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Mike Ruffner's avatar

I feel like I start all my comments this way, but "Spot on, Mike"

I take a longer view and realize that there is a wax and wane to development and health in particular. There will be openings in the future and we must take a sober look at what was right and wrong in the HIV era. Let's be honest, so much of the infrastructure was built on and depended on HIV and would have to be rightsized anyway. It is happening in a lurch as opposed to a step down.

You asked whether academic global health became indispensable. It is probably more that academia *thought* they were indispensable. There is hubris, entitlement and an echo chamber that counters a lot of the good work. Add to that the natural bureaucratic tendency to judge success by the size of the budget and need to feed the infrastructure. Sound familiar?

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Ronald Tamale's avatar

Great piece Mike

From the vantage point of Uganda Sub-Saharan Africa, I can say with confidence that the global health enterprise as traditionally conceived has reached an inflection point.

Down here, we're navigating a quiet but profound shift. The government has laid out a Primary Health Care Integration Roadmap that’s attempting to realign the entire delivery architecture, moving us from the vertical, donor-driven models toward more coherent, people-centred, and system-integrated care. As you know, this is happening against a backdrop of declining donor aid, political uncertainty around global health assistance, and the urgent need to translate health investments into locally meaningful outcomes.

What’s striking is how much of this transition is happening outside the orbit of academic global health. There’s often a mismatch between what is funded and studied and what systems on the ground actually need. Applied public health would mean research embedded in service delivery, data use rooted in local governance, leadership training conducted in-country, and implementation science focused on practical, durable change, not publications or pipeline prestige.

We don’t need to end collaboration; we need to reshape its architecture. That means listening more than prescribing and showing up with a bit more humility

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