From Colonial Legacies To Community Empowerment: A Paradigm Shift In Global Healthcare

The unequal distribution of vaccines between countries at the height of the pandemic manifested “as a global system privileging those former colonial powers to the detriment of formerly colonised states and descendants of enslaved groups,” according to the UN Committee on the Elimination of Racial Discrimination.

For centuries, colonialism has shaped global healthcare, leaving behind a legacy of disparities and injustices between the Global North and Global South that continues to exert a profound influence on the health and well-being of marginalised and indigenous populations across the globe.

Today, colonialism’s legacy is being challenged by a growing movement to decolonise the healthcare sector by shifting power to marginalised communities and empowering them to design and deliver their own care.

At a recent panel discussion hosted by the Global Health Centre of the Geneva Graduate Institute, in collaboration with Medicus Mundi, experts from across the health spectrum discussed practical steps to decolonise global health governance and give marginalised communities a greater voice and agency in their own healthcare systems.

“We are speaking about localisation, shifting powers and decolonising,” said Hafid Derbal, Co-Desk for Sexual and Reproductive Health and Rights (SRHR) and Co-Program Coordinator for Zimbabwe, South Africa and Mozambique, Terre des Hommes Schweiz. “Who is ultimately benefiting from our work and these changes? It must be the people we work with – the local organisations and civil society.”

One example of this approach is community-based healthcare initiatives, which tailor services to the specific needs and preferences of the local population. 

“Participative urbanism is a concept that we came up with to bring the voice of the marginalised as part of the mainstream public policy,” said Danny Gotto, founder and executive director of Innovations for Development (I4DEV), Uganda.

“We created a space for people in so-called slums to voice their concerns based on their context, based on their cultures, based on their interests, based on their aspirations,” Gotto said. “Then, we created a space for dialogue between policymakers and the common people to ensure that they decolonise urbanism because the context of urbanism, as borrowed from the West, is that the poor all live on the fringes.”

On a broader scale, collaborations are emerging to support countries with limited resources to manage specific health conditions. For example, the African Centers for Disease Control and Prevention (Africa CDC) is dedicated to building Africa’s capacity to confront healthcare challenges.

“Because many national health organizations lack the capacity and resources to represent what’s going on, the African Union’s creation of the Africa Center for Disease Control and Prevention has great potential,” said Ravi Ram of the Kampala Initiative and co-chair of the WHO Civil Society Commission.

Colonial legacies often resulted in the suppression of indigenous healing traditions and the imposition of Western medical paradigms. Ongoing efforts are underway to decolonize global health education by revising curricula to encompass diverse perspectives and local knowledge and experiences.

Dr Agnes Binagwaho.

“First, we educate students to amplify the voice of the marginalised and vulnerable people in the country, the region, the societies, the communities, and families,” Agnes Binagwaho, a former minister of health in Rwanda and the retired vice chancellor of the University of Global Health Equity, told the panel.

“We educate our students inside the communities the most in need in the country. Normally, medical schools are in cities and in the richest part of countries, not where the most needs are for health professionals. On top of that, we put our students in direct contact with local, national, and regional leaders,” Binagwaho said.

However, the idea that decolonisation is only about the Global North versus the Global South was challenged during the panel discussion. Power imbalances in global health extend beyond former colonial powers, reaching into emerging economies where this disconnect poses challenges for policymakers and healthcare organisations.

“India has also been following, in many ways, a colonial mentality toward its development programs,” said Kampala Initiative’s Ram. “We saw that in COVID, where protectionism overruled their public commitment toward sharing vaccines.”

“Brazil is doing the same work in Latin America, using its regional dominance, trade, and other economic factors to dominate smaller states, even within Brazil,” Ram added. “Much of the general and Afro-Brazilian populations have been excluded from the formal health system.”

Proposals to include intellectual property waivers for vaccines during the next pandemic in a potential Pandemic Treaty have run up against sharp resistance from the pharmaceutical industry and rich countries.

The inequities of the COVID-19 vaccine rollout exposed the deep inequities in global health, leading to calls for a decolonisation of the sector and negotiations on international legal instruments like the World Health Organization’s (WHO) Pandemic Treaty.

The WHO’s “zero-draft” treaty proposes that 20% of pandemic-related products, such as vaccines, diagnostics, protective equipment, and therapeutics, be allocated to the organisation, which can then ensure equal distribution.

But the increasing monopolisation of entire economic sectors and various forms of profiteering are threatening to derail the Pandemic Treaty. Vaccine inequity was not solely shaped by perceived colonial division, but also the increasing monopolisation of the healthcare sector by private companies, the panelists said. 

“We’ve seen that member states and international organisations won’t necessarily be representing a national interest in the sense of the public. They’ll be representing a corporate interest,” said Ram. “I want to call attention to what’s happening here in Kenya, where a lot of health service delivery is being increasingly encroached upon by Indian corporates, where the Indian private sector is probably one of the most privatised in the Global South.”

Binagwaho echoed this concern, adding: “Money is controlled by the people who don’t want to change because they benefit from the system they have created over decades, and they’re resisting a lot.

“They have to give up a little, but to change that, we must change the world’s economic structure.”

Image Credits: CC, US Mission Geneva.

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