Decolonizing Local Health: Advancing from Participation to Equitable Partnership along the Thailand-Myanmar Border

Background: The movement to decolonize global health has increasingly challenged inequities in funding, leadership, knowledge production, authorship, and representation between global and local actors. However, less attention has been given to power dynamics within local and national health systems and partnerships. We propose extending the decolonization lens to local health: examining who leads, decides, speaks, controls resources, produces knowledge, and benefits within health systems themselves. Perspective: Drawing on decades of experience along the Thailand-Myanmar border, we reflect on the evolution of ethnic health organizations (EHOs), community-based health systems, and their partnerships with donors, governments, international organizations, and intermediary organizations. The border provides a distinctive setting for this discussion: over several decades of conflict, displacement, migration, and political instability, locally developed and sustained health systems have delivered essential services to underserved populations and increasingly assumed roles in health workforce development, health information, disease control, and emergency response. These experiences demonstrate substantial progress toward locally led health systems, but also persistent asymmetries in funding, agenda setting, knowledge production, representation, and risk sharing. In particular, localization of implementation may advance without equivalent transfer of decision-making power. Implications: Decolonizing local health requires moving beyond participation toward equitable partnership. Funding mechanisms should enable greater direct and flexible support to local organizations; partnerships should share governance and decision-making; local actors should receive equitable opportunities for authorship and representation; and accountability and risk should be shared more fairly. The experience of the Thailand-Myanmar border suggests that decolonization is not only about shifting power between global and local actors, but also about redistributing power among actors within local health systems. Ultimately, decolonization should be judged not by whether local actors are invited to participate, but whether they are trusted and empowered to lead.