Repositioning Global Health: Decolonising Narratives and Practice in the African Context.

Background: Global health practice in Africa remains shaped by enduring colonial legacies that privilege external expertise and undervalue indigenous knowledge systems. Despite widespread recognition of inequities in authorship, funding and representation, global health discourse often overlooks the deeper epistemic and cultural dimensions of decolonisation. Main Argument: This article argues that true decolonisation of global health requires dismantling the enduring mechanisms of coloniality, specifically epistemic injustice, misrepresentation and peripheral positioning, that continue to produce knowledge hierarchies and limit African autonomy. We propose a shift from a donor-recipient logic to a partnership logic, where African institutions and scholars lead in defining priorities and generating knowledge. Examples such as the widespread use of herbal and traditional medicine, often the first line of care for rural communities, illustrate how local innovations are frequently dismissed as unscientific rather than recognised as valuable health assets. Furthermore, the routine portrayal of deprived African communities in global health imagery perpetuates stereotypes that reinforce dependency. Conclusion: Decolonising global health in Africa demands not only fair authorship and funding practices but also epistemic inclusion and representational justice. Global health must be repositioned to leverage Africa's own resources, cultural practices and institutional capacities to create contextually grounded, equitable and sustainable health systems.