BACKGROUND:
Public health systems across much of Africa continue to reflect colonial epistemologies that privilege Eurocentric biomedical paradigms while marginalising indigenous knowledge systems and community-based health practices. This structural imbalance contributes to persistent health inequities, weak community ownership, and limited responsiveness of health interventions, thereby constraining progress toward universal health coverage and the Sustainable Development Goals (SDGs). As global public health discourse increasingly emphasises equity, inclusion, and sustainability, there is an urgent need to reposition decolonisation as a practical and evidence-informed strategy for strengthening people-centred health systems.

METHODS:
A mixed-methods approach was employed. This included a narrative review of peer-reviewed literature and a comparative policy analysis of selected national and subnational public health frameworks across African contexts. In addition, in-depth qualitative interviews were conducted with over 60 stakeholders, including public health professionals, traditional health practitioners, policymakers, and community leaders. Data were analysed thematically to identify structural constraints, opportunities for integrating indigenous knowledge, and governance mechanisms capable of enhancing accountability, service delivery, and community participation.

RESULTS:
The findings reveal that colonial legacies remain deeply embedded within public health education, financing models, and institutional governance structures. However, settings that intentionally incorporate indigenous knowledge—through culturally grounded health promotion, participatory leadership, and respectful collaboration with traditional systems—demonstrated improved service utilisation, increased community trust, and enhanced intervention acceptability. Such approaches were associated with more equitable resource distribution, revitalisation of primary healthcare, and greater system resilience.

CONCLUSIONS:
Decolonising public health extends beyond symbolic reform and represents a critical pathway toward equitable, inclusive, and sustainable health systems. Integrating indigenous knowledge within formal health governance can strengthen social legitimacy, improve health outcomes, and advance health justice across Africa and other post-colonial settings. Embedding culturally responsive frameworks within global and national health strategies is essential for achieving universal health coverage and realising the vision of health without borders.