Brain sustain partnerships: Equity-orientation and decolonization theory to promote Global North-Global South collaborations in health professions education

Academic partnerships between institutions in the Global North (GN) and Global South (GS) are promoted as a strategy to strengthen health systems and build workforce capacity, particularly through health professions education. At the same time, growing calls to decolonize global health partnerships have highlighted persistent inequities in power, knowledge production, and resource distribution that shape how these are enacted. While existing literature often emphasizes technical and outcome-oriented models of collaboration, the relational and processual dynamics that sustain or constrain partnerships in practice have been significantly under-examined. This qualitative study is a postcolonial exploration of academic global health partnerships and how they are experienced and negotiated by those involved. Nineteen participants with experience in long-term partnerships between GN and GS universities were interviewed using semi-structured interviews. Data were analyzed iteratively and thematically, revealing how people, processes, and power shape partnership work. Participants described partnerships as fundamentally relational, sustained by individuals who invested significant emotional and relational effort over time. Partnership processes were iterative and required ongoing negotiation of roles, expectations, and priorities in response to changing contexts. Power operated across relationships and processes, shaping whose expertise was recognized, how decisions were made, and how collaboration unfolded. Participants also described moments in which power was acknowledged, reflected upon, and, at times, resisted in efforts to create more egalitarian partnerships by mitigating systemic colonial practices. These findings suggest that academic global health partnerships are not sustained primarily through formal structures or predefined outcomes, but through the dynamic interplay of people, processes, and power. We introduce the concept of “brain sustain” to reframe health workforce development as a collective, relational, and contextually grounded endeavour. Advancing decolonial and equitable partnerships requires recognition of global, historical, and structural conditions, alongside promotion of the relational and processual work that sustain collaboration.