Decolonization of global health is not a future event. This journey started decades ago, before use of the term was common or the development sector saw the concept as disruptive. The goals of diversity, equity and inclusion (DEI) have been a major catalyst for the shift, with new voices and local viewpoints being elevated to create sustainable change and accomplish many of the targets we have set for global development. While host country nationals are now taking on greater responsibility in their organizations, more can be done to take full advantage of the benefits of diversity and the potential of decolonization.
Move toward locally led development
Only 14 years ago, I worked for a project where the 17 leadership positions included only one host country national — a common and costly occurrence among international nongovernmental organizations. Funders have since invested millions of dollars in training host country national staff. The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) alone has trained more than 290,000 health care workers since 2003, the majority in sub-Saharan Africa.
Affordable distance-based education programs have increased the pool of local staff with advanced degrees from Global North institutions. Over time, leadership positions historically reserved for expatriates have been filled by equally capable local experts without compromising program performance (expatriates still contribute in more discreet, complementary roles within programs). This is more cost-efficient, more appropriate and more sustainable. As a result, funders increasingly prefer proposals with a team of experienced host country national experts.
Diversify senior leadership
Lack of diversity is also reflected in the makeup of boards and senior executive teams — powerful bodies whose decisions affect strategic direction, organizational priorities and resource allocation. While more should be done to diversify the top levels of organizations, there have already been encouraging shifts toward the presence of more host country nationals in regional and country leadership, where they are exposed to and have a voice in corporate task teams, strategic meetings and regional priority-setting. More importantly, by attending international conferences and workshops, they expand their network of clients, high-level ministry officials and peers — a critical foundation for assuming corporate responsibilities and advancing in their careers.
Increase scholarly activities
Evidence generated through research has an important role in setting the agenda for global development, and publication in peer-reviewed journals is often required for career advancement. The acceptance of manuscripts by those journals is largely influenced by who the primary author is and with whom they co-author. While experts from the Global South have been sorely underrepresented over the years, the number of published scientists from these countries is increasing, in part due to the growing number of regional and online journals. Still, there must be more opportunities for these experts to be lead researchers and not be relegated to co-authorship. Meanwhile, the number of host country nationals in attendance at international conferences is growing even faster, as virtual events remove cost barriers and increase access to professional development.
Overcome the scarcity mindset
In my conversations with colleagues and friends, I find wide agreement on the principles of decolonization — but the term itself is often controversial. For many (especially for those from the Global South, where this movement originated), decolonization conveys the desire to break free from unsustainable dependence on external support and dictates from outside (Global North) power structures and culture. The celebration of Indigenous expertise, knowledge and history and the sharing and redistribution of resources are the underpinning motivations of most decolonization champions. Yet their motives are lost on those operating with a “scarcity” mindset, who feel that there are winners on one side and losers on the other. Discomfort ranges from “I didn’t colonize any country” to the dismissive “It’s a political concept” to the scarcity-minded “Will I still have a job?”
All the same, we development professionals must get comfortable with our discomfort and examine our biases to become more effective in our work. Decolonization is here to stay, and we can expect its acceleration. Access to digital technology will increase awareness of inequalities, host countries will limit the number of expatriates through visa restrictions and other policies, and funders will incentivize hiring host country nationals in leadership positions. It is good, cost-efficient business. The progress and positive outcomes of the past decades suggest that there is nothing to fear: These are the necessary steps toward the more diverse, equitable and inclusive development environment that will create lasting change.