Sunday, June 11, 2023

Global Governance: The emerging agenda

This is the first installment of a series of articles that I am going to be writing on global health governance, health policy and health systems strengthening in the public debate discourse.  Many a times, I am asked the question as to whether my back ground is not in public policy analysis and why am I now researching and concentrating on health policy and health systems. Well, I have not deviated but rather now concentrating on health as an area of specialty in my research focus. I have background training in international health policy and management from the USA, after having previously turned down PhD offers on Global Health and Policy at the University of Sydney and Deakin University in Australia respectively. I have previously worked for World Health Organization, in Geneva, Switzerland as a Global Health Fellow and as well as for the Institute for Health Measurement in New York City, USA and Lesotho respectively.

Toward the end of the millennium, there emerged widespread recognition that a variety of processes often taking the short hand of Globalization reconstituted and intensified both the risks of ill health and opportunities for addressing them. This recognition was accompanied by concern that existing institutional arrangements were not only increasingly constrained from addressing risks, but also from taking advantage of emerging opportunities.

New Organizations and networks thus were formed to address global health issues and new ways of delivering health services and strengthening health systems. This dynamic environment constitutes what is called global health governance.

In public policy literature, there is explicit recognition of the role played by actors outside the government in the formulation and development plans. These extra-governmental policy actors can include international or multi-lateral agencies. For many, the proliferation of new global health actors and shifts in the relative importance and roles of existing actors is to be welcomed. For others, this multitude of diverse actors and net works indicates continuing and growing fragmentation and chaos at global and national levels. 

The proliferation of the new global health actors means there are many different bodies involved in quite similar activities both at global and national levels and many a times this being used as a platform to siphon resources from funders especially in less developed countries. It has been observed that this can result in duplication and even conflict in terms of the approaches they advocate or the activities that they are willing to fund or support. One such highly contested domain is on the health intervention treatment and prevention campaigns developed towards fighting HIV/AIDS such as the Safe Male Circumcision Project, Sexual and Reproductive health amongst the many others and now a shift in the global health financing architecture from infectious diseases to non infectious diseases..

For instance donors such as the USA refuse resources to any organizations offering abortion a highly contested subject area. There has also been mushrooming of International Non Governmental Organizations in many less developed countries doing same projects thus competing for funds and research participants in some instances.
 The spreading web of social relationships that characterizes contemporary globalization has important consequences in terms of the speed and reach of disease transmission, the distribution of health and disease patterns worldwide.  Since the past two decades there has also been evidence of growing apprehension about the vicious circle of rising poverty and greater vulnerability to health problems in an increasingly global world. 

People are becoming ill because they are poor, while the illness makes them even poorer, particularly where there is no adequate public health service or there are other barriers to access. There is also expansion and acceleration of global mobility which impact s on the spread of infectious disease. The ongoing HIV crisis, Ebola and now Non Communicable Disease represent global threats.

With increasing global concern for the state of ill-health and the in-equalities that fuel it , from the mid 1990s, the sector witnessed  a rash of developments initiatives to respond to new challenges and fill gaps un attended by established organizations. This new found consciousness was reflected in far reaching innovations in global health governance.  Various new financing arrangements emerged, largely as a result of a new breed of philanthropist with interests in global health, epitomized by the Bill and Melinda Gates Foundation. In part fostered and incubated by the Gates Foundation, new mechanisms to raise and disburse finance were established.

Innovative financing arrangements have been accompanied by the establishment of novel organizational arrangements to tackle health problems through global health partnerships.  What is striking about these new partnerships is the increasingly structured and sustained level of interaction that they engendered between inter-governmental organizations, states and nongovernmental organizations.  From the year 2000, there has been a series of significant developments in the field of global health that gave expression to the increasingly intense interaction between representatives of sectors which had hitherto operated in less networked manner. 

The discussion above might be viewed as an initial set of governance responses to an emerging global health agenda. These responses have arisen from the interactions of inter-governmental organizations with a diverse set of member states and non state actors. There are three policy goals, which aim to tackle new patterns of health and disease, and their unequal distribution across populations, particularly affecting the poor, are central to the global health governance. Strengthening health System:   Health systems encompass a number of components to ensure more equitable and sustained improvements in service out puts and outcome. These include health work force mobilization, management of health services, leadership and stewardship, health financing systems. Health systems are basically access goods required to turn knowledge into health outcomes.  Ensuring policy coherence across sectors for improved public health, this provides for working more effectively with other policy sectors to control bads and promote those goods which affect health determinants and outcomes.

The heightened interest in global health is related to globalization and increasing interdependence. Economic integration appears to have outpaced society’s collective ability to manage this interdependence, but its governance and its consequences should not be left to the market. Seizing the opportunity to develop governance solutions is not a straightforward as one might hope. There are an exponentially increasing number of determinants of ill health and components of health care systems and hence an increase in the number of actors and initiatives that are involved in and impact on global health. To craft health policy today, governments, international organizations and nongovernmental organizations must find mechanisms to manage health risks.┬á There is also an urgent need to address the chronic non communicable diseases, which have not been met with a policy response proportionate to the size of the problem.┬á

The key trend in global health governance is the expansion of health into different areas of policy and politics, it is clearly gaining a strategic place in the international agenda and time is now for us to push this agenda forward and not adopt a rigid conservative approach by thinking that health belongs to medicine and or only restricted to the discipline of public health.  Health is a right of global citizenship.
*Thabo Lucas Seleke researcher, health policy and health systems strengthening


Read this week's paper