Decolonising global health in the Global South by the Global South: Turning the lens inward

The authors write this piece as a Global South-based global surgery researcher, educator and practitioner in India (DS), and as a Global South-based global health researcher, educator and practitioner in West Africa (NAS-A). We have attempted to write this outside of the foreign gaze; our pose and the gaze we write for is the Global South.10

We have observed that there is relatively little depiction of the Global South’s role in perpetuating coloniality and of its responsibilities in promoting decolonisation within its own geography. While the impact of colonisation, coloniality and neocolonisation from the Global North is appropriately a major focus, it is not sufficient to fully achieve the aspirations for decolonisation in global health.2–4 We, the Global South, appear to be waiting somewhat passively for the rising tide of decolonisation initiatives from the Global North to lift all boats, rather than actively partnering in, or leading the process. Individuals, communities and countries in the Global South need to turn the lens of decolonisation inward and scrutinise their own errors of omission and commission at the ‘local Global South’ level (figure 1).3

Granted, resource constraints in LMICs of the Global South can hamper decolonsation initiatives and limit sustainment. However, we believe that major reasons for the paucity of ‘local Global South’ discussion and action on decolonisation are that (1) we have not educated ourselves appropriately on the ‘what’ and ‘why’ of decolonisation for our purpose and (2) we have not done enough introspection into our roles in perpetuating coloniality in global health in the postcolonial era. Decolonisation responsibilities for Global South personnel working in global health research, education or practice are not trivial and are worth considering for action, because (1) Global North-led initiatives will be more likely to be pragmatic and uphold the status quo11 and (2) Global South-led initiatives promote Global South ownership, which is more likely to drive aspirations that bring about fundamental change.2 12

From industry, we borrow the Four Actions Framework,13 which guides business organisations to identify and address internal bottlenecks to optimising product innovation, value and affordability. For this paper, we consider decolonisation the ideal ‘product’, and the ‘internal bottlenecks’ are coloniality of thinking and actions in global health by the Global South within its own ‘organisation’.