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Global Health Econ Sustain Decolonization of health care

encouraged to seek greater representation on the editorial whom there would be no story to tell. However, it is well
boards of influential journals. Indeed, not only editorial documented that this is not always the case. As recently
support but positive discrimination should be considered as 2021, the proposed Spectrum 10K study came under
(Clark et al., 2023). heavy criticism for not including sufficient input from the
autistic community within its construct, leading to a 2-year
There was an inevitable dependency on remote access
during the COVID-19 pandemic, which left many Africans voluntary pause for detailed consultation (Sanderson,
2021). The invited involvement of patients and academics
struggling to remain involved due to unreliable internet to help design and complete studies relevant to them is
access (Tremblay et al., 2021) or unavailable electronic surely self-evident. Such an approach is essential if the work
devices (Makri, 2019). Colonialism continues to influence is to be relevant and credible, and this approach facilitates
the structure and function of health-care systems in East a wider distribution of relevant information among those
Africa, persisting long after other legacies have left (Yanful to whom the study recommendations apply. This principle
et al., 2023). COVID-19 was only the latest in a series of is commended wherever possible for all people-based
African epidemics, following hot on the heels of the Ebola research as required by patient and public involvement
crisis, which was related to chronic underfunding of the (PPI) (Jackson et al., 2020). Recent practical resources
health-care system, with funds previously prioritized for facilitating the widespread adoption of these principles are
profitable mining operations (Frankfurter et al., 2019). now published (Arumugam et al., 2023).
This hints at the heart of the issue. European guidelines
for maternity and antenatal services recommend access 7. Future priorities
to hospital support services for all (European Foundation
for Care of Newborn Infants, 2018), whereas global A change in the balance of power is required with the
guidelines in Africa accept a much more basic level of evolution of an “equal access to health care for all”
philosophy (Basu et al., 2017). The Global North must learn
care, leading to difficulties in transportation to the hospital to work in partnership with Africans on their terms and in
if complications arise (the World Health Organization their own environment (Victora & Moreira, 2006). Clear
2009). As Yanful et al. (2023, p. 380) state, “Highlighting outcome measures must be discussed and agreed upon,
such double standards may push health systems to change with an expectation of mutual knowledge exchange (Hedt-
course, develop innovative solutions to facilitate access Gauthier et al., 2019). Practical, affordable, and culturally
to comprehensive services before labor begins, and help acceptable change must be considered in the context of a
achieve more equitable and effective systems.” Most African sound evidence base, with lessons learned shared with the
countries, including Tanzania, can only spend about population from whence the data were derived (Bhakuni
US$100 – 200/person/year on health, while the UK invests and Abimbola, 2021). Indeed, given that PPI has become
US$4000 – 5000/person/year into their health care (Wirtz ingrained in the philosophy adopted by clinical researchers
et al., 2016). A global and common health-care standard in the Global North, why should Africans accept anything
may appear fanciful at present, but a hard-hitting article less? At a teaching level, too, a change in approach is
on racism in maternal care argues otherwise. Catalao et al. overdue. Perhaps the curriculum should include a reflection
(2022) suggest that new approaches are needed to tackle on the nature of colonialism and its effects on present-day
the root causes of race inequalities in this area, as they are societal structures and related health-care priorities (Skopec
a direct consequence of both historic and current colonial et al., 2020)? On a positive note, the introduction of newer
policies. technologies, such as point-of-care ultrasonography into the
Although this paper focuses chiefly on decolonization emergency departments, does save lives and is now being
and its specific application to health care, it seems taught in several LMICs in East Africa (Trovato et al., 2016).
appropriate to reference the EDIJ agenda and other Clinical research studies on novel pharmaceutical
disadvantaged groups. Disability can be associated with agents primarily use data derived from populations in
reduced representation in academic circles (Lewis, the Global North, with few participants of African origin.
2022), and diversity may be underrepresented among Given such historically low representation in clinical
senior academics (Von Below et al., 2021). The parallel studies, it is hardly surprising that African countries and
with the challenges faced by many people of color is their people might be skeptical about replacing their more
apparent. It seems self-evident that the motto “nothing traditional approaches to treating illness with drugs that
about us without us” (Charlton, 1998) should be applied have not been proven efficacious in the African population.
equally to all minority groups under the EDIJ banner, Future studies should actively recruit participants from all
and that academic proposals should invite, involve, and populations to which drugs are subsequently likely to be
include those on whom the research focuses and without marketed or made available.

Volume 2 Issue 2 (2024) 6 https://doi.org/10.36922/ghes.2299