Critical Ecology of Partnership: A Proposed Integrated Framework to Explore Equity-Informed North/South Partnerships in Global Health

Background

Partnerships in global health are essential to addressing the world’s most pressing health challenges. Recognizing the critical role of partnerships in addressing global health challenges, social workers leverage their expertise in human relationships and community participatory approaches. Partnerships bring together a range of stakeholders: international, national, regional, and local and are rooted in shared decision-making and mutual goals that emphasize equity and relationships. These partnerships navigate a complicated landscape marred by colonial legacies and entrenched power dynamics that often silence equity concerns. Global health partnerships often reproduce power imbalances between the Global North and South, undermining the leadership, expertise, and priorities of Global South partners. This paper proposes a Critical Ecology of Partnerships (CEP) framework, integrating ecological systems theory with critical theory. This framework examines the stakeholders, power dynamics, and forces shaping partnerships at every ecological level to more aptly identify facilitators, barriers, and opportunities for equity-informed partnership.

Methods

We conducted a comprehensive literature review, analyzing over Google Scholar publications from 2000 to 2025 that address North/South partnerships in global health, utilizing inclusion criteria that focused on equity and power dynamics. Key search terms included "global health", "partnership", and "equity". We first reviewed abstracts to select relevant articles and then drew from literature findings to map the complex array of stakeholders, influences, and dynamics that characterize these collaborations. Using an ecological systems framework, we categorized each factor according to its system level. We then applied a critical theoretical lens to examine how power operates within and across these levels.

Results

By centering the community, the CEP model redefines each ecological level to reflect actors and dynamics in the Global South and North. Central to the CEP model ,are the communities directly impacted by global health initiatives, often marginalized in decision making processes, ensuring their needs and voices drive the partnership dynamics. The microsystem includes the diverse Global South entities such as NGOs, universities, and government agencies involved in such initiatives, which is mirrored again in the exosystem that captures the same stakeholders in the further-distanced Global North. The mesosystem is home to relationships within and between systems - a place to examine those factors such as language hierarchies, decision-making power, and buy-in that influence the nature of relationships. In the macrosystem, we interrogate structural oppression fed by colonial legacies and funding inequities that reverberate across the model. Finally, the chronosystem considers historical and temporal power in partnerships. Together, this model offers a nuanced, equity-informed lens to assess and guide partnerships in global health research and practice. An illustrative example of such partnership work in Kenya will be described by the author.

Conclusion

Aligned with the conference theme of transformative change, this framework operationalizes social work values to foster genuine partnerships that prioritize justice and accountability, guiding transformative science, policies and practices in global health.