Decolonizing Global Health: Why “Capacity Building” Often Means Something Else Entirely

Justice & Advocacy  ·  Decolonizing Global Health

When we say “capacity building,” sometimes we mean “teaching communities to want what we want to give them.”

Decolonizing global health is not a rebrand. It is not a more culturally competent version of the same intervention. It is a reckoning with a question that most global health institutions are not yet ready to ask: whose knowledge counts — and who decides?

What “Capacity” Assumes

The problem starts with the word itself. “Capacity” implies a container — one that is either empty or not full enough. It opens from a diagnosis of lack. When we ask “how do we build your capacity?” we are never asking “what has our system extracted from yours?” The architecture of global health — the WHO, the World Bank, the Gates Foundation — runs on an assumption that some communities possess expertise and some communities need to receive it. That assumption is not neutral. It is a legacy.

The phrase “low- and middle-income country” is itself a measure of what a place lacks relative to a Global North standard. “Capacity building” sits inside the same logic. It locates the problem in the community — not in the systems that extracted resources, suppressed knowledge, and rewarded communities only when they adopted externally designed protocols. We have written before about why this framing harms more than it helps.

The Colonial Genealogy of the Phrase

The language of capacity building emerged from post-WWII development economics. By the 1970s and 80s, structural adjustment programs led by the World Bank and IMF were requiring low-income countries to defund public health systems in exchange for loans — to eliminate subsidies for local food production and hollow out the very institutions they were ostensibly being built up to run. The theory: adopt the right frameworks and you will grow into full participation in the global order.

What actually happened: health systems that had existed — imperfect, under-resourced, but rooted in place — were reorganized around imported protocols. Traditional healers were criminalized or sidelined. Community health knowledge that lacked a clinical trial behind it was considered not knowledge at all. The result was not a more capable global health system. It was a more dependent one.

“The community’s existing knowledge — its healers, its oral tradition, its intergenerational health practices — rarely factors into the ‘capacity’ being measured.”

What It Looks Like in Practice

Global health programs train community health workers to refer patients to physicians who don’t exist in their communities. Mental health frameworks pathologize grief rituals that have sustained people through loss for generations. Nutrition programs arrive with packaged supplements and leave without learning the names of the local plants that have been managing nutritional deficiency since before the program’s founders were born.

Maternal health initiatives are designed without consulting traditional birth attendants — women who have attended thousands of births, who know the land, the seasons, the family histories. In each case, communities are not asked what they know. They are asked to learn what the program brought.

This is not always malicious. Often it is earnest. But intention does not change the structure. And the structure says: you lack. We bring.

What Communities Already Have

Before any NGO arrived. Before any capacity-building cohort. Communities had knowledge.

In Uganda, traditional healers developed botanical protocols for conditions that Western medicine would later classify as metabolic syndrome and autoimmune disease — protocols that epidemiologists are now beginning to study formally, decades after they were dismissed. In Kenya, community midwives built systems for managing obstetric complications in settings without electricity or running water. In East Harlem, community members had been mapping food access, organizing for green space, and running mutual aid networks before any public health institution named what they were doing a “social determinants intervention.”

The capacity was never missing. The systems built to see it were.

Ubuntu Village’s Community-Led Alternative

Ubuntu Village doesn’t enter a community asking what it lacks. We enter asking what it knows.

In our programs in Kenya, Uganda, and Nigeria — and here in East Harlem — the first question is always: who holds the knowledge here? Who are the healers? What practices have kept people alive and whole across generations? Our role is not to import a framework and teach communities to adopt it. Our role is to be in relationship with what is already working — to resource it, to protect it, and, where invited, to amplify it.

This is not a softer version of capacity building. This is a different orientation entirely. The same commitment runs through our work on initiation and rites of passage — the understanding that what looks like “tradition” to an outside observer is often a living health system doing exactly what a health system should do: holding people through the most vulnerable moments of their lives.

What Decolonizing Global Health Actually Requires

It requires funders to follow, not lead. It requires institutions to define “capacity” the way communities define it — not by what a program was already designed to deliver, but by what communities say they need and already have.

It requires honest accounting. What colonialism extracted from communities was not only land and labor. It was knowledge systems, healing traditions, biodiversity, and the intergenerational transmission of practice. The “capacity gap” in global health is not a feature of communities. It is a consequence of what was taken — and of systems still designed to take, just more politely.

Decolonizing global health means starting from what is already here. It means redistribution of resources without redistribution of authority over the communities those resources are meant to serve. It means funders and institutions learning to be accountable to communities — not the other way around.

This is the work Ubuntu Village was built to do. Not charity. Investment in what is already whole.

If this named something you’ve felt but couldn’t say — share it with someone working in global health who needs the language.

References

1. Abimbola, Seye, and Madhukar Pai. “Will global health survive its decolonisation?” The Lancet 396, no. 10263 (2020): 1627–1628.
2. Abimbola, Seye. “The uses of knowledge in global health.” BMJ Global Health 6, no. 4 (2021): e005802.
3. Farmer, Paul. “An Anthropology of Structural Violence.” Current Anthropology 45, no. 3 (2004): 305–325.
4. Pfeiffer, James, and Rachel Chapman. “Anthropological Perspectives on Structural Adjustment and Public Health.” Annual Review of Anthropology 39 (2010): 149–165.
5. Shiffman, Jeremy. “A social explanation for the rise and fall of global health issues.” Bulletin of the World Health Organization 87, no. 8 (2009): 608–613.
6. Biehl, João, and Adriana Petryna, eds. When People Come First: Critical Studies in Global Health. Princeton University Press, 2013.

Related Reading

• Decolonizing Healing: Why Your Community Doesn’t Need Saving
• The Violence of Visibility: What It Costs to Be a “Model” Nonprofit
• Initiation and Rites of Passage: What African Coming-of-Age Traditions Protect
• Your Donation Isn’t Charity — It’s an Investment in Our Collective Liberation

Michele Mitchell is the Founder, President & CEO of Ubuntu Village Inc., a 501(c)(3) nonprofit rooted in East Harlem, New York, with programs in Kenya, Uganda, and Nigeria. A writer, advocate, and community strategist working at the intersection of ancestral wisdom, public health, and community power, Michele leads Ubuntu Village’s work to center communities as the protagonists of their own healing. She writes from the conviction that science and spirit are complementary, that healing is relational, and that community is the medicine.