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RESEARCH ARTICLE
Decolonising global health evaluation:
Synthesis from a scoping review
Ichhya PantID
1‡
*, Sonal Khosla
2‡
, Jasmine Tenpa Lama
3‡
, Vidhya ShankerID
4‡
,
Mohammed AlKhaldiID
5, 6, 7, 8, 9, 10
, Aisha El-BasuoniID
11
, Beth Michel
12
, Khalil BitarID
13
,
Ifeanyi McWilliams NsoforID
14‡
1Department of Prevention and Community Health, George Washington University School of Public Health,
Washington, DC, United States of America, 2Independent Evaluation Scholar and Practitioner, Vancouver,
British Columbia, Canada, 3Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson
University, Philadelphia, PA, United States of America, 4Interdependent Evaluation Scholar and Practitioner,
Minneapolis, Minnesota, United States of America, 5Faculty of Medicine and Health Sciences, McGill
University Health Center (MUHC), McGill University, Montreal, QC, Canada, 6Faculty of Medicine and
Health Sciences, School of Physical and Occupational Therapy (SPOT), McGill University, Montreal, QC,
Canada, 7Canadian Institutes of Health Research (CIHR), Health Systems Impact Fellowship, Ottawa,
Canada, 8Department of Environmental Health Sciences, Faculty of Communication, Arts and Sciences,
Canadian University Dubai (CUD), Dubai, United Arab Emirates, 9University of Basel, Swiss Tropical and
Public Health Institute (Swiss TPH), Basel, Switzerland, 10 Council on Health Research for Development
(COHRED), Research Fairness Initiative, Geneva, Switzerland, 11 An-Najah University, North Gaza, Gaza
Strip, Palestine, 12 Indigenous Evaluator and Public Health Practitioner, Office of Undergraduate
Admissions, Emory University, Atlanta, GA, United States of America, 13 Khalil Bitar, Wyss Academy for
Nature, University of Bern, Bern, Switzerland, 14 Nigeria Health Watch, Abuja, Nigeria
‡ IP, SK, JTL, VS and IMN co-authors contributed equally to this work.
*ipant@gwmail.gwu.edu
Abstract
As decolonisation awareness and activism amplifies in the mainstream masses and within
academic realms across a variety of fields, the time is right to converge parallel movements
to decolonise the fields of global health and evaluation by restructuring relations of depen-
dency and domination reified through the “foreign gaze”
1
or “white gaze.” We conducted a
review of relevant records with the following inclusion criteria–they define or advocate for
the decolonisation of global health evaluation or explicate methods, policies or interventions
to decolonise global health evaluation published by advocates of the decolonisation move-
ment from both fields. These records were derived following a systematic article search by
the lead autthor on Google, Google Scholar, NewsBank, and PubMed using the following
keywords: “decolonising” and “global health,” “evaluation,” or “global health evaluation” repli-
cating a digital search strategy utilized by scoping reviews across a variety of topics.
Because the topic of interest is nascent and still emerging, the date range was not restricted.
The lead author screened abstracts retrieved from the search. In total, 57 records, ranging
in publication date from 1994 to 2020, were selected and charted for this review. We
reviewed these records to identify socio-ecological factors that influence the decolonisation
of global health evaluation, such as decolonising minds; reorienting funders and reforming
funding mechanisms; and investing in sustainable capacity exchange. In doing so, we
reflected on our positionality as well as our internalisation and potential reinforcement of
colonial relations in the process of reporting our results. In the context of turmoil and
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OPEN ACCESS
Citation: Pant I, Khosla S, Lama JT, Shanker V,
AlKhaldi M, El-Basuoni A, et al. (2022)
Decolonising global health evaluation: Synthesis
from a scoping review. PLOS Glob Public Health
2(11): e0000306. https://doi.org/10.1371/journal.
pgph.0000306
Editor: Jose Ignacio Nazif-Munoz, Universite
´de
Sherbrooke: Universite de Sherbrooke, CANADA
Received: August 16, 2021
Accepted: October 14, 2022
Published: November 16, 2022
Copyright: ©2022 Pant et al. This is an open
access article distributed under the terms of the
Creative Commons Attribution License, which
permits unrestricted use, distribution, and
reproduction in any medium, provided the original
author and source are credited.
Data Availability Statement: All data are in the
manuscript and/or supporting information files.
Funding: The authors received no specific funding
for this work.
Competing interests: The authors have declared
that no competing interests exist.
transition due to the COVID-19 pandemic, our scoping review offers a starting point to
embark on a journey first to transform and decolonise global health evaluation and then to
achieve the greater goal of equity and justice.
Introduction
The concept of the “foreign gaze” [1] or “white gaze” [2] of development assumes whiteness as
the primary reference of power, prestige, and progress across the world. The prevailing foreign
or white gaze of development measures the political, socio-economic, and cultural processes of
the Global South against the expectations of Northern saviourism and standard of Northern
supremacy.The same applies to scientific scholarship and practice. Among many sectors, two
fields that the foreign or white gaze has plagued are global health and evaluation [3]. While the
fields of global health and evaluation have called out the importance of cultural competence
(see Mews, Schuster & Vadja, et al., 2018 [4] to gain a nuanced and thorough understanding of
the influence of cultural competence on global health evaluation), their failure to integrate cur-
ricula that acknowledge and repair damage from both fields’ colonial roots is telling [5,6].
Emerging scholars are now explicitly naming the “depoliticized, un-critical, and ahistorical”
disciplinary lens maintained within these fields, whose obliviousness to unequal economic,
social, and power relations steeped in historical and ongoing injustice feels wilful to those who
are disadvantaged by those relations [7].
Colonial legacy of Global Health
Despite the rising prominence and proliferation of Global Health efforts since World War II,
Global Health trudges forward without a universally agreed upon established definition [8,9].
Of the many proposed definitions for Global Health, this review will adopt the definitional
lens offered by Beaglehole and Bonita (2010) [8] which centres transnational collaboration,
research, and action to promote health for all. Collaborative co-creation of an evidence-base
and its application through actions such as interventions, policies, or other constructive public
health strategies to improve health equity and ensure health for all aligns with the ethos guid-
ing this review. While all definitions of Global Health signal transnational perspectives, a
phrase that implies lateral rather than colonial relationships, they are remiss in their omission
of the health status of approximately four hundred million indigenous people. Drawing from
postcolonial frameworks, we consider Indigenous Health an integral component of Global
Health. Additionally, disparities in the health outcomes between racially otherized peoples and
whites worldwide can largely be attributed to the detrimental effects of colonization and
enslavement, exacerbated by the colonial legacy, capitalist economy and present propensities
of Global Health as a field [10]. Drawing from critical theories more generally, we similarly
centre colonized and enslaved peoples as a whole.
The official narrative of the history of the field of global health proclaims that its origins lie
in colonial efforts to protect colonial settlers and administrators from acquiring infectious dis-
eases prevalent within colonies in the tropics. Perhaps a decolonised perspective would revise
this historical account by offering a counter-narrative—for example, indigenous efforts to pro-
tect the peoples of Turtle Island (now called North America) from infectious diseases that
were prevalent among colonisers precedes contemporary global health [11]. While territorial
colonialism might have ended decades ago in many but not all parts of the world, the colonisa-
tion of minds, cultures, politics, and economies continues and reparations are yet to be realised
[11,12]. Over the last few decades, global health scholars have called to improve health justice
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universally. A recently developed ethical framework titled Research for Health Justice was
developed that provides guidance on meaningfully promoting global health equity through
metrics such as, what research populations and questions ought to be selected, what research
capacity strengthening ought to be performed and what post-study benefits ought to be pro-
vided [13]. Despite the broadened scope of global health justice, colonial knowledge and prac-
tices still dictate policies and decision making in the field. Those from the Global South are
largely relegated to token positions—for example, primarily as enumerators and implementa-
tion, research or evaluation partners and rarely as principal investigators—in global health dis-
cussions rather than inhabiting powerful roles in policy and decision making [12]. The current
global health ecosystem and its governance structure are not equipped to address contextual
disadvantage in the Global South as a determinant of health [14]. As it became evident during
the COVID-19 pandemic, many strategies implemented by Western structures such as lock-
down and social distancing are impossible privileges that communities living in slums in the
Global South cannot avail, triggering a high prevalence of diseases among such communities
[15]. These points suggest that decolonising global health involves much more than merely
adding seats for members of the Global South at the proverbial table. Diverse composition of
authority does not automatically translate into changed values or reformed structures. We sus-
pect that decolonizing the field of global health may require transforming the way in which we
think about global health overall, understand the “winners” and “losers” of systems of oppres-
sion, and demonstrate awareness of who has the final say in decision making. Decolonising
the field of global health likely further requires redefining its purpose, reimagining the system,
and reformulating its policies and rules accordingly.
Colonial influence in the field of evaluation
As donor assistance in the form of Global Health investments has increased in the past two
decades, the Global Health community is embracing the evaluation of Global Health efforts
with resolve [16]. There is consensus on the need to determine the effectiveness of Global
Health investments to enhance evidence building, support decision making and capacity
building [17]. The United States Agency for International Development (USAID) frames eval-
uation of Global Health programs as a systematic endeavour which generates insight on pro-
grammatic processes and outcomes to enhance accountability, incorporate learning to
improve developmental outcomes, and guide strategic planning of future investments [18].
Not unlike the global health field, evaluation theory, policies, and practices derive from and
have historically been dictated by Western frameworks that fail to recognise and that systemat-
ically exclude ontologies and epistemologies that are culturally distinct from those of the Euro-
pean Enlightenment [19,20]. Although the field of evaluation is intended to garner effective
interventions while mitigating iatrogenic effects [21], it is grappling with its own colonial leg-
acy and epistemological limitations [22]. Evaluation as a field is embedded in the contested
power relations that plague international development as a whole and it has until recently
articulated no need to fundamentally transform the power relations in which it is embedded.
Among other groups, indigenous peoples and researchers have made entirely clear that they
want evaluations that are “of, for, by and with us” and research that does not “plan about us,
without us” [23,24]. Evaluators increasingly voice that evaluations should honour local beliefs,
manners, and customs and act with integrity and honesty in their relations with all stakehold-
ers, prioritising the most marginalised groups [25]. Although the field of evaluation considers
cultural competence, the field has yet to develop a critical body of literature or guidelines for
practice that interrogate understanding of difference and inequality, including its own role
therein [20].
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Call to decolonise global health evaluation
As decolonisation awareness and activism amplifies in the mainstream masses and within aca-
demic realms across a variety of fields, the time is ripe to converge parallel movements of deco-
lonising global health and decolonising evaluation (hereafter collectively referred to as Global
Health Evaluation) by rethinking the existing models and restructuring relations of depen-
dency and domination reified through the foreign or white gaze [1,2]. Under the backdrop of
rising social inequality and injustice, there is an awakening of social consciousness tying limi-
tations in the meaningful advancements of these fields to lack of true diversity with respect to
ways of knowing and being [20,26].
The American Evaluation Association is centering the decolonisation of evaluation in its
annual conference in 2022. Similarly, in recent years, there have been innumerous conferences
and workshops in the field of global heath to fuel the demand for this subject matter worldwide.
Aims and objectives
This paper offers a description of the decolonisation of global health evaluation as specified by pro-
fessionals advocating for decolosniation in their respective fields. Furthermomre, we offer a socio-
ecological lens to decolonise global health along with, and by, materially decolonising evaluation.
This paper begins to answer the following research questions: 1) How do the advocates of
the decolonisation global health evaluation movement describe the decolonisation of global
health evaluation? 2) What socio-ecological factors do advocates of the decolonisation of global
health evaluation associate with the decolonisation of global health evaluation? It draws on
critical theories, particularly postcolonialism, which raises questions about the power of the
gaze in defining the other relative to Europe/ European settler states [27]. To a lesser degree,
this study also draws on critical whiteness studies, which names whiteness as the unmarked
standard of normativity [28,29].
Methods
This scoping reviewutilises Arksey and O’Malley’s (2005) scoping methodology [30] and Bronfen-
brenner’s (1979) socio-ecological model [31] as a conceptual framework to synthesise peer-
reviewed and grey literature published on topics related to the decolonisation of global health,
evaluation, or global health evaluation. Bronfenbrenner’s systems-oriented socio-ecological model
[31] theorises that factors at various levels of individuals’ environment shape their development,
health, and well-being, both independently and interactively. Our study adapts this conceptual
framework to produce a socio-ecological perspective on factors that are associated in the literature
with the decolonisation of global health, evaluation, or both specialties collectively.
A scoping methodology offers rigor, structure, and transparency to synthesise studies that
are 1) focused on nascent topics to identify key concepts associated with them, or 2) conducted
using disparate methodologies and tools to foster reliability and replicability of study findings
[32,33]. Both apply to the topics of decolonisation of global health and evaluation. Research
activities were conducted between September 2020 and January of 2021. Inadequate resources
and linguistic capacity within the authorship team limited the scope of selection to records
published in English (Fig 1). This scoping review did not warrant institutional ethical approval
because it did not involve primary research with human subjects.
Search strategy and eligibility criteria
The lead author (IP) conducted a systematic article search on Google, Google Scholar, News-
Bank, and PubMed using the following keywords: “decolonising” and “global health,”
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“evaluation,” or “global health evaluation” replicating a digital search strategy utilized by scop-
ing reviews across a variety of topics [32,33]. Because the topic of interest is nascent and still
emerging, the date range was not restricted (see Table 1 for details on full search strategy).
These databases were selected to account for and incorporate both grey and scholarly literature
Fig 1. PRISMA flow chart of scoping review (based on Arksey & O’Malley 2005).
https://doi.org/10.1371/journal.pgph.0000306.g001
Table 1. Digital search strategy.
Database/Search
Engine
PubMed decolonising, global health, evaluation, global health evaluation, decolonising global health
evaluation, decolonising global health, decolonising evaluation, decolonising global health
evaluation
Google Scholar decolonising, global health, evaluation, global health evaluation, decolonising global health
evaluation, decolonising global health, decolonising evaluation, decolonising global health
evaluation
Google decolonising global health evaluation, decolonising global health, decolonising evaluation,
decolonising global health evaluation
NewsBank decolonising global health evaluation, decolonising global health, decolonising evaluation,
decolonising global health evaluation
https://doi.org/10.1371/journal.pgph.0000306.t001
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in our search strategy. The lead author screened abstracts retrieved from the search. Records
were selected if they included one of the following six criteria:
1. a call to decolonise global health evaluation;
2. a conceptualisation of theories or frameworks to decolonise global health evaluation;
3. a definition of decolonisation of global health evaluation;
4. an explication of methods to decolonise global health evaluation;
5. detailed interventions or curricula to decolonise global health evaluation; and
6. a description or demonstration of capacity to decolonise global health evaluation.
Data charting process
The lead researcher (IP) reviewed all selected records (N = 57) and developed, collaboratively
with the research team, a structured charting framework which includes descriptive informa-
tion for all records and emerging themes identified during the preliminary reading of included
records (See S1 Table to review our charting template). Then, each research team member
charted randomly-assigned records using the structured charting framework. Through this
process, relevant data were extracted from records and put into the following categories: article
title; number of pages; publisher; geographic location of authors’ affiliated institutions (city,
state, country); applicable inclusion criteria (assigned researchers selected one out of the six
listed above); definition for decolonising global health, evaluation, or global health evaluation
(assigned researchers selected one); methods utilized or proposed; theoretical framework pro-
posed or applied; barriers and facilitators; curricula proposed or applied; role of self-determi-
nation, empowerment, or sovereignty; role of cultural, spiritual, holistic, or social justice
philosophy and values; role of funding and funders; any legislation, policies, or structural pro-
grams mentioned or implemented; role of knowledge generation, mobilization, and mutually
beneficial reciprocity; key actors or activists; role of community support, participation, and
consent; role of positionality and gaze with respect to the community (insider, outsider,
insider-outsider); role of domination and control vis-à-vis liberation or transformation; efforts
to build capacity and south-to-south collaborations; role of trust or mistrust; role of solidarity;
role of collectivism and inter-connectedness; role of power and privilege; any additional fac-
tors/themes unlisted in the charting framework; and general notes.
Synthesis of results
Following the charting of data, the research team used Bronfenbrenner’s socio-ecological
model (1979) [31] to collate and summarise their results in a template developed by the lead
researcher. Based on the results summary template, researchers clustered the factors that advo-
cates for decolonisation of global health evaluation who authored the selected records associ-
ated with the decolonisation of their respective fields into each level of the socio-ecological
model: micro, meso, exo, and macro (see Table 2). The next step in synthesizing our results
involved one researcher reviewing the results summaries submitted by all co-authors and
developing an initial analytical framework [32–34]. They coded all applicable factors within
the initial analytical framework for each record and incorporated new factors into the frame-
work as they emerged. This analytical framework was shared with the entire authorship team
and finalized with their feedback. Previously coded records were re-coded using the finalized
analytical framework. All remaining records were then coded for applicable themes using the
finalized analytical framework. Afterwards, the lead author validated all coded records with a
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Table 2. Descriptive characteristics, inclusion criteria, and factors associated with decolonisation by advocates in the field of global health and evaluation within included studies.
Title Type Year Author/s Authors’
Location
Inclusion Criteria Socioecological Factors
MICRO MESO EXO MACRO
CL CO DD EM DIC DCA SD DIM IS RF ELP CK CP SCE PC PG PP ES AM CSD CS DCM RR
1. Health promotion and the
discourse on culture
Peer
reviewed
Journal
Article
1994 Airhihenbuwa,
C.
USA ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
2. Indigenizing evaluation
research: How Lakota
methodologies are helping
“Raise the Tipi” in the
Oglala Sioux Nation
Peer
reviewed
Journal
Article
2004 Robertson et al. USA ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
3. Indigenous evaluation can
decolonize us
Peer
reviewed
Journal
Article
2006 Deschenie, T. USA ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
4. Appropriate engagement
and nutrition education on
reserve
Peer
reviewed
Journal
Article
2010 Tobin et al. Canada ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
5. Reframing evaluation:
defining an indigenous
evaluation framework
Peer
reviewed
Journal
Article
2010 LaFrance et al. USA ✓ ✓ ✓
6. A decolonizing approach
to health promotion in
Canada: the case of the
urban Aboriginal
community kitchen garden
project
Peer
reviewed
Journal
Article
2010 Mundel et al. Canada ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
7. Decolonize philosophy/
being life: the power of
discourse in western and
Africanist epistemologies of
life and the revolution of
language in AIDS narratives
Dissertation 2010 Clinton Wills,
D.
USA ✓ ✓ ✓
8. A framework for
decolonization
interventions: broadening
the focus for improving the
health and wellbeing of
Indigenous communities
Peer
reviewed
Journal
Article
2010 Guerin, B. Australia ✓ ✓ ✓ ✓ ✓
9. Beyond informed consent:
how is it possible to ethically
evaluate Indigenous
programs?
Seminar
paper
2011 Williams et al. Australia ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
10. Decolonising evaluation
in a developing world
Report 2011 Hopson et al. USA ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
11. Kaupapa Māori–theory-
based evaluation
Peer
reviewed
Journal
Article
2012 Kerr, S. New
Zealand
✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
12. Decolonisation–a brief
history of the word
Book chapter 2012 Betts, R. USA ✓ ✓ ✓ ✓
(Continued)
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Table 2. (Continued)
Title Type Year Author/s Authors’
Location
Inclusion Criteria Socioecological Factors
MICRO MESO EXO MACRO
CL CO DD EM DIC DCA SD DIM IS RF ELP CK CP SCE PC PG PP ES AM CSD CS DCM RR
13. Decolonization is not a
metaphor
Peer
reviewed
Journal
Article
2019 Tuck et al. USA ✓ ✓ ✓ ✓ ✓ ✓
14. Decolonising evaluation:
the necessity of evaluation
advisory groups in
Indigenous evaluation
Peer
reviewed
Journal
Article
2012 Johnson-
Goodstar, K.
USA ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
15. Decolonisation of social
science research and
practice in Latin America
Peer
reviewed
Journal
Article
2013 Meckesheimer,
A.
Germany ✓ ✓ ✓ ✓ ✓
16. Across the colonial
divide–conversation about
evaluation in Indigenous
contexts
Peer
reviewed
Journal
Article
2013 Marama
Cavino, H.
USA ✓ ✓ ✓ ✓ ✓ ✓
17. “Because we have really
unique art”: Decolonizing
research with Indigenous
youth using the arts
Peer
reviewed
Journal
Article
2014 Flicker et al. Canada ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
18. Made in Africa
Evaluation Concept
Synthesis
paper
2015 Chilisa, B. Botswana ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
19. Self-determination and
the right to health:
Australian Aboriginal
community-controlled
health services
Peer
reviewed
Journal
Article
2016 Mazel, O. Australia ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
20. Considering the social
determinants of equity in
Intl Development
Evaluation guidance
documents
Peer
reviewed
Journal
Article
2016 Robertson, K. USA ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
21. A transcultural global
systems perspective: in
search of Blue Marble
Evaluators
Peer
reviewed
Journal
Article
2016 Quinn Patton,
M.
USA ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
22. A cross-cultural
evaluation conversation in
India: benefits, challenges,
and lessons learned
Peer
reviewed
Journal
Article
2016 Al Hudib et al. India &
Canada
✓ ✓ ✓ ✓
23. Decolonising and
indigenizing evaluation
practice in Africa: toward
Africa relational evaluation
approaches
Peer
reviewed
Journal
Article
2016 Chilisa et al. Botswana ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
24. Getting to the roots of
evaluation capacity building
in the Global South: multiple
streams model to frame the
agenda status of evaluation
in turkey
Peer
reviewed
Journal
Article
2016 Cakici et al. Ethiopia ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
(Continued)
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Table 2. (Continued)
Title Type Year Author/s Authors’
Location
Inclusion Criteria Socioecological Factors
MICRO MESO EXO MACRO
CL CO DD EM DIC DCA SD DIM IS RF ELP CK CP SCE PC PG PP ES AM CSD CS DCM RR
25. Sexy carnival on the
powwow trail: HIV
Prevention by and for
Indigenous Youth
Peer
reviewed
Journal
Article
2016 Monchalin
et al.
Canada ✓ ✓ ✓ ✓ ✓ ✓
26. Lessons on decolonising
evaluation from Kaupapa
Māori Evaluation
Peer
reviewed
Journal
Article
2016 Cram, F. New
Zealand
✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
27. Negotiating solidarity
between indigenous and
transformative paradigms in
evaluation
Peer
reviewed
Journal
Article
2016 Cram et al. New
Zealand
✓
28. Kaupapa Māori
evaluation: A collaborative
journey
Peer
reviewed
Journal
Article
2017 Carlson et al. New
Zealand
✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
29. How do Masters of
Public Health programs
teach monitoring and
evaluation?
Peer
reviewed
Journal
Article
2017 Negandhi et al. India ✓ ✓ ✓ ✓
30. Critical evaluation of
international health
programs: Reframing global
health and evaluation
Peer
reviewed
Journal
Article
2017 Chi et al. USA &
Chile
✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
31. Looking backward but
moving forward: honouring
the sacred and asserting the
sovereign in Indigenous
evaluation
Peer
reviewed
Journal
Article
2018 Bowman-
Farrell, N.
USA ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
32. Conceptualizing
evaluations in African
contexts
Peer
reviewed
Journal
Article
2018 Gaotlhobogwe
et al.
Botswana ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
33. Body map storytelling as
a health research
methodology: blurred lines
creating clear pictures
Peer
reviewed
Journal
Article
2018 Gastaldo et al. Spain ✓ ✓ ✓ ✓ ✓ ✓
34. A new look at impact
evaluation capacity in Sub-
Saharan Africa
Research
brief
2019 Altshuler et al. South
Africa
✓ ✓ ✓ ✓ ✓
35. ‘We were made to feel
comfortable and . . . safe’:
co-creating, delivering, and
evaluating coach education
and health promotion
workshops with Aboriginal
Australian peoples
Peer
reviewed
Journal
Article
2019 Bennie et al. Australia ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
(Continued)
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Table 2. (Continued)
Title Type Year Author/s Authors’
Location
Inclusion Criteria Socioecological Factors
MICRO MESO EXO MACRO
CL CO DD EM DIC DCA SD DIM IS RF ELP CK CP SCE PC PG PP ES AM CSD CS DCM RR
36. Towards postcolonial
capacity building
methodologies–some
remarks on the experiences
of health researchers from
Mozambique and Angola
Peer
reviewed
Journal
Article
2019 Carvalho et al. Portugal ✓ ✓ ✓ ✓ ✓
37. Examining indigenous
food sovereignty as a
conceptual framework
Peer
reviewed
Journal
Article
2019 Ray et al. Canada ✓ ✓ ✓ ✓ ✓
38. White privilege and the
decolonization work needed
in evaluation to support
indigenous sovereignty and
self-determination
Peer
reviewed
Journal
Article
2019 McKegg, K. New
Zealand
✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
39. Decolonizing epidemics Dissertation 2019 Deane
Ferguson, E.
USA ✓ ✓ ✓ ✓
40. Ukombozi means
liberation: A case for
decolonizing global health
research, methodology, and
praxis
Thesis 2019 Millet, H. USA ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
41.
#DecolonizeGlobalHealth:
Rewriting the narrative of
global health
Blog post 2019 Guinto, R. Philippines ✓ ✓ ✓ ✓ ✓ ✓ ✓
42. The foreign gaze:
authorship in academic
global health
Editorial 2019 Abimbola, S. Australia ✓ ✓ ✓ ✓ ✓
43. On the coloniality of
global public health
Think piece 2019 Richardson, E. USA ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
44. Pandemicity, COVID-
19, and the limits of public
health science
Commentary 2020 Richardson, E. USA ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
45. Indigenous health
service evaluation
Peer
reviewed
Journal
Article
2020 Firestone et al. Canada ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
46. Integrative and
complementary practices in
the health field: towards a
decolonization of knowledge
and practices
Peer
reviewed
Journal
Article
2020 Guimarães
et al.
Brazil &
Portugal
✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
47. Mystic medicine: Afro-
Jamaican religio-cultural
epistemology and the
decolonization of health
Thesis 2020 Wumkes, J. USA ✓ ✓ ✓ ✓ ✓ ✓ ✓
48. Decolonizing global
public health
Commentary 2020 Affun-
Adegbulu et al.
Belgium &
UK
✓ ✓ ✓ ✓
(Continued)
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Table 2. (Continued)
Title Type Year Author/s Authors’
Location
Inclusion Criteria Socioecological Factors
MICRO MESO EXO MACRO
CL CO DD EM DIC DCA SD DIM IS RF ELP CK CP SCE PC PG PP ES AM CSD CS DCM RR
49. Solidarity in global
health research
Peer
reviewed
Journal
Article
2020 Daftary et al. Canada &
South
Africa
✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
50. Global health beyond
geographical boundaries:
reflections from global
health education
Commentary 2020 Van Wees et al. Sweden &
USA
✓ ✓ ✓ ✓ ✓
51. Decolonizing global
public health: if not now
then when?
Commentary 2020 Bu¨yu¨m et al. USA ✓ ✓ ✓ ✓ ✓ ✓
52. Decolonizing global
health education: rethinking
institutional partnerships
and approaches
Commentary 2020 Eichbum et al. USA,
Tanzania &
South
Africa
✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
53. The C-Word: Tackling
the enduring legacy of
colonialism in global health
News article 2020 Saha et al. Bangladesh ✓ ✓ ✓ ✓
54. Teaching global health
from the south: challenges
and proposals
Peer
reviewed
Journal
Article
2020 Montenegro
et al.
Chile ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
55. How (not) to write about
global health
Editorial 2020 Jumbam, D. Ghana ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
56. Bridging western and
Indigenous knowledge
through intercultural
dialogue: lessons from
participatory
Practice note 2020 Sarmiento et al. Canada,
Colombia
& Mexico
✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
57. Research imperialism
resurfaces in South Africa in
the midst of the COVID-19
pandemic–this time, via a
digital portal
Editorial 2020 Moodley, K. South
Africa
✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
INCLUSION CRITERIA: (CL) calls for decolonization of global health or evaluation or global health evaluation; (CO) conceptualizes decolonization of global health or evaluation or global health
evaluation; (DD) defines decolonization of global health or evaluation or global health evaluation; (EM) explicates methods for decolonization of global health or evaluation or global health
evaluation; (DIC) develops interventions or curriculums to decolonize global health or evaluation or global health evaluation; (DCA) demonstrates capacity for decolonization of global health or
evaluation or global health evaluation. THEMES: (SD) self-determination; (DM) decolonising individual minds; (IS) individual sovereignty; (RF) re-orient funders and reform funding mechanisms;
(ELP) enabling legislations and policies; (CK) co-option of knowledge generation, production, mobilisation & translation (CK);(CP) co-production of curricula, methods, and theoretical
frameworks (CP); (SCE) sustainable capacity exchange; (PC) prioritise community support, engagement and consent; (PG) positionality and gaze (PG); (PP) power and privilege; (ES) emphasise
spiritual, holistic, cultural, safety and liberty; (AM) adopting mutually beneficial reciprocity; (CSD) collective self-determination; (CS) collective sovereignty; (DCM) decolonising collective minds;
(RR) repairing and regaining trust against a historical backdrop of mistrust
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second round of coding followed by a third round of review by research team members for the
group of records assigned to them.
One researcher subsequently computed frequencies of records published on each topic by
publication year, publication type, and geographic location. Additionally, collaboratively writ-
ten records were coded into three categories: North X North collaboration, defined as a collab-
orative effort in which all authors were affiliated with an institution located in the Global
North; North X South collaboration, defined as a collaborative effort in which one or more
authors affiliated with an institution located in the Global North collaborated with at least one
co-author affiliated with an institution located in the Global South or vice-versa; and South X
South collaboration, defined as a collaborative effort in which all authors were affiliated with
an institution located in the Global South. Figs 2and 3and Tab 2 present these frequencies
along with the factors present within each article included in our study respectively. As a final
step, a member of the research team conducted two rounds of thematic analysis of the
Fig 2. Number and types of papers included in our review published between 1994–2020.
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Fig 3. Countries and total number of papers associated with geographical regions.
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summarised results, with feedback from the entire research team. Preliminary findings were
drafted in narrative and visual form.
Statement on researcher positionality, reflexivity, and gaze
As noted above with respect to the authors of records included in our study, positionality is lay-
ered, fluid, intersectional, and sometimes conflicting rather than unidimensional, fixed, or static
even within an individual author, let alone within a team. While our own authorship team mem-
bers all share the experience of settler or franchise colonization and colonial educations—reflected
in part by our study’s delimitation to the colonial language of English—we diverge with respect to
classifications of gender, religion, class, and caste (as applicable), among other dimensions of dif-
ference—both those of our upbringings and those of our current situations. Some are still
experiencing occupation or minoritisation. Others may enjoy political independence or numerical
majority status, even as they live with the ongoing legacy of colonization and neo-colonization.
Some represent the first generation in their family to gain access to internationally-recognized
educational credentials. Others continue to benefit from the intergenerationally compounded
access and opportunity that arises from their ancestral community or caste’s socio-economic and
spiritual exclusion, exploitation, and violation of other groups, which colonial powers often take
advantage of and exacerbate, even as they experience the effects of the racialized and gendered
economy of global health and evaluation. These nuances and tensions complicate any uniformly
authentic or subaltern voice that we may want or try to claim, and that others may attribute to us
based on the geographic location of our institutional affiliations.
These nuances and tensions further complicate our own gaze, as our colonial educations
derive from European languages and knowledge systems that were refined during, and for pur-
poses of, imperial and capitalist expansion. As tied as we may be to our ancestral systems of
knowledge and values, the lens through which we interpret the experiences of those we con-
sider our people is inevitably colonially influenced [35]. This manifests in our struggle to name
patterns that global health evaluation widely observes—even if it disavows—in ways that are
accurate and that acknowledge both the experience of victimisation from structures of exclu-
sion, marginalisation, infantilisation, and violence [35] as well as the individual and collective
agency involved in survival and resistance. Additionally, the colonial gaze is evident in the
choices that we made regarding capitalisation, terminology, and comparisons as part of our
analysis and reporting. Examples include decisions about whether and when to capitalise the
first letter of words like “indigenous”: When do we do so intentionally to honour diasporic
political identity and solidarity, and when do we do so reluctantly to facilitate legibility and
recognisability for a disproportionately white, colonially educated readership who is accus-
tomed to artificial, racialized categories? The latter amplifies the ongoing flattening of within-
group difference—the essentialisation of analytical categories—at the expense of more specific
references to sovereign peoples or ancestral names for culturally, politically, or linguistically
distinct groups or micro-nations. Third, as raised earlier, the lens of our gaze shows up in our
tendency to conflate culture, nationality, and geography. Fourth, the gaze materialises in our
distinction and potential otherisation of ways of knowing that are indigenous to the Americas,
Asia, and Africa, including South/ West/ Central Asia and North Africa, as well as even Europe
itself—as inherently spiritual and relational. Those of us schooled in colonial academic tradi-
tions often fail to acknowledge how similar forces also shaped and continue to shape contem-
porary knowledge systems derived from the court-supported and church-supported European
Enlightenment, which was under-girded by religious doctrine and state power. Shaping of the
latter, however, continues to happen in ways that scientific and positivistic narratives of ratio-
nality and individual merit shroud.
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Lastly and perhaps most importantly, micro level internalisation of the colonial gaze is
reflected in our use of terminology that relies on dichotomies like “First World/ Third World,”
“developed/ developing,” “Global South/ Global North,” “Eastern/ Western,” “insider/ out-
sider/ insider-outsider,” “low-income/ high income,” as well as “power and privilege,” all of
which heighten between-group difference. The dialectical nature of identity development not-
withstanding, these dichotomous constructions of categorical difference treat “have nots” and
“haves” as pre-social, fixed, and presumably mutually exclusive groups. This construction of
difference contrasts with one which acknowledges how groups are continuously differentiated
from each other—and from whiteness—through socio-economic processes, namely, the asym-
metrically structured exchange of multiple types of capital, resources, power, or energy more
generally. With respect to global health evaluation, neither “North/ South” nor “East/ West”
maps onto hemispheric boundaries, after all, but both correspond closely to patterns of coloni-
sation and racialisation. In a similar way, “high-/ low-income” and “power and privilege” fail
to account for the source of income, power, and privilege, and direction of their flow, wherein
exploitative, extractive relations systematically devalue the labour, land, and knowledge of
many individual and collective bodies even as they produce great value for a few other individ-
ual and collective bodies. Migration patterns and brain-drain heavily influenced by colonisa-
tion and enslavement further complicate these categorical distinctions—especially “insider/
outsider/ insider-outsider” [36]. Referring to them in ways that obscure the material condi-
tions and socio-economic relations that continuously (re)produce the observed difference
allows such relations to persist, unchecked.
Results
This section provides a descriptive summary of the research sample, summarizes how the
advocates of the decolonisation of global health evaluation describe the decolonisation of
global health evaluation, and adapts the socio-ecological framework to categorize the factors
that sampled records associated with the decolonisation of global health evaluation. Within
each level, factors are organized by theme, and their implications are elaborated upon in the
Discussion section.
Descriptive summary of sampled papers
In total, 57 records, ranging in publication date from 1994 to 2020, were selected and charted
for this review. Table 2 details descriptive characteristics, inclusion criteria, and factors coded
for the reviewed records. Records published on the decolonisation of global health, of evalua-
tion, or of global health evaluation have steadily increased over time, reaching their peak in
2020. The majority of reviewed records were peer-reviewed journal articles (63.16%) followed
by peer-reviewed or non-peer reviewed academic documents (33.33%) such as book chapters,
commentaries, research briefs, reports, seminar papers, dissertations, editorials, etc. A small
percentage of reviewed papers consisted of grey literature such as blog posts and news articles
(Fig 2). Authors reporting institutional affiliations in the Global North published the majority
of the reviewed papers (65.0%), with just a handful of reviewed papers reporting authors from
African (12.28%), Asian (5.26%), or South American (3.51%) countries, or a North-South col-
laboration (10.53%; Fig 3) [37].
RQ1. How do advocates of the decolonisation of global health evaluation
describe the decolonisation of global health evaluation?
To derive an understanding of how the decolonisation of global health evaluation movement
advocates describe decolonisation of global health evaluation, we relied on sampled records
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which included definitions as an inclusion criterion (8.7% or 5 out of 57 records) as well as the
summary results documents prepared by research team members with a sub-section collating
definitions provided within their assigned group of records. A research team member identi-
fied key words (e.g., “cultures,” “slavery,” “colonial”) and phrases from the definitions of global
health evaluation that these two sources offered (See Fig 4 for a visual representation of recur-
ring words and phrases associated with definitions of the decolonisation of global health evalu-
ation in the reviewed records). Based on a thematic analysis of definitions for the
decolonisation of global health evaluation available and descriptions listed within sampled rec-
ords, advocates of the decolonisation of global health evaluation describe it as:
A transformative and liberatory movement that considers the effects of imperialism, slavery,
racism, and colonialism on directly or indirectly colonised populations, and aims to restruc-
ture power imbalances within the fields of global health and evaluation to establish equitable,
mutually beneficial, and reciprocal partnerships between those who continue to profit from
the above forces of oppression and those who continue to lose from them.
RQ2. What socio-ecological factors do advocates of the decolonisation of
global health evaluation associate with the decolonisation of global health
evaluation?
Following the scoping review, we used Bronfenbrenner’s socio-ecological model [31] to iden-
tify, co-develop, and organise themes (Tab 2). Factors that influence decolonising global health
evaluation include micro level themes (individuals’ and groups’ perceptions, views, stances,
and attitudes); meso level themes (largely related to community, organisations, and systems);
exo level themes (mainly national); and macro level themes (including collective cultural val-
ues and wider economic conditions) (Fig 5). Analyses of sub-themes are grouped under each
Fig 4. Word cloud of definitions extracted from sampled records.
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level below. All reviewed records included factors from multiple, and typically at least three,
levels of the Bronfenbrenner’s model as opposed to just one. Reviewed records tended to
emphasize the meso and exo levels relative to the micro level, in particular.
Micro level
According to advocates of the decolonisation of global health evaluation movement, at the
micro-level, the decolonisation of global health evaluation involves self-determination of indi-
viduals, sovereignty of individuals, and decolonisation of individual minds. 14.03% or 8 out of
57 sampled records associated these micro-level factors as being integral to the decolonisation
of global health evaluation (Refer to Table 2 for a listing of these records).
Self-determination and sovereignty of individuals. Sarmiento and colleagues (2020) [6]
denote how the fields of global health and evaluation currently adopt a deficit-based and dam-
age-centred mindset, projecting native and non-western spheres and individuals as at-risk,
vulnerable, unaware, and lacking knowledge to function with sovereignty and self-determina-
tion [6]. Self-determination of social problems and solutions by local individuals contests this
hegemony of oppressive physical or mental constructs that default to external saviours
Fig 5. Socio-ecological factors associated with decolonisation of global health evaluation.
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introducing reform and development, resisting proxy colonising forces’ direct and indirect
structural influence. As Abimbola (2018) [38] explains:
We can begin to truly decolonise global health by being aware of what we do not know, that
people understand their own lives better than we could ever do,that they
And only they can truly improve their own circumstances and that those of us who work in
global health are only, at best, enablers [38].
Robertson and colleagues (2004) [39] advise that when recipients of global health evaluation
efforts are empowered and sovereign at the individual level, they are no longer performing the
role of passive objects of research and interventions. Rather, individuals with self-determination
and sovereignty are self-actualised, active participants and contributors to global health evalua-
tion efforts—generating data, interpreting data, and shaping dissemination and translation of
outputs for community needs and transformation. Respecting and acknowledging the self-
determination and sovereignty of the recipients of global health evaluation efforts requires
global health evaluation professionals to reframe their mental models first and foremost. It
requires them to be intentional in allowing the recipients to lead efforts and to serve as followers
recognizing their own privilege, power, positionality and gaze to counter racist an oppressive
mindsets and actions [40] Several advocates of the decolonisation of global health evaluation
successfully demonstrate these principles in practice. Bennie and colleagues (2019) [41] applied
the four domains of an Aboriginal Ngaa-bi-nya health and social evaluation framework to co-
create and deliver a “culturally respectful, meaningful, and beneficial health education and pro-
motion coaching workshop program with, and for, Aboriginal peoples” [41]. Similarly, Flicker
and colleagues (2014) [42] co-designed and co-implemented an arts-based research approach to
collaboratively respond to rising rates of HIV within Indigenous communities with commu-
nity-based researchers and Indigenous youth. Their approach was intentional in affirming and
building upon the sovereignty and self-determination of Indigenous youth by adopting a
strengths and resilience-based mindset while acknowledging historical colonial and structural
oppression. Indigenous youth invested in the arts-based research program shared that they felt
empowered to be “living in this world too” [42] with self-determination and sovereignty.
Advocates of the decolonisation of global health evaluation movement cite concerns that in
the absence of such intentional decolonisation efforts, deliverers and recipients of global health
evaluation efforts may not consciously awaken to the beneficial impact derived from affirming
and asserting the sovereignty and self-determination of individuals [11] For recipients and
deliverers of global health evaluation efforts to consciously awaken to these realities, they
require an internal paradigm shift to transform one’s minds and critically reflect on current
norms and practices within the fields of global health and evaluation state scholars such as
Bu¨yu¨m (2020) [14], Guimarães (2020) [43] and Eichbaum (2020) [44].
Decolonisation of individual minds. Richardson et al. (2020) [11] and Sarmiento et al.
(2020) [6] elaborate on how colonialism destroys peoples’ economies, cultures, values, religion,
and much more—unravelling the social fabric and safety net of indigenous societies. Colonised
peoples subsequently often doubt their own abilities and competencies, distrusting and under-
valuing the ability of their nations to define the way that governance, global health, or evalua-
tion should be conceptualised and approached [11].
Many Aboriginal people are suffering not simply from specific diseases and social problems,
but also from a depression of spirit resulting from 200 or more years of damage to their cul-
tures, languages, identities and self-respect [45].
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The decolonisation of individual minds refers to repairing and reversing those internalised
effects of colonization—specifically addressing how the internalisation of colonial mindsets
affects global health partnerships and influences decision making and policy formulation [11,
44]. Decolonisation systematically liberates colonised minds and ways of thinking, culturally,
politically, and mentally [46]. Decolonisation of the self must therefore facilitate critical exami-
nation of mental and normative models through creative and therapeutic arts-based
approaches [41] or religious and spiritual mediums
42
which facilitate a shift in “how individu-
als relate to the world, respond to their internal desires, and as a result, transform into a more
holistic version of themselves” [14,41].
Meso level
At the meso-level, advocates of the decolonisation of global health evaluation movement rec-
ommend reorienting funders and reforming funding mechanisms; enabling legislation and
policies; resisting the co-option of knowledge generation, production, translation, and mobili-
sation; investing in sustainable capacity exchange; and engaging in the co-production of cur-
ricula, methods, and theoretical frameworks. 94.73% or 54 of 57 sampled records associated
these meso-level factors as being integral to the decolonisation of global health evaluation
(Refer to Table 2 for a listing of these records).
Reorientation of funders and reform of funding mechanisms. Decolonisation of the global
health evaluation movement advocates consistently pose the question: is it possible to decolo-
nise global health evaluation if “he who pays the piper calls the tune,” and funders and funding
institutions disproportionately represent western countries and institutions? [6,39,47–49]
The preponderance of external funding, specifically from former colonial powers, means that
funding agendas and streams typically reflect imperial interests [see Levich (2015) [50] and
Waitzkin & Jasso-Aguilar (2015) [51] for a definition of imperialism and explication of its his-
torical and continuing influence on global health evaluation]. Several scholars such as Chi
(2016) [21], Hopson (2012) [47], Sarmiento (2020) [6] and Robertson (2004) [39] highlight
how programming is formulated based on inflexible funds, fixed timelines and shifts in the
internal dynamics of donors—centring their priorities, often to the detriment of local commu-
nities. Chilisa (2015) [48] and Horton (2019) [49] caution that a skewed source of funding con-
stitutes a hazard to global health evaluation because foreign governments, multi-lateral
agencies, and international non-profit/non-governmental organizations make decisions about
what to fund and how to deploy funding—at best based on national, regional, or supra-
national economic and developmental goals—with little or no input from the groups on
whom the global health and evaluation efforts would be directed [49]. Lessons on how to veer
away from dependence on external funding and international aid (e.g., how to increase indi-
vidual and collective self-determination and sovereignty; how to enhance capacity to pivot,
increase, and leverage local financial, technical, and other resource pools) can be drawn from
countries now transitioning from low to middle-income status, which render them ineligible
to receive donor aid [52].
Enabling legislation and policies. Decolonised global health interventions and evaluations
prioritize the host country, local authorities, and stakeholders in addition to respecting local
cultures, values, laws, and sovereignty assert Saha and colleagues (2019) [7]. While it the cur-
rent norm for global health interventions and evaluations to require prior Institutional Board
Reviews or ethical clearances, reviews and clearances from foreign schools and governments
alone are insufficient. Beyond engaging with and abiding by appropriate ethical bodies and
codes of ethics, decolonisation involves scrutinizing legislation and policies, replacing them as
necessary with those that enable local control. Failure to prioritise local or indigenous
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languages and cultural and social contexts during policy making and enforcement presents a
barrier to health care for local and indigenous populations, actively harming them.
In Guatemala, for example, participation in research trials or community-based global
health often requires fluency in Spanish, despite national-level policies stating that health care
must be accessible in ones’ language of choice according to Flood and Rohloff (2018) [53].
Similarly, Sarmiento (2020) [6] denotes that despite a preference among expectant mothers in
Mexico for indigenous birthing rituals, practices, and traditional midwifery—especially in
rural settings with few skilled healthcare providers—local health systems instated sanctions on
those who chose these rather than institutionalised hospital births, denying them access to
birth registration and state-provided child support. In the process, they displaced the knowl-
edge, leadership, and livelihood of indigenous midwives, ultimately harming pregnant indige-
nous women. Without services in their language and providers familiar with their traditions
during delivery, they were unable to choose and advocate for indigenous birthing positions.
Being caught between two health systems that are at odds with each other increased their risk
for birth complications.
Co-option of knowledge generation,production,translation,and mobilisation. Colonisation
not only occurs by hijacking and debilitating spirits and minds, enforcing pro-colonial legisla-
tion that actively oppresses, and policy-making that erases, regulates, or criminalizes local cul-
tures, languages, and norms [42]. It is thought provoking that our results point to scholars in
the Global North domineering presence as advocates for the decolonisation of global health
evaluation movement. This points to the potential co-option or take-over of the movement
where exclusively Global North scholars have a dominant presence and voice while exclusively
Global South scholars appear to be entirely absent. Colonisation in global health evaluation
has perhaps always occurred insidiously, such as through “safari” and “helicopter” initiatives
that are tourist products masked as practicums for students in Europe and European settler
states. Van Wees and colleagues (2020) [54] raise objections to the framing global health as
health problems that take place “somewhere else but specifically in low-income countries,”
global health programs and curricula offer trips to the Global South for global health missions.
Caciki (2016) [55] and Smith (1999) [56] exemplify this predilection with the quote below:
This overall essentialist tone in Western research and its cognate field of evaluation: Research
“through imperial eyes” describes an approach which assumes that Western ideas about the
most fundamental things are the only ideas possible to hold, certainly the only rational ideas,
and the only ideas which can make sense of the world, of reality, of social life, and of human
beings. It is an approach to Indigenous peoples which still conveys a sense of innate superiority
and an overabundance of desire to bring progress into the lives of Indigenous peoples—spiritu-
ally, intellectually, socially, and economically [55,56].
Because such engagements operate for a limited period and engage minimally with local
leaders and structures, they offer the communities whose data they extract and lives they
entangle with little that is of substantial use value or that is sustainable. Instead, they offer par-
ticipating institutions and individuals’ opportunities for their own advancement and edifica-
tion [39]. Entrenched in neo-colonial mindsets, such practices wield a heavy price in terms of
their carbon, economic, and energy footprint.
Global health and evaluation programs compound such asymmetries in knowledge produc-
tion, generation, and mobilisation by generally taking place in English and other colonial lan-
guages, particularly of Europe. International journals disproportionately publish scholarship
in English and other colonial languages [57,58] and ostracize publications in local or preda-
tory journals, which many local researchers resort to because of the exclusive and exclusionary
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practices of high-impact journalsc [1,58]. Global health evaluation professionals in high-
income countries lead, manage, and attend academic and organisational centres that are head-
quartered in high-income countries. They hold key conferences with fees, travel costs, and visa
restrictions that are inaccessible for the majority of the Global South [59]. The circulation of
ideas and citations among a global minority steeped in colonial knowledge systems has con-
tributed to fixed epistemological positions that centre the foreign or white gaze within which
“a certain global distribution has consolidated expertise (in the ‘north’) and need (in the
‘south’)” [21,60].
Sustainable exchange of capacity. The United Nation’s Sustainable Development Goals
(SDG 17) embed capacity building through North-South and South-South cooperation as a
strategic priority for research partnerships in science and technology to foster innovation [23,
57]. Yet such cooperative exchange mostly remains performative and lopsided, with North-
South paradigmatic, academic, and experiential rifts fuelled by historical and structural co-
option of knowledge generation, production, and mobilisation and with conflation of research
partnerships and capacity building efforts [55,57]. Advocates of the decolonisation of global
health evaluation movement such as Carvalho (2019) [57] and Hudib (2016) [61] recommend
the following as potential pathways toward establishing sustainable capacity exchange: adopt-
ing cross-cultural humility [57]; suspending epistemological authority [61]; and developing
symmetric methodologies [61], fair access to technologies and resources [61], and systems to
exchange (as opposed to build) capacity [61]. Learning and growth for all parties is both the
goal and outcome of capacity exchange.
Co-production of curricula,methods,and theoretical frameworks. Local communities’ priori-
ties, principles, and methods guide frameworks in decolonised global health evaluation. A ran-
domised control trial conducted by Sarmiento and colleagues [6] in Mexico to examine the
effects of inter-cultural dialogue on maternal health highlights the potential benefit of engaging
in co-production with local communities as well as the potential harm that can result from not
doing so. This study found that birth complications significantly decreased among indigenous
women in the treatment arm compared to the control arm. It also demonstrates the effects of
more than ten years of co-production alongside the local community.
The responsibility for co-producing curricula, methods, and theoretical frameworks rests
squarely on those seeking to engage with communities whose cultural and historical heritages
continue to be subjugated. Among the Māori of New Zealand, tikanga—which refers to cus-
tomary practices or behaviours—decrees that evaluation is only authoritative when practition-
ers sustain Kawa whakaruruhau (cultural safety and appropriateness) in all stages of the
research [22]. Similarly, in the African context, Chilisa and colleagues suggest that the ideal
community development evaluation framework is based on five interrelated and complemen-
tary principles rooted in ubuntu [48]. While they propose that such a relational framework is
indigenous to and pervasive across all of Africa, others caution against totalising and poten-
tially essentialising characterizations of a monolithic or universal “African” culture or society
[see Ram and Affun-Adebulu (2020) [62] for a more nuanced take on this matter].
Exo level
At the exo level, decolonisation of global health evaluation prioritises community support, con-
sent, and engagement or involvement in addition to the cultivation of collective awareness and
understanding of the micro level internalisation of power and privilege, positionality, and gaze
[1,22]. 84.21% or 48 out of 57 sampled records associated these exo-level factors as being inte-
gral to the decolonisation of global health evaluation (Refer to Table 2 for a listing of these
records).
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Prioritising community support,engagement,and consent. Any sincere effort to decolonise
global health evaluation garners community support, involvement, and consent as demon-
strated by the Oglala Sioux CIRCLE Project evaluation researchers [39]. This principle was
upheld from conceptualisation through design and implementation. Pledges followed by
action demonstrated that data offered by the community for research and evaluation purposes
can be used responsibly and shared transparently with the community; both to avoid exploit-
ing them and to equip them with critical information that can empower them to successfully
navigate and transform the systems and stakeholders they engage with in their day-to-day
lives. This project highlights how to avoid extractive relations and decentre global health evalu-
ators’ intentions by centering local communities. Though such depth of community participa-
tion can signal altruistic intentions, asymmetrical power dynamics at institutional and
structural, even if not individual, levels can lead participatory approaches to play out as a new
form of tyranny (see Dorman edited by Cooke and Kothari 2001 [63]). Decolonizing global
health evaluation distinguishes between participation and collaboration. It involves collaborat-
ing with local communities as equals—as self-determined, sovereign agents of change who are
capable of prioritising and strategizing [39]—beyond simply creating opportunities for them
to participate within structures established by outsiders.
Power and privilege. The leadership of global health organisations is concentrated among
those classified as white and as men, who are products of and still tied to elite institutions
within the Global North, reflecting the hegemony of the field [24]. The 2020 Global Health 50/
50 report shows that high-income countries make up only 17% of the global population but
are responsible for 83% of global health organisations; 50% of such organisations are based in
the U.S.A. and U.K [26]. Control over more than three-quarters of the industry by a single,
small group portends an unrestrained ability to wield power and unearned privilege to decide
what merits evaluation, who should conduct it, and how. Decolonising global health evaluation
requires shared decision-making power between the Global North and Global South. Balanced
leadership can provide the necessary check on the preponderance of racist and colonial ideolo-
gies [14].
Positionality and gaze. Positionality is an inherently relational term. As opposed to the idea
of coming to be in relation with, relationality could be considered the original state of being
and development of personal and collective identity, like many indigenous knowledge and
value systems proffer, because all human beings begin life in relation, in utero and then as
infants still attached to their mothers [64]. Positionality’s inherently relational nature lies in its
reference to the researcher’s location in relation to the subject matter, populations, and context
[1]. Additionally, however, positionality is an inherently structural term—unlike essentialised
notions of culture—that draws from standpoint theory in that it requires that researchers situ-
ate themselves in space and time—not just geographically but also historically and in terms of
social location, including economically, politically, linguistically, spiritually, etc. Researcher
positionality does not exist on a bipolar continuum as “insider, outsider, insider-outsider”
might suggest [1,22]. Rather, it is multidimensional, because researchers are human beings
and human beings are multidimensional. Their identities are formed in part through the sys-
tems of oppression that human beings have constructed and continue to navigate.
Gaze is the viewpoint of the knowledge producer, which is inevitably shaped by their posi-
tionality. The knowledge producer’s orientation to and perspective on the subject matter, pop-
ulation, and context affect every phase of the evaluation process [22]. Gaze is largely not a
matter of individual choice, but the biases inherent in any individual gaze can be balanced by
mitigating the influence of individuals in the evaluation process through the relational, collab-
orative production of knowledge. The “insider, outsider, insider-outsider” construction of
positionality and gaze are themselves reductive if not false in that even locals—certainly those
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with global health evaluation and decision-making power—likely gained their internationally
recognisable understanding of and credentials in global health evaluation through a foreign
language and curriculum, even if that foreignness is defined by classifications and experiences
of caste, class, or spirituality in addition to or instead of geography or race.
Still, Cram (2016) [22] emphasises the positionality (whether outsider, insider, outsider-
insider or multidimensional viewpoint is rooted in social and economic location ultimately
influencing relationality) adopted by a researcher affects all phases of research and evaluation
efforts. Being blind to ones’ positionality and gaze can lead to adverse outcomes has been
detailed by Moodley (2020) [65]. University of Kent researchers fielded a survey seeking to
research views of South African healthcare practitioners on abortion access and provision of
services across a variety of sectors without local ethical approvals or meaningful local engage-
ment. When these researchers were alerted to the absence of South African researchers on the
project as well as their lack of ethical approval, their response was to publish a letter in a local
medical brief titled ‘University of Kent wants South African input on abortion project’. Mood-
ley (2020) [65] objects to the colonialist tones and raises concerns about harms produced by
such research conducted exclusively with colonialist positionality and gaze without meaningful
local context and input.
Macro level
At the macro level, the decolonisation of global health evaluation movement advocates advise
facilitating the decolonisation of global health evaluation necessitates an emphasis on holistic
understandings of safety and liberation that encompass spirituality and culture. It involves
acknowledging a historical backdrop of mistrust and repairing or restoring trust (noting that
“repairing” and “restoring” suggest that there was trust originally). Fostering the decolonisa-
tion of global health evaluation’s collective mind—or mental model—requires articulating its
collective purpose as transformative, liberatory, and focused on restructuring power imbal-
ances within the fields of global health and evaluation to establish equitable, mutually benefi-
cial, and reciprocal partnerships. 70.17% or 40 out of 57 sampled records associated these
macro-level factors as being integral to the decolonisation of global health evaluation (Refer to
Table 2 for a listing of these records).
Emphasising safety and liberty that holistically encompass spiritual and cultural values. Cul-
ture refers to shared meaning [66]. Culture distinguishes one community from another by
embodying their history, lived experiences, knowledge, values, learned behaviours, beliefs,
social hierarchies, ways of communicating, intergenerational traditions, and collective pro-
gramming of the mind [67]. Sarmiento (2020) [6] and Robertson (2004) [39] underscore that
aligning health with their spiritual, ancestral, and cultural values matters to all groups [6,39].
Similarly, Iseke (2013) [68] explains:
Decolonising and spirituality are inextricably linked: the outer and inner selves are connected
through understandings of spirituality [69].
While spiritual beliefs and practices shape how all communities live and access knowledge,
it is more explicit and perceptible among groups associated with otherized and minoritized
spiritual traditions. The normativity of whiteness and Christianity, however, conceal their
influence within scientism, and positivism. Colonial authorities view local traditions, cultures,
and holistic health systems as backward or devilish and the people as savages suggest Sar-
miento (2020) [6] and Mundel (2010) [45]. Advocates of the decolonisation of global health
evaluation movement recommend global health efforts [69–71] recognise the sacred, especially
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in relation to health, which is tied to some of the most intimate dimensions of life. They elabo-
rate on how value systems in Indigenous and other formerly or currently colonised popula-
tions are built around a sense of community and togetherness between the living and
ancestors with guidance from elders in the community. These values are often grounded in
collective and fair responsibilities, cooperation, interdependence, and interpersonal relation-
ships among people [69–71]. And such, they recommend that decolonised global health evalu-
ation require policy makers, funders, evaluators, and global health practitioners to embody
and enact the values of local residents with whom they collaborate. For example, Wumkes
(2020) [70] elaborates within their dissertation how the Jamaican biomedical healthcare system
has been entirely divorced from the indigenous Afro-Jamaican healing practices resulting in a
failure to serve the majority of the population. They advocate for a decolonised integrative
healthcare model reconciling the differential approach to culture, spirituality, and holism
adopted by biomedicine and indigenous Afro-Jamaican medicine. Along the same vein, Bow-
man-Farrell’s (2018) [71] Culturally Responsive Indigenous Evaluation (CRIE) evaluation
model explicates how Western global health evaluation efforts can connect to and emphasise
safety and liberty for cultural and spiritual values by incorporating the multidimensional
“physical, mental, spiritual, and emotional” aspects of evaluation.
Repairing and regaining trust against a historical backdrop of mistrust. Addressing the deco-
lonisation of global health evaluation is impossible without acknowledging the history of colo-
nialism and its tremendous ramifications according to advocates of the decolonisation of
global health evaluation movement such as Bennie (2019) [41], Bowman-Farrell (2018) [71],
Horton (2019) [49] and McKegg (2019) [40] among several others. Decolonised global health
explicitly must recognize and repairs the pain of the past and engages in present and future
practice through the lens of social justice [40,41,49,71].
Any western medical institution more than a century old and which claims to stand for peace
and justice has to confront a painful truth–that its success was built on the savage legacy of
colonialism. Perhaps we deal with uncomfortable pasts by burying them, excusing them, or
atoning for them. The Lancet, for example,is a colonial era institution [49]
Horton’s (2019) [49] quote above acknowledges the “painful truth” of the colonial origins of
global health evaluation. Some of the first schools of public health were established as part of
colonial occupation and meant to protect the health of colonial authorities, the local labour and
productivity that they relied upon, and their overarching imperialist aims [50,51]. For instance,
the Liverpool School of Tropical Medicine is the first school of tropical medicine in the world,
having been established in November 1898. According to its website, the school’s founder was
Sir Alfred Lewis, “an influential shipping magnate who made significant profits from various
European countries’ colonial exploitations, mainly in Africa” [72]. The association between sci-
entific enterprise and oppressive colonial regimes is also illustrated by rural Palestinians’ mis-
trust of and resistance against smallpox vaccination during British colonisation as indicated by
Dadidovitch and colleagues (2007) [73]. Although we invoke historical colonisation here, colo-
nisation continues via other agendas and means, including through the imperialistic monopoli-
zation of global health decision making and evaluation processes [refer to Levich (2015) [50]
and Waitzkin & Jasso-Aguilar (2015) [51] for a thorough definition of imperialism and explica-
tion of its historical and continuing influence on global health evaluation].
Collective self-determination and sovereignty. The current colonial form of global health
evaluation compromises collective self-determination and sovereignty and relegates local peo-
ple to second-class citizenship within their own land (e.g., Palestinians in Occupied Palestinian
Territories). Collective self-determination with respect to decolonised global health evaluation
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means that local stakeholders, people, officials, and leaders hold the power to decide how,
what, and when to implement and evaluate efforts assert Cram (2016) [22], McKegg (2019)
[40], Chilisa (2015) [48], Bowman-Farrell (2015) [71], Wumkes [70], among several other
decolonisation of global health evaluation advocates. Similarly, collective sovereignty connotes
political authority [74]. It means supreme authority within a territory over matters such as
governance, policy making, resource utilisation and allocation, negotiation of borders and
advocacy for inalienable rights to liberty, freedom of expression, housing, health, and human
rights, etc. Collective sovereignty shapes decision making, leadership, governance, and regula-
tions defining how to do things within a community [75].
For example, “nation building” is a term increasingly found in the literature, used particu-
larly by leaders in Indian Country (any of the many self-governing Native American commu-
nities throughout the United States—all federal trust lands held for Native American tribes
[76]). It refers to the process of constructing effective institutions of self-governance that can
provide a foundation for sustainable social development, including health and education; judi-
ciary and legal institutions; and successfully democratised political systems, advocacy, and
actions. In other words, nation-building is the process of promoting individual and collective
self-determination, self-governance, and sovereignty [77,78]—ultimately improving tribal citi-
zens’ social and economic situations through the creation of more capable, culturally legiti-
mate institutions of governance and stewardship [39]. Translating the “nation building” ethos
into praxis, advocates of the decolonisation of global health evaluation movement such as Chi
and colleagues (2017) [21] challenge mainstream global health evaluation efforts while propos-
ing the Critical International Health Program Evaluation framework which uphold the princi-
ples of collective self-determination and sovereignty. The following quote illustrates their
motivations for challenging the mainstream global health evaluation efforts by developing an
alternative framework to uphold collective self-determination and sovereignty during global
health evaluation efforts.
A vital tenet of our framework is that a community possesses the right to determine the path
of its health development. A prerequisite of success, regardless of technical outcomes, is that
programs must address communities’ high priority concerns. Current participatory methods
still seldom practice community ownership of program selection because they are vulnerable
to funding agencies’ predetermined priorities [21].
Mutual benefit and reciprocity. The Kaupapa Māori theory-based evaluation framework
emphasises transformation as a core principle through the concept of koha or reciprocity [79].
Reciprocity must be inherent in all collaborative effort to facilitate collective transformation
and achieve useful outcomes for the collective good [79]. Cavino (2013) [80] adds that privileg-
ing the principle of achieving mutual benefit and reciprocity in an equitable way paves the
path for local communities to own and protect the knowledge that is generated. Pai (2020)
[81] acknowledges the importance of centering mutual benefit and reciprocity to decolonise
global health evaluation efforts. They outline ten recommendations on how global health eval-
uation efforts can apply the principle of mutual benefit and reciprocity which includes measur-
ing and tracking reciprocity. Measuring and tracking reciprocity has the potential to lay bare
the normatively extractive and transactional nature of global health evaluation efforts [49,81].
Decolonising collective minds. The effects of colonialism are devastating and can last for gen-
erations, entrenched in colonial or neo-colonial structures and mental constructs.
Decolonisation reaches beyond removal of colonial power and dismantling of colonial struc-
tures to include decolonisation of the mind that made the coloniser feel superior and the
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colonised feel inferior by enforcing structural drivers of discrimination and barriers to self-
determination [32].
Decolonising collective minds involves removing colonial powers and conditions and dis-
mantling colonial structures to decolonise individual and collective minds—which are mutu-
ally reinforcing [11].
Decolonisation, therefore, is a systematic way of research and evaluation that attempts to lib-
erate the colonized mind (individual) so that formally colonized people (collective) are not
only politically emancipated, but also mentally emancipated [56].
Mundel (2010) [45] details that decolonising collective minds has revolutionary potential
for decolonising global health evaluation efforts and society-at-large. Doing so begins with an
individual paradigm shift leading to the dismantling of the dominant colonial mental models
influencing the collective. This requires both the non-Indigenous and Indigenous to transform
their inner selves. The non-Indigenous must then collectively mobilize to respect, engage with,
and immerse in the decolonisation movement such as privileging Indigenous self-determina-
tion and sovereignty. Similarly, the Indigenous must experience an inner transformation as
well such that they can collectively mobilize and advocate for decolonised global health evalua-
tion as illustrated by Chilisa (2015) [82] with the following quote:
Along with the African renaissance concept is the Africanisation concept which refers to ‘a process
of placing the African worldview at the centre of analysis’. It can be viewed as an empowerment
tool directed towards the mental decolonisation, liberation and emancipation of Africans, so that
they do not see themselves only as objects of research and consumers or borrowers of knowledge,
but also as producers of knowledge capable of theorising about the production of knowledge in
ways embedded in the cultures and experiences of the African peoples [82].
Discussion
Intended to re-imagine global health evaluation by considering its decolonisation, this study
sought to define and provide a socio-ecological understanding of factors associated with the
decolonisation of global health evaluation through a scoping review of papers published on the
decolonisation of global health, of evaluation, or of global health evaluation. It defines the
decolonisation of global health evaluation more as a means for the advocates of the movement
than an end. Representing a commitment to a process—a transformative and liberatory move-
ment that aims to restructure relations—the definition resists the product-oriented exhorta-
tions of positivism and scientism. Understanding the factors associated with decolonisation in
a socio-ecological context provides practitioners and scholars in the field of global health eval-
uation with micro, meso, exo, and macro level mechanisms through which the experiences,
perspectives, and interests of displaced and dispossessed communities can shape the evaluation
of global health interventions. In the remainder of this section, we summarize the findings and
interpret the meaning of our review’s results in the context of prevailing research and theory
in global health evaluation; consider their implications and significance for theory and prac-
tice; and share recommendations for future practice and scholarship on its decolonisation.
Summary & interpretation
Results of this scoping review offer global health evaluation practitioners, educators, and
researchers a socio-ecological framework through which to understand the interactive,
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mutually-causal factors involved in decolonisation. Such an understanding allows practitioners
and scholars alike to act within their spheres of influence, regardless of their personal and pro-
fessional positionality or social and geographical location, with the aim of effecting change at
multiple socio-ecological levels (as in micro, meso, exo, and macro). That nearly every article
addressing global health, evaluation, or global health evaluation that was reviewed proferred
multi-level decolonizing factors contrasts with de facto institutional understanding and
approaches that rest entirely on individual level factors such as: 1) the “diversity” of individual
contributors, without considering institutional and structural mechanisms that enable (or pre-
vent) diverse perspectives to shape policy and practise; 2) the “cultural competence” of individ-
ual members of dominant groups; or 3) the benevolence of dominant institutions to “include”
members of the indigenous and colonized groups whose lives their work affects [83]. Instead,
the literature on decolonizing global health evaluation offers everyone engaged in global health
evaluation multiple avenues to act in decolonizing ways, regardless of their identity or posi-
tional power, and the socio-ecological model articulates those avenues explicitly.
Implications & significance
The consistency of factors identified within and across fields points to the need for intentionality
among the relevant fields to act on them. In other words, while this review’s collation and organi-
sation of decolonising factors into socio-ecological levels adds value to the relevant fields by vali-
dating the factors against each other and starting to build a conceptual framework among them—
thus making them more accessible and actionable—the individual factors themselves have been
documented across fields, in some cases repeatedly, for nearly 30 years, with little movement
toward decolonisation as this paper defines it. The global health evaluation system’s homeostatic
resistance to change and tendency toward isomorphism can be partially explained through con-
cepts from natural and social systems that undergird the socio-ecological model employed in this
paper [84]. Similarly, the system’s more specific entrenchment of inequality along pervasive, per-
sistent, and predictable patterns can be partially explained through concepts about power offered
by critical theories of systemic oppression, which this paper also employs. In the spirit of both dis-
ciplinary traditions and the results of our review, we interrogate our process and findings below.
Strengths
This study is rare in its employment of Arksey & O’Malley’s scoping methodology [30] and in
its application of Bronfenbrenner’s socio-ecological model [31] not to research subjects or pro-
gram participants “out there” but rather to researchers, program staff, and program evaluators
“in here”, by critically reflecting on the fields of global health and evaluation themselves. It
addresses global health and evaluation separately and together, identifying factors related to
decolonisation of each at multiple levels. The length and nature of the research period—during
a global pandemic and international uprising with respect to multiple forms of systemic
oppression including direct and indirect forms of colonisation—necessarily shaped the scope
and type of engagement with the literature. Still, the overwhelming consistency and synergy
across reviewed records and, indeed, fields—captured systematically through a scoping meth-
odology and conceptual framework—allows global health evaluation to move toward a theory
of transformation and an associated research agenda to support its decolonisation.
Limitations
Our search strategy was limited to records in the English language and to a handful of data-
bases that associated with academic and grey literature archives. Delimiting this review to
English-language literature ironically re-centres the colonial powers of Europe and European
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settler states. Indeed, the word “decolonise” itself was coined by colonial powers, in reference
to the independence of what is now the USA from Britain [85] and later in reference to inde-
pendence from European colonial powers in the mid-20
th
century [86]. Another limitation lies
in its potential reification of the artificial boundaries between levels of the socio-ecological
model—not unlike other artificial boundaries, between groups, that we described in our sec-
tion on positionality and gaze. The micro level factors of self-determination, individual sover-
eignty, and decolonisation of individual minds that were identified through this review require
macro and exo level interventions as much as the exo and macro level changes listed in the
results require individual agency and interpersonal relationships at the micro and meso levels.
The process of decolonisation of global health evaluation is thus interactive among levels and
could be characterised as “inter-level” beyond simply being “multi-level.” Lastly, the results of
this study reflect the literature identified through the databases specified which may produce a
selection bias as it is possible we did not capture all available documents available on this topic.
The study was also conducted during a global pandemic and related series of uprisings against
oppression and the results have yet to be validated by practitioners or tested empirically—steps
that were beyond the scope of this study but form the basis of a research agenda focused on the
decolonisation of global health evaluation. Finally, with respect to positionality, the geographic
location of authors’ affiliated institutions does not necessarily correspond with their individual
nationality, country of current residence, upbringing, or training, nor can it be assumed to
reflect any particular cultural or political identity, experience, or perspective even when it does
correspond—especially when considering displaced and diasporic communities. Geographic
location of authors’ affiliated institution also does not necessarily correspond with the authors’
institutional perspective, privilege, or power, especially when considering institutions serving
minoritised populations in settler colonial states (such as Asian American and Native Ameri-
can Pacific Islander serving institutions, historically Black colleges and universities, Hispanic
serving institutions, and tribal colleges). This is particularly so in cases of team authorship.
Categorizing collaboratively written records by geographic location of affiliated institution
only provides some insight into the system of structural opportunities, incentives, and con-
straints available to authors in relation to the international political economy and authors’
efforts to work within and across disparities therein.
Recommendations
Because the publishing industry and academia privilege colonial languages and especially
English, as described earlier, collaborating across language—colonial and indigenous—would
mitigate but not resolve the limitations of focusing on English-language items for review.
Additionally, future studies can intentionally and explicitly question and seek to further com-
plicate taken-for-granted boundaries and associated perspectives, constructed along artificial
binaries, through the research process and decisions. Finally, future research and practice can
focus on the iterative application of and reflection on the factors identified through this review
in various contexts. For global health evaluation to transform itself—to decolonise—it must
sustain the praxis of interrogating everyday decisions and processes, asking how each channel
multiple types of power: To what extent and in what ways do we continue to feed—and alter-
natively, do we starve—the ongoing (re)production of difference in the form of artificially con-
structed disparities, disproportionalities, and distinctions?
Conclusion
In sum, decolonisation is now at the risk of becoming a comfortable, trendy but misused,
exploited, performative—and most worrisome of all—commercial buzzword [7,87,88]. An
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irony Khan (2021) [69] points out is that a corresponding word does not exist within many
non-European languages. Moreover, many in the Global South are unable to relate to or agree
with the terminology considering its Eurocentric origin and central focus on the Global North.
For some, decolonisation can only occur when colonising institutions are shuttered and cease
to influence the Global South or settler-colonial contexts [7,87]. For others, decolonisation is
simply a principle under which those interested in furthering the cause can organise [7].
Our paper demonstrates that scholars and practitioners have identified a myriad of socio-
ecological factors that are associated with the practice of decolonisation. We have also summa-
rised their collective wisdom and perspectives on how to define decolonisation. Despite advanc-
ing the discourse and critical assessment of the decolonisation of global health evaluation and
factors associated with the term through this review, gaps exist and obstacles remain. Echoing
Khan (2015) [87], the origin of the papers we have reviewed in this study highlights how the
scholarship centred on decolonising global health evaluation primarily emerges from the Global
North (specifically the U.S.A., Australia, Canada, and New Zealand) (Fig 4). The ideas and
knowledge we have collated thus represent the viewpoint of scholars and practitioners residing
in or affiliated with institutions in these countries. We can surely concede that it is entirely feasi-
ble that the origins of many of the authors of the reviewed papers mirror the co-authors of this
reviewing paper—those who have ancestral origins or national affiliation within the Global
South or Indian Country but whose current or former residence or training is in the Global
North. Therefore, one could argue that the gaze this paper offers is from a third perspective,
between the foreign or white gaze and the local gaze, because its co-authors—and the authors of
many of the reviewed papers—experience and traverse these two orthogonal spheres.
The pandemic has highlighted the social, economic, financial, and political inequities faced
by the marginalised majority (82% of the world’s population)—Black, Indigenous, Peoples of
Colour (BIPOC). It also lays bare a concept that was previously intangible—global intercon-
nectedness tying together our shared destiny and threats [14]. The pandemic has also exposed
and reversed the perception of the Global North’s superiority in upholding aspirational public
governance, health, and well-being, as Asian and African countries effectively flattened the
spread’s curve and returned to normalcy while European and North American countries con-
tinue to face the pandemic unabated during the first wave [89,90]. On the darker side, there
are now real risks of exacerbating existing apartheid (vaccine or financial) and rising inequities
[91,92]. Yet, there is also an unprecedented and urgent window of opportunity to transform
and decolonise global health evaluation [14]. What might decolonisation look like under these
unchartered territories? Our review offers a starting point towards framing this discussion. In
revisiting whether decolonisation is a product, checklist, badge, outcome, or journey: we lean
heavily towards viewing decolonisation as a journey that exacts a process of transformation
towards the greater goal of achieving equity and justice.
Supporting information
S1 Checklist. Preferred Reporting Items for Systematic reviews and Meta-Analyses exten-
sion for Scoping Reviews (PRISMA-ScR) checklist.
(DOCX)
S1 Table. Charting framework template.
(DOCX)
Author Contributions
Conceptualization: Ichhya Pant.
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Data curation: Ichhya Pant.
Formal analysis: Ichhya Pant, Sonal Khosla, Jasmine Tenpa Lama, Vidhya Shanker, Aisha El-
Basuoni, Beth Michel, Ifeanyi McWilliams Nsofor.
Methodology: Ichhya Pant, Ifeanyi McWilliams Nsofor.
Project administration: Ichhya Pant.
Resources: Ichhya Pant.
Software: Ichhya Pant.
Supervision: Ichhya Pant.
Validation: Ichhya Pant.
Visualization: Ichhya Pant, Ifeanyi McWilliams Nsofor.
Writing – original draft: Ichhya Pant, Sonal Khosla, Jasmine Tenpa Lama, Vidhya Shanker,
Ifeanyi McWilliams Nsofor.
Writing – review & editing: Ichhya Pant, Sonal Khosla, Jasmine Tenpa Lama, Vidhya Shan-
ker, Mohammed AlKhaldi, Beth Michel, Khalil Bitar, Ifeanyi McWilliams Nsofor.
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