A new study from researchers at the Yale School of Medicine and the University of Liberia’s College of Health Services has found that hierarchical power imbalances significantly impact global health collaborations in post-war, post-Ebola Liberia.
The study, which explored the experiences of various stakeholders involved in global health initiatives in Liberia, revealed that the power to set priorities for these collaborations was primarily held by high-resource donors, with implementation plans often geared towards meeting their expectations.
“Global health collaborations between high-resource and low-resource settings are inherently complex, often built on hierarchical structures and power differentials that are difficult to change,” said the study’s lead author. “Our findings highlight that these dynamics hinder the potential for equitable partnerships in Liberia and likely elsewhere as well.”
The researchers conducted key informant interviews with participants representing the Liberian government, Liberian academics, foreign donors, and non-governmental organizations.
Through thematic analysis, they identified several factors contributing to the power imbalance, including the donor’s prior history of engagement, as well as the levels of transparency and accountability within the collaborations.
“The power structure tied to financial ownership offers little space for recipients to have an equitable role in these collaborations, which maintains dependence on external aid and ensures that weak systems remain weak,” the authors noted.
While the study was limited to the Liberian context, the researchers believe these dynamics are likely common in similar settings worldwide, underscoring the importance of intentional efforts to ensure equitable decision-making and power structures in global health partnerships.
“There have been many calls and frameworks developed to facilitate more equity within these collaborations, yet little is known about the lived experiences of those working within such partnerships,” the lead author said.
“Our study aims to shed light on these issues and reinforce the need for meaningful change to address the power imbalances that undermine the potential of global health collaborations.”
The study’s findings have been published in a prominent global health journal, sparking calls for a reevaluation of the accountability and transparency within international health partnerships, particularly in low-resource settings.
