Rethinking global health through a better understanding of power, privilege, and influence – the narrative and voices of those who operate in the infectious diseases global health environment

Background: Infectious Diseases research is a field that lends itself to global collaboration and representation, but sometimes, to misrepresentation and injustice. We conducted qualitative research to better understand how power dynamics manifest in Infectious Diseases in different spaces (central or peripheries) globally and more specifically in Southern Africa. How this is used to facilitate and/or exclude/limit participation of actors in the identified centres and peripheries of global health environments. Methods: We purposively sampled actors in global health from different professions, ethnicities and race, geographical location, dis/ability, and gender, for face-to-face (or online) interviews, beginning in June 2023 (ongoing). Using a piloted semi-structured interview guide we explored the impact of operating in the Infectious Diseases global health environment on their lives, careers, and populations they serve. The interviews were auto-transcribed verbatim using Otter AI (software). The transcripts of the interviews are thematically analysed to identify key emerging concepts. Results: To date 15 interviews have been conducted with participants predominantly from Southern Africa. Iterative analysis has demonstrated that data saturation is being reached. Capacity strengthening in global health is recognised as being critical not only for infrastructure, but community, human resource, and societal as well. Parachute solutions in global health imported from high-income countries (HIC) remains problematic and in part driven by a lack of representation and agency of expertise from those who are situated in low- and middle-income countries (LMICs). Those operating in global health from LMICs don't often see themselves as operating in global health. Divergent value systems between HIC and LMICs is hindering equitable approaches that serve to benefit all, not just funders, organisations, or individuals. There is a recognition that more direct investment from governments in LMICs is needed to support local agency and power in driving the narrative and decision making. Discussion: Participants from diverse professional backgrounds operating in the global health space identified current injustices and ambiguities in global health definitions and practices. Calling for greater agency of LMIC expertise and a transparency around the values that drive infectious diseases global health work is needed to address the existing power asymmetries.