spread, and prevented overwhelming the already stressed healthcare systems across the continent. Crone describes Africa CDC as “an Africa-grown institution associated with the continent’s most inclusive international organization.” This gives it an edge on nimble responsiveness free from the bureaucracy of its funders. Furthermore, the lessons learned from the 2014-2016 Ebola epidemic in West Africa informed the global response to later outbreaks such as integrating community engagement and supporting survivors, strategies that were successfully applied against the 2018-2020 Ebola epidemic in the Congo. Alongside increasing national governments’ funding for healthcare, donor agencies should support research hubs based in the global south and focus on building local capacity for research and development.

Colonization in global health is the enduring legacy of colonial structures and power differentials that drive discrimination and allow for disproportionate benefits to individuals at HIC institutions at the expense of their LMIC partners. Decolonizing of global health therefore remains the responsibility of every global health professional who understands the complicated framework and history of global inequities.

 

About the authors:

Susan Awor is an emerging researcher from Sub-Saharan Africa who is committed to helping vulnerable communities achieve better health outcomes. She is currently applying epidemiological methods to identify opportunities for prevention of adverse outcomes following female genital fistula repair in Uganda.

Efison Dhodho is a public health practitioner on the front lines of implementing client inspired, data driven solutions to deliver HIV care and treatment in Zimbabwe with a special focus on rural communities. He is a global health fellow at the UC Berkeley, School of Public Health.

Asiphas Owaraganise is an obstetrician/gynecologist based in rural southwestern Uganda. He is also a clinical researcher focusing on the intersection between HIV and COVID-19. He is a global public health fellow at the UC Berkeley, School of Public Health.

Amete Mihret Teshale is a microbiology researcher at the Ethiopian Public Health Institute, aspiring to serve the underserved communities using evidence-based practices. She is a global public health fellow at the UC Berkeley, School of Public Health.

Eunice Ndzerem-Shang is clinical pharmacist with a variety of public health affiliations that manage public health programs to maximize outcomes. As a UC Berkeley, School of Public Health alumni, she serves as the International Fellows Academic Advisor.

Sandra McCoy is a Professor in the Division of Epidemiology at the UC Berkeley, School of Public Health, and Program Lead of the Epidemiology & Biostatistics concentration in Berkeley’s Online MPH Program. She studies how social, economic, and cultural forces influence disease transmission and health outcomes.

Acknowledgments: This blog article is from a group of international graduate fellows centered around the current conversation on the decolonization of global health. The online Global Health International Fellows program at UC Berkeley’s School of Public Health is led by Dr. Eunice Ndzerem-Shang and has the following members in addition to the authors: Maureen Kesande, Moliehi Mokete, Ivan Mufumba, Jane Mwafulirwa, Belinda Odhiambo, Mahnoor Fatima, Abel Wilson Walekhwa, Survana Kantipudi, Bongekile Nkosi, Jaspreet Singh, John Mboya, and Lesly Joseph. We thank the entire group of sixteen members for their full and dedicated participation in the initial data collection process. All authors contributed to the writing and editing of this blog post. Heartfelt gratitude to our esteemed mentor, Dr. Sandra McCoy, for her dedicated input and direction.

Competing interests: AMT, AO, ED, and SA are current Gilead Global Health fellows in the University of California, Berkeley’s Online/On-campus MPH program and are receiving sponsorship for their graduate studies through the global health program. ENS is a graduate of the University of California, Berkeley School of Public Health. SM is a professor in Epidemiology at the University of California, Berkeley School of Public Health. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Handling Editor: Neha Faruqui

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