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Decolonial thought and African consciousness for socially just health systems: An imaginative space

Decolonial thought and African consciousness for socially just health systems: An imaginative space

By Lance Louskieter
on August 20, 2020

Decolonizing health in Africa is a conscientization project, historical and political in nature, that calls for a (k)new language and (k)new ways of being as thinkers and practitioners.

On the 30th September 2020, 1st and 2nd October 2020, we plan to host a virtual Africa convening  to have a conversation about decoloniality in the broader field of Global Health. The purpose of the convening is for African health scholars and practitioners to build collective capacity to engage in critical decolonial thinking in order to re-imagine socially just African health systems. While the importance of decolonial perspectives for global health has emerged in recent years, many of the discussions and ideas have, so far, been concentrated in well-resourced global north institutions which is once again in line with the colonial project. Decolonizing health in Africa must therefore, necessarily, include African scholars shifting their focus inward to build solidarity across the continent. They must break down the silos and divides that exist across the diverse African contexts, and re-imagine African knowledge and realities as valuable, and the people as legitimate knowledge bearers.

The convening, in early October, which is supported by the HSG Africa regional network, the Atlantic Institute and Tekano, will allow African health scholars to engage authentically and honestly, and make space for difficult conversations about power and hegemonic epistemologies. These conversations are part of a larger initiative, and will therefore make links with the HSR 2020 symposium organized session (track 5), scheduled for Thursday, Nov 12, 2020, titled “What does a socially just health system look like: an imaginative space?”. Stay tuned for that.

In the convening, we intend to build a bridge between the global health and decoloniality communities which, while related, often operate separately. The goal of the convening is for health thinkers and practitioners to learn from decolonial thinkers and practitioners. During the event, we will consider the limitations of (globally) hegemonic epistemologies, and their implications for African health and health systems. Explicit decolonial thinking can facilitate a process of African conscientization – that is, an unthinking/ unlearning/ unravelling of the ’status quo’ in episteme traditions to help us critically reflect on the way we think about the world and the things we do. 

Decolonial thought as a segue toward African-centred socially just health systems

In a podcast entitled “Covid-19 and its impact on the Geo-politics of knowledge production”, Prof Sabelo J Ndlovu-Gatsheni discussed how decolonial thinking enables the politicizing and historicizing of health and health systems challenges in Africa, and enables us to call out the insidious and ubiquitous ways in which coloniality manifests itself in health systems and policies and in African health.  This is work of disruptions, shifts and explicit engagement with oppressive power to improve the lives and re-instil the dignity of African people and places.  What are we shifting away from? What the colonial project has predetermined: that African people cannot produce knowledge and that they are not legitimate holders of knowledge. We radically resist narratives of Africa as a ‘dark’ continent and discourses about its people being primitive, and the nuanced and insidious ways in which these ideas persist both in contemporary global relationships and within African institutions of academia, civil society and health systems. Instead, decolonial thinking requires health thinkers and practitioners to explicitly name invisible power that continues to reinforce and perpetuate oppression, marginality and poor material and social conditions of African people. Moreover, the decolonial project calls for African health scholars and practitioners, despite good intentions, to critically reflect and be reflexive on how our training, research and practices perpetuate the very systems of oppression underlying the field of global health and (post-)colonial medicine. We need to move away from stereotypes that exist within ourselves about ourselves, and de-centre “weaknesses” constructed by and through colonialism. A shift away from the white and ‘foreign’ gaze, is an important step. We also need to look to critical social science theories, ideas and strategies that challenge predominant racial, patriarchal, sexist, homo- and trans-phobic conservative, liberal, and neoliberal politics in African settings. Explicitly connecting decolonial thought to a discourse of health in Africa can inform a paradigm shift in health which ignites African consciousness amongst health practitioners and fosters the development of Afrocentric and socially just health systems and policies.

An alternative decolonial Pan-African paradigm that can advance socially just health systems and policies (and the role of HPSR in this)

As Molefi Asante put it, African intellectuality has been undermined for far too long.  Against this overall backdrop, the conveningwill hone in on Health Policy and Systems Research (HPSR) as a progressive field on the continent and its success and possibilities for African-centredness in its knowledge and praxis. The field of HPSR offers us theorisations and empirical work to guide us in engaging with the social, economic and political nature of health systems. Over the past decade, HPSR scholars in Africa have utilised different knowledge and methodological approaches across disciplinary boundaries, with a particular focus on foregrounding the legitimacy of often under-valued social science contributions. HPSR scholars have also increasingly theorised and worked with local actors, including policymakers and civil society who have shaped the nature of HPSR.

In this convening we will explore how the field can go further. Decolonial thought leaders and health thinkers and practitioners will reflect on the possibilities for alternative paradigms of knowledge and for the curating of an African/decolonial archive of health knowledge and praxis to advance socially just health systems on the continent. We seek to engage with the existing knowledge archive in African health and health systems and policy work and reflect on the knowledge contributions from different parts of the world, what Gatsheni calls the “ecology of knowledge”, examining dominant knowledge paradigms and how knowledge is used to assert power and authority. Health scholars and practitioners in Africa will consider critical questions about the knowledge archives we should be drawing on to deepen social justice within health policies and health systems in Africa.

Tools for dismantling the master’s house: An African knowledge paradigm informing praxis  

After considering what constitutes an African-centred paradigm for health in Africa, it is only appropriate that we explore the praxis elements of this alternative paradigm. We will interrogate ‘Afrocentric methods’ in research, advocacy, policy making, activism and health systems. We will grapple with what the possibilities are for African consciousness as a foundation for Afrocentric methodologies for praxis. We will ask ourselves: What questions, methods, tools, approaches and strategies are necessary when African people are at the centre? How do our technologies or methodologies reaffirm or reinforce hegemonic paradigms? Audre Lorde offers a powerful caution when she states, ‘for the master’s tools will never dismantle the master’s house. They may allow us temporarily to beat him at his own game, but they will never enable us to bring about genuine change.’  The dismantling of the ‘master’s house’ – that is colonial ideologies and traditions that are imbued within our psyches and entrenched in our systems – only threatens those who still define the master’s house as their only source of possibilities, solutions, or support. For Lorde, the tools of resistance and building formed within prevailing practices, structures, and institutions are ultimately unusable for the task of overturning the hegemonic conditions that still prevail. The re-imagining project requires (and forges) different sets of tools. We must therefore be cautious that the technologies of methods, strategies and techniques are not implicated in the very thing they seek to dismantle, that their use does not replicate the same conditions of hegemonic power and decentring of African peoples, though it may take on new guises. When we continue to use the master’s tools, “it means that only the most narrow perimeters of change are possible and allowable” (1984, 110–11). It is important then that ‘genuine measures of resistance and liberation must come from somewhere else, somewhere “outside,” whether outside of “the canon,” outside of mainstream Academia, outside of modern political institutions, structures, and social processes, or perhaps from outside of history altogether.’  It is our hope that this convening can help us forge (or think about a process of forging) tools to ‘dismantle the master’s house’ so that all that is African can flourish. 

A starting point

The convening is a starting point for a political project/process amongst HPSR scholars located in Africa to engage in catalytic, yet difficult conversations and deliberations for developing a language, theories, tools, strategies, approaches, methodologies and research priorities for a decolonial HPSR paradigm/orientation. Through conversation, we aim to advance theories and praxis for decolonising HPSR and to seek strategies for dismantling processes and structures that produce and sustain inequities and injustices in health policies and systems. The convening aims to engage in a process of politicising and historicising HPSR space, critically reflecting on whether we are doing work that transforms unjust political economic and social systems & structural arrangements. We will draw together decolonial theoretical insights and HPSR theories to understand shifts in HPSR for health system change and strategies for transforming African health systems. An important part of this journey will involve ‘re-membering, re-claiming, and re-imagining’ decolonial futures, through reclaiming the origins, histories and realities of African people, politics, systems, institutions and current affairs.

Not only will the deliberations reframe and redirect HPSR towards localised needs and realities, they will also develop a collective mandate amongst African scholars and practitioners within the HPSR community to determine, mobilize and organize an African-centred HPSR to advance equitable and socially just health systems. We intend this as a platform for drawing on collective insights and capacities and building solidarity across diverse African schools, building bridges, harnessing multiple perspectives for a decolonial HSPR orientation, and building strategic partnerships for action.

The urgency of these conversations is greater than ever now that Africa has to cope with the COVID-19 pandemic, including its massive socio-economic impact.  As Arundhati Roy has so aptly said, the pandemic is a portal, a gateway between one world and the next. We see this convening as an important moment to shape history.

More details of the event will be advertised soon.

About Lance Louskieter

PhD Candidate, Health Systems and Policy Research Division, School of Public Health and Family Medicine, University of Cape Town, Queer Activist, Decolonial Scholar, Advocate for the decriminalization of sex work in South Africa. Senior Atlantic Fellow for Health Equity at Tekano. @lancelouskieter

About Shehnaz Munshi

Shehnaz Munshi is a HPSR researcher, occupational therapist, Emerging Voice (2018) and Senior Atlantic Fellow for Health Equity at Tekano. Currently she is the Project Manager for the Sheiham Family/Wits program on social determinants of health and health equity, School of Public Health, University of the Witwatersrand. She serves on the steering committee of the People's Health Movement. @shehnazmunshi
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