A recently published letter by a group of prominent African scientists and health practitioners to international funders has reignited a conversation over the funding models used by western governments and global health institutions for the continent.
In January, the global nonprofit PATH, which is headquartered in the US, announced it had been chosen by the US President’s Malaria Initiative to lead a $30 million malaria project in Africa. Seven other institutions in the US, the UK and Australia were listed as partners in the initiative, including the London School of Hygiene & Tropical Medicine and departments at Harvard and MIT.
While these groups all collaborate with African research institutions, the fact that not one of the lead organizations on the project was based primarily in Africa took some aback.
In response, six health experts, who work as scientists, policy analysts, public-health practitioners, and academics for African and western organizations, published an open letter in the scientific journal Nature calling for international funders of science and development to make their policies and practices more just and inclusive for their target populations.
“The past year has been full of calls from staff and collaborators of various public-health entities for equality and inclusion, so one might imagine that such a partnership to support Africa should be led from Africa by African scientists, partnering with Western institutions where appropriate, especially where capacity has been demonstrated,” the letter says.
Funding power dynamics
Local communities in Africa have increasingly criticized global health projects in which they are largely the beneficiaries of medical interventions and research, but not the decision-makers or partners.
The project in question is a five-year operational research and program evaluation project to help partner countries fight malaria, which still kills hundreds of thousands of people in Africa each year (PATH works in 24 African countries, and has three programs in southeast Asia).
But, the letter says, funding models such of this PATH-led initiative hand western organizations the power to determine the delivery of health interventions, and in the process risk weakening local health systems and capacity.
It notes that there are African institutions with “excellent capabilities” in malaria work, for example, such as Kenya’s KEMRI-Wellcome Trust.
One of the letter’s authors, Ngozi Erondu, is a senior scholar at the O’Neill Institute for National and Global Health Law, who has advised African governments and institutions on the capacity required to control infectious diseases. She says paying western institutions to oversee African institutions creates an unequal power dynamic.
“You can’t have shared decision-making when one person works for someone else, and so if they’re really investing locally it needs to be direct investment,” Erondu says.
To strengthen local research efforts, the letter writers argue, decisions about major funding initiatives should be led by local scientists, researchers, health ministries and national disease-control programs.
“Omitting African institutions from leadership roles and relegating them to recipients of ‘capacity strengthening’ ignores the agency these institutions have, their existing capacity, the value of their lived experience and their permanence and close proximity to policy-makers,” they write.
PMI responded to the letter by acknowledging that local communities should be directly involved in addressing the problems that affect them. The initiative said it’s working on a new strategy that prioritizes investing more in local leaders, researchers, and organizations, and that it will soon publicize the draft strategy for comment.
“We haven’t done enough in working directly with local institutions. And we want to do more,” it says.
Calls to “decolonize” global health
The letter from the experts references a movement in the last few years to “decolonize” different sectors of education and knowledge, from university curricula to philosophy. The group argues that the current model of public health funding gives western institutions power over knowledge, influencing the health systems of low-income countries in way that could result in racial and structural inequities.
This has also manifested in research, with many facilities funded by the West and having to ascribe to their priorities, Gerald Mboowa, a bioinformatics researcher at the Makerere University in Uganda and infectious disease specialist, recently told Quartz. Mboowa believes that this is one of the reasons, in addition to the lack of government-funded research projects, that African countries have yet to develop their own Covid-19 vaccine.
“African researchers generate data for these funders which is then used to manufacture value-added innovations [and] products that again get sold back to the continent,” Mboowa says.
Erondu says that African institutions such as the African Union, the African Academy of Sciences, and the African CDC also have a role to play in changing this narrative. These include setting regional standards for fair partnerships with international funders, and encouraging African governments to increase their domestic spending in health public health and health research.
“There is a way to create equitable and dignified partnerships and to defeat the diseases that threaten everyone,” the letter writers say.
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