Inspired by the 2021 BMJ Global Health Editorial by Atkinset alon global health (GH) teaching during the COVID-19 pandemic, a group of GH students and recent graduates from around the world convened to discuss our experiences in GH education during multiple global crises. Through weekly meetings over the course of several months, we reflected on the impact the COVID-19 pandemic and broader systemic inequities and injustices in GH education and practice have had on us over the past 2 years. Despite our geographical and disciplinary diversity, our collective experience suggests that while the pandemic provided an opportunity for changing GH education, that opportunity was not seized by most of our institutions. In light of the mounting health crises that loom over our generation, emerging GH professionals have a unique role in critiquing, deconstructing and reconstructing GH education to better address the needs of our time. By using our experiences learning GH during the pandemic as an entry point, and by using this collective as an incubator for dialogue and re-imagination, we offer our insights outlining successes and barriers we have faced with GH and its education and training. Furthermore, we identify autonomous collectives as a potential viable alternative to encourage pluriversality of knowledge and action systems and to move beyond Western universalism that frames most of traditional academia.

Background Global concern with strengthening institutions is evident and has been underscored in the wake of the COVID-19 pandemic. Trusted or trustworthy institutions are vital in addressing institutional capacity strengthening, but there is limited research on institutional trust and how to build it. A preliminary approach entitled, Trusted Institutions (TI), identifies six essential elements of trust including: team culture, autonomy, scale and longevity, commitment to quality and ethics, sustainability, and good fit with local context and culture. We aimed to explore capacity building initiatives and the notion of ‘trust’ within non-government health institutions in low- and middle-income countries (LMICs) and validate these essential elements of trust through a systematic review.Methods We searched the published literature in PubMed and EMBASE in March 2020 and employed a three-concept search that included “health-related institutions”; “capacity building”; and “LMICs”. The study team used PRISMA reporting guidelines to conduct title and full-text reviews and conduct data extraction and analysis.Results The search yielded 342 unique articles. Seventy-seven references met initial inclusion criteria and underwent full-text extraction; 31 studies were included in the final analysis. Capacity building activities ranged from individual-level skills to institutional systems and structures. All articles addressed at least one element of trust with over half of articles describing sustainability (n = 18; 58%) and good fit with local context and culture (n = 18; 58%). Only 14 (45%) of articles explicitly mentioned the concept of trust either within an institution (intra-institutional) or between two or more institutions (interinstitutional). Four additional themes emerged as relevant to institutional trust including collaboration, communication, extent of institutional networks, and intersectionality.Conclusions This review validates essential elements of trust in the TI approach and documents the importance of building trust both within and between institutions. The TI approach can be used by public health institutions in LMICs to enhance their abilities to achieve institutional missions and meet global targets.

Recent calls for global health decolonization suggest that addressing the problems of global health may require more than ‘elevating country voice’. We employed a frame analysis of the diagnostic, prognostic, and motivational framings of both discourses and analyzed the implications of convergence or divergence of these frames for global health practice and scholarship. We used two major sources of data–a review of literature and in-depth interviews with actors in global health practice and shapers of discourse around elevating country voice and decolonizing global health. Using NVivo 12, a deductive analysis approach was applied to the literature and interview transcripts using diagnostic, prognostic and motivational framings as themes. We found that calls for elevating country voice consider suppressed low- and middle-income country (LMIC) voice in global health agenda-setting and lack of country ownership of health initiatives as major problems; advancing better LMIC representation in decision making positions, and local ownership of development initiatives as solutions. The rationale for action is greater aid impact. In contrast, calls for decolonizing global health characterize colonialityas the problem. Its prognostic framing, though still in a formative stage, includes greater acceptance of diversity in approaches to knowledge creation and health systems, and a structural transformation of global health governance. Its motivational framing is justice. Conceptually and in terms of possible outcomes, the frames underlying these discourses differ. Actors’ origin and nature of involvement with global health work are markers of the frames they align with. In response to calls for country voice elevation, global health institutions working in LMICs may prioritize country representation in rooms near or where power resides, but this falls short of expectations of decolonizing global health advocates. Whether governments, organizations, and communities will sufficiently invest in public health to achieve decolonization remains unknown and will determine the future of the call for decolonization and global health practice at large.