What actions and strategies are required for countries and communities to have more agency in their health?

This is the topic of the latest episode of the Global Health Matters “Dialogues” podcast series, in which host Dr. Garry Aslanyan tries to “blow up some of the echo chambers that exist in global health.”

In this episode, he talks with Olusoji Adeyi, a seasoned Nigerian global health practitioner who has held many prominent leadership positions, about overhauling the existing power dynamics in global health.

“Aid is still used as a lever to exert power over nations at times,” Aslanyan said.

Adeyi proposed six essential changes to turn the situation around.

No. 1—Have clarity of purpose.

No. 2—Consider the needs, realities, and interests of recipient countries as the starting point for any deliberation.

No. 3—Emphasise learning.

“All too often, it’s almost as if principal actors in global health resist learning because such learning might threaten the status quo,” said Adeyi. “When it threatens the status quo, it threatens the current imbalance. And so it’s shut down or suffocated.”

No. 4—Overhaul the legacy foreign aid paradigm, including ending aid for basic health services and commodities and goods.

“This is not a call for an abrupt cessation today,” Adeyi stressed, “but it ought to be done, say by the year 2030, that’s a six to seven-year period so that there’s a finite date in sight and there is a transition out of it, with exceptions only for say countries at war, because then we’re talking about humanitarian purposes or countries that have suffered sudden and devastating natural disasters. Those would be sensible exceptions there.”

No. 5—End the current practice of technical assistance so that the aid given via technical assistance is no longer tied to the source of financing for that technical assistance.

No. 6—Developing/improving/supporting mission-critical institutions in low- and lower-middle-income countries.

Systemic Flaws in Vaccine Distribution

Adeyi highlighted the vaccine distribution process during the COVID-19 pandemic as a prime illustration of systemic flaws. He told Aslanyan that during the pandemic’s peak, “a few individuals convened at Davos and hastily drafted what would essentially become global policy for distributing COVID-19 vaccines and related technologies to low- and middle-income nations.”

Those initial sketches materialized into ACT-A for accelerated access to COVID technologies and COVAX, managed by Gavi. Consequently, during the pandemic’s peak, high-income nations stockpiled vaccines, leaving African countries in a predicament where even those countries that wanted to buy vaccines had to rely on donations rather than purchase vaccines themselves.

“If you go to buy a car, a computer, or a pair of shoes, you are empowered as the buyer,” Adeyi explained. “But if you are waiting for somebody to donate a car, a pair of shoes, or a computer to you, you are disempowered, and you are at the mercy of the donor. And, of course, COVID did not live up to the hype.

“If you had accountable leadership, they would acknowledge that failure and find ways to do better,” he continued. “But the leadership of Gavi did the exact opposite by claiming they had established a blueprint for how to get vaccines to poor people in an emergency, which was just the exact opposite of what had happened.”

Adeyi said that this illustrates how significant power imbalances result in policies, decisions, and practices that counter the interests of those intended to benefit.

Previous “Dialogues” episode: A Conversation with Daisy Hernández.

Listen to previous episodes of Global Health Matters on Health Policy Watch.

Image Credits: Screenshot, Global Health Matters Podcast.