Equity in Action Blog

Of Legacies in Practice of Global Health Partnerships by Christian Acemah

About 18 months ago, I read an article on death and memory that helped me reflect on the centrality of equity in global health partnerships. The article, in many ways, continues to influence how I interact with colleagues of all stripes, with an emphasis on listening and embedding trustworthiness in each engagement (Nachmanovitch, 2019). Beyond grand projects that involve institutions in different countries, a sense of togetherness and shared purpose elicits our shared humanity. Let me relay some points from that article before delving back into the world of equity global health partnerships.

If you enjoy reading autobiographies, you may have noticed a pervasive aspect of these texts: they emphasize significant events in their authors’ lives as they evolve from late childhood to early adulthood. Moreover, those events seem to conform to what counts as important in the authors’ particular socio-cultural contexts. For example, suppose a specific society prizes education, marriage, family, and a stable job. In that case, an author will most likely tell a story that chronicles discrete events in school, a marriage ceremony, the birth of a child, and a career. What accounts for these tendencies in autobiographies? Two researchers—Travis Cyr and William Hirst—conducted a study to answer this question. They published their findings in 2019 in the Journal of Applied Research in Memory and Cognition.

Cyr & Hirst (2019) wanted to know what type of questions guided autobiographies. They found that participants who answered conventional questions about their lives  (e.g., how did you get to sixty years of age?) followed the formulaic pattern described above. Another group answered a different type of question: which valuable memory would they choose to take with them in death? This question inspired responses that demonstrated what gave participants’ lives meaning, highlighting how they perceived themselves, what added value to their relationships, and hitherto forgotten formative experiences. The choice of memories under this unconventional (death cue) scenario articulated participants’ sense of purpose and put them in touch with their cherished past or obscured selves, unshackled by socio-cultural considerations. In other words, the death cue implicitly asked participants to select their legacies and imagine comfortably living with them for eternity.

So what? Well, the preceding points challenge us, as global health practitioners, to become radically intentional in our approach to the narratives we construct for ourselves, our organizations, and the communities we claim to serve. Instead of asking boring questions about inputs, outputs, outcomes, KPIs, and impacts, we could seek to engage in partnerships that intentionally leave valuable, humanizing legacies. For sure, institutional structures, legal agreements, logic models, theories of change, and impact evaluations have their place. However, reflecting on what infuses our global health lives with meaning and what kind of mark we want to leave on each other as we experiment with “partnership” and “collaboration” models needs to take center stage before we can hope to have equitable global health partnerships.

As the dialogue on decolonizing global health continues (Forsberg & Sundewall, 2023), we have seen a call for values-driven partnerships (Prasad et al., 2022). We have also seen a call for disrupting power dynamics, language, and communicative practices in global health partnerships (Sewankambo et al., 2023). These calls ask us to interact in ways that honor each other. And yet, current global health partnerships rely on arcane and archaic frameworks that preserve the power dynamics between the so-called high-income countries and so-called low-income countries (Gautier et al., 2018; Voller et al., 2022). Sadly, even when the COVID-19 pandemic gave us an opportunity to reset power imbalances and genuinely work together, anti-partnership practices undermined it (Assefa et al., 2021; Gostin et al., 2020). This business-as-usual model will continue to give us the same results as decades past.

What Next?
Away from philosophizing, I have three initial steps for your consideration:

  1. Interaction: As we lead our institutions, we should set the tone for how we act with each other. If those we lead see us listen to each other, give each other the space to speak (i.e., voice), and respect each other on the basis of our context-specific expertise, we will go a long way in eliminating some of the actions that corrode potential partnerships.
  2. Creativity: I have witnessed global health practitioners lose interest in the field and anything to do with partnerships because of all the administrative tasks they do to fulfill the wishes of a funder. These demands stifle imagination and creative professionalism. We all understand work pressures, but we should never let day-to-day operations constrain our aspirations. We occupy a coveted and indispensable position in our field. We do ourselves little good if we cannot balance institutional demands and our aspiration to have equity at the heart of every global health partnership.
  3. Evolving Contexts: We exist in dynamic professional systems. The multiplicity of global health systems gives us almost limitless opportunities to improve our understanding and practice of equity in partnerships. In that way, we will become better versions of ourselves. Our institutions can become better versions of themselves, too. The intentional practice of improving how we enact equity in our daily interactions is the key to unlocking the power of our evolving partnerships. Always ask: What version of me as a global health practitioner do I want to hold onto in eternity?

How strange! What started as a death scenario has emerged as the key to new, more fulfilling, and sustained beginnings for our companies and us. I want to know the version of you that you choose to hold onto for eternity. Let us place a premium on leading intentional, meaningful professional lives. Let us show the world how to take charge of our legacies through our values-driven approach to global health partnerships!

About the Author

Christian Acemah serves as Executive Director (also referred to as Executive Secretary) of the Uganda National Academy of Sciences (UNAS). Previously, Christian was Director for Strategy and Program Development for the U.S. National Academies of Sciences, Engineering, and Medicine (NASEM) Africa program. He was concurrently a Visiting Professor of African Studies and Social Sciences at Quest University, Canada, for six years. Additionally, Christian experienced the internal workings of a global health partnership as Executive Officer, Policy and Research at Gavi, the Vaccine Alliance in Geneva, Switzerland. At the same time, GAVI transitioned from being part of UNICEF to becoming a Swiss foundation. He has worked in the Sudan-Uganda program of the Lutheran World Federation on refugee health and HIV/AIDS M&E. Christian holds a first degree in Mathematics and Philosophy from St. John’s College (Santa Fe, New Mexico), a graduate degree in International Development and Strategy from Georgetown University (Washington, DC), and qualified as an international corporate governance professional through The Chartered Governance Institute of UK and Ireland. He holds a Graduate Certificate in Refugees and Humanitarian Crises from the Institute for the Study of International Migration (ISIM). He delivered the Keynote Speech at the 8th ESTHER Ireland Partnerships Forum. You can find his talk here.

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