Recently, Dr. Ngozi Erondu and colleagues wrote an open letter in the journal Nature Medicine, which called out international funders of science and development in Africa and has pledged better ways of funding for malaria programs and initiatives.
They referenced a recent announcement of a US$30 million grant awarded to the nonprofit health organization PATH by the US government's President's Malaria Initiative (PMI). This grant funded several institutions in the USA, the UK and Australia to support African countries in malaria control and elimination, and not a single African institution was included.
It is commendable that PMI has responded, saying that communities should be directly involved in addressing the problems that affect them and acknowledged the roles of local institutions such as universities, NGOs, businesses, and civil society organisations. However, we expect more international donors to come out with official statements and state clearly how they intend to decolonize global health.
If global health by its nature addresses issues such as health inequalities and inequities, it is most ironic that the funding and administrative structures that enable activities in the sector are steeped in similar inequities driven by supremacy. Clearly, that culture must change.
Bringing about this necessary change will not rely on efforts by international funding organizations alone. Vital stakeholders in this discussion would include African national governments and the African Union.
Both have critical roles to play in conceptualization, funding, implementation, monitoring, evaluation, and sustainability of global health programs. The mostly passive stance African governments have had to maintain in the sourcing of COVID-19 vaccines is just one example of how important it is for governments on the continent to become more active in taking ownership of such development structures.
Consequently, we expect the following from the African Union (AU) and its member states.
Firstly, funding and administrative decisions for international aid initiatives should be made in consultation with the destination country government and the AU. With the implementation of African Continental Free Trade Area (AfCTFA), there is no better opportunity for trade coordination among member states. Global health programs require commodities and human resources, and by collaborating with national governments and the AU, movements of vital resources can be facilitated towards capacity-building and sustainable development on the continent.
Secondly, the AU and member states must prioritize building local capacity of individual researchers, program specialists and institutions. There should be a clearly defined percentage of consortium members that should come from the destination country. We recommend a minimum of 20%. Additionally, such aid would facilitate knowledge transfer if it were clearly stipulated in the agreements that the consortium would need to collaborate with African universities.
To further strengthen the development of local capacity, the heads of the consortium should ideally be native of the destination country, ensuring that a pipeline of skilled researchers and specialists are continually supported and enabled to lead global health and development programs on the continent, build a reputable portfolio of capacity and develop robust networks.
Lastly, African governments must deal with corruption by blocking illicit financial flows. Africa loses US$50 billion yearly to corruption, amounting to nearly 75% of the continent's health financing gap. Illicit financial flows such as mis‑invoicing, tax fraud, and money‑laundering are linked to criminal activities which fuel conflict and instability.
Corruption also drains the resources that are urgently needed for infrastructure, health security, economic and social development. Foreign governments must join in the effort to address corruption, and when stolen funds are repatriated, they must be channeled towards improving health, education, and other social determinants of health.
According to Erondu and her colleagues, "There is a way to create equitable and dignified partnerships and to defeat the diseases that threaten everyone."
Several years ago, Bill Gates, on a visit to Nigeria urged the federal government to prioritize investments in health and education to ensure sustained prosperity. This advice is certainly valid for most countries in the region.
Needs are infinite but resources are limited. African leaders by leaning in, restructuring partnership conversations and taking greater responsibility for the funding of some of these global health programs is a way to ensure dignity for our people.
Donor fatigue has always been a thing but is currently being amplified by the devastations wreaked by COVID-19. For how long can African nations keep depending on the global north to fund our health systems? Our guess is not for much longer.
Dr. Ifeanyi M. Nsofor is the CEO of EpiAFRIC and Director of Policy and Advocacy at Nigeria health Watch. He is a senior Atlantic Fellow for Health Equity at George Washington University and a senior New Voices Fellow at the Aspen Institute. You can follow Ifeanyi @ekemma on Twitter.
Dr Adaeze Oreh is a Consultant Family Physician and Country Head of Planning, Research and Statistics for Nigeria’s National Blood Transfusion Service who led a PEPFAR-funded Ministry of Health project between 2009 and 2014. She is also an Amujae Leader and Senior Fellow for Global Health with the Aspen Institute in Washington D.C. You. can follow Adaeze @Adaeze_Oreh on Twitter.