Scrambling for Africa? Universities and global health.

The Consortium of Universities for Global Health (CUGH) has emerged as a major voice within the fi eld of academic global health. Established in 2008 in San Francisco, the group’s membership includes many of the most prestigious universities in the USA, and its leadership is well connected to US policy makers and funding agencies. On Sept 19–21, 2010, the Consortium convened its third meeting at the University of Washington, Seattle, WA, USA. I have attended all three meetings as an anthropologist and participant observer. The 2010 meeting gave an opportunity to confront some of the inequalities emerging within global health, and within CUGH itself. The rapid proliferation of academic programmes in global health is well documented. These programmes provide valuable opportunities for collaboration between students and faculty in the global North and South, particularly in sub-Saharan Africa, where most global health programmes are located. However, as global health becomes an increasingly hot fi eld, there is a risk these well-intentioned eff orts are creating a 21st-century scramble for Africa by US universities. It is the responsibility of leaders within the fi eld to ensure that global health programmes benefi t African institutions, and do not become merely a means by which to brand US universities in a competitive academic environment. “A substantive, current, long-term relationship with an international partner university in a lowor middleincome country” is a condition for membership in CUGH, and the organisation’s emphasis on “the mutuality of real partnership” represents an important commitment to equitable collaboration between rich and poor nations. However, at the inaugural meeting, only four of the 50 invited participants were from resource-limited countries. These scholars stated that their institutions often had little decision-making power in international collaborations, and challenged the audience to consider the possibility that global health was a Northern concept. Although these critiques were included in the meeting’s offi cial notes, they were notably absent from the “common defi nition of global health” later published on behalf of CUGH in The Lancet. This omission is particularly noteworthy because the same article asserted that “the developed world does not have a monopoly on good ideas”. Participation was similarly limited at the 2009 meeting, where I noted one CUGH leader as saying: “There is lots of discussion about how low and middle income country partners should participate, but there interventions in maternity care could save the lives of tens of thousands of babies who die unnecessarily during pregnancy and labour every year. In high-income countries, although infant mortality rates have dropped, stillbirth rates have not changed in more than a decade and there is no room for complacency. More can and must be done to reduce this unacceptable loss of life. Bereaved parents are key to bringing about change. Where parents have joined together to support each other, the silence of stillbirth is broken. By voicing their stories, speaking the unspeakable, and being heard, parents can undo some of the myths that surround stillbirth and focus attention on how things could be done better. In some countries, the powerful role of parents has been demonstrated in a profound transformation in attitudes to bereavement care. Working collaboratively with health professionals, parents’ groups such as Sands in the UK have been able to build a culture of sensitive and caring bereavement support that respects parents’ needs, acknowledging that stillbirths matter and that the quality of care grieving parents receive can have a lifelong eff ect. Parents can play a similar part in pushing for improvements to reduce stillbirths. Every bereaved parent wants to know what can be done to stop other families experiencing the same heartache. The passion that parents have to save other babies’ lives makes them powerful advocates for change. The energy they bring to fundraising, campaigning, and lobbying, and their bravery in sharing their diffi cult stories in public, will never bring their own babies back, but it will perhaps one day prevent the unnecessary and ignored death of another child.