Breaking the Aid Trap: Why Fragile States Need Local Solutions, Not Global Fixes

By guest contributor Esias Bedingar, Ph.D.

Throughout my doctoral journey at the Harvard T.H. Chan School of Public Health and Harvard Kenneth C. Griffin Graduate School of Arts and Sciences, I conducted research in some of the world’s most fragile and conflict-affected settings, where traditional research methods often fall short. From rural Mali to Chad, my work focused on addressing critical public health challenges, including under-five mortality and adolescent HIV care, through complex health interventions. These experiences taught me one crucial lesson: research in fragile settings demands a different approach—one grounded in flexibility, cultural sensitivity, and local ownership.

Fragile settings, marked by political instability and limited resources, challenge conventional research methods but offer opportunities for innovative, context-specific solutions. To navigate these complexities, we must rethink how research is designed and implemented, shifting from externally imposed interventions to home-grown, community-led solutions.

The Value of Homegrown Solutions

Sustainable solutions must come from within the communities they serve. International research agendas often prioritize global concerns that diverge from local needs, causing many interventions to fail. Externally driven projects can foster dependency and disempower local communities. In Chad, where I worked on adolescent HIV care, co-creating solutions with local youth was essential. Community-based participatory research (CBPR), involving local actors as co-researchers, proved invaluable in fostering ownership, cultural relevance, and sustainability. This contrasts with traditional models that treat communities as passive recipients, reinforcing calls for decolonizing global health.

Flexibility and Adaptation

In fragile contexts, rigid study designs are often impractical. Unpredictable conditions—such as shifting security and infrastructure challenges—necessitate adaptability. During an RCT in Mali evaluating a community health worker intervention, we encountered high loss-to-follow-up rates and security issues. This mirrors experiences in similar settings where conflict and seasonal changes impact research outcomes.

Adaptability is not just beneficial; it’s essential. Hybrid study designs that combine quantitative and qualitative methods offer holistic insights into complex health systems. These designs help navigate limitations and support success where community trust and local infrastructure are critical.

Decolonizing Global Health Research

Another critical reflection from my work is the urgent need to decolonize global health research. Decolonization is more than a buzzword; it’s about dismantling the power imbalances that favor Global North perspectives over local knowledge in the Global South. Too often, research projects in fragile settings impose Western frameworks, perpetuating power dynamics that marginalize local communities. The legacies of colonialism continue to shape global health research, often to the detriment of the very populations they aim to serve.

In Chad, I made a concerted effort to center the voices of adolescents—particularly those living with or at risk for HIV—who are frequently sidelined in health interventions. By involving them as active participants from design to data interpretation, we enhanced the relevance and legitimacy of our findings. This approach aligns with youth-led research principles, emphasizing young people as partners, empowering them to shape interventions that affect their lives.

Decolonizing research also requires examining the frameworks that underpin global health interventions. Many of these frameworks are rooted in colonial histories and fail to account for local knowledge systems. In fragile settings, where colonial legacies exacerbate health inequities, it is essential to incorporate local methodologies. By doing so, we can produce research that not only addresses immediate needs but also fosters long-term, community-driven solutions.

Building Resilience Through Innovation

Resilience is foundational to health systems in fragile settings. One effective way to build it is through innovation, especially digital technologies. In Chad, our project digitizing health worker payments showed that leveraging innovation enhances resilience. By moving from cash to mobile money, we addressed inefficiencies and increased transparency.

This example highlights the importance of investing in digital infrastructure, even in low-resource environments. Digital payment systems bypass traditional bottlenecks, ensuring continuity of services during disruptions. This adaptability is crucial where delays in health worker compensation can affect care quality.

The Path Forward

Research in fragile settings is challenging but offers transformative potential. To succeed, approaches must prioritize local ownership, flexibility, and decolonization. By centering local voices, adopting hybrid study designs, and building resilience through innovation, we can produce impactful research that empowers communities.

Fragile states need more than external interventions—they need culturally embedded, locally driven solutions with active participation from those who benefit most. As researchers, we must evolve our methodologies to contribute to a more equitable global health landscape.

About the author:

Esias Bedingar, Ph.D., is a global health researcher and early-stage investigator specializing in health systems, adolescent health, and public health innovations in fragile settings. With extensive experience in policy advising and project implementation, he has made impactful contributions to healthcare reforms in Chad and beyond.

Disclaimer: Views expressed by contributors are solely those of individual contributors, and not necessarily those of PLOS.

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