A much needed discussion on decolonising global health is finally taking place with more urgency, in Canada and globally. There is a recognition that the global health system is built on a colonial structure resulting in widespread injustices shown so starkly during the COVID-19 pandemic. Structural racism is a pillar of the colonial system. But it is not enough to just decolonise; we need to co-create and build a new way forward based on diverse, equitable and inclusive representation, participation and action.
Four global health activists from diverse backgrounds spoke about how to decolonise global health partnerships during the Canadian Conference on Global Health in November 2021.
Here are the 10 ways they propose:
1. Be antiracist
“It’s not enough to not be racist; be antiracist!”
—Dr Teresa Bonyo, echoing the words of Angela Y. Davis
Dr Bonyo, Medical Doctor and Public Health Specialist, made it clear that to have substantive change we need to address the institutional and structural racism that is embedded in most organisations, address ongoing white saviourism, and embrace humanity, dignity and inclusiveness. In addition to acknowledging racism, being antiracist means taking action. Individuals and institutions need to actively invest in education and learning targeted towards understanding racism and discrimination. Organisations should review policies and procedures that could promote racism and discrimination, but in addition critically look at affirmative actions that will help to foster inclusion. Dr Bonyo further reiterated that it’s not about the number of People of Colour that an organisation hires, but where they are placed in the organisation. What do they earn in comparison with white counterparts? Organisations should also work towards eliminating tiers and categorization of staff that perpetuate discrimination and inequality. More efforts towards eliminating unconscious bias in recruitments and evaluations should be made whilst ensuring equitable access to benefits regardless of background.
2. Mind your language
“In order to decolonize we must critically look at terminology that is loosely used or deeply entrenched.”
—Dr Teresa Bonyo
Some of the terminology used are demeaning and disrespectful, while others are openly derogatory. Terminology can also perpetuate othering (us versus them) and fail to foster equal and respectful partnerships. Examples include: third world, field, vulnerable, beneficiaries, recipients, local, expatriate, ground, etc. The issue is not necessarily in the words themselves, but the stereotypes and power dynamics that lie behind them. We must ask ourselves whether the words we are using actually recognize people’s agency or merely dehumanize? We need to start using new or adapted words that actually empower, that bring out people’s inherent strengths.
“Proximity is key.”
—Dr Germán Casas, Medical Doctor, Professor at the University of Los Andes and President of Médecins Sans Frontières Latin America.
Dr Casas explained how the COVID-19 pandemic has demonstrated once again the importance of decisions being made where operations are based. At present, most humanitarian organisations have their headquarters in Europe or North America. This distance privileges a response created outside of the context focusing on expediency and western practices. Being close to the locus of the crisis opens space for culturally appropriate responses, innovation and respect for local knowledge and ways of doing. Western partners need to have local branches that must also be well resourced to perform efficiently and effectively. They have to acknowledge that local actors have important strengths including ensuring fast response and access, quality, acceptance, cost-effectiveness, and sustainability through longevity and knowledge footprints.
4. Diversify governance
“We need a paradigm shift. If we want to truly decolonize, we need to move away from seeing communities as passive recipients of aid and start involving them at the inception and operation of all projects. ”
—Dr Germán Casas
Most organisational governing boards are not representative of the communities they purport to serve. Dr Casas called on organisations to acknowledge the importance of diversity in governance– better decisions, especially in terms of strategy, approaches and direction, are made when varied perspectives are sought and included. Boards of directors should ensure Black and Indigenous People as well as People of Colour are not only present but also coming into spaces that allow open and meaningful dialogue as well as an equal decision-making responsibility and role.
5. “He who pays the piper, calls the tune”
“Partnering with local organisations is essential, but effective and decolonised partnership means ensuring that local actors can access funds directly to carry out the work which is critical to promoting the cost-efficiency and effectiveness of humanitarian aid.”
—Dr Germán Casas
There is a concentration of wealth and aid money in the Global North and decisions about how those should be spent are taken by western donors and western organisations. Both Drs Casas and Bonyo stressed that the practice of untenable bureaucratic standards imposed by western donors to transfer financial resources to stakeholders must end. “This has to change,” said Dr Casas. “To decolonise partnerships, we need to decolonise funding.” This will shift power and responsibility to local actors in responding to the crises. “Large international humanitarian NGOs should no longer consider local NGOs as service providers or proxies, but as fully-fledged partners to pass the baton to and redefine their social mission in this sense,” said Dr Bonyo.
6. Meet communities where they are
“We have to be open to hearing and understanding the priorities of communities, and not just assume that the priorities we hold will be the same for them.”
—Jessica Farber, Community Readiness Coordinator, SeeChange
We need to listen deeply, take time, beware of imposing external worldviews and mindsets. Farber spoke about the importance of recognising intersectionality, from the nature of the crises to the identities of individuals and communities affected. The most vulnerabilized communities are at the intersection of multiple crises: the climate crisis, future global pandemics, water and food insecurity, and infectious diseases, as well as poverty and conflict. Meeting communities where they are also means recognizing the trauma– both historical and present– that communities are facing as a result of these compounding crises, and as a result of racism and colonisation.
7. Adopt a strengths-based mindset
“We need to support communities to amplify solutions that mobilize their own traditional knowledge, their historical memory, their special skills, community networks and organisations.”
Communities have strengths and assets that can be leveraged for more effective, sustainable and empowering humanitarian action. Utilizing strengths-based approaches, as opposed to viewing people living through humanitarian crises from a deficit standpoint, can unlock those inherent capabilities and improve the efficacy of humanitarian emergency response. This means recognizing that the solutions are within the communities themselves. When communities are using their own skills and assets, they will feel a greater sense of ownership over their health crisis responses, and these responses will be more likely to be sustainable and adaptable to future crises.
8. Be accountable to communities
“Using a strength-based approach requires humanitarian and global health interventions to become accountable to communities and not to numbers required by donors.”
The measures of success are the health and social impacts that the community values and sees, not what the organisation or donor expected to see. Being accountable to communities also means prioritizing sustainability, rather than having a short-term, project-based view.
9. Adopt a feminist leadership lens
“To achieve paradigm shifts in the way we partner with communities and local organisations, practicing intersectional feminist leadership is key.”
This focuses on centring care, healing and compassion. “During the COVID-19 pandemic, this has meant focusing on self-care and emotional wellness with the community leaders with whom we have been working at SeeChange. We also work to build networks of solidarity and mutual accompaniment.” Embracing feminist leadership also means nurturing and supporting women and girls as leaders in health crisis response.
10. Reimagine humanitarian action
“We need to reimagine humanitarian action. We need to open ourselves to change. And that change needs to be now!”
—Rachel Kiddell-Monroe, Founder and Executive Director, SeeChange
Other contributors to the CCGH 2021, including Seye Abimbola, Catherine Kyobutungi, Pamela Roach and Thoko Elphick-Pooley also spoke about the importance of acknowledging racism and colonialism in the global health system and the steps we need to take to address it. We need to be open to moving away from the traditional humanitarian principle of neutrality and instead highlighting the central tenets of the humanitarian principle of humanity: equity, diversity and inclusion. Together we need to reimagine what aid will look like. It is not about tweaking the current system. It is about seeing a whole new way of doing.