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Decolonisation of global health must include civil society. Power and resource imbalances experienced by African non-government organisations must be remedied to ensure that people with lived experience in the global south can participate meaningfully in creating healthcare policy and practice, write Kwanele Asante, Francis Chinegwundoh, and Rachel Hammonds

The pre-eminent global health organisation, the World Health Organization, models respectful and substantive engagement. It has convened over 200 advocates with lived experience from 60 countries to inform a global declaration on NCDs and mental health to be endorsed by states at September’s general assembly.5 6 WHO recognises the importance of self-determination as a catalyst for decolonisation and prioritises the right of local communities and countries to identify their own health priorities and develop local solutions for them.7 The 2023 WHO framework on meaningful engagement with people living with NCDs, mental health and neurological conditions is a guide to implementation of participatory approaches.3 8 The Africa NCDs Network has adapted the framework for use in African contexts, with a plan initiated and co-created through consultations with African people with lived experience.9 Other NGOs should follow this guidance. Inadequate engagement with people with lived experience and insufficient co-creation of advocacy and policy interventions perpetuates African and global health inequities. Amazingly, meetings about African health are being held outside Africa (for example, Harvard Chan’s annual Africa health conference10) instead of promoting Africa based global south leadership and maximising the equitable and diverse inclusion of people affected.

In addition, international NGOs have Western biomedicine as a cornerstone, displacing Indigenous health knowledge and practices in colonised countries.11 Although most Africans entwine biomedical and traditional approaches to health,12 knowledge hierarchies persist,13 adversely affecting health behaviour and outcomes.14 Truly holistic and comprehensive healthcare requires merging biomedical and traditional healing models, and international NGOs should ensure their work reflects this.12 15 For example, culturally sensitive and effective HIV/AIDS prevention and treatment strategies in South Africa, including respecting traditional health practices such as using herbal remedies in the safe management of patients.12 14 15 16 Greater partnership with African academic and health institutions to acquire regional health information and develop knowledge is crucial for international NGOs to move away from reliance on institutions and expertise about Africa in the global north. People with lived experience should be represented at all organisational levels of NGOs, including in governance and executive boards, and African representation in international NGOs is vital. The free online PxP conference (“for patients, by patients”), which is wholly patient led and supported by the Canadian Institutes of Health Research, offers a model for partnership defined by respectful inclusion and diversity.17 This year’s annually appointed steering committee has 12 members—six from global south countries, including two from Africa. Participants receive honorariums, and roles are remunerated.

Ultimately, international NGOs must share power and resources more equitably with counterparts in the global south. Africa based NGOs experience inequities in funding, knowledge, and technical skills. For example, of $9bn funding from US foundations spent in Africa in 2011-15, just 5.9% went to local organisations.18 And NGOs in the global north received 58% of 202 large grants for work in Africa in 2010-19; African NGOs received just 20%.18 Funding is increasingly uncertain, with 70% cuts in international aid to Africa between 2021 and 2025 and recent withdrawal of US development aid.19 20 Some African NGOs have claimed that they put more effort in to get funding compared with organisations based in the US and UK and blame lack of trust from donors. Of 49 African NGO leaders surveyed, 45% indicated that unconscious biases or geographical or racial prejudices were inhibiting funding reaching their organisations.21 African institutions need to take more leadership for funding local NGOs, with a focus on developing capacity and skills.17 African states should recommit to their 2001 pledge to raise health spending to 15% of annual budgets; almost all continue to fall short.22 Regional organisations like the African Philanthropy Forum and the African Development Bank should provide more support to African health NGOs to ensure they receive more sustainable funding; the money is there.23 The private sector should be incentivised to increase funding to African NGOs through corporate social investment, corporate social responsibility, and corporate foundations.

frican Development Bank should provide more support to African health NGOs to ensure they receive more sustainable funding; the money is there.23 The private sector should be incentivised to increase funding to African NGOs through corporate social investment, corporate social responsibility, and corporate foundations. Finally, lived experience must be considered a form of expertise, and WHO recommends payment parity with technical experts.3 Fair remuneration from all NGOs is essential for African patient partners to participate in health decision making that affects them and their communities.24