How to Keep Doing Global Health: Tips From the Global South

The series of U.S. federal defunding initiatives has been debilitating for global health researchers in the U.S. and beyond. We thought this would be the right time to share three experience-based strategies with our peers in crisis. 

Change who you work for. 

At times, global health researchers can forget who they should work for. This is partly due to the systems in-place and accompanying culture forcing researchers to think more narrowly—often about “fundable” ideas. 

If you’re in global health, you work for the underprivileged, underserved people. Full stop. We must remind ourselves now more than ever that we do not work for the funders, the program officers, or any other overlords. The bureaucratic and financial systems constructed to help our work are secondary to that work and the people we intend to serve. 

One of us (Dhananjaya Sharma) worked for decades in a relatively under-funded public Indian institution. His lab—Centre for Global Surgical Innovations and Low-Cost Solutions—focused on innovating surgical devices and operative techniques for his patients and peers. The Centre’s mission statement reads: “In the purest pursuit of science, there is no financial involvement of any kind, we don’t seek any grant or fund and feel privileged to contribute in an honorary voluntary capacity as a payback to society.” 

Change what you work on. 

When you do not have money, you have to be creative about what you work on. You may not change your research questions, but you can change how you answer them. We believe that some global health researchers have relied too heavily on the “randomized controlled trials (RCTs) as the gold standard of all evidence” Kool-Aid. We appreciate the role of RCTs in evidence-based policymaking. However, the rise of larger and costlier RCTs may have happened without asking: Do we truly need another RCT to answer the question?

The current crisis nudges researchers to ask: Can we answer the same questions in less expensive, more contextually appropriate, and scientifically rigorous ways? Under resource constraints, many research questions in the Global South can be answered with well-designed, well-conducted, and rigorously analyzed economical observational studies. 

One of us (Siddhesh Zadey) has been working with a think-and-do tank—the Association for Socially Applicable Research (ASAR)—that uses existing datasets, builds new analysis methods and tools, and relies on relatively inexpensive mixed-methods implementation studies to gain context-specific insights needed by health policymakers. While these may not be gold standard in the conventional sense, they certainly push the envelope in the right direction to make the best of what is available.

Walk the talk. 

Global health has long celebrated volunteerism. Professors love students who volunteer and researchers love volunteer study participants. Accredited Social Health Activists (ASHAs) in India, who are paid next to nothing and work in communities as volunteers, were awarded WHO’s Global Health Leaders Award in 2022. Perhaps, the crisis is an opportunity for the “topmost” to rekindle their volunteering spirit by lending their expertise and time to those most adversely affected by the defunding initiatives.

Similar to others in Global South, research at Prof. Sharma’s center was voluntary. ASAR is a bootstrapped nonprofit with over 50 active volunteers.

We encourage our global health peers, especially those in the Global North, to reflect on who they are working for and what they are working on. 

Finally, we all need to walk the talk, or as Mahatma Gandhi put it, “An ounce of practice is worth more than tons of preaching.”

Siddhesh Zadey, MSc, is a global health researcher and writer and a co-founder of the nonprofit Association for Socially Applicable Research (ASAR) in India. 

Professor Dhananjaya Sharma, PhD, DSc, MS, FRCS, is a retired professor and head of the Department of Surgery at NSCB Government Medical College Jabalpur (MP) India. He is a lifelong activist and campaigner for “appropriate technology for health care in the developing world” and has more than 100 publications on global surgery/low-cost surgical solutions to achieve health equity for underserved populations.

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