Letters to the Global Health community from African students and young professionals (part 2)

By guest contributors Kumbirai Trish Kujeke (Ms), Zahra A Fazal (Ms), and Prince Adu (Ms, PhD) on behalf of the African Diaspora Public Health working group

In our first letter, we highlighted the inequities that continue to sideline African voices in global health – from conferences to publications and leadership roles. In this letter, we aim to explore areas where further decolonization efforts are needed, while also recognizing the significant progress that Africa and the Global South have made in redefining their role in global health.

As individuals who have navigated the complexities of balancing our Global South lived experiences with working in Global North-led research projects, we recognize that while decolonization begins with demands for inclusion, it cannot succeed without meaningful structural change from within. Conversations on this topic often center on the actions of the Global North due to its control over resources and influence in global health. The hyper fixation on the view that change must come from the North reinforces a colonial mindset, casting the Global South as a passive actor and a perpetual victim incapable of solving its own problems. Decolonization necessitates proactive measures beyond merely relying on the Global North to make accommodations;  it demands that African nations shift the focus towards self-determination. By asserting leadership, strengthening local systems, investing in local talent, and reclaiming financial sovereignty, African nations can redefine their role within the global health system.

Investing in Local Talent and Retaining Expertise

As part of its decolonization project, Africa must prioritize building capacity by investing in local talent and expertise. A significant challenge to this effort is the persistent brain drain where highly skilled African professionals trained at better-resourced institutions in the North remain abroad post-graduation to gain the best returns on their educational investment. Compared to the Global South, the North offers higher salaries, more opportunities for career progression and stable research environments, making it difficult for African nations to retain or reclaim young professionals. The loss of skilled professionals represents missed opportunities for the African continent to leverage the expertise of their citizens in solving local issues and strengthening health systems. To incentivize skilled professionals and graduates abroad to return, African nations must focus on creating competitive work environments characterized by competitive salaries, sustainable research funding, strong mentorship, and career advancement opportunities that align with global standards. Additionally, African nations could mobilise their nationals in the diaspora to contribute to the development of their home countries’ health system through short-term assignments or remote collaborations. For example, the Diaspora Engagement in the Rwandan Health Sector project has harnessed the technical skills and knowledge of the Rwandan diaspora in Europe, thereby strategically filling domestic gaps in the healthcare sector. Through such initiatives, African nations can better position themselves to retain and benefit from their talent, ultimately driving sustainable progress in global health.

Achieving Financial Autonomy in Global Health

With the sudden withdrawal of foreign aid  from African initiatives, the urgency for financial self-reliance in global health funding has never been clearer. While external funding has played a crucial role in improving disease control, healthcare infrastructure and research, overdependence leaves African countries vulnerable to shifting geopolitical interests and donor priorities. Moreover, donor-driven funding often comes with external agendas which, at times, misalign with the most pressing health needs and values. To break away from this cycle, African leadership must take decisive action in two areas. First, leaders must assert strict funding criteria which ensures that external investments align with national health strategies rather than dictate them. Having set the terms of engagement with external funders based on local priorities, African leaders can potentially drive the health agenda to ensure funding is allocated where it is most needed. Second, African countries must focus on achieving financial autonomy through local resources, public-private partnerships and strategic intra-continental collaborations. Countries must explore innovative financing models, such as taxation mechanisms, health bonds, and regional funding pools, to build resilient health systems that are not solely dependent on foreign aid. Over time, as Africa’s financial capacity and stability grows, reliance on external funding with strings attached can be reduced, positioning Africa as a leader in tackling its health-related issues.

In recent years, Africa and the Global South have made significant strides in redefining their role in decolonizing global health by fostering self-reliance in key sectors. In the realm of research and publications, several African nations have established their own academic journals, promoting locally driven research and ensuring that knowledge produced within the continent is accessible without the financial barriers often imposed by international publication fees. For instance, African Journals Online (AJOL) hosts 223 such journals, increasing the visibility of African research. Additionally, initiatives like the ‘Collaboration for Sustainable Open Access Publishing in Africa‘ project aim to strengthen the quality and sustainability of these journals, further supporting in-country data ownership. This approach not only enhances in-country data ownership but also amplifies African voices in global health discourse. In pharmaceutical development, the establishment of the African Medicines Agency (AMA) in 2021 marks a critical step toward regulating and overseeing drug production within the continent. Additionally, institutions like South Africa’s Biovac Institute are advancing local vaccine production, exemplifying efforts to expand the manufacturing of vaccines, diagnostics, and essential medicines across multiple countries. These initiatives collectively strengthen Africa’s ability to shape its healthcare landscape, shifting the narrative from dependency to leadership in global health innovation.

To build on these advancements, it is crucial to recognize that decolonizing global health is not merely a choice-it is an urgent necessity for Africa. The path forward demands a bold commitment to recognizing and harnessing the continent’s own human and financial resources. Africa’s diaspora holds vast potential which can be leveraged to build Africa’s health system. At the same time, the external funding Africa continues to receive needs to be redirected with strict criteria to local priorities while local financial mechanisms are being developed to reduce over-dependence on the Global North. Africa has the talent, expertise, human capital and resources to build resilient health systems. The real question is whether we have the political will and leadership to usher in a new era of health sovereignty.

About the authors:

Kumbirai (Trish) Kujeke is a Zimbabwean life-long learner who holds a MSc in Global Health Policy from the University of Edinburgh and a BSc in Global Health and Nutrition from the University of British Columbia. She was awarded the Mastercard Foundation Scholarship twice to pursue both degrees. Trish has collaborated with global health and international development leaders on research and initiatives focused on health equity in Sub Saharan Africa, Indonesia, and Canada. She is a founding member of the African Diaspora Public Health Working Group. Outside of work, you will find her connecting with her community, taking workout classes, exploring nature, trying new herbal teas and singing.

Zahra Fazal is from Morogoro, Tanzania and has a Msc. in Epidemiology and Clinical research from Stanford School of Medicine and a Bsc. in Global health from the University of British Columbia (UBC). She was a Knight-Hennessey and Karen McKellin International Leader of Tomorrow scholar. Zahra has led mixed-methods research on health inequities amongst under-served populations within Sub-Saharan Africa, Canada and the United States. She is the founder for the African Diaspora Public health working group and in her free time enjoys rock climbing, gardening, crocheting and being outdoors.

Prince Adu Ph.D. is an Assistant Professor at Ohio University Heritage College of Osteopathic Medicine, Dublin, OH. His research focuses on the structural determinants of health, using both quantitative and qualitative approaches to examine how systemic inequities shape disease patterns-particularly among minority and under-served populations. With expertise in health equity, epidemiology, and policy development, his work spans multiple global contexts, including Canada, the United States, Ecuador, Ghana, Mozambique, Zimbabwe, and South Africa. When he is not working, Prince enjoys cooking, listening to music and playing football (soccer).

Editor biography:

Aisha Zerbo is an Ivorian-Burkinabé Research Specialist with a Masters of Public Health from the University of British Columbia, specialising in Epidemiology and Biostatistics. She has led numerous and published numerous articles in the fields of global health, public health and clinical health. Her passions lie in the realm of health equity and knowledge translation to ensure accessible knowledge to all demographics, especially within the Global South. When she is not working as a Research Specialist, she is attending school to complete her certificate in Graphic Design and Visual Communications, an asset she hopes to apply within the field of public health.

Disclaimer: Views expressed by contributors are solely those of individual contributors, and not necessarily those of PLOS.