Samuel Jonathan Ujewe

This article establishes the foundations of an ethical framework of harmony as a policy pathway towards equitable access to mental health care and resources in the global south. It explores existing policies and strategies for mental health in Africa and points to the need to underpin the relevant approaches with an ethical framework of harmony. The insights reflect on the disproportionately low attention given to mental health care, despite its high burden tying to social, cultural and moral distress among affected persons and their communities. Against this background, a critical analysis of the dominant Western approach to mental health demonstrates how underlying epistemic assumptions are prioritised over lived experiences, resulting in mental health care approaches and policies that do not reflect local and lived realities. This paper shows that, to be effective, mental health care approaches and policies must reflect local social, cultural and moral experiences in African contexts and other similar contexts in the global south. It proposes a communitarian ethical framework of harmony, which reflects local and lived contextual realities, to guide approaches and policy processes towards effective mental health reforms.

Although the principle of “respect for personal autonomy” is largely conceptualized against the background of values of societies that espouse individual liberty, not all societies in the world place a high premium on the place of the individual person. This chapter examines the value of autonomy in bioethics and determines whether other values, such as “communal responsibility” dominant in African settings, are equally valuable in the context of healthcare and health research. It uses elderly care, as a case example, to explore the subtleties of personal autonomy and determine its valuableness in African contexts. In African settings, the care of elderly persons is binding on families and considered a responsibility of their communities. Elderly persons enjoy the privilege of being cared for, and families and communities are responsible for providing care. While some individual persons may choose not to provide the care and some elderly persons may reject care offered, the question remains whether the refusal is morally acceptable or if rejection removes the moral responsibility to provide similar care to others. This chapter will examine the value and place of autonomy in African socio-cultural contexts, barring its already presumed universal value in bioethics.

This paper introduces the concept of moral residue to global health, and shows how its presence undermines crucial interventions and research, especially in the global south. Lingering feelings of anxiety, anger, blame or frustration often exist among local populations, where previous interventions or research have left traces of harm and/or exploitation. The existence of such feelings reflects the presence of moral residue, recognizing the moral experiences of epistemic injustices, which in turn undermines critical interventions and research through outright rejection or passive non-compliance among affected populations. While such situations have been variously interpreted and relevant strategies developed to address the issues, little to no consideration is made on the implications of moral residue experiences in global health contexts and how to address them. This paper demonstrates the presence of moral residue in global health and proffers an African ethical approach, a harmony framework, for addressing moral residue issues, as part of a holistic approach towards tackling population health crises without compromising health gains for affected populations in the global south.