Q&A: Locally led leadership key to global health solutions

It’s time for low-income countries on the African continent and elsewhere to stand up and take on leadership in finding global health solutions, said Gavin Churchyard, founder and group CEO at The Aurum Institute.

Not your traditional global health organization, Aurum was born out of a South African gold mining company in 1998. Since then, it’s been working to tackle tuberculosis, HIV, and other health issues prevalent among disadvantaged communities — with an emphasis on researching drugs, diagnostics, and vaccines.

It’s organizations like Aurum, which are based in-country and utilizing local expertise, that should be driving health solutions, as well as the discourse around the decolonization and localization of global health, Churchyard said

“It's Africa's time to stand up and play this leadership role,” he said. “It would be wonderful if the multinational donors [could be] supportive and encouraging of that so that we can get a true transformation and that local people can help find solutions to local problems.”

Despite various expressions of intent to give greater responsibility to local organizations, that’s not quite happened, Churchyard explained. “It really remains the domain of large international NGOs in the [global] north, and it really has not served to build the capacity of local organizations.”

Speaking to Devex, Churchyard explained how a local approach has helped to advance Aurum’s work, urged local organizations to become “masters of [their] own fate,” and detailed the role both local and global organizations can play in pushing toward a more equitable and locally led global health space.

This conversation has been edited for length and clarity.

When tackling health problems, how important is it to utilize local expertise?

We have to deal with health problems at a local level. Local people seeking local solutions ... is the best way of solving these challenges. Then people are much more likely to take ownership and implement the findings because, at the end of the day, they've been party to finding those solutions. It's time for people in high-burden, low- and middle-income countries to play this leadership role so that we are not pressured recipients of what others think should be the solution. We can find solutions for ourselves.

How much of Aurum’s work has been driven by experts and scientists who are based locally?

A large amount of the research has been driven by us, and so right from the outset, Aurum has sought to do what we call Aurum-defining work. These are research projects or programs that we’ve conceived, devised, got funding for, and led on the implementation, both from a research and a health program perspective.

In addition to doing our own investigator-initiated research and health program work, we also participate in other larger research networks or program implementation consortiums to scale up and deliver on various aspects. We are very keen that Aurum plays a leadership role in research as well as policy, and we strive to form both local and global policy through the work that we do.

What do you think is the role of African organizations such as Aurum in the discourse around the decolonization and localization of global health?

Decolonization and localization of global health has recently come into the public domain for discussion. There have been moves in the past to try to decentralize the funding and leadership of big grants to local organizations that have largely been unsuccessful.

We can play a leadership role here ... We have the experience of managing, conceiving, leading large brands, both in terms of the fund compliance issues, implementation of projects, and delivering on the expected output. African organizations, and there are a few, should be given the opportunity to do this. As we do that, it will help both build capacity in Africa. It will require establishing a network of African partners who are willing to step up to the plate and say, “We want to do this for ourselves and we want to gain this experience.”

Clearly, it still requires partnerships both within Africa and other organizations in the [global] south, but importantly also with the [global] north. It's not a case of completely severing the ties, but it's changing where the leadership comes from. I, and others, feel very strongly that the time is now for African organizations to stand up and play that leadership role. If we don't play this leadership role, then we only have ourselves to blame as to why we are overlooked.

We've seen huge inequity with COVID-19 vaccine rollout, and a lot of that has to do with wealthy countries hoarding vaccines for themselves. But it goes beyond that … There's an extensive network of African clinical trial sites that are quite capable of participating in such trials and even needing some of these trials. And so we need to ask, why have we been overlooked and what can we do about it?

It's time for us to set the narrative. Decolonization is not about us, it's not us who's decolonizing, but we need to become the solution to the [global] north decolonizing this stuff. It's us taking ownership of the localization issue and playing that leadership role.

Off the back of that, what’s your key message for the global development community about how to go about advancing and supporting this movement?

It requires the commitment to seek African partners and elsewhere that have the capacity to do this. Aurum, for instance, is not as big as some of the very large international NGOs, but we are certainly a sizable NGO and bigger than many in the United States. We have a track record now of over 23 years of delivery and of being able to manage these grants. We are a safe pair of hands that can be trusted to implement and lead big grants within South Africa and broader settings.

The message is to give organizations the opportunity and to provide support so that those that don't yet have the extensive experience will gain that experience so that we, as African organizations, can play that leadership role. We are the masters of our own fate so we need to stand up.

We're starting to think through these issues. We certainly don't have all the answers, but what we’re saying is that this is of such importance to an African-based organization that we have set this as one of our strategic priorities for the next five years. We believe it's going to require commitment, investments, and efforts from us and other organizations to step into that leadership role. But we are willing to make that commitment to make it happen.