Shifting the Power : A Road Map to Decolonise Global Health
AmplifyChange Chair of the Board of Directors, Narmeen Hamid; Founding Member and Board member, Sara Seims; and Graduate Student at New York University, Hayley Lynn Herzog, discuss how we can prioritise the decolonisation and localisation agenda in global health and international development. This blog is an abridged version of a full article, which you can download at the link below.
Movements such as Black Lives Matter have inspired and energised efforts to improve social justice and address racial inequities. The field of global health – the term used to define efforts of rich nations to improve the health status of low income countries (LICs) – is currently facing the challenge of how to embrace these principles. Historically, global health priorities and agendas have largely been determined by institutions based in or shaped by the Global North, with considerable variability in how much involvement the Global South has been invited to have.
The tenets of global health are rooted in colonial tropical medicine, an approach that was formulated during the peak of European colonisation. The goals at the time were primarily to protect the colonisers from the perils of tropical diseases. Little was done to understand and serve the health needs of local populations. This led to inequities being baked into the public health infrastructure in LICs.
This structured power imbalance has energised efforts to decolonise global health. The movement toward decolonisation, sometimes called localisation or shifting the power, is aimed at changing this status quo in which power, influence, resources, and policies that affect the health of LICs reside significantly in high income countries rather than in communities in the Global South where they belong. Decolonisation we hope will at least limit, if not eliminate, the situation where donor driven priorities control the agenda in the Global South.
How can we support and accelerate the progress?
The following pragmatic actions could make a difference in support of a decolonised and fairer set of relationships in global health and other development sectors for that matter.
- Express commitment to decolonisation and localisation publicly. Explicit commitments set alongside clear statements of what would be different, and by when, could give more credibility to vague statements of intent.
- Turn commitment into action such as putting local experts in charge of teams that design, implement, and evaluate global health programs and remunerating them appropriately, and shifting the offices of organisations involved in global health as much as possible to the LICs.
- Raise more resources from the Global South. Initiatives from within the Global South to raise support from well-resourced individuals, philanthropies, and corporations in the Global South would go a long way to increasing local control of global health. This solution supports stronger local accountability of health providers and of those responsible for allocating resources for health.
- Make better use of civil society within the Global South. Civil society organisations (CSOs) can provide the political impetus for their governments to make rational and transparent decisions. Although CSOs cannot replace the role of governments, ideally they can complement and support state efforts.
- Recognise and be realistic about the limitations funding agencies have in fully implementing global health decolonisation. Addressing government funding policies to better fit the needs of the countries the funding is going to, supporting the priorities of the grantee, and involving a lighter oversight touch towards grantees will enable localisation and decolonisation more effectively in global health funding.
- Expedite technology transfer and strengthen scientific research capacities. Health research led by LIC institutions is more likely to reflect the priorities of the region, the LIC diaspora of scientists would have meaningful work to return to, and local populations would no longer always be at the back of the queue as far as their own health needs are concerned.
- Increase representation of experts from LICs on the boards of funding agencies. We believe that this absence impedes decolonisation efforts.
- Improve SRHR vocabulary itself to reflect the cultural complexities of these issues within the various geographies of the Global South. Decolonisation of aid must also include decolonisation of language .
We would like to see greater political awareness of and commitment to the actions needed to make decolonisation a reality. We hope that the decolonisation movement will lead to genuine representation at all levels of governance, advisory boards, and institutional arrangements for delivery by people with lived experience from countries on the issues of concern. We believe that the actions and approaches outlined above will help speed the decolonisation process. It is not often that the right thing to do is also the most practical and impactful, but in the case of decolonisation, all of these goals can be reached and by so doing health for all will benefit.
