Who Sets the Agenda for Global Health?



In the past two decades, cross-border and international health challenges together with their risks factors, have mobilized unmatched attention and resources. Once led by a few United Nations organizations,  global health has attracted hundreds of new actors, ranging from public to private sector organizations including foundations. With the plurality, comes the challenge to coordinate international health work and avoid needless duplication and wastes. And the absence of clear practice to set agenda, unveils a growing gulf between health needs and where resources are spent.

What interests, values and mechanisms underpin global health governance?  In a recent article, Dr. Devi Sridhar argues that, the complex manner of setting agenda, ‘’is a consequence of a general phenomenon in global health, where the nature and type of funding dictates priorities[1]..’’ She calls the emerging trend ‘’multibi-funding:’’ donors increasingly earmarked and channeled their support through traditional multilateral organisations and new multi-stakeholder initiatives to specify diseases, countries and regions of their interests.

The opaque manner in setting priorities runs counter to evidence-based approach, a cornerstone in public health. Through the practise, donors, including private foundations, cherry pick diseases that get attention and support.  As a consequence, much needed resources are diverted away from where needs are greatest. For example, the Bill Gates funded Institute for Health Metrics and Evaluation estimates that in 2010, non-communicable diseases— like cancer, diabetes and hypertension— the biggest killers, received less than 3 percent of the 28 billion dollars international assistance to health.  In contrast, HIV/AIDS, malaria and tuberculosis together attracted 31 percent of the overall global health resources.  Donors tie their support to specific programs within United Nations organizations like WHO, as well as channel a lion’s share of their contributions to vertical funds like the Global Fund to fight HIV/AIDS, Tuberculosis, and Malaria and the Global Action for Vaccines and Immunization (GAVI).

Praise for the progress to achieve health MDGs, disease-specific initiatives however, have added complexity, uncertainty and even chaos to the business of global health. Their innovative decision-making structures raise some important concerns about accountability and legitimacy. Whereas Member States are the only vote holders in key United Nations organizations, decision-making in global health initiatives is by a selected number of donors and non-governmental organizations. Even though, total funds for health have quadrupled over the years, allocation to priorities is unpredictable. Global health initiatives with their specific mandates are funded entirely by voluntary contributions. Intergovernmental health organizations, with their broad mandates have witnessed an exponentially growth in their unpredictable non-core budgets, as long-term, core funds remain flat.

The shift in funding channels has significant implications for global health governance. What donors are unable to achieve in open-multilateral forums, where each country has a vote, they turn to closed ‘’market places’’, where money counts. As a consequence, short term gains are favored over coordinated efforts to address long-term health challenges. An even greater risks, is undermining core capacities of traditional global health institutions, which rely on fixed, predictable, long-term funds to collate and disseminate vital information about diseases, a foundation of global health research.

It remains unclear whether business will continue as usual, at least in the short-term. Health appears to have buck a downward trend of cuts to international development work. Funding  has recovered to pre-crisis levels, perhaps dissipating the urgency to reform, introduced by the global financial. Emerging economies are reluctant to use the power of their purse to shake up the status quo, too. 



[1] Sridhar D (2012) Who Sets the Global Health Research Agenda? The Challenge of Multi-Bi
Financing. PLoS Med 9(9): e1001312. doi:10.1371/journal.pmed.1001312

Comments

Post a Comment

Popular posts from this blog

The Africa Mining Vision after the Boom

Mineral rich Africa confronts its strongest ever headwind since adopting the Africa Mining Vision, in 2009. Prolonged fall in commodity prices, presents a challenging environment for implementing the forward-looking continental framework to promote broad-based linkages from the minerals sector into the wider economy in ways that will diversify economies. Demand-driven factors underpinned by slowdown of growth in China— which consumes over 50% of all metals— as well as industry-specific forces together have   significantly weaken mineral prices since their recent high of 2011.   The depressing volatility is hardly new phenomenon. Commodity price peaks and troughs repeat themselves often in painful patterns of vulnerability, risk and crisis. The targeting of revenue while important is not decisive for transforming the sector. The slump in prices therefore reveals fundamental cracks in the revenue-first model, whose unrealistic assumption of sustained high commodity prices ...
Read more

Strategic narratives autonomy matter more than industrial policy

Industrial policy has returned to fashion. Governments are subsidising industries, reshaping supply chains and asserting economic sovereignty. Across Africa, plans for industrialisation, value addition and green growth proliferate. On paper, the ambition is impressive. Yet outcomes remain stubbornly familiar. The problem is not that African countries lack industrial policy. It is that many lack strategic narrative autonomy : the power to author futures that are not only persuasive, but binding . In the modern political economy, narrative is not messaging. It is a mechanism of control.   The power to define what is “realistic” Every industrial policy rests on a story about the future. What technologies will dominate. Which markets will grow. How fast change must happen. What is feasible — and what is dismissed as wishful thinking. These stories do not merely describe reality. They produce it. When investors say local processing is “not viable”. When financiers ins...
Read more

Wanted: Farsighted African Leadership against Ebola

Few emergencies in modern history have cumulated an endless list of frightening superlatives in such a short period of time. Within a couple of months, the West African Ebola Virus Outbreak (EVO) has been qualified as: public health emergency of international concern, extraordinary event, uncontrollable, fatally inadequate, exponential in growth, unprecedented, catastrophic, worst ever and greatest peace time threat. Since the outbreak ten months ago, it is only now that the international community seems to wake up albeit in panic to the ravaging scale of the epidemic. The response so far, has revealed an epic failure of collective actions at the global level for addressing African health challenges— something akin to a ''Rwandan moment'', when the international community fatally underestimated, misread and dithered to avert genocide. But a lack of farsighted leadership by Africa has not only mishandled the epidemic but also squandered a chance to show the world ...
Read more