Academic Global Health Partnerships Rely on Relational Work and Negotiated Power

Academic collaborations between higher education institutions in the Global North and the Global South are sustained primarily through interpersonal commitment, iterative processes, and negotiated power dynamics rather than through predefined outcomes or formal administrative structures, according to a qualitative study published in PLOS Global Public Health. The investigation explores how long-term global health partnerships focused on health professions education are experienced and actively negotiated by the individuals engaged in them, showing that the relational work underpinning these initiatives is vital to their persistence.

Collaborative programs linking Global North and Global South universities have frequently been promoted as an essential strategy for strengthening health systems and developing workforce capacity, especially through education for health professionals. Even so, the authors observe that existing academic literature has traditionally concentrated on technical frameworks and outcome-oriented models of institutional collaboration. At the same time, increasing calls to decolonize global health have drawn attention to enduring asymmetries in authority, knowledge production, and resource distribution that dictate how international partnerships operate, leaving the practical relational and processual mechanisms that either sustain or constrain these alliances substantially under-examined.

To address this gap, the researchers conducted a postcolonial qualitative exploration focused on understanding how participants experience and manage academic global health partnerships over time. The study sample comprised nineteen individuals with direct experience working within long-term partnerships between universities located in the Global North and Global South. The researchers collected qualitative data through semi-structured interviews and subsequently analyzed the transcripts using an iterative, thematic approach designed to capture the structural and interpersonal factors at play. This analysis demonstrated that the functioning of international academic partnerships is fundamentally shaped by three interrelated elements: people, processes, and power.

The study findings indicate that academic partnerships are inherently relational endeavors maintained by individual professionals who invest substantial emotional and interpersonal effort over extended periods. Because the partnerships operate within evolving institutional environments, their operational processes are iterative, demanding continuous renegotiation of professional roles, institutional expectations, and operational priorities in response to changing local and global contexts. Furthermore, power was found to operate across both interpersonal relationships and administrative procedures, directly determining whose professional expertise was formally recognized, how key project decisions were reached, and how joint activities developed in daily practice.

Beyond documenting structural imbalances, the analysis revealed specific instances where participants openly acknowledged, critically reflected upon, and resisted systemic power dynamics to mitigate colonial practices and foster more egalitarian collaboration. The authors emphasize that academic global health initiatives cannot rely solely on formal contracts or predetermined metrics, proposing instead the concept of “brain sustain” to reframe health workforce development as an inherently collective, relational, and contextually grounded endeavor. They conclude that fostering truly equitable, decolonial partnerships requires explicit recognition of broader global, historical, and structural conditions while actively supporting the ongoing relational and processual labor necessary to maintain collaboration.

Subject of Research: Relational dynamics and power negotiation in Global North and Global South academic health partnerships

Article Title: Brain sustain partnerships: Equity-orientation and decolonization theory to promote Global North-Global South collaborations in health professions education

Article References: Enns, R. K., Martimianakis, M. A., Peter, E., Chavez, F., & Gastaldo, D. (2026). Brain sustain partnerships: Equity-orientation and decolonization theory to promote Global North-Global South collaborations in health professions education. PLOS Global Public Health, 6(11), e0007630. https://doi.org/10.1371/journal.pgph.0007630

Image Credits: AI Generated

DOI: 10.1371/journal.pgph.0007630

Keywords: global health partnerships, health professions education, Global North, Global South, decolonization, brain sustain, health workforce development, qualitative research, semi-structured interviews, iterative thematic analysis, postcolonial theory, relational dynamics, power asymmetries, institutional collaboration, knowledge production, resource distribution, equitable partnerships, health systems strengthening