Global health research suffers from a power imbalance

Want to save time? These two paragraphs pretty much summarize this long opinion editorial.

Hierarchical relationships, especially those between people from the Global North and Global South, are not mutually beneficial or fair. Based on our personal experiences and research as public health researchers, statisticians and social scientists, we believe that cultural humility and equitable partnerships are key to effective global health projects.

> Mentorship environments characterized by humility and co-learning can help researchers break free from historical power imbalances. This includes acknowledging and valuing the unique perspectives and experiences of scholars from local regions.

So some finger-pointing at Global North's colonial mindset.

BUT

I've read recent reports and studies over problems faced in Global South healthcare systems . . . from practitioners in-country, themselves; and not from a university think tank. I have found five of them.

Want to know what they say the problems are?

First: Abandonment; once trained or semi-trained, they leave for other countries. Due to more pay and more opportunities.

Second: A shortage of basic supplies, largely due to theft. (Hard to put it any way other than bluntly). Equipment is there at the end of shift one day, and is missing the beginning of the next one. And local police show little interest in finding it.

Third: Increased work loads and burnout, due to medicos leaving the country once trained (see above).

Fourth: Government-imposed restrictions on trained personnel - with their families - leaving the country (see above). So government demands guarrantees that you will return, including requiring some substantial capital as a guarantee of returning.

Fifth: Prescribed minimum health benefits for the general population, for many countries, is extremely ill-defined in law and regulation (intentionally, so many say), creating huge grey areas of non-eligibility for services, based on criteria that sometimes literally changes hour-by-hour. Along with growing pressure to enroll in a pay-as-you-go politicized parallel healthcare system.

Sixth: Lop-sided deployment of the workforce in terms of geographical location. You can have a critical health provider shortage in one regional city, while the regional city next to it is swarming with personnel of all types (many will tell you that the regional politics is to blame).

Seventh: The central government is not stable, so their supervision of healthcare suffers from maladministration, is sporadic, and is very unstable.

Eighth: Corruption and wasteful expenditures. Biggest reason cited overall. Hard to develop any systems of quality and dependability, when resources are constantly funneled off to support a corrupt government that needs money to stay in power. But also local hospitals and clinics must pay armed factions money for ‘protection,’ so ‘nothing bad happens to them.’

Ninth: Sudden inflows of refugees from war-torn countries or regions . Just about the time health administrators start to see light at the end of the tunnel, there comes tens or hundreds of thousands of people escaping regional tribal conflict or battles where government troops are suppressing local uprisings.

There is more, but these are the problems-in-common going on now around Global South.

Now . . . what is Global North supposed to do to cure all of this?

As of October 2023, although over 95% of available doses have been used, less than 52% of the population is fully vaccinated.

Is this supposed to be a bad thing?