Colonialism Didn’t End: It Became Global Health Policy

“The conditions of the grant are not neutral.”

Read the fine print of almost any global health grant and you will find it: the logic model borrowed from Western corporate management. The indicators tied to outputs that can be photographed. The reporting timeline designed around a fiscal year that has nothing to do with planting seasons, harvest prayers, or school calendars in East Africa. The requirement that all funds flow through a U.S.-registered intermediary.

None of this is accidental. It is architecture.

Colonialism did not end when flags were lowered and independence was declared. It evolved. It put on the language of development, of partnership, of capacity building. It learned to say “community-led” while still holding the pen that signs the check. And nowhere is this evolution more legible — or more consequential — than in the structure of global health funding.

Colonialism learned to say ‘community-led’ while still holding the pen that signs the check.

What the Architecture Reveals

At Ubuntu Village, we work across East Harlem, Kenya, Uganda, and Nigeria. In every location, we witness the same dynamic: communities that have sustained life — through war, through drought, through epidemic — are asked to translate their survival into a language that was not built for them. They must prove their work is “evidence-based” using studies conducted by universities in countries that colonized them. They must demonstrate “capacity” to organizations whose definition of capacity looks like miniature versions of themselves.

The ancestral knowledge systems that kept communities alive for centuries? They do not appear in most logic models. The grandmothers who have been delivering babies safely for decades? They are not the “qualified health workers” the grant requires. The ceremony that brings a community back from collective trauma? It cannot be measured in QALYs.

This is not a gap in global health policy. It is a feature.

The grandmothers who have been delivering babies safely for decades? They are not the ‘qualified health workers’ the grant requires.

The Funding Flows Tell the Story

Follow the money in global health and the colonial map becomes visible. The majority of funding for health programs in sub-Saharan Africa is controlled by organizations headquartered in the United States and Europe. Community-based organizations in Kenya, Uganda, and Nigeria routinely receive a fraction of what passes through the hands of international intermediaries who take “management fees” before resources reach the people doing the actual work.

When we at Ubuntu Village asked our partners in Nairobi, Kampala, and Lagos what they needed most, the answer was rarely the intervention a funder had already designed. It was unrestricted funding. Time. Trust. The ability to respond to what their community identified as urgent — not what a grant cycle deemed fundable.

That gap between what communities need and what the system funds is not a resource problem. It is a power problem.

What Alternatives Actually Look Like

We are not the first to name this. We will not be the last. But naming it without offering a different way forward is its own kind of violence.

At Ubuntu Village, we are building toward a model of partnership rooted in the Ubuntu principle: I am because we are. This means:

• Centering the community’s own definition of health — not just the absence of disease, but the presence of dignity, belonging, and ancestral continuity.
• Funding relationships, not just projects — because trust takes longer than a grant cycle.
• Recognizing ancestral and traditional knowledge as evidence — not as a supplement to research, but as a primary source.
• Demanding that international organizations shrink their footprint and expand their accountability to the communities they claim to serve.

None of this requires a new program. It requires a different set of questions. Not “How do we bring health to this community?” but “What does this community know about health that we have been too colonial to learn?”

What does this community know about health that we have been too colonial to learn?

A Note to Our Donors

If you support Ubuntu Village, you are part of this reckoning. We do not ask you to fund us as saviors delivering services to passive recipients. We ask you to invest in communities as protagonists of their own healing — communities that were whole before the grant, and will be whole after it.

The conditions of the grant are not neutral. But your relationship with us can be. Read with us. Ask questions with us. And when you see the architecture of extraction in the organizations you fund, name it.

That is where change begins.

Ubuntu Village Inc. is a 501(c)(3) rooted in East Harlem, with programs in Kenya, Uganda, and Nigeria. We work at the intersection of ancestral wisdom, public health, and community power. Learn more at ubuntuvillageusa.org.

References

1. Institute for Health Metrics and Evaluation (IHME). Financing Global Health 2025: Cuts in Aid and Future Outlook. Seattle, WA: IHME, 2025. Development assistance for health declined 21% globally between 2024 and 2025; sub-Saharan Africa experienced the largest cuts at 25%. The United States has historically contributed ~35% of global DAH annually.
   
   healthdata.org — Financing Global Health 2025
2. KFF Global Health Policy. U.S. Global Health Country-Level Funding Tracker. Updated 2025. Sub-Saharan Africa receives the largest share of U.S. global health funding — historically 85% or approximately $5.4 billion annually — underscoring the dependency risks of externally controlled health systems.
   
   kff.org — U.S. Global Health Funding Tracker
3. Osakwe N, et al. Decolonizing global health: a scoping review. BMC Health Services Research, 2025. Reviews how colonial power structures persist in global health funding architecture, research agenda-setting, and the positioning of local versus international partners.
   
   BMC Health Services Research — Decolonizing Global Health: A Scoping Review
4. Abimbola S & Pai M. Decolonizing global health—what does it mean for us? BMJ Global Health / PMC, 2023. Argues that cooperation between donors and recipients today is still largely shaped by colonial relations, and that a disproportionate share of funding flows to Global North intermediaries rather than to communities and Global South institutions.
   
   PMC — Decolonizing Global Health: What Does It Mean for Us?
5. Mwangi W, et al. Decolonising global health research: Shifting power for transformative change. PLOS Global Public Health, 2024. Makes the case for requiring local institutions to serve as primary partners and ensuring high percentages of budgets are allocated to local lead institutions — not international intermediaries.
   
   PLOS Global Public Health — Shifting Power for Transformative Change
6. Rao N, et al. Towards authentic institutional allyship by global health funders. PMC, 2024. Examines how funder practices mirror colonial heritage and calls for structural reform in how global health institutions relate to the communities they claim to serve.
   
   PMC — Towards Authentic Institutional Allyship by Global Health Funders
7. Think Global Health. The State of Global Health Funding: August 2025. Council on Foreign Relations, 2025. Documents the cascading impact of 2025 U.S. funding cuts — a 67% reduction — on NGOs, community organizations, and health systems across sub-Saharan Africa.
   
   Think Global Health — State of Global Health Funding, August 2025

Related at Ubuntu Village

• → Reparations as Healing: A Public Health Argument
  — The case for reparations as structural health intervention, not charity.
• → Spiritual Afflictions, Ancestral Causes: What African Healing Systems Know That Western Psychiatry Is Just Discovering
  — On ancestral knowledge as evidence, not supplement.
• → What Happens to a Village When the Elders Stop Being Asked
  — What we lose when institutions stop centering community wisdom.

Ubuntu Village follows an Ethical Storytelling Policy. All references are cited to center community expertise and peer-reviewed scholarship from Global South researchers wherever available.