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None of the authors of this decolonising roadmap listed an association with an academic institution in a low-and middle-income country (LMIC). They represented two London schools, two NGO organizations based in Geneva, and one from a former colony—Australia. No doubt these authors share a wealth of experience in low- and middle-income countries but the platforms they chose to speak from exemplify some of the best of high-income country Western (Northern?) educational and humanitarian outreach.
The critical inequities they cite include:
• Limiting participation of LMIC experts and community representatives
• Arbitrarily choosing interventions or research topics with little coordination or engagement
• Typically placing European or North American ‘experts’ in leadership positions with minimal experience working in the project setting,
• Basing staff, offices and other resources in high-income countries
• Funding application evaluation panels without or with limited representation from affected communities or stakeholders in which work will be done; grants awarded without due consideration for partnership ethics.
A 15 April 2021 Nature Medicine letter reported, “Not one African institution was named in the press release” when a USD30 million grant for assisting African nations in “improved use of data for decision-making in malaria control and elimination” was announced. 1
Perhaps this BMJ GH editorial is a roadmap for s...
Perhaps this BMJ GH editorial is a roadmap for starting a revised and improved dialogue. When viewed through the lens of the LMIC academic community who often are involved directly or indirectly in projects and especially research, there are additional areas of decolonising that require addressing:
• Trusting and supporting local LMIC stakeholders to initiate projects of value to their communities and to head or co-head those projects including shared authority over funds
• Agreeing to share benefits of projects including (but not limited to)
o equipment, travel support for presentations
o authorship equity, i.e., criteria that is not Western dominated 2, 3
• Ensuring bidirectional visits between HIC and LMIC researchers rather than LMIC stakeholders serving only as hosts
• Encouraging international conferences to be “hybrid” with options for virtual presentations and posters to avoid the financial burdens of air travel, visas, and accommodation while allowing for professional advancement and CV entries (the
Covid-19 pandemic demonstrated the feasibility of the virtual and hybrid meetings)
• Promoting recognition for the vital research and programs initiated and performed by LMIC-based organizations such as African Academy of Science, African Union, and institutions including universities in Nigeria, Ghana, Botswana, South Africa, Uganda, Kenya, Ethiopia, Rwanda, etc.
• Discouraging the push to submit articles to “high-impact” (spell that Western, often proprietary that may charge exorbitant fees for open access) journals rather than encouraging publication in the national or continent-wide journals within the LMICs
• Seeking solutions to attenuate the dominance of English proficiency for communication as well as publications
The road to decolonising global health is long with numerous curves and potholes but the authors of the editorial are clearly thoughtful and intentional in addressing the issues. We appreciate the opportunity to expand the dialogue.
1 Erondu, N.A., Aniebo, I., Kyobutungi, C. , Midega J, Okoro E, Okumu F. Open letter to international funders of science and development in Africa. Nat Med. 2021. https://doi.org/10.1038/s41591-021-01307-8
2 International Committee of Medical Journal Editors. Defining the Role of Authors and Contributors. Available at: http://www.icmje.org/recommendations/browse/roles-and-responsibilities/d.... Accessed 15 April 2021.
3 Tarpley M. Letter to the editor: Honorary authorships in surgical literature. World J Surg. 2020; 44(2):644-645. DOI 10.1007/s00268-019-05261-y.