Hanson-DeFusco, J., et al. (2023).
International Studies Perspectives.
Abstract
Billions in development aid is provided annually by international donors in the Majority World, much of which funds health equity. Yet, common neocolonial practices persist in development that compromise what is done in the name of well-intentioned policymaking and programming. Based on a qualitative analysis of fifteen case studies presented at a 2022 conference, this research examines trends involving unethical partnerships, policies, and practices in contemporary global health. The analysis identifies major modern-day issues of harmful policy and programming in international aid. Core issues include inequitable partnerships between and representation of international stakeholders and national actors, abuse of staff and unequal treatment, and new forms of microaggressive practices by Minority World entities on low-/middle-income nations (LMICs), made vulnerable by severe poverty and instability. When present, these issues often exacerbate institutionalized discrimination, hostile work environments, ethnocentrism, and poor sustainability in development. These unbalanced systems perpetuate a negative development culture and can place those willing to speak out at risk. At a time when the world faces increased threats including global warming and new health crises, development and global health policy and practice must evolve through inclusive dialogue and collaborative effort.
Here are some thoughts:
Neocolonialism continues to shape global health and development practices, perpetuating unethical partnerships and power imbalances between high-income countries (HICs) and low- and middle-income countries (LMICs). Despite progress, subtle forms of discrimination and exploitation persist, undermining program effectiveness and exacerbating existing inequalities. The research highlights how these practices manifest across the policy cycle, from problem definition to evaluation, often sidelining local expertise and cultural context.
Key issues include limited inclusion of LMIC actors in decision-making processes, the application of one-size-fits-all solutions, and the marginalization of local professionals. Case studies illustrate these problems, such as the promotion of mass male circumcision for HIV prevention in Africa without adequate local input, and the exploitation of African researchers at the Kenya Medical Research Institute.
The consequences of these unethical practices are significant, creating hostile work environments for LMIC professionals, hindering the development of local expertise, and ultimately compromising the sustainability and effectiveness of global health initiatives. To address these challenges, the research recommends open dialogue about power dynamics, internal audits of organizational practices, increased investment in LMIC staff development, and prioritization of local leadership.
Decolonizing global health requires a paradigm shift in how partnerships are formed and maintained. This involves recognizing non-Western forms of knowledge, acknowledging discrimination, and disrupting colonial structures that influence healthcare access. Educators and practitioners from HICs must immerse themselves in the communities they serve, promote cultural safety, and work closely with local partners to develop appropriate ethical frameworks.
Ultimately, the goal is to move towards a more equitable and effective approach to global health that genuinely benefits the communities it aims to serve. This requires a commitment to authentic collaboration, sustainable change, and meaningful inclusion of LMIC voices at all levels of global health work.
