July 12, 2022 • 31 mins
An important Global Health Matters podcast topic this month, discussing the need to build an awareness of the ways we interact with colleagues in the workplace to adapt our programmes to be more inclusive. We need to talk about “the future of global health through diversity and dignity”. Host Garry Aslanyan interviews our special guests who have a deep understanding of diversity and dignity and their application worldwide.
Our first guest, Marie Ba, is from Ouagadougou Partnership where she advocates for reproductive health and development across West and Central Africa. Marie Ba questions whether diversity is just a tick-box exercise, ensuring that we break down the definition and elements that make up the term “diversity”.
Tom Wein is based in Kenya where he leads research on dignity in development with IDinsight. By analysing further the two concepts of diversity and dignity together, the link is formed and shows that representation is only one aspect, and that agency and equality also need to be factored in to realize dignity within diversity.
Join us in this podcast episode to develop a broader understanding of the future of global health through diversity and dignity.
Guests are:
- Marie Ba, Director of the Ouagadougou Partnership Coordination Unit
- Tom Wein, Director, Dignity Initiative IDinsight
Related documents, transcripts and other information can be found on our website at
The future of global health is through diversity and dignity (who.int)
We are keen to engage with you, our listeners, at every step of the way – please feel free to suggest topics and questions to be discussed and share your feedback by dropping us a line at TDRpod@who.int.
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Disclaimer: The views, information, or opinions expressed during the Global Health Matters podcast series are solely those of the individuals involved and do not necessarily represent those of TDR or the World Health Organization
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SPEAKER_04 (00:44):
Hello and welcome to another episode of the Global
Health Matters podcast.
I'm your host, Gary Aslanjan.
It's great to welcome you back,our listeners, who now span over
134 countries.
Thank you for your ongoingsupport of this podcast.
As many of you, I follow with alot of interest the current
(01:06):
dialogue and debates on thefuture of global health.
Academics and practitioners fromNorth and South are really
considering a lot of aspects ofglobal health practice that need
to be reimagined.
Equity, inclusion, furtherlocalization.
All of these have becomeaspirant goals receiving
(01:29):
unanimous support.
So in this episode, we will bediscussing the role of diversity
and dignity and how these twofactors can enhance global
health.
For this conversation, I'mjoined by Marie Ba and Tom
(01:50):
Wayne.
Marie is the director of theWagadougou Partnership
Coordination Unit based inDakar, Senegal.
Marie has extensive experiencein fostering partnerships and
managing health programs in Westand Central Africa.
Tom is the director of IDInsight, based in Nairobi,
(02:13):
Kenya, leading various researchinitiatives, and Tom also is the
founder of the Dignity Project,a campaign promoting more
respectful internationaldevelopment.
Hi Marie.
SPEAKER_05 (02:31):
Hi Gary, how are you?
SPEAKER_04 (02:33):
Hi Tom.
Hi, Gary.
Hi Marie.
SPEAKER_01 (02:35):
Really glad to meet both of you.
SPEAKER_04 (02:36):
I'd like for us to start by unpacking the key
terminology in our discussionwe'll be having today.
So we are all on the same pageand have a common understanding.
In summary, the term diversityholds many connotations in
global health and development.
Marie, in your piece that youpublished in the Lancet Global
(03:00):
Health, you mentioned that theterm diversity entails
representative participation,which has often been reduced to
a checkbox exercise.
What else would be important foryou in using this term?
SPEAKER_05 (03:15):
I think diversity is the hot new thing I feel in the
past couple of months.
And I think even though it maymean a lot of different things
to different folks and differentpeople, to me it shouldn't be
limited just to representation.
I think it's one aspect of it,of having meaningful diversity
(03:36):
through representation.
But I think it's also veryimportant to have
decision-making powers andleadership powers in that
diversity.
And I feel like that's whatlacks a time where you have
diverse looking, either staffmembers, crew, or board members,
but not in actuality verydiverse.
(04:00):
And so being able tomeaningfully shift the powers,
if all we do is look atrepresentation, we're only going
to end up with gimmicks and notreal power shifting.
And so addressing the system,meaning funding streams, meaning
decision making, shaping theglobal health agenda, is also
(04:23):
extremely important.
SPEAKER_04 (04:25):
So, Tom, you just heard from Marie that the term
diversity has become a verypopular term in global health
and in development.
However, in your work, you'veemphasized the term dignity.
What do you mean by dignity andwhy it's important, especially
when we talk about diversity?
SPEAKER_01 (04:44):
Dignity to me is about this fundamental,
inalienable quality that everyhuman has that means they ought
to be treated in a certain way,in a way that recognizes or
respects their dignity.
That work then leads us to awhole range of ways in which we
might change our behavior.
(05:05):
And I really I love what Murraywas saying about these
fundamental changes to the powerrelations that might be
necessary to achieve that.
We're in the middle of thesereally extraordinary campaigns
and changes for greater racialjustice, greater gender justice.
I hope that dignity is neversupplanting or taking energy
(05:26):
away from those campaigns thathave their own fully worked out
language and frameworks anddon't need me to suggest how to
go about them.
One thing that I hope dignitycan do is extend those to all
the ways in which people want tobe treated, to be treated as
their best selves, as full,complex humans in all the
interactions they have withother people and with
(05:49):
institutions.
And that I hope is what theDignity Initiative can start to
lead us towards.
SPEAKER_04 (05:56):
Marie, the Wakadogum partnership that you worked in
has been very successful inlooking at localizing and giving
opportunity for country-basedleadership.
You already alluded to that inyour definition.
Maybe you could share with ussome of the factors that enabled
this to happen?
SPEAKER_05 (06:14):
So I think, first of all, just in the name, from the
beginning, this was set up as apartnership.
Um so it never really felt likea grantor, funder, grantee
relationship.
Um I think even at the at theoffset, um, it was set up for
success.
Um and then every single partnerand member who joined the
(06:35):
Wagadugu Partnership really feltthis equal um opportunity and an
equal partnership between thesenine Francophone West African
countries as well as the youknow powerful donors that were
um funding some of these healthprograms.
So I feel like that was thefirst step in setting us up for
success.
And then it's it's been aprocess.
(06:56):
It's been we've been um um onboard now for about 10 years.
So it took really 10 years tomature into a partnership where
there was enough trust um toactually set us up into this
localization.
And one other very importantaspect um is this generational
(07:17):
renewal.
And I feel like really havingthis new generation of African
leaders and talents who are umuh maybe a bit more pushy and
and and you know, fierce and andbolder in making that
localization happen was alsoinstrumental in setting us up
for this local um entity, was uhinstrumental in making us what
(07:42):
we are today.
SPEAKER_04 (07:43):
Early on, the approach taken really is an
important factor in how theoutcome is unfolding or unfolded
over the 10 years period.
Yeah, yeah.
Exactly.
Thank you.
Tom, you mentioned that uhdignity is a universal human
trait or human desire,obviously.
(08:04):
It would be simplistic to assumethat this is experienced in the
same way by all people.
From your research, uh, if wewere to look and see across
different settings, how isdignity experienced across
different countries andcultures?
SPEAKER_03 (08:23):
I think this is a really important question.
SPEAKER_01 (08:26):
Dignity is one of these things that appears in
virtually every theologicaltradition, philosophical
tradition.
Almost everybody who's talkedabout morality has had some idea
of this is what makes peoplespecial, this is what we owe to
people and how they ought to betreated.
But of course, those traditionsvary and popular understandings
(08:48):
vary too.
Because of that, I think it'sprofoundly important that we
keep doing good qualitativeresearch and keep understanding
the subjective experience inevery new place and every new
context that we're that we'retrying to uh understand uh
dignity.
There's a Western idea ofdignity that is um uh comes out
of Western philosophy, descendsfrom in part from Immanuel Kant,
(09:13):
which is um about eachindividual having this uh this
trait, and therefore they mustbe treated in this way.
And that's kind of what Isketched out in my first answer.
And that's fine as far as itgoes.
That's actually not a bad thingthat takes us quite a long way
across a number of differentglobal traditions.
But I did some participatoryresearch with uh the activists
(09:35):
of the Mathari Social JusticeCenter here in uh in Kenya.
Mathari is a very toughneighborhood.
The Social Justice Center havebeen fighting for um greater
access to many of the thingsthat they are supposed to be
granted in the constitution andthat have not been achieved, not
least freedom from policeviolence.
The activists there told me, aswe came to a consensus
(09:56):
definition, two things.
They said that that Westerndefinition works okay for us.
But there are two things youneed to know that are that are
missing from that definition.
One is capability, and the otheris purpose.
So they said, yes, of course youshould treat people in this way,
but not everyone has thecapability to do that.
You need a basic foundation ofself-respect, capacity,
(10:20):
self-efficacy, uh perhaps somematerial resources in order to
create the mental room to treatothers in the way that you would
aspire to.
And they told me that we do thisfor a reason.
The reason we show respect toone another, the reason we take
care to notice one another, isnot just because a philosopher
tells us to.
It was, in their opinion,because it gives us the
(10:41):
opportunities to care for oneanother and to discharge what
they viewed as their God-givenduty to provide care for one
another.
And I think we could talk aboutother traditions.
There's been great work done,for instance, by the Overseas
Development Institute onunderstanding of dignity in
Colombia and the Philippines.
We're doing some qualitativework in Uganda right now.
Um, and there's lots we couldtalk about.
(11:03):
But I think the important thingto note here is there are these
varied traditions, which is whywe have to keep embedding it in
the subjective experience ofpeople to they feel they were
treated in the way that theywould hope.
SPEAKER_04 (11:13):
From where you are, Marie, what do you think of this
issue of settings and dignitythat Tom just alluded to?
SPEAKER_05 (11:21):
I really appreciate him talking about this because
at times I've questioned myself,why are we doing this?
Or I've questioned otherpeople's intentions as to why
they were interested in workingin global health or in
international developmentglobally.
So I started, and even before Istarted my career, when I I
(11:43):
remember I was in school in theUS, and both universities I went
to were not the most diverse.
Um and I remember one student inone of my um international
development classes mentioningthat maybe we should go back to
colonization as an answer to howthe West or the global north
(12:03):
could best um help Africa umsucceed.
And I, you know, obviously Ifroze, but then, you know, even
within my career, there are somany instances where I've rolled
my eyes in a meeting or or readan email where I felt so much
condescendence at times, um,sometimes pure ignorance.
And that's always because atsome point, either the system or
(12:28):
the people have removed thisaspect of morality and dignity
out of the equation, which Ithink is just so important um
and that we really shouldn'tbypass.
SPEAKER_04 (12:41):
Mm-hmm.
So you've alluded to yourpersonal and professional
experience.
Based on that experience and thereflection you just had, what do
you think can be done to achievegenuine diversity such that
global health goals can actuallybe achieved?
How do you do this in your work?
SPEAKER_05 (13:02):
So I think first you probably need to have very
uncomfortable uh conversations,fortunately or unfortunately.
Um and I think that has started,which also triggered just the
this mayor podcast we're we'reon.
So all of these conversationswhere I feel like the global
north needs to give um a safespace for us, for you know,
(13:25):
African or or um minority or ummiddle income countries leaders
um to actually voice what someof our needs are.
Um because most of theconversations that I've heard so
far about um shifting powers orum uh the sometimes the lack of
diversity has mostly come fromthe north.
(13:48):
It's I haven't I don't feel likewe've had enough of these
conversations, even amongstourselves in the global south.
And I think that's what we'remissing.
So being able to share ideas,what are some of our asks to set
us up for success in the in thefuture?
Um, so first having thoseconversations, but then also
being able to step away from theconversations and really going
(14:10):
into action.
Um, so this doesn't end up justbeing conversations.
Um, and I think we also need tobe deliberate and understanding
that there is a system in placethat is intentionally or
unintentionally designed, uh,keeping this imbalance, being
very honest and crude about it,um, and seeing how we can we can
(14:30):
fix that.
SPEAKER_04 (14:31):
Mm-hmm.
Tom, do you have anyobservations on Marie's uh
assessment?
SPEAKER_01 (14:37):
Yeah, I think Marie's right that these
conversations are reallyimportant.
We did some research withAmerican nonprofit staff and
asked them what helped themcommit to a culture of dignity,
even when that meant realsacrifice for them.
And a couple of things seemedreally important.
One was managers talking aboutit and giving them a permission
(14:58):
structure to say, yes, we'regoing to go ahead with this.
And the other was listening tothose who've experienced
disrespect in their own lives,who have felt that experience of
being maltreated, and makingsure that their voices were
leading the conversation, evenif that was leading them
sometimes to be kind of cynicalabout this cause, who were
saying that you know, thattherefore development doesn't
(15:19):
always practice what itpreaches.
Those people are reallyimportant to be listened to.
The third final thing I'd add isthere are ways that we might try
and change an organization andstructures that you might use,
of accountability, ofmeasurement, and so on.
Before we get there, everyorganization should know that
there are places they'd begetting this right.
(15:41):
This is not an impossible ideal.
We will all have our favoriteexamples.
I deeply admire Partners inHealth, as I'm sure almost
everybody does.
I deeply admire the work thatAltogether in Dignity Fourth
World have done.
I used to work for a placecalled Raising Voices, which
works to prevent violenceagainst women and children in
Uganda.
All these places are places thathave really built cultures of
dignity through constantreinforcement internally, and
(16:03):
have can show us the way, canshow us this is not
unattainable.
And I think that's reallyimportant for people to know.
Mm-hmm.
SPEAKER_04 (16:12):
So, from the work that you've done, you mentioned
in the reading that I had thatthere are three pathways to
disrespect.
So maybe we can unpack that alittle bit more.
So agency, representation, andequality.
What are the recommendationsthat you have for the global
health researchers orpractitioners on how these three
(16:33):
aspects can be taken intogreater consideration when
designing health programs?
And then we'll see what Mariethinks of that.
SPEAKER_01 (16:42):
All the way through my answers today and all the way
through all the work I do, I'mreally emphasizing the
subjective experience of theperson with the least power in
any interaction.
If they say that they feelthey've been treated in a way
that respects their dignity,they have.
And if they don't say that, theyhave not been treated in the
right way.
Regardless of what else we mighthave done or how how some global
(17:04):
development actor may feelthey've acted, whether no matter
how good the intentions were, ithas to come down to that
subjective experience of theperson with the least power in
interaction.
Now, that subjective experienceis going to vary enormously from
place to place, as we weresaying.
But when we do study thesedifferent traditions of dignity,
and when we ask people what'simportant to them, we seem to
(17:27):
see these three pathwaysrecurring of representation,
agency, and equality.
Representation is about peoplefeeling seen by the institutions
that they're interacting withand seeing themselves
represented in thoseinstitutions.
Agency is about having choicesand a meaningful chance to
consent for the decisions thatare being made about their
(17:49):
lives.
And equality is about the powerinequalities being reduced, and
even where they cannot beeliminated, people feeling
treated as if they werefundamentally equal, even if
those power of differentialspersist.
And those three pathways I findare great starts.
We use them in the workshops wedo here at Idea Insight, because
(18:10):
they're a great way of beginningto generate ideas, and those
ideas will vary depending onwhat uh what program you're
operating, what type oforganization you are.
But there's a I think everybodycan begin to think about ways in
which people could feel moreseen, better represented, ways
in which people could have abetter chance to consent, and so
on.
I think those three pathways area great place to start for
(18:32):
brainstorming ideas for foralmost any program.
SPEAKER_04 (18:36):
Mm-hmm.
So kind of look at how ouraudience, our listeners uh who
are going to take some of thesemessages and see how they can
adopt that in their programs.
Marie, how would you use this tobuild on the work that you've
done already?
SPEAKER_05 (18:53):
So I really like this idea of these three
pathways.
And I think unfortunately, we'vewe've focused so much more um
recently on representation beingseen and giving a voice to the
global south, which is veryimportant.
But I think where we we lack abit more is on agency and
equality.
(19:13):
Um and I think that's how we getto really meaningful power
shifts.
Um and those are some of theconversations that I've had with
certain colleagues who noticedthe same things.
And in the beginning, you feellike, wait, is it just me?
Um, and then you realize it'snot just you, it's not uh just
this one time that it happened,um, that it happened also to
(19:35):
colleagues in the field.
So really being able to get asense of what those perceptions
are, and as Tom has put it, I Imean, whether you're talking,
you could be talking to twopeople and they would have
varying, very differentexperiences.
So I think taking most of them,if not all, into account is also
extremely important.
But as far as I can um I haveexperienced so far, a lot of the
(20:00):
focus, and I think it's theeasiest, usually, right?
You just go to representationbecause that's the the easiest
one to be seen and tick thatbox, um, as we've we've
mentioned before.
Um, and the really hard work, Ithink, is really working on
agency, on equality, and reallyshifting those powers.
And I've I think Tom alluded tothat.
(20:21):
Um, it's not about transferringa hundred percent of the power
over to the global south.
I understand that there might besome uh worries about this new
agenda, but I think it's just amatter of um equity and and um
and equality.
And we see the same fight whenit comes to race relations,
(20:42):
exactly the same fight when itcomes to gender equality, it's
just about giving um less of ahead start and less privileges
to one side over the other.
SPEAKER_04 (20:52):
Are there any other points around examples or the
pathways towards findingsolutions you'd like to add?
SPEAKER_01 (21:01):
There was one more point I wanted to make, which is
that everybody acrossdevelopment has good intentions
and wants agendas like this tosucceed.
We can certainly brainstorm moresolutions.
I hope those three pathways arean interesting and valuable
framework through which to doit.
We know that initiatives likethis have failed before.
(21:23):
There have been a lot of effortsto reform global health, to
reform global development.
One way in which we can helpmake sure this has a better
chance of success is by holdingourselves accountable.
And I think a crucial part ofthat is measurement.
It's perhaps a shame in globalhealth and development that we
always need to look toquantitative measures, and we're
(21:45):
not great at digestingqualitative evidence, but we
know that kind of is true.
And a really central part ofwhat we've been doing here at
the ID Insight is thinkingthrough quantitative measures
that can be validated, that canbe demonstrated in different
contexts and differentsituations, that focus on
people's subjective experienceof how they were treated and
(22:06):
whether they were treated in theway they would aspire to be.
And that um developing thosemeasures, I think, is absolutely
crucial to this work becauseit's what's going to allow us to
check our progress, to trial newimprovements, and to hold
ourselves accountable when wefall short of this promise to
uphold everyone's dignity.
SPEAKER_04 (22:25):
Marie, did you want to add anything?
SPEAKER_05 (22:28):
For me, uh beyond what Tom just mentioned, I think
that's Idea of accountabilityand good intentions, it needs to
come from both sides.
I know we talk a lot aboutshifting powers, decolonizing
global health, and reallyputting the focus on the global
north, but I feel like there'ssome work that needs to be done
(22:48):
from the global south first.
I think there needs to be, andit doesn't have to be a
consensus, but at leastunderstanding what some of our
asks are, what some of our needsare, um, what some of the
issues, um, I think that's theother one aspect that we usually
just completely um forego andand put probably too much focus
(23:08):
on hearing voices from theglobal south and then pointing
fingers at the global north.
And I feel like they're, youknow, it needs to be vice versa,
where both experiences also canbe heard.
Um to me, it would only add tothe dialogue that we're having,
um, and and really making surethat we're setting up good
intentions at the end of it andbeing um reactive and really
(23:33):
making it sustainable so itdoesn't end up just being
conversations.
SPEAKER_04 (23:37):
So despite our goals of achieving health for all,
maybe each of you could sharewith our audience what helps you
to proceed and process thisdifficult experience that you've
had such that you can still holdto a more hopeful vision of the
future.
SPEAKER_05 (23:55):
I entered this field of global health full of ideals
and and good intentions.
And as you said it, uh, youknow, it's easy to get cynical.
And I I did, I think I I got tothat point.
Um, and that's why sometimes Icall it a business.
But uh I think it's also veryimportant to recognize that um
times are evolving.
(24:15):
I feel like um from when I firststarted to now, I've met so many
wonderful global health leadersor global health actors who
genuinely want to help um changethat system, the the status quo,
the way things have been done inthe past.
So, you know, even having uh alistening ear from donors, for
example, within this Wagadugapartnership, um, I feel like
(24:39):
we've been supported um so farin all of these issues that
happened and took place.
And so that to me brings mehope.
And this other point that I alsomentioned about um making room
for youth, but because I feellike they're, you know, in in
their approach, uh willing toquestion the status quo.
(25:00):
I remember when I started, I Ihad so many questions about why
are we doing it this way?
This doesn't make sense.
Um, but what do you really if ifyou set it up this way, there's
no way that you know the fieldcould be successful.
And so um seeing other youth,other people who look like me,
um, who actually question it,other people who don't even look
like me, who also question that,I think brings me hope that um
(25:24):
though it's a it's a difficultquestion and a difficult matter
to to uh to resolve, thatthere's a possibility that at
the end of this long process andit takes time because it's a
whole set of norms that you'retrying to uh to shift.
Um, I think at the the end ofthis very long process, we could
come up with a much equitable umpartnership, is what what it
(25:48):
would feel like.
SPEAKER_03 (25:51):
Tom, what are your thoughts for the future?
SPEAKER_01 (25:54):
Social change theorists like to talk about
critical junctures, thesemoments when much greater change
is possible.
You spend years butting yourhead against the wall and
nothing happens, and thensuddenly everything seems to
shift.
And they're always a bit vagueabout how you identify when
you're in a critical juncture.
It seems pretty important.
But if ever we're in one, itmust be now.
(26:17):
Everything feels like it'schanging.
This is a moment when so muchseems to be shifting in ways
that are profoundly exhausting.
It's really hard to keep gettingup and saying, my goodness, the
world has changed againovernight.
But if ever there was a momentwhen change could be affected,
it feels like now.
That exhaustion, that's how Ithink about change perhaps at
(26:39):
the global level, but thatexhaustion is very real at a
personal level.
For me, there's only two things: there's people and the work. (26:45):
undefined
And when I'm not sure how I'mever going to achieve a change
in a year or two years or sixmonths, I can still lose myself
in the work that day.
And look to the left and rightof me.
Are there a bright, idealisticpeople who are trying to do the
same things with the greateststandards of research rigor and
(27:08):
dedication and hard work?
And that helps a lot.
Losing yourself in in the workalongside people who are doing
the same is um is all that'sever worked for me.
Um and I guess everybody has tofind their own solution, but
that that's certainly how Icontinue to find uh energy each
(27:29):
uh each time.
SPEAKER_04 (27:32):
Marie, Tom, thanks very much for joining for this
really interesting discussion.
Thank you, Gary.
SPEAKER_05 (27:39):
Thank you very much, Gary.
Thank you, Tom.
SPEAKER_04 (27:41):
Thank you, Marie.
As Marie and Tom havehighlighted in this episode,
diversity is so much more thanrepresentation.
Diversity is closely linked todignity, and if separated, it
can become what Marie called acheckbox exercise that fails to
(28:02):
shift the dominant powerdynamics.
I found Tom's insights from hisresearch in Kenya fascinating
and constructive.
Although dignity has auniversality to it, it can also
be regarded as a capability thatif lacking can result in the
best intentions achieving ratherunintended and even hurtful
(28:25):
consequences.
Strengthening one's own dignitycapability should be a daily
intention that all of us inglobal health pursue.
In so doing, we can hopefullyfoster more respectful
engagement in global health,making everyone feel seen and
valued.
(28:47):
Before we end, we wanted toshare another clip we received
from our listeners.
SPEAKER_00 (28:53):
Hi, my name is Mary.
I listen to the podcast from awindy little village about 200
kilometers northwest of CapeTown in South Africa.
I love hearing the stories andexperiences of researchers and
academics from all over theworld, especially those who are
not stuck only in big urbancenters.
And I'd love to know if anyoneis doing research on the
(29:17):
environmental impact of thehealth sector and ways in which
that could be reduceddramatically and quickly and
yeah, in ways that are accordingwith what's needed in our world
at the moment.
Thanks, bye.
SPEAKER_04 (29:32):
Mary, thank you for listening to Global Health
Matters all the way from yourwindy town in Western Cape in
South Africa, and for yoursuggestion for a future episode.
Tune in again next month for yetanother motivating episode.
Remember to subscribe and sharethis podcast with your
(29:54):
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SPEAKER_02 (30:06):
Global Health Matters is produced by TDR, an
infectious diseases researchprogram based at the World
Health Organization.
Gary Aslanian, Lindy Van Niekerkand Maki Kitamura are the
content producers, and ObadiahGeorge is the technical
producer.
This podcast was also madepossible with the support of
(30:29):
Chris Koes, Elisabeth Adesti,Isa Studel Dayau, Noreen
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The goal of Global HealthMatters is to produce a forum
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Send us your comments andsuggestions by email or voice
(30:51):
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Thank you for listening.
Hello and welcome to another episode of the Global
Health Matters podcast.
I'm your host, Gary Aslanjan.
It's great to welcome you back,our listeners, who now span over
134 countries.
Thank you for your ongoingsupport of this podcast.
As many of you, I follow with alot of interest the current
(01:06):
dialogue and debates on thefuture of global health.
Academics and practitioners fromNorth and South are really
considering a lot of aspects ofglobal health practice that need
to be reimagined.
Equity, inclusion, furtherlocalization.
All of these have becomeaspirant goals receiving
(01:29):
unanimous support.
So in this episode, we will bediscussing the role of diversity
and dignity and how these twofactors can enhance global
health.
For this conversation, I'mjoined by Marie Ba and Tom
(01:50):
Wayne.
Marie is the director of theWagadougou Partnership
Coordination Unit based inDakar, Senegal.
Marie has extensive experiencein fostering partnerships and
managing health programs in Westand Central Africa.
Tom is the director of IDInsight, based in Nairobi,
(02:13):
Kenya, leading various researchinitiatives, and Tom also is the
founder of the Dignity Project,a campaign promoting more
respectful internationaldevelopment.
Hi Marie.
SPEAKER_05 (02:31):
Hi Gary, how are you?
SPEAKER_04 (02:33):
Hi Tom.
Hi, Gary.
Hi Marie.
SPEAKER_01 (02:35):
Really glad to meet both of you.
SPEAKER_04 (02:36):
I'd like for us to start by unpacking the key
terminology in our discussionwe'll be having today.
So we are all on the same pageand have a common understanding.
In summary, the term diversityholds many connotations in
global health and development.
Marie, in your piece that youpublished in the Lancet Global
(03:00):
Health, you mentioned that theterm diversity entails
representative participation,which has often been reduced to
a checkbox exercise.
What else would be important foryou in using this term?
SPEAKER_05 (03:15):
I think diversity is the hot new thing I feel in the
past couple of months.
And I think even though it maymean a lot of different things
to different folks and differentpeople, to me it shouldn't be
limited just to representation.
I think it's one aspect of it,of having meaningful diversity
(03:36):
through representation.
But I think it's also veryimportant to have
decision-making powers andleadership powers in that
diversity.
And I feel like that's whatlacks a time where you have
diverse looking, either staffmembers, crew, or board members,
but not in actuality verydiverse.
(04:00):
And so being able tomeaningfully shift the powers,
if all we do is look atrepresentation, we're only going
to end up with gimmicks and notreal power shifting.
And so addressing the system,meaning funding streams, meaning
decision making, shaping theglobal health agenda, is also
(04:23):
extremely important.
SPEAKER_04 (04:25):
So, Tom, you just heard from Marie that the term
diversity has become a verypopular term in global health
and in development.
However, in your work, you'veemphasized the term dignity.
What do you mean by dignity andwhy it's important, especially
when we talk about diversity?
SPEAKER_01 (04:44):
Dignity to me is about this fundamental,
inalienable quality that everyhuman has that means they ought
to be treated in a certain way,in a way that recognizes or
respects their dignity.
That work then leads us to awhole range of ways in which we
might change our behavior.
(05:05):
And I really I love what Murraywas saying about these
fundamental changes to the powerrelations that might be
necessary to achieve that.
We're in the middle of thesereally extraordinary campaigns
and changes for greater racialjustice, greater gender justice.
I hope that dignity is neversupplanting or taking energy
(05:26):
away from those campaigns thathave their own fully worked out
language and frameworks anddon't need me to suggest how to
go about them.
One thing that I hope dignitycan do is extend those to all
the ways in which people want tobe treated, to be treated as
their best selves, as full,complex humans in all the
interactions they have withother people and with
(05:49):
institutions.
And that I hope is what theDignity Initiative can start to
lead us towards.
SPEAKER_04 (05:56):
Marie, the Wakadogum partnership that you worked in
has been very successful inlooking at localizing and giving
opportunity for country-basedleadership.
You already alluded to that inyour definition.
Maybe you could share with ussome of the factors that enabled
this to happen?
SPEAKER_05 (06:14):
So I think, first of all, just in the name, from the
beginning, this was set up as apartnership.
Um so it never really felt likea grantor, funder, grantee
relationship.
Um I think even at the at theoffset, um, it was set up for
success.
Um and then every single partnerand member who joined the
(06:35):
Wagadugu Partnership really feltthis equal um opportunity and an
equal partnership between thesenine Francophone West African
countries as well as the youknow powerful donors that were
um funding some of these healthprograms.
So I feel like that was thefirst step in setting us up for
success.
And then it's it's been aprocess.
(06:56):
It's been we've been um um onboard now for about 10 years.
So it took really 10 years tomature into a partnership where
there was enough trust um toactually set us up into this
localization.
And one other very importantaspect um is this generational
(07:17):
renewal.
And I feel like really havingthis new generation of African
leaders and talents who are umuh maybe a bit more pushy and
and and you know, fierce and andbolder in making that
localization happen was alsoinstrumental in setting us up
for this local um entity, was uhinstrumental in making us what
(07:42):
we are today.
SPEAKER_04 (07:43):
Early on, the approach taken really is an
important factor in how theoutcome is unfolding or unfolded
over the 10 years period.
Yeah, yeah.
Exactly.
Thank you.
Tom, you mentioned that uhdignity is a universal human
trait or human desire,obviously.
(08:04):
It would be simplistic to assumethat this is experienced in the
same way by all people.
From your research, uh, if wewere to look and see across
different settings, how isdignity experienced across
different countries andcultures?
SPEAKER_03 (08:23):
I think this is a really important question.
SPEAKER_01 (08:26):
Dignity is one of these things that appears in
virtually every theologicaltradition, philosophical
tradition.
Almost everybody who's talkedabout morality has had some idea
of this is what makes peoplespecial, this is what we owe to
people and how they ought to betreated.
But of course, those traditionsvary and popular understandings
(08:48):
vary too.
Because of that, I think it'sprofoundly important that we
keep doing good qualitativeresearch and keep understanding
the subjective experience inevery new place and every new
context that we're that we'retrying to uh understand uh
dignity.
There's a Western idea ofdignity that is um uh comes out
of Western philosophy, descendsfrom in part from Immanuel Kant,
(09:13):
which is um about eachindividual having this uh this
trait, and therefore they mustbe treated in this way.
And that's kind of what Isketched out in my first answer.
And that's fine as far as itgoes.
That's actually not a bad thingthat takes us quite a long way
across a number of differentglobal traditions.
But I did some participatoryresearch with uh the activists
(09:35):
of the Mathari Social JusticeCenter here in uh in Kenya.
Mathari is a very toughneighborhood.
The Social Justice Center havebeen fighting for um greater
access to many of the thingsthat they are supposed to be
granted in the constitution andthat have not been achieved, not
least freedom from policeviolence.
The activists there told me, aswe came to a consensus
(09:56):
definition, two things.
They said that that Westerndefinition works okay for us.
But there are two things youneed to know that are that are
missing from that definition.
One is capability, and the otheris purpose.
So they said, yes, of course youshould treat people in this way,
but not everyone has thecapability to do that.
You need a basic foundation ofself-respect, capacity,
(10:20):
self-efficacy, uh perhaps somematerial resources in order to
create the mental room to treatothers in the way that you would
aspire to.
And they told me that we do thisfor a reason.
The reason we show respect toone another, the reason we take
care to notice one another, isnot just because a philosopher
tells us to.
It was, in their opinion,because it gives us the
(10:41):
opportunities to care for oneanother and to discharge what
they viewed as their God-givenduty to provide care for one
another.
And I think we could talk aboutother traditions.
There's been great work done,for instance, by the Overseas
Development Institute onunderstanding of dignity in
Colombia and the Philippines.
We're doing some qualitativework in Uganda right now.
Um, and there's lots we couldtalk about.
(11:03):
But I think the important thingto note here is there are these
varied traditions, which is whywe have to keep embedding it in
the subjective experience ofpeople to they feel they were
treated in the way that theywould hope.
SPEAKER_04 (11:13):
From where you are, Marie, what do you think of this
issue of settings and dignitythat Tom just alluded to?
SPEAKER_05 (11:21):
I really appreciate him talking about this because
at times I've questioned myself,why are we doing this?
Or I've questioned otherpeople's intentions as to why
they were interested in workingin global health or in
international developmentglobally.
So I started, and even before Istarted my career, when I I
(11:43):
remember I was in school in theUS, and both universities I went
to were not the most diverse.
Um and I remember one student inone of my um international
development classes mentioningthat maybe we should go back to
colonization as an answer to howthe West or the global north
(12:03):
could best um help Africa umsucceed.
And I, you know, obviously Ifroze, but then, you know, even
within my career, there are somany instances where I've rolled
my eyes in a meeting or or readan email where I felt so much
condescendence at times, um,sometimes pure ignorance.
And that's always because atsome point, either the system or
(12:28):
the people have removed thisaspect of morality and dignity
out of the equation, which Ithink is just so important um
and that we really shouldn'tbypass.
SPEAKER_04 (12:41):
Mm-hmm.
So you've alluded to yourpersonal and professional
experience.
Based on that experience and thereflection you just had, what do
you think can be done to achievegenuine diversity such that
global health goals can actuallybe achieved?
How do you do this in your work?
SPEAKER_05 (13:02):
So I think first you probably need to have very
uncomfortable uh conversations,fortunately or unfortunately.
Um and I think that has started,which also triggered just the
this mayor podcast we're we'reon.
So all of these conversationswhere I feel like the global
north needs to give um a safespace for us, for you know,
(13:25):
African or or um minority or ummiddle income countries leaders
um to actually voice what someof our needs are.
Um because most of theconversations that I've heard so
far about um shifting powers orum uh the sometimes the lack of
diversity has mostly come fromthe north.
(13:48):
It's I haven't I don't feel likewe've had enough of these
conversations, even amongstourselves in the global south.
And I think that's what we'remissing.
So being able to share ideas,what are some of our asks to set
us up for success in the in thefuture?
Um, so first having thoseconversations, but then also
being able to step away from theconversations and really going
(14:10):
into action.
Um, so this doesn't end up justbeing conversations.
Um, and I think we also need tobe deliberate and understanding
that there is a system in placethat is intentionally or
unintentionally designed, uh,keeping this imbalance, being
very honest and crude about it,um, and seeing how we can we can
(14:30):
fix that.
SPEAKER_04 (14:31):
Mm-hmm.
Tom, do you have anyobservations on Marie's uh
assessment?
SPEAKER_01 (14:37):
Yeah, I think Marie's right that these
conversations are reallyimportant.
We did some research withAmerican nonprofit staff and
asked them what helped themcommit to a culture of dignity,
even when that meant realsacrifice for them.
And a couple of things seemedreally important.
One was managers talking aboutit and giving them a permission
(14:58):
structure to say, yes, we'regoing to go ahead with this.
And the other was listening tothose who've experienced
disrespect in their own lives,who have felt that experience of
being maltreated, and makingsure that their voices were
leading the conversation, evenif that was leading them
sometimes to be kind of cynicalabout this cause, who were
saying that you know, thattherefore development doesn't
(15:19):
always practice what itpreaches.
Those people are reallyimportant to be listened to.
The third final thing I'd add isthere are ways that we might try
and change an organization andstructures that you might use,
of accountability, ofmeasurement, and so on.
Before we get there, everyorganization should know that
there are places they'd begetting this right.
(15:41):
This is not an impossible ideal.
We will all have our favoriteexamples.
I deeply admire Partners inHealth, as I'm sure almost
everybody does.
I deeply admire the work thatAltogether in Dignity Fourth
World have done.
I used to work for a placecalled Raising Voices, which
works to prevent violenceagainst women and children in
Uganda.
All these places are places thathave really built cultures of
dignity through constantreinforcement internally, and
(16:03):
have can show us the way, canshow us this is not
unattainable.
And I think that's reallyimportant for people to know.
Mm-hmm.
SPEAKER_04 (16:12):
So, from the work that you've done, you mentioned
in the reading that I had thatthere are three pathways to
disrespect.
So maybe we can unpack that alittle bit more.
So agency, representation, andequality.
What are the recommendationsthat you have for the global
health researchers orpractitioners on how these three
(16:33):
aspects can be taken intogreater consideration when
designing health programs?
And then we'll see what Mariethinks of that.
SPEAKER_01 (16:42):
All the way through my answers today and all the way
through all the work I do, I'mreally emphasizing the
subjective experience of theperson with the least power in
any interaction.
If they say that they feelthey've been treated in a way
that respects their dignity,they have.
And if they don't say that, theyhave not been treated in the
right way.
Regardless of what else we mighthave done or how how some global
(17:04):
development actor may feelthey've acted, whether no matter
how good the intentions were, ithas to come down to that
subjective experience of theperson with the least power in
interaction.
Now, that subjective experienceis going to vary enormously from
place to place, as we weresaying.
But when we do study thesedifferent traditions of dignity,
and when we ask people what'simportant to them, we seem to
(17:27):
see these three pathwaysrecurring of representation,
agency, and equality.
Representation is about peoplefeeling seen by the institutions
that they're interacting withand seeing themselves
represented in thoseinstitutions.
Agency is about having choicesand a meaningful chance to
consent for the decisions thatare being made about their
(17:49):
lives.
And equality is about the powerinequalities being reduced, and
even where they cannot beeliminated, people feeling
treated as if they werefundamentally equal, even if
those power of differentialspersist.
And those three pathways I findare great starts.
We use them in the workshops wedo here at Idea Insight, because
(18:10):
they're a great way of beginningto generate ideas, and those
ideas will vary depending onwhat uh what program you're
operating, what type oforganization you are.
But there's a I think everybodycan begin to think about ways in
which people could feel moreseen, better represented, ways
in which people could have abetter chance to consent, and so
on.
I think those three pathways area great place to start for
(18:32):
brainstorming ideas for foralmost any program.
SPEAKER_04 (18:36):
Mm-hmm.
So kind of look at how ouraudience, our listeners uh who
are going to take some of thesemessages and see how they can
adopt that in their programs.
Marie, how would you use this tobuild on the work that you've
done already?
SPEAKER_05 (18:53):
So I really like this idea of these three
pathways.
And I think unfortunately, we'vewe've focused so much more um
recently on representation beingseen and giving a voice to the
global south, which is veryimportant.
But I think where we we lack abit more is on agency and
equality.
(19:13):
Um and I think that's how we getto really meaningful power
shifts.
Um and those are some of theconversations that I've had with
certain colleagues who noticedthe same things.
And in the beginning, you feellike, wait, is it just me?
Um, and then you realize it'snot just you, it's not uh just
this one time that it happened,um, that it happened also to
(19:35):
colleagues in the field.
So really being able to get asense of what those perceptions
are, and as Tom has put it, I Imean, whether you're talking,
you could be talking to twopeople and they would have
varying, very differentexperiences.
So I think taking most of them,if not all, into account is also
extremely important.
But as far as I can um I haveexperienced so far, a lot of the
(20:00):
focus, and I think it's theeasiest, usually, right?
You just go to representationbecause that's the the easiest
one to be seen and tick thatbox, um, as we've we've
mentioned before.
Um, and the really hard work, Ithink, is really working on
agency, on equality, and reallyshifting those powers.
And I've I think Tom alluded tothat.
(20:21):
Um, it's not about transferringa hundred percent of the power
over to the global south.
I understand that there might besome uh worries about this new
agenda, but I think it's just amatter of um equity and and um
and equality.
And we see the same fight whenit comes to race relations,
(20:42):
exactly the same fight when itcomes to gender equality, it's
just about giving um less of ahead start and less privileges
to one side over the other.
SPEAKER_04 (20:52):
Are there any other points around examples or the
pathways towards findingsolutions you'd like to add?
SPEAKER_01 (21:01):
There was one more point I wanted to make, which is
that everybody acrossdevelopment has good intentions
and wants agendas like this tosucceed.
We can certainly brainstorm moresolutions.
I hope those three pathways arean interesting and valuable
framework through which to doit.
We know that initiatives likethis have failed before.
(21:23):
There have been a lot of effortsto reform global health, to
reform global development.
One way in which we can helpmake sure this has a better
chance of success is by holdingourselves accountable.
And I think a crucial part ofthat is measurement.
It's perhaps a shame in globalhealth and development that we
always need to look toquantitative measures, and we're
(21:45):
not great at digestingqualitative evidence, but we
know that kind of is true.
And a really central part ofwhat we've been doing here at
the ID Insight is thinkingthrough quantitative measures
that can be validated, that canbe demonstrated in different
contexts and differentsituations, that focus on
people's subjective experienceof how they were treated and
(22:06):
whether they were treated in theway they would aspire to be.
And that um developing thosemeasures, I think, is absolutely
crucial to this work becauseit's what's going to allow us to
check our progress, to trial newimprovements, and to hold
ourselves accountable when wefall short of this promise to
uphold everyone's dignity.
SPEAKER_04 (22:25):
Marie, did you want to add anything?
SPEAKER_05 (22:28):
For me, uh beyond what Tom just mentioned, I think
that's Idea of accountabilityand good intentions, it needs to
come from both sides.
I know we talk a lot aboutshifting powers, decolonizing
global health, and reallyputting the focus on the global
north, but I feel like there'ssome work that needs to be done
(22:48):
from the global south first.
I think there needs to be, andit doesn't have to be a
consensus, but at leastunderstanding what some of our
asks are, what some of our needsare, um, what some of the
issues, um, I think that's theother one aspect that we usually
just completely um forego andand put probably too much focus
(23:08):
on hearing voices from theglobal south and then pointing
fingers at the global north.
And I feel like they're, youknow, it needs to be vice versa,
where both experiences also canbe heard.
Um to me, it would only add tothe dialogue that we're having,
um, and and really making surethat we're setting up good
intentions at the end of it andbeing um reactive and really
(23:33):
making it sustainable so itdoesn't end up just being
conversations.
SPEAKER_04 (23:37):
So despite our goals of achieving health for all,
maybe each of you could sharewith our audience what helps you
to proceed and process thisdifficult experience that you've
had such that you can still holdto a more hopeful vision of the
future.
SPEAKER_05 (23:55):
I entered this field of global health full of ideals
and and good intentions.
And as you said it, uh, youknow, it's easy to get cynical.
And I I did, I think I I got tothat point.
Um, and that's why sometimes Icall it a business.
But uh I think it's also veryimportant to recognize that um
times are evolving.
(24:15):
I feel like um from when I firststarted to now, I've met so many
wonderful global health leadersor global health actors who
genuinely want to help um changethat system, the the status quo,
the way things have been done inthe past.
So, you know, even having uh alistening ear from donors, for
example, within this Wagadugapartnership, um, I feel like
(24:39):
we've been supported um so farin all of these issues that
happened and took place.
And so that to me brings mehope.
And this other point that I alsomentioned about um making room
for youth, but because I feellike they're, you know, in in
their approach, uh willing toquestion the status quo.
(25:00):
I remember when I started, I Ihad so many questions about why
are we doing it this way?
This doesn't make sense.
Um, but what do you really if ifyou set it up this way, there's
no way that you know the fieldcould be successful.
And so um seeing other youth,other people who look like me,
um, who actually question it,other people who don't even look
like me, who also question that,I think brings me hope that um
(25:24):
though it's a it's a difficultquestion and a difficult matter
to to uh to resolve, thatthere's a possibility that at
the end of this long process andit takes time because it's a
whole set of norms that you'retrying to uh to shift.
Um, I think at the the end ofthis very long process, we could
come up with a much equitable umpartnership, is what what it
(25:48):
would feel like.
SPEAKER_03 (25:51):
Tom, what are your thoughts for the future?
SPEAKER_01 (25:54):
Social change theorists like to talk about
critical junctures, thesemoments when much greater change
is possible.
You spend years butting yourhead against the wall and
nothing happens, and thensuddenly everything seems to
shift.
And they're always a bit vagueabout how you identify when
you're in a critical juncture.
It seems pretty important.
But if ever we're in one, itmust be now.
(26:17):
Everything feels like it'schanging.
This is a moment when so muchseems to be shifting in ways
that are profoundly exhausting.
It's really hard to keep gettingup and saying, my goodness, the
world has changed againovernight.
But if ever there was a momentwhen change could be affected,
it feels like now.
That exhaustion, that's how Ithink about change perhaps at
(26:39):
the global level, but thatexhaustion is very real at a
personal level.
For me, there's only two things: there's people and the work. (26:45):
undefined
And when I'm not sure how I'mever going to achieve a change
in a year or two years or sixmonths, I can still lose myself
in the work that day.
And look to the left and rightof me.
Are there a bright, idealisticpeople who are trying to do the
same things with the greateststandards of research rigor and
(27:08):
dedication and hard work?
And that helps a lot.
Losing yourself in in the workalongside people who are doing
the same is um is all that'sever worked for me.
Um and I guess everybody has tofind their own solution, but
that that's certainly how Icontinue to find uh energy each
(27:29):
uh each time.
SPEAKER_04 (27:32):
Marie, Tom, thanks very much for joining for this
really interesting discussion.
Thank you, Gary.
SPEAKER_05 (27:39):
Thank you very much, Gary.
Thank you, Tom.
SPEAKER_04 (27:41):
Thank you, Marie.
As Marie and Tom havehighlighted in this episode,
diversity is so much more thanrepresentation.
Diversity is closely linked todignity, and if separated, it
can become what Marie called acheckbox exercise that fails to
(28:02):
shift the dominant powerdynamics.
I found Tom's insights from hisresearch in Kenya fascinating
and constructive.
Although dignity has auniversality to it, it can also
be regarded as a capability thatif lacking can result in the
best intentions achieving ratherunintended and even hurtful
(28:25):
consequences.
Strengthening one's own dignitycapability should be a daily
intention that all of us inglobal health pursue.
In so doing, we can hopefullyfoster more respectful
engagement in global health,making everyone feel seen and
valued.
(28:47):
Before we end, we wanted toshare another clip we received
from our listeners.
SPEAKER_00 (28:53):
Hi, my name is Mary.
I listen to the podcast from awindy little village about 200
kilometers northwest of CapeTown in South Africa.
I love hearing the stories andexperiences of researchers and
academics from all over theworld, especially those who are
not stuck only in big urbancenters.
And I'd love to know if anyoneis doing research on the
(29:17):
environmental impact of thehealth sector and ways in which
that could be reduceddramatically and quickly and
yeah, in ways that are accordingwith what's needed in our world
at the moment.
Thanks, bye.
SPEAKER_04 (29:32):
Mary, thank you for listening to Global Health
Matters all the way from yourwindy town in Western Cape in
South Africa, and for yoursuggestion for a future episode.
Tune in again next month for yetanother motivating episode.
Remember to subscribe and sharethis podcast with your
(29:54):
colleagues and friends, and signup for our Global Health Matters
newsletter.
In this way, you will be firstto know when a new episode
becomes available.
SPEAKER_02 (30:06):
Global Health Matters is produced by TDR, an
infectious diseases researchprogram based at the World
Health Organization.
Gary Aslanian, Lindy Van Niekerkand Maki Kitamura are the
content producers, and ObadiahGeorge is the technical
producer.
This podcast was also madepossible with the support of
(30:29):
Chris Koes, Elisabeth Adesti,Isa Studel Dayau, Noreen
Ogalaer, and ChembeCollaborative.
The goal of Global HealthMatters is to produce a forum
for sharing perspectives on keyissues affecting global health
research.
Send us your comments andsuggestions by email or voice
(30:51):
message to idrpod at wo.int andbe sure to download and
subscribe wherever you get yourpodcasts.
Thank you for listening.
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The Bobby Bones Show
Listen to 'The Bobby Bones Show' by downloading the daily full replay.