Stories

Tag: decolonization

  • How do we stop AI-generated ‘poverty porn’ fake images?

    How do we stop AI-generated ‘poverty porn’ fake images?

    There is an important and necessary conversation happening right now about the use of generative artificial intelligence in global health and humanitarian communications.

    Researchers like Arsenii Alenichev are correctly identifying a new wave of “poverty porn 2.0,” where artificial intelligence is used to generate stereotypical, racialized images of suffering – the very tropes many of us have worked for decades to banish.

    The alarms are valid.

    The images are harmful.

    But I am deeply concerned that in our rush to condemn the new technology, we are misdiagnosing the cause.

    The problem is not the tool.

    The problem is the user.

    Generative artificial intelligence is not the cause of poverty porn.

    The root cause is the deep-seeded racism and colonial mindset that have defined the humanitarian aid and global health sectors since their inception.

    This is not a new phenomenon.

    It is a long-standing pattern.

    In my private conversations with colleagues and researchers like Alenichev, I find we often agree on this point.

    Yet, the public-facing writing and research seem to stop short, focusing on the technological symptom rather than the systemic illness.

    It is vital we correct this focus before we implement the wrong solutions.

    The old poison in a new bottle

    Long before Midjourney, large organizations and their communications teams were propagating the worst kinds of caricatures.

    I know this.

    Many of us know this.

    We remember the history of award-winning photographers being sent from the Global North to “find… miserable kids” and stage images to meet the needs of funders. Organizations have always been willing to manufacture narratives that “show… people on the receiving end of aid as victims”.

    These working cultures — which demand images of suffering, which view Black and Brown bodies as instruments for fundraising, and which prioritize the “western gaze” — existed decades before artificial intelligence.

    Artificial intelligence did not create this impulse.

    It just made it cheaper, faster, and easier to execute.

    It is an enabler, not an originator.

    If an organization’s communications philosophy is rooted in colonial stereotypes, it will produce colonial stereotypes, whether it is using a 1000-dollar-a-day photographer or a 30-dollar-a-month software subscription.

    The danger of a misdiagnosis

    If we incorrectly identify artificial intelligence as the cause of this problem, our “solution” will be to ban the technology.

    This would be a catastrophic mistake.

    First, it is a superficial fix.

    It allows the very organizations producing this content to performatively cleanse themselves by banning a tool, all while eluding the fundamental, painful work of challenging their own underlying racism and colonial impulses.

    The problem will not be solved; it will simply revert to being expressed through traditional (and often staged) photography.

    Second, it punishes the wrong people.

    For local actors and other small organizations, generative artificial intelligence is not necessarily a tool for creating poverty porn.

    It is a tactical advantage in a fight for survival.

    Such organizations may lack the resources for a full communication team.

    They are then “punished by algorithms” that demand a constant stream of visuals, burying stories of organizations that cannot provide them.

    Furthermore, some organizations committed to dignity in representation are also using artificial intelligence to solve other deep ethical problems.

    They use it to create dignified portraits for stories without having to navigate the complex and often extractive issues of child protection and consent.

    They use it to avoid exploiting real people.

    A blanket ban on artificial intelligence in our sector would disarm small, local organizations.

    It would silence those of us trying to use the tool ethically, while allowing the large, wealthy organizations to continue their old, harmful practices unchanged.

    The real work ahead

    This is why I must insist we reframe the debate.

    The question is not if we should use artificial intelligence.

    The question is, and has always been, how we challenge the racist systems that demand these images in the first place.

    My Algerian ancestors fought colonialism.

    I cannot separate my work at The Geneva Learning Foundation from the struggle against racism and fighting for the right to tell our own stories.

    That philosophy guides how I use any tool, whether it is a word processor or an image generator.

    The tool is not the ethic.

    We need to demand accountability from organizations like the World Health Organization, Plan International, and even the United Nations.

    We must challenge the working cultures that green-light these campaigns.

    We should also, as Arsenii rightly points out, support local photographers and artists.

    But we must not let organizations off the hook by allowing them to blame a piece of software for their own lack of imagination and their deep, unaddressed colonial legacies.

    Artificial intelligence is not the problem.

    Our sector’s colonial mindset is.

    References

    Image: The Geneva Learning Foundation Collection © 2025

  • Why guidelines fail: on consequences of the false dichotomy between global and local knowledge in health systems

    Why guidelines fail: on consequences of the false dichotomy between global and local knowledge in health systems

    Global health continues to grapple with a persistent tension between standardized, evidence-based interventions developed by international experts and the contextual, experiential local knowledge held by local health workers. This dichotomy – between global expertise and local knowledge – has become increasingly problematic as health systems face unprecedented complexity in addressing challenges from climate change to emerging diseases.

    The limitations of current approaches

    The dominant approach privileges global technical expertise, viewing local knowledge primarily through the lens of “implementation barriers” to be overcome. This framework assumes that if only local practitioners would correctly apply global guidance, health outcomes would improve.

    This assumption falls short in several critical ways:

    1. It fails to recognize that local health workers often possess sophisticated understanding of how interventions need to be adapted to work in their contexts.
    2. It overlooks the way that local knowledge, built through direct experience with communities, often anticipates problems that global guidance has yet to address.
    3. It perpetuates power dynamics that systematically devalue knowledge generated outside academic and global health institutions.

    The hidden costs of privileging global expertise

    When we examine actual practice, we find that privileging global over local knowledge can actively harm health system performance:

    • It creates a “capability trap” where local health workers become dependent on external expertise rather than developing their own problem-solving capabilities.
    • It leads to the implementation of standardized solutions that may not address the real needs of communities.
    • It demoralizes community-based staff who see their expertise and experience consistently undervalued.
    • It slows the spread of innovative local solutions that could benefit other contexts.

    Evidence from practice

    Recent experiences from the COVID-19 pandemic provide compelling evidence for the importance of local knowledge. While global guidance struggled to keep pace with evolving challenges, local health workers had to figure out how to keep health services going:

    • Community health workers in rural areas adapted strategies.
    • District health teams created new approaches to maintain essential services during lockdowns.
    • Facility staff developed creative solutions to manage PPE shortages.

    These innovations emerged not from global technical assistance, but from local practitioners applying their deep understanding of community needs and system constraints, and by exploring new ways to connect with each other and contribute to global knowledge.

    Towards a new synthesis

    Rather than choosing between global and local knowledge, we need a new synthesis that recognizes their complementary strengths. This requires three fundamental shifts:

    1. Reframing local knowledge

    • Moving from viewing local knowledge as merely contextual to seeing it as a source of innovation.
    • Recognizing frontline health workers as knowledge creators, not just knowledge recipients.
    • Valuing experiential learning alongside formal evidence.

    2. Rethinking technical assistance

    • Shifting from knowledge transfer to knowledge co-creation.
    • Building platforms for peer learning and exchange.
    • Supporting local problem-solving capabilities.

    3. Restructuring power relations

    • Creating mechanisms for local knowledge to inform global guidance.
    • Developing new metrics that value local innovation.
    • Investing in local knowledge documentation and sharing.

    Practical implications

    This new synthesis has important practical implications for how we approach health system strengthening:

    Investment priorities

    • Funding mechanisms need to support local knowledge creation and sharing
    • Technical assistance should focus on building local problem-solving capabilities
    • Technology investments should enable peer learning and knowledge exchange

    Capacity building

    Knowledge management (KM)

    New paths forward

    Moving beyond the false dichotomy between global and local knowledge opens new possibilities for strengthening health systems. By recognizing and valuing both forms of knowledge, we can create more effective, resilient, and equitable health systems.

    The challenges facing health systems are too complex for any single source of knowledge to address alone. Only by bringing together global expertise and local knowledge can we develop the solutions needed to improve health outcomes for all.

    References

    Braithwaite, J., Churruca, K., Long, J.C., Ellis, L.A., Herkes, J., 2018. When complexity science meets implementation science: a theoretical and empirical analysis of systems change. BMC Med 16, 63. https://doi.org/10.1186/s12916-018-1057-z

    Farsalinos, K., Poulas, K., Kouretas, D., Vantarakis, A., Leotsinidis, M., Kouvelas, D., Docea, A.O., Kostoff, R., Gerotziafas, G.T., Antoniou, M.N., Polosa, R., Barbouni, A., Yiakoumaki, V., Giannouchos, T.V., Bagos, P.G., Lazopoulos, G., Izotov, B.N., Tutelyan, V.A., Aschner, M., Hartung, T., Wallace, H.M., Carvalho, F., Domingo, J.L., Tsatsakis, A., 2021. Improved strategies to counter the COVID-19 pandemic: Lockdowns vs. primary and community healthcare. Toxicology Reports 8, 1–9. https://doi.org/10.1016/j.toxrep.2020.12.001

    Jerneck, A., Olsson, L., 2011. Breaking out of sustainability impasses: How to apply frame analysis, reframing and transition theory to global health challenges. Environmental Innovation and Societal Transitions 1, 255–271. https://doi.org/10.1016/j.eist.2011.10.005

    Salve, S., Raven, J., Das, P., Srinivasan, S., Khaled, A., Hayee, M., Olisenekwu, G., Gooding, K., 2023. Community health workers and Covid-19: Cross-country evidence on their roles, experiences, challenges and adaptive strategies. PLOS Glob Public Health 3, e0001447. https://doi.org/10.1371/journal.pgph.0001447

    Yamey, G., 2012. What are the barriers to scaling up health interventions in low and middle income countries? A qualitative study of academic leaders in implementation science. Global Health 8, 11. https://doi.org/10.1186/1744-8603-8-11

  • Brevity’s burden: The executive summary trap in global health

    Brevity’s burden: The executive summary trap in global health

    It was James Gleick who noted in his book “Faster: The Acceleration of Just About Everything” the societal shift towards valuing speed over depth:

    “We have become a quick-reflexed, multitasking, channel-flipping, fast-forwarding species. We don’t completely understand it, and we’re not altogether happy about it.”

    In global health, there’s a growing tendency to demand ever-shorter summaries of complex information.
     
    “Can you condense this into four pages?”

    “Is there an executive summary?”

    These requests, while stemming from real time constraints, reveal fundamental misunderstandings about the nature of knowledge and learning.

    Worse, they contribute to perpetuating existing global health inequities.

    Here is why – and a few ideas of what we can do about it.

    We lose more than time in the race to brevity

    The push for shortened summaries is understandable on the surface.

    Some clinical researchers, for example, undeniably face increasing time pressures.

    Many are swamped due to underlying structural issues, such as healthcare professional shortages.

    This is the result of a significant shift over time, leaving less time for deep engagement with new information.

    If we accept these changes, we lose far more than time.

    Why does learning require time, depth, and context?

    True understanding and the ability to apply knowledge in diverse contexts demands deep engagement, reflection, and often, struggle with our own assumptions and mental models.

    Consider the process of learning a new language.

    No one expects to become fluent by reading a few pages of grammar rules.

    Mastery requires immersion, practice, making mistakes, and gradually building competence over time.

    The same principle applies to making sense of multifaceted global health issues.

    5 risks of executive summaries

    Here are five risks of demanding summaries of everything:

    1. Oversimplification: Complex health challenges often cannot be adequately captured in a few pages. Crucial nuances and context-specific details get lost. Those ‘details’ may actually be the ‘how’ of what makes the difference for those leading change to achieve results.
    2. Losing context: Information that can be easily summarized (quantitative data, broad generalizations) gets prioritized over more nuanced, qualitative, or context-specific knowledge. 
    3. Stunting critical thinking: The habit of relying on summaries can atrophy our capacity for deep, critical engagement with complex ideas.
    4. Overconfidence: It assumes that learning is primarily about information transfer, rather than a process of engagement, reflection, and application. Reading a summary can give the false impression that one has grasped a topic, leading to overconfidence in decision-making.
    5. Devaluing local knowledge: Rich, contextual experiences from health workers and communities often do not lend themselves to easy summarization.

    The expectation that complex local realities can always be distilled into brief summaries for consumption by decision-makers (often in the Global North) perpetuates existing power structures in global health.

    The ability to demand summaries often comes from positions of power.

    This can lead to privileging certain voices (those who can produce polished summaries) over others (those with deep, context-specific knowledge that resists easy summarization).

    This knowledge then gets sidelined in favor of more easily digestible but potentially less relevant information.

    10 ways to value and engage with knowledge in global health

    Addressing the “summary culture” requires more than better time management.

    It calls for a fundamental rethinking of how we value and engage with knowledge in global health.

    Instead of defaulting to demands for ever-shorter summaries, we need to rethink how we engage with knowledge.

    Here are 10 practical ways to do so.

    1. Prioritize productive diversity over reductive simplicity: Sometimes, it is better to engage deeply many different ideas than to seek one reductive generalization.
    2. Value local expertise: Prioritize knowledge from those closest to the issues, even when it does not fit neatly into summary format.
    3. Value diverse knowledge forms: Recognize that not all valuable knowledge can be easily summarized. Create space for stories, case studies, and rich qualitative data.
    4. Improve information design: Instead of just shortening, focus on presenting information in more accessible and engaging ways that do not sacrifice complexity.
    5. Create new formats: Develop ways of sharing information that balance accessibility with depth and nuance.
    6. Pause and reflect: What might be lost in the condensing? Are you truly seeking efficiency, or avoiding the discomfort of engaging with complex, potentially challenging ideas? Are you willing to advocate for systemic changes that truly value deep learning and diverse knowledge sources?
    7. Challenge the demand: When asked for summaries, push back (respectfully) and explain why certain information resists easy summarization.
    8. Foster critical engagement: Encourage professionals to develop skills in quickly assessing and engaging with complex information, rather than providing pre-digested summaries.
    9. Educate funders and decision-makers: Help those in power understand the value of engaging with complexity and diverse knowledge forms.
    10. Rethink the economy of time allocation: Advocate for systemic changes that value time spent on deep learning and reflection as core to effective practice and leadership.

    Image: The Geneva Learning Foundation Collection © 2024

  • Do Civil Society Organizations (CSOs) actually help global health?

    Do Civil Society Organizations (CSOs) actually help global health?

    This summary analyzes two important articles examining the role of civil society organizations (CSOs) in global health: “Civil society organisations and global health initiatives: Problems of legitimacy” by Doyle and Patel (2008), and “Civil society in global health policymaking: a critical review” by Gómez (2018).

    While both articles challenge dominant assumptions about CSOs in global health, Doyle and Patel focus more on issues of legitimacy, representation and effects on democracy. Gómez focuses more on the lack of theoretical and empirical evidence for CSOs’ influence across all stages of the policy process. 

    Doyle and Patel (2008) challenge the assumption that CSOs automatically enhance representation and democracy in global health governance.

    • They argue that talk of ‘partnership’ obscures logistical and political obstacles to Southern CSO participation.
    • The authors also question the real agenda of many global health governance agencies and Western donor countries in the use of CSOs to deliver health interventions directly, bypassing government agencies where possible.
    • They suggest this CSO-led approach and the bypassing of government agencies has had a number of negative effects that either undermines claims of CSOs to be enhancing democracy or undermines the potential effectiveness of global health interventions.

    Gómez (2018) similarly critiques the lack of evidence for CSOs’ assumed comparative advantage in health program delivery.

    • His review finds the literature “narrowly focused on the agenda-setting and policy implementation stages, failing to account for all stages of the policymaking process and civil society’s role in it.”
    • He argues that “very little effort has been made to test and develop theoretical and analytical policymaking frameworks, clearly and consistently defining and conceptualizing civil society’s role and influence in global health policymaking, provide methodological specificity and diversity, while emphasizing the importance of causal mechanisms.”

    Doyle and Patel conclude that failure by advocates to respond to the sceptical arguments put forward here may weaken the legitimacy of CSO involvement in GHIs [global health initiatives].

    They call for research to clarify how different CSOs operate in different contexts to help to identify those variables that promote or impede the success of health interventions in different settings globally.

    Gómez, on the other hand, concludes by “encouraging scholars to address these lacuna in the literature and to explore the utility of political science theory and alternative policymaking models to better define and explain the complexity of civil society’s role and influence in global health policymaking processes.”

    Together, these articles make a compelling case for more critical examination of the role of CSOs in global health, and for moving beyond broad assumptions to more nuanced, context-specific and empirically-grounded analysis. They provide a valuable counterpoint to the often unquestioning enthusiasm for CSO engagement in much of the global health field.

    Dominant Assumption  Evidence Challenging Assumption 
    CSOs enhance representation and democracy in global health governance  Questionable existence of a coherent “global civil society” (Doyle & Patel)
    Lack of accountability and representation of populations claimed to be represented (Doyle & Patel)
    Elevating CSOs can undermine democracy and state legitimacy in developing countries (Doyle & Patel) 
    CSOs have a comparative advantage in delivering health interventions  Lack of evidence for comparative advantage (Gómez)
    Short-term donor funding creates perverse incentives and unsustainable interventions (Doyle & Patel)
    “Marketization” leads to duplication, inefficiencies, and focus on easy to measure outputs vs impact (Doyle & Patel)
    Bypassing and competing with public health systems is detrimental (Doyle & Patel) 
    CSOs play a significant role across all stages of the global health policy process  Literature narrowly focused on agenda-setting and implementation stages (Gómez)
    Lack of theoretical and empirical analysis of CSO roles and influence across all policy stages (Gómez) 
    Partnership rhetoric reflects genuine collaboration and equality between Northern and Southern CSOs  “Talk of ‘partnership” obscures logistical and political obstacles” to Southern CSO participation (Doyle & Patel)
    Unequal power relations and Northern dominance in CSO partnerships (Doyle & Patel) 
    CSO involvement improves the effectiveness of global health interventions  Lack of evidence for impact of CSO involvement on health outcomes (Gómez)
    Focus on short-term, easily measurable outputs vs long-term impact and sustainability (Doyle & Patel)
    Negative effects on health systems and government capacity (Doyle & Patel) 

    References

    Doyle, C., Patel, P., 2008. Civil society organisations and global health initiatives: Problems of legitimacy. Social Science & Medicine 66, 1928–1938. https://doi.org/10.1016/j.socscimed.2007.12.029

    Gómez, E.J., 2018. Civil society in global health policymaking: a critical review. Global Health 14, 73. https://doi.org/10.1186/s12992-018-0393-2

  • Towards reimagined technical assistance: thinking beyond the current policy options

    Towards reimagined technical assistance: thinking beyond the current policy options

    In the article “Towards reimagined technical assistance: the current policy options and opportunities for change”, Alexandra Nastase and her colleagues argues that technical assistance should be framed as a policy option for governments. It outlines different models of technical assistance:

    1. Capacity substitution: Technical advisers perform government functions due to urgent needs or lack of in-house expertise. This can fill gaps but has “clear limitations in building state capability.”
    2. Capacity supplementation: Technical advisers provide specific expertise to complement government efforts in challenging areas. This can “fill essential gaps at critical moments” but has limitations for building sustainable capacity.  
    3. Capacity development: Technical advisers play a facilitator role focused on enabling change and strengthening government capacity over the long term. This takes time but “there is a higher chance that these [results] will be sustainable.”

    Governments may choose from this spectrum of roles for technical advisers in designing assistance programs based on the objectives, limitations, and tradeoffs involved with each approach: “The most common fallacy is to expect every type of technical assistance to lead to capacity development. We do not believe that is the case. Suppose governments choose to use externals to do the work and replace government functions. In that case, it is not realistic to expect that it will build a capability to do the work independently of consultants.”

    Furthermore, technical assistance should be designed through “meaningful and equal dialogue between governments and funders” to ensure it focuses on core issues and builds sustainable capacity. Considerations that need to be highlighted include balancing short-term needs with long-term capacity building and shifting power to local experts.

    However, this requires reframing technical assistance as a policy option through transparent dialogue between government and funders.

    What key assumptions about technical assistance does this challenge?

    The article challenges some key assumptions and orthodox views about technical assistance in global health:

    1. It frames technical assistance not as aid provided by donors, but as a policy option and domestic choice that governments make to meet their objectives. This contrasts with the common donor-centric view.
    2. It critiques the assumption that all technical assistance inherently builds sustainable government capacity and questions this expected linear relationship. The article argues different types of technical assistance have fundamentally different aims – gap-filling versus long-term capacity building.
    3. The article challenges the idealistic principles often promoted for technical assistance, like localization, government ownership, and adaptability. It suggests the evidence is lacking on if these principles effectively lead to better development outcomes on the ground.  
    4. The article argues that technical assistance decisions involve real dilemmas, tradeoffs and tensions in practice rather than being clear cut. It challenges the notion of win-win solutions and highlights risks like unintended consequences.
    5. By outlining limitations of different technical assistance approaches, the article pushes back against a one-size-fits-all mindset. The appropriate approach depends on contextual factors and clarity of purpose.
    6. The article questions typical measures of success for technical assistance based on fast results and output delivery. It advocates for greater focus on processes that enable long-term capacity development even if slower.

    How does The Geneva Learning Foundation’s work fit into such a model?

    At The Geneva Learning Foundation (TGLF), we realized that our own model to support locally-led leadership to drive change could be described as a new type of technical assistance that does not fit into any of the existing three categories, because:

    1. TGLF’s model is grounded in principles of localization and decolonization that shift power dynamics by empowering government health workers from all levels of the health system – not only the national authorities – to recognize what change is needed, to lead this change where they work. We have observed that, even in fragile contexts, this accelerates progress toward country goals, and strengthens or can help rebuild civil society fabric.
    2. It focuses on nurturing intrinsic motivation and peer accountability rather than imposing top-down directives or extrinsic incentives. 
    3. It utilizes lateral feedback loops and informal, self-organized networks that cut across hierarchies and geographic boundaries.
    4. It emphasizes flexibility, adaptation to local contexts, and problem-driven iteration rather than pre-defined solutions.
    5. It builds sustainable capacity and self-organized learning cultures that reduce dependency on external support.

    Reference: Nastase, A., Rajan, A., French, B., Bhattacharya, D., 2020. Towards reimagined technical assistance: the current policy options and opportunities for change. Gates Open Res 4, 180. https://doi.org/10.12688/gatesopenres.13204.1

    Illustration: The Geneva Learning Foundation Collection © 2024

  • Colonialism and disease: tuberculosis in Algeria

    Colonialism and disease: tuberculosis in Algeria

    Tuberculosis in Algeria as part of colonization: high death rates and false explanations

    During French colonial rule in Algeria (1830-1962), tuberculosis became a major killer disease.

    The French brought this deadly sickness with them when they invaded Algeria.

    Before the French came, tuberculosis was not a big problem for Algerian people.

    The disease spread quickly through Algerian communities during colonial times.

    By the 1930s and 1940s, studies showed that tuberculosis infection rates were very high.

    In 1938, about 5 out of every 100 Algerian people got infected with tuberculosis each year.

    By 1948, this number was still about 4 out of every 100 people.

    Around 300 out of every 100,000 Algerians got tuberculosis each year before independence.

    Why tuberculosis in Algeria spread so fast under colonial rule

    The French colonial system created perfect conditions for tuberculosis to spread among Algerian people.

    The colonial government took away good land from Algerians and forced them to live in crowded, poor areas.

    French policies of displacement, starvation, and impoverishment made Algerian society very weak.

    People lived in terrible conditions without clean water, good food, or proper housing.

    French colonial reports show that Algerians died from tuberculosis at much higher rates than French settlers.

    Although the number of infections was small compared to the French colonists, the death rate among Algerians was high.

    This happened because Algerians could not get proper medical care and lived in much worse conditions than the French people.

    During periods of drought, locusts, and famine, many Algerians had to move toward cities like Algiers.

    They carried diseases with them because they were weak from hunger and poor living conditions.

    The French authorities put them in shelters and prisons, but this did not stop tuberculosis from spreading to French areas too.

    False colonial explanations for tuberculosis in Algeria: blaming Algerian people

    French colonial doctors and officials did not want to admit that their policies caused the tuberculosis disaster.

    Instead, they created false explanations that blamed Algerian people themselves for getting sick.

    Colonial doctors said that Algerians got tuberculosis because they were naturally inferior to French people.

    They claimed that Arab and Berber people had weak bodies and minds that could not fight disease.

    French medical writings described Algerians as lazy, criminal, incompetent, and prone to bad behavior.

    They said these supposed character flaws made Algerians more likely to get sick.

    Colonial doctors also claimed that Algerian culture and religion made people vulnerable to disease.

    They criticized traditional Algerian healing practices and said that Islamic beliefs prevented people from getting proper medical care.

    French medical officials argued that only Western medicine could help Algerians, but they made sure that most Algerian people could not access good medical treatment.

    Some French doctors wrote that the “inferior populations” of Arabs and other non-European groups naturally weakened the health of everyone in Algeria.

    They used racist theories to explain why tuberculosis spread so fast, rather than looking at the terrible living conditions that French policies had created.

    The French colonial medical service was set up mainly to protect French settlers, not to help Algerian people.

    Colonial doctors saw their job as keeping French people healthy and safe from local diseases, not as caring for the Algerian population that suffered the most from tuberculosis.

    Independence and the fight against tuberculosis in Algeria

    When Algeria became independent in 1962, the new government inherited a serious tuberculosis problem.

    The disease was still killing many people across the country.

    But instead of accepting this situation, Algerian leaders decided to fight tuberculosis with scientific methods and strong public health programs.

    Early steps after independence

    Right after independence, Algeria faced many challenges.

    The country was poor, and the health system was very weak.

    Few doctors remained in the country, and there were not enough hospitals or medical supplies.

    Despite these problems, the new Algerian government made tuberculosis control a top priority.

    In 1964, Algeria established the Tuberculosis Office (Bureau de la Tuberculose).

    This office began organizing a national fight against the disease.

    The government also started working with the World Health Organization to learn the best ways to treat and prevent tuberculosis.

    Between 1966 and 1967, studies showed that tuberculosis infection rates were already starting to drop in Algeria.

    The annual risk of getting tuberculosis fell in different regions, showing that the new approach was working.

    The national tuberculosis control program

    In December 1972, Algeria launched its first National Tuberculosis Control Program.

    This program had clear goals: to integrate anti-tuberculosis activities into all health sectors nationwide and to create a unified, systematic approach to tuberculosis control.

    The program also standardized evaluation methods so doctors could monitor and assess tuberculosis prevention and treatment efforts effectively.

    Algeria also established a National Tuberculosis Control Laboratory, which became the national reference center for research on tuberculosis.

    This laboratory played a key role in strengthening tuberculosis diagnosis and research, helping the country fight the disease more effectively.

    Pierre Chaulet and the tuberculosis revolution

    One of the most important figures in Algeria’s fight against tuberculosis was Dr. Pierre Chaulet.

    Chaulet was a French doctor who had supported Algerian independence and stayed in the country after 1962 to help build the new health system.

    Chaulet worked at Mustapha University Hospital in Algiers and became a leading tuberculosis researcher.

    He met with international experts and learned about new treatment methods that could cure tuberculosis much faster than old treatments.

    In the 1970s, Chaulet and his team tested new drug combinations that could cure tuberculosis in just six months instead of the years of treatment that had been needed before.

    These shorter treatments were much easier for patients to complete, which meant more people got fully cured.

    Amazing results: how did the rates of tuberculosis in Algeria drop so fast?

    The results of Algeria’s tuberculosis program were remarkable.

    The World Health Organization reported that tuberculosis rates in Algeria fell dramatically after independence:

    • 1975: 78 cases per 100,000 people;
    • 1981: 60 cases per 100,000 people;
    • By the 2000s: Below 26 cases per 100,000 people;
    • 2016: Below 17 cases per 100,000 people;
    • 2023: Only 9.4 cases per 100,000 people.

    In 1980, Algeria adopted the six-month tuberculosis treatment as standard care across the entire country.

    This treatment approach became a model that eradicated tuberculosis in Algeria and was later copied by other nations around the world.

    Key factors in Algeria’s success

    Several important factors helped Algeria succeed in fighting tuberculosis:

    Free healthcare for all: Algeria established free healthcare that allowed access for most of the population.

    This meant that poor people could get tuberculosis treatment without paying money.

    BCG vaccination program: Algeria started vaccinating all newborn babies with BCG vaccine, which helps prevent tuberculosis.

    Within one year, they achieved nearly 90% vaccination coverage.

    This large-scale immunization effort greatly reduced tuberculosis risk, especially among children.

    Better diagnosis: Algeria expanded microscopy laboratories, which improved tuberculosis diagnosis by enabling doctors to confirm the disease in 85% of new lung tuberculosis cases.

    This advance meant more accurate detection and treatment of infectious cases, reducing disease transmission.

    Standardized treatment: Algeria adopted a six-month treatment regimen for all forms of tuberculosis across all health sectors.

    This standardized approach, following global recommendations, significantly improved treatment outcomes and patient recovery rates.

    Training and education: The government trained many health workers in tuberculosis care and prevention.

    This created a network of skilled staff who could identify and treat tuberculosis cases throughout the country.

    The contrast: colonial failure versus independence success

    The difference between tuberculosis control under French colonial rule and after Algerian independence is striking and clear.

    Under colonial rule (1830-1962)

    • Tuberculosis rates were extremely high (around 300 cases per 100,000 people);
    • Algerians died from tuberculosis at much higher rates than French settlers;
    • Colonial policies created perfect conditions for disease spread through poverty, overcrowding, and malnutrition;
    • French doctors blamed Algerian people for getting sick rather than addressing the real causes;
    • Medical care was designed mainly to protect French settlers, not to help Algerian people;
    • The colonial system lasted 132 years without solving the tuberculosis problem.

    After independence (1962-present)

    • Tuberculosis rates dropped dramatically in just a few decades;
    • Algeria achieved nearly complete tuberculosis eradication by international standards;
    • The government addressed root causes through free healthcare, better living conditions, and comprehensive public health programs;
    • Algerian and international doctors worked together using scientific methods;
    • Medical care was designed to serve all Algerian people equally;
    • Major progress was achieved within 20 years, with continued improvement over 60 years.

    What the evidence shows

    The historical evidence proves several important points:

    Colonial rule made tuberculosis worse: The French colonial system created the conditions that allowed tuberculosis to spread rapidly among Algerian people.High infection rates, poor living conditions, and limited medical care for Algerians were direct results of colonial policies.

    Racist explanations were false: French colonial doctors blamed Algerian culture and supposed racial inferiority for high tuberculosis rates.

    This was completely wrong.

    When Algerians gained control of their own healthcare system after independence, they quickly brought tuberculosis under control using the same scientific methods available to French doctors.

    Independence brought real solutions: Once Algeria became independent, the government was able to address the real causes of tuberculosis: poverty, malnutrition, overcrowding, and lack of medical care.

    By fixing these problems and providing free healthcare to all people, Algeria achieved what the colonial system never could.

    Scientific medicine works when applied fairly: The same medical knowledge that was available during colonial times became much more effective after independence because it was applied to serve all Algerian people, not just French settlers.

    Lessons for today

    Algeria’s victory over tuberculosis teaches important lessons about health, colonialism, and independence:

    Health problems have social and political causes: Tuberculosis spread in colonial Algeria not because of Algerian people’s character or culture, but because of unjust policies that created poverty and poor living conditions.

    Racist explanations hide the real problems: When health officials blame sick people for their illness instead of addressing unfair social conditions, they prevent real solutions from being found.

    Public health requires political commitment: Algeria succeeded against tuberculosis because the independent government made it a priority and committed resources to serve all people equally.

    International cooperation helps when based on equality: Algeria worked successfully with international health experts after independence because these relationships were based on mutual respect rather than colonial domination.

    Algeria’s experience shows that with proper political commitment, adequate resources, and scientific methods applied fairly, even the most serious health problems can be solved.

    The country transformed from having one of the world’s worst tuberculosis problems to achieving near-eradication in just a few decades.

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