The case for a Global South centred model in global health

Calls to decolonise global health and tackle historic and systemic injustices in the field have intensified in recent years, but sometimes the way the argument is presented can be counterproductive.

For those of us in the Global South, the discourse can make us feel that our experiences are invalid. We are often portrayed as helpless and needing to be rescued,1 not by white saviours as in the past, but by well meaning actors in the Global North who are themselves struggling with the legacy of white supremacy, such as racism. This portrayal oversimplifies the power dynamics in the Global South. An essential element of coloniality is that it reproduces itself in colonised countries in the Global South by using incentives—such as granting access to the decision makers in coloniser countries in the Global North. The current discourse overlooks this complexity, and ignores that many people and institutions in the Global South are both beneficiaries and enablers of the existing inequities in global health.2 This idea is often ignored or resisted.

I write this as a woman from Pakistan and a researcher in early childhood development. I have trained in psychology, which enables me to understand the needs behind human behaviours. But beyond my professional roles, I am also human as much as you are, with a heart that can feel and hurt deeply. My views on decolonisation have evolved over the years as I have engaged with the global health community in Pakistan and in other countries of the Global South.

Concentrating only on changing global health institutions in the Global North to decolonise while ignoring the voices and perspectives of the health community in the Global South misses the point of decolonisation.1 The calls for action should go beyond the notions of equity in research authorship3 or funding4 generously granted to us by our colleagues in the Global North, and must recognise that our existence is not solely defined by partnerships.5 This approach implies that we need to fit into a system that exists in the Global North, even though it may not function in our contexts nor align with our needs.67

Decolonisation seeks to confront inequities that are horizontal (within countries) and vertical (between countries), and we must recognise the distinction. The danger of tackling horizontal inequities without the vertical is that we end up merely transitioning from one form of exploitation to another, regardless of the race or nationality of the oppressors. Rather than the discourse revolving around decentring power and resources in the Global North, we must pursue models of self-determination that centre the Global South in the primary role, as is the true notion of decolonisation.

The model requires that the Global South pursues its own independence and self-reliance in global health.8 It is not only about challenging a system that favours power, privilege, and prestige and expects conformity to these values,9 but also claiming the fundamental right to shape our system. This may take decades to achieve, but it starts with the crucial first step of deciding to be leaders for change.

Through this vision we transform not only our own narratives but also the dynamics of collaboration with counterparts in the Global North. We reclaim the power we’ve often unwittingly ceded, realising that power doesn’t rest exclusively with the giver but also with the receiver. This would mean choosing to be partners only when the goals align with our vision of change, and refusing when it reinforces our role as “glorified data collectors”10; allowing us effectively to demand equitable partnerships and pave the way for a more just global health landscape where both giver and receiver equally share influence and responsibility.11

I aspire for us to reshape our mindsets and institutions, to shift from a charity based model whereby the Global South serves as a site for data provision in exchange for funding to a value-based model that drives collaboration for equitable health outcomes. I am optimistic because I have witnessed the remarkable work taking place in my country1213 and across the region.14 I have found that impactful work doesn’t always need foreign funds, but it does need people leading from the heart and with a belief that reducing health inequities is not only possible but essential. I invite colleagues in the Global North to consciously identify such work as part of decolonisation efforts, but I ask that you do so with humility and readiness to learn. Many ongoing home grown endeavours in the Global South to reduce inequities aren’t recognised in your countries partly because they challenge the dominant narrative, but also because those leading the work are oblivious to validation from the Global North.1314 And this is where, my colleagues in the Global South, our power lies. I urge you to reclaim that power, organise, learn from each other, and create an alternative value system based on benefit for our communities rather than seeking glorification from the Global North. To be honest, I don’t know if the shift of power in global health will ever be realised in our lifetimes, but I can assure you there is no other path to achieve it. Hence, I dare to dream, and I do so unapologetically.