Transforming Global Health: Moving Beyond Grant-Dependent Systems

Efforts to decolonize global health highlight the need to fundamentally change the dominant structures governed by institutions from the Global North. A recent study published in PLOS Global Public Health, authored by Daniel Krugman from Brown University and Alice Bayingana from the University of Sydney, emphasizes the importance of 'ruinous solidarity' — a concept urging Northern institutions to accept significant sacrifices, including the potential loss of resources, to foster true equity. Despite growing scholarship on decolonization, these institutions continue to wield disproportionate influence via a 'soft money' funding model, heavily reliant on grant acquisition to sustain research programs and individual careers.

Interviews with 30 faculty members from an anonymous top U.S. school of public health reveal internal conflicts: many support redistributing power to the Global South but feel constrained by the current funding system. Researchers’ careers often depend on winning grants, which cover salaries and research costs, creating a competitive and precarious environment. This 'soft money' structure encourages researchers to chase grants relentlessly, often at the expense of impactful work and long-term partnerships.

The reliance on external funding also leads to job insecurity, researcher burnout, and project discontinuations when donors shift priorities. While the idea of shifting financial support directly to Global South institutions gains support, many academics worry about personal and institutional repercussions, illustrating a deep-seated resistance to change.

Krugman and Bayingana argue that for genuine transformation, Northern global health actors must be willing to accept the personal and institutional costs associated with restructuring their financial systems. True decolonization requires confronting the material realities and systemic inequalities embedded in current funding practices — a necessary step toward equitable and sustainable global health progress.

You can find more details on this research in the article "Soft money, hard power: Mapping the material contingencies of change in global health academic structures" published in PLOS Global Public Health (2025).